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A new way to prevent HIV delivers dramatic results in trial

Maria Isabel Barros Guinle

A patient with AIDS at a community hospital in the Central African Republic. Sub-Saharan Africa has high rates of infection -- and was the location for a trial testing the effectiveness of a new strategy for preventing infection.

A patient with AIDS at a community hospital in the Central African Republic. Sub-Saharan Africa has high rates of HIV infection -- and was the location for a trial testing the effectiveness of a new strategy for preventing infection. Barbara Debout/AFP via Getty Images hide caption

For over a decade, taking a pill like Truvada every day has been the standard of care for HIV prevention efforts.

In clinical trials, this type of preventive drug, called pre-exposure prophylaxis (PrEP), can be 99% effective in stopping new HIV infections from sex. In the real world, however, that is not always the case.

People don’t always take their pills. In a study in South Africa, women said they felt there was a stigma to the pill —- a sexual partner might assume they’re taking it because they already have HIV or because they have other partners.

Now a new trial —- called PURPOSE 1 —- points the way to a new preventive strategy —- a twice yearly injection of a drug called lenacapavir. The trial was sponsored by Gilead Sciences, the California-based maker of the drug.

In this double-blind, randomized study of 5,300 cisgender women in South Africa and Uganda, 2,134 got the injection and the others took one of two types of daily PrEP pills. The trial began on August 2021 and, so far, not a single woman who received the injections has contracted HIV. The participants who received either of the oral PrEP options, Truvada and Descovy, had infection rates of about 2% — consistent with the infection rates of oral PrEP in other clinical trials.

These results were significant enough for the Data Monitoring Committee —- an independent group of experts appointed to assess the progress of clinical trials —- to recommend that Gilead halt its blinded trial and offer lenacapavir to all study participants. On June 20, Gilead announced these results, and now, all participants can choose to receive the injection.

The study’s focus on women in sub-Saharan Africa is based on HIV data. Despite accounting for 10% of the world’s population, sub-Saharan Africans comprise two-thirds of people living with HIV – 25.7 million out of 38.4 million. And, every week, about 4,000 teen girls and young women in Africa are newly infected with HIV.

Early reaction is positive

The trial has yet to be peer-reviewed, but these early results have been met with excitement.

“It’s fantastic,” says Dr. Jason Zucker , an assistant professor of medicine and infectious disease expert at Columbia University Vagelos College of Physicians and Surgeons. “It’s hard to take a medication every single day. A medication that is [given] every 6 months has a lot of potential.”

Dr. Philip Grant , clinical associate professor and director of the HIV clinic at Stanford University School of Medicine, agrees that lenacapvir could help fill a gap in prevention options. “It would be a big benefit in populations that have adherence challenges,” he says.

Despite being 99% effective in some trials, oral PrEP effectiveness drops significantly in the real-world. One study showed PrEP effectiveness to be as low as 26% in certain populations — men under age 30, for example.

“Medications work when you take them,” says Zucker. “A medication that is given every six months has a lot of potential because, essentially, if you can make two visits a year, you are protected for an entire 12 months.”

Advocacy groups have also expressed enthusiasm about lenacapavir’s preliminary results as a PrEP option. “Lenacapavir would be “a real game-changer,” particularly for people facing stigma and discrimination in low- and middle-income countries,” read a statement by People’s Medicines Alliance —- a global coalition of more than 100 organizations that span 33 countries and that advocate for making medications more accessible.

The drug isn't new; the usage is

Lenacapavir is not a new drug. It’s been approved by the FDA in the United States for multi-drug resistant HIV treatment since 2022 . But PURPOSE 1 is the first clinical trial to test it for HIV prevention.

The PURPOSE 1 trial is part of a larger initiative to improve HIV prevention across the global south. It is one of several studies that are part of ongoing efforts to end the HIV epidemic by 2030.

An ongoing PURPOSE 2 trial is analyzing lenacapavir’s efficacy among cisgender men, transgender men, transgender women and non-binary individuals who have sex with partners assigned male at birth in Argentina, Brazil, Mexico, Peru, South Africa, Thailand and the United States.

Any eventual approval and widespread use would come with challenges. According to an analysis presented at the 24th International AIDS Conference (AIDS 2022), PrEP medications would need to cost less than $54 a year per patient for South Africa, for example, to afford them. Lenacapavir’s cost as HIV treatment in the United States in 2023 was $42,250 per new patient per year. Oral PrEP options, on the other hand, can cost less than $4 a month.

“The biggest gap in prevention isn’t medication, it’s accessing medications,” says Dr. Grant.

Activists across Uganda and South Africa [MIG5] have urged Gilead Sciences to license lenacapavir to the Medicines Patent Pool — a United Nations-backed organization that partners with governments, industry and other organizations to license medications. This would allow for manufacturing of generic versions of the drug at a fraction of the cost.

These activists fear that history will repeat itself: In 2021, cabotegravir. a long-acting injectable PrEP medication manufactured by ViiV Healthcare, was FDA-approved. The medication is more effective than oral options and only requires one injections every two months after the initiation period. But despite approval for generic versions of the medication, these versions still have to go through the World Health Organization review process to show they are equally effective to the brand version. Because this process takes time, generic cabotegravir will likely not be available in Africa until 2027 .

Since sharing lenacapavir’s early success , Gilead has announced that they intend to “deliver lenacapavir swiftly, sustainably and in sufficient volumes, if approved, to high-incidence, resource-limited countries.” Their access strategy includes developing a voluntary licensing program that would enable generic versions to be produced before the original patent expires. When NPR asked Dr. Jared Baeten, Gilead’s vice president of HIV Clinical Development, about timeframes, he said that estimates will depend on "another trial, a regulatory review and approval."

“Cost is going to play into this dramatically,” says Dr. Zucker, “I think and hope we will do everything we can to try to reduce barriers to access.”

  • HIV prevention

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NHLBI’s MACS/WIHS study targets chronic health conditions in people living with HIV

Photo of a pair of open hands holding a red ribbon, the symbol of awareness and support for people living with HIV. Source: Shutterstock

Longest running study of HIV survivors is marking its 40th anniversary this year.

In the 1980s, infection with HIV, the virus that causes AIDS, was often viewed as a death sentence. With no treatments available and little understanding of the virus or the disease, hundreds of thousands of people in the United States ultimately lost their lives and millions more died worldwide.

Much has changed in the past four decades. Thanks to the availability of powerful antiretroviral drugs, new infections have decreased significantly, the virus is held at low levels in the body, and the HIV death rate has plummeted. People living with HIV are now more likely to die of a chronic illness, such as cardiovascular disease, than from AIDS. Meanwhile, researchers continue to make inroads in finding an effective vaccine or even a cure.

Now, this year, another milestone: the nation’s largest and longest running study of HIV survivors is marking its 40th anniversary.

The Multicenter AIDS Cohort Study (MACS) launched in 1984 to help shed light on how AIDS was affecting gay and bisexual men living with or at risk for HIV. Over the years it enrolled some 7,300 men and eventually merged with the Women’s Interagency HIV Study (WIHS). That study has focused on the health impact of HIV on nearly 5,000 women living with or at risk for the virus.

Since then, the combined research effort – the so-called MACS/WIHS Combined Cohort Study – has been pursuing an ambitious goal: to understand and reduce the impact of chronic health conditions, including heart, lung, blood, and sleep disorders, that affect people living with HIV. That’s an estimated 1.1 million people ages 13 and older in the United States and the nearly 37 million people worldwide.

The study – coordinated by the NHLBI and conducted in collaboration with the NIH Office of AIDS Research and several co-funding institutes – not only has produced a host of findings; it also has provided a way to take stock of what its research has meant for real people.

“It’s amazing today to see that people with HIV are surviving into old age,” said Beth Pathak, Ph.D., NHLBI’s program director of the MACS/WIHS study and an epidemiologist. “On the other hand, HIV/AIDS is still a big public health problem around the world. We still have a lot more to learn.”

Pathak says that the program will honor the legacy of the participants with a specially designed panel on the National AIDS Memorial quilt . That panel will be unveiled on December 5 during a special ceremony in Washington, D.C.

David C. Goff, M.D., Ph.D., director of the NHLBI’s Division of Cardiovascular Sciences, said the MACS/WIHS study is often called the “jewel in the crown” of NIH HIV/AIDS research for good reason. To date, MACS/WIHS investigators have published over 2,000 articles on HIV-related topics. Those studies show that people living with HIV tend to carry a higher disease burden. Nearly half of HIV survivors over 50 develop one or more chronic conditions not directly associated with HIV itself – cardiovascular disease, lung diseases such as pulmonary hypertension and COPD, anemias and other blood-related disorders, sleep disorders, cognitive dysfunction, osteoporosis, and certain cancers. While common in older people generally, these conditions tend to show up at higher rates in younger people with HIV.

Some of the more important findings to emerge from the MACS/WIHS research program have direct relevance to NHLBI’s research focus areas:

  • Men and women living with HIV have a higher burden of heart disease than those without HIV.
  • Men and women living with HIV are more likely to have abnormal lung function than those without HIV.
  • Women living with HIV have a higher comorbidity burden (health problems) than men with HIV.
  • Untreated HIV lowers levels of ‘good’ cholesterol (high-density lipoprotein (HDL) cholesterol).
  • High-risk coronary artery plaque is more common in men with HIV than their HIV-negative counterparts.
  • At the DNA level, men living with HIV appear to age faster than men without .
  • Men with HIV are more likely to have sleep-disordered breathing.
  • People living with HIV have lower antibodies and greater inflammation from the COVID-19 vaccines.
  • Smoking is strongly linked to atherosclerosis in men with HIV.

NHLBI’s Goff said findings like these are critical to research that could lead to better treatments for those with the disease. It’s why it is so important, he said, to “keep the study going.”

After all, he noted, “it’s one of the world’s most important sources of rigorous scientific knowledge about the evolving impact of HIV infection and its comorbidities on human health.”

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  • High-Impact Prevention
  • Case Studies

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  • National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention

HIV Screening and Testing

What to know.

HIV testing and screening are important first steps in diagnosing infection. Diagnosing HIV infection early is cost-effective and saves the public money on direct medical costs. Expanding HIV testing saves lives and prevents others from getting infected.

A doctor wearing gloves collects blood from a patient.

The benefits of HIV screening and testing

In 2015, approximately 39,000 persons received a new HIV (human immunodeficiency virus) infection diagnosis. HIV testing is the vital first step for HIV care and effective prevention. These persons had been living undiagnosed with HIV but now know their status and have the opportunity to receive life-saving treatment.

HIV diagnosis also greatly reduces the risk of transmitting the virus to others. Persons without HIV learn about effective tools for reducing their risk of getting infected.

Cost-effectiveness of HIV screening and testing

Initial studies reported voluntary HIV screening to be cost-effective in health care settings where undiagnosed HIV infection is less than ≥0.1% 1 2 . It was also reported to be more cost-effective than many established screening programs for chronic disease (e.g., hypertension, colon cancer, and breast cancer). 2 3 Treatment costs are lowered as well because treatment can begin before severe immunologic compromise occurs.

A more recent study reported HIV testing in clinical settings is cost-saving. This study focused on a model with consistent, standardized methods of evaluating the costs and effects of established and emerging HIV prevention strategies. 4

The unit cost of testing was adjusted by the positivity rate of persons tested (0.6%). This was based on reports of HIV testing from CDC-funded sites to find a cost per new diagnosis. It found that the cost per case of HIV prevented by testing in a clinical setting was less than the lifetime treatment cost per HIV case.

Effectiveness of expanded testing in the United States

CDC-funded testing programs in the U.S. are substantial. They led to approximately one-third of all new HIV diagnoses in 2013.

From 2007 to 2010, CDC-funded Expanded Testing Initiative sites provided more than 2.8 million HIV tests. These tests resulted in approximately 18,000 new HIV diagnoses and saved $1.2 billion in direct medical costs. 4 For every $1.00 spent on HIV testing, CDC saved the general public $2.00 on direct medical costs.

As more people receive an HIV infection diagnosis, the percentage of people who are unaware of their infection decreases. In 2006, 19% of persons with HIV were unaware of their infection. In 2014, this decreased to 15%. 5 Some of the biggest improvements were among young gay and bisexual males between the ages of 13-24. 6 This group was previously at the highest risk of HIV infection.

  • Walensky RP, Weinstein MC, Kimmel AD, et al. Routine human immunodeficiency virus testing: an economic evaluation of current guidelines. Am J Med 2005;118:292–300.
  • Paltiel AD, Weinstein MC, Kimmel AD, et al. Expanded screening for HIV in the United States—an analysis of cost-effectiveness. N Engl J Med 2005;352:586–95.
  • Sanders GD, Bayoumi AM, Sundaram V, et al. Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. N Engl J Med 2005;352:570–85.
  • Lin F, Farnham PG, Shrestha RK, Mermin J, Sansom SL. Cost effectiveness of HIV prevention interventions in the U.S. Am J Prev Med 2016; 50:699–708.
  • Satcher Johnson A, Song R, Hall HI. State-level estimates of HIV incidence, prevalence, and undiagnosed infections [Abstract 899]. Presented at the Conference on Retroviruses and Opportunistic Infections, Seattle, Washington, February 13–16, 2017.
  • Singh S, Song R, Satcher Johnson A, McCray E, Hall HI. HIV incidence, prevalence and undiagnosed infections in men who have sex with men [Abstract 30]. Presented at the Conference on Retroviruses and Opportunistic Infections, Seattle, Washington, February 13–16, 2017.
  • Krueger A, Dietz P, Van Handel M, Belcher L, Johnson AS. Estimates of CDC-funded and national HIV diagnoses: a comparison by demographic and HIV-related factors. AIDS Behav 2016;20:2961–5.

High-Impact Prevention is a cost-effective, proven, scalable public health approach that prevents new infections, saves life-years, and reduces disparities.

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HIV breakthrough: drug trial shows injection twice a year is 100% effective against infection

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Professor of medicine and deputy director of the Desmond Tutu HIV Centre at the Institute of Infectious Disease and Molecular Medicine, University of Cape Town

Disclosure statement

Linda-Gail Bekker has received honoraria for advisories from Gilead sciences, ViiV Healthcare and Merck Pty Ltd.

University of Cape Town provides funding as a partner of The Conversation AFRICA.

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A large clinical trial in South Africa and Uganda has shown that a twice-yearly injection of a new pre-exposure prophylaxis drug gives young women total protection from HIV infection.

The trial tested whether the six-month injection of lenacapavir would provide better protection against HIV infection than two other drugs, both daily pills. All three medications are pre-exposure prophylaxis (or PrEP ) drugs.

Physician-scientist Linda-Gail Bekker , principal investigator for the South African part of the study, tells Nadine Dreyer what makes this breakthough so significant and what to expect next.

Tell us about the trial and what it set out to achieve

The Purpose 1 trial with 5,000 participants took place at three sites in Uganda and 25 sites in South Africa to test the efficacy of lenacapavir and two other drugs.

Lenacapavir (Len LA) is a fusion capside inhibitor . It interferes with the HIV capsid, a protein shell that protects HIV’s genetic material and enzymes needed for replication. It is administered just under the skin, once every six months.

The randomised controlled trial, sponsored by the drug developers Gilead Sciences , tested several things.

The first was whether a six-monthly injection of lenacapavir was safe and would provide better protection against HIV infection as PrEP for women between the ages of 16 and 25 years than Truvada F/TDF , a daily PrEP pill in wide use that has been available for more than a decade.

Secondly, the trial also tested whether Descovy F/TAF , a newer daily pill, was as effective as F/TDF. The newer F/TAF has superior pharmacokinetic properties to F/TDF. Pharmacokinetic refers to the movement of a drug into, through, and out of the body. F/TAF is a smaller pill and is in use among men and transgender women in high-income countries.

The trial had three arms. Young women were randomly assigned to one of the arms in a 2:2:1 ratio (Len LA: F/TAF oral: F/TDF oral) in a double blinded fashion. This means neither the participants nor the researchers knew which treatment participants were receiving until the clinical trial was over.

In eastern and southern Africa, young women are the population who bear the brunt of new HIV infections . They also find a daily PrEP regimen challenging to maintain, for a number of social and structural reasons.

During the randomised phase of the trial none of the 2,134 women who received lenacapavir contracted HIV. There was 100 percent efficiency.

By comparison, 16 of the 1,068 women (or 1.5%) who took Truvada (F/TDF) and 39 of 2,136 (1.8%) who received Descovy (F/TAF) contracted the HIV virus.

The results at a recent independent data safety monitoring board review led to the recommendation that the trial’s “blinded” phase should be stopped and all participants should be offered a choice of PrEP.

This board is an independent committee of experts who are put in place at the start of a clinical trial. They see the unblinded data at stipulated times during the trial to monitor progress and safety. They ensure that a trial does not continue if there is harm or a clear benefit in one arm over others.

What is the significance of these trials?

This breakthrough gives great hope that we have a proven, highly effective prevention tool to protect people from HIV.

There were 1.3 million new HIV infections globally in the past year. Although that’s fewer than the 2 million infections seen in 2010, it is clear that at this rate we are not going to meet the HIV new infection target that UNAIDS set for 2025 (fewer than 500,000 globally) or potentially even the goal to end Aids by 2030 .

PrEP is not the only prevention tool.

PrEP should be provided alongside HIV self-testing, access to condoms, screening and treatment for sexually transmitted infections and access to contraception for women of childbearing potential.

In addition, young men should be offered medical male circumcision for health reasons.

But despite these options, we haven’t quite got to the point where we have been able to stop new infections, particularly among young people.

For young people, the daily decision to take a pill or use a condom or take a pill at the time of sexual intercourse can be very challenging .

HIV scientists and activists hope that young people may find that having to make this “prevention decision” only twice a year may reduce unpredictability and barriers.

For a young woman who struggles to get to an appointment at a clinic in a town or who can’t keep pills without facing stigma or violence, an injection just twice a year is the option that could keep her free of HIV.

What happens now?

The plan is that the Purpose 1 trial will go on but now in an “open label” phase. This means that study participants will be “unblinded”: they will be told whether they have been in the “injectable” or oral TDF or oral TAF groups.

They will be offered the choice of PrEP they would prefer as the trial continues.

A sister trial is also under way: Purpose 2 is being conducted in a number of regions including some sites in Africa among cisgender men, and transgender and nonbinary people who have sex with men.

It’s important to conduct trials among different groups because we have seen differences in effectiveness. Whether the sex is anal or vaginal is important and may have an impact on effectiveness.

How long until the drug is rolled out?

We have read in a Gilead Sciences press statement that within the next couple of months the company will submit the dossier with all the results to a number of country regulators, particularly the Ugandan and South African regulators.

The World Health Organization will also review the data and may issue recommendations.

We hope then that this new drug will be adopted into WHO and country guidelines.

We also hope we may begin to see the drug being tested in more studies to understand better how to incorporate it into real world settings.

Price is a critical factor to ensure access and distribution in the public sector where it is badly needed.

Gilead Sciences has said it will offer licences to companies that make generic drugs, which is another critical way to get prices down .

In an ideal world, governments will be able to purchase this affordably and it will be offered to all who want it and need protection against HIV.

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  • Pre-exposure prophylaxis

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A new way to prevent hiv delivers dramatic results in trial.

A patient with AIDS at a community hospital in the Central African Republic. Sub-Saharan Africa has high rates of HIV infection -- and was the location for a trial testing the effectiveness of a new strategy for preventing infection.<br>

For over a decade, taking a pill like Truvada every day has been the standard of care for HIV prevention efforts.

In clinical trials, this type of preventive drug, called pre-exposure prophylaxis (PrEP), can be 99% effective in stopping new HIV infections from sex. In the real world, however, that is not always the case.

People don’t always take their pills. In a study in South Africa, women said they felt there was a stigma to the pill —- a sexual partner might assume they’re taking it because they already have HIV or because they have other partners.

Now a new trial —- called PURPOSE 1 —- points the way to a new preventive strategy —- a twice yearly injection of a drug called lenacapavir. The trial was sponsored by Gilead Sciences, the California-based maker of the drug.

In this double-blind, randomized study of 5,300 cisgender women in South Africa and Uganda, 2,134 got the injection and the others took one of two types of daily PrEP pills. The trial began on August 2021 and, so far, not a single woman who received the injections has contracted HIV. The participants who received either of the oral PrEP options, Truvada and Descovy, had infection rates of about 2% — consistent with the infection rates of oral PrEP in other clinical trials.

These results were significant enough for the Data Monitoring Committee —- an independent group of experts appointed to assess the progress of clinical trials —- to recommend that Gilead halt its blinded trial and offer lenacapavir to all study participants. On June 20, Gilead announced these results, and now, all participants can choose to receive the injection.

The study’s focus on women in sub-Saharan Africa is based on HIV data. Despite accounting for 10% of the world’s population, sub-Saharan Africans comprise two-thirds of people living with HIV – 25.7 million out of 38.4 million. And, every week, about 4,000 teen girls and young women in Africa are newly infected with HIV.

Early reaction is positive

The trial has yet to be peer-reviewed, but these early results have been met with excitement.

“It’s fantastic,” says Dr. Jason Zucker , an assistant professor of medicine and infectious disease expert at Columbia University Vagelos College of Physicians and Surgeons. “It’s hard to take a medication every single day. A medication that is [given] every 6 months has a lot of potential.”

Dr. Philip Grant , clinical associate professor and director of the HIV clinic at Stanford University School of Medicine, agrees that lenacapvir could help fill a gap in prevention options. “It would be a big benefit in populations that have adherence challenges,” he says.

Despite being 99% effective in some trials, oral PrEP effectiveness drops significantly in the real-world. One study showed PrEP effectiveness to be as low as 26% in certain populations — men under age 30, for example.

“Medications work when you take them,” says Zucker. “A medication that is given every six months has a lot of potential because, essentially, if you can make two visits a year, you are protected for an entire 12 months.”

Advocacy groups have also expressed enthusiasm about lenacapavir’s preliminary results as a PrEP option. “Lenacapavir would be “a real game-changer,” particularly for people facing stigma and discrimination in low- and middle-income countries,” read a statement by People’s Medicines Alliance —- a global coalition of more than 100 organizations that span 33 countries and that advocate for making medications more accessible.

The drug isn't new; the usage is

Lenacapavir is not a new drug. It’s been approved by the FDA in the United States for multi-drug resistant HIV treatment since 2022 . But PURPOSE 1 is the first clinical trial to test it for HIV prevention.

The PURPOSE 1 trial is part of a larger initiative to improve HIV prevention across the global south. It is one of several studies that are part of ongoing efforts to end the HIV epidemic by 2030.

An ongoing PURPOSE 2 trial is analyzing lenacapavir’s efficacy among cisgender men, transgender men, transgender women and non-binary individuals who have sex with partners assigned male at birth in Argentina, Brazil, Mexico, Peru, South Africa, Thailand and the United States.

Any eventual approval and widespread use would come with challenges. According to an analysis presented at the 24th International AIDS Conference (AIDS 2022), PrEP medications would need to cost less than $54 a year per patient for South Africa, for example, to afford them. Lenacapavir’s cost as HIV treatment in the United States in 2023 was $42,250 per new patient per year. Oral PrEP options, on the other hand, can cost less than $4 a month.

“The biggest gap in prevention isn’t medication, it’s accessing medications,” says Dr. Grant.

Activists across Uganda and South Africa [MIG5] have urged Gilead Sciences to license lenacapavir to the Medicines Patent Pool — a United Nations-backed organization that partners with governments, industry and other organizations to license medications. This would allow for manufacturing of generic versions of the drug at a fraction of the cost.

These activists fear that history will repeat itself: In 2021, cabotegravir. a long-acting injectable PrEP medication manufactured by ViiV Healthcare, was FDA-approved. The medication is more effective than oral options and only requires one injections every two months after the initiation period. But despite approval for generic versions of the medication, these versions still have to go through the World Health Organization review process to show they are equally effective to the brand version. Because this process takes time, generic cabotegravir will likely not be available in Africa until 2027 .

Since sharing lenacapavir’s early success , Gilead has announced that they intend to “deliver lenacapavir swiftly, sustainably and in sufficient volumes, if approved, to high-incidence, resource-limited countries.” Their access strategy includes developing a voluntary licensing program that would enable generic versions to be produced before the original patent expires. When NPR asked Dr. Jared Baeten, Gilead’s vice president of HIV Clinical Development, about timeframes, he said that estimates will depend on "another trial, a regulatory review and approval."

“Cost is going to play into this dramatically,” says Dr. Zucker, “I think and hope we will do everything we can to try to reduce barriers to access.”

Copyright 2024 NPR

Outcomes of Patients Living with HIV Hospitalized due to COVID-19: A 3-Year Nationwide Study (2020–2022)

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  • Published: 04 July 2024

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  • Rafael Garcia-Carretero   ORCID: orcid.org/0000-0001-7532-4585 1 ,
  • Oscar Vazquez-Gomez 1 ,
  • Belen Rodriguez-Maya 1 ,
  • Ruth Gil-Prieto   ORCID: orcid.org/0000-0002-5229-3832 2 &
  • Angel Gil-de-Miguel   ORCID: orcid.org/0000-0003-1295-7101 2  

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Scientific reports on the association between human immunodeficiency virus (HIV) in patients with COVID-19 and mortality have not been in agreement. In this nationwide study, we described and analyzed the demographic and clinical characteristics of people living with HIV (PLWH) and established that HIV infection is a risk factor for mortality in patients hospitalized due to COVID-19. We collected data from the National Hospital Data Information System at Hospitalization between 2020 and 2022. We included patients admitted to the hospital with a diagnosis of COVID-19. We established a cohort of patients with PLWH and compared them to patients without HIV (non-PLWH). For multivariate analyses, we performed binary logistic regression, using mortality as the dependent variable. To improve the interpretability of the results we also applied penalized regression and random forest, two well-known machine-learning algorithms. A broad range of comorbidities, as well as sex and age data, were included in the final model as adjusted estimators. Our data of 1,188,160 patients included 6,973 PLWH. The estimated hospitalization rate in this set was between 1.43% and 1.70%, while the rate among the general population was 0.83%. Among patients with COVID-19, HIV infection was a risk factor for mortality with an odds ratio (OR) of 1.25 (95% CI, 1.14–1.37, p  < 0.001). PLWH are more likely to be hospitalized due to COVID-19 than are non-PLWH. PLWH are 25% more likely to die due to COVID-19 than non-PLWH. Our results highlight that PLWH should be considered a population at risk for both hospitalization and mortality.

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Introduction

The coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, imposed a great burden of illness worldwide, from both socioeconomic and healthcare points of view. As of July 5, 2023, a total of 13,914,811 confirmed cases of COVID-19 had been reported in Spain, with 682,216 hospitalizations and 122,057 deaths [ 1 ]. Some comorbidities are considered risk factors for adverse effects and mortality. Chronic conditions, such as diabetes, hypertension, obesity, immunosuppression, malignancies, and HIV infection, have been associated with worse outcomes in COVID-19 [ 2 ].

People living with HIV (PLWH) may be proportionally more affected by infection with SARS-CoV-2 than people without HIV (non-PLWH), although conflicting results have been reported [ 3 ]. If coinfection with HIV and SARS-CoV-2 puts patients at high risk for mortality, health systems should engage in more aggressive preventive measures and therapeutic efforts to avoid adverse outcomes in PLWH when infected by SARS-CoV-2.

In this study, we analyzed the impact of coinfection with HIV and SARS-CoV-2 in PLWH. We describe the incidence of hospitalization among PLWH and related outcomes in terms of comorbidities, severity, and mortality.

Study Design

We conducted a retrospective, population-based study using data drawn from the Spanish National Hospital Data Information System at Hospitalization (MBDS-H), a valuable database for epidemiological analyses of included conditions created by the Spanish Ministry of Health. The MBDS-H is an administrative registry of discharge reports. Nearly 95% of hospitals in Spain, both public and private, are covered by the database. It is estimated that 97% of all discharge reports are registered in this database. The data are exclusively drawn from hospital discharges, including information on age, sex, date of admission/discharge, type of hospital, place of residence, and diagnoses. MBDS-H includes diseases encoded using the 10th Clinical Revision of the International Classification of Diseases (ICD-10-CM). A new dataset is generated in January of each year. However, due to the high volume of data, the data only become available after a delay of 1 year. The Spanish Ministry of Health provided us with data up to December 31, 2022.

Data Collection

We used data from populations covered by hospitals included in the MBDS-H information system, as noted. We were provided with the microdata extracted from the MBDS-H from the Ministry of Health between 2020 and 2022 using the code for COVID-19 (U07.1) in any diagnostic position. That is, we collected data for patients presenting with a diagnosis of COVID-19 from January 1, 2020, to December 31, 2022. For HIV infection, we used the codes Z21 and B20 to B24. No data on treatment or immunovirological status were provided. For each hospitalized patient, we collected data on age, sex, dates of admission and discharge, ICU admission, and type of discharge. Main and secondary diagnoses were also gathered to identify HIV infection, diabetes, hypertension, and other chronic conditions. Patients who had incomplete data regarding ICU admission, mortality, length of hospitalization, or diagnosed conditions of interest were excluded. No names or personal identifying details were recorded. Data were anonymized and de-identified to ensure patients’ privacy.

Definition of Waves

We categorized the pandemic into waves based on the classification of the Epidemiological National Surveillance Net study, which exclusively used data from Spain. The observation periods were split into outbreaks based on the 14-day cumulative incidence and on a turning point for each wave, such that every turning point indicated the end of one wave and the beginning of the next [ 4 ].

Univariate Analysis

We performed descriptive and correlational analyses. We used means or medians with continuous variables as appropriate, as well as percentages with categorical variables. Average hospital length of stay is defined as the total number of days of stay, divided by the total number of hospitalizations. Mortality and the need for ICU admissions are considered clinical severity criteria. Deaths and ICU admissions, as numerators, are divided by the total number of hospitalizations to calculate the mortality rate and ICU admission rate, respectively. Both parameters are expressed as percentages. The chi-square test and the Wilcoxon signed-rank test were performed as tests of independence when appropriate.

Multivariate Analyses

Logistic regression was used to analyze mortality in our cohort and hence to estimate the impact of the included variables. We used a combination of a classical approach (with binary logistic regression) and a machine learning approach (with penalized logistic regression) to calculate beta coefficients for variables as well as odds ratios (ORs). Binary logistic regression is the most frequently used statistical approach in biomedical sciences with binary outcomes, i.e., yes/no. Logistic regression is simple and straightforward, and it provides easy interpretation of the effects of explanatory variables on response variables. However, a model may have too many features selected as explanatory variables, making it too complex for use. The rationale for the use of machine learning at this stage was that it allowed us to select a set of features, that is, a parsimonious model, without loss of accuracy or reliability.

As noted, our machine learning approach adopted logistic regression with L1-penalized regularization. This approach is also known as the least absolute shrinkage and selection operator (LASSO) [ 5 , 6 ]. It discards variables that do not contribute to the fit of the final model. It forces beta coefficients to a range from very small values to exactly zero. All beta coefficients shrink, but those with weak effects are dropped. We used cross-validation to internally validate the LASSO algorithm. We plotted the average model evaluation scores to select the set of variables that maximized the model’s predictive accuracy. Penalization is determined by the lambda value, which was used to select the subset of variables. LASSO is recommended by the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis checklist for developing and validating risk and diagnostic models [ 7 ].

Interpretability of Results

Once a subset of features was selected, the beta coefficients were obtained, and the ORs were calculated, we used random forest (RF), another machine learning algorithm based on decision trees, to better interpret the results. This generated many independent decision trees, which then were combined to obtain a single output [ 8 , 9 ]. RF allowed the model to be interpreted at a global scale.

For all tests, the level of statistical significance was set at P  < 0.05. We used R language version 4.3.2 (Vienna, Austria) running on a Debian 12 GNU/Linux workstation for both standard and machine learning-based analyses.

We assessed data on 1,188,160 hospitalized patients, including 6,973 patients living with HIV (0.58% of all hospitalized patients) between 2020 and 2022. The main characteristics are presented in Table  1 . Men among PLWH were more likely to be hospitalized than men among non-PLWH. PLWH were also significantly younger than non-PLWH. They also had a lower prevalence of diabetes, hypertension, coronary disease, heart failure, and other cardiovascular risk factors. However, chronic liver disease, malignancy, and chronic pulmonary diseases were significantly more common in PLWH.

By December 31, 2021, it was estimated that there were between 136.436 and 162.307 PLWH in Spain. That is, the prevalence of HIV in Spain was between 0.28% and 0.31%. The rate of hospitalization of patients among the general population was 0.83% per year between 2020 and 2022. Regarding PLWH, the ratio of hospitalized patients was between 1.43% and 1.70%, that is, greater than the general population.

Overall, the prevalence of HIV and hepatitis B virus (HBV) coinfection was 0.7%, but we found that among PLWH the prevalence was 4.2%. Regarding hepatitis C virus, the prevalence among PLWH was even higher (25.5%). We did not found infection caused by human T-lymphotropic virus types I and II.

Due to the predominance of men among PLWH, we decided to plot the relationship between age and sex in a population pyramid (Fig.  1 ) and to show the main characteristics related to COVID-19 in Table  2 . It can be seen that the mortality rate in men was higher than it was in women (8.5% vs. 5.6%, X 2  = 25.7, p  < 0.001). In addition, cardiovascular risk factors, such as diabetes and coronary diseases, were more prevalent in men. Malignancy was also more prevalent in male PLWH. However, women tended to be more obese and to have a higher prevalence of chronic pulmonary disease. There were no differences regarding hypertension, heart failure, dementia, chronic kidney disease, chronic liver disease, or cerebrovascular disease.

figure 1

Population pyramid by age range among hospitalized people living with HIV between 2020 and 2022

Figure  2 ; Table  3 present the evolution of the pandemic among PLWH, splitting the observation period into epidemiological waves. The first wave included 1,303 hospitalizations, and this number steadily dropped until the fourth and fifth waves. More men were admitted than women, with no changes in the distribution along the pandemic. The median age was 54 years, with almost no changes for the entire period. While the mortality rate was 7.7% globally, we observed a decreasing trend from the third wave onward.

figure 2

Evolution of the pandemic during the observation period regarding people living with HIV

The first multivariate analyses were performed with all patients included. Table  4 presents the results. Mortality was used as the dependent variable. We included coinfection with SARS-CoV-2 and HIV as an independent variable, alongside sex, age, and the remaining comorbidities in the final model of logistic regression. HIV infection was a risk factor for hospitalizations due to COVID-19, that is, a patient had a 25% greater chance if a PLWH than a non-PLWH to be hospitalized for COVID-19.

The results of the multivariate analysis of the data for PLWH using binary logistic regression are shown in Table  5 . Sex, age, malignancies, heart failure, hypertension, and chronic liver disease were the main risk factors for a PLWH to be admitted to a hospital. To identify the most relevant variables, we also performed penalized logistic regression for mortality. Compared to the standard binary logistic regression, the list of variables was small, as LASSO dropped non-relevant variables as the model was being fitted. LASSO only identified age, malignancies, and heart failure as the most relevant variables associated with the risk of death. LASSO only provides beta coefficients so that ORs can be calculated, it does not report confidence intervals. In addition, these ORs tend to be lower than those in standard logistic regression, due to the characteristics of the algorithm. LASSO proposed a more constrained model using a lambda value that chose only three variables (Fig.  3 ).

figure 3

Lambda values for penalized regression (LASSO). Lambda values represent the penalization of the beta coefficients. Vertical lines represent the range of lambda for which accuracy is not adversely affected. Numbers across the top of the plot represent the number of variables in the model when a certain value of lambda was used (15 versus 3 features). We chose the lambda values that received the minimum number of features without losing accuracy (determined according to mean square error)

Finally, to improve the interpretation of the results, we used RF to rank variables in order of importance. The variable importance for the selected features can be examined visually to allow us to observe which were the most important for predicting the response variable. Using all variables, therefore, Fig.  4 shows the results provided by the RF algorithm, and the 15 features included are displayed. Age, malignancy, and acute heart failure were the most relevant variables, as identified by penalized logistic regression.

figure 4

Importance of features based on the random forest algorithm

The main aim of our study was to determine the impact of COVID-19 in hospitalized PLWH. We found that PWLH with COVID-19 were at high risk for both hospitalization and mortality. Coinfection with HIV and SARS-CoV-2 was determined to be an independent risk factor for mortality when it was adjusted by age, sex, and other comorbidities.

More specifically, we found that hospitalized PLWH were younger than hospitalized non-PLWH. PLWH tended to have a lower prevalence of diabetes, obesity, and hypertension but a higher prevalence of chronic liver or pulmonary diseases. Malignancy was also higher in PLWH. This suggests that the demographic and clinical profiles among hospitalized PLWH are different than those in the general population. Below, we further discuss the relationship between these variables and the risk of mortality.

In a recent meta-analysis, the pooled prevalence of PLWH in European countries was 0.73% (95%CI 0.24–1.22), although there was risk of bias due to the small number of patients included [ 3 ]. Still, our results among hospitalized patients are similar to that prevalence. In the included European studies, the median age was 50, in line with the age of 54 in our study. In addition, in that meta-analysis, men represented 74% of all patients (the value was 75% in our study). Overall, our results are in line with those of Danwang et al. [ 3 ], with the exception of the mortality risk. Those authors did not find that HIV infection increases the likelihood of severe COVID-19 outcomes.

Our results are also in line with a large retrospective study performed in the UK [ 10 ] that found that PLWH were more likely to be men, with a median age of 48. That study also found that, after adjusting for age, sex, and other comorbidities, PLWH were at higher risk for death.

In our multivariate analyses, age and sex were risk factors for mortality, not only in the general population but also in PLWH [ 11 , 12 ]. HIV infection was a risk factor for mortality once sex and age were included in adjusted analyses, as reported previously [ 13 , 14 , 15 , 16 , 17 ].

We found that the mortality rate was lower among PLWH in unadjusted univariate analyses (Table  1 ). However, when adjusted multivariate analyses were performed, we found that HIV infection was associated with increased risk of mortality (OR 1.25, 95%CI 1.14–1.37); that is, that PLWH are 25% more likely to die due to COVID-19 than non-PLWH. As noted, the meta-analysis by Danwang et al. [ 3 ] did not find evidence for a link between HIV infection and mortality risk in COVID-19 patients, although the authors identified two studies that suggested this association. Our results may seem controversial in light of this difference between univariate and multivariate outcomes with respect to the risk of mortality among PLWH. However, this phenomenon is well documented and can be explained by the fact that univariate analyses can miss some variables that are deemed relevant in multivariate analyses; for this reason, it can produce biased estimates of effects of other variables on the response [ 18 ].

Another controversy is that we also found that PLWH who were coinfected with SARS-CoV-2 were 75–110% more likely to be admitted to a hospital. Conditions such as HIV infection can be considered a risk factor, along with cardiovascular comorbidities, in patients with COVID-19. A preliminary report of a case-control study suggested that SARS-CoV-2 coinfection does not have an extraordinarily great impact on PLWH [ 19 ]. However, the authors emphasized limitations of their study and reported certain trends on severity and mortality that could be worse in PLWH than in non-PLWH. A later study suggested that PLWH are at increased risk for hospitalization [ 3 ] did not find an increased risk for adverse outcomes, including death. The authors referred to the role of immunodepression and immunovirological status in PLWH to explain their results. They hypothesized that the cytokine storm could be averted if immunodepression is present. They also proposed further research that would stratify immunovirological status, including CD4 + T lymphocytes counts and viral load, to identify patients that are most likely to present with severe forms of COVID-19. Bhaskaran et al. [ 10 ] demonstrated that HIV infection is a risk factor for mortality. They also stratified risk based on age and comorbidities.

Although well-controlled HIV infection has been associated with cardiovascular disease [ 17 , 20 , 21 ], the comorbidities analyzed in our cohort did not have a significant effect on mortality. Hypertension, obesity, chronic kidney disease, and coronary disease were risk factors in the general population but not in PLWH. We found that heart failure was associated with a higher risk of mortality in our cohort. PLWH may be at high cardiovascular risk, not only due to aging but also because anti-retroviral therapy (ART) may predispose PLWH to the development of cardiovascular diseases. Heart failure has been noted as an important comorbidity in PLWH, despite ART [ 22 , 23 ].

It should be noted that we found not only a higher prevalence of malignancy among PLWH than among non-PLWH but also that cancer was a risk factor for mortality in the case of coinfection with SARS-CoV-2. In a recent multicenter study, Suarez et al. [ 24 ] investigated the relationship between malignancy and HIV in 17,978 PLWH in Spain. The authors found that mortality due to cancer was higher among PLWH than among the general population. Malignancy was split into several categories, including viral, nonviral, and non-AIDS-defining cancer, and they concluded that cancer was a risk factor for mortality in all categories analyzed.

Our study had several strengths. First, we used machine learning for data analyses, which gave us better insight into the results. In the first step, we used LASSO as an alternative to standard logistic regression. LASSO provides more parsimonious models through feature selection. It selects only a subset of relevant variables while irrelevant or noisy variables are dropped, with no effect on the accuracy of the resulting model. LASSO is simple and easy to understand. In the second step, to better interpret the effect of each variable in the resulting model, we used RF to rank the variables, ordered by their importance in the model. Overall, machine learning allows for better explanation of results, which can help clinicians obtain better insight from them. For these reasons, we believe that our results are robust and provide important implications.

Another strength of our study was its inclusion of almost all patients hospitalized due to COVID-19 in Spain within the observation period and therefore our ability to analyze almost all PLWH coinfected and hospitalized with SARS-CoV-2. Furthermore, this research depicts the situation of hospitalized PLWH in Spain over the first 3 years of the pandemic. In addition, we included demographic and clinical estimators to adjust the risk (sex, age, cardiovascular disease). However, we are aware that further studies with stratified CD4 + T lymphocytes counts, viral loads, and ART would help shed light on the risk for adverse outcomes in PLWH.

A major limitation of this study is the lack of information on immunovirological status and on the prevalence of ART. However, Spain reached the aim of the United Nations Programme on HIV, that is, the 90–90–90 target, in 2021 [ 25 , 26 ], that is, 90% of all PLWH will know their HIV status, 90% of PLWH will receive ART, and 90% of people receiving ART will have viral suppression. It is therefore plausible to assume that at least 80% of inpatients have received antiretroviral therapy and exhibit viral suppression [ 26 ]. Bhaskaran et al. also had the limitation of not including data regarding ART, viral load, or CD4 + T lymphocytes status, but they did not consider that to have distorted their findings [ 10 ].

Conclusions

PLWH have a greater chance of being hospitalized due to COVID-19 than non-PLWH. PLWH are 25% more likely to die if coinfected with SARS-CoV-2 than non-PLWH. Our results indicate that PLWH should be considered at risk for both hospitalization and adverse outcomes, including mortality. The effects of age, sex, and other comorbidities should also be considered as adjusting estimators because they can modify the clinical course of COVID-19 in PLWH.

Data Availability

A contract signed with the Spanish Health Ministry, which provided the data set, prohibits the authors from providing their data to any other researcher. Furthermore, the authors must destroy the data upon the conclusion of their investigation. The data cannot be uploaded to any public repository.

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Department of Internal Medicine, Mostoles University Hospital, Rey Juan Carlos University (Madrid), Madrid, Spain

Rafael Garcia-Carretero, Oscar Vazquez-Gomez & Belen Rodriguez-Maya

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Contributions

Dr. Garcia-Carretero conceived and designed the study, wrote the first draft of the manuscript, and preprocessed and analyzed the data. Drs. Vazquez-Gomez and Rodriguez-Maya made substantial contributions to the interpretation of the results, critically reviewed the first draft of the manuscript, and made valuable suggestions. Drs. Gil-Prieto and Gil-de-Miguel supervised the project and critically reviewed and edited the final draft of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Rafael Garcia-Carretero .

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Garcia-Carretero, R., Vazquez-Gomez, O., Rodriguez-Maya, B. et al. Outcomes of Patients Living with HIV Hospitalized due to COVID-19: A 3-Year Nationwide Study (2020–2022). AIDS Behav (2024). https://doi.org/10.1007/s10461-024-04394-z

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DOI : https://doi.org/10.1007/s10461-024-04394-z

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A case study of HIV/AIDS services from community-based organizations during COVID-19 lockdown in China

  • Jennifer Z.H. Bouey 1 , 2 ,
  • Jing Han 3 ,
  • Yuxuan Liu 1 ,
  • Myriam Vuckovic 1 ,
  • Keren Zhu 2 ,
  • Kai Zhou 4 &

BMC Health Services Research volume  23 , Article number:  288 ( 2023 ) Cite this article

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Introduction

People living with HIV (PLHIV) relied on community-based organizations (CBOs) in accessing HIV care and support during the COVID-19 pandemic in China. However, little is known about the impact of, and challenges faced by Chinese CBOs supporting PLHIV during lockdowns.

A survey and interview study was conducted among 29 CBOs serving PLHIV in China between November 10 and November 23, 2020. Participants were asked to complete a 20-minute online survey on their routine operations, organizational capacity building, service provided, and challenges during the pandemic. A focus group interview was conducted with CBOs after the survey to gather CBOs’ policy recommendations. Survey data analysis was conducted using STATA 17.0 while qualitative data was examined using thematic analysis.

HIV-focused CBOs in China serve diverse clients including PLHIV, HIV high-risk groups, and the public. The scope of services provided is broad, ranging from HIV testing to peer support. All CBOs surveyed maintained their services during the pandemic, many by switching to online or hybrid mode. Many CBOs reported adding new clients and services, such as mailing medications. The top challenges faced by CBOs included service reduction due to staff shortage, lack of PPE for staff, and lack of operational funding during COVID-19 lockdowns in 2020. CBOs considered the ability to better network with other CBOs and other sectors (e.g., clinics, governments), a standard emergency response guideline, and ready strategies to help PLHIV build resilience to be critical for future emergency preparation.

Chinese CBOs serving vulnerable populations affected by HIV/AIDS are instrumental in building resilience in their communities during the COVID-19 pandemic, and they can play significant roles in providing uninterrupted services during emergencies by mobilizing resources, creating new services and operation methods, and utilizing existing networks. Chinese CBOs’ experiences, challenges, and their policy recommendations can inform policy makers on how to support future CBO capacity building to bridge service gaps during crises and reduce health inequalities in China and globally.

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The COVID-19 pandemic is a defining catastrophic public health event of our lifetimes.In China, the COVID-19 pandemic started with a national lockdown in 2020. After two years of conservative intervention focusing on mass testing and quarantine, COVID-19 came back in 2022 and caused millions of infections and an overwhelming death toll, which put a significant strain on China’s healthcare system and paralyzed the economic engine. How do Chinese community organizations support vulnerable populations such as HIV/AIDS patients during such disasters? What policy changes do the Chinese CBOs hope to see? Our case study strives to answer these questions.

China was the first country to encounter the novel coronavirus disease and to implement a strict, large-scale lockdown between January 23, 2020, and April 2020 to contain the virus [ 1 , 2 ]. Most of the 31 provinces in China declared the highest Emergency Level on January 23rd of 2020, enabling local governments to employ social policing mechanisms to enforce quarantine and to close public events with crowd gatherings across the country. Most highways and public transportation were shut down (January 23- February 7) [ 2 ]. All businesses and recreational facilities were closed, except for medical emergency rooms, grocery stores, and keyinfrastructure-related economic activities. In rural areas, many villages stalled traffic and set up entrance checks, whereas urban residential communities required residents to prove their residence to use the weekly grocery shopping quota [ 3 ]. After the outbreak peaked in mid-February, many prefecture-level cities switched from the stringentshutdown to semi-lockdown for another month [ 4 ]. Wuhan, the capital of Hubei province and the origin of the outbreak, experienced the longest lockdown from January 21 to April 7, 2020 [ 5 ]. COVID-19 and the stringent intervention had a profound impact on the lives of the Chinese people during this initial period of the COVID-19 pandemic [ 6 , 7 ].

China is also home to 1.05 million people living with HIV (PLHIV) who needed long-term antiviral medical treatment and care in 2020 [ 8 ]. The central government provides PLHIVs access to free antiretroviral therapy (ART) and free voluntary counseling and testing since 2003 [ 9 ]. In 2016, the new “Treatment for All’’ policy removed the requirement of low CD4 levels as a treatment qualifier. By 2020, about 978,138 PLHIV had gained access to ART, covering 92.9% of all PLHIV in China [ 8 ]. Despite this progress and updated policies, various structural, psychological, and behavioral barriers to ART adherence persist [ 10 ]. Barriers including patients’ concerns for side effects and “pill burden,” lack of effective communication between patients and health care providers, low patient self-efficacy of ART, competing priorities for patients, and depression and stigma associated with HIV [ 11 , 12 ]. Like many Community-Based Organizations (CBO) serving vulnerable populations globally, Chinese CBOs play critical roles in helping PLHIV to improve their access to HIV screening, treatment and care, and reduce stigma, especially among men who have sex with men (MSM) [ 13 , 14 , 15 , 16 ]. In China, there are two main types of CBOs providing services to PLHIV: those independently registered with the state/provincial or local government of Civil Affairs as a non-profit organization, and those affiliated with health clinics and local public health offices without an independent registry [ 17 ]. Both types of CBOs rely on government public health agencies for funding.

COVID-19 has led to unprecedented stress on health and public health systems and has intensified disruptions in HIV prevention, testing, and HIV care continuum services worldwide [ 18 ]. China is not an exception. A Chinese provincial study based on the HIV registration system found a 49% drop in HIV testing rates and a 37% drop in new HIV diagnoses during the first months of COVID-19. In addition, only half of the 475 newly diagnosed HIV patients underwent CD4 count testing and 28.6% did not receive routine linkage to care in the same time period [ 19 ].

Around the world,PLHIV and high-risk populations rely on CBOs for their rich local knowledge, operational flexibility, and direct contact to people in need, to provide humanitarian aid during a crisis [ 20 ]. Facing challenges due to quarantine requirements and transportation service requirements, CBOs in many countries responded by moving their services online and utilizing technology-driven solutions to promote access to HIV counseling, testing, and treatment [ 21 ]. Global [ 22 , 23 ] and China-specific [ 24 ] studies have shown that CBOs promoting community connectedness among MSM resulted in higher HIV testing rates during COIVD-19. However, CBOs themselves are not immune to the negative impact of COVID-19. Preliminary studies in the U.S. have found that the COVID-19 pandemic presents multifaceted challenges to CBOs providing HIV services, including but not limited to structural inequality, resources shortages, and disruption to patient-centered services provision [ 25 , 26 ].

Clearly, more in-depth studies among CBOs are necessary to understand COVID-19’s impact among CBOs serving PLHIV in China. Although several studies in China highlighted the challenges to PLHIV [ 19 , 27 , 28 , 29 ] and healthcare workers [ 30 , 31 ], few looked at the implications for Chinese CBOs during the lockdowns. Only one stakeholder study published in English included 17 CBO workers in the interviews and found that CBOs could assist HIV care among PLHIV in multiple ways during COVID-19 [ 13 ].

In this study, a team of CBO leaders, clinicians, and public health researchers try to answer the following questions using data collected from a mixed-method study (survey and focus group): What challenges did PLHIV face during the first pandemic lockdown in China? What were the challenges to the CBOs and how did they cope? What innovation came out of the crisis? What gaps in CBOs’ capacity were revealed and how to build better preparedness for future emergencies? The study provides critical information on how best to prepare and utilize community organization services on HIV care during a public health emergency or a disaster.

Study design and participants

The study research team included HIV specialists of a large infectious disease hospital in Beijing, their affiliated and long-term CBO partner “Home of Red Ribbon (HRR),” staff of the Joint United Nations Programme on HIV/AIDS (UNAIDS) Beijing office, and global health researchers from Georgetown University and the RAND Corporation, an American think tank that develops solutions to public policy challenges. HRR was founded in 1999 to serve local PLHIV. In 2019, HRR founded the “Beijing Red Ribbon Alliance,” a national platform with 60 + CBO members serving PLHIV. In this study, CBO participants were recruited by HRR from the Alliance. They come from all seven geographic regions of China and were considered reliable information sources based on previous collaborations with HRR. Organizations participating in the study had to meet the following criteria: (a) established Chinese CBOs providing HIV prevention and treatment services; (b) delivered services from January 20, 2020, to April 29, 2020; and (c) would like to provide informed consent for the study. Among survey invitations to 32 qualified CBOs, 29 CBOs responded. Three CBOs have multiple branch offices that completed the survey, yielding a 90% response rate.

Data collection

Both qualitative and quantitative data on service provision and needs during the COVID-19 pandemic were collected from the participating CBOs. A 20-minute online survey with both closed- and open-ended questions was first disseminated and collected between November 10 and November 23, 2020, and a virtual focus group interview was conducted on November 13, 2020. In addition to the survey data, detailed notes from the focus group interview were used for theme analysis. All data collection followed the principles of confidentiality and voluntary participation. There were no consequences if a participant withdrew from the study. The study protocol was approved by the Ditan Hospital Internal Research Board (IRB number: KY2020-019).

The online survey questionnaire was designed by the research team staff from Beijing Ditan Hospital with HRR. A Chinese online survey platform “Wen-Juan-Xing’’ was used to host the survey, which was then disseminated to the invited participants through the social media app WeChat. The CBO organizations that completed the online survey received RMB 800 (approximately USD 125) for their participation. The questionnaire contained nineteen close-ended multiple-choice questions and eleven open-ended short-answer questions to cover the following three domains:

CBO routine operational characteristics

questions obtained information on the CBO’s location of operation, operational years, registration status, number of full-time and part-time staff and volunteers, presence of PLHIV among staff and volunteers, CBO’s social media platform usage, target client populations and routine services provided.

Service provision during COVID-19

questions included CBO’s operational modes during COVID-19, presence of operation interruptions during the pandemic, CBO’s target client populations during the pandemic, types of services requested and provided during the pandemic. The survey also asked about the ways clients contacted CBOs during the COVID-19 lockdown.

If CBOs reported unresolved requests or an interruption in service provision during COVID-19 lockdowns, they were asked to provide follow-up information on the types of such requests in open-ended short answers, whether service provision had resumed, and whether there was staff loss. Finally, the CBOs were asked to rate their satisfaction on their collaborations with government agencies and other CBOs during the pandemic.

Needs and organizational capacity building

questions started with a description of the CBO’s operational advantages and challenges during COVID-19, including short answers on CBOs’ most urgent needs, the relative advantages of their organizations compared to other CBOs, and whether their services were better recognized and expanded during COVID-19. They also estimated whether COVID-19 was helpful or not, in terms of future prospects of the organization.

Focus group interview

While the survey focused on the challenges CBOs faced during the lockdown, a focus group interview was set up to help researchers contextualize the findings of the survey and to collect policy recommendations to support CBOs’ work in future outbreaks. All 29 survey participants were invited to the focus group interviews and eighteen CBOs (62%) participated through Tencent Meeting (an online meeting platform in China) after they completed the survey. The focus group interview was led by a Ditan Hospital HIV specialist and an HRR staff following a semi-structured question guide. The semi-structured question guide was developed to capture the following themes: (a) what services delivery challenges they encountered during COVID-19 in 2020; (b) which special groups of patients (e.g., elderly, people with disability etc.) came to their service during the COVID-19 lockdown; (c) what innovation and lessons they have learned from providing services for PLHIV during the COVID-19 pandemic; and (d) what policy recommendations do they have to enhance CBOs’ service delivery in future pandemics.The online focus group interview lasted two hours until data saturation was achieved. Detailed field notes were used for data analyses.

Data analysis

Online survey data was collected and managed through the online service platform Wen-Juan-Xing and analyzed using STATA 17.0 [ 32 ]. We first provided descriptive statistics to summarize the characteristics of the CBOs operations, services, and clients during COVID-19 with multiple choice questions. We then used thematic analysis to analyze and explore potential themes of the open-ended questions. Two independent researchers followed the analytic process recommended for thematic analysis [ 33 ]: (a) familiarizing themselves with the data; (b) generating-e initial themes and codes; (c) coding the open-ended answers according to the themes; (d) discussing the differences, obtaining consensus, and finalizing the name of the themes; and (e) producing the report for the results section. The same approach was used to summarize additional themes from the notes of the focus group interview. Quotations were used to highlight the findings. Both survey and focus group scripts were analyzed in Chinese and translated to English for the report. Back translations were used to check for translation accuracy.

Characteristics of CBOs

29 CBOs participated in the study and their characteristics aree summarized in Table  1 . More than half (55.2%) were registered with the Chinese government as a civil organization, while 13 CBOs (44.8%) were affiliated with hospitals or the local public health agencies. More than one third of the CBOs (41.4%) in the study were located in the North or Northeast Region of China, about another third (34.5%) were from Eastern or Southern China, and seven (24.1%) CBOs were from West China. Number of staff was another measurement of the operation scale: 41.4% (n = 12) of CBOs reported more than 50 staff, while only two (6.9%) reported having less than 10 staff (Table  1 ). 69.0% of CBOs employed PLHIV, and all organizations reported having PLHIV among their volunteers.

CBOs’ new services during the COVID-19 lockdown

Even before COVID-19, Chinese CBOs often served a diverse client population. In our study, the majority (96.4%) of CBOs reported providing services to MSM, 80% catered to PLHIV, 60.7% provided services to adolescents at risk, and others facilitated services to migrants (28.6%), female commercial sex workers (25%), substance users (7.1%), children affected and orphaned by AIDS (14.3%), and the general public (25%) before the COVID-19 pandemic (Table  2 ). During COVID-19 lockdowns, almost all CBOs reported providing new services to non-local clients seeking HIV related services when they could not go back to their routine medical services (n = 28, 96.6%), and to their regular clients who got stranded in other cities (n = 26, 89.7%), in addition to their regular local clients. These new services were requested through various channels, including peer referrals, online platforms and group chats, hospitals and clinics, and through CBOs’ pre-pandemic services.

The scope of CBO services also changed during the COVID-19 lockdown period. While most CBOs reported continued provision of regular services, they had to add services unique to the lock-down period, including mailing ART medicines and post-exposure prophylaxis (PEP), supporting family notification of PLHIV’s HIV status, and peer support (Table  2 ).

Not only did the service requests intensify during the COVID-19 lockdown, but many CBOs also had to switch their on-site services to phone- and online-based when the travel restrictions hit. All participating CBOs reported using one or more new platforms such as WeChat, TikTok, etc. for services during this period (Table  2 ). Meanwhile, most CBOs still maintained on-site services except for five who stopped providing in-person services.

To cope with the challenges brought by the pandemic, many CBOs turned to innovative communication strategies and digital technology to secure medicine supplies. One CBO said: “There are 10 internet volunteers to promote online, and 5 volunteers to make appointments for testing, so that you can ensure access to various HIV supplies via the internet without having to come to the office.” (Medium CBO, 5–9 yrs of operation, independent, large city in the West). Six CBOs also attributed human-centered care and respect for PLHIV, their rapport with marginalized clients, and their ability to operate at the grass-roots level as key factors in their success. As one CBO put it: “Government agencies work according to rules and regulations, while friends of the community work more on the basis of their enthusiasm and human feelings for the community.” (Large CBO,10–14 yrs of operation, independent, small city in the Northeast/North).

Challenges and coping strategies during COVID-19

While many CBOs successfully carried out services for PLHIV, challenges still mounted during the unexpected lockdowns. In the survey, most CBOs (90%) reported unmet needs from their clients during the pandemic, especially on access to ART (41%), referral to health care (24%), and HIV testing and confirmation (21%). About a third of CBOs reported that their services were disrupted by the pandemic, particularly their in-person services (31.0%). Among the services most impacted were in-person HIV testing (27.6%), in-person counseling (10.3%), in-person volunteering (3.4%) and outreach (3.4%). After the lockdown, all CBOs resumed their services. However, 33.3% of organizations reported losing staff.

When asked about the top three challenges during the COVID-19 lockdown, 18 CBOs identified limited service provision modes as their main challenge, followed by shortage of personal protective equipment (PPE) for staff (51.7%), lack of funding (37.9%), staff shortages and loss of staff and volunteers (17.2%), limited or slow HIV testing services (10.3%), lack of support from other sectors and society at large (3.4%), limited medical resources (3.4%), and hard to obtain and deliver medication (13.8%). CBOs also mentioned short-term funding shortfalls, weak Wi-Fi, and inaccessibility of office space as challenges.

One additional challenge CBOs reported was the lack of mail courier services, especially in remote areas and to college students who live on locked-down campuses. One CBO observed: “Some patients stop taking their medication when they can’t even get to the courier company in places where transportation is inconvenient.” (Medium CBO, 5–9 yrs of operation, civil governance registered, medium city in the West). Another said: “It is difficult to give medication to students because the school is very strict, no deliveries to campus for 8 months, and security checks to enter school, risking exposure of privacy.” (Medium CBO, 5–9 yrs of operation, independent, small city in the West).

Another common challenge was associated with HIV testing and confirmation tests: “There has been no opportunity to confirm and then start treatment for infected persons with positive initial screening due to the lockdown and home isolation…. Someone tested positive in July and it took three months to confirm.” (Medium CBO, 5–9 yrs of operation, independent, small city in the West).

Finally, several CBOs mentioned that they could not meet clients’ needs in gaining peer support, resolving financial issues and how to navigate other barriers.

An important coping strategy among the CBOs was building collaboration with various government agencies, including local CDC (86.2%), hospitals (86.2%), the Ministry of Public Security (10.3%), and local government organizations or other agencies (10.3%). On a scale from 0 to 10, most organizations were very satisfied with their collaborations during the pandemic (24 CBOs > 8), four CBOs were somewhat satisfied (ratings of 5–7), and only one CBO was completely unsatisfied (rating of 0). Almost 80% of CBOs reported collaborations with other non-governmental organizations, mostly with similar organizations in the same region (e.g., provincial and municipal sister agencies). Such collaboration helped relieve shortages of service, medicine, and PPEs.

CBO’s sustainability and capacity building needs

When asked about the top three areas of needs, 15 CBOs named funding and personnel as their top need (51.72%). Other top needs included technical assistance, supplies, organizational capacity building, and collaboration among CBOs and with other sectors. While the second and third needs varied, organizational capacity building was mentioned seven times (24.14%), demonstrating its significance for the CBOs. Only two CBOs did not report any external needs.

Many organizations felt that the capacity needed during the pandemic were better coordination and communication skills (27.6%), flexibility (20.7%), and good service provision (13.8%). Six CBOs also emphasized that the ability to provide online consultation and telemedicine services were useful skills during a pandemic. A large network and emergency response training were also desirable capacities reported by the CBOs.

Despite the many challenges faced by the participating CBOs and their clients during the COVID-19 pandemic, most of the CBOs felt that they had gained popularity during the pandemic, and many mentioned thank-you-notes from their clients. They were also able to build a larger network with requests from other organizations (34.5%), received media coverage (20.7%), and additional project funding (31.0%) during the pandemic. About half of the CBOs considered the COVID-19 pandemic beneficial to their organization’s development.

Policy recommendations from the CBOs

The focus group interview helped confirm capacity-building needs. More importantly participating CBOs also offered the following recommendations during the focus group discussion, which expand on the needs expressed in the survey. We summarized the policy recommendations in the following:

Create regional CBO service alliance networks : “Alliances can be formed between community organizations, and a directory of information on local drug assistance, etc., can be produced and sent to patients so that they can refer to the directory for targeted help.” (Large CBO, 5–9 yrs of operation, independent, mega city in the Northeast/North).

Strengthen multisectoral cooperation between CBOs, hospitals, the CDC, community level government and community health centers from different regions: “… the local CDC alone may not be able to get the job done. There is a need for the creation of a network of emergency support services in the event of an emergency.” (Large CBO, 14 yrs + of operation, civil governance registered, large city in the Northeast/North).

Develop standardized emergency response operational manuals/guidelines (including recruitment). One CBO talked about preparing both CBOs and their clients by establishing guidelines: “There should be guidelines for patients, but also for community organizations, including what community organizations can do, how to do it, how to do risk assessment (e.g. group lending, mutual aid lending), and what are the channels for obtaining supplies; for patients, it is a manual for self-management of infected persons in case of emergency.” (Large CBO, 14 yrs + of operation, civil governance registered, large city in the Northeast/North).

Support PLHIV community resilience building . Many CBOs discussed ways to build resilience among PLHIV during emergencies, including on ART: “Infected people need to be better guided and educated about treatment adherence.” (Small CBO, 5–9 yrs of operation, independent, medium city in the East/South).

Optimize medicine access during a crisis . CBOs identified access to medicine as the top challenge during COVID-19 and the necessity of flexible policy on longer-term prescriptions: “It would be better for the infected to be prepared when something like this happens again, and to have peace of mind, if they are advised by the agency that dispenses the drugs.” (Large CBO,5–9 yrs of operation, independent, medium city in the East/South).

Build a larger volunteer pool to offset staff shortage during a crisis : “Policies are needed to involve volunteers in the fight against the pandemic and AIDS.” (Medium CBO, 5–9 yrs of operation, independent, small city in the West).

COVID-19 posed unprecedented challenges to global health and reversed decades of hard-earned progress on health [ 34 ]. Our study was one of the first to survey and interview frontline CBO staff that serve PLHIV around China in the first year of the pandemic. The CBOs in our study varied in their operational size and their affiliations status with the CDC and clinics. While some work in urban centers with advanced economic development, others are located in rural districts. In both the survey and the focus group interview, the common themes were the challenges they faced unexpectedly when COVID-19 hit and how the strict lockdown added to their service scope and forced them to change service methodology. Our survey findings add to the growing literature on resilience of communities during a natural disaster and highlight the importance of networking, digital platforms, and operational flexibility among grass-root community organizations. The focus group interview with the CBOs further explained the mechanisms of coping and provided a much-needed reflection on the need for capability building for future pandemics or disasters.

Our study found that CBOs serving people living with HIV in China often had at least 5–10 years of experience working with local PLHIV and generally have good working knowledge and close collaborations with local public health agencies and medical institutions. This type of three-in-one network has proven to improve performance metrics on disease testing and detections among high-risk populations [ 35 ]. The community organizations also serve a diverse population, including PLHIV as well as people at higher risk for HIV, such as MSM and female sex workers, and routinely carry out services including health promotion, peer support, and treatment coordination. Many CBOs have volunteers from the local PLHIV or high-risk population, which enables them to conduct targeted outreach and build trust with their clients. This finding validates a community resilience theory [ 36 ] that named four primary sets of adaptive capacities as critical to community resilience: social capital, economic development, information and communication, and community competence. The social capital, community competency, and communication skills of the CBOs have helped the organizations to achieve high efficiency in HIV control with flexible working venues and low operating costs.

During emergencies, to build collective resilience, communities must create organizational linkages, boost and protect social supports, and plan for not having a plan – which requires flexibility, decision-making skills, and trusted sources of information that function in the face of unknowns [ 36 ]. Our study found that CBOs that can provide PLHIV with wider organizational connections and mobilize social support through flexible operation plans, had a pivotal role in building community resilience during COVID-19. For example, despite the fact that the National Center for AIDS/STD Control and Prevention of China’s CDC issued a special policy to facilitate ART treatment continuity among PLHIV at the early stage of the COVID-19 pandemic [ 37 ], travel restrictions under the COVID-19 lockdown still had a significant impact on PLHIV’s access to and the CBO’s ability to provide services, such as ART, testing, and other medical care [ 13 ]. Since the lockdown happened at Chinese New Year, a time when internal migration is at its peak and a large population visits their family away from where they work, many PLHIV found themselves stuck in places away from their routine care. Many who had to quarantine with their parents found themselves having to forgo privacy and to disclose to their parents and families for the first time that they needed HIV care [ 27 , 38 ]. Meanwhile, most of the local staff at public health stations were redeployed to respond to COVID-19. CBOs found significant workload increase with new clients stranded in their location in need of HIV care, new demands to coordinate HIV treatment continuity and testing, and additional requests on peer support in this time of crisis. In response, many CBOs had to make quick decisions to switch their service online and to seek new connections with fellow organizations and new government agencies– with varying success as our survey showed. Similar to our study’s findings, a 2020 China AIDS Fund for NGOs and UNAIDS’s CBO survey found that 87% of community organizations set up their own hotlines and implemented flexible working hours for volunteers during the COVID-19 epidemic from February to April 2020, to provide AIDS-related services. Nearly half added express mailing services for delivery of HIV self-testing kits and medicine to their services [ 39 ].

The same UNAIDS survey revealed that some CBOs encountered difficulties in HIV/AIDS services during the peak of the pandemic during February and March of 2020. The main reasons for the service interruption were urban traffic control (86%) and CDC staff who were unable to support AIDS prevention work (51%) because of their participation in the prevention and control of the COVID-19 epidemic. By the end of April 2020, about 53% of community organizations had fully restored their services, and 42% had restored some services [ 39 ]. Our findings are in line with the scenario described in the UNAIDS report and found the most critical challenges to the CBOs to be a lack of funding, limited service provision methods, shortage of staff and PPE, limited medical resources, testing and medication delivery capacities, and lack of support and understanding from society at large. All these factors contributed to CBOs’ service disruption, in addition to the reasons identified by the UNAIDS survey.

Paton (2000) defined community resilience as the capacity to bounce back and use physical and economic resources effectively to aid recovery following exposure to hazards [ 40 ]. In an earlier report for UNAIDS, we found that as a vulnerable population, PLHIV faced unique challenges during the unexpected COVID-19 lockdowns [ 41 ]. However, they had better resiliency resources – the CBOs that had already served their community before the pandemic – compared to other vulnerable populations, such as migrant workers and people with disabilities in China [ 41 ]. To build stronger resilience in the face of future disaster situations, the CBOs in our study offered multiple suggestions that we can summarize into four recommendations: First, enhance CBOs network building both horizontally and vertically: horizontally among CBOs with similar missions across different geographic areas so that when PLHIV travel, they can rely on the network for the continuation of support; vertically between CBOs and multiple hierarchies of government and healthcare facilities for resource coordination. Such collaborations should be included in government-level emergency response plans and policies to ensure the continuation of support for PLHIVs.

Secondly, funding agencies should consider supporting CBOs’ capacity building in communication and technology upgrades so that CBOs can expand their digital direct service platforms and mobilize resources during a crisis.

Thirdly, CBOs should consider strengthening their volunteer base and building a workforce reserve for their community-based services to prepare for staff shortages during emergencies. CBOs can mobilize these local talents from various groups. One way is to empower PLHIV to become peer supporters/volunteers during emergencies. Their presence in an emergency response would benefit the utilization of community-based services, and reduce PLHIV’s unease to disclose their status and seek help. Another way to engage more talents to grassroot community governance is to provide CBO-based internships for college students and professional training institutes (e.g., to students of public health, medicine, sociology, or other related fields). Efforts should also be made to cultivate professional talent serving grassroot communities, adjust policies and incentive mechanisms, and encourage more experts to provide intellectual support for community governance. Encouraging the public to participate in grassroots social governance can also help empower community members and generate increased cohesion and community resilience.

Finally, the CBOs’ capacity building should include a community-level emergency response plan. Education on disaster prevention and mitigation at the community level should be strengthened, and communities with excellent emergency response and disaster relief operations should be promoted as models, so their experiences can be shared. Bureaucratically and institutionally, the division of labor in emergency response and community governance should be further clarified, and community staff should receive training in emergency planning and response, to provide speedy and efficient public service when faced with future uncertainties and emergencies.

The findings of this study should be viewed in the context of several limitations. First, the study survey was cross-sectional. Therefore, causal inference could not be established, and the results can only reflect the situation of CBOs during a certain period during the pandemic. Second, the study only analyzed 29 responses from different CBOs and their operational branches, utilizing the connections of HRR. The limited number of participants and the recruitment method may have led to biased results, as the selected CBOs might not be representative of the population. Third, all information in the study was self-reported by one manager of each CBO, thus is subject to risk of bias.

Risks and vulnerabilities induced by pandemics and other natural hazards and disasters are on the rise globally. Some emergencies, such as COVID-19, have severe and widespread destructive impacts on health, the economy, social development, and global supply chains. In this context, community resilience to disasters is critical for government hazard mitigation and recovery planning [ 36 , 42 ]. Our case study showed that CBOs serving a highly stigmatized and vulnerable population before the crisis were instrumental in building resilience in the community. They were able to quickly mobilize resources, set up new business platforms/models, and expand their network to meet unprecedented challenges. They also identified key areas for capacity building for future crisis preparedness. Their experience and reflections may help governments, communities, and international organizations when considering how to reduce health inequity and how to serve those who need long-term healthcare during an unexpected natural or manmade crisis.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

Thanks to all community organizations serving HIV patients and people who are at high risk for HIV in China, who participated in the survey and focus group discussion. Special thanks to the House of Red Ribbon that coordinated interviews and focus groups, and to UNAIDS China Office for providing support on information and data analysis.

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Jing Han, Jennifer Bouey designed the study and manuscript, Jing Han and Ye Su. collected data, Yuxuan Liu, Myriam Vuckovic conducted data analysis, Jennifer Bouey, Yuxuan Liu, Myriam Vuckovic drafted the manuscript., Keren Zhu and Kai Zhou participated in drafting and editing.

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Bouey, J.Z., Han, J., Liu, Y. et al. A case study of HIV/AIDS services from community-based organizations during COVID-19 lockdown in China. BMC Health Serv Res 23 , 288 (2023). https://doi.org/10.1186/s12913-023-09271-4

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The lived experience of HIV-infected patients in the face of a positive diagnosis of the disease: a phenomenological study

  • Behzad Imani   ORCID: orcid.org/0000-0002-1544-8196 1 ,
  • Shirdel Zandi 2 ,
  • Salman khazaei 3 &
  • Mohamad Mirzaei 4  

AIDS Research and Therapy volume  18 , Article number:  95 ( 2021 ) Cite this article

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AIDS as a human crisis may lead to devastating psychological trauma and stress for patients. Therefore, it is necessary to study different aspects of their lives for better support and care. Accordingly, this study aimed to explain the lived experience of HIV-infected patients in the face of a positive diagnosis of the disease.

This qualitative study is a descriptive phenomenological study. Sampling was done purposefully and participants were selected based on the inclusion and exclusion criteria. Data collection was conducted, using semi-structured interviews. Data analysis was performed using Colaizzi’s method.

12 AIDS patients participated in this study. As a result of data analysis, 5 main themes and 12 sub-themes were identified, which include : emotional shock (loathing, motivation of social isolation), the fear of the consequences (fear of the death, fear of loneliness, fear of disgrace), the feeling of the guilt (feeling of regret, feeling guilty, feeling of conscience-stricken), the discouragement (suicidal ideation, disappointment), and the escape from reality (denial, trying to hide).

The results of this study showed that patients will experience unpleasant phenomenon in the face of the positive diagnosis of the disease and will be subjected to severe psychological pressures that require attention and support of medical and laboratory centers.

Patients will experience severe psychological stress in the face of a positive diagnosis of HIV.

Patients who are diagnosed with HIV are prone to make a blunder and dreadful decisions.

AIDS patients need emotional and informational support when they receive a positive diagnosis.

As a piece of bad news, presenting the positive diagnosis of HIV required the psychic preparation of the patient

Introduction

HIV/AIDS pandemic is one of the most important economic, social, and human health problems in many countries of the world, whose, extent and dimensions are unfortunately ever-increasing [ 1 ]. In such circumstances, this phenomenon should be considered as a crisis, which seriously affects all aspects of the existence and life of patients and even the health of society [ 2 ]. Diagnosing and contracting HIV/AIDS puts a person in a vague and difficult situation. Patients suffer not only from the physical effects of the disease, but also from the disgraceful consequences of the disease. HIV/AIDS is usually associated with avoidable behaviors that are not socially acceptable, such as unhealthy sexual, relations and drug abuse: So the patients are usually held guilty for their illness [ 3 ]. On the other hand, the issue of disease stigma in the community is the cause of rejection and isolation of these patients, and in health care centers is a major obstacle to providing services to these patients [ 4 ]. Studies show that HIV/AIDS stigma has a completely negative effect on the quality of life of these patients [ 5 ]. Criminal attitudes towards these patients and disappointing behavior by family, community, and medical staff cause blame and discrimination in patients [ 6 ]. HIV/AIDS stigma is prevalent among diseases, making concealment a major problem in this behavioral disease. The stigma comes in two forms: a negative inner feeling and a negative feeling that other people in the community have towards the patient [ 7 ]. The findings of a study that conducted in Iran indicated that increasing HIV/AIDS-related stigma decreases quality of life of people living with HIV/AIDS [ 8 ]. Robert Beckman has defined bad news as “any news that seriously and unpleasantly affects persons’ attitudes toward their future”. He considers the impact of counseling on moderating a person’s feeling of being important [ 9 ]. Therefore, being infected by HIV / AIDS due to the stigma can be bad news, which will lead to unpleasant emotional reactions [ 10 ]. Studies that have examined the lives of these patients have shown that these patients will experience mental and living problems throughout their lives. These studies highlight the need for age-specific programming to increase HIV knowledge and coping, increase screening, and improve long-term planning [ 11 , 12 ].

A prerequisite for any successful planning and intervention for people living with HIV/AIDS is approaching them and conducting in-depth interviews in order to discover their feelings, attitudes; their views on themselves, their illness, and others; and finally, their motivation to follow up and the participation in interventions [ 13 ]. Accordingly, the present study aimed to explain the lived experience of HIV-infected patients in the face of a positive diagnosis of the disease, since the better understanding of the phenomena leads to the smoother ways to help and care for these patients.

Study setting

In this study, a qualitative method of descriptive phenomenology was used to discover and interpret the lived experience of HIV-positive patients, when they face a positive diagnosis of the disease. The philosophical strengths underlying descriptive phenomenology afford a deeper understanding of the phenomenon being studied [ 14 ]. Husserl’s four steps of descriptive phenomenology were employed: bracketing, intuiting, analyzing and interpreting [ 15 ].

Participants and sampling

Sampling was done purposefully and participants were selected based on inclusion criteria. In this purposeful sampling, participants were selected among those patients who had sufficient knowledge about this phenomenon. The sample size was not determined at the beginning of the study, instead, it continued until no new idea emerged and data-saturated. Participants were selected from patients who were admitted to the Shohala Behavioral Diseases Counseling Center in Hamadan-Iran. The center has been set up to conduct tests, consultations, medical and dental services, and to distribute medicines among the patients. Additional inclusion criteria for selecting a participant are: having a positive diagnosis experience at the center, Ability to recall events and mental thoughts in the face of the first positive diagnosis of the disease, having psychological and mental stability, having a favorable clinical condition, willingness to work with the research team, and the possibility of re-access for the second interview if needed. Exclusion criteria were unwillingness to participate in the study and inability of verbal communication in Persian language.

Data collection

The interviews began with a non-structured question (tell us about your experience with a positive diagnosis) and continued with semi-structured questions. Each interview lasted 35–70 min and was conducted in two sessions if necessary. All interviews were conducted by the main investigator (ShZ) that who has experience in qualitative research and interviewing. The interview was recorded and then written down with permission of the participant.

Data analysis

The descriptive Colaizzi method was used to analyses the collected data [ 16 ]. This method consists of seven steps: (1) collecting the participants’ descriptions, (2) understanding the meanings in depth, (3) extracting important sentences, (4) conceptualizing important themes, (5) categorizing the concepts and topics, (6) constructing comprehensive descriptions of the issues examined, and (7) validating the data following the four criteria set out by Lincoln and Guba.

Trustworthiness criteria were used to validate the research, due to the fact that importance of data and findings validity in qualitative research [ 17 ]. This study was based on four criteria of Lincoln and Guba: credibility, transferability, dependability, and conformability [ 18 ]. For data credibility, prolong engagement and follow-up observations, as well as samplings with maximum variability were used. For dependability of the data, the researchers were divided into two groups and the research was conducted as two separate studies. At the same time, another researcher with the most familiarity and ability in conducting qualitative research, supervised the study as an external observer. Concerning the conformability, the researchers tried not to influence their own opinions in the coding process. Moreover, the codes were readout by the participants as well as two researcher colleagues with the help of an independent researcher and expert familiar with qualitative research. Transferability of data was confirmed by offering a comprehensive description of the subject, participants, data collection, and data analysis.

Ethical considerations (ethical approval)

The present study was registered with the ethics code IR.UMSHA.REC.1398.1000 in Hamadan University of Medical Sciences. The purpose of the study was explained and all participants’ consents were obtained at first step. All participants were assured that the information obtained would remain confidential and no personal information would be disclosed. Participants were also told that there was no need to provide any personal information to the interviewer, including name, surname, phone number and address. To gain more trust, interviews were conducted by a person who was not resident of Hamadan and was not a native of the region, this case was also reported to the participants.

Twelve HIV-infected participated in this study. The mean age of the participants was 36.41 ± 4.12 years. 58.33% of the participants were male and 41.66% were married. Of these, 2 were illiterate, 2 had elementary diploma, 6 had high school diploma and 2 had academic education. Six of them were unemployed, 5 were self-employed and 1 was an official employee. These people had been infected by this disease for 6.08 ± 2.71 years, in average (Table 1 ).

Analysis of the HIV-infected patients’ experiences of facing the positive diagnosis of the disease by descriptive phenomenology revealed five main themes: emotional shock, the fear of the consequences, the feeling of the guilt, the discouragement, and the escape from reality (Table 2 ).

Emotional shock

Emotional shock is one of the unpleasant events that these patients have experienced after facing a positive diagnosis of the disease. This experience has manifested in loathing and motivation of social isolation.

These patients stated that after facing a positive diagnosis of the disease, they developed a strong inner feeling of hatred towards the source of infection. The patients feel hatred, since they hold the carrier as responsible for their infection. “…After realizing I was affected, I felt very upset with my husband, I did not want to see him again, because it made me miserable, I even decided to divorce ….”(P3).

Motivation of social isolation

The experiences of these patients showed that after facing the incident, they have suffered an internal failure that has caused them to try to distance from other people. These patients have become isolated, withdrawing from the community and sometimes even from their families. “…After this incident, I decided to live alone forever and stay away from all my family members. I made a good excuse and broke up our engagement…” (P7).

Fear of the consequences

Fear of the consequences is one of the unpleasant experiences that these patients will face, as soon as they receive a positive diagnosis of the disease. Based on experiences, these patients feel fear of loneliness, death, and disgrace as soon as they hear the positive diagnosis.

Fear of the death

The patients said that as soon as they got the positive test results, they thought that the disease was incurable and would end their lives soon. “…When I found I had AIDS, I was very upset and moved like a dead man because I was really afraid that at any moment this disease might kill me and I would die …” (P1).

Fear of loneliness

The participants stated that one of the feelings that they experienced as soon as they received a positive diagnosis of the disease was the fear of being alone. They stated that at that moment, the thought of being excluded from society and losing their intimacy with them was very disturbing. “…The thought that I could no longer have a family and had to stay single forever bothered me a lot, it was terrifying to me when I thought that society could no longer accept me as a normal person …” (P10).

Fear of disgrace

One of the feelings that these patients experienced when faced the positive diagnosis of the disease was the fear of disgrace. They suffer from the perception that the spread of news of the illness hurts the attitudes of those around them and causes them to be discredited. “…It was very annoying for me when I thought I would no longer be seen as a member of my family, I felt I would no longer have a reputation and everyone would think badly of me …” (P2).

Feeling of the guilt

From other experiences of these patients in facing the positive diagnosis of the disease is feeling guilty. This feeling appears in patients as feeling of regret, guilty and remorse.

Feeling of regret

These patients stated that they felt remorse for their lifestyle and actions as soon as they heard the positive diagnosis of the disease, because they thought that if they had lived healthier, they would not have been infected. “…After realizing this disease, I was very sorry for my past, because I really did not have a healthy life. I made a series of mistakes that caused me to get caught. At that moment, I just regretted why I had this disaster …” (P11).

Feeling guilty

The experience of these patients has shown that after receiving a positive diagnosis of the disease, they consider themselves guilty and complain about themselves. These patients condemn their lifestyle and sometimes even consider themselves deserving of the disease and think that it is a ransom that they have paid back. “…after getting the disease, I realized that I was paying the ransom because I was hundred percent guilty, I was the one who caused this situation with a series of bad deeds, and now I have to be punished …” (P5).

Feeling of conscience-stricken

One of the experiences that these patients reported is the pangs of conscience. These patients stated that after receiving a positive diagnosis of the disease, the thought that as a carrier they might have contaminated those around them was very unpleasant and greatly affected their psyche. “…after getting the disease. It was shocked and I was just crazy about the fact that if my wife and children had taken this disease from me, what would I do, I made them hapless … and this as very annoying for me …” (P8).

Discouragement

Discouragement is an unpleasant experience that patients experienced after receiving a positive HIV test results. Discouragement in these patients appears in the suicidal ideation and disappointment.

Suicidal ideation

The patients stated that they were so upset with the positive diagnosis of the illness and they immediately thought they could not live with the fact and the best thing to do was to end their own lives. “…The news was so bad for me that I immediately thought that if the test result was correct and I had AIDS, I would have to kill myself and end this wretch life, oh, I had a lot of problem and the thought of having to wait for a gradual death was horrible to me …” (P12).

Disappointment

The experience of these patients shows that a positive diagnosis of the disease for these patients leads to a destructive feeling of disappointment. So that they are completely discouraged from their lives. These patients think that their dreams and goals are vanished and that they have reached the end and everything is over. “…It was a horrible experience, so at that moment I felt my life was over, I had to prepare myself for a gradual death, I was at marriage ages when I thought I could no longer get married, I saw life as meaningless …” (P7).

Escape from reality

The lived experience of these patients shows that after receiving a positive diagnosis of the disease, they found that this fact was difficult to accept and somehow tried to escape from the reality. This experience has been in the form of denial and trying to hide from others.

One of the experiences of these patients in dealing with the positive test result of this disease has been to deny it. In this way, patients believed that the test result was wrong or that the result belonged to someone else. For this reason, the patients referred to other laboratories after receiving the first positive diagnosis of the disease. “…After the lab told me this and found out what the disease really was, I was really shocked and said it was impossible, it was definitely wrong and it is not true … I could not believe it at all, because I was a professional athlete and this could not happen to me. So I immediately went to a bigger city and there I went to a few laboratories for further tests …” (P6).

Trying to hide

These patients stated that after receiving the first positive diagnosis of the disease, they thought that no one should notice their disease and should remain anonymous as much as possible. “…I immediately decided that no one in my city should know that I got this disease and the news should not be spread anywhere, so I discard my phone number through which our city laboratory communicated with me and I came here to do a re-examination and go to the doctor, and after all these years, I always come here again for an examination …” (P4).

In this qualitative study, we attempted to discover lived experience of HIV-infected patients in the face of a positive diagnosis of the disease. Therefore, a descriptive phenomenological method was applied. As a result of this study, based on the experiences of the HIV-infected patients, the five main themes of emotional shock, fear of the consequences, feelings of guilt, discouragement and, escape from reality were obtained.

In this study, it was shown that the confrontation of these patients with the positive diagnosis of the disease causes them to experience a severe emotional shock. In this regard, Yangyang Qiu et al. [ 19 ] argued that anxiety and depression are very common among HIV-infected patients who have recently been diagnosed with the disease. The experience of the participants has shown that this emotional shock appears in the form of loathing and the motivation of social isolation. In fact, in these patients, the feeling of the loathing is an emotional response to the primary carrier that has infected them. The study of Imani et al. [ 20 ] have shown that decrease emotional intelligence in an environment where there is an HIV carrier, other people hate him/her, because they see him/her as a risk factor for their infection. The experience of the participants has also shown that receiving a positive diagnosis will motivate social isolation in these patients. Various studies have revealed that one of the consequences of AIDS/HIV that patients will suffer from, is social isolation [ 21 , 22 ].

Another experience of the participants, according to this study is fear of the consequences. This phenomenon appears in these patients as fear of the death, fear of loneliness, and fear of disgrace. Due to the nature of the disease, these patients feel an inner fear of premature death, as soon as they receive a positive diagnosis. In this regard, the study of Audrey K Miller et al. [ 23 ] showed that death anxiety in AIDS patients is a psychological complication. the participants have stated that they are very afraid of being alone after receiving a positive diagnosis, which is a natural feeling according to Keith Cherry and David H. Smith [ 24 ]; because these patients will mainly experience some degree of loneliness. HIV-infected patients also experienced a fear of disgrace, which will go back to the nature of the disease and people’s insight; but they should be aware that, as Newman Amy states, AIDS/ HIV is a disease, not a scandal [ 25 ].

Another experience of the participants in dealing with the positive diagnosis of the disease is guilt feeling. The patients will experience feelings of regret, the feeling guilty and feeling of the conscience-stricken. The experience of the participants shows that they regret their past. Earlier studies have also revealed that regret for the past is a common phenomenon among the patients living with HIV [ 26 , 27 , 28 ]. HIV-infected feel guilty while facing the positive diagnosis of the disease and consider themselves the main culprit of the situation. They often play a direct role in their infection, and their past lifestyle for sure [ 29 ]. Our study also found that these patients feel the conscience-stricken after a positive diagnosis, because they suspect that they may have infected people around them. This disease can be easily transmitted from the carrier to others if the health protocols are not followed [ 30 , 31 , 32 ].

Another experience of HIV-infected in dealing with the receiving a positive diagnosis of the disease is discouragement. These patients are disappointed and sometimes decide to suicide. Based on the lived experience of HIV-infected, it was found that receiving a positive diagnosis of the disease, will discourage them from life and patients will be disappointed in many aspects of life. Studies have shown that AIDS/HIV, as a crisis, will greatly reduce the patients' life expectancy and that they will continue to live in despair [ 33 ]. Studies also stated that they considered suicide as a solution to relieve stress when receiving a positive diagnosis. In this regard, various studies have emphasized that among the AIDS/HIV patients, loss of self-esteem and severe stress have led to high suicide rates [ 34 , 35 , 36 ].

According to the patients, trying to escape from reality is another phenomenon that they will experience. This phenomenon will occur in patients as denial and trying to hide the disease from others. Based on the lived experience of these patients, it was found that after facing a positive diagnosis, HIV-infected tend to deny that they are infected. In this regard, various studies have shown that AIDS/HIV patients in different stages of the disease and their lives try to deny it in different ways [ 37 , 38 , 39 ]. The HIV-infected also stated that at the beginning of the positive diagnosis of the disease, did not want others to know, so they wanted to hide themselves from others in any way possible. In this regard, Emilie Henry et al. [ 40 ] have shown that a high percentage of the patients living with AIDS/HIV have tried that others do not notice that they are ill.

One of the strengths of this study is the methodology of the study, because in this study, an attempt has been made to use descriptive phenomenology to explain the lived experience of HIV-infected patients when faced with a positive diagnosis of this disease. In fact, in this study, patients' experience of this particular situation was identified, and with careful analysis, the experiences of these people became codes and concepts, each of which can be a bridge that keeps the path of modern knowledge open to help these patients. One of the limitations of this study is the generalizability of the findings because patients’ experiences in different societies that have cultural, religious, subsistence, and economic differences can be different.

The results of this study showed that patients will experience unpleasant experiences in the face of receiving a positive diagnosis of the HIV. Patients’ unpleasant experiences at that moment include emotional shock, fear of the consequences, feeling guilty, discouragement and escape from reality. Therefore, medical and laboratory centers must pay attention to the patients' lived experience, and try to support the patients through education, counseling and other support programs to minimize the psychological trauma caused by the disease.

Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding authors through reasonable request.

Acknowledgements

The authors would like to express their gratitude to the Hamadan Health Network, the Hamadan Shohada Behavioral Diseases Counseling Center, and the participants who helped us in this study.

The study was funded by Vice-chancellor for Research and Technology, Hamadan University of Medical Sciences (No. 9812209934).

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Behzad Imani

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Shirdel Zandi

Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran

Salman khazaei

Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran

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BI designed the study, collected the data, and provide the first draft of manuscript. ShZ designed the study and revised the manuscript. SKh participated in design of the study, the data collection, and revised the manuscript. MM participated in design of the study and revised the manuscript. All authors read and approved the final manuscript.

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Imani, B., Zandi, S., khazaei, S. et al. The lived experience of HIV-infected patients in the face of a positive diagnosis of the disease: a phenomenological study. AIDS Res Ther 18 , 95 (2021). https://doi.org/10.1186/s12981-021-00421-4

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Meeting the complex needs of individuals living with HIV: a case study approach

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  • 1 HIV Specialist Nurse, St Thomas' Hospital, London.
  • PMID: 25381847
  • DOI: 10.12968/bjcn.2014.19.11.526

This article critically discusses the nursing care and management of a person living with the human immunodeficiency virus (HIV) infection as a long-term condition, requiring highly complex HIV care. Complex HIV care is managed in the secondary care setting. However, recent legislation has motivated shifts in HIV care to the community care setting. This article aims to enhance health professionals' understanding in order to equip practice and district nurses to deliver HIV care provision. Antiretroviral adherence is a prerequisite for disease survival as well as an essential component of complete HIV self-care management. It is therefore imperative that nurses tailor adherence strategies according to each patient's requirements. Case management strategies such as the use of cognitive behavioural therapy to alleviate depressive symptoms will be considered. Furthermore, the use of motivational interviewing for antiretroviral adherence is highlighted as a potential intervention to help patients overcome the physical, psychological and physiological challenges of living with HIV-associated comorbidities. The delivery of integrated HIV care is pivotal for the management of the person living with HIV, as is the facilitation of a self-caring behaviour.

Keywords: Disease management; HIV; HIV-associated depression; Long-term conditions; Self-management.

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Prevalence of common mental disorder and its association with perceived stigma and social support among people living with HIV/AIDS in Ethiopia: a systematic review and meta-analysis

  • Bereket Duko   ORCID: orcid.org/0000-0002-4419-0016 1 , 2 , 3 , 4 ,
  • Yitagesu Belayhun 5 &
  • Asres Bedaso 1 , 6  

International Journal of Mental Health Systems volume  18 , Article number:  25 ( 2024 ) Cite this article

Metrics details

When common mental disorders (CMD) co-occur with HIV/AIDS, they can complicate patient diagnosis, help-seeking behaviors, quality of life, treatment outcomes, and drug adherence. Thus, estimating the pooled prevalence of CMD and its association with perceived stigma and social support among people living with HIV/AIDS (PLWHA) in Ethiopia could potentially support policymakers and health professionals to understand the disease burden and set a solution to improve the mental well-being of PLWHA.

Popular databases such as PubMed, SCOPUS, EMBASE, and Psych-INFO as well as Google Scholar, AJOL, CINAHL, PILOTS and Web of Science were searched for the relevant articles conducted in Ethiopia. We included cross-sectional, case–control, and cohort studies in the review. The Comprehensive Meta-Analysis software version 3.0 was used to pool the results of the included studies. The Q- and I 2 -statistics were used to assess the heterogeneity between the included studies. We employed a random-effects meta-analysis model to estimate the pooled prevalence of CMD and to account for heterogeneity among the included studies. We also conducted a leave-one-out analyses, and stratified meta-analyses by gender (male and female).

The studies included in this systematic review and meta-analysis were published between 2009 and 2021, recruiting a total of 5625 participants. The pooled estimated prevalence of CMD among PLWHA in Ethiopia was 26.1% (95% CI 18.1–36.0). The pooled estimated prevalence of CMD was significantly higher among females, at 39.5% (95% CI 21.2–39.0), compared to males, 26.9% (95% CI 15.6–31.7). Moreover, the pooled estimated prevalence of CMD in PLWHA ranged from 23.5 to 28.9% in the leave-one-out sensitivity analysis, indicating that the removal of any single study did not significantly affect the pooled estimate. The pooled effects (AOR) of Perceived HIV stigma and poor perceived social support on common mental disorder were 2.91, 95% CI (1.35–6.29) and 5.56, 95% CI (1.89–16.39), respectively.

People living with HIV/AIDS (PLWHA) who received poor social support and those with HIV-related perceived stigma were found to have strong association with CMD. Therefore, it is advisable that all PLWHA attending ART clinic should be screened for CMD, social support and HIV-related perceived stigma.

Common mental disorder (CMD) refers to a group of mental health disorders that include depression, anxiety, and somatoform disorders with a significant contribution to the burden of disease in the middle- and low-income countries [ 1 ].  According to systematic review and meta-analysis of 174 surveys across 63 countries  in 2014, the global lifetime prevalence of CMD was 29.2% [ 2 ]. CMDupsurges the risk of emerging both communicable and non-communicable diseases in all age groups of the general population [ 3 ]. CMD is frequently reported among HIV infected individuals and it is the leading cause of infirmity among PLWHA [ 4 , 5 , 6 ].

Based on the reports from studies conducted in the low and middle-income countries (LMICs), the prevalence of CMD was found to be high [ 7 , 8 , 9 ]. For example, a study conducted in Zimbabwe using the Shona Symptom Questionnaire (SSQ14 >  = 9) reported 68.5% prevalence of CMD s among PLWHA (7). In contrast, another study from South Africa showed that 23.9% of people living with HIV reported symptoms of CMD [ 8 ]. Further, finding from the Nigerian study that used the Kessler Psychological Distress Scale (K10) to assess CMD reported 47.9% of PLHIV participants scored ≥ 20, suggesting CMD  [ 9 ].

Female gender, poverty, and stressful life events were found to be common determinants of CMD in non-HIV populations [ 10 ]. In other studies, correlates of CMD in PLWHA include the death of a significant other [ 11 ], family history of mental illness, poor coping style, alcohol dependency, food insecurity [ 12 ], exposure to negative life events [ 7 , 13 ], posttraumatic stress disorder (PTSD) and perceived HIV stigma [ 14 , 15 , 16 ]. Additionally, factors such as poor social support, not disclosing HIV status, stressful feelings about the illness were significant provoking factors [ 17 , 18 ].

Research has shown that individuals with CMD experience accelerated progression from HIV to AIDS [ 19 ]. Additionally, these individuals may have difficulty adhering to ART treatment [ 20 ], which can lead to increased viral load and death in patients with AIDS  [ 21 , 22 ]. However, effective management of CMD has been found to improve the health and quality of life of PLWHA  [ 22 , 23 ]. Although several studies have been conducted in Ethiopia to assess CMD among PLWHA [ 17 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ], there is significant inconsistency in the prevalence of CMD across the studies in the topic. Furthermore, there have been no previous systematic reviews or meta-analyses conducted on this topic in Ethiopia. Therefore, this review aimed to systematically review previous studies, summarize the magnitude of CMD, and examine their association with HIV-related perceived stigma and social support among PLWHA in Ethiopia. This review also aimed to formulate recommendations for future better clinical services.

Search strategy and selection process

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to conduct this systematic review and meta-analysis [ 34 ]. A predesigned study protocol for database searching, data extraction, inclusion–exclusion criteria, and quality evaluation was used. PubMed, SCOPUS, EMBASE, and Psych INFO databases were searched for relevant articles that assessed the prevalence of CMD among PLWHA in Ethiopia using the following search terms and keywords: (epidemiology OR prevalence OR magnitude) AND (common mental disorders OR psychological distress OR common mental illness OR psychiatric morbidity OR mental health problems) AND (associated factors OR correlates OR risk factors OR determinants) AND (people living with HIV/AIDS OR HIV patients OR HIV/AIDS) AND Ethiopia. Furthermore, we searched EMBASE, SCOPUS, and Psych INFO using database-specific subject headings. The search yielded relevant articles that were assessed for inclusion in the study. We also searched for articles indexed in Google Scholar, African Index Medicus, African Journals Online (AJOL), CINAHL, PILOTS and Web of Science.

Eligibility criteria

We included cross-sectional, case–control, and cohort studies conducted either in community or institutional settings and assessed the prevalence and factors associated with CMD s or psychological distress among PLWHA  in Ethiopia. Commentaries, editorials, reviews, and letters to editors were excluded from the review.

Methods for data extraction and quality assessment

Two independent reviewers (BD and AB) conducted data extraction based on the predefined data extraction form. The data extraction form included the authors' names, year of publication, sample size, study design, study setting, and the instrument used to measure common mental disorders as well as associated factors along with adjusted odds ratios. The Newcastle–Ottawa Scale (NOS), adapted for cross-sectional studies was used to check the methodological quality of studies included in the review [ 35 ]. This tool has been used in previous studies [ 36 , 37 ]. The NOS scale assessed the quality of studies based on methods, sample size, sample representativeness, and comparability between participants. The agreement between the evaluators was appraised using the unweighted kappa statistic (YB and AB). The levels of agreement were categorized as poor (0), slight (0.01–0.20), fair (0.21–0.40), moderate (0.41–0.60), substantial (0.61–0.80), and almost perfect (0.81–1.00) [ 38 ].

Data synthesis and analysis

We systematically reviewed qualitative data, including the identification of studies, study characteristics, and the quality of the included studies. Comprehensive Meta-Analysis software version 3.0 was used to conduct a meta-analysis, employing a random-effects meta-analysis model to pool the overall prevalence of CMD among PLWHA in Ethiopia [ 39 ]. We also computed pooled adjusted odds ratio (AOR) for factors associated with CMD  among PLWHA. The Q- and the I 2 -statistics were used to assess the heterogeneity between the studies [ 40 ], with values of 25, 50 and 75% indicating low, low, medium and high level of heterogeneity, respectively [ 40 ]. Publication bias was evaluated by using Egger’s test and visual inspection of funnel plot [ 41 ]. The level of significance was set at P < 0.05. Furthermore, we conducted a meta-regression to quantify the impact of the screening tools used to measure CMD, gender, and region a study originated on the observed heterogeneity across the studies included in the review.

Identification of studies

A total of 162 articles were identified through electronic database searching. Besides, five more articles were obtained from references of the included articles. Out of the 167 articles, 142 were excluded as they did not meet the eligibility criteria (Fig.  1 ). Subsequently,  25 articles were selected for further screening, out of which 14 full text articles were excluded. Finally, 11 full-text articles were included in the final systematic review and meta-analysis.

figure 1

PRISMA flowchart of review search

Characteristics of included studies

The studies included in the current systematic review and meta-analysis were published between 2009 and 2021 and recruited a total of 5625 study participants. Ten studies employed a cross-sectional study design, whereas one study used a cohort study design. Two studies were conducted in South Nation Nationalities and People Regional States, three in the Amhara region, five studies in the Oromia region, and one in the Harar region. Four studies used the Self-Reporting Questionnaire item 20 (SRQ20), one study used Hospital Anxiety and Depression scale (HADS) and six studies used the Kessler scale (K-10) (Table  1 ).

The quality of studies included in the review

Based on the Newcastle–Ottawa Scale, 8 studies were of high methodologic quality, whereas three studies were of moderate methodologic quality. The agreed levels between the authors regarding the quality of the studies included the meta-analysis ranged from moderate to almost perfect levels (Supplementary file 1).

Meta-analysis

The overall pooled prevalence estimate of CMD among PLWHA in Ethiopia was 26.1% (95% CI 18.1–36.0), with significant  observed heterogeneity ( I 2  = 97.436%; Q = 234.037, df = 6, p < 0.001) (Fig.  2 ).

figure 2

The prevalence of CMD among PLWHA in Ethiopia: a meta-analysis

Sensitivity analysis

We performed a leave-one-out sensitivity analysis to identify the possible source of heterogeneity in the pooled meta-analysis of the prevalence of the CMD among PLWHA in Ethiopia. This sensitivity analysis involves performing a meta-analysis on each subset of the studies obtained by leaving out exactly one study at a time. This approach helps to determine how the removal of each study affects the overall estimate of the remaining studies. The pooled prevalence of CMD ranged between 23.5% (16.5–31.7%) and 28.9% (20.5–39.0), suggesting the pooled estimated prevalence of the CMD among PLWHA was not significantly affected by the removal of any single study (Table  2 ).

Meta-regression

In this systematic review and meta-analysis, we first employed univariate regression analysis to guide the selection of the associated factors to include in the final meta-regression model. In the final meta-regression model, we quantified the impacts of the screening tools used to measure the CMD the gender of the study participants (male or female), and the region where the study was originated. The overall proportion of variance explained by the tools used to assess CMD, the gender of the study participants, and the study region was analyzed in the final model. The overall proportion of variance explained by the gender of the study participants and the region the study was conducted were 34% ( R 2  = 34%;  P -value = 0.02) and 6% ( R 2  = 6%;  P -value = 0.34) respectively. Except for the gender of the study participants, neither the tools used to assess the CMD nor the region where the studies were originated were statistically significant determinants for the observed variation in the prevalence of the CMD among studies included in this  review.

Statistical analysis of factors associated with CMD 

In our statistical analysis of factors associated with CMD among PLWHA  in Ethiopia, we identified  two determinants that were commonly adjusted for in the studies included in this systematic review and meta-analysis. The pooled adjusted odds ratios (AOR) of perceived HIV-related stigma and perceived poor social support on CMD were 2.91, 95% CI (1.35–6.29) and 5.56, 95% CI (1.89–16.39)), respectively (Table  3 ).

Publication bias

The Egger’s regression test, as well as visual inspection of the funnel plot, showed no evidence of publication bias ((B = − 28.39, SE = 6.45, P = 0.09) (Fig.  3 ).

figure 3

Funnel plot shows no evidence of publication bias among studies included in the meta-analysis

In this systematic review and meta-analysis, we examined  the pooled prevalence of CMD among PLWHA in Ethiopia. The final meta-analysis included eleven studies, and the pooled prevalence of CMD among PLWHA was 26.1%. This implies that CMD is a major public health problem among PLWHA in Ethiopia. The pooled prevalence of CMD in this review was in line with a study conducted in South Africa, which reported a prevalence rate of 23.9% (8). A cross-sectional study conducted in southwest regional hospitals of Cameroon among PLWHA on HAART also reported a similar prevalence rate [ 43 ]. Furthermore, a study conducted in Ethiopia to assess the prevalence of CMD  among patients with glaucoma reported a similar prevalence rate of (23.2%) [ 44 ]. Nevertheless, the pooled estimated prevalence of CMD among PLWHA was lower than the findings of a study  from a Nigerian teaching hospital, which showed a prevalence rate of ( 47.9%) [ 9 ]. Further, a study on psychological distress among Ugandan female adolescents living with HIV reported a much higher CMD prevalence rate of 53% [ 45 ]. A cross-sectional survey conducted in Zimbabwe at a large primary health care facility found a CMD prevalence rate of 68.5% using locally to identify factors associated with CMD  using locally validated screening tools, namely the Shona Symptom Questionnaire (SSQ-14) [ 7 ]. In contrast, the pooled estimated prevalence of CMD was higher than the findings from studies conducted in East Zimbabwe among individuals living with HIV [ 46 ] and in the general community of Kenya [ 45 ]. The variation in the prevalence of CMD might be attributed to the difference in geographical, cultural, and socio-economy status of the study areas as well as the difference in the study populations. For example, a study conducted in Uganda only included female adolescents aged 12–19 living with HIV [ 45 ].

The prevalence of CMD in the current meta-analysis was significantly higher in females (39.5%) compared to males (26.9%). This finding aligns with prior study that has shown a higher prevalence of CMD among females than males [ 45 ]. For example, a study assessing the  prevalence of psychological distress among individuals in HIV Care Service Utilization in East Zimbabwe found a prevalence of 4.5% among men and 12.9% among women [ 46 ]. This variation may be attributed to specific forms of depression-related illness experienced by women, such as  premenstrual dysphoric disorder, postpartum depression, and postmenopausal mental illness, which are linked with changes in ovarian hormones that may have contributed to the observed difference in the prevalence of CMD among PLWHA  [ 47 , 48 ].

People living with HIV/AIDS who reported HIV -related perceived stigma were approximately three times more likely to have CMD compared to their counterparts. Of the eleven studies included in the review, four reported statistically significant associations between perceived stigma [ 26 , 27 , 28 , 29 ]. Individuals who experience stigma may develop a poor self-image and become  socially isolated, which can increase their risk of developing CMD [ 49 ]. Furthermore, perceived stigma may lead to internalized prejudice and negative self-perceptions, resulting in decreased self-esteem and further contributing to the progression of CMD PLWHA  [ 50 ]. These negative self-perceptions and social isolation can limit social interactions and affect occupational functioning thereby increasing the risk of CMD. 

Furthermore, PLWHA  who reported poor social support were approximately 6 times more likely to have CMD compared to those with better social support.  This finding was supported by three of the studies included in the review [ 17 , 27 , 29 ]. Poor social support can trigger feelings of social isolation and negatively impact both physical and mental well-being [ 26 , 27 , 28 ]. This is consistent with the social causation model, which suggests that  a lack of social support increases the likelihood of CMD, such as depression  [ 51 , 52 ] Conversely, good social support may alleviate CMD by improving self-esteem and reducing negative thoughts  [ 53 , 54 ].

This review found that the pooled prevalence of CMD among PLWHA was considerably high. Our findings suggest that PLWHA who receive poor social support and those experiencing HIV-related perceived stigma are at a greater risk of developing CMD. Therefore, it is advisable that all PLWHA attending ART clinics be routinely screened for CMD, social support,  and HIV-related perceived stigma. In addition to this, health professionals, more specifically, clinical psychologists and mental health professionals should provide regular counselling to enhance stress-coping mechanisms and improve the mental well-being of PLWHA attending ART clinics. Finally, we recommend that researchers consider conducting a large -scale longitudinal studies to further explore the burden and risk factors of CMD among PLWHA.

Limitations of the review

The following are the limitations of our systematic review and meta-analysis that should be  considered when interpreting our findings. First, only eleven studies published in the past ten years met the inclusion criteria. Second, due to variations in diagnostic approaches, the tools used to screen CMD may be prone to measurement bias. However, we have addressed this issue of heterogeneity during our analysis, which provides more reliable estimate of CMD and its associated factors among PLWHA in Ethiopia.

Availability of data and materials

All data generated or analyzed during this study are included in this article.

Abbreviations

Acquired immune deficiency syndrome

African journal of online

Adjusted odds ratio

Anti-retroviral therapy

Confidence interval

Common mental disorder

Hospital anxiety and depression scale

Human immune virus

Kessler scale

Newcastle–Ottawa Scale

People living with HIV/AIDS

Preferred reporting items for systematic reviews and meta-analyses

Post-traumatic stress disordersrq-20: self-reporting questionnaire item 20

Shona symptom questionnaire item 14

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Supplementary Material 1. Summary of the quality and agreed level of bias and level of agreement on the methodological qualities of included studies in a meta-analysis.

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Duko, B., Belayhun, Y. & Bedaso, A. Prevalence of common mental disorder and its association with perceived stigma and social support among people living with HIV/AIDS in Ethiopia: a systematic review and meta-analysis. Int J Ment Health Syst 18 , 25 (2024). https://doi.org/10.1186/s13033-024-00641-x

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A rare case of invasive thyroid aspergillosis revealed on 18 f-fdg-pet/ct.

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Jaafari, A.; Mansour, S.; Lebrun, L.; Kaefer, K.; Attou, R. A Rare Case of Invasive Thyroid Aspergillosis Revealed on 18 F-FDG-PET/CT. Diagnostics 2024 , 14 , 1451. https://doi.org/10.3390/diagnostics14131451

Jaafari A, Mansour S, Lebrun L, Kaefer K, Attou R. A Rare Case of Invasive Thyroid Aspergillosis Revealed on 18 F-FDG-PET/CT. Diagnostics . 2024; 14(13):1451. https://doi.org/10.3390/diagnostics14131451

Jaafari, Ayoub, Sohaïb Mansour, Laetitia Lebrun, Keitiane Kaefer, and Rachid Attou. 2024. "A Rare Case of Invasive Thyroid Aspergillosis Revealed on 18 F-FDG-PET/CT" Diagnostics 14, no. 13: 1451. https://doi.org/10.3390/diagnostics14131451

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‘Visionary’ study finds inflammation, evidence of Covid virus years after infection

Isabella Cueto

By Isabella Cueto July 3, 2024

Nucleocapsid of the novel coronavirus in green and the virus's spike protein in blue shown across animal tissues represented in red — in the lab coverage from STAT

R emember when we thought Covid was a two-week illness? So does Michael Peluso, assistant professor of medicine at the University of California, San Francisco. 

He recalls the rush to study acute Covid infection, and the crush of resulting papers. But Peluso, an HIV researcher, knew what his team excelled at: following people over the long term. 

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So they adapted their HIV research infrastructure to study Covid patients. The LIINC program, short for “Long-term Impact of Infection with Novel Coronavirus,” started in San Francisco at the very beginning of the pandemic. By April 2020, the team was already seeing patients come in with lingering illness and effects of Covid — in those early days still unnamed and unpublicized as long Covid. They planned to follow people’s progress for three months after they were infected with the virus.

By the fall, the investigators had rewritten their plans. Some people’s symptoms were so persistent, Peluso realized they had to follow patients for longer. Research published Wednesday in Science Translational Medicine builds on years of that data. In some cases, the team followed patients up to 900 days, making it one of the longest studies of long Covid (most studies launched in 2021 or 2022, including the NIH-funded RECOVER program).

Investigators found long-lasting immune activation months and even years after infection. And, even more concerning, they report what looked like lingering SARS-CoV-2 virus in participants’ guts. Even those who’d had Covid but no continuing symptoms had different results than those who’d never been infected. 

Related: Listen: Why Long Covid can feel scarier than a gun to the head

The team’s big idea — hypothesizing in early 2020 that, contrary to the popular narrative, Covid would last in the body — was “visionary,” long Covid researcher Ziyad Al-Aly said. “A lot of people don’t think like that.” Al-Aly was not involved with the study, but has published other long-term studies of Covid patients. He is chief of research and development at the VA Saint Louis Healthcare System. 

The research makes use of novel technology developed by the paper’s senior authors, Henry Vanbrocklin, professor in the department of radiology at UCSF, and associate professor of medicine Timothy Henrich. They figured out in the last several years they could use an antibody that bound to HIV’s code protein as a guide to see viral reservoirs. The HIV antibody, labeled with radioactive isotopes, could be tracked with imaging as it moved through the body and migrated to infected tissues. 

There were no antibodies to latch onto early in the coronavirus pandemic. Vanbrocklin instead used a chemical agent, called F-AraG, that binds to activated T cells — immune cells that flood into infected tissues. They injected F-AraG into patients, and into a scan they went. 

Tissues full of activated T cells glowed in the resulting image. Researchers found more glowing sites of immune activation in people who had been infected with Covid than in those who had not, including: the brain stem, spinal cord, cardiopulmonary tissues, bone marrow, upper pharynx, chest lymph nodes, and gut wall. 

In people with long Covid symptoms, like brain fog and fatigue, the study found the gut wall and spinal cord lit up more than in other participants. People with continuing pulmonary symptoms showed greater immune activation in their lungs. Gut biopsies in five participants revealed what appears to be persistent virus, said Peluso, who is part of the LongCovid Research Consortium of the PolyBio Research Foundation (which helped fund the study). 

Related: ‘Concern is real’ about long Covid’s impact on Americans and disability claims, report says

“The data are striking,” said Akiko Iwasaki, a professor of immunobiology and long Covid researcher at Yale University. Iwasaki was not involved in the study but is also part of PolyBio’s long Covid research group. 

Researchers used pre-pandemic scans as a control group, “the cleanest comparison that there is, before anybody on the planet could’ve possibly had this virus,” Peluso said. There were 30 participants in total (24 who’d had Covid, and six controls). Uninfected participants showed some T cell activation, but it showed up in parts of the body that help clear inflammation, like the kidney and liver. In the post-Covid group, immune activation was widespread, even in those who report that they are back to their normal health. 

The data don’t explain what exactly T cells are reacting to. As Iwasaki noted, activated T cells can be responding to persistent SARS-CoV-2 antigens or autoantigens found in people with autoimmune disease. The immune response could also be to antigens coming from other pathogens, like the common Epstein-Barr Virus. This piece requires more study, she said. 

In the gut, the researchers found what they think is RNA that encodes the virus’s signature spike protein. Other studies have found similar pieces of virus in autopsies, or within a couple of months after infection. Peluso’s work suggests the virus may stay in the body much longer — up to years after infection.

The researchers don’t know if what they’re seeing is “fossilized” leftover virus or active, productive virus. But they found double-stranded RNA in the guts of some patients who underwent biopsy. That should technically only be there if a virus is still alive, going through its life cycle, Peluso said. 

Related: Long Covid research gets a big-time funding boost

Scientists and patient advocates have been suspicious for a while of the gut reservoir post-Covid. This new data may add fuel to the idea that SARS-CoV-2 stays in some people’s guts for a long time and could actually be driving long Covid. Or, on the other hand, it could mean our immune response is failing to clear the virus and leaving behind little pieces (which might not be harmful). There are still a lot of questions, Peluso admitted. But the paper undermines the paradigm that declares Covid infection disappears after two weeks, and long Covid is just residual damage. 

The findings also suggest a need for more aggressive evaluation of immunomodulating therapies, and treatments that target leftover virus. 

Most researchers hunting for a long Covid biomarker have turned to the blood or small pieces of tissue as surrogates for what’s happening inside a patient. With the new imaging technique, Peluso and his team can see a full person on their screen — a patient’s phantom figure and gauzy organs covered in splotches of light. “It’s really striking,” he said. “‘Oh, my goodness, this is happening in someone’s spinal cord, or their GI tract, or their heart wall, or their lungs.’” 

For patients like Ezra Spier, a member of the LIINC cohort who’s had imaging done after the period captured in this latest study, the experience was validating. Finally, the life-changing experience of long Covid had become visible. “ I can now see with my own eyes the kind of dysfunction going on throughout my own body,” said Spier, who created a website for long Covid patients to more easily find clinical trials near them. 

Most participants had been infected with a pre-Omicron variant of the virus, and one person had repeat infections throughout the study period. Two participants had been hospitalized during their initial bout of Covid, but neither one received intensive care. A half-dozen patients in the study reported zero long Covid symptoms, but still showed elevated levels of immune activation. 

Related: Could long Covid’s signs of immune dysregulation in the blood lead to a diagnostic test?

The paper does not explain what the sites of infection mean for symptoms, and immune activation in a particular organ doesn’t correspond to symptoms (for example, a gut full of T cells doesn’t necessarily match with GI problems). More studies are needed to figure out what the glowing spots mean for patients’ experience of long Covid. 

And the scans don’t work as a diagnostic. In other words, patients shouldn’t rush to San Francisco (Peluso’s group only accepts study participants from the area). The imaging technique isn’t available to the general public, either. F-AraG is still being studied in this context.

But Peluso and Vanbrocklin said imaging could be a major tool in figuring out long Covid. They’ve expanded their research program to do imaging on about 50 additional patients. They are also scanning people before and after they receive different long Covid clinical trial interventions to see if there’s a change in immune activity.

About the Author Reprints

Isabella cueto.

Chronic Disease Reporter

Isabella Cueto covers the leading causes of death and disability: chronic diseases. Her focus includes autoimmune conditions and diseases of the lungs, kidneys, liver (and more). She writes about intriguing research, the promises and pitfalls of treatment, and what can be done about the burden of disease.

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High abuse rates against LGBTQ, HIV-positive people in immigration detention, study finds

Immigrants in ICE detention at the Eloy Detention Center in Arizona. (Photo credit: ICE)

LGBTQ and HIV-positive people locked up in immigration detention centers are experiencing high rates of sexual assault, harassment and threats, according to a report released last month.

The report, which was based on interviews with dozens of people who have been held by a federal immigration agency, found that nearly all of them had experienced some type of abuse based on their sexual orientation or HIV status, leading its authors to call for a dramatic reduction in the use of immigration detention.

According to one of the report’s authors, immigration facilities in Louisiana — which has among the highest populations of detainees in the country — have some of the highest rates of abuse in the country.

The findings confirm “what voluminous studies have previously shown – [the U.S. Department of Homeland Security] is incapable of safely detaining LGBTQ/H people,” the report’s authors wrote. “The government’s continued use of this abusive detention system, which operates with impunity and puts vulnerable people in physical and psychological danger, is inexcusable.”

Three immigrants rights organizations – Immigration Equality, National Immigrant Justice Center and Human Rights First – interviewed 41 people who had been held in an immigration detention center at some point between 2009 and 2023. All identified as LGBTQ. Seventeen of them had HIV.

The survey found that 16, or 40% of people interviewed, had been sexually or physically assaulted while in detention. Two others reported witnessing an assault of another LGBTQ detainee.

In some cases, reports of assaults were met with indifference. One interviewee highlighted in the report —  a transgender woman identified as Leona who was housed in a Florida facility — was placed in a men’s detention unit where her cellmate repeatedly abused and harassed her. Leona reported the abuse to guards and asked to be moved, according to the report, but the request was ignored. Later, she said her cellmate attempted to rape her.

Most detainees — 85% — interviewed reported experiencing verbal and nonverbal abuse, including homophobic, transphobic or racist remarks and threats of violence while in federal custody. In most cases, the report says, the remarks came from facility staff.

Nearly half of the participants were placed in solitary confinement, often as a safety measure.  Many had their sexual orientations, gender identities or confidential medical information disclosed without their consent. Roughly two-thirds of the participants reported receiving poor medical care or not receiving care when they asked for it. And 13 out of the 17 interviewees living with HIV said they were either denied medical HIV treatment or experienced some form of medical neglect.

“No human being should be held there,” said a transgender woman, identified as Zoe, to interviewers when asked about her time in federal immigration custody.

Officials with U.S. Immigration and Customs Enforcement and Customs and Border Patrol did not respond to requests for comment by Wednesday (July 3).

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Report recommends more releases

One of the report’s author’s Bridget Crawford, director of law and policy at Immigration Equality, said the abuses and mistreatment highlighted in the report only lead to compounded trauma for LGBTQ and HIV-positive immigrants, as most of them have already fled persecution and violence in their countries of origin and are seeking asylum in the United States.

“We want people to understand the types of violence that we see among our clients. They include high levels of sexual assault … torture, death threats.” Crawford said. “And then they come to the U.S. and they’re put in immigration jails where they experience more homophobic abuse and mistreatment.”

Liza Doubossarskaia, a staff attorney at Immigration Equality who works with LGBTQ and HIV positive immigrants in detention and a co-author of the report, added that clients she speaks with express a “sense of betrayal” when they are met with more abuse once inside the U.S. immigration detention system.

The report recommends prioritizing LGBTQ and HIV-positive asylum seekers for immigration parole rather than placing them into detention while their cases are being considered.

According to a 2018 analysis of federal data the Center for American Progress (CAP) found that LGBTQ people in immigration detention were 97 times more likely to be sexually victimed than non-LGBTQ people.

LGBTQ and HIV positive migrants have some of the strongest claims to asylum, as they can provide evidence that they face persecution in their home countries due to their perceived sexual orientations, gender identities or HIV positive status. Crawford said roughly 99% of Immigration Equality’s asylum seeking clients are granted some form of protection in the U.S..

The U.S. government can release them to their communities to go through the asylum process. Instead many LGBTQ and HIV positive immigrants are placed in environments where the risk of harassment or abuse is high and the only way to offer them protection is to place them in extended solitary confinement, which can be isolating and psychologically damaging.

Doubossarskaia said she often speaks with transgender women who have been placed in male facilities, where they complain of experiencing different forms of aggression and abuse from other detainees. When they ask for alternative housing they are commonly placed in isolation – where they are in a cell on their own for the majority of the day.

High levels of abuse in Louisiana, report author says

Crawford said Immigration Equality had seen “some of the highest levels of abuse” of detainees in Louisiana.

One detainee referenced in the report, identified as Vicky, filed a complaint in 2023 with oversight bodies within the Department of Homeland Security, while she was being housed at Pine Prairie ICE Processing Center in Louisiana. The complaint said she was repeatedly told that her only options were to either stay in a cisgendered men’s dorm or to be placed in isolation.

That facility claimed to have adopted a set of transgender care guidelines from a 2015 memorandum authored by U.S. Immigration and Customs Enforcement.  The memo advised limiting solitary confinement and establishing transgender housing units in detention facilities, but the report said facilities continue to overuse isolation as a way to safely house transgender detainees.

The transgender care memo also advised field office directors,who oversee immigration detention facilities, to “consider whether the use of detention resources is warranted” and to consider  “all relevant factors in this determination, including whether an individual identifies as transgender.” Doubossarskaia said she has experienced a reluctance by ICE field offices to release LGBTQ detainees who have complained of abuse.

This is most frequently the case, she said, in the New Orleans ICE Field Office, which oversees immigration detention centers in five states, including Mississippi and Louisiana, where the bulk of the region’s facilities are located. Louisiana became a hub for immigration detention under the Trump administration and now has the second largest detained immigrant population in the United States, behind Texas.

Doubossarskaia said two recent Immigration Equality clients were allegedly injured while in ICE custody within the New Orleans field office – one by another detainee and another while being transported between facilities. Both men had strong claims to asylum, and later won their cases, and sponsors willing to take responsibility for them. Still the New Orleans field office director would not release the men.

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This article first appeared on Verite News and is republished here under a Creative Commons license.

The post High abuse rates against LGBTQ, HIV-positive people in immigration detention, study finds appeared first on Louisiana Illuminator .

More From Forbes

How BCG Is Revolutionizing Consulting With AI: A Case Study

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In a world where AI is transforming every sector, companies are constantly seeking ways to gain a competitive edge. Boston Consulting Group (BCG) is leading the charge by embracing artificial intelligence (AI), particularly generative AI, to revolutionize its internal operations and consulting services. Let’s delve into how BCG is leveraging AI to transform its business processes and the consulting industry as a whole.

The Strategic Importance Of AI At BCG

AI is not just a buzzword at BCG; it is a fundamental element of their strategy. Vlad Lukic, Managing Director and Senior Partner at BCG, emphasizes the significance of AI, stating, "It gets into the crux of our business, right? And it's going to be fundamental to the toolkit and skills that we need to have." AI serves as an assistant, enabling BCG consultants to operate at unprecedented speeds, thus allowing them to generate insights faster and drive impactful results for their clients.

Real-World Applications Of AI At BCG

1. Interview Processing and Analysis:

Lukic recalls his summer internship, where he had to interview 30 engineers about materials science over three days, transcribe the conversations, distill the insights, and create slides. This labor-intensive process took two weeks. In contrast, a recent consultant used BCG's enterprise GPT to perform a similar task. "On the third day, he had slides and insights ready to go," Lukic marvels. The AI tool transcribed interviews, highlighted key themes, and generated draft presentations in minutes, reducing a two-week process to two or three days.

NYT ‘Strands’ Hints, Spangram And Answers For Wednesday, July 10th

How the ‘lady gaga of math’ is thinking differently about math education, ‘the acolyte’ episode 7 recap and review: woo-hoo, witchy woman.

2. Gene: BCG's Innovative Conversational AI:

Another striking example of AI's impact at BCG is the development of Gene, a conversational AI designed to engage with humans and create audio experiences. Originally conceived as a co-host for BCG's "Imagine This" podcast about the future, Gene has evolved into a versatile tool for client engagement and content creation.

Paul Michelman, editor-in-chief at BCG, explains, "Gene was born for a specific job, really one job, and its original training was to be a co-host of a podcast." However, the potential of Gene quickly became apparent, and its applications have expanded. Gene now appears at live events with clients and other audiences, engaging in conversations about the future of AI and thought leadership.

Enterprise GPT: A Game Changer

BCG's enterprise GPT is a cornerstone of their AI strategy. Rolled out to every employee, this tool ensures all data remains within BCG's control. Consultants can also build their own GPTs for specific engagements, fostering innovation and efficiency. Over 3,000 GPTs have been created, addressing tasks from document summarization to administrative functions. Lukic highlights its impact on productivity, noting, "It's really helping us move to a different level of speed."

Evolving Roles And Skills In The AI Era

With AI taking over routine tasks, the role of consultants is evolving. Lukic underscores the need for purposeful toil and sanity checks to ensure junior consultants develop essential skills. He explains, "We are forcing some of those conversations with our team members, so that we can build their skills along the way." This includes teaching consultants how to engage with AI tools effectively, ensuring they can provide accurate and reliable insights.

The development of Gene has also prompted new considerations in AI deployment. Bill Moore from BCG Design Studios, who created Gene, explains the challenges in balancing autonomy and control: "We adjust, we work with the temperature to keep that sort of fine-tuned and we'll drop it down to zero if we need really accurate responses."

Measuring The Impact Of AI

BCG conducted a scientific experiment involving 750 employees to measure the impact of generative AI on performance and efficiency. The results were compelling. For straightforward tasks, productivity increased by 30-40% for new hires and 20-30% for experienced consultants. However, for complex tasks, productivity sometimes decreased due to the challenges of debugging AI-generated outputs. This experiment highlighted the importance of understanding where AI can be most effective and implementing proper guardrails to ensure accuracy.

Insights From BCG's GenAI Experiment

BCG's broader research into generative AI reveals significant insights into its value and potential pitfalls. The study found that around 90% of participants improved their performance when using GenAI for creative ideation. However, when applied to business problem-solving—a task outside the tool's current competence—many participants trusted misleading outputs, resulting in a 23% decline in performance compared to those who didn't use the tool. This underscores the necessity of proper training and understanding the limitations of AI tools.

Ensuring Accuracy And Mitigating Risks

To mitigate risks associated with AI, BCG has implemented several guardrails. Human experts review AI-generated insights, and workflows are designed to ensure continuous oversight. Additionally, BCG fine-tunes their models based on usage and feedback, reducing the likelihood of errors.

In the case of Gene, transparency and ethical considerations are paramount. Paul Michelman emphasizes, "We think it's very important... to be fully clear when we're using technology. And two, to really avoid anthropomorphizing." This approach extends to Gene's voice, which is intentionally androgynous and slightly robotic to clearly differentiate it from a human.

Governance And Strategic Implementation Of AI

BCG employs a dual approach to AI implementation. While top-down initiatives identify key workflows that can benefit from AI, grassroots innovation is also encouraged. A senior task force focuses on internal support functions and consulting cohorts, identifying where AI can eliminate bottlenecks and enhance productivity.

The Future Of Consulting In The AI Era

Looking ahead, AI is poised to reshape the consulting industry. Lukic predicts that within a decade, 50% of current tasks will be automated through AI, allowing consultants to focus more on change management and driving adoption within client organizations.

Bill Moore envisions a future where conversational interfaces like Gene become a new layer of interaction with technology, potentially revolutionizing accessibility and user experience.

Strategies For Successful AI Adoption

For CEOs considering AI adoption, Lukic offers two key pieces of advice. First, don't wait. Start addressing frictions and building the necessary governance structures now. Second, engage the organization. Avoid outsourcing AI implementation entirely and instead, focus on building internal capabilities.

Transforming Consulting With AI

BCG's strategic application of AI, particularly generative AI and conversational AI like Gene, showcases how embracing technology can revolutionize internal processes and enhance client service. By leveraging AI tools like enterprise GPT and Gene, BCG is boosting productivity, fostering innovation, and preparing its workforce for the future. As AI continues to evolve, BCG's proactive approach provides a valuable blueprint for other organizations aiming to harness the power of AI in their own operations.

Bernard Marr

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  • Malays Fam Physician
  • v.10(1); 2015

A case study of human immunodeficiency virus with positive seroconversion to negative

V paranthaman.

1. Paranthaman Vengadasalam (Corresponding author) Family Medicine Specialist, Jelapang Health Clinic, Ipoh, Malaysia Email: moc.liamg@naraprd

2. Yip Hung Loong @ Elvind Yip Community Based Department, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia. Email: moc.liamtoh@piydnivle

3. Ker Hong Bee Infectious Disease Consultant, Department of Medicine, Hospital Raja PermaisuriBainun, Ipoh, Malaysia. Emai: moc.liamtoh@bhrek

This case study demonstrates a 36-year-old ex-intravenous drug user (IVDU) who had been initially tested positive for human immunodeficiency virus (HIV) twice using Enzyme Immunoassay (EIA) method (Particle agglutination, PA done), but a year later he was tested HIV-negative. The patient was asymptomatic for HIV and T helper cells (CD4) count remained stable throughout this period.

In light of this case, there may be a need to retest by molecular methods for high risk category patients who were initially diagnosed HIV-positive, but later showing an unexpected clinical course, such as a rising or stable CD4 titre over the years.

Introduction

Combination of antiretroviral therapy has led to a major reduction in Human immunodeficiency virus-related (HIV-related) mortality and morbidity. However, HIV still cannot be cured. 1

This case illustrates a 36-year-old man who was initially tested HIV-positive twice according to the Joint United Nations Programme on HIV and AIDS (UNAIDS) and World Health Organization (WHO) HIV testing strategies II, 2 but a year later he was tested HIV-negative. This may have implications in future for blood test models for such patients.

Case report

A 36-year-old single man had been using illicit drugs since 2000 including ganja (cannabis) and heroin through inhalation and sharing needles. He was enrolled for methadone maintenance therapy (MMT) at a health clinic A in mid-2008. On entry to the MMT, he was tested positive for both HIV and Hepatitis C ( Table 1 ). He was asymptomatic, with no signs of opportunistic infections.

Table 1. Laboratory results

Date (Month/year)Laboratory resultsPlace
August 2008Anti-HIV 1 and 2 (ELISA): ReactiveClinic A
Serology
PA test for HIV 1 and 2: HIV 1 Detected
HBs antigen (EIA): Non reactive
Anti-HCV (EIA): Reactive
HCV test for LIA: Positive
Liver function test: ALT: 69 (NR: 30–65)
Other parameters: Normal
September 2008Repeated with new serology sampleClinic A
Anti-HIV 1 and 2 ( ELISA): Reactive
PA test for HIV 1 and 2: HIV 1 detected
September 2008T helper cells (CD4 ): 609 cells/µLClinic A
May 2009T helper cells (CD4): 816 cells/µLClinic A
September 2009T helper cells (CD4 ): 1193 cells/µLClinic A
October 2010Anti-HIV 1 and 2 (ELISA): Weak reactiveClinic B
November 2010PA test for HIV 1 and 2: Not detectedClinic B
HIV viral load result : Target not detected
Line immunoassay (LIA) method HIV 1 and 2: Not detected
November 2011Anti-HIV 1 and 2 ( ELISA): Non reactiveClinic A
HBs antigen (EIA): Non reactive
Anti-HCV (EIA): Reactive
HCV test for LIA: Positive
December 2011Anti-HIV 1 and 2 (ELISA): Non reactiveClinic A
PA test for HIV 1 and 2: Non reactive
January 2012Line immunoassay (LIA) method HIV 1 and 2: Not detectedClinic A

a ELISA Axsym HIV 1/2 G.O test Manufacturer: Abbott Laboratory, Germany. Sensitivity: 100%, Specificity: 99.94% 3

b PA Serodia HIV 1/2 test manufacturer: Fujirebio, Japan. Sensitivity: 100%, Specificity: 99.97% 4

On urine drug screening, he was tested positive for morphine in 2008 prior to MMT, but since then it remained negative. The client is currently on MMT. In early 2010 he was transferred out to clinic B for employment purposes elsewhere but returned in 2011 to clinic A. On entry to clinic B for continuation of MMT, patient was retested for HIV according to local protocol. The tests done at clinic B showed a negative result for HIV but Hepatitis C remains positive.

The laboratory test results are shown below in Table 1 .

Serology testing has been the cornerstone in detection of HIV infection. 5 The traditional confirmatory tests, Western blot (WB), line immunoassay (LIA) and indirect immunofluorescence assay are highly specific and have played a central role in diagnostic algorithms. 6 However, studies have shown that combinations using enzyme-linked immunosorbent assays (ELISA) and Simple/ Rapid (S/R) assays can provide results as reliable as the WB or LIA at a lower cost and are easier to perform and interpret with fewer indeterminate results. 7 Therefore, WHO and UNAIDS have recommended testing strategies, which include a combination of ELISAs and/or S/R assays for HIV antibody detection, especially in settings with limited resources. Confirmatory testing with methods such as WB/LIA is not done in initial diagnosis. 2

In this patient, the initial diagnosis of HIV was made after two separate reactive serology tests in the year 2008, in accordance with WHO/UNAIDS HIV testing strategies II. 2 A third HIV serology testing after 2 years in October 2010 showed weakly reactive result.

In view of the conflicting lab results, a HIV viral load test was requested by the doctor in clinic B in November 2010, which showed the results as HIV-negative. An algorithm issued by the Ministry of Health Malaysia for screening and confirmation of HIV recommends this approach. 8 The initial T helper Cells (CD4) count at diagnosis was 609 cells/uL with an increasing trend over the next 1 year.

In June 2014, Centers for Disease Control and Prevention (CDC) updated their recommendations to state that initial testing for HIV should be conducted with an FDAapproved antigen/antibody combination immunoassay that detects HIV-1 and HIV-2 antibodies with HIV-1 p24 antigen. 9 In our local setting it was not done in accordance with guidelines at that particular time.

There were several implications with these results: Most likely, it was an initial false-positive result due to serological cross-reactivity, in which antibody produced by immature immune response, other infections or autoimmune disorders, bind to the antigen in the test reagent. 10 , 11 This patient was tested positive for Hepatitis C with an initial slightly elevated levels of liver enzyme which may be due to a transient hepatitis at the time of diagnosis. His liver functions subsequently normalised when he was tested HIV-negative. There were some weak evidences linking Hepatitis B but not Hepatitis C infection with false-positive HIV result. 12

Another common reason for false-positive was administrative errors such as patient’s blood mix up, but it was not likely because the second testing was done with a fresh serology sample. Other less likely causes such as overinterpretation of weak reactivity, genetics and contamination 12 were unable to be verified.

The least possible scenario was a true cure whence the patient had seroconverted from a HIV-positive to -negative status. The case report of a German patient with acute myeloid leukaemia, who received a bone marrow transplant from a donor, was the only known example of a sterilising cure. 13 Without genetic testing performed for this patient, there cannot be any certainty about this issue.

A false-positive HIV result could have severe negative impacts on patient in terms of emotional, social and economical aspects. Patient might be subjected to unnecessary emotional stress and social stigma, leading to breakdown in relationship and loss of employment. It would also incur higher healthcare cost due to unnecessary investigations and treatment. 14 As the current incidence and impact of false-positives in Malaysia was unknown, it was hoped that this paperwould stimulate more research in this area.

This patient was initially upset with the false diagnosis and being subjected to multiple tests repeatedly. However, he eventually accepted the fact after an honest, empathetic and reassuring pre and post test counselling session while addressing the possible causes of false-positive results.

Conclusion and recommendation

This case study highlights the need to retest highrisk category patients who are diagnosed with HIV initially, but later showing an unexpected clinical course, such as a rising or stable CD4 titre over the years. The latest CDC recommendations on the diagnostic algorithm in June 2014 may help to avoid false-positive diagnosis which can be devastating to the patient. Appropriate counselling strategies to handle this type of scenarios will be useful.

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors would like to thank the Director General of Health Malaysia for permission to publish this article.

Paranthaman V, Yip HL, Ker HB. A case study of human immunodeficiency virus with positive seroconversion to negative. Malays Fam Physician. 2015;10(1);44-46.

After Supreme Court ruling, judge considers Trump's immunity claim in classified docs case

hiv on case study

Donald Trump is seeking to build on his Supreme Court victory, which provided immunity from criminal prosecution for his official acts as president, by asking judges in his federal classified documents case and in his New York hush money conviction to throw out all of those charges.

U.S. District Judge Aileen Cannon postponed deadlines Saturday to debate evidence in the classified documents case and instead asked for written arguments about Trump’s immunity in the next two weeks.

Trump’s lawyers asked Cannon on Friday to halt all action in the classified documents case until she rules whether the charges are valid.

New York Judge Juan Merchan postponed sentencing Trump for his hush-money conviction of 34 counts of falsifying business records, which had been scheduled for Thursday, until September.

When the Supreme Court formally returns the election-interference case to U.S. District Judge Tanya Chutkan, she must weigh which charges are still valid to prosecute.

Neither Justice Department special counsel Jack Smith nor Manhattan District Attorney Alvin Bragg has responded to the Supreme Court’s decision yet.

Trump’s lawyers, Todd Blanche and Christopher Kise, have argued the high court’s ruling means each of the judges will have to determine which conduct is official or unofficial – and not use any official conduct as evidence for charges against unofficial conduct.

Here is where the cases stand:

Supreme Court orders 'close analysis' of whether Trump conduct was unofficial

The reason for uncertainty about criminal charges against Trump is because no former president has ever been charged before and the Supreme Court hadn’t ruled on whether they could be.

Until July 1. That’s when Chief Justice John Roberts wrote for a 6-3 majority that former presidents can’t be tried for their official acts, but could potentially be charged for unofficial acts.

The ruling said presidents discussing policy with executive agencies can’t even be questioned about their motives. This ruled out charges involving Trump urging his acting attorney general to pursue allegations of election fraud with officials in swing states.

But the ruling left open the possibility of charges dealing with Trump’s recruitment of fake presidential electors to support him in states President Joe Biden won. Roberts wrote that determining whether Trump's pressure on then-Vice President Mike Pence "requires a close analysis of the indictment’s extensive and interrelated allegations."

“The President is not above the law,” Roberts wrote. “But under our system of separated powers, the President may not be prosecuted for exercising his core constitutional powers, and he is entitled to at least presumptive immunity from prosecution for his official acts."

Trial judges must now determine whether Trump’s conduct for the various charges was official or unofficial.

Judge postpones filings in classified documents case to study Trump's immunity claim

Trump was charged with retaining national defense records and conspiring to hide them from government authorities until FBI agents seized them during a search of Mar-a-Lago, his Florida estate, in August 2022.

Prosecutors have noted the entire case involves conduct after Trump left the White House in January 2021. Smith's team office said Trump did not have legal authority to designate secret national security documents as personal records and send them to his private home. But Trump’s lawyers have argued his decision to ship the documents to Mar-a-Lago was an official act.

In an order Saturday, Cannon scrapped a Monday deadline for Trump to disclose his experts and Wednesday deadlines for prosecutors and defense lawyers to share more evidence in the case.

Instead, Cannon set a deadline July 18 for Smith to respond to Trump’s request for immunity. Trump will have until July 21 to respond.

Cannon hasn’t set a date for a hearing, but said she could still collect more evidence.

Trump’s lawyers want Cannon to only move forward on two issues in the case: Smith's request for a gag order preventing Trump from making comments that could incite threats against FBI agents working the case, and whether Smith was properly appointed to his job as special counsel.

In the Supreme Court’s ruling on immunity, Justice Clarence Thomas, wrote  a concurrence  questioning Smith's appointment, even though that wasn't at issue in the case and many special counsels have been previously appointed under similar circumstances.

Judge in federal election interference must also determine unofficial conduct

The Supreme Court hasn’t formally returned Trump’s election-interference case to Chutkan, under what is called a “mandate,” which might not happen until Aug. 2.

“The judgment or mandate of this Court will not issue for at least thirty-two days,” Supreme Court clerk Scott Harris wrote July 1 to the D.C. Circuit Court of Appeals.

Chutkan will have to review which charges – if any – can go to trial once she gets the case back.

New York sentencing postponed because of potential immunity

Merchan previously postponed sentencing Trump in the hush-money case, which had been scheduled Thursday, until Sept. 18.

But that’s only if necessary. Merchan plans to decide Sept. 6 whether Trump is immune from the charges, even though his case involves state charges and the Supreme Court was reviewing federal charges.

Trump was convicted May 30 of falsifying records to hide his reimbursement to private lawyer Michael Cohen, who paid $130,000 to silence porn actress Stormy Daniels about alleged sex with Trump before the 2016 election.

The financial arrangements between Cohen and Daniels happened before Trump was elected president. But his series of 11 payments to Cohen – through his private company – happened the first year of his presidency.

Merchan previously ruled that Trump filed an immunity argument in the case too late to be considered.

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  1. Case Discussion || HIV || CNS Infection

  2. Week 3 Case Study Presentation

  3. Infectious disease case discussion || HIV

  4. HIV Case Study

  5. Implementation of HIV Case Based Surveillance : Use of Unique Identifiers in Management of HIV/AIDS

  6. Ocular Manifestations of HIV

COMMENTS

  1. Case 27-2021: A 16-Year-Old Boy Seeking Human Immunodeficiency Virus

    An estimated 1 in 2 Black men who have sex with men in the United States will become infected with HIV over a lifetime. 1 Among the nearly 50,000 adolescents and young adults (13 to 24 years of ...

  2. Clinical microbiological case: a 35-year-old HIV-positive man with

    A 35-year-old HIV-positive man was admitted to our hospital with intermittent fever for several months (Figure 1) and chronic diarrhea. He was diagnosed HIV-positive 4 years earlier and had subsequently developed several AIDS-defining diseases such as Pneumocystis carinii pneumonia and CMV retinitis. Three months before admission the patient began complaining of watery diarrhea and recurrent ...

  3. Case 9-2018: A 55-Year-Old Man with HIV Infection and a Mass on the

    In a 2014 study, the standardized incidence ratio for non-Hodgkin's lymphoma in persons with HIV as compared with the general U.S. population was 11.5. 24 However, although rates of diffuse ...

  4. Case 32-2005

    One study found that the overall rate of infections up to four months after the insertion of an intrauterine device was the same among HIV-negative women as among HIV-positive women. 29 Therefore ...

  5. A new way to prevent HIV delivers dramatic results in trial

    The study's focus on women in sub-Saharan Africa is based on HIV data. Despite accounting for 10% of the world's population, sub-Saharan Africans comprise two-thirds of people living with HIV ...

  6. NHLBI's MACS/WIHS study targets chronic health conditions in people

    That study has focused on the health impact of HIV on nearly 5,000 women living with or at risk for the virus. Since then, the combined research effort - the so-called MACS/WIHS Combined Cohort Study - has been pursuing an ambitious goal: to understand and reduce the impact of chronic health conditions, including heart, lung, blood, and ...

  7. Effects of clinical, comorbid, and social determinants of health on

    In this retrospective case-control study, people with HIV from Washington University in St Louis, MO, USA, and people without HIV identified through community organisations or the Research Participant Registry were clinically characterised and underwent 3-Tesla T 1-weighted MRI between Dec 3, 2008, and Oct 4, 2022.Exclusion criteria were established by a combination of self-reports and medical ...

  8. <em>Journal of the International AIDS Society</em>

    We conducted a qualitative multiple case study on PrEP care implementation in eight HIV clinics. Thirty-six semi-structured interviews were conducted between January 2021 and May 2022 with a purposive sample of PrEP care providers (e.g. physicians, nurses, psychologists), supplemented by 50 hours of observations of healthcare settings and ...

  9. HIV Screening and Testing

    Cost-effectiveness of HIV screening and testing. Initial studies reported voluntary HIV screening to be cost-effective in health care settings where undiagnosed HIV infection is less than ≥0.1% 1 2.It was also reported to be more cost-effective than many established screening programs for chronic disease (e.g., hypertension, colon cancer, and breast cancer). 2 3 Treatment costs are lowered ...

  10. HIV breakthrough: drug trial shows injection twice a year is 100%

    A large clinical trial in South Africa and Uganda has shown that a twice-yearly injection of a new pre-exposure prophylaxis drug gives young women total protection from HIV infection.

  11. Journey from victim to a victor—a case study of people living with HIV

    Case study methods involve an in-depth, longitudinal (over a long period of time) examination of a single instance or event, a case. This case study is about Anamika (name changed), a 35-year-old female who is an empowered HIV-positive and presently works as Community Co-ordinator at an anti-retroviral treatment (ART) centre.

  12. HIV: A Socioecological Case Study

    A medically and socially complex patient with HIV is presented as the initial case study that leads to identification of barriers and needs on individual, community, and public policy levels. This is an active-learning resource that includes both small- and large-group discussion driven by self-directed learners using the provided resources.

  13. A new way to prevent HIV delivers dramatic results in trial

    The study's focus on women in sub-Saharan Africa is based on HIV data. Despite accounting for 10% of the world's population, sub-Saharan Africans comprise two-thirds of people living with HIV - 25.7 million out of 38.4 million. And, every week, about 4,000 teen girls and young women in Africa are newly infected with HIV.

  14. Outcomes of Patients Living with HIV Hospitalized due to ...

    Conditions such as HIV infection can be considered a risk factor, along with cardiovascular comorbidities, in patients with COVID-19. A preliminary report of a case-control study suggested that SARS-CoV-2 coinfection does not have an extraordinarily great impact on PLWH . However, the authors emphasized limitations of their study and reported ...

  15. A case study of HIV/AIDS services from community-based organizations

    Introduction People living with HIV (PLHIV) relied on community-based organizations (CBOs) in accessing HIV care and support during the COVID-19 pandemic in China. However, little is known about the impact of, and challenges faced by Chinese CBOs supporting PLHIV during lockdowns. Methods A survey and interview study was conducted among 29 CBOs serving PLHIV in China between November 10 and ...

  16. Clinical Case Studies

    Clinical Case Studies Active Resources; Archived Resources; Resources: 28. ... The National HIV Curriculum (NHC) provides free, up-to-date content for clinicians to learn about HIV diagnosis, treatment, and prevention. The 37 les... Type. Curricula. Publication Date. 09/05/2023.

  17. Case Study of A Patient With Hiv-aids and Visceral Leishmaniasis Co

    Based on this case study and literature review, it is evident that co-infection presents typical clinical, diagnostic, and therapeutic features, and can be observed in the prognosis of the disease. Therefore, prospective studies are required to clarify gaps such as the efficacy of secondary prophylaxis and need for clinical and laboratory ...

  18. The lived experience of HIV-infected patients in the face of a positive

    AIDS as a human crisis may lead to devastating psychological trauma and stress for patients. Therefore, it is necessary to study different aspects of their lives for better support and care. Accordingly, this study aimed to explain the lived experience of HIV-infected patients in the face of a positive diagnosis of the disease. This qualitative study is a descriptive phenomenological study.

  19. Determinants of virological failure among HIV clients on second-line

    Institutional-based unmatched case-control study design was conducted from September first, 2021, to December last 2021. Source population All HIV patients at FHCSH and UGCSH who were on second-line ART regimens. Study population All HIV patients on ART at FHCSH and UGCSH who took second line ART for more than six

  20. Advancing toward a preventative HIV vaccine

    Priming rare antibodies. In the first study, which focused on BG18, Scripps Research scientists collaborated with co-senior authors Shane Crotty, PhD, chief scientific officer at La Jolla ...

  21. Four Decades of HIV/AIDS

    Numerous studies have led to the conclusion that a once-daily, single-pill PrEP regimen is 99% effective in preventing sexual acquisition of HIV infection by an at-risk uninfected person.

  22. Meeting the complex needs of individuals living with HIV: a case study

    Abstract. This article critically discusses the nursing care and management of a person living with the human immunodeficiency virus (HIV) infection as a long-term condition, requiring highly complex HIV care. Complex HIV care is managed in the secondary care setting. However, recent legislation has motivated shifts in HIV care to the community ...

  23. PDF HIV Case Study: Ryan White and Activism

    HIV Case Study: Ryan White and Activism. HIV (Human Immunodeficiency Virus) infects human immune cells and reproduces within them. HIV causes AIDS (Acquired Immunodeficiency Syndrome), which describes a weakened and "deficient" immune system. The body of someone with AIDS can no longer fight against many diseases that a person with a ...

  24. Prevalence of common mental disorder and its association with perceived

    We included cross-sectional, case-control, and cohort studies in the review. The Comprehensive Meta-Analysis software version 3.0 was used to pool the results of the included studies. ... CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV epidemiology research study. JAMA. 2001;285 ...

  25. Diagnostics

    Invasive aspergillosis (IA) represents a common form of fungal infection caused by various species of Aspergillus that most frequently affect immunocompromised patients. Typically, this disease occurs preferentially in high-risk groups including patients infected with the human immunodeficiency virus (HIV), patients with leukemia, patients with autoimmune diseases, and organ transplant ...

  26. Long Covid study: Via imaging, virus found years post-infection

    So they adapted their HIV research infrastructure to study Covid patients. The LIINC program, short for "Long-term Impact of Infection with Novel Coronavirus," started in San Francisco at the ...

  27. High abuse rates against LGBTQ, HIV-positive people in ...

    LGBTQ and HIV-positive people locked up in immigration detention centers are experiencing high rates of sexual assault, harassment and threats, according to a report released last month. The ...

  28. How BCG Is Revolutionizing Consulting With AI: A Case Study

    Ensuring Accuracy And Mitigating Risks. To mitigate risks associated with AI, BCG has implemented several guardrails. Human experts review AI-generated insights, and workflows are designed to ...

  29. A case study of human immunodeficiency virus with positive

    Abstract. This case study demonstrates a 36-year-old ex-intravenous drug user (IVDU) who had been initially tested positive for human immunodeficiency virus (HIV) twice using Enzyme Immunoassay (EIA) method (Particle agglutination, PA done), but a year later he was tested HIV-negative. The patient was asymptomatic for HIV and T helper cells ...

  30. Does Trump have immunity in his other cases? Judges weigh question

    Judge postpones filings in classified documents case to study Trump's immunity claim. Trump was charged with retaining national defense records and conspiring to hide them from government ...