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Psychosocial Correlates of HIV-related Sexual Risk Factors among Male Clients in Southern India
International Journal of Psychology and Behavioral Sciences , 2012, DOI: 10.5923/j.ijpbs.20120206.08
Abstract: Psychosocial theories suggest that individuals’ behavior is a reflection of their intention and ability to carry out a typical behavior. This study proposes to examine the psychosocial correlates of HIV-related sexual risk factor among male clients of female sex workers (FSWs). Data were used from a cross-sectional survey, collected using two-stage sampling, conducted among 2382 clients of FSWs in four states of India in November 2008. Clients were males who had engaged in paid sex with a FSW in the 12 months preceding the survey. Multiple logistic regression models were fitted to assess the effect of different psychosocial measure on HIV-related sexual risk factors: multiple sexual partners, inconsistent condom use and self reported sexually transmitted infections (STIs). The odds of inconsistent condom use with FSWs was more among clients with low self-efficacy (Adjusted Odds Ratio (AOR): 2.2, 95% Confidence Interval (CI): 1.7-3.0), low perceived social support (AOR: 1.8, 95% CI: 1.3-2.6), low perceived personal norms (AOR: 1.7, 95% CI: 1.2-2.3) and low perceived access to condoms (AOR: 1.5, 95% CI: 1.1-2.0) than others. Similarly, experience of STI-related symptoms in the last 12 months was associated with low self-efficacy, low perceived social support and low perceived vulnerability. Findings highlight strong influence of psychosocial attitudes on HIV-related sexual risk factors among male clients of FSWs, suggesting the need for designing HIV prevention strategies to address psychosocial issues like self-efficacy, vulnerability and social support.
HIV/TB: When is it safe to start HAART?
R Wood
Southern African Journal of HIV Medicine , 2008,
Abstract: South Africa has the fourth highest burden of tuberculosis (TB) worldwide after China, India and Indonesia and has the highest TB notification rate of any country. The World Health Organization (WHO) estimated that in 2006 South Africa had 303 114 incident TB cases; of these patients, 32% were tested for HIV and 53% were found to be HIV infected.1 HIV testing of TB cases has been encouraged by the WHO and testing has resulted in identification of increasing numbers of HIV-infected individuals in the TB control programme. The success of this policy has been demonstrated in the Cape Town Gugulethu antiretroviral clinic, where referrals directly from the local TB clinics have increased from 15% to 30% within the past 2 years. The national TB control programme has therefore become an increasingly important pathway to HIV care and access to highly active antiretroviral therapy (HAART). An additional 15 - 20% of patients in the Gugulethu programme have a diagnosis of TB made during the HAART screening period, further increasing the number of individuals on TB medication who require HAART. Mortality after referral is very high. The HIV/TB case mortality has been reported to be as high as 16 - 35%2 prior to the introduction of HAART, with both HIV and TB contributing to this mortality. Optimal timing of HAART is currently unknown and there is an urgent need for development of evidence-based protocols for HAART initiation and immune reconstitution disease (IRD) management. Southern African Journal of HIV Medicine Vol. 9 (4) 2008: pp. 18-24
Genetic profile of 81 retinoblastoma patients from a referral hospital in Southern India  [cached]
Harini Rajasekhar,Ata-ur-Rasheed Md,Shanmugam Mahesh,Amali Jacob
Indian Journal of Ophthalmology , 2001,
Abstract: Purpose: To determine chromosomal abnormalities and inheritance pattern in patients with retinoblastoma from a referral hospital in southern India. Materials and Methods: Eighty-one retinoblastoma patients from 78 families were included in this study. Peripheral venous blood was taken for chromosomal analysis and pedigree was ascertained for segregation analysis. Results: Male to female ratio was 1.7:1, 55.56% were bilateral retinoblastoma, the mean age of onset was 12.37 months in bilateral and 33.07 months in unilateral cases (p=0.048). Majority (90.12%) had sporadic inheritance and 6.17% had autosomal dominant inheritance. In chromosomal abnormalities, 8.33% had 13q14 deletion, three cases had de novo balanced translocations. Conclusion: The age of onset of the disease was much earlier in the bilateral cases compared to unilateral cases. Sporadic inheritance was predominant while only a small percentage of patients had autosomal dominant inheritance. The percentage of patients with 13q14 deletion was higher than reported in the literature and three novel chromosomal translocations were observed. This is one of the largest series of cases reported from India.
Gender distribution of adult patients on highly active antiretroviral therapy (HAART) in Southern Africa: a systematic review
Adamson S Muula, Thabale J Ngulube, Seter Siziya, Cecilia M Makupe, Eric Umar, Hans Prozesky, Charles S Wiysonge, Ronald H Mataya
BMC Public Health , 2007, DOI: 10.1186/1471-2458-7-63
Abstract: A systematic review of the literature was carried out to describe the gender distribution of patients accessing highly active antiretroviral therapy (HAART) in Southern Africa. Data on number of patients on treatment, their mean or median age and gender were obtained and compared across studies and reports.The median or mean age of patients in the studies ranged from 33 to 39 years. While female to male HIV infection prevalence ratios in the southern African countries ranged from 1.2:1 to 1.6:1, female to male ratios on HAART ranged from 0.8: 1 to 2.3: 1. The majority of the reports had female: male ratio in treatment exceeding 1.6. Overall, there were more females on HAART than there were males and this was not solely explained by the higher HIV prevalence among females compared to males.In most Southern African countries, proportionally more females are on HIV antiretroviral treatment than men, even when the higher HIV infection prevalence in females is accounted for. There is need to identify the factors that are facilitating women's accessibility to HIV treatment. As more patients access HAART in the region, it will be important to continue assessing the gender distribution of patients on HAART.There is increasing global interest to ensure that HIV infected persons have access to antiretroviral therapy. In the developed world, mortality from AIDS has significantly reduced, in part due to wide availability and accessibility to highly active antiretroviral therapy (HAART). In resource-limited countries however, although there has been steady progress in increasing accessibility to antiretroviral therapy (ART), most patients have no access to this life saving intervention [1]. Natrass suggests that the poor and vulnerable segments of society are likely to miss out from accessing HAART. In many societies, women are likely to be poor and socially vulnerable.When patients in resource limited settings access HAART, treatment adherence has been reported to be comparable
Profile of Substance Use among Patients Attending De-Addiction Centres in a Coastal City of Southern India  [PDF]
Nithin Kumar, Tanuj Kanchan, Bhaskaran Unnikrishnan, Rekha Thapar, Prasanna Mithra, Vaman Kulkarni, Mohan Kumar Papanna, Ramesh Holla, Saran Sarathy
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0057824
Abstract: Drug dependence is still to be recognized in developing countries as a significant public health problem and literature on the magnitude of this problem is limited. The present research was planned to study the socio-demographic profile and the reasons for substance use among patients admitted at De-addiction centres in Mangalore, India. In this cross-sectional study, all the patients admitted at the De-addiction centres during the study period were interviewed. The data was analyzed and the results obtained were expressed in proportions. A total of 83 patients were included in the study, all of whom were males. A positive family history of substance use was evident in 63% of the respondents. The mean age of the study participants was 41.9 (SD±11.2) years and the mean age for starting substance use was 20.9 (SD±7.7) years. The most common substance used was alcohol (95.2%). Majority of the subjects (56.6%) cited peer pressure as a reason for initiating substance use. Our findings suggest that the initiation of substance use occurs during late teenage years and mostly due to peer pressure. Our observations point towards the vulnerability of younger age towards substance use and hence, it is proposed that the preventive health policies in this regard should be targeted specifically during teenage years.
Immune restoration in the context of HAART
Des Martin
Southern African Journal of HIV Medicine , 2004,
Abstract: The advent of highly active antiretroviral combination therapy (HAART) has resulted in significantly improved survival of patients and a reduction in the progression of human immunodeficiency virus (HIV) infection. At the root of these clinical benefits is a dramatic reduction in HIV viral load. HAART induces a sustained effective suppression of HIV replication in most patients and leads to a preservation or restoration of immune function. The restoration of an impaired immune system is assessed by clinical parameters, immunological changes which can be measured in the laboratory and a marked reduction in the morbidity and mortality of patients. To understand the features of immune restoration it is necessary to review the immunopathogenesis of HIV infection and highlight areas where improvement of function occurs with HAART. Southern African Journal of HIV Medicine Vol. 5 (1) 2004: 8-14
Behavioral Characteristics of Adult Patients on Highly Active Antiretroviral Therapy (HAART) in Uganda
Constance Shumba,Ruth Atukunda,Richard Imakit,Peter Memiah
Global Journal of Medicine and Public Health , 2012,
Abstract: Background: Behavioral factors have an impact on patient adherence and treatment outcomes. Specific information on behavioral factors is however minimal at health facilities in resource settings. Such information is vital in helping health facilities to provide targeted interventions. Method: Adherence surveys (n=783) were carried out to assess self-reported condom use, alcohol intake in the past month and disclosure in patients 19 years and above on HAART in 19 HIV clinics. Health workers were trained on how to administer the survey questions. The questions aimed at determining risky behaviors and disclosure of HIV illness. Results: More than half of the patients (59%) do not use condoms in the 19 HIV clinics. 30% reported using condoms always. Most of the patients (79%) on HAART had not taken alcohol in the past one month suggesting that most patients on HAART did not use alcohol. The majority of the patients (99%) disclosed their status with implications for better adherence and increased psychosocial support. Conclusion: It may be important to relate condom use, alcohol intake and disclosure to viral suppression and also advocate for comprehensive positive prevention at the HIV clinics. There is need to carry out an in-depth analysis of alcohol intake among HAART patients. Steps should be taken to address these behavioral issues in support groups and community programs
Correlates of HIV and malaria co-infection in Southern India  [cached]
Bharti Ajay R,Saravanan Shanmugam,Madhavan Vidya,Smith Davey M
Malaria Journal , 2012, DOI: 10.1186/1475-2875-11-306
Abstract: Background Malaria and HIV co-infection adversely impact the outcome of both diseases and previous studies have mostly focused on falciparum malaria. Plasmodium vivax contributes to almost half of the malaria cases in India, but the disease burden of HIV and P. vivax co-infection is unclear. Methods HIV-infected subjects (n=460) were randomly selected from the 4,611 individuals seen at a Voluntary Counseling and Testing Center in Chennai, India between Jan 2 to Dec 31 2008. Malaria testing was performed on stored plasma samples by nested PCR using both genus-specific and species-specific primers and immunochromatography-based rapid diagnostic test for detecting antibodies against Plasmodium falciparum and P. vivax. Results Recent malaria co-infection, defined by the presence of antibodies, was detected in 9.8% (45/460) participants. Plasmodium vivax accounted for majority of the infections (60%) followed by P. falciparum (27%) and mixed infections (13%). Individuals with HIV and malaria co-infection were more likely to be men (p=0.01). Between those with and without malaria, there was no difference in age (p=0.14), CD4+ T-cell counts (p=0.19) or proportion CD4+ T-cell below 200/mL (p=0.51). Conclusions Retrospective testing of stored plasma samples for malaria antibodies can facilitate identification of populations with high rates of co-infection, and in this southern India HIV-infected cohort there was a considerable burden of malaria co-infection, predominantly due to P. vivax. However, the rate of P. falciparum infection was more than 6-fold higher among HIV-infected individuals than what would be expected in the general population in the region. Interestingly, individuals co-infected with malaria and HIV were not more likely to be immunosuppressed than individuals with HIV infection alone.
HIV-1 drug resistance among untreated patients in India: Current status
Pachamuthu Balakrishnan,Shanmugam S,Nagalingeswaran K,Solomon S
Journal of Postgraduate Medicine , 2006,
Abstract: HAART has dramatically improved survival and quality of life among people living with HIV and AIDS globally. However, drug resistant mutations of HIV are a great challenge to the benefits of HAART. Antiviral resistance can be mediated either by changes in the molecular target of therapy (the primary mechanism observed in HIV-1) or in other viral proteins that indirectly interfere with a drug′s activity. Drug resistant mutations easily evolve in the presence of sub-optimal adherence. With the introduction of generic HAART, there has been a steep increase in the number of patients put on HAART in India. It should also be noted that since most patients pay for medications out of their own pockets, interruptions in therapy due to monetary constraints are not uncommon. There is little information on HIV drug resistance in resource constrained settings like India where the predominant circulating HIV-1 sub-type is C. The transmissibility of drug-resistant forms of the virus is also a major concern especially when formulating treatment guidelines. This article reviews published data available on the patterns of HIV-1 drug resistance among treatment naοve in India.
Psychosocial Determinants of Tobacco Use among School Going Adolescents in Delhi, India  [PDF]
Varun Kumar,Richa Talwar,Neelam Roy,Deepak Raut,Saudan Singh
Journal of Addiction , 2014, DOI: 10.1155/2014/170941
Abstract: Background. Tobacco use is one of the major preventable causes of premature death and disease in the world. Many psychosocial factors were found to influence tobacco use. Therefore the present study was designed to determine the role of psychosocial factors associated with tobacco use among school going adolescents in Delhi, India. Methods. Cross-sectional study was conducted from February 2013 to September 2013 in four government schools in South district of Delhi, India. The questionnaire contains questions adapted from GYTS (Global Youth Tobacco Survey) to find the prevalence and pattern of tobacco use among adolescents. Data were analyzed using SPSS version 21. Results. The prevalence of ever and current tobacco use was found in 16.4% and 13.1%. Current smoking and current tobacco chewing were found in 10.2% and 9.4% students, respectively. The risk of current tobacco use was found to be higher among males ( value = 0.000) and in those who got higher pocket money ( value = 0.000). Psychosocial factors like lower general self-efficacy and maladjustments with peers, teachers, and schools were also found to be significant predictors of current tobacco use. Conclusion. The study has revealed higher prevalence of ever and current tobacco use among adolescent students in Delhi, India. 1. Introduction Tobacco use is one of the major preventable causes of premature death and disease in the world [1]. A disproportionate share of the global tobacco burden falls on developing countries, where 84% of 1.3 billion current smokers reside. Nearly 70% of the world’s smokers live in low and middle-income countries [2]. The World Health Organization (WHO) attributes approximately 5 million deaths a year to tobacco. The number is expected to exceed 10 million deaths by 2020, with approximately 70% of these deaths occurring in developing countries [3]. India is the second largest consumer of tobacco in the world. The tobacco situation in India is unique because of a vast spectrum of tobacco products available for smoking as well as smokeless use. The early age of initiation underscores the urgent need to intervene and protect this vulnerable group from falling prey to this addiction. In India alone, nearly 1 in 10 adolescents in the age group 13–15?yr have ever smoked cigarettes and almost half of these report initiating tobacco use before 10?yr of age. Addiction to tobacco and harmful nontobacco products by youth is assuming alarming proportion in India [4]. Recent studies have found that tobacco use is increasing among school children in India and a sizeable
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