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Clinical characteristics of psychosis in HIV infection have been described, but there have been limited comparative studies in HIV-endemic low-resource regions.
Aim
To compare clinical characteristics of psychosis in HIV-positive and HIV-negative patients at the main psychiatric referral units in Uganda.
Method
Patients with psychosis were consecutively recruited and completed a standardised demographic questionnaire and psychiatric and laboratory assessments including an HIV test. The Mini International Neuropsychiatric Interview was used to diagnose psychiatric illness. Psychosis symptoms were compared between HIV-positive and HIV-negative individuals using bivariate methods. A logistic regression model was used to assess the effects of age, gender and HIV status on different types of psychosis.
Results
There were 478 patients enrolled, of which 156 were HIV positive and 322 were HIV negative. The mean age was 33.2 years (95% CI 31.8–34.5) for the HIV-positive group and 29.6 years (95% CI 28.7–30.5) for the HIV-negative group (P < 0.001). Female patients had a higher proportion of seropositivity 40.6% (95% CI 34.8–46.4) compared with males 21.8% (95% CI 16.1–27.5) (P < 0.001). Psychotic disorder not otherwise specified occurred more in the HIV-positive individuals (88% (95% CI 82.9–93.1) v. 12% (95% CI 8.4–15.5), P < 0.001). Motor activity, irritability, emotional withdrawal, feelings of guilt, mannerisms and posturing, grandiosity, suspiciousness, unusual thoughts, blunted affect, excitement and disorientation were associated with HIV seropositivity.
Conclusion
The presentation of psychosis in patients with HIV is unique to this HIV endemic setting. Characterisation of the symptomatology of patients presenting with psychosis is important for proper diagnosis and care.
The prevalence of poor linear growth among African children with perinatally acquired HIV remains high. There is concern that poor linear growth may to lead to later total and central fat deposition and associated non-communicable disease risks. We investigated associations between height-for-age Z score (HAZ) and total and regional fat and lean mass measured by dual-energy X-ray absorptiometry, expressed as internal population Z scores, among 839 Zimbabwean and Zambian perinatally HIV-infected male and female adolescents aged 11–19 years. Stunting (HAZ < –2) was present in 37 % of males and 23 % of females. HAZ was strongly positively associated with total, trunk, arm and leg fat mass and lean mass Z scores, in analyses controlling for pubertal stage, socio-economic status and HIV viral load. Associations of linear growth with lean mass were stronger than those with fat outcomes; associations with total and regional fat were similar, indicating no preferential central fat deposition. There was no evidence that age of starting antiretroviral therapy was associated with HAZ or body composition. Non-suppressed HIV viral load was associated with lower lean but not fat mass. The results do not support the hypothesis that poor linear growth or stunting are risk factors for later total or central fat deposition. Rather, increased linear growth primarily benefits lean mass but also promotes fat mass, both consistent with larger body size. Nutritional and/or HIV infection control programmes need to address the high prevalence of stunting among perinatally HIV-infected children in order to mitigate constraints on the accretion of lean and fat mass.
This chapter charts the processes by which deceptive sex came to be regarded as potentially constituting rape. Through tracing these developments, the chapter shows how doctrinal features of the law, such as the way consent and deception are thought to be related and the modes of deception punished by law, were important to this process. Yet the chapter also argues that to fully appreciate how and why the changes occurred, it is necessary to pay attention to the array of interests the law has sought to protect and how these have shaped the range of topics of deception that might ground a charge of rape. This argument leads to the conclusion that, in the context of deceptive sex, deception has not been considered wrongful because it invalidates or precludes consent, as is commonly thought; rather, deception has invalidated or precluded consent because it has sometimes been considered wrongful. The chapter ends by introducing some reasons why this insight is important to ongoing debates regarding the criminalisation of deceptive sex.
This chapter summarises the overarching narrative of this book and argues that as was as being intrinsically valuable it can inform contemporary debates about using law to regulate the practices of inducing intimacy. The discussion is organised around three sets of issues: the public and private dimensions of sex and intimate relationships, including the interests protected by law, the form of response (i.e., state or non-state), and the variety of legal response (i.e., public or private); the structure of legal responses, the meaning of consent and its relation to deception, targeted modes of deception, culpability matters, the requirement for a causal link between deception and ‘outcome’, and the temporalities of the legal wrong; and the substance of deceptions, including the dynamics governing the range of topics about which transparency has been expected. Drawing the discussion together, the chapter concludes by offering a new framework for constructing legal responses to deceptively induced intimacy, which builds on the core insight and these responses have historically been predicated on temporally sensitive associations between self-construction and intimacy.
This chapter shows that a series of public policies have the potential to boost citizens’ perspectives for finding work and thereby foster incentives for peace. The first prominent policy is to invest in education. A more educated population generates countless benefits, one of which is the prospect of obtaining better jobs. Fundamentally, more meaningful employment raises the opportunity cost of giving up paid work to join an armed rebellion. Furthermore, physical capital (money) can more easily be stolen than human capital (knowledge). Hence, investing cash in building classrooms means that trying to topple the state will become less lucrative. Next, it is spelled out how better health leads to both a longer time horizon and a higher opportunity cost of conflict. This, in turn, makes long-run (peaceful) investments more appealing and reduces the scope for short-term appropriation and looting. Finally, a series of labor market policies are assessed, stressing the role of good jobs in making it less attractive to leave work and go to war. Empirical evidence from a variety of contexts is presented.
, During the 1980s and early 1990s, as the HIV/AIDS epidemic swept the country, thousands of gay men and lesbians perished from AIDS-related infections. Their same-sex partners quickly discovered that they had no rights because the law did not recognize their relationships. Advocates consequently pressed municipalities to adopt domestic partnership programs, a concept that originated in union efforts to secure benefits for unmarried partners. In the 1980s, cities, towns, and counties around the country began offering both health benefits to their employees as well as registries where all couples could record their commitment. The total number of these programs were small, and the rights they offered were limited. However, they helped produce new debates over the nature and meaning of family. They also inspired queer workers in the private sector to demand domestic partnership benefits from their employers. By the mid-1990s, domestic partnership benefits had become a mainstay of corporate America.
Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) prevalence is expected to increase in East Africa as treatment coverage increases, survival improves, and this population ages. This study aimed to better understand the current cognitive phenotype of this newly emergent population of older combination antiretroviral therapy (cART)-treated people living with HIV (PLWH), in which current screening measures lack accuracy. This will facilitate the refinement of HAND cognitive screening tools for this setting.
Method:
This is a secondary analysis of 253 PLWH aged ≥50 years receiving standard government HIV clinic follow-up in Kilimanjaro, Tanzania. They were evaluated with a detailed locally normed low-literacy neuropsychological battery annually on three occasions and a consensus panel diagnosis of HAND by Frascati criteria based on clinical evaluation and collateral history.
Results:
Tests of verbal learning and memory, categorical verbal fluency, visual memory, and visuoconstruction had an area under the receiver operating characteristic curve >0.7 for symptomatic HAND (s-HAND) (0.70–0.72; p < 0.001 for all tests). Tests of visual memory, verbal learning with delayed recall and recognition memory, psychomotor speed, language comprehension, and categorical verbal fluency were independently associated with s-HAND in a logistic mixed effects model (p < 0.01 for all). Neuropsychological impairments varied by educational background.
Conclusions:
A broad range of cognitive domains are affected in older, well-controlled, East African PLWH, including those not captured in widely used screening measures. It is possible that educational background affects the observed cognitive impairments in this setting. Future screening measures for similar populations should consider assessment of visual memory, verbal learning, language comprehension, and executive and motor function.
Sexually transmitted infections (STIs), along with sexual health and behaviour, have received little attention in schizophrenia patients.
Aims
To systematically review and meta-analytically characterise the prevalence of STIs and sexual risk behaviours among schizophrenia patients.
Method
Web of Science, PubMed, BIOSIS, KCI-Korean Journal Database, MEDLINE, Russian Science Citation Index, SciELO and Cochrane Central Register were systematically searched from inception to 6 July 2023. Studies reporting on the prevalence or odds ratio of any STI or any outcome related to sexual risk behaviours among schizophrenia samples were included. PRISMA/MOOSE-compliant (CRD42023443602) random-effects meta-analyses were used for the selected outcomes. Q-statistics, I2 index, sensitivity analyses and meta-regressions were used. Study quality and publication bias were assessed.
Results
Forty-eight studies (N = 2 459 456) reporting on STI prevalence (including 15 allowing for calculation of an odds ratio) and 33 studies (N = 4255) reporting on sexual risk behaviours were included. Schizophrenia samples showed a high prevalence of STIs and higher risks of HIV (odds ratio = 2.11; 95% CI 1.23–3.63), hepatitis C virus (HCV, odds ratio = 4.54; 95% CI 2.15–961) and hepatitis B virus (HBV; odds ratio = 2.42; 95% CI 1.95–3.01) infections than healthy controls. HIV prevalence was higher in Africa compared with other continents and in in-patient (rather than out-patient) settings. Finally, 37.7% (95% CI 31.5–44.4%) of patients were sexually active; 35.0% (95% CI 6.6–59.3%) reported consistent condom use, and 55.3% (95% CI 25.0–82.4%) maintained unprotected sexual relationships.
Conclusions
Schizophrenia patients have high prevalence of STIs, with several-fold increased risks of HIV, HBV and HCV infection compared with the general population. Sexual health must be considered as an integral component of care.
This chapter details the epidemiology, route of spread, prevalence, incubation period and at-risk groups relating to HIV. It gives information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.
This chapter provides details of the viruses and other organisms that are more severe in immunocompromised patients (HIV, CMV, EBV, HSV, VZV, HHV6, HHV7, HHV8, adenoviruses, influenzaviruses, parainfluenzaviruses, RSV, SARS-CoV-2, HBV, HEV, polyomaviruses, papillomaviruses, parvovirus, T gondii). It gives details of symptoms, diagnosis, treatment and strategies for reducing the risk of severe symptoms.
This chapter details the epidemiology, route of spread, symptoms and prevalence, relating to viral infections acquired while abroad (HBV, HAV, HEV, HIV, noroviruses, dengue fever, arboviruses, haemorrhagic fever viruses, rabies).
This chapter provides an overview of the antiviral drugs currently available, including maraviroc, aciclovir, penciclovir, ganciclovir, amantadine, zydovudine, adefovir, ribavirin, indinavir , oseltamivir, zanamivir, interferon alpha, rituximab , palivizumab, cidofovir, brincidofovir, foscarnet, remdesivir and paxlovid with an indication of their modes of action for treating virus infections, including HIV, herpes viruses, respiratory viruses, HBV, HCV, CMV, adenoviruses , BK, EBV (especially for PTLD), RSV, poxviruses and SARS-CoV-2.
This chapter deals with Occupational Health and how to protect healthcare workers from acquiring infections (e.g. HAV, HBV, HIV, HCV, VZV, influenza, Covid-19, measles, mumps, rubella, polio, TB, diphtheria, meningococcal infection and tetanus) while at work. It describes how healthcare workers can be protected by providing pre-exposure vaccinations and post-exposure treatments, as well as discussing responses to outbreaks and routes of infection.
This chapter details to genital tract and sexually transmitted infections (HSV, VZV, Treponema pallidum, papillomaviruses, poxviruses, HIV, HBV, C. trachomatis, LGV). It gives information on symptoms, laboratory diagnosis, management, treatment, prophylaxis and infection control.
This chapter details the organisms causing congenital and neonatal infections in infants born to mothers with infection in pregnancy (rubella, CMV, T gondii, parvovirus B19, VZV, zikavirus, T pallidum, HIV, HBV, HCV, HTLV1, HSV and C trachomatis). It details the route of spread, symptoms, laboratory diagnosis and treatment.
This chapter deals with public health and pandemic preparedness. It recognises the five stages of a new pandemic (detection, assessment, treatment, escalation and recovery). The chapter also deals with the issue of laboratory preparedness and the need to maintain a critical mass of laboratory and skilled staff expertise at all times in order to be able to respond rapidly and effectively to a new emerging pandemic.
Health and science diplomacy is the activity of deploying international cooperation in the service of science and public health, and using global health and science efforts to achieve foreign-policy goals. As a bridge between the scientific community and decision-makers in government, a science or health diplomat must understand the work of both and, ideally, how they think. Scientists see a pattern or anomaly in nature and try to gather data and evidence to explain it. They publish their findings in peer-reviewed scientific journals. But those findings also have to be packaged and communicated to nonscientists, because the data rarely speaks for itself. This is where science diplomats come in. They need to understand the evidence and incorporate it into persuasive arguments that can influence policymakers to elevate the potential threat as a priority and take action.
Migrants in Europe face a disproportionate burden of HIV infection; however, it remains unclear if this can be prevented through public health interventions in host countries. We undertake a systematic review and meta-analysis to estimate post-migration HIV acquisition (PMHA) as a proportion of all HIV cases in European migrants. MEDLINE, EMBASE, Global Health, HMIC, and Cochrane Library were searched with terms capturing ‘HIV’, ‘migration’, and ‘Europe’. Data relating to the proportion of HIV acquired following migration were extracted and random-effects model (REM) meta-analysis was undertaken to calculate a pooled estimate for the proportion of PMHA in European countries. Subgroup meta-analysis was undertaken for PMHA by migrant demographic characteristics and host country. Fifteen articles were included for systematic review following retrieval and screening of 2,320 articles. A total of 47,182 migrants in 11 European countries were included in REM meta-analysis, showing an overall PMHA proportion of 0.30 (95% CI: 0.23–0.38). Subgroup analysis showed no significant difference in PMHA between host country and migrant demographic characteristics. This work illustrates that migrants continue to be at high risk of HIV acquisition in Europe. This indicates the need for targeted screening and HIV prevention interventions, ensuring resources are appropriately directed to combat the spread of HIV.
Mental health conditions among people living with HIV (PLWH) are important to address as they adversely affect quality of life, impede adherence to HIV treatment and increase mortality. Planning for integrating mental health care in resource-limited HIV care settings requires substantial effort. Learning networks are a useful way to exchange knowledge between countries about best and current practices in planning mental health care for PLWH. This paper describes the launch of a mental health learning network within a global health implementing center and the lessons learned across participating members from six countries: the United States, Jamaica, Trinidad and Tobago, Zimbabwe, Malawi and India. Lessons learned from the learning network sessions spanned four broad domains: (i) the need for routine and integrated mental health data collection, (ii) developing standardized protocols to implement mental health care, (iii) adequate training and supervision of health care staff and (iv) prioritization of mental health care integration by program funders. We find that time and resource constraints can be barriers to shared leadership and sustainability of learning networks. Prioritizing learning networks as an important component of integrated HIV and mental health care programs is one of the potential strategies to ensure long-term continuity.
The potency of a vaccine against cancer-causing HPV – and the body’s ability to clear it – offers many women a fighting chance. But extinguishing this source of cervical cancer overlooks another sexually transmitted virus that’s been raging around the globe for decades: the human immunodeficiency virus (HIV). The lethal effects of HPV mixed with HIV can be like setting gasoline on fire. HPV infections in HIV-positive women last longer, progress more quickly, recur more frequently, and are harder to eradicate. Cervical cancer in HIV-positive women – many of them in lower-income countries – strikes younger, is more aggressive, and harder to cure. Women with HIV are six times more likely to die of cervical cancer. They face a particular threat in Africa, home to two-thirds of the world’s 40 million HIV cases. Without a concerted effort to overcome the dual stigma of HIV and HPV through education, appropriate medical care to all persons with cervixes, and a means to address the vulnerability of the continent’s child brides, Africa will remain at the core of the HIV-HPV inferno – undermining the quest for global cervical cancer elimination.