IntroductionCurrently, many young people living with perinatally-acquired HIV (YPHIV) are adults. Living with HIV and chronic use of antiretroviral medication might increase the risk of metabolic and cardiovascular diseases and affect the physical fitness of individuals. This study assessed muscle strength and functional exercise capacity in YPHIV patients in Thailand. MethodsThe cross-sectional study was conducted at Chiang Mai University. Inclusion criteria were 1) YPHIV aged 16-30 years, 2) having perinatal HIV infection, and 3) receiving antiretroviral treatment and being clinically healthy. Those with active concurrent illnesses or physical disabilities were excluded. Anthometric measurements were performed, and data were collected using self-administered questionnaires. Handgrip strength was measured using a digital handgrip dynamometer (TKK 5401; Takei, Japan), with Korean reference ranges used. The six-minute walk test (6MWT) was performed to assess functional exercise capacity. The regression equation from a Singaporean study was adopted to calculate predicted values. ResultsThirty-four YPHIV were included; 19 (56%) were female. Their median age was 23.5 years (interquartile range, IQR 19.8, 26.6), and their median body mass index was 21.7 kg/m2 (IQR 18.6, 24.2). The median handgrip strength was 23.8 kilograms (IQR 20.8, 30.3) in females and 33.6 kilograms (IQR 26.1, 40.2) in males. There were 10 (29%) participants with suboptimal handgrip strength and 1 (2.9%) with low handgrip strength. The median 6-minute walk distances were 489 meters (IQR 447, 523) in females and 536 meters (IQR 485, 568) in males. 6 participants (18%) had walking distances < 10% of their predicted values. DiscussionIt was demonstrated that around two-thirds of YPHIV had optimal muscle strength, as most of them were found to have good physical fitness. Suboptimal strength in some participants could be related to HIV and its treatment, as well as other social factors. As low muscle strength was identified as a marker of cardiovascular risk and related to metabolic syndrome, YPHIV could benefit from age-appropriate exercise to minimize long-term health consequences. ConclusionDespite being clinically healthy and having good physical fitness, nearly one-third of YPHIV had suboptimal muscle strength for their age and gender. Physical activities and muscle-strengthening exercises should be encouraged.
Introduction Studies reveal that condomless sex is more common among sex workers with casual and steady partners than with commercial partners. There is limited research explaining condom use among sex workers with non-commercial casual partners. Therefore, this study aims to identify predictors of condom use among sex workers with non-commercial casual partners using an extended Information-Motivation-Behavioral Skills (IMB) model. Methods The research was conducted using a cross-sectional online survey between March and October 2022. Non-commercial casual partners were defined as sexual relationships without long-term commitments, including one-night stands, affairs, anonymous encounters, friends with benefits, and similar arrangements. Eligible participants were aged 16 or older, living in Switzerland, and had received money or gifts for sexual services in the past 12 months. The data were collected via a self-administered online questionnaire, developed in collaboration with partners of Non-Governmental Organizations (NGOs), pretested twice, and available in 11 languages. Recruitment was supported by local NGOs through advertising, social media, and outreach at sex worker drop-in centers, with options for independent completion or computer-assisted interviews. Using validated instruments, the researchers measured condom use frequency during vaginal or anal sex with non-commercial casual partners in the past 12 months and the variables of the extended IMB model. The convenience sample consisted of 386 sex workers (265 cisgender women, 82 cisgender men, 39 transgender) who had vaginal or anal sex with at least one non-commercial casual partner within the 12 months before the survey. Fifty-six percent were heterosexual, 16.3% were homosexual, and 14.8% were bisexual. Approximately 31% were migrants from HIV high-prevalence countries. Structural Equation Modeling (AMOS) was used to analyze predictors of condom use. Results Fifty-seven percent of the sex workers always used condoms when having sex with non-commercial casual partners. Higher condom use was associated with stronger intention to use condoms (β = 0.28, p < 0.001), more positive attitudes toward condoms (β = 0.22, p < 0.001), and higher perceived subjective norm supporting condom use (β = 0.12, p < 0.01). Older age (β = 0.11, p < 0.05) was associated with increased condom use frequency, while non-heterosexual orientation (β = −0.11, p < 0.05) and sex-related drug use (β = −0.14, p < 0.01) were associated with decreased condom use frequency. Higher intention to use condoms was associated with older age (β = 0.21, p < 0.001). Intention to use condoms was lower in sex workers with non-heterosexual orientation (β = −0.10, p < 0.05). A more positive attitude towards condoms was observed among cisgender females (β = 0.13, p < 0.05) and among sex workers with a higher level of education (β = 0.14, p < 0.01). Attitude was more negative in non-heterosexual sex workers (β = −0.20, p < 0.001). Greater experiences of sex worker-related discrimination were associated with more negative attitudes (β = −0.13, p < 0.01). Sex workers in committed relationships had a more positive subjective norm for condom use (β = 0.11, p < 0.05). Experiences of sex-work-related discrimination (β = 0.13, p < 0.01) and a suicide attempt in the last 12 months (β = 0.14, p < 0.01) were associated with more frequent sex-related drug use and a higher likelihood of having attempted suicide more often. The explained variance for condom use was 30%. Discussion Psychosocial factors, particularly intention, attitude, and subjective norm, emerged as crucial to condom use among sex workers, whereas information and behavioral skills had no effect. Lower condom use was observed among non-heterosexual and younger sex workers who engaged in sex-related drug use. The latter was more prevalent among younger, well-educated, cisgender male and transgender sex workers and was positively associated with discrimination experiences and suicide attempts. These findings underscore the intersecting vulnerabilities related to gender identity, sexual orientation, discrimination, and mental health. Nevertheless, the findings must be interpreted with caution, given the cross-sectional design, self-reported data, and limited generalizability due to convenience sampling. The unexplained variance suggests the presence of additional influences such as condom negotiation and power dynamics with non-commercial casual partners, which require further investigation through qualitative research. Conclusion The extended IMB model offers significant insights into condom use behavior among sex workers who have sex with non-commercial casual partners. Interventions should aim to strengthen intention and positive attitudes toward condoms, challenge prevailing discrimination, and address co-occurring issues such as sex-related drug use and mental health, with a focus on tailoring these interventions to diverse genders.
Introduction This study aimed to improve the attendance of people living with HIV (PLHIV) in the Risk of Treatment Failure (ROTF) support group via quality improvement initiatives at Delft Community Health Center, Western Cape, in South Africa. Methods A quality improvement approach (QI) was employed. The “five whys framework” was used to identify the root cause of low attendance of PLHIV in the ROTF support group. Plan–do–study–act (PDSA) cycles were conducted, and measures were set to monitor project outcomes. The project started with a baseline analysis with stakeholders to identify root causes and drivers of change. We implemented the required changes with continuous engagement of QI teams and PLHIV members. Results The number of PLHIV attendees in the ROTF support group increased with the implementation of the QI intervention, from non-attendance at baseline to improved attendance over subsequent months. One month after the QI intervention started in April 2023, 30% of the participants (3) attended the ROTF support group, and the number increased to five (100%) in the next month. It increased to thirteen in June 2023 (100%), and 19 attended the ROTF support group meeting in the final session. Three ROTF support group members attained the required VL suppression levels and graduated from the program. Discussion This QI project shows that structured, low-cost QI approaches can substantially improve attendance of people living with HIV in ROTF adherence support groups. Using the five whys framework to identify root causes and iterative PDSA cycles to address them led to improvements in participation, increasing from non-attendance at baseline to improved attendance within three months. Enhanced engagement was accompanied by meaningful clinical gains, including viral load suppression and graduation of three participants from the programme. These findings highlight the effectiveness of simple QI methods in strengthening adherence support and improving outcomes in resource-constrained primary healthcare settings when patient engagement, frontline involvement, and leadership support are prioritized. As a limitation, the study's small sample size and short study period make it difficult to ascertain clinical outcomes. Continuous quality improvement, scaled up with a larger sample size, could help to better ascertain clinical outcomes. Conclusion This study highlights the use of quality improvement approaches that improved PLHIV attendance in the ROTF adherence support group. Health and health outcomes can improve even in resource-constrained settings by optimally allocating available resources and adapting and adopting simple measures. The attendance of PLHIV in the ROTF adherence support group improved with the use of QI practices. Training in QI concepts and principles, as well as project implementation, is recommended to ensure QI sustainability through a robust methodology, skilled support structures, prioritization, and leadership involvement.
IntroductionOral Pre-Exposure Prophylaxis (PrEP) effectively prevents HIV in women, especially adolescent girls and young women. However, the COVID-19 lockdown disrupted access to healthcare services, impacting PrEP outcomes. MethodsThis study analyses data from the TB/HIV Care program in the Dr. Kenneth Kaunda District, North-West Province, South Africa, from December 2018 to December 2021. It evaluates changes in PrEP initiation, uptake, and adherence among women aged 16 and older, comparing the pre-pandemic (December 2018 to February 2020) and pandemic (March 2020 to December 2021) periods using Bayesian regression models. ResultsA total of 1,339 women engaged in transactional sex were counselled about PrEP services, with 776 initiating treatments at an average age of 33. Pre- lockdown trends in PrEP initiation were disrupted during the lockdown, exhibiting subsequent changes. Although there was no significant increase in PrEP uptake among clients tested within a month, a modest, statistically significant upward trend was observed over time. DiscussionThe initiation and adherence to PrEP decreased despite innovative interventions implemented during lockdowns. Although there was a slight improvement in uptake after the lockdown, the interventions had a limited effect. These findings highlight the necessity for resilient health system structures and recognize the limitations posed by pandemic-related disruptions that may have hindered implementation and measurement efforts. ConclusionThe study highlighted decreased initiation, uptake, and adherence to PrEP during the COVID-19 lockdown, emphasising the need for innovative strategies to enhance HIV control and prepare for potential future pandemics.
Introduction The study aimed to assess knowledge and perceptions regarding HIV/AIDS among adults in Saudi Arabia's Eastern Province, a region with a rising HIV burden and documented gaps in public awareness. Methods A cross-sectional study was conducted from March to July 2024 using anonymous online and paper-based questionnaires targeting residents aged 18–80 years in the Eastern Province. Convenience sampling recruited participants from community centers, public spaces, and social media platforms. The 21-item questionnaire assessed demographics and knowledge of HIV transmission, diagnosis, and treatment. Data were analyzed using descriptive statistics and Chi-square or Fisher's exact tests, with p ≤0.05 considered statistically significant. Results A total of 984 participants were included, predominantly female (61.0%) and Saudi nationals (85.4%), with 64.7% having postsecondary education. Most recognized sexual transmission (92.7%), availability of confidential diagnostic methods (94.2%), and that HIV can be controlled with treatment (84.6%). Misconceptions persisted, with 25.7% believing HIV is transmitted through casual contact and 27.7% through sharing public restrooms, and several perceptions showed significant associations with age, gender, education, nationality, marital status, and healthcare work status. Discussion Findings show high overall awareness but important misconceptions that may perpetuate stigma and hinder prevention, particularly among younger, less educated, and non-healthcare groups. Conclusion Targeted, culturally sensitive educational interventions, with a focus on younger and less educated populations and the active involvement of healthcare professionals as key educators, are needed to strengthen HIV prevention efforts and support national public health goals.
