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142 Cards in this Set
- Front
- Back
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In 2014, what % of babies born to HIV+ women in Canada were HIV+? |
<2% |
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About how many babies were born with HIV in 2014 worldwide? |
More than 200,000 |
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In 2014, approximately what % of people had access to HIV treatment? |
60% |
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What is the leading cause of HIV infection in Russia? |
Sharing drug-related equipment |
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How many times/day does HIV reproduce in the body? |
10 billion to 1 trillion times per day |
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Approx how many HIV infections occur in the USA every day? |
110 |
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How long does it take from time of HIV infection to detection by HIV test? |
3-12 weeks |
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In which American state is the saliva ofa person living with HIV considered by lawto be a “deadly weapon”? |
Texas |
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Approximately how many people are living with HIV today? How many new infections per year? How many deaths per year? (2011) |
31 million; 2.5 million; 1.7 million |
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What % of infected individuals live in SSA? what % of new infections occur in SSA? |
69%; 72% |
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Name the bodily fluids which transmit HIV? |
1. Blood |
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What are the main pathways of transmission? |
1. Sex (vaginal, anal, oral) 2. Contaminated needles 3. Perinatally - MTCT (pregnancy, labour/delivery, breastfeeding) 4. Blood Transfusion |
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What determines an AIDS diagnosis? |
1. Diagnosis with an AIDS-defining cancer or other illness 2.CD4 count below 200 cells per cubic mm of blood |
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What is the most common method of testing for HIV? |
ELISA Test - tests for antibodies, which begin to present between 3-12 weeks after initial infection -Most contagious during this period where HIV antibodies are not present |
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What is seroconversion illness? |
Brief, flu-like symptoms following initial HIV infection as a result of immune system's first response. Nearly half of all patients experience this. |
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What are the most vulnerable populations to HIV infection? |
1. People in endemic countries of SSA 2. MSM 3. Sex workers 4. IDU 5. Indigenous people in Canada 6. Incarcerated populations |
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What are the 4 main positive effects of ART? |
1. Viral load is suppressed 2. Decrease in associated illness 3. Lifespan increased 4. Transmission risk decreased to non-zero |
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Describe the four steps of how HIV enters cells. |
1. The GP120 envelope protein binds to the CD4 molecule 2. V3 loops of GP120 binds to co-receptor 3. Binding of virus to cell surface results in fusion of viral envelope with cell membrane 4. Viral core is released into cell cytoplasm |
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What are the 9 steps of the HIV life cycle? |
1. Free virus circulates in blood 2. HIV attached to CD4+ T-cell via GP120 envelope protein 3. HIV empties its content into cell 4. Reverse transcriptase translates HIV RNA to DNA 5. HIV DNA is inserted into the cell's chromosome by HIV integrase 6. When infected cell reproduced, it activates HIV DNA, producing new virion material 7. New material comes together to form baby virions 8. Immature virion buds off from cell (taking some membrane with it) 9. Further assembly and maturation occurs outside the host cell using protease - virus is now infectious |
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How many virions are produced daily and what is the life span of each virion? |
10 billion, 6 hours |
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What is viral load? |
1. Marker of HIV replication rate 2. # of HIV RNA copies/cubic mm of plasma |
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What is CD4 count? |
1. Marker of immunologic damage 2. # of CD4 T-lymphocytes/cubic mm of plasma |
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Draw the natural history of HIV within the body. |
Y axis - amount of CD4 and viral load X axis - time (start with up to 12 weeks and then go to year) 2. Then they reverse, VL falls below CD 4 count 3. CD 4 declines gradually and viral load spikes gradulally 4. Eventually CD 4 is 0 and viral load massively spikes (AIDS/Death) |
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What are the 4 stages of the natural history of HIV within the body. |
1. Primary infection/seroconversion (acute seroconversion illness, antibody development) 2. Clinical latency (asymptomatic, virus controlled by immune system) 3. Constitutional Symptoms (opportunistic infections start) 4. AIDS (CD4 < 200 cells per cubic mm, AIDS-defining illness) |
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Name 3 opportunistic infections. |
1. Toxoplasmosis 2. Thrush 3. Histoplasmosis |
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Describe some of the characteristics of AZT, early HIV treatment. |
1. Eventual viral resistance and spike in viral load 2. Reverse transcriptase inhibitor 3. Lots of side effects (anemia, cardiomyopathy, lipodystrophy) |
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Describe some of the characteristics of ART, today's HIV treatment. |
1. Restores immune function 2. Requires high adherence 3. Effects multiple stages of HIV life cycle, fusion, reverse transcription, integration with DNA, virion construction 4. Huge reduction in viral load to non-transmissible levels |
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What is the concept of 90/90/90 |
1. 90% of people with HIV knowing their status 2. 90% of diagnosed on treatment 3. 90% on treatment with suppressed viral load |
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What are the 6 points in the Cascade of Care? |
1. Prevent new HIV infections 2. Identify those infected 3. Link infected to care 4. Retain infected in care 5. Treat with ART 6. Suppress viral load |
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List 5 barriers to TESTING. |
1. Unaware of individual risk 2. Vulnerable populations at greater risk 3. Limited access to testing 4. Refusal to test due to denial or stigma 5. Provider practice - risk-based vs routine testing |
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List 4 barriers to LINKAGE/RETENTION in care. |
1. Limited access to HIV-related care services 2. Self-efficacy (substance use, homelessness, mental illness) 3. Experienced or anticipated stigma 4. Mistrust of healthcare system |
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List 5 barriers to ACCESSING TREATMENT. |
1. Limited access based on availability/cost 2. Limited treatment literacy 3. Fear/experience of side effects 4. Provider attitudes about initiation 5. Lifetime commitment |
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List 8 barriers to ART ADHERENCE/VIRAL LOAD SUPPRESSION. |
1. Availability of ART 2. Unstable lifestyle 3. Side effects + pill burden 4. Disclosure worries + stigma 5. Constant reminder of illness 6. Self-efficacy + health literacy 7. Gender 8. Limited adherence support system |
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How do people who inject drugs do with adherence? |
People who inject drugs have significantly lower adherence. However, male injectors have about the same rate of adherence as women who do not inject. In general, women have a harder time with adherence. |
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Describe some characteristics of HIV in Canadian aboriginals. |
1. 4 x more likely to get infected 2. Highest prevalence in Saskatchewan (11/100,000) 3. Super high prevalence on reserves (63/100,000) |
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What are the 5 pillars of combination prevention? |
1. Biomedical interventions (circumcision, microbicides, vaccines) 2. Structural interventions (micro-credit programs to pull people out of poverty) 3. Community interventions (HIV counselling) 4. Individual and small group behavioural interventions (harm-reduction strategies with IDU) 5. HIV testing and linkage to care |
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What is the difference between efficacy and effectiveness? |
Efficacy = how well a product works under ideal conditions Effectiveness = how well a product works in practice |
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What are the two main functions of antibodies? |
1. Neutralize pathogens 2. Tag pathogens for destruction by the immune system |
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What do T-cells do? |
Recognize and eliminate infected cells via recognition of virally-derived peptide epitopes on cell surface? |
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Why, generally, is it difficult to develop an HIV vaccine? |
Typically, vaccines stimulate the natural immune response that would occur upon infection. In the case of HIV, our natural immune response is not good enough. We've never developed a vaccine that acts better than the host immune system is capable of under ideal conditions. |
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More specifically, what about HIV makes it so difficult to create a vaccine? |
1. Need to stimulate the immune response stronger than it actually is 2. HIV uses immune evasion 3. Escape mutants don't show HIV proteins on infected cells 4. 10 billion virions are produced daily with large amount of mutation |
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Where are we at with an HIV vaccine? (3 points) |
1. Experts agree that an effective HIV vaccine will have to stimulate both antibodies and t-cells 2. It may not be possible to generate a vaccine that provides everyone with immunity 3. Until recently, history of vaccine design has been a lot of failure |
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Prior to ART, what were vertical transmission rates in Canada? |
30-50% (20% difference is due to birthing practices) |
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Which viruses and carriers are the precursors to HIV-1 and HIV-2? |
HIV-1 - SIVcpz - chimpanzees HIV-2 - SIVsm - sooty managbeys (less virulent) *SIV does not cause disease in natural host |
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How old is SIV? |
At least 32,000 years. |
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Describe the serial passage of HIV emergence. |
1. HIV-1 and 2 start as weakly pathogenic - starts as SIV 2. During unsterile injection campaigns, virus is transmitted to many hosts and has the opportunity to evolve pathogenic strains - SIV becomes HIV 3. Pathogenic strains get transmitted around populations by way of sexual transmission |
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What happened with AIDS denialism in South Africa? |
1. President Mbeki believed HIV was not the cause of AIDS 2. Prevented rollout of ART therapy for South Africans during the mid-2000's 3. More than 300,000 people lost their lives as a direct result (includes vertical transmission) 4. No world leaders were willing to speak up and confront Mbeki publicly |
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Globally, how many PLWH are over 50 years old? What % of PLWH are 50+ in low/middle income? |
3.6 million; 10%, 30% |
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What are the three reasons we are seeing a "greying" of the HIV epidemic? |
1. ART increases lifespans 2. Successful prevention aimed at younger people 3. Overlooked risk behaviours among older groups |
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What are some challenges of managing HIV in older individuals? |
1. Distinguishing between normal aging, HIV, and medication side effects 2. Increased co-morbidities/chronic health conditions - increase in non-AIDS-defining cancers 3. Immune function begins to wane, even when HIV is controlled 4. Decreased psychological capacity makes adherence difficult. |
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How does HIV affect cancer incidence? |
1. Immunodeficiency - depletion of CD4 cells 2. Immune senescence - cancer causing viruses are not cleared, laps in immunosurveillance 3. Chronic immune activation/inflammation 4. Confounding - high prevalence of non-HIV risk factors (e.g. smoking rates are higher in people with HIV) |
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What are some other health effects for older PLWH? |
1. Higher incidence of CVD/CAD - more MI 2. Premature bone loss 3. Cognitive impairment (HAND) 4. Decreased psychological well-being -> mental illness 5. Social isolation |
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Which age group of women is most vulnerable to HIV infection? |
Age 15-24. Infection rates are twice as high as men in this age group. 85% of infected women live in SSA (58% of HIV infections are women in SSA). |
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What proportion of Canadian HIV infections are in women? |
22% - disproportionately Indigenous (31% of new cases in Indigenous Canadians). |
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What proportion of new HIV cases in women come from heterosexual sex vs IDU? |
79% and 21% respectively. |
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Describe 3 trends of HIV in BC. |
1. 22% of cases are women 2. 1/4 of people are unaware of their status 3. Both men and women show a decreasing trend in diagnoses since 2004. |
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List 5 women-specific consequences of HIV infection. |
1. Recurrent vaginal yeast infections 2. Pelvic inflammatory disease 3. Genital ulcer disease 4. Abnormalities related to HPV and cervical cancer 5. Early menopause |
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List 5 reasons why women are more physiologically vulnerable to HIV infection. |
1. Mucosal lining of vagina offers a greater surface area than penis. 2. Vagina is more susceptible to small tears during intercourse than penis. 3. Semen has higher concentrations of virus than vaginal secretions. 4. Bacterial infections may increase transmission risk. 5. Cervical ectopy - particularly among young and pregnant women |
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List 8 social/cultural/structural vulnerabilities for women? |
1. Gender-based violence 2. Lack of access to healthcare services 3. Lack of access to education 4. Lack of recognition under law and legal restrictions 5. Intergenerational sex 6. Poverty 7. Lack of negotiating power re safe sex or sexual advances 8. FGM compounds risks |
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How do rates of accessing and adhering to HAART vary between men and women? |
Numerous North American studies show that women access and adhere to HAART at lower rates than men. |
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Name 4 women-specific barriers to HAART access and adherence? |
1. Higher rates of depression 2. Lack of women-centred HIV services 3. Competing demands - children, work, etc. 4. Fear of adverse events (e.g. lipodystrophy) |
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What is the WHO's 4-pronged strategy to PMTCT? |
1. Primary prevention of HIV in serodiscordant parents-to-be 2. Prevention of unwanted pregnancies 3. Prevention of transmission from HIV-infected mother to infant (HAART) 4. Appropriate treatment and care |
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What are the 3 points that HIV can be vertically transmitted? |
1. During gestation 2. During labour/delivery* 3. During breast-feeding |
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What are the rates of MTCT without and with treatment? |
12-45% vs 2% -> difference has to do with birthing practices |
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List 5 interventions to prevent MTCT. |
1. Antenatal HIV testing and counselling 2. ART 3. Formula feeding 4. C-section 5. Avoid procedures during delivery |
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What is the association between injectable hormonal contraceptives and HIV? |
Injectable hormonal contraceptives appear to increase the risk of HIV-1 transmission - these risks must be balanced with risks of unplanned pregnancy. Strategies to improve access to other methods of female-controlled contraception should be investigated. |
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What 3 forces of population dynamics result in an increased risk of HIV for MSM? |
1. Smaller Networks - only so many people that you can choose to sleep with 2. Fewer Inactive Dyads - MSM don't get married as often - for legal or other reasons 3. Overlapping social and sexual networks - instead of dating someone outside your circle, and being cautious, you tend to date people within your network, who you inherently trust more - which is actually a bad idea |
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What is a "concentrated epidemic"? |
An epidemic that is predominantly found in specific groups i.e. IDU, MSM, Canadian Indigenous |
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The paper on injection drug use challenged what common assumption? |
That drug resistance will develop if people whose illicit drugs access ART due to their inability to adhere to therapy. Found this not to be true. |
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What sparked the HIV epidemic among PWID in Vancouver? |
Increased availability of affordable cocaine -> increased # of injections/day - > increased number of shared needles |
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In what 3 ways can lawyers help PLWH? |
1. Argue for medical care in custody for people who use illicit drugs 2. Provide help in attaining stable housing 3. Challenge the surveillance of needle exchange sites |
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What is the main reason that women are more likely to test than men? |
They are engage in pre and peri natal care - no other reason. |
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Why are women at a greater risk of acquiring HIV compared to men? |
Women experience greater physiological vulnerability due to changing hormone levels which trigger immune responses and lead to inflammation. |
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In 2011, what %of PLWH did NOT know their serostatus? |
55% |
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According to MANCOUNT, what were the common reasons that MSM did not get tested for HIV? |
1. Perceived low risk 2. Procrastination 3. Consistent safety |
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When is HIV the MOST infectious? |
During the window period (more infectious than immediately after transmission). |
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What are 3 characteristics of Duesberg's hypothesis on the origin and nature of HIV? |
1. AIDS in contagious and caused by one conventional microbe or virus 2. HIV is a harmless retrovirus that just happens to be found in high risk groups 3. AIDS is caused by pathogenic factors associated with IDU, malnutrition and homosexual promiscuity |
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How EFFECTIVE are condoms and why? |
Condoms are only 69% effective due to adherence issues. |
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What is genderqueer? |
Having a fluid gender identity. Might identify as neither man, nor woman, or as both! |
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How did the Tuskegee study recruit/maintain study participation? |
Connected with prominent black community members and churches. |
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Name 4 ways to address the risk environment of sex workers in BC. |
1. Setting agreed upon practices and prices with peers 2. Establishing areas in which sex work is practiced 3. Decriminalizing sex work 4. Providing stable housing |
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Describe two regional context for IDU and HIV vulnerability? |
1. New Zealand has a low HIV risk due to geographic isolation - low amount of drugs trafficked in, small amount of people coming and going 2. SSA may be at risk of developing IDU subpopulations due to drug trades routes to Europe |
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Name 4 principles of CBPR. |
1. The community is the unit of identity 2. Research partnership is not associated with a single study 3. Power is shared by all members/stakeholders 4. Focus on developing and reinforcing community strengths and resources 6. Links community needs with academic research interests 7. Products of research are shared by partners |
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List 4 biomedical intervention strategies for HIV prevention. |
1. Condoms 2. Male circumcision 3. ART 4. STI testing and treatment |
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List 4 areas of research for promoting engagement in care among PLWH. |
1. Improve doctor-patient relationships 2. Mental health care 3. Address HIV-related stigma 4. Text messaging/mobile tools |
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Name the two psychological comorbidities identified among PLWH in the US. |
1. Depression 2. PTSD |
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What is the prevalence of HIV in sex workers in low and middle income countries? |
Approximately 12% (14% in men). In 16 countries in SSA, prevalence was more than 37% among sex workers. |
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List 4 reasons for the increased HIV vulnerability among sex workers. |
1. Violence (decreased ability to negotiate condoms) 2. Criminalization (fear of carrying condoms or accessing services) 3. Stigma/Discrimination (fear of accessing services, provider discrimnation) 4. Lack of services and funding (many countries expect sex workers to access care through general settings, where they may not feel comfortable) |
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What were the three primary goals of the Sonagachi Project? |
1. Establish economic independence 2. Combat stigma 3. Increase physical safety |
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What are the 5 strategies of Sonagachi? |
1. Facilitate sense of community among sex workers 2. Increase access and control over material resources (micro-credit, co-op banks) 3. Increase social participation - self-governing org of sex workers 4. Decrease perceived powerlessness - capacity building workshops and seminars 5. Facilitate social acceptance of sex workers by involving society stakeholders |
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What are the 3 best practices of community participation? |
1. Build human and community capacity 2. Promote structural and environmental change 3. Transfer project ownership to community |
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What are some measurable HIV outcomes of the Sonagachi Project? |
1. Increased condom use 2. Increased screening 3. Increased knowledge 4. Decreased incidence and prevalence 5. Decreased violence 6. Decreased stigma |
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How many young people are living with HIV globally? |
5.7 million as of 2001 (majority in SSA). |
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Describe the HIV death rate trends globally for the different categories of youth. |
All groups having falling HIV death rates except for adolescents (10-19). |
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How much more likely are young women who have experienced intimate partner violence to acquire HIV than those who have not? |
50% more likely. |
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Describe the prevention trends among youth in SSA. |
1. Knowledge is low 2. Condom use is low 3. HIV testing is especially low in young men 4. Medical male circumcision may offer a critical opportunity for prevention support |
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How do poverty and family AIDS predict adolescent HIV risks? |
Hunger, community violence and parental HIV/AIDS can lead to: 2. Age-disparate sex 3. Sex using substances 4. Multiple partners 5. Unprotected sex 6. Unwanted pregnancy |
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What are the 6 UNAIDS recommendations for intervention. |
1. Promote biomedical interventions. 2. Develop interventions controlled by women. 3. Create economic opportunity. 4. Foster workplace policies and culture that respects sexual/health rights and reduces stigma 5. Improve access to integrated reproductive health services 6. Recognize and address social norms that make young people highly vulnerable due to gender roles and economic realities |
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What are the 4 critical intervention strategies for early adolescence (10-14)? |
1. Sexuality education 2. Mass media 3. Parent-child communication 4. Strengthening the protective environment |
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What are the 6 critical intervention strategies for older adolescence (15-19)? |
1. Sexuality and reproductive health education 2. Harm reduction and risk reduction - delay onset of first sex, use condoms 3. Mass media + tech 4. Engage young people and community to change social norms 5. Cash transfers to change behaviours 6. Address stigma, discrimination and legal barriers to access |
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What are the three assumptions behind Combination Social Protection? What's an example of an intervention based on this theory? |
1. HIV risk behaviours are influenced by adversities in different domains of an adolescent's life 2. Different sexual behaviours increase HIV-infection risks, but have different causal mechanisms 3. Childhood adversities can cumulate to increase HIV risk behaviours more than single adversities * |
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What are the 4 critical intervention strategies for young adults (20-24)? |
1. Biomedical interventions 2. Condom provision and uptake 3. Sexual + repro health, family planning, PMTCT 4. Reach young people in the workplace |
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What are the 4 critical intervention strategies for young people living with HIV? |
1. Increase opportunities for early diagnosis 2. Greater involvement of young people living w HIV 3. Provide support for adherence, disclosure and elimination of stigma 4. Expand comprehensive services to meet learning, emotional and psychological needs |
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What is a "risk environment." |
The space - social or physical - in which a variety of factors interact to increase the chance of harm occurring. |
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What is harm reduction? |
Policies, programs, practices that aim to reduce adverse health, social and economics consequences of the use of illegal psychoactive drugs without necessarily reducing drug consumption. |
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How does drug criminalization affect HIV risk? |
1. Disrupts access to harm reduction and other prevention 2. Drives PWID away form preventative medical care 3. Reinforces stigma and discrimination 4. Increases risks associated with injection drug use (no reliable source of sterile syringes, absence of safety and security, punitive consequences if discovered) |
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List 3 impacts of INSITE. |
1. Decline in overdose mortality near the facility 2. Increase in uptake of treatment for addiction 3. Decrease in syringe sharing and other risk behaviours for HIV infection - decrease in HIV infections |
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How does the Canadian HIV prevalence compare to that of people living on-reserve in Saskatchewan? |
5.9/100,000 VS 63.6/100,000 -> 11X the national rate. |
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What are the 4 pillars to Saskatchewan's approach to address its epidemic? |
1. Community engagement and education 2. Prevention and harm reduction 3. Clinical management 4. Surveillance and research |
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Indigenous people in Canada (particularly women) are disproportionately affected by HIV. Provide some stats. |
Make up 3.8% of Canada's population, but 9% of all people living with HIV. 4x more likely to get HIV than non-aboriginal Canadians. |
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What are some of examples of colonization in the Canadian context? |
1. Population decimation via infectious disease 2. Indian act and criminalization of culture (reserves, residential schools, loss of status) |
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Describe 3 impacts of residential schools? |
1. Disruption of family structure 2. Abuse 3. Systematic devaluing of culture |
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How does colonization affect HIV risk? |
1. Early sexual abuse -> revictimization 2. Self-medication -> IDU 3. Poverty, low education, lack of opportunities on resevre -> sex work 4. Poor coping skills -> low HIV testing, low condom use, unsafe injection practices |
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Describe a few trends related to HIV care and Indigenous people in Canada. |
1. More likely to have a later diagnosis 2. Slower uptake of ART 3. Less access to experienced physicians (higher morbidity, shorter survival times, 3x higher mortality rate) |
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Summarize the results of the CEDAR Project. |
1. ~50% had experienced sexual abuse (69% were women) 2. 85% experienced abuse under age 13 and median age was 6 3. Those abused were more likely to have been on streets, self-harmed, have mental illness, been paid for sex, had over 20 sexual partners, OD'd |
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How to reduce the impact among Canadian Indigenous peoples? |
1. Ind. leadership 2. Cultural safety 3. Gender-based services 4. Youth friendly services 5. Resources for rural communities 6. Prevention and education tailored to culture |
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Describe the HIV epidemic in the USA. |
Concentrated in certain geographic areas, among certain communities -> MSM, ethnic minorities, low SES. Disparities in access to care and health outcomes as well. |
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How many people are living with HIV in Canada? |
Approx 75,000 (21% undiagnosed) |
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What happened with president Mbeki in South Africa? |
-Was an AIDS denialist -Restricted use of ARV's, obstructed global grants, and delayed implementing a national ARV program -300,000+ South Africans died as a result |
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For what two reasons has the OPV theory been refuted? |
1. Found a common ancestor older than 1957 (1930's ish) |
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What are the results of the Patterson et al. paper on the impact of the criminalization of HIV non-disclosure on healthcare engagement of women living with HIV in Canada? |
-Criminalization negatively affects willingness to test for HIV -Can result in reluctance to engage in open dialogue with healthcare providers - confidentiality concerns -Some people find it reasonable to avoid seeking treatment due to fears of HIV-related prosecution *Criminalization is a structural barrier |
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What is the defining characteristic of a structural intervention? |
Aims to change the social, economic, political or environmental factors that determine HIV risk and vulnerability in specific contexts. |
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According to the Dubrow et al. paper, what is the relationship between HIV, aging and cancer risk? |
HIV infection results in chronic immune activation and inflammation, which promotes cancer development - especially those of viral cause. This has resulted in an increase in non-AIDS defining cancers among this population. |
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What are the main findings of the Campbell paper on building adherence-competent communities in rural Zimbabwe? |
Two main factors played a role in ART adherence: 1. Public acceptance of HIV/AIDS 2. Increased health service effectiveness and treatment availability
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What are the recommendations from the Jackson report on Canadian Aboriginals + HIV? |
1. Dedicate resources to establish new traditional Indigenous health and wellness services 2. Service design and delivery must account for logistical barriers 3. Must ensure confidentiality 4. Primary care staff require professional development related to specific needs of Indigenous populations 5. GP's need to be more knowledgeable about HIV/AIDS |
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What are the three recommendations from the Awofeso paper on community art? |
1. Train health professional in community-based art methods to facilitate their participation in community-based art advocacy 2. Community artists and health advocates should be incentivized to approach each other as equal partners in joint planning of health activities 3. Funders should consider payment arrangements that equitably reflect the contribution of all partners |
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According to the Puskas paper, what factors may be fuelling non-adherence in women? |
Multiple conditions more common in women: -Lack of supportive relationships -Drug and alcohol use -Emotional distress -Stigmatization |
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What are three biological reasons that women have a greater vulnerability to HIV infection? |
1. Increased mucosal surface area exposed to pathogens 2. Higher rate of STI's 3. Hormonal-induced vulernability |
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What does socio-economic vulnerability in SSA place women at greater risk of HIV infection? |
Income inequality = women in positions of low SES = earlier sexual experience, lower condom use, multiple sex partners, increased chance that sex is non-consensual, greater likelihood of transactional sex |
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Give an example of a behavioural vulnerability for women in SSA? |
Alcohol abuse affects sexual decision making, condom negotiation skills and correct condom use. |
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What are some structural vulnerabilities that affect women's HIV risk in SSA? |
-Hierarchical gender roles -Gender norms promoting multiple concurrent partners for men -Violence against women -Stigma and fear of social exclusion -Political conflicts/war/displacement of women |
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What were the main findings of the Joseph paper about IDU in Canada? |
Those engaged in harm reduction MMT were more likely to test for HIV, initiate treatment, have better ART outcomes and better adherence. |
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What did MANCOUNT find regarding age and HIV prevalence in Vancouver MSM? |
Prevalence increased with age, meaning there are increasingly more HIV+ men in older age groups. |
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How does homophobia affect HIV risk? |
-Drives discussion about MSM and homosexuality underground, legitimizing fear and prejudice and compromising AIDS service orgs so they cannot work publicly with LGBT and MSM communities |
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What are the characteristics of the HIV epidemic among trans people in Canada? |
-Higher prevalence than gay men -Trans women are particularly effected, especially if they've been involved in sex work or incarcerated -Often left out of policies and administrative procedures -Uneasy relationship to health care services and professionals -Increased rates of violence |
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What is the "definition" of trans people? |
Someone who lives partly or entirely in a sex or gender that was not assigned to them at birth. |
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What difficulties do older children living with HIV face? |
Fears and concerns about who they could disclose to, self-esteem issues, dealing with death of loved ones, and fitting in with peers. |
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What did the Cluver paper about combination social protections suggest were effective interventions in South Africa? |
-Child-focused grants -Free schooling -School feeding -Teacher support and parental monitoring |
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What is the relationship between having a parent in a residential school and sexual abuse? |
Strong association between having a parent attend a residential school and experiencing sexual abuse - which is related to increased HIV vulnerability. |
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What did the Eaton paper regarding medical mistrust of Black MSM find? |
-Both HIV+ and HIV- black MSM report similar rates of experiencing stigma from healthcare providers -High, but similar rates of medical mistrust in both HIV+ and HIV- black MSM -Experiencing stigma from health care providers is associated with longer time since last examination for both HIV+ and HIV- black MSM -And it is possible that having found a provider one trusts negates the global mistrust -Need to focus on provider-patient relationship building |
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What are the conclusions of the FSW epi report? |
Coverage and equitable access to condoms, ART and HIV preventions lag unacceptably behind that of the general population. But a scale-up needs to coincide with structural changes, sex-work left interventions and engagement through community empowerment. |
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What are the main findings of the paper on medical mistrust among MSW? |
-Fewer MSW report disclosing MSM behaviour -MSW express more mistrust of providers -Overlapping stigmas may combine to disadvantage population subgroups such as MSW through increased medical mistrust and reduced access to care |
