Labor migrants are those of the at-risk groups for HIV. This cross-sectional study has tried to examine HIV/AIDS-related stigma among Nepalese returnee male labor migrants. Migrant workers who have worked at least six...Labor migrants are those of the at-risk groups for HIV. This cross-sectional study has tried to examine HIV/AIDS-related stigma among Nepalese returnee male labor migrants. Migrant workers who have worked at least six months abroad were asked different questions related to sexual behavior, knowledge on HIV/AIDS & condom and HIV/AIDS-related stigma. Stigma was measured on a three-point rating scale as high, average and low stigma. About 58% of migrants had the view “I would rather not know if I have HIV” followed by “I don’t want to be friends with people living with HIV” (53.6% migrants) and “people with HIV are cursed” (35.5% migrants). High stigma was present among 15.5% of the total respondents with high proportion among those with higher age, lower education, rural residence, and no knowledge on Voluntary Counseling and Testing (VCT) service. About a quarter of respondents were of the view that migrants infected with HIV while abroad should not be allowed to return Nepal. Some level of stigma on HIV/AIDS exists among male labor migrants in Nepal. Interventions aiming at reducing stigma should consider the factors like migrants’ age, education, place of residence and knowledge on VCT services.展开更多
Background: The lack of cause of death information is the main challenge in monitoring the effectiveness of interventions aimed at reducing HIV and AIDS-related deaths in countries where the majority of deaths occur a...Background: The lack of cause of death information is the main challenge in monitoring the effectiveness of interventions aimed at reducing HIV and AIDS-related deaths in countries where the majority of deaths occur at home. Objective: To evaluate the accuracy of physician reviewers of verbal autopsies in diagnosing HIV and AIDS-related deaths in the adult population of Addis Ababa, the capital of Ethiopia. Methods: This study was done within the context of a burial surveillance system in Addis Ababa. Trained interviewers completed a standard verbal autopsy questionnaire and an independent panel of physicians reviewed the completed form to assign cause of death. Physicians' review was compared to a reference standard constructed based on prospectively collected HIV-serostatus and patients' hospital record. Sensitivity and specificity were calculated to validate the physicians' verbal autopsy diagnoses against reference standards. Results: Physicians accurately identified AIDS-related deaths with sensitivity and specificity of 0.88 (95% CI: 0.80 - 0.93) and 0.77 (95% CI: 0.64 - 0.87), respectively. Generally, there was high level of agreement (Cohen's Kappa Statistic (K > 0.6) between the first two physicians with some yearly variations. In 2008 and 2009 there was an almost perfect agreement (K > 0.80). Conclusion: This study demonstrated the agreement level between two independent physicians in diagnosing AIDS-related death is very high and thus using a single verbal autopsy coder is practical for programmatic purposes in countries where there is critical shortage of doctors.展开更多
Despite the roll out of free life prolonging HIV and AIDS drugs in many public clinics in Zambia and the well documented effects of Anti Retrovirals (ARVs) in reducing mortality among people living with HIV, some peop...Despite the roll out of free life prolonging HIV and AIDS drugs in many public clinics in Zambia and the well documented effects of Anti Retrovirals (ARVs) in reducing mortality among people living with HIV, some people living with HIV still abandon treatment. This study explores patient-related factors that influence adherence to the life prolonging drugs. It is hoped that such information would be useful in enhancing adherence so as to achieve the goal of ART. This information is critical considering irrefutable evidence that non-adherence to Anti-Retroviral Therapy (ART) can lead to drug resistance and consequently, transmission of drug resistant HIV. Drug resistant HIV is not only expensive to handle, but can lead to increased morbidity, mortality and increased incidence of HIV cases particularly, for a low income country like Zambia. Methods: This paper uses data from a large mixed method study which was conducted in a rural setting. The study explored how patient-related factors influence people living with HIV in continuing taking of medication. The paper, therefore, discusses the major reasons reported by HIV infected people on ART for either being able to consistently take their medication or failing to do so. Results: Both limiting and facilitating factors were identified as influencing adherence. Among the facilitators identified were one having a reminder, feeling better after being on ART, seeing someone on ART recover, desire to live longer and disclosure of one’s positive status. The limiting factors included forgetting to take medication, non-recovery while on treatment for some time and drug fatigue. A significant association was found between adherence treatment and one having a reminder, desire to live longer and seeing someone on ART get better. Conclusion: While facilitators enhanced adherence, the barriers prevented or discouraged people on ART from continuing taking AIDS medicines as prescribed by their health care providers. In order to avoid drug resistance and other public health implications, such as transmission of drug resistant HIV virus and deaths, there is need to address these patient-related barriers.展开更多
文摘Labor migrants are those of the at-risk groups for HIV. This cross-sectional study has tried to examine HIV/AIDS-related stigma among Nepalese returnee male labor migrants. Migrant workers who have worked at least six months abroad were asked different questions related to sexual behavior, knowledge on HIV/AIDS & condom and HIV/AIDS-related stigma. Stigma was measured on a three-point rating scale as high, average and low stigma. About 58% of migrants had the view “I would rather not know if I have HIV” followed by “I don’t want to be friends with people living with HIV” (53.6% migrants) and “people with HIV are cursed” (35.5% migrants). High stigma was present among 15.5% of the total respondents with high proportion among those with higher age, lower education, rural residence, and no knowledge on Voluntary Counseling and Testing (VCT) service. About a quarter of respondents were of the view that migrants infected with HIV while abroad should not be allowed to return Nepal. Some level of stigma on HIV/AIDS exists among male labor migrants in Nepal. Interventions aiming at reducing stigma should consider the factors like migrants’ age, education, place of residence and knowledge on VCT services.
文摘Background: The lack of cause of death information is the main challenge in monitoring the effectiveness of interventions aimed at reducing HIV and AIDS-related deaths in countries where the majority of deaths occur at home. Objective: To evaluate the accuracy of physician reviewers of verbal autopsies in diagnosing HIV and AIDS-related deaths in the adult population of Addis Ababa, the capital of Ethiopia. Methods: This study was done within the context of a burial surveillance system in Addis Ababa. Trained interviewers completed a standard verbal autopsy questionnaire and an independent panel of physicians reviewed the completed form to assign cause of death. Physicians' review was compared to a reference standard constructed based on prospectively collected HIV-serostatus and patients' hospital record. Sensitivity and specificity were calculated to validate the physicians' verbal autopsy diagnoses against reference standards. Results: Physicians accurately identified AIDS-related deaths with sensitivity and specificity of 0.88 (95% CI: 0.80 - 0.93) and 0.77 (95% CI: 0.64 - 0.87), respectively. Generally, there was high level of agreement (Cohen's Kappa Statistic (K > 0.6) between the first two physicians with some yearly variations. In 2008 and 2009 there was an almost perfect agreement (K > 0.80). Conclusion: This study demonstrated the agreement level between two independent physicians in diagnosing AIDS-related death is very high and thus using a single verbal autopsy coder is practical for programmatic purposes in countries where there is critical shortage of doctors.
文摘Despite the roll out of free life prolonging HIV and AIDS drugs in many public clinics in Zambia and the well documented effects of Anti Retrovirals (ARVs) in reducing mortality among people living with HIV, some people living with HIV still abandon treatment. This study explores patient-related factors that influence adherence to the life prolonging drugs. It is hoped that such information would be useful in enhancing adherence so as to achieve the goal of ART. This information is critical considering irrefutable evidence that non-adherence to Anti-Retroviral Therapy (ART) can lead to drug resistance and consequently, transmission of drug resistant HIV. Drug resistant HIV is not only expensive to handle, but can lead to increased morbidity, mortality and increased incidence of HIV cases particularly, for a low income country like Zambia. Methods: This paper uses data from a large mixed method study which was conducted in a rural setting. The study explored how patient-related factors influence people living with HIV in continuing taking of medication. The paper, therefore, discusses the major reasons reported by HIV infected people on ART for either being able to consistently take their medication or failing to do so. Results: Both limiting and facilitating factors were identified as influencing adherence. Among the facilitators identified were one having a reminder, feeling better after being on ART, seeing someone on ART recover, desire to live longer and disclosure of one’s positive status. The limiting factors included forgetting to take medication, non-recovery while on treatment for some time and drug fatigue. A significant association was found between adherence treatment and one having a reminder, desire to live longer and seeing someone on ART get better. Conclusion: While facilitators enhanced adherence, the barriers prevented or discouraged people on ART from continuing taking AIDS medicines as prescribed by their health care providers. In order to avoid drug resistance and other public health implications, such as transmission of drug resistant HIV virus and deaths, there is need to address these patient-related barriers.
