Experiences of stigma in healthcare settings among adults living with HIV in the Islamic Republic of Iran

<p>Abstract</p> <p>Background</p> <p>People living with HIV (PLHIV) sometimes experience discrimination. There is little understanding of the causes, forms and consequences of this stigma in Islamic countries. This qualitative study explored perceptions and experiences of PLHIV regarding both the quality of healthcare and the attitudes and behaviours of their healthcare providers in the Islamic Republic of Iran.</p> <p>Methods</p> <p>In-depth, semi-structured interviews were held with a purposively selected group of 69 PLHIV recruited from two HIV care clinics in Tehran. Data were analyzed using the content analysis approach.</p> <p>Results and discussion</p> <p>Nearly all participants reported experiencing stigma and discrimination by their healthcare providers in a variety of contexts. Participants perceived that their healthcare providers' fear of being infected with HIV, coupled with religious and negative value-based assumptions about PLHIV, led to high levels of stigma. Participants mentioned at least four major forms of stigma: (1) refusal of care; (2) sub-optimal care; (3) excessive precautions and physical distancing; and (4) humiliation and blaming. The participants' healthcare-seeking behavioural reactions to perceived stigma and discrimination included avoiding or delaying seeking care, not disclosing HIV status when seeking healthcare, and using spiritual healing. In addition, emotional responses to perceived acts of stigma included feeling undeserving of care, diminished motivation to stay healthy, feeling angry and vengeful, and experiencing emotional stress.</p> <p>Conclusions</p> <p>While previous studies demonstrate that most Iranian healthcare providers report fairly positive attitudes towards PLHIV, our participants' experiences tell a different story. Therefore, it is imperative to engage both healthcare providers and PLHIV in designing interventions targeting stigma in healthcare settings. Additionally, specialized training programmes in universal precautions for health providers will lead to stigma reduction. National policies to strengthen medical training and to provide funding for stigma-reduction programming are strongly recommended. Investigating Islamic literature and instruction, as well as requesting official public statements from religious leaders regarding stigma and discrimination in healthcare settings, should be used in educational intervention programmes targeting healthcare providers. Finally, further studies are needed to investigate the role of the physician and religion in the local context.</p

Nano/micro electro-spun polyethylene terephthalate fibrous mat preparation and characterization

Electro-spun polyethylene terephthalate (PET) fibrous mats are potential substrates for biotechnological and biomedical applications. In this regard, substrate characteristics including, fiber diameter, orientation and mechanical properties play an important role in controlling the interaction of substrate with biological entities. However, few studies reporting the preparation of electro-spun PET substrates with such controlled characteristics have been published. In this study, electro-spun PET fibrous mats with fiber diameters in the nanometer and micrometer range were produced by varying polymer solution concentration and flow rate. Fiber orientation within the mats was also varied by varying collector surface velocities in rotation and translation. Their morphological, mechanical, thermal and structural properties were evaluated as a function of fiber diameter and collector speed using scanning electron microscopy (SEM), a micromechanical tester, differential scanning calorimetry (DSC) and X-ray diffraction (XRD), respectively. Varying polymer solution concentration and flow rate allowed the production of matrices with fiber diameters ranging from 400 nm to 2 \u3bcm. Tensile properties increased with fiber diameter and collector surface velocity. Thermal properties of electro-spun PET fibers were different from the structure of as received raw PET in the form of pellets, revealing an amorphous structure for the entire electro-spun PET. This was also confirmed by XRD analysis. No considerable differences were observed between electro-spun PET fibers, in terms of crystalline and thermal properties, produced under various conditions. These electro-spun mats with different fiber diameters, orientation and mechanical properties can be used for various applications including tissue engineering scaffolds. \ua9 2010 Elsevier Ltd.Peer reviewed: YesNRC publication: Ye

Development of a compliant and cytocompatible micro-fibrous polyethylene terephthalate vascular scaffold

Bioengineering approaches have been intensively applied to create small diameter vascular grafts using artificial materials. However, a fully successful, high performing and anti-thrombogenic structure has not been achieved yet. In this study, we have designed and fabricated a novel non-woven fibrous vascular graft with biomechanical properties closely resembling those of native vessels. Vascular cell growth, preservation of cell phenotype, retention of vasoactive properties, as well as the effect of gelatin coating on the cellular interaction with the scaffolds under static and shear stress conditions were investigated. The non-woven fibrous scaffolds were made from melt blown polyethylene terephthalate fiber webs stacked by means of a consolidation technique. The scaffold variables were fiber diameter distribution and the number of consolidated web stacks. SEM analysis confirmed various fiber diameter and pore size ranges corresponding to the different conditions. The scaffolds showed burst pressure values of ~1500 mmHg and compliance (8.4 6 \ub1 1.0 7 10\u207b\ub2% mmHg\u207b\ub9) very similar to those of native arteries (~8 7 10\u207b\ub2% mmHg\u207b\ub9). The structure with the smallest fiber diameter range (1\u20135 \ub5m) and pore size range (1\u201320 \ub5m) was the most suitable for the growth of human brain endothelial cells and aortic smooth muscle cells. The cells maintained their specific cell phenotype, expressed collagen and elastin and produced cAMP in response to \u3b1-calcitonin gene-related peptide. However, under shear stress conditions (0.9 dyne cm\u207b\ub2), only 30% of the cells were retained in both uncoated and gelatincoated scaffolds indicating the need for improving the cell retention capacity of these structures, which is our future research direction. This study indicates that the biomechanical and biocompatible properties of this novel vascular scaffold are promising for the development of a vascular graft with similar characteristics to those of native vessels.Peer reviewed: YesNRC publication: Ye