Rewriting the narrative of the epidemiology of HIV in sub-Saharan Africa

The fight against HIV remains complicated with contracting donor resources and high burden of HIV among reproductive age adults still often limiting independent economic development. In the widespread HIV epidemics of sub-Saharan Africa (SSA), it is proposed that key populations with specific HIV acquisition and transmission risk factors, such as men who have sex with men (MSM), female sex workers (FSW), and people who use drugs (PUD), are less relevant because HIV transmission is sustained in the general population with average HIV acquisition and transmission risks. However, the understanding that key populations are less relevant in the epidemics of Africa is based on the surveillance system from which these populations are mostly excluded. Outside of SSA, the epidemics of HIV are generally concentrated in the same populations that are excluded from the primary HIV surveillance systems in SSA. The manuscripts included in this special issue present convincing data that FSW, MSM, and PUD carry disproportionate burdens of HIV wherever studied in SSA, are underrepresented in HIV programs and research, and require specific HIV prevention services. These manuscripts collectively suggest that the only effective path forward is one that transcends denial and stigma and focuses on systematically collecting data on all populations at risk for HIV. In addition, there is a need to move to a third generation of HIV surveillance as the current one inadvertently devalues HIV surveillance among key populations in the context of widespread HIV epidemics. Overall, the data reviewed here demonstrate that the dynamics of HIV in Africa are complex and achieving an AIDS-free generation necessitates acceptance of that complexity in all HIV surveillance, research, and prevention, treatment, and care programs

Assessing the effects of anti-homosexuality legislation in Uganda on HIV prevention, treatment, and care services

Uganda’s response to the HIV epidemic has been lauded for its robustness and achievements. However, a key component of HIV prevention programming has been missing, for men who have sex with men (MSM). The main reason cited has been criminalization of male homosexual behavior. In 2009, the Anti-Homosexuality Bill (AHB) was introduced in the parliament to enhance existing anti-homosexuality law. A multi-disciplinary team made a Health Impact Assessment of the proposed AHB. The bill as tabled would severely increase punishments, increased closeting. Social capital of MSM would be eroded by clauses mandating reporting byfriends, relatives, and acquaintances. Health-care professionals would have to inform on homosexuals. Mandatory HIV testing would be a blow to programming. Probable disclosure of HIV status in a public space (court) would also be a deterrent. Heftier punishments for those testing positive increases stigma and hobbles subsequent care. The AHB argues for exclusion, and more discrimination targeting persons living with HIV and sexual minorities. It will exacerbate the negative public healthconsequences of the existing legislation. The government of Uganda should review guidance documents published by authoritative bodies including the World Bank, World Health Organization to develop and bring to scale Human rightsaffirming HIV prevention, treatment, and care responses

Adsorption of Hexavalent Chromium from Aqueous Solution using Various Adsorbents

The removal of Cr(VI) from aqueous solution by batch adsorption technique using different low-cost adsorbents was investigated. The objective of the study was to find out a suitable low cost, environmental friendly and highly effective adsorbent. In the present study different low cost adsorbents such as bauxite, sawdust and sweet water weed were used to determine the adsorption efficiency. All these adsorbents were used as such or after pretreatment. Among all, the pretreated materials were found to be better adsorbents as compared to untreated materials. The influence of agitation speed, pH, temperature, adsorbent dose, initial adsorbate concentration and contact time on the selectivity and sensitivity of the removal process were investigated. The physico-chemical properties of all the adsorbents were studied using different characterization techniques such as FTIR, SEM, XRD, BET surface area and porosity. Effect of agitation speeds on the Cr(VI) adsorption capacity of the adsorbe..

Bulk Processing of Multi-Temporal Modis Data, Statistical Analyses and Machine Learning Algorithms to Understand Climate Variables in the Indian Himalayan Region.

Studies relating to trends of vegetation, snowfall and temperature in the north-western Himalayan region of India are generally focused on specific areas. Therefore, a proper understanding of regional changes in climate parameters over large time periods is generally absent, which increases the complexity of making appropriate conclusions related to climate change-induced effects in the Himalayan region. This study provides a broad overview of changes in patterns of vegetation, snow covers and temperature in Uttarakhand state of India through bulk processing of remotely sensed Moderate Resolution Imaging Spectroradiometer (MODIS) data, meteorological records and simulated global climate data. Additionally, regression using machine learning algorithms such as Support Vectors and Long Short-term Memory (LSTM) network is carried out to check the possibility of predicting these environmental variables. Results from 17 years of data show an increasing trend of snow-covered areas during pre-monsoon and decreasing vegetation covers during monsoon since 2001. Solar radiation and cloud cover largely control the lapse rate variations. Mean MODIS-derived land surface temperature (LST) observations are in close agreement with global climate data. Future studies focused on climate trends and environmental parameters in Uttarakhand could fairly rely upon the remotely sensed measurements and simulated climate data for the region

A systematic review of evidence to inform HIV prevention interventions among men who have sex with men in Europe.

An estimated 42% of all newly diagnosed HIV cases in Europe in 2013 were transmitted during sex between men. This review was performed to identify and describe studies evaluating the efficacy and effectiveness of HIV prevention interventions among men who have sex with men (MSM), in relation to implementation data from European settings. A systematic search was performed individually for 24 interventions.Data were extracted from studies including efficacy or implementation data from European settings,appraised for efficacy, implementation and plausibility, and assigned a grade (1-4) according to the Highest Attainable Standard of Evidence (HASTE)framework. Four interventions (condom use, peer outreach,peer-led groups, and using universal coverage of antiretroviral treatment and treatment as prevention)were assigned the highest HASTE grade, 1. Another four interventions were assigned 2a for probable recommendation, including voluntary counseling and testing for HIV, using condom-compatible lubricant,using post-exposure prophylaxis, and individual counselling for MSM living with HIV. In addition, seven interventions were assigned a grade of 2b, for possible recommendation. Encouragingly, 15 interventions were graded to be strongly, probably or possibly recommended.In the relatively resource-rich European setting, there is an opportunity to provide global leadership with regard to the regional scale-up of comprehensive HIV prevention interventions for MSM

Self-Monitoring of Blood Pressure in Hypertension: A UK Primary Care Survey

This study aimed to determine the prevalence of Self-Monitoring Blood Pressure amongst people with hypertension using a cross-sectional survey. Of the 955 who replied (53%), 293 (31%) reported that they self-monitored blood pressure. Nearly 60% (198/331) self-monitored at least monthly. Diabetic patients monitoring their blood glucose were five times more likely than those not monitoring to monitor their blood pressure. Self-monitoring is less common in the UK than internationally, but is practiced by enough people to warrant greater integration into clinical practice