Social Determinants of Late Stage HIV Diagnosis and its Distributions among African Americans and Latinos: A critical literature review

ABSTRACT This critical literature review was conducted to identify both individual- and environmental-level social determinants of health using an ecological framework as a way to contextualize risk for, and distributions of, late HIV diagnosis among African Americans and Latinos in the United States. Background: Late diagnosis, defined as a diagnosis of AIDS simultaneously with or within one year of an initial HIV diagnosis,1 disproportionately affects African American and Latino communities;2,3 disparities in this health problem thus represent a preventable inequity. Such disparities affect not only late diagnosed individuals but also population levels of HIV incidence, as transmission is unhindered before diagnosis.4,5 Methods: A total of 26 unduplicated studies in 26 peer-reviewed articles were analyzed within a social ecological conceptual framework. Both quantitative and qualitative studies of factors influencing HIV testing were reviewed. To be included, studies had to have been conducted in the United States, published in English within the past 11 years, and to have focused on Latino or African American populations and/or on racial disparities between these and other populations. Findings: The majority of studies on racial disparities in HIV testing and diagnosis have been either cross-sectional1,2,6–11 or focused on one racial or ethnic group, often in one geographic location.12–18 In all studies that compared racial and ethnic groups (n=17), Latinos and African Americans were more likely to receive a late diagnosis3,19 than non-Hispanic Whites or Asian Americans. 95.8% (n= 23) of the reviewed studies focused on individual level risk factors or investigated structural barriers via measurements at the individual level. Next Steps: Both more quantitative and qualitative studies are needed that will enhance understanding of the social determinants of HIV testing behavior among at-risk groups by measuring variables at the appropriate rung of the ecological model, and not solely on the individual level. Studies that investigate barriers to and facilitators of HIV testing in partnership with communities will help further interventions that can reduce racial/ethnic disparities in late diagnosed HIV/AIDS

Economic Self-Help Group Programs for Improving Women’s Empowerment: A Systematic Review

Motivation: Self-help groups (SHGs) are implemented around the world to empower women, supported by many developing country governments and agencies. A relatively large number of studies purport to demonstrate the effectiveness of SHGs. This is the first systematic review of that evidence. Approach: We conducted a systematic review of the effectiveness of women’s economic SHG programs, incorporating evidence from quantitative and qualitative studies. We systematically searched for published and unpublished literature, and applied inclusion criteria based on the study protocol. We critically appraised all included studies and used a combination of statistical meta-analysis and meta-ethnography to synthesize the findings based on a theory of change. Findings from quantitative synthesis: Our review suggests that economic SHGs have positive effects on various dimensions of women’s empowerment, including economic, social, and political empowerment. However, we did not find evidence for positive effects of SHGs on psychological empowerment. Our findings further suggest there are important variations in the impacts of SHGs on empowerment that are associated with program design and contextual characteristics. Findings from qualitative synthesis: Women’s perspectives on factors determining their participation in, and benefits from, SHGs suggest various pathways through which SHGs could achieve the identified positive impacts. Evidence suggested that the positive effects of SHGs on economic, social, and political empowerment run through the channels of familiarity with handling money and independence in financial decision making, solidarity, improved social networks, and respect from the household and other community members. In contrast to the quantitative evidence, the qualitative synthesis suggests that women participating in SHGs perceive themselves to be psychologically empowered. Women also perceive low participation of the poorest of the poor in SHGs due to various barriers, which could potentially limit the benefits the poorest could gain from SHG membership. Findings from integrated synthesis: Our integration of the quantitative and qualitative evidence suggests there is no evidence for adverse effects of women’s SHGs on the likelihood of domestic violence. Women’s perspectives in the qualitative research indicate that even if domestic violence occurs in the short term, in the long term the benefits from SHG membership may mitigate the initial adverse consequences of SHGs on domestic violence

Detecting Instability in Animal Social Networks: Genetic Fragmentation Is Associated with Social Instability in Rhesus Macaques

The persistence of biological systems requires evolved mechanisms which promote stability. Cohesive primate social groups are one example of stable biological systems, which persist in spite of regular conflict. We suggest that genetic relatedness and its associated kinship structure are a potential source of stability in primate social groups as kinship structure is an important organizing principle in many animal societies. We investigated the effect of average genetic relatedness per matrilineal family on the stability of matrilineal grooming and agonistic interactions in 48 matrilines from seven captive groups of rhesus macaques. Matrilines with low average genetic relatedness show increased family-level instability such as: more sub-grouping in their matrilineal groom network, more frequent fighting with kin, and higher rates of wounding. Family-level instability in multiple matrilines within a group is further associated with group-level instability such as increased wounding. Stability appears to arise from the presence of clear matrilineal structure in the rhesus macaque group hierarchy, which is derived from cohesion among kin in their affiliative and agonistic interactions with each other. We conclude that genetic relatedness and kinship structure are an important source of group stability in animal societies, particularly when dominance and/or affilative interactions are typically governed by kinship

Efficiency in PrEP Delivery: Estimating the Annual Costs of Oral PrEP in Zimbabwe.

Although oral PrEP is highly effective at preventing HIV acquisition, optimizing continuation among beneficiaries is challenging in many settings. We estimated the costs of delivering oral PrEP to populations at risk of HIV in seven clinics in Zimbabwe. Full annual economic costs of oral PrEP initiations and continuation visits were estimated from the providers' perspective for a six-clinic NGO network and one government SGBV clinic in Zimbabwe (January-December 2018). Disaggregating costs of full initiation and incremental follow-up visits enabled modeling of the impact of duration of continuation on the cost per person-year ($pPY) on PrEP. 4677 people initiated oral PrEP, averaging 2.7 follow-up visits per person. Average cost per person initiated was$238 ($183-$302 across the NGO clinics; $86 in the government facility). The full cost per initiation visit, including central and direct costs, was$178, and the incremental cost per follow-up visit, capturing only additional resources used directly in the follow up visits, was $22. The average duration of continuation was 3.0 months, generating an average$pPY of $943, ranging from$839 among adolescent girls and young women to $1219 in men. Oral PrEP delivery costs varied substantially by scale of initiations and by duration of continuation and type of clinic. Extending the average oral PrEP continuation from 2.7 to 5 visits (about 6 months) would greatly improve service efficiency, cutting the$pPY by more than half

Frequent Arousal from Hibernation Linked to Severity of Infection and Mortality in Bats with White-Nose Syndrome

White-nose syndrome (WNS), an emerging infectious disease that has killed over 5.5 million hibernating bats, is named for the causative agent, a white fungus (Geomyces destructans (Gd)) that invades the skin of torpid bats. During hibernation, arousals to warm (euthermic) body temperatures are normal but deplete fat stores. Temperature-sensitive dataloggers were attached to the backs of 504 free-ranging little brown bats (Myotis lucifugus) in hibernacula located throughout the northeastern USA. Dataloggers were retrieved at the end of the hibernation season and complete profiles of skin temperature data were available from 83 bats, which were categorized as: (1) unaffected, (2) WNS-affected but alive at time of datalogger removal, or (3) WNS-affected but found dead at time of datalogger removal. Histological confirmation of WNS severity (as indexed by degree of fungal infection) as well as confirmation of presence/absence of DNA from Gd by PCR was determined for 26 animals. We demonstrated that WNS-affected bats aroused to euthermic body temperatures more frequently than unaffected bats, likely contributing to subsequent mortality. Within the subset of WNS-affected bats that were found dead at the time of datalogger removal, the number of arousal bouts since datalogger attachment significantly predicted date of death. Additionally, the severity of cutaneous Gd infection correlated with the number of arousal episodes from torpor during hibernation. Thus, increased frequency of arousal from torpor likely contributes to WNS-associated mortality, but the question of how Gd infection induces increased arousals remains unanswered

Casting a Wide Net: HIV Drug Resistance Monitoring in Pre-Exposure Prophylaxis Seroconverters in the Global Evaluation of Microbicide Sensitivity Project.

BACKGROUND: Evidence of HIV drug resistance (HIVDR) in individuals using oral pre-exposure prophylaxis (PrEP) who acquire HIV is limited to clinical trials and case studies. More data are needed to understand the risk of HIVDR with oral PrEP during PrEP rollout. Mechanisms to collect these data vary, and are dependent on cost, scale of PrEP distribution, and in-country infrastructure for the identification, collection, and testing of samples from PrEP seroconverters. METHODS: The Global Evaluation of Microbicide Sensitivity (GEMS) project, in collaboration with country stakeholders, initiated HIVDR monitoring among new HIV seroconverters with prior PrEP use in Eswatini, Kenya, South Africa, and Zimbabwe. Standalone protocols were developed to assess HIVDR among a national sample of PrEP users. In addition, HIVDR testing was incorporated into existing demonstration projects for key populations. LESSONS LEARNED: Countries are supportive of conducting a time-limited evaluation of HIVDR during the early stages of PrEP rollout. As PrEP rollout expands, the need for long-term HIVDR monitoring with PrEP will need to be balanced with maintaining national HIV drug resistance surveillance for pretreatment and acquired drug resistance. Laboratory capacity is a common obstacle to setting up a monitoring system. CONCLUSIONS: Establishing HIV resistance monitoring within PrEP programs is feasible. Approaches to drug resistance monitoring may evolve as the PrEP programs mature and expand. The methods and implementation support offered by GEMS assisted countries in developing methods to monitor for drug resistance that best fit their PrEP program needs and resources

Emotional intelligence moderates the relationship between communication technology use and the quality of face-to-face relationships

Increased communication technology use, including contact through email, cell phones, chat rooms, instant messaging and social network systems, has dramatically modified social interactions. Specifically, communication technology has increased the frequency of communication between individuals but has resulted in the loss of face-to-face interactions. This study was designed to test the relationship between communication technology use, personality characteristics and the quality and quantity of face-to-face interactions. In this study, 176 adults from one corporation were surveyed on their communication technology use, emotional intelligence, extroversion and face-to-face relationships. The results from this study provide evidence that emotional intelligence moderates the relationship between communication technology use and the quality of face-to-face interactions. However, there was no evidence that emotional intelligence moderated the relationship between communication technology use and the number of face-to-face interactions. The results for extroversion are converse to those examining emotional intelligence. There is support that extroversion moderated the relationship between communication technology use and the quantity of face-to-face interactions, but not the quality of face-to-face interactions. It is clear that there is a relationship between personality characteristics, communication technology use and face-to-face interactions

Costing Cairo: An Annotated Bibiliography of the Cost Literature on ICPD Programme of Action Components in Sub-Saharan Africa

The 1994 International Conference on Population and Development (ICPD), held in Cairo, produced a Programme of Action accepted and signed by over 180 governments. The Programme of Action marked an important shift in the ideological framework of population programs. By stating such programs should ensure that “a full-range of reproductive health care services, including family planning, are accessible, affordable, acceptable and convenient to all users” (ICPD Programme of Action, 1994, 7.5.a), Cairo identified the crux of population programs to be the reproductive health of women, and expanded the notion of family planning accordingly. This bibliography was initiated as part of an effort to revise the original UNFPA estimates of the cost of implementing the Cairo agenda. It is focused on sub-Saharan Africa for two reasons. First, sub-Saharan Africa, by almost any measure, is most in need of improved provision of health services. Second, accuracy and completeness was a high priority, requiring that the scope be narrowed. Every effort was made to include all relevant literature published in developing countries or unpublished sources. It is primarily focused on recent literature, as the objective is to facilitate estimation of current and future implementation costs. When little or no cost estimates in sub-Saharan Africa are available, such as for breast cancer screening and treatment, we include cost estimates from outside the region. Within each topic references are organized in order (subjectively) of usefulness and quality. Each reference gives a description of points of the study relevant to the cost figures to the extent that the study presents itself. We briefly describe the methodology, including any information provided on which costs were included or not included. The costs presented are typically unit costs, where the units are most often per CYP, per capita, per illness and per affected individual. When additional calculations were necessary to produce unit costs, the additional figures used in the calculations are also presented. We provide the year-basis for the cost figures where possible and the exchange rate used where necessary. When the precise year-basis information was not available or was ambiguous in the source material we attempted provide the dates for the period of the intervention as available to offer some context for the cost data. We occasionally included dates in other references as well to offer addition context as necessary

Reducing undiagnosed HIV infection among adolescents in sub-Saharan Africa: Provider-initiated and opt-out testing are not enough.

Community efforts and peer support programs are needed in addition to provider-initiated and opt-out HIV testing in adolescents, Sheri Weiser and colleagues discuss