Overlapping HIV and sex-work stigma among female sex workers recruited to 14 respondent-driven sampling surveys across Zimbabwe, 2013.

HIV stigma can inhibit uptake of HIV testing and antiretroviral therapy as well as negatively affect mental health. Efforts to reduce discrimination against people living with HIV (LWH) have contributed to greater acceptance of the infection. Female sex workers (FSW) LWH may experience overlapping stigma due to both their work and HIV status, although this is poorly understood. We examined HIV and sex-work stigma experienced by FSW LWH in Zimbabwe. Using the SAPPH-IRe cluster-randomised trial baseline survey, we analysed the data from 1039 FSW self-reporting HIV. The women were recruited in 14 sites using respondent-driven sampling. We asked five questions to assess internalised and experienced stigma related to working as a sex worker, and the same questions were asked in reference to HIV. Among all FSW, 91% reported some form of sex-work stigma. This was not associated with sociodemographic or sex-work characteristics. Rates of sex-work stigma were higher than those of HIV-related stigma. For example, 38% reported being "talked badly about" for LWH compared with 77% for their involvement in sex work. Those who reported any sex-work stigma also reported experiencing more HIV stigma compared to those who did not report sex-work stigma, suggesting a layering effect. FSW in Zimbabwe experience stigma for their role as "immoral" women and this appears more prevalent than HIV stigma. As HIV stigma attenuates, other forms of social stigma associated with the disease may persist and continue to pose barriers to effective care

Utilisation of sexual health services by female sex workers in Nepal

Background The Nepal Demographic Health Survey (NDHS) in 2006 showed that more than half (56%) of the women with sexually transmitted infections (STIs), including HIV, in Nepal sought sexual health services. There is no such data for female sex workers (FSWs) and the limited studies on this group suggest they do not even use routine health services. This study explores FSWs use of sexual health services and the factors associated with their use and non-use of services. Methods This study aimed to explore the factors associated with utilisation of sexual health services by FSWs in the Kathmandu Valley of Nepal, and it used a mixed-method approach consisting of an interviewer administered questionnaire-based survey and in-depth interviews. Results The questionnaire survey, completed with 425 FSWs, showed that 90% FSWs self-reported sickness, and (30.8%) reported symptoms of STIs. A quarter (25%) of those reporting STIs had never visited any health facilities especially for sexual health services preferring to use non-governmental clinics (72%), private clinics (50%), hospital (27%) and health centres (13%). Multiple regression analysis showed that separated, married and street- based FSWs were more likely to seek health services from the clinics or hospitals. In- depth interviews with 15 FSWs revealed that FSWs perceived that personal, structural and socio-cultural barriers, such as inappropriate clinic opening hours, discrimination, the judgemental attitude of the service providers, lack of confidentiality, fear of public exposure, and higher fees for the services as barriers to their access and utilisation of sexual health services. Conclusion FSWs have limited access to information and to health services, and operate under personal, structural and socio-cultural constraints. The ‘education’ to change individual behaviour, health worker and community perceptions, as well as the training of the health workers, is necessary

The HIV care cascade among female sex workers in Zimbabwe: results of a population-based survey from the Sisters Antiretroviral therapy Programme for Prevention of HIV, an Integrated Response (SAPPH-IRe) Trial.

: Female sex workers (FSW) in sub-Saharan Africa have a higher prevalence of HIV than other women of reproductive age. Social, legal, and structural barriers influence their access to care. Little is known about the HIV diagnosis and care cascade in most countries in Southern Africa. We aimed to describe the HIV diagnosis and care cascade among FSW in Zimbabwe. : We conducted cross-sectional respondent driven sampling (RDS) surveys of FSW in 14 sites across Zimbabwe as the baseline for a cluster-randomised controlled trial investigating a combination HIV prevention and care package. We administered a questionnaire, tested women for HIV and measured viral load. We report the mean, minimum, and maximum respondent-driven sampling-2 weighted site values. : The survey included 2722 women, approximately 200 per site. The mean HIV prevalence was 57.5% (42.8-79.2 site minimum and maximum). Of HIV-positive women, 64.0% (51.6-73.7) were aware of their status, 67.7% (53.4-84.1) of these reported taking antiretroviral therapy, and 77.8% (64.4-90.8) of these had a suppressed HIV viral load (&lt;1000 copies/mL). Among all HIV-positive women, 49.5% had a viral load &lt; 1000 copies/mL. : Although most HIV-positive women aware of their status are accessing antiretroviral therapy, 36.0% of HIV-positive women are unaware of their status and 29.3% of all FSW have an unsuppressed HIV viral load. Investigation and investment into models of testing, treatment, and care are necessary to reach UNAIDS targets for HIV elimination.<br/

How Can Programs Better Support Female Sex Workers to Avoid HIV Infection in Zimbabwe? A Prevention Cascade Analysis

BACKGROUND: “HIV prevention cascades” have been proposed to support programs by identifying gaps in demand for, access to, and capability to adhere to HIV prevention tools, but there are few empirical examples to guide development. We apply a prevention cascade framework to examine prevention coverage and factors associated with condoms and/or PrEP adherence among female sex workers. SETTING: Seven sites across Zimbabwe. METHODS: Seven respondent-driven sampling surveys from the intervention sites of a pragmatic cluster-randomized trial in Zimbabwe in 2016 were analyzed, and 611/1439 women testing HIV-negative included. We operationalized key components of an HIV prevention cascade including demand, supply, and capability to adhere to 2 tools for HIV prevention: condoms and pre-exposure prophylaxis (PrEP). We used adjusted logistic regression to identify determinants of adherence to condoms and PrEP in turn, examining the effect of adherence to one tool on adherence to the other. RESULTS: There were 343/611, 54.7%, women reporting adherence to condoms and/or PrEP, leaving almost half uncovered. Although women were aware that condoms prevented HIV and reported good access to them, only 45·5% reported full adherence to condom use. For PrEP, a new technology, there were gaps along all 3 domains of demand, supply, and adherence. Alcohol use decreased adherence to PrEP and condoms. Younger and newer entrants to sex work were less likely to take PrEP every day. CONCLUSIONS: HIV prevention programming among female sex workers in Zimbabwe could consider increasing awareness of PrEP alongside supply, alcohol use interventions, and approaches to engaging younger women

Search for physics beyond the standard model in events with two leptons, jets, and missing transverse momentum in pp collisions at √s = 8 TeV

A search is presented for physics beyond the standard model in final states with two opposite-sign same-flavor leptons, jets, and missing transverse momentum. The data sample corresponds to an integrated luminosity of 19.4 fb[superscript −1] of proton-proton collisions at √s = 8 TeV collected with the CMS detector at the CERN LHC in 2012. The analysis focuses on searches for a kinematic edge in the invariant mass distribution of the oppositesign same-flavor lepton pair and for final states with an on-shell Z boson. The observations are consistent with expectations from standard model processes and are interpreted in terms of upper limits on the production of supersymmetric particles.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Health workers' views on quality of prevention of mother-to-child transmission and postnatal care for HIV-infected women and their children

<p>Abstract</p> <p>Background</p> <p>Prevention of mother-to-child transmission has been considered as not a simple intervention but a comprehensive set of interventions requiring capable health workers. Viet Nam's extensive health care system reaches the village level, but still HIV-infected mothers and children have received inadequate health care services for prevention of mother-to-child transmission. We report here the health workers' perceptions on factors that lead to their failure to give good quality prevention of mother-to-child transmission services.</p> <p>Methods</p> <p>Semistructured interviews with 53 health workers and unstructured observations in nine health facilities in Hanoi were conducted. Selection of respondents was based on their function, position and experience in the development or implementation of prevention of mother-to-child transmission policies/programmes.</p> <p>Results</p> <p>Factors that lead to health workers' failure to give good quality services for prevention of mother-to-child transmission include their own fear of HIV infection; lack of knowledge on HIV and counselling skills; or high workloads and lack of staff; unavailability of HIV testing at commune level; shortage of antiretroviral drugs; and lack of operational guidelines. A negative attitude during counselling and provision of care, treating in a separate area and avoidance of providing service at all were seen by health workers as the result of fear of being infected, as well as distrust towards almost all HIV-infected patients because of the prevailing association with antisocial behaviours. Additionally, the fragmentation of the health care system into specialized vertical pillars, including a vertical programme for HIV/AIDS, is a major obstacle to providing a continuum of care.</p> <p>Conclusion</p> <p>Many hospital staff were not being able to provide good care or were even unwilling to provide appropriate care for HIV-positive pregnant women The study suggests that the quality of prevention of mother-to-child transmission service could be enhanced by improving communication and other skills of health workers, providing them with greater support and enhancing their motivation. Reduction of workload would also be important. Development of a practical strategy is needed to strengthen and adapt the referral system to meet the needs of patients.</p

Measurement of the W boson helicity in events with a single reconstructed top quark in pp collisions at √s = 8 TeV

A measurement of the W boson helicity is presented, where the W boson originates from the decay of a top quark produced in pp collisions. The event selection, optimized for reconstructing a single top quark in the final state, requires exactly one isolated lepton (muon or electron) and exactly two jets, one of which is likely to originate from the hadronization of a bottom quark. The analysis is performed using data recorded at a center-of-mass energy of 8 TeV with the CMS detector at the CERN LHC in 2012. The data sample corresponds to an integrated luminosity of 19.7 fb[superscript −1]. The measured helicity fractions are F [subscript L] = 0.298 ± 0.028 (stat) ± 0.032(syst), F [subscript 0] = 0.720 ± 0.039 (stat) ± 0.037(syst), and F [subscript R] = −0.018 ± 0.019 (stat) ± 0.011(syst). These results are used to set limits on the real part of the tWb anomalous couplings, g [subscript L] and g [subscript R]

Search for a standard model Higgs boson produced in association with a top-quark pair and decaying to bottom quarks using a matrix element method

A search for a standard model Higgs boson produced in association with a top-quark pair and decaying to bottom quarks is presented. Events with hadronic jets and one or two oppositely charged leptons are selected from a data sample corresponding to an integrated luminosity of 19.5 fb[superscript -1] collected by the CMS experiment at the LHC in pp collisions at a centre-of-mass energy of 8 TeV. In order to separate the signal from the larger t[bar over t] + jets background, this analysis uses a matrix element method that assigns a probability density value to each reconstructed event under signal or background hypotheses. The ratio between the two values is used in a maximum likelihood fit to extract the signal yield. The results are presented in terms of the measured signal strength modifier, μ, relative to the standard model prediction for a Higgs boson mass of 125 GeV. The observed (expected) exclusion limit at a 95 % confidence level is μ < 4.2 (3.3), corresponding to a best fit value [^ over μ] = 1.2[+1.6 over −1.5].United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Search for new physics in events with same-sign dileptons and jets in pp collisions at √s = 8 TeV

A search for new physics is performed based on events with jets and a pair of isolated, same-sign leptons. The results are obtained using a sample of proton-proton collision data collected by the CMS experiment at a centre-of-mass energy of 8 TeV at the LHC, corresponding to an integrated luminosity of 19.5 fb[superscript −1]. In order to be sensitive to a wide variety of possible signals beyond the standard model, multiple search regions defined by the missing transverse energy, the hadronic energy, the number of jets and b-quark jets, and the transverse momenta of the leptons in the events are considered. No excess above the standard model background expectation is observed and constraints are set on a number of models for new physics, as well as on the same-sign top-quark pair and quadruple-top-quark production cross sections. Information on event selection efficiencies is also provided, so that the results can be used to confront an even broader class of new physics models.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Search for the production of dark matter in association with top-quark pairs in the single-lepton final state in proton-proton collisions at √s = 8 TeV

A search is presented for particle dark matter produced in association with a pair of top quarks in pp collisions at a centre-of-mass energy of √s = 8 TeV. The data were collected with the CMS detector at the LHC and correspond to an integrated luminosity of 19.7 fb[superscript −1]. This search requires the presence of one lepton, multiple jets, and large missing transverse energy. No excess of events is found above the SM expectation, and upper limits are derived on the production cross section. Interpreting the findings in the context of a scalar contact interaction between fermionic dark matter particles and top quarks, lower limits on the interaction scale are set. These limits are also interpreted in terms of the dark matter-nucleon scattering cross sections for the spin-independent scalar operator and they complement direct searches for dark matter particles in the low mass region.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio