Treatment-as-Prevention in AIDS Control: Why Communication Still Matters

Abstract: Treatment-as-prevention is a term used to describe an HIV prevention method that uses antiretroviral treatment to minimize the chance of HIV transmission, with the idea that treatment can decrease the viral load of those infected to a level where transmission risk is minimal. However, for treatment-as-prevention to be a success, individuals must get tested, know their status, seek care, and adhere to their antiretroviral regimen. Communication plays a role in each of these steps, as communication can be used to create demand for health-seeking behavior and as a means to increase quality and support on the supply side, at the clinic and community level. From the demand side, communication has played a role in convincing people to get tested and obtain their results, in ensuring treatment access, linking those infected to care, and addressing stigmatizing attitudes that may prevent individuals from taking these actions. On the supply side, communication has been shown to mobilize community care and support and increase the quality of patient-provider interaction, which in turn can improve adherence. Finally, communication has played an integral role in structural issues related to treatment-as-prevention, including the assurance of adequate supplies, including HIV testing kits, anti-retrovirals, and condoms

Treatment-as-Prevention in AIDS Control: Why Communication Still Matters

Abstract: Treatment-as-prevention is a term used to describe an HIV prevention method that uses antiretroviral treatment to minimize the chance of HIV transmission, with the idea that treatment can decrease the viral load of those infected to a level where transmission risk is minimal. However, for treatment-as-prevention to be a success, individuals must get tested, know their status, seek care, and adhere to their antiretroviral regimen. Communication plays a role in each of these steps, as communication can be used to create demand for health-seeking behavior and as a means to increase quality and support on the supply side, at the clinic and community level. From the demand side, communication has played a role in convincing people to get tested and obtain their results, in ensuring treatment access, linking those infected to care, and addressing stigmatizing attitudes that may prevent individuals from taking these actions. On the supply side, communication has been shown to mobilize community care and support and increase the quality of patient-provider interaction, which in turn can improve adherence. Finally, communication has played an integral role in structural issues related to treatment-as-prevention, including the assurance of adequate supplies, including HIV testing kits, anti-retrovirals, and condoms

Talking about sex in Malawi: toward a better understanding of interpersonal communication for HIV prevention

The generalised AIDS epidemic in Malawi presents many challenges. As communication and advice from parents, peers, and partners are important factors in influencing sexual behaviour, understanding communication may provide insights into behaviour change programming. This mixed-method study used a household survey (n=1812) and 15 focus group discussions from the southern districts of Malawi to explore communication about sex and sexuality. Quantitative study findings point to the idea that self-efficacy, perceived benefits, and injunctive norms about talking about condom use are important factors influencing intentions to discuss condom use with partners. Qualitative study findings found that communication regarding sex between parents and children, partners, and peers was not common, and when there was communication, messages about sex focused on negative consequences of sexual activity. In Malawi, there is a need to increase efficacy in talking about sex and protective sexual behaviours, including condom use. Interventions should include components to increase communication skills, shift norms about sexual communication, and provide alternative mechanisms for individuals to gather pertinent information regarding their sexual behaviour

Micromultileaf collimator-based stereotactic radiosurgery for selected arteriovenous malformations: Technique and preliminary experience

Purpose : To report our experience of stereotactic radiosurgery (SRS) in consecutively treated patients with arteriovenous malformations (AVMs). Materials and Methods : Of the 87 patients, 23 patients qualified and were treated with SRS as per predefined protocol according to AVM size, location, neurological status, prior bleeding, and the AVM score. All had Spletzer-Martin grade II/III and AVM scores < 2.5. Patients underwent SRS using micromultileaf collimators delivering multiple noncoplanar fixed fields. Doses were prescribed using the Flickinger model. Patients were followed up with magnetic resonance angiography (MRA) and digitally subtracted angiography (DSA). Results : The mean nidus volume was 3.65 cc. The mean prescribed maximum dose was 22 Gy and the marginal dose was 19.24 Gy; 12 Gy normal brain volume was 8.39 cc and 12 Gy marginal volume was 5.03 cc. Mean dose to brain stem, pituitary hypothalamic axis, and optic chiasm was 2.5, 0.72, and 0.49 Gy, respectively. At a median follow-up of 22 months (range 1.5-71.2 months), 7 of 10 patients presenting with a neurological deficit showed significant improvement. All 15 patients who underwent MRA 1.5-2 years after SRS had no residual nidus yielding an MRA complete obliteration rate of 100%. Twelve patients also underwent a check DSA, which confirmed obliteration in 11 of them resulting in an accuracy of MRA of 92%. One patient after SRS had transient deterioration of motor power, which resolved completely after a short course of steroids and another had mild worsening of the hemiparesis. All patients are able to lead an active functional life. Conclusions : Careful selection of cases suitable for SRS provides optimum obliteration rates with low toxicity