Gender and ethnicity intersect to reduce participation at a large European hybrid HIV conference.

OBJECTIVE To evaluate how gender and ethnicity of panel members intersect to effect audience participation at a large European hybrid conference. DESIGN An observational cross-sectional study design was used to collect data at the conference and descriptive survey was used to collect data retrospectively from the participants. SETTING European AIDS Clinical Society 18th Conference; a 3223-delegate, hybrid conference held online and in London over 4 days in October 2021. MAIN OUTCOME MEASURES We observed the number and type of questions asked at 12 of 69 sessions and described characteristics of the panel composition by ethnicity, gender and seniority. A postconference survey of conference attendees collated demographic information, number of questions asked during the conference and the reasons for not asking questions. RESULTS Men asked the most questions and were more likely to ask multiple questions in the observed sessions (61.5%). People from white ethnic groups asked >95% of the questions in the observed sessions. The fewest questions were asked in the sessions with the least diverse panels in terms of both ethnicity and gender. Barriers to asking questions differed between genders and ethnicities. CONCLUSIONS Our study aims to provide evidence to help conference organisers improve leadership, equality, diversity and inclusion in the professional medical conference setting. This will support equitable dissemination of knowledge and improve education and engagement of delegates. To our knowledge, this is the first study describing conference participation by both ethnicity and gender in panellists and delegates within a hybrid conference setting

Shame, Stigma, HIV: Philosophical Reflections

It is a distinctive feature of HIV that its pathology cannot be adequately grasped separate from a number of psycho-social factors, and stigma is widely seen as the most prominent. We argue that it is equally important to have an adequate understanding shame, as the emotional response to stigma. We have identified five ways shame might negatively impact upon attempts to combat and treat HIV, which emerge from the stigma HIV carries and STI-stigma in general. In this paper, we draw-out four insights from philosophical work on emotions and shame which we propose will improve understanding of shame and stigma. We conclude by briefly discussing how these insights might shed light on the negative role shame can play for a person living with HIV engaging with, or being retained in, care. We conclude by proposing further study

The experience of intimate partner violence among older women: A narrative review

Intimate partner violence (IPV) against women is a significant public health issue globally. It has serious physical and psychological health consequences as well huge economic and social costs. With an ageing population globally, it is important to understand how older women experience IPV. We present a narrative review of 48 studies exploring IPV in women aged ≥45 years, focusing on: (1) prevalence of IPV; (2) factors associated with IPV; (3) impact of IPV; (4) responses to IPV; (5) IPV interventions; and (6) key populations. Although we found significant gaps in the literature and an inconsistency in definitions, data suggest that IPV is commonly experienced by older women (lifetime prevalence 16.5%–54.5%), but that their age and life transitions mean that they may experience abuse differently to younger women. They also face unique barriers to accessing help, such as disability and dependence on their partners. We recommend commissioning services that are specifically tailored to meet their needs. Professionals working in frontline services where older women are commonly seen should be trained to identify and respond to IPV appropriately

Experiences of initiating rapid antiretroviral therapy among people newly diagnosed with HIV in East London: a qualitative study

Objectives We aimed to explore the experiences of people who initiated rapid antiretroviral therapy (ART) within 7 days of HIV diagnosis, as part of routine care in London. Methods Using purposive sampling, 18 in-depth, semistructured interviews were conducted between December 2020 and September 2021 with people who started rapid ART at Barts Health NHS Trust. Participants aged 22–69 years included 15 cisgender men and three cisgender women. Five identified as heterosexual and 13 as gay and bisexual and other men who have sex with men. Ethnic identities: six White Non-UK, five White UK, three Black Caribbean, two South Asian and two East Asian. Interviews explored feelings about the new HIV diagnosis, attitudes to rapid ART including barriers to and facilitators of starting. Thematic analysis of transcribed interviews was undertaken. Results Four themes were identified: (1) being offered rapid ART is acceptable; (2) it is a way of taking control of their health; (3) the need for information and support and (4) an individualised approach to care. Reasons for starting included getting well, staying well and reducing the likelihood of passing on HIV. Facilitators included being given comprehensive information about treatment and managing potential side-effects and a supportive clinical team. Support specified included a non-judgemental attitude, approachability, reassurance, encouragement and information about peer support. Most participants expressed they could not understand why people would not begin treatment, but suggested needing more time to decide and denial of diagnosis as possible barriers. Conclusions To our knowledge, this is the first qualitative study exploring the experiences of people initiating rapid ART in the UK. It was deemed acceptable to an ethnically diverse, predominantly male sample of people newly diagnosed with HIV. Future research should include strategies to recruit a more gender diverse sample and those who declined or stopped rapid ART

Patterns of mental health symptoms among women living with HIV ages 45-60 in England: associations with demographic and clinical factors

OBJECTIVE: We aimed to describe the prevalence of various mental health symptoms according to menopausal status (pre, peri, post) among women living with HIV ages 45-60 in England, and to identify groups of women with similar general and menopause-related mental health symptoms. We then investigated demographic predictors of group-membership and group differences in HIV-related care outcomes (antiretroviral therapy adherence, HIV clinic attendance, CD4-count, and last HIV viral load). METHODS: An analysis of cross-sectional data from the Positive Transitions through Menopause study, an observational study of the health and well-being impacts of menopause on 869 women with HIV aged 45-60 years. Self-reported data on eight mental health indicators were collected from women in pre-, peri- and post-menopausal state using validated measures. Groups (termed "classes") of women with similar mental health symptoms were derived via latent class analysis. Class membership was linked to demographic factors using nominal logistic regression, and to clinical outcomes using Wald tests. RESULTS: We identified five classes: 1) few mental health symptoms (n = 501, 57.8%); 2) high current anxiety/depression (n = 120, 13.8%); 3) history of depression, with elevated current substance use (n = 40, 4.6%); 4) history of depression with current psychological menopause symptoms (n = 81, 9.3%); and 5) high previous and concurrent mental health problems (n = 125, 14.4%). University attendance, ethnicity, and longer time since HIV diagnosis predicted class membership. Antiretroviral therapy adherence was lower in classes 3 (11%), 4 (19%) and 5 (24%) compared to class 1 (4%; all P < 0.001). Members of class 5 were more likely to have missed ≥1 HIV clinic appointment in the past year than those in class 1 (34% vs 17%, P = 0.005). CONCLUSIONS: Women with a history of depression, current anxiety/depression, and current menopause-related mental health symptoms were more likely to have poorer clinical outcomes. Although we cannot comment on causality, our findings highlight the importance of assessing and managing menopausal symptoms and mental health to improve well-being and engagement in HIV care

Confronting the consequences of racism, xenophobia, and discrimination on health and health-care systems

Racism, xenophobia, and discrimination are key determinants of health and equity and must be addressed for improved health outcomes. We conclude that far broader, deeper, transformative action is needed compared with current measures to tackle adverse effects of racism on health. To challenge the structural drivers of racism and xenophobia, anti-racist action and other wider measures that target determinants should implement an intersectional approach to effectively address the causes and consequences of racism within a population. Structurally, legal instruments and human rights law provide a robust framework to challenge the pervasive drivers of disadvantage linked to caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour. Actions need to consider the historical, economic, and political contexts in which the effects of racism, xenophobia, and discrimination affect health. We propose several specific actions: a commission that explores how we action the approaches laid out in this paper; building a conversation and a series of events with international multilateral agency stakeholders to raise the issue and profile of racism, xenophobia, and discrimination within health; and using our multiple platforms to build coalitions, expand knowledge, highlight inequities, and advocate for change across the world

Antenatal Atazanavir: A Retrospective Analysis of Pregnancies Exposed to Atazanavir

Introduction. There are few data regarding the tolerability, safety, or efficacy of antenatal atazanavir. We report our clinical experience of atazanavir use in pregnancy. Methods. A retrospective medical records review of atazanavir-exposed pregnancies in 12 London centres between 2004 and 2010. Results. There were 145 pregnancies in 135 women: 89 conceived whilst taking atazanavir-based combination antiretroviral therapy (cART), &quot;preconception&quot; atazanavir exposure; 27 started atazanavir-based cART as &quot;firstline&quot; during the pregnancy; and 29 &quot;switched&quot; to an atazanavir-based regimen from another cART regimen during pregnancy. Gastrointestinal intolerance requiring atazanavir cessation occurred in five pregnancies. Self-limiting, new-onset transaminitis was most common in first-line use, occurring in 11.0%. Atazanavir was commenced in five switch pregnancies in the presence of transaminitis, two of which discontinued atazanavir with persistent transaminitis. HIV-VL &lt; 50 copies/mL was achieved in 89.3% preconception, 56.5% first-line, and 72.0% switch exposures. Singleton preterm delivery (&lt;37 weeks) occurred in 11.7% preconception, 9.1% first-line, and 7.7% switch exposures. Four infants required phototherapy. There was one mother-to-child transmission in a poorly adherent woman. Conclusions. These data suggest that atazanavir is well tolerated and can be safely prescribed as a component of combination antiretroviral therapy in pregnancy