Law, Criminalisation and HIV in the World: Have countries that criminalise achieved more or less successful AIDS pandemic response?

How does the use of criminal law affect disease-fighting efforts, particularly in a pandemic? This longstanding question for governments around the world is felt acutely in the context of the COVID-19 and HIV pandemics. Many countries have laws and policies that criminalise behaviours, making same-sex relationships, illicit drug use, and sex work illegal. Meanwhile, some countries have enshrined gender- and rights-protective institutions in law. Under the global AIDS strategy of the last five years, national AIDS response efforts in countries have focused on reaching people living with HIV with testing and antiretroviral treatment to suppress the HIV virus, preventing mortality and HIV transmission. At the end of this 5-year push, this article provides an ecological analysis of whether those countries with criminalising legal environments achieved more or less success. In countries where same-sex relationships were fully criminalised, the portion of people living with HIV who knew their status was 11% lower and viral suppression rates were 8% lower. Under sex-work criminalization, the rate of people living with HIV who knew their status was 10% lower and viral suppression 6% lower. Drug use criminalisation was associated with 14% lower knowledge of status and viral. On the other hand in countries with laws advancing non-discrimination, human rights institutions, and gender-based violence response, HIV services indicators were significantly better. This ecological evidence on the relationships between the legal environment and successful HIV response provides support for a strategy that includes a focus on law reform to achieve goals missed in 2020.

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Law, criminalisation and HIV in the world: have countries that criminalise achieved more or less successful pandemic response?

BMJ Global Health ◽

10.1136/bmjgh-2021-006315 ◽

2021 ◽

Vol 6 (8) ◽

pp. e006315

Author(s):

Matthew M Kavanagh ◽

Schadrac C Agbla ◽

Marissa Joy ◽

Kashish Aneja ◽

Mara Pillinger ◽

...

Keyword(s):

Viral Suppression ◽

Hiv Transmission ◽

People Living With Hiv ◽

Hiv Status ◽

Gender Based Violence ◽

Hiv Virus ◽

The World ◽

Gender Based ◽

And Gender ◽

Living With Hiv

How do choices in criminal law and rights protections affect disease-fighting efforts? This long-standing question facing governments around the world is acute in the context of pandemics like HIV and COVID-19. The Global AIDS Strategy of the last 5 years sought to prevent mortality and HIV transmission in part through ensuring people living with HIV (PLHIV) knew their HIV status and could suppress the HIV virus through antiretroviral treatment. This article presents a cross-national ecological analysis of the relative success of national AIDS responses under this strategy, where laws were characterised by more or less criminalisation and with varying rights protections. In countries where same-sex sexual acts were criminalised, the portion of PLHIV who knew their HIV status was 11% lower and viral suppression levels 8% lower. Sex work criminalisation was associated with 10% lower knowledge of status and 6% lower viral suppression. Drug use criminalisation was associated with 14% lower levels of both. Criminalising all three of these areas was associated with approximately 18%–24% worse outcomes. Meanwhile, national laws on non-discrimination, independent human rights institutions and gender-based violence were associated with significantly higher knowledge of HIV status and higher viral suppression among PLHIV. Since most countries did not achieve 2020 HIV goals, this ecological evidence suggests that law reform may be an important tool in speeding momentum to halt the pandemic.

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Sexual function and dysfunction in older HIV-positive individuals

Sexual Health ◽

10.1071/sh11041 ◽

2011 ◽

Vol 8 (4) ◽

pp. 502 ◽

Cited By ~ 3

Author(s):

Darren B. Russell

Keyword(s):

Sexual Dysfunction ◽

Sexual Functioning ◽

Hiv Transmission ◽

Hiv Positive ◽

People Living With Hiv ◽

Organ Systems ◽

The World ◽

Risk Of Disease ◽

Living With Hiv ◽

Hiv Negative

With many parts of the world seeing an aging cohort of people living with HIV (PLHIV), it is becoming clear that some organ systems in these individuals are at a greater risk of disease. There are effects on sexual functioning in aging PLHIV, with many studies finding higher levels of sexual dysfunction in HIV-positive individuals compared with those who are HIV-negative. HIV itself, along with antiretroviral agents, may cause dysfunction. Treatment involves making an assessment of the dysfunction and using the usual methods available, although treatment may be complicated by hormonal deficiencies in HIV-positive individuals, along with the effects of antiretroviral therapy, and drug interactions involving such medications. Furthermore, the issue of HIV transmission needs to be addressed in those seeking treatment for sexual dysfunction.

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Examining common mental health disorders in people living with HIV on methadone maintenance therapy in Hanoi, Vietnam

Harm Reduction Journal ◽

10.1186/s12954-021-00495-3 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Anisa Y. Mughal ◽

Melissa Ann Stockton ◽

Quynh Bui ◽

Vivian Go ◽

Brian W. Pence ◽

...

Keyword(s):

Mental Health ◽

Substance Use ◽

Drug Use ◽

Injection Drug Use ◽

Hiv Transmission ◽

Methadone Maintenance ◽

Injection Drug ◽

People Living With Hiv ◽

High Prevalence ◽

Living With Hiv

Abstract Background Injection drug use drives HIV transmission in Southeast Asia, where around a quarter of users are living with HIV. Vietnam developed Methadone Maintenance Therapy (MMT) programs to reduce unsafe drug abuse. Common mental health disorders (CMD), including depression, anxiety and post-traumatic stress disorder (PTSD), can worsen MMT outcomes and are highly prevalent among people living with HIV (PLH). We aimed to characterize HIV and CMD among MMT patients and assess the impact of HIV and CMD on MMT engagement outcomes in Hanoi, Vietnam. Methods This cross-sectional study was conducted at an urban MMT clinic in Hanoi. Participants were screened for CMD with the relevant sections of the Mini International Neuropsychiatric Interview (MINI). Tabular comparisons and regression models were used to understand the association of HIV and CMD with substance use and methadone compliance. Results Of the 400 MMT participants, 22% were living with HIV, 11% a CMD, 27% reported injection drug use, and 27% reported methadone noncompliance. Around 17% of those with HIV also had a CMD. Reporting non injection and injection drug use were each higher among those with CMD regardless of HIV status. In addition, reporting any drug use was much higher among those with both HIV and CMD than among those with neither (73% vs 31%, p value 0.001). While methadone noncompliance was lower among PLH than among those without HIV (16.3% vs 30.1%, p value 0.010), noncompliance was higher among those with CMD than among those without (40.5% vs 25.6%, p value 0.045). Among those without HIV, noncompliance was higher among those with CMD than among those without, but among those with HIV, the opposite relationship was observed. Conclusion There is complex overlap between substance use and methadone noncompliance among MMT patients living with HIV, CMD or both. In this population, we found a high prevalence of CMD and substance use among PLH, and a high prevalence of substance use and methadone noncompliance among those with CMD. Prioritizing provision of mental health care services to MMT patients living with HIV can help improve engagement with substance use disorder treatment and reduce the risk of HIV transmission.

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Current Interventions for People Living with HIV Who Use Alcohol: Why Gender Matters

Current HIV/AIDS Reports ◽

10.1007/s11904-021-00558-x ◽

2021 ◽

Author(s):

Wendee M. Wechsberg ◽

Felicia A. Browne ◽

Courtney Peasant Bonner ◽

Yukiko Washio ◽

Brittni N. Howard ◽

...

Keyword(s):

Viral Suppression ◽

Intervention Studies ◽

Alcohol Misuse ◽

Small Samples ◽

People Living With Hiv ◽

Alcohol Intervention ◽

The World ◽

Significant Efficacy ◽

Hiv Research ◽

Living With Hiv

Abstract Purpose of Review Alcohol is the most misused substance in the world. For people living with HIV (PLWH), alcohol misuse may impact ART adherence and viral suppression. This review of the most recently published alcohol intervention studies with PLWH examines how these studies considered gender in the samples, design, and analyses. Recent Findings Three searches were conducted initially, and 13 intervention studies fit our criteria with alcohol outcomes. In general, most studies did not consider gender and had used small samples, and few demonstrated significant efficacy/effectiveness outcomes. Five studies considered gender in their samples or analyses and/or were woman-focused with larger samples and demonstrated significant outcomes. Summary It is essential for women who misuse alcohol to not only be well represented in alcohol and HIV research but also for studies to consider the barriers to reaching them and their contextual demands and/or co-occurring issues that may affect participation and outcomes in intervention research.

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Modelling of HIV prevention and treatment progress in five South African metropolitan districts

Scientific Reports ◽

10.1038/s41598-021-85154-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Cari van Schalkwyk ◽

Rob E. Dorrington ◽

Thapelo Seatlhodi ◽

Claudia Velasquez ◽

Ali Feizzadeh ◽

...

Keyword(s):

South Africa ◽

South African ◽

Viral Suppression ◽

Hiv Transmission ◽

Transmission Model ◽

Hiv Positive ◽

People Living With Hiv ◽

Treatment Target ◽

Specific Data ◽

Living With Hiv

AbstractGlobally, large proportions of HIV-positive populations live in cities. The Fast-Track cities project aims to advance progress toward elimination of HIV as a public health threat by accelerating the response in cities across the world. This study applies a well-established HIV transmission model to provide key HIV estimates for the five largest metropolitan districts in South Africa (SA): Cape Town, Ekurhuleni, eThekwini, Johannesburg and Tshwane. We calibrate the model to metro-specific data sources and estimate progress toward the 90-90-90 targets set by UNAIDS (90% of people living with HIV (PLHIV) diagnosed, 90% of those diagnosed on antiretroviral therapy (ART) and viral suppression in 90% of those on ART). We use the model to predict progress towards similarly defined 95-95-95 targets in 2030. In SA, 90.5% of PLHIV were diagnosed in 2018, with metro estimates ranging from 86% in Johannesburg to 92% in eThekwini. However, only 68.4% of HIV-diagnosed individuals nationally were on ART in 2018, with the proportion ranging from 56% in Tshwane to 73% in eThekwini. Fractions of ART users who were virally suppressed ranged from 77% in Ekurhuleni to 91% in eThekwini, compared to 86% in the whole country. All five metros are making good progress to reach diagnosis targets and all (with the exception of Ekurhuleni) are expected to reach viral suppression targets in 2020. However, the metros and South Africa face severe challenges in reaching the 90% ART treatment target.

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The Bio/Necropolitics of ACTG 076: Lessons from Pregnant Women of Colour Living with HIV for Treatment for Prevention in the Twenty-first Century

Somatechnics ◽

10.3366/soma.2020.0315 ◽

2020 ◽

Vol 10 (2) ◽

pp. 233-253

Author(s):

Eli Manning

Keyword(s):

Hiv Transmission ◽

Ethical Dilemmas ◽

Hiv Treatment ◽

First Century ◽

Hiv Positive ◽

Treatment As Prevention ◽

People Living With Hiv ◽

Hiv Positive Women ◽

Aids Clinical Trials ◽

Living With Hiv

Since the pharmaceutical turn, using HIV treatment to prevent transmission is increasingly common. Treatment as Prevention®, or TasP, has relied on HIV treatment to prevent HIV transmission, targeting people living with HIV. However, TasP is predicated on troublesome heterosexist, classist, and racist medical practices borrowed from various times and spaces that enact biopolitical and necropolitical relations. This paper discusses the debate surrounding the first clinical trial that used HIV treatment to prevent transmission from woman-to-foetus. The 1994 landmark AIDS Clinical Trials Group 076 study laid the groundwork for using HIV treatment to prevent HIV transmission, the essential precursor to TasP. By examining the concerns of HIV positive women of colour and other AIDS activists, we are able to understand the ethical dilemmas and practical consequences that still haunt today's game-changing uses of HIV treatment for prevention and to see how biopolitics and necropolitics persist in TasP.

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Antiretroviral Drugs Impact Autophagy with Toxic Outcomes

Cells ◽

10.3390/cells10040909 ◽

2021 ◽

Vol 10 (4) ◽

pp. 909

Author(s):

Laura Cheney ◽

John M. Barbaro ◽

Joan W. Berman

Keyword(s):

Quality Control ◽

Antiretroviral Therapy ◽

Side Effects ◽

Viral Suppression ◽

Antiretroviral Drugs ◽

People Living With Hiv ◽

Foreign Material ◽

Complete Understanding ◽

Living With Hiv ◽

Target Effects

Antiretroviral drugs have dramatically improved the morbidity and mortality of people living with HIV (PLWH). While current antiretroviral therapy (ART) regimens are generally well-tolerated, risks for side effects and toxicity remain as PLWH must take life-long medications. Antiretroviral drugs impact autophagy, an intracellular proteolytic process that eliminates debris and foreign material, provides nutrients for metabolism, and performs quality control to maintain cell homeostasis. Toxicity and adverse events associated with antiretrovirals may be due, in part, to their impacts on autophagy. A more complete understanding of the effects on autophagy is essential for developing antiretroviral drugs with decreased off target effects, meaning those unrelated to viral suppression, to minimize toxicity for PLWH. This review summarizes the findings and highlights the gaps in our knowledge of the impacts of antiretroviral drugs on autophagy.

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Clinical situation of Venezuelan migrants living with HIV in a hospital in Lima, Peru

International Journal of STD & AIDS ◽

10.1177/09564624211024080 ◽

2021 ◽

pp. 095646242110240

Author(s):

Genesis S Huerta-Vera ◽

Manuel A Amarista ◽

Fernando A Mejía ◽

Ana B Graña ◽

Elsa V Gonzalez-Lagos ◽

...

Keyword(s):

Viral Suppression ◽

Clinical Situation ◽

Cross Sectional Study ◽

People Living With Hiv ◽

Sectional Study ◽

Cross Sectional ◽

Epidemiological Trends ◽

Clinical Conditions ◽

Living With Hiv

Due to a huge crisis extensive to health services many Venezuelan people living with HIV (PLWH) had migrated abroad, including Peru where favorable laws were in place until June 2019. We describe the health status and epidemiological trends of PLWH from Venezuela at an HIV program in Lima. We analyzed baseline and follow-up data of all Venezuelan PLWH enrolled in our HIV program from January 2017 to December 2019. A cross-sectional study in a subsample served to describe ARV adherence and context of migration. Between 2017-2019 our HIV Program registered 398 Venezuelan PLWH, representing 20% of the 2018 annual enrollments; numbers decreased since mid-2019. The median age was 30 years (IQR 26;37) and 90.5% were men. Between 2017 and 2019, the proportion with diagnosis in Peru increased from 14.3% to 60.9%; of AIDS stage at entry, from 8.8% to 27.2%. By December 2019, 182/250 (72.8%) were still in care, and 43 (10.8%) had not started ART. Viral suppression evaluated in 195, was achieved in 71.8%. From 2017 to 2019, migrant PLWH arrived in worsened clinical conditions, with increasing diagnosis in Peru; the flow of migrant PLWH entering care diminished with less favorable laws. Viral suppression rates were suboptimal.

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Exploring the Factors Considered by People Living with HIV and Their Partners during Preconception

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325957416682089 ◽

2016 ◽

Vol 16 (3) ◽

pp. 239-246 ◽

Cited By ~ 3

Author(s):

V. Logan Kennedy ◽

Micaela Collins ◽

Mark H. Yudin ◽

Lena Serghides ◽

Sharon Walmsley ◽

...

Keyword(s):

Logit Model ◽

Hiv Transmission ◽

Horizontal Transmission ◽

People Living With Hiv ◽

Relative Importance ◽

Hiv Status ◽

Ordered Logit Model ◽

Living With Hiv ◽

Shed Light ◽

Hiv Negative

Data are lacking on factors that may impact conception-related decision-making among individuals living with HIV. This study’s aim was to shed light on these considerations. Participants were invited to complete a survey on preconception considerations. A rank-ordered logit model was fit to estimate the relative importance of listed consideration factors; the interaction of HIV status and the factors was assessed. Fifty-nine participants living with HIV and 18 partners (11 HIV-negative participants and 7 living with HIV) were included. Risk of vertical and horizontal HIV transmission and the effect of antiretroviral therapy on the fetus were the top considerations. However, individuals living with HIV prioritized vertical transmission, whereas HIV-negative participants prioritized horizontal transmission. Other factors of importance were probability of conception, stress of trying to conceive, cost associated with fertility clinics, and stigma associated with certain conception methods. This study builds our understanding of the preconception considerations for people living with HIV.

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