CMEonHIV.com is dedicated to providing online CME presentations (slides with voiceover) on HIV/AIDS for healthcare professionals given by local and international experts to keep you up-to-date on the ongoing developments in the field.
If the care of HIV infected patients is evidently medical and pharmacological, it is also social, psychological, and even spiritual. Patient care should be tailored to the individual patient (man, woman, child…), and must take into account the particular difficulties being faced by that patient (drug addiction, migration etc.). Healthcare providers would therefore in the patient’s best interest, work in multidisciplinary teams.
"HIV and Women" Linda Dayan (biography) English - 2008-05-15 - 25 minutes
Summary : Women represent a little under half of the people living with HIV worldwide. In Australia, however, they represent 10% of HIV patients. The repercussions of HIV infection are slightly different in men and women, for both biological and social reasons.
Viral loads in women tend to be lower, and CD4 counts tend to be higher than in men. The progression of the disease, however, appears to be similar. Furthermore, HIV influences other diseases that are associated with women, such as cervical cancer, vaginal candidiasis, and pelvic inflammatory disease. HIV also appears also to increase the incidence of HPV related abnormalities.
As for HIV treatment, studies suggest lower compliance in women, which may be due to a higher occurrence of adverse reactions such as lactic acidosis and body shape changes.
Another issue is that most women diagnosed with HIV are of childbearing age. This raises questions relating to contraception and fertility, with concerns regarding the possibility of finding a partner and the danger of transmitting the virus. As for menopause, there is some evidence to suggest that it may occur earlier in HIV positive women.
Dr. Dayan addresses social and behavioral issues for HIV positive women that she has noticed from managing such cases. She mentions problems such as a lack of ''female HIV'' community, stigmas, domestic violence, and many more. A community survey of 75 women with HIV was conducted in Australia in 2002, revealing issues the participants faced, such as discrimination in health care and in the workplace, and fear of disclosure in many contexts. Another social issue is the perception by health professionals and women that they are not at risk, with consequentially too few women being tested for HIV, which is particularly important in pregnancy.
Learning objectives : After viewing this presentation the participant will be able to discuss:
-The pattern of HIV infection in women in Australia
-Gender differences in the natural history of HIV
-Gender differences in the treatment of HIV
-Social issues for HIV positive women
-HIV testing in women
Summary : Providing HIV Care to Hard-to-Reach Populations
Antiretroviral therapy has led to a significant reduction in morbidity and mortality as well as an enhanced quality of life for many HIV-positive individuals. Injection drug users (IDUs), however, have a lower uptake of antiretroviral (ARV) therapy compared to other HIV-positive persons. There are many obstacles to the provision of HIV care and treatment that must be considered in this population if sustainable benefits are to be realized. These include substandard housing, inadequate drug and alcohol treatment, poor coordination with the criminal justice system, lack of coherent harm reduction strategies, and concurrent infections such as Hepatitis C and tuberculosis. Physicians are also reluctant to initiate therapy if they cannot be reasonably certain of adherence as the efficacy and durability of therapy is closely linked to consistent ingestion of the medications. Public health concerns are also arising due to multi-drug resistant virus that is promoted in populations who do not adhere to therapy.
Vancouver’s Downtown Eastside (DTES) is one of Canada’s poorest urban neighborhoods and is characterized by unemployment, crime, mental illness, prostitution and inadequate housing. The community’s harsh social environment and crippling poverty perpetuate the serious health consequences facing its residents. These include pervasive drug addiction and epidemics of blood-borne infections and overdose deaths. Accurate estimates on the burden of HIV infection and the number individuals who are eligible for ARV treatment in the DTES are not available. For argument sake, it is estimated that there are 4000 to 5000 active injection drug users in the DTES. Of these, between 30% and 40% or about 2000 people are HIV positive. If half of these individuals quality for treatment than it can be estimated that approximately 1000 people should be on ARVs. The Drug Treatment Program at the BC Centre for Excellence currently distributes ARV medications to about 250 people with postal codes in the DTES indicating a significant under-utilization of ARVs in this community.
There are currently several community-based models to enhance the delivery of ARVs in Vancouver based on simplified treatment regimes and social support systems. There have been some excellent therapeutic results for the people in these programs and further expansion, refinement, and evaluation are ongoing.
"Psychosocial Determinants of Adherence in HIV" Dr. Josie Geller (biography) English - 2003-03-29 - 46 minutes
Summary : Antiretroviral therapy represents a complex and demanding set of challenges for individuals living with HIV. Despite newer formulations of antiretrovirals that require fewer pills and dosing times, compliance can still be very demanding in light of psychological, economic, and medical challenges faced by individuals living with HIV. Understanding the factors that contribute to achieving and maintaining adherence to antiretroviral treatment is critical.
Research and clinical experience suggests that adherence is affected by a complex array of psychological and health related challenges. These include patient's experiences of social and medical support, beliefs regarding their own ability to overcome barriers to adherence, beliefs about medication outcomes, drug and alcohol use, and motivation stage of change.
Several clinical research projects are contributing to our understanding of these factors. The first involves the development and validation of a measure of readiness for adherence to antiretrovirals, the Antiretroviral Readiness and Motivate Scale. This tool will enable treatment providers to target persons who are not ready for treatment with appropriate preparatory interventions to increase readiness. This could result in improved quality of care to persons living with HIV, reduced risk to the general public, and savings to the health care system.
Two other qualitative projects are also underway to better understand barriers to adherence, as described by HIV patients. The first identifies themes that characterize patient's decision to decline antiretroviral therapy. The second examines the experiences of individuals described by their physicians as "treatment successes". In this latter project, factors that assist and hinder adherence in individuals who have been successful at sticking to their antiretroviral therapy regimes are identified.
This work highlights factors that assist and hinder care provider-patient interactions in preparing patients for antiretroviral therapy. Encouraging open and honest discussion of barriers to adherence is useful early on in treatment and may assist individuals in identifying needs and accessing appropriate resources. Ways of incorporating knowledge of these factors into treatment, and of promoting productive discussions about adherence will be addressed.
Bibliographic references : http://www.sciencedirect.com/science
J Psychosom Res 2003 Mar;54(3):271-8
Personality, quality of life and HAART adherence among men and women living with HIV/AIDS.
Penedo FJ, Gonzalez JS, Dahn JR, Antoni M, Malow R, Costa P, Schneiderman N.
Antivir Ther 2002 Sep;7(3):185-93
Consequences and determinants of adherence to antiretroviral medication: results from Adult AIDS Clinical Trials Group protocol 370.
Ickovics JR, Cameron A, Zackin R, Bassett R, Chesney M, Johnson VA, Kuritzkes DR; Adult AIDS Clinical Trials Group 370 Protocol Team
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