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Introduction: Implementation science (IS) offers methods to systematically achieve the Ending the HIV Epidemic goals in the United States, as well as the global UNAIDS targets. Federal funders such as the National Institutes of Mental Health (NIMH) have invested in implementation research to achieve these goals, including supporting the AIDS Research Centres (ARCs), which focus on high‐impact science in HIV and mental health (MH). To facilitate capacity building for the HIV/MH research workforce in IS, "grey areas," or areas of IS that are confusing, particularly for new investigators, should be addressed in the context of HIV/MH research. Discussion: A group of IS experts affiliated with NIMH‐funded ARCs convened to identify common and challenging grey areas. The group generated a preliminary list of 19 grey areas in HIV/MH‐related IS. From the list, the authors developed a survey which was distributed to all ARCs to prioritize grey areas to address in this paper. ARC members across the United States (N = 60) identified priority grey areas requiring clarification. This commentary discusses topics with 40% or more endorsement. The top grey areas that ARC members identified were: (1) Differentiating implementation strategies from interventions; (2) Determining when an intervention has sufficient evidence for adaptation; (3) Integrating recipient perspectives into HIV/MH implementation research; (4) Evaluating whether an implementation strategy is evidence‐based; (5) Identifying rigorous approaches for evaluating the impact of implementation strategies in the absence of a control group or randomization; and (6) Addressing innovation in HIV/MH IS grants. The commentary addresses each grey area by drawing from the existing literature (when available), providing expert guidance on addressing each in the context of HIV/MH research, and providing domestic and global HIV and HIV/MH case examples that address these grey areas. Conclusions: HIV/MH IS is key to achieving domestic and international goals for ending HIV transmission and mitigating its impact. Guidance offered in this paper can help to overcome challenges to rigorous and high‐impact HIV/MH implementation research. [ABSTRACT FROM AUTHOR]

Human immunodeficiency virus (HIV) is a serious disease that threatens and affects capital stock, population composition, and economic growth. This research paper aims to study the mathematical modeling and disease dynamics of HIV/acquired immunodeficiency syndrome (AIDS) with memory effect. We propose two fractional models in the Caputo sense for HIV/AIDS with and without migration. First, we prove the existence and positivity of both models and calculate the basic reproduction number R0$$ {\mathcal{R}}_0 $$ using the next generation method. Then, we study the local and global stability of the obtained equilibria. In addition, numerical simulations are provided for different values of the fractional order ρ$$ \rho $$ using the Adams–Bashforth–Moulton fractional scheme, to verify the theoretical results. Moreover, a sensitivity analysis of the parameters for the model with migration is carried out. [ABSTRACT FROM AUTHOR]

In this paper, to investigate the synthetic effect of PrEP (pre‐exposure prophylaxis) and ART (antiretrovial therapy) on HIV transmission among MSM (men who have sex with men) in heterogenous environment, a realistic HIV epidemic model with spatial diffusion is established. Here, HIV infectious people are divided into three immunity based compartments, that is, CD4+ T cell count less than 350, between 350 and 500, and more than 500, respectively. The basic reproduction number R0 is established and proved as a threshold parameter: The global asymptotic stability of the disease‐free steady state holds for R0<1, and the disease will be present if R0>1. Considering the substantial advantages of PrEP and ART in controlling HIV transmissions among MSM, the optimal control problem is presented for the case of positive constant diffusion coefficients, which minimize the total population of susceptible individual and HIV infected individual, the cost of PrEP and ART therapy. As an illustration of our theoretical results, we conduct numerical simulations. We also conduct an optimal control case study where model parameters are estimated from the demographic and epidemiological data from China. This work suggests the following: (1) Spatial factors cannot be ignored during the HIV intervention; (2)taking the PrEP intervention measure for HIV transmissions among MSM as early as possible will help to improve the control efficiency and reduces its cost; (3) reducing the PrEP drug costs will promote the efficiency of PrEP treatment in preventing the spread of HIV among MSM. [ABSTRACT FROM AUTHOR]

Ethnostatistics is the study of the social practices surrounding the construction and interpretation of statistics. This paper considers certain ethnostatistical aspects of the official statistics on AIDS cases - the monthly updated figures on AIDS cases supplied by the Department of Health and derived from the English and Scottish voluntary reporting schemes. The paper focuses on problems in the classification of cases according to the route of virus transmission, particularly where multiple risk practices may be reported. Some (but not all) classification problems can be avoided by adopting a cross-tabular format of presentation. The data on reported Scottish AIDS cases are re-analysed in order to illustrate such a cross-tabular representation. These data are the basis for a concluding statement on the difficulties in projecting future heterosexual epidemic spread. [ABSTRACT FROM AUTHOR]

Introduction: The transition from paediatric to adult care poses risks to the health of young adults living with HIV if unsuccessful, including interruptions in care and poor health outcomes. Evolving best practices in HIV healthcare transition should ideally be informed by real-world qualitative and quantitative clinical healthcare transition outcomes. There has been a recent proliferation of HIV healthcare transition outcome research, largely from Europe and North America. Methods: A literature search was undertaken using the online databases PubMed, Web of Science, and Google Scholar. Medical subject and text word searches were combined for terms relating to HIV, paediatric transition outcomes, and internal and external factors were used to identify peer-reviewed articles. Results: In this paper, we review data on HIV healthcare transition outcomes in North America and Europe. Internal and external factors which may impact the success of HIV healthcare transition are examined. We describe ongoing research efforts to capture transition outcomes in the North America and Europe. Clinical, operational, and implementation science research gaps that exist to date are highlighted. Efforts to improve HIV healthcare transition research through country-level surveillance networks and large multicentre cohorts, including data integration and linkage between paediatric and adult cohorts are discussed. Conclusions: We identified the need for a comprehensive approach to implementing empirically supported protocols to support healthcare transition for ALHIV. While there is limited prospective longitudinal cohort data available at this time, cohorts linking the paediatric and adolescent with ongoing surveillance into adulthood are being developed. Through a review of existing qualitative and quantitative healthcare transition outcomes studies, we identify emerging areas of consensus surrounding healthcare transition research implementation. Successful healthcare transition programmes in Europe and North America often share several characteristics, including implementation of a youth friendly multidisciplinary approach, consistent communication and integration between paediatric and adult care teams, and an individualized approach which is attuned the adolescent's transition readiness. Moving forward, the voices of youth and young adults living with HIV should be included in the development and evaluation of healthcare transition protocols to ensure that the definition of successful transition reflects all of the stakeholders in the transition process. [ABSTRACT FROM AUTHOR]

The interplay between HIV-1 and epithelial cells represents a critical aspect in mucosal HIV-1 transmission. Epithelial cells lining the oral cavity cover subepithelial tissues, which contain virus-susceptible host cells including CD4+ T lymphocytes, monocytes/macrophages, and dendritic cells. Oral epithelia are among the sites of first exposure to both cell-free and cell-associated virus HIV-1 through breast-feeding and oral-genital contact. However, oral mucosa is considered to be naturally resistant to HIV-1 transmission. Oral epithelial cells have been shown to play a crucial role in innate host defense. Nevertheless, it is not clear to what degree these local innate immune factors contribute to HIV-1 resistance of the oral mucosa. This review paper addressed the following issues that were discussed at the 7th World Workshop on Oral Health and Disease in AIDS held in Hyderabad, India, during November 6-9, 2014: (i) What is the fate of HIV-1 after interactions with oral epithelial cells?; (ii) What are the keratinocyte and other anti- HIV effector oral factors, and how do they contribute to mucosal protection?; (iii) How can HIV-1 interactions with oral epithelium affect activation and populations of local immune cells?; (iv) How can HIV-1 interactions alter functions of oral epithelial cells? [ABSTRACT FROM AUTHOR]

HIV/AIDS continues to constitute a serious threat to the social and physical wellbeing of African mothers and their babies. In the hardest hit countries of sub-Saharan Africa, more than 60% of all new HIV infections are occurring in women, infants and young children. Mother-to-child transmission (MTCT) constitutes 90% of new HIV infections among infants and young children. Most of these infections can be prevented. However, the social stigma of HIV/AIDS insidiously continues to undermine the success of prevention programs. Ironically, some attributes or characteristics of prevention of mother-to-child transmission (PMTCT) programs may in fact serve as catalysts to the stigmatization process. This paper identifies and discusses six potential initiators: (1) Routine HIV testing, (2) Six months exclusive breastfeeding, (3) Incentives, (4) Home visits, (5) Location of PMTCT program, and (6) PMTCT terminology. In all these areas, there are practical strategies that may be applied to reduce the chances of being stigmatized. These strategies are introduced and discussed. [ABSTRACT FROM AUTHOR]

The main aim of this work is to numerically investigate a mathematical model of the HIV/AIDS disease with awareness effect, as the fractional derivatives capture more the genetic and memory properties of the biological models in comparison to the classical derivative. Therefore, in this article, we utilize the generalized Caputo fractional derivative to extend the integer‐order model of HIV/AIDS transmission to fractional order. A novel fixed‐point approach is used to identify the existence and uniqueness of the FO model. We use a new numerical technique based on the Adams‐Bashforth predictor‐corrector method to solve the fractional‐order HIV/AIDS transmission model. We illustrated the obtained numerical results through graphs. [ABSTRACT FROM AUTHOR]

Epidemiological data on HIV seroprevalence has been essential in assessing the (future) extent of the AIDS epidemic. By coupling these data with quantifiable variables related to injection drug use (frequency of injecting, number of needle sharing partners) specific 'risk behaviors' could be determined, accounting for the rapid spread of the virus in the injecting drug user (IDU) population. Yet, such data give little information on the social mechanisms and setting generating such risk behaviors. In order to understand the transmission of HIV among the IDU population one needs to study the micro settings and social context of drug use. This paper describes and explores certain patterns of drug use, sharing, and natural support systems found amongst IDUs in two very different cities, Rotterdam (The Netherlands) and the Bronx, New York City (USA). By specifying details of the micro-settings of everyday drug use in both locales, it is possible to identify certain common elements and consequences of personal and social behavior driven by drug use per se (e.g. drug preference), and to differentiate these from behaviors and consequences determined by drug policy and the social context in which drug use actually occurs. These policies and the social context they create can in turn be shown to relate to risks for HIV transmission, e.g. the increased likelihood of sharing injection equipment. A more careful ethnographic approach, taking advantage of natural experimental opportunities, comparisons and controls, may be utilized to examine drug-related behaviors in their social context and to better assess their relevance to public health--especially to AIDS. [ABSTRACT FROM AUTHOR]

Asserts that receptive anal intercourse is the major risk factor for seroconversion to HIV among male homosexuals. Association of the sexual practice with increased risk for seroconversion; Correlation of the gradient of risk for seroconversion with the number of receptive anal partners; Reliability of the risk calculations.

Background HIV remains a major cause of preventable morbidity and mortality in Kenya. The effects of behaviors that accompany unhealthy alcohol consumption are a pervasive risk factor for HIV transmission and progression. Our objective was to estimate the portion of HIV infections attributable to unhealthy alcohol use and to evaluate the impact of hypothetical interventions directed at unhealthy alcohol use on HIV infections and deaths. Methods We estimated outcomes over a time horizon of 20 years using a computer simulation of the Kenyan population. This computer simulation integrates a compartmental model of HIV transmission with a mechanistic model of HIV progression that was previously validated in sub- Saharan Africa. Integration of the transmission and progression models allows simultaneous consideration of alcohol's effects on HIV transmission and progression (e.g., lowering antiretroviral adherence may increase transmission risk by elevating viral load, and may simultaneously increase progression by increasing the likelihood of AIDS). The simulation considers important aspects of heterogeneous sexual mixing patterns, including assortativeness of partners by age and activity level, age-discordant relationships, and high activity subgroups. Outcomes included number of new HIV infections, number of AIDS deaths, and infectivity (number of new infections per infected person per year). Results Our model estimated that the effects of behaviors accompanying unhealthy alcohol consumption are responsible for 13.0% of new HIV infections in Kenya. An alcohol intervention with effectiveness similar to that observed in a published randomized controlled trial of a cognitive-behavioral therapy-based intervention in Kenya (45% reduction in unhealthy alcohol consumption) could prevent nearly half of these infections, reducing their number by 69,858 and reducing AIDS deaths by 17,824 over 20 years. Estimates were sensitive to assumptions with respect to the magnitude of alcohol's underlying effects on condom use, antiretroviral therapy adherence, and sexually transmitted infection prevalence. Conclusions A substantial number of new HIV infections in Kenya are attributable to unhealthy alcohol use. An alcohol intervention with the effectiveness observed in a published randomized controlled trial has the potential to reduce infections over 20 years by nearly 5% and avert nearly 18,000 deaths related to HIV. [ABSTRACT FROM AUTHOR]

BACKGROUND: One hundred and twenty educators from KwaZulu-Natal, South Africa, underwent HIV/AIDS training. The educators were surveyed about their attitudes toward people with HIV. METHODS: The educators completed self-administered survey questionnaires both before and after 2 interventions. Measures included demographic characteristics, teachers' knowledge about HIV/AIDS, self-efficacy in handling HIV/AIDS situations, and attitudes (stigma and otherwise) toward HIV-related issues. The first intervention was a CD-ROM and the second intervention involved educators receiving a 2-day workshop on HIV transmission, risk factors, and actions that educators should know and undertake. The first step entailed testing the stigma instrument for its internal consistency and developing and testing potential subscales from the instrument. The second step entailed testing for the statistical associations between stigma (as measured by the stigma instrument and its subscales) and various demographic and HIV knowledge-related variables. RESULTS: The overall stigma scale had a Cronbach α coefficient of .66. Educators in the workshop generally had lower baseline levels of stigma than those in the CD-ROM intervention. Following both interventions, the stigma levels of both groups of educators were significantly reduced. Improvements in the general knowledge about HIV as a disease and in the specific knowledge about HIV transmission risks were both statistically significantly associated with reductions in stigma attitudes, having controlled for educators' baseline stigma levels and demographic profiles. CONCLUSIONS: The levels of teachers' stigma attitudes were statistically significantly lower after both types of HIV/AIDS training and were also statistically significantly associated with improvements in HIV knowledge. [ABSTRACT FROM AUTHOR]

Global debates in approaches to HIV/AIDS control have recently moved away from a uniformly strong human rights-based focus. Public health utilitarianism has become increasingly important in shaping national and international policies. However, potentially contradictory imperatives may require reconciliation of individual reproductive and other human rights with public health objectives. Current reproductive health guidelines remain largely nonprescriptive on the advisability of pregnancy amongst HIV-positive couples, mainly relying on effective counselling to enable autonomous decision-making by clients. Yet, health care provider values and attitudes may substantially impact on the effectiveness of nonprescriptive guidelines, particularly where social norms and stereotypes regarding childbearing are powerful, and where providers are subjected to dual loyalty pressures, with potentially adverse impacts on rights of service users. Data from a study of user experiences and perceptions of reproductive and HIV/AIDS services are used to illustrate a rights analysis of how reproductive health policy should integrate a rights perspective into the way services engage with HIV-positive persons and their reproductive choices. The analysis draws on recognised tools developed to evaluate health policies for their human rights impacts and on a model developed for health equity research in South Africa to argue for greater recognition of agency on the part of persons affected by HIV/AIDS in the development and content of policies on reproductive choices. We conclude by proposing strategies that are based upon a synergy between human rights and public health approaches to policy on reproductive health choices for persons with HIV/AIDS. [ABSTRACT FROM AUTHOR]

Abstract: The rates of HIV infection among women are rising at a higher rate than among men. After citing the reasons for women''s vulnerability, this report argues the potential role of gynecologists and obstetricians through integration of HIV/AIDS into sexual and reproductive health services to strengthen the response to the epidemic. [Copyright &y& Elsevier]

Research Summary: The prevalence of AIDS infection is approximately four times higher in state and Federal prisons than among the general U.S. population. It is also apparent that high-risk HIV transmission behaviors occur inside prison; however, data that validly document cases of HIV transmission in prison are rare. This study uses data from a large sample of state prison inmates and logistic regression to determine what inmate characteristics are associated with contracting HIV inside prison. Findings indicate that inmates who are nonwhite and younger and who have been convicted of sexual crimes and have served longer sentences are more likely to contract HIV inside prison. Policy Implications: Documenting that HIV is transmitted inside prisons justifies the need for additional research and effective prevention strategies. Modeling what types of inmates might be at risk for contracting HIV inside prison can help public and correctional health researchers and officials improve their current prevention practices and ultimately reduce or prevent HIV transmission both inside and outside prison. [ABSTRACT FROM AUTHOR]

This article examines the sexual behaviour and the HIV/AIDS knowledge and vulnerability of female street hawkers in Lagos metropolis, Nigeria. A total of 126 female street hawkers under 18 were sampled in a cross-sectional survey and six Focus Group Discussions (FGDs) were conducted to generate data from respondents. Data on sexual behaviour reveal that 79.4% of respondents are sexually active, while 62.6% of them initiated sexual intercourse at 11 years old or below. Data on knowledge about HIV/AIDS show that all the respondents have heard about the pandemic. Specifically, 64.3% and 35.7% of respondents mentioned sexual intercourse and blood contact as major routes for HIV transmission, respectively. Only 7.1% of the respondents use condoms during sexual intercourse. FGD data show significant relationships between sexual behaviour and condom use and the poverty level of the families, parental neglect, and poor parent – child communication. Since female street hawkers in Nigeria are highly vulnerable to HIV infection, the government and NGOs working on the prevention of HIV/AIDS should pay special attention to children, especially urban street hawkers. [ABSTRACT FROM AUTHOR]

If we have a duty not to infect others, how far does it go? This question is often discussed with respect to HIV transmission, but reflection on other diseases like influenza raises a number of interesting theoretical issues. I argue that a duty to avoid infection not only yields requirements for persons who know they carry a disease, but also for persons who know they are at increased risk, and even for those who definitely know they are completely healthy. Given the numerous ways in which human interaction facilitates the spread of communicable diseases, a maximum level of precaution would be very demanding – possibly unreasonably demanding. The ‘over-demandingness problem’ is mostly invoked as a criticism of utilitarianism, as this theory requires moral agents to always maximise general welfare, even at significant cost for themselves. However, I argue that, with respect to precautions against infectious diseases like influenza, utilitarianism is able to avoid the over-demandingness problem. A contractualist account, on the other hand, whilst able to explain how one's obligations to avoid infection can be limited, given that other persons have opportunities and responsibilities to protect themselves, in the end requires precautions that raise the over-demandingness problem. [ABSTRACT FROM AUTHOR]

This article surveys the main economic issues associated with the HIV/AIDS epidemic, paying special attention to sub–Saharan Africa. It explores the economic and behavioural determinants of HIV transmission, the microeconomics of market failures associated with high HIV prevalence, the prospects for regional development from a macroeconomic perspective and the efficient design of policies for coping with the epidemic. In line with the recent appeal by the UN Secretary General, the article argues that, without a decisive effort to halt HIV/AIDS, people living in the region are bound to experience a further fall in their standard of living in both relative and absolute terms. However, to be effective, anti–AIDS programmes must be rooted in sound economic principles. [ABSTRACT FROM AUTHOR]

Eighty-seven HIV-infected patients in a provincial hospital in Northern Thailand were examined for oral manifestations of HIV disease and AIDS. The median age was 31.3 years. Seventy-four of the patients were women, 13 were men. 96.6% had a history of heterosexual transmission. Sixty-one patients were CDC-category A, 20 were category B and 6 were category C (AIDS). Thirty-eight percent of the patients revealed oral lesions; 23% had one oral lesion and 13.8% had two oral lesions. Common lesions were oral candidiasis (10.3% pseudomembranous candidiasis, 6.9% erythematous candidiasis and 3.4% both forms), oral hairy leukoplakia (11.5%) and exfoliative cheilitis (6.9%). Gingival linear erythema was seen in 8% of the patients; periodontal lesions and necrotising ulcerative gingivitis were not observed. Men were more commonly affected by oral manifestations than women (P < 0.004). The spectrum of oral lesions is comparable to other studies from the region, although most of these reported more men than women. Also, the degree of immunosuppression was more marked (AIDS). [ABSTRACT FROM AUTHOR]

Despite the increase in social research into drug misuse that has occurred in the wake of the AIDS pandemic, the focus of the research has tended to be overly restricted in terms of the populations studied. Younger, nonopiate, non-agency samples are more representative of national patterns of illicit drug use but have been relatively neglected in favour of older, opiate users receiving treatment from drug agencies. Amphetamine misuse illustrates the dangers of such sampling bias. In comparing the HIV-related risk behaviour of amphetamine injectors with that of heroin injectors, the data suggest that amphetamine misuse is associated with patterns of behaviour that have serious implications for the transmission of HIV infection. [ABSTRACT FROM AUTHOR]