https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(98)10411-7.pdf

Short-course zidovudine for perinatal HIV-1 transmission in Bangkok, Thailand: a randomised controlled trial

This paper synthesizes the rates, barriers, and outcomes of HIV serostatus disclosure among women in developing countries. We identified 17 studies from peer-reviewed journals and international conference abstracts — 15 from sub-Saharan Africa and 2 from south-east Asia — that included information on either the rates, barriers or outcomes of HIV serostatus disclosure among women in developing countries. The rates of disclosure reported in these studies ranged from 16.7% to 86%, with women attending free-standing voluntary HIV testing and counselling clinics more likely to disclose their HIV status to their sexual partners than women who were tested in the context of their antenatal care. Barriers to disclosure identified by the women included fear of accusations of infidelity, abandonment, discrimination and violence. Between 3.5% and 14.6% of women reported experiencing a violent reaction from a partner following disclosure. The low rates of HIV serostatus disclosure reported among women in antenatal settings have several implications for prevention of mother-to-child transmission of HIV (pMTCT) programmes as the optimal uptake and adherence to such programmes is difficult for women whose partners are either unaware or not supportive of their participation. This article discusses these implications and offers some strategies for safely increasing the rates of HIV status disclosure among women.

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Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes

Background and objectives: Sexual behavior following voluntary HIV counseling and testing (VCT) is described in 963 cohabiting heterosexual couples with one HIV positive and one HIV negative partner (‘discordant couples’). Biological markers were used to assess the validity of self-report. Methods: Couples were recruited from a same-day VCT center in Lusaka Zambia. Sexual exposures with and without condoms were recorded at 3-monthly intervals. Sperm detected on vaginal smears pregnancy and sexually transmitted diseases (STD) including HIV gonorrhea syphilis and Trichomonas vaginalis were assessed. Results: Less than 3% of couples reported current condom use prior to VCT. In the year after VCT > 80% of reported acts of intercourse in discordant couples included condom use. Reporting 100% condom use was associated with 39–70% reductions in biological markers; however most intervals with reported unprotected sex were negative for all biological markers. Under-reporting was common: 50% of sperm and 32% of pregnancies and HIV transmissions were detected when couples had reported always using condoms. Positive laboratory tests for STD and reported extramarital sex were relatively infrequent. DNA sequencing confirmed that 87% of new HIV infections were acquired from the spouse. Conclusions: Joint VCT prompted sustained but imperfect condom use in HIV discordant couples. Biological markers were insensitive but provided evidence for a significant under-reporting of unprotected sex. Strategies that encourage truthful reporting of sexual behavior and sensitive biological markers of exposure are urgently needed. The impact of prevention programs should be assessed with both behavioral and biological measures. (authors)

Sexual behavior of HIV discordant couples after HIV counseling and testing.

Background. We conducted a systematic review of estimates of hepatitis C virus (HCV) vertical transmission risk to update current estimates published more than a decade ago. Methods. PubMed and Embase were searched and 109 articles were included. Pooled estimates of risk were generated for children born to HCV antibody–positive and viremic women, aged ≥18 months, separately by maternal human immunodeficiency virus (HIV) coinfection. Results. Meta-analysis of the risk of vertical HCV infection to children of HCV antibody–positive and RNApositivewomen was 5.8% (95% confidence interval [CI], 4.2%–7.8%) forchildren of HIV-negativewomen and 10.8% (95% CI, 7.6%–15.2%) for children of HIV-positive women. The adjusted meta-regression model explained 51% of the between-study variation in the 25 included risk estimates. Maternal HIV coinfection was the most important determinant of vertical transmission risk (adjusted odds ratio, 2.56 [95% CI, 1.50–4.43]). Additional methodological (follow-up rate and definition of infection in children) and risk factors independently predicted HCV infection and need to be captured and reported by future studies of vertical transmission. Studies assessing the contribution of nonvertical exposures in early childhood to HCV prevalence among children at risk of vertical transmission are needed. Conclusions. More than 1 in every 20 children delivered by HCV chronically infected women are infected, highlighting that vertical transmission likely constitutes the primary transmission route among children. These updated estimates are a basis for decision making in prioritization of research into risk-reducing measures, and inform case management in clinical settings, especially for HIV-positive women in reproductive age.

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Vertical Transmission of Hepatitis C Virus: Systematic Review and Meta-analysis

The expansion of AIDS treatment initiatives in resource-poor settings provides an opportunity for integrating mental health care into these programs. This systematic review of the literature on HIV and mental illness in developing countries examines the mental health risk factors for HIV, mental health consequences of HIV, psychosocial interventions of relevance for HIV-infected and affected populations, and highlights the relevance of these data for HIV care and treatment programs. We reviewed seven studies that measured the prevalence of HIV infection among clinic and hospital-based populations of people with mental illness or assessed sexual risk behavior in these populations; 30 studies that described the mental health consequences of HIV infection; and two reports of psychosocial interventions. The review demonstrates the need for methodologically sound studies of mental health throughout the course of HIV, including factors that support good mental health, and interventions that employ identified variables (e.g. coping, family support) for efficacy in reducing symptoms of mental illness. Promising intervention findings should encourage investigators to begin to study the implementation of these interventions in HIV service settings.

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What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review.

Determinants of depression and HIV-related worry among HIV-positive women who have recently given birth, Bangkok, Thailand

Context.—Most prior studies of the human immunodeficiency virus (HIV) epidemic
in Thailand have focused on commercial sex encounters; however, because the
epidemic increasingly concerns stable heterosexual relationships, determining
risk factors for this form of transmission is warranted.Objectives.—To determine temporal trends in HIV prevalence, risk factors for HIV
seropositivity, and rates of partner serodiscordance for pregnant women in
Bangkok, Thailand.Design.—Retrospective review of hospital antenatal clinic HIV test results from
1991 through 1996. Baseline demographic and behavioral risk factors for HIV
were assessed for subjects enrolled from November 1992 through March 1994.Setting.—Two Bangkok hospitals with routine antenatal clinic HIV counseling and
testing.Participants.—The HIV-positive pregnant women enrolled in a perinatal HIV transmission
study and their partners and HIV-negative pregnant controls.Results.—From 1991 through 1996, antenatal clinic HIV seroprevalence increased
from 1.0% to 2.3%. On multivariate analysis of data from 342 HIV-positive
and 344 HIV-negative pregnant women, more than 1 lifetime sex partner, history
of a sexually transmitted disease, and a high-risk sex partner were the most
important factors for seropositivity (all P<.001).
Twenty-six percent of partners of HIV-positive women were HIV negative. Women
reporting more than 1 lifetime sex partner were more likely to have an HIV-negative
partner than women reporting only 1 (45% vs 8%; relative risk, 5.5; 95% confidence
interval, 3.2-9.5; P<.001); women reporting no
high-risk behaviors were less likely to have an HIV-negative partner (10%
vs 44%; relative risk, 0.2; 95% confidence interval, 0.1-0.4; P <.001).Conclusions.—Prevalence of HIV in pregnant women has increased steadily in Bangkok
from 1991 through 1996. Sex with current partners was the only identified
risk exposure for about half (52%) of the HIV-positive women. Although few
HIV-positive pregnant women reported high-risk behaviors, more than 1 lifetime
partner and a partner with high-risk behavior were strong risk factors for
seropositivity. Together with the unexpected finding that one fourth of partners
of seropositive pregnant women were seronegative, these data emphasize that
women in the general population are at risk for HIV because of the risk behavior
of both current and previous partners.

https://jamanetwork.com/journals/jama/articlepdf/187694/joc71354.pdf

HIV Prevalence, Risk, and Partner Serodiscordance Among Pregnant Women in Bangkok

Objective. The purpose of this study was to describe the epidemiology of coinfection with hepatitis C virus (HCV) and HIV among a cohort of pregnant Thai women. Methods. Samples from 1771 pregnant women enrolled in three vertical transmission of HIV studies in Bangkok, Thailand, were tested for HCV. Results. Among HIV-infected pregnant women, HCV seroprevelance was 3.8% and the active HCV infection rate was 3.0%. Among HIV-uninfected pregnant women, 0.3% were HCV-infected. Intravenous drug use by the woman was the factor most strongly associated with HCV seropositivity. Among 48 infants tested for HCV who were born to HIV/HCV coinfected women, two infants were HCV infected for an HCV transmission rate of 4.2% (95% 0.51–14.25%). Conclusions. HCV seroprevalence and perinatal transmission rates were low among this Thai cohort of HIV-infected pregnant women.

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Wimol Siriwasin

Papers

Determinants of depression and HIV-related worry among HIV-positive women who have recently given birth, Bangkok, Thailand

HIV Prevalence, Risk, and Partner Serodiscordance Among Pregnant Women in Bangkok

Infection with hepatitis C virus among HIV-infected pregnant women in Thailand.