Introduction Tennessee (TN) ranked 16th among US states for the number of HIV diagnoses in 2015. By TN grand division region (East, Middle, and West), the highest rate of persons living with HIV/AIDS (PLWH) were in the Middle and West. Barriers to HIV testing are still very much unknown in research studies. Further, understanding how Adverse Childhood Experience (ACEs) play a role in HIV testing and specifically in marginalized groups is not fully understood. The present study sought to understand the relationship between ACEs, living in poverty, and testing for HIV among adults in Tennessee. Methods Behavioral Risk Factor Surveillance System data for 2016 and 2017 were obtained from the Tennessee Department of Health. Sociodemographic factors, diagnosis of depression, binge drinking behaviors, HIV risk behaviors (one or more of these in the past year: injection drug use, anal sex, sex without a condom, paid sex, four or more sexual partners), grand division, poverty level, and ACEs were analyzed to determine if an association exists with having been tested for HIV in the past year (yes or no). ACEs were categorized into 0, one to three, or four or more, all having occurred before the age of 18. Frequencies, percents, chi-square, and independent T-tests were completed. Sex stratified simple and multiple logistic regression models were conducted to determine the strength of association with having been tested for HIV (N=1,506 males; N=1,433 females). Results Males who reported HIV risk behaviors were 46% less likely to be tested for HIV (aOR: 0.54, 95% CI: 0.53-0.55) whereas females with HIV risk behaviors were 61% less likely to test for HIV (aOR: 0.39, 95% CI: 0.39-0.40) compared to those without HIV risk behaviors. Males with 4 or more ACEs were 38% more likely to be tested for HIV compared to males with 0 ACEs (aOR: 1.38, 95% CI 1.36-1.39), whereas females with 4 or more ACEs were two times more likely to be tested for HIV (aOR: 2.09, 95% CI: 2.07-2.11) compared to females with 0 ACEs. Males making <$25,000 annually were only 5% more likely to be tested for HIV (aOR: 1.05, 95% CI: 1.04-1.06), whereas women making the same income were 30% less likely to be tested for HIV (aOR: 0.70, 05% CI: 0.69-0.71) compared to incomes greater than $25,000. Males in West TN were 12% less likely to be tested for HIV compared to males in East TN (aOR: 0.88, 95% CI: 0.87-0.89). Similarly, females in West TN were 15% less likely to be tested for HIV compared to females in East TN (aOR: 0.85, 95% CI: 0.84-0.86). Conclusion Education and awareness may be too focused on adults with more ACEs rather than ensuring individuals with HIV risk behaviors, living in poverty, or residing in West TN, understand their risk and have access to HIV testing. Regions of TN, specifically West TN compared to East TN, may require additional resources to ensure the general population understands their risk for HIV; however further research is warranted through longitudinal studies.

This study examined associations between the prevalence of HIV testing and factors or behaviors that influence HIV testing in U.S.A. 9th to 12th graders using the 2017 Youth Risk Behavior Surveillance Survey (YRBSS) data. Selection criteria was based on a positive report of sexual debut (Ever had sex? Yes/No). Outcome of interest was having ever tested for HIV. Independent risk factors included age, sex, grade, race, condom use, age at first sexual intercourse, number of lifetime sexual partners, use of contraceptives, use of drug or alcohol before last sexual activity and several other factors. Chi-square and logistic regression analyses were conducted to evaluate factors associated with HIV screening participation. HIV testing prevalence was 20.34%. Females (53.97%) were more likely to participate in HIV screening test than males (67.37% females versus 32.63% males) and had higher odds of testing (OR: 2.229; p <.0001). Those in 11th and 12th grade, aged greater than 16 and with multiple sexual partners had higher rates of HIV testing. Strongest associations with HIV testing were older age at 1st sexual intercourse, odds ratio (OR): 0.413; (p ≤.0001), having three or more sexual partners (OR: 2.023; p ≤.0001), being female (OR: 2.021; p ≤.0001), use of contraceptives (OR: 1.828; p ≤.0001) and describing grades in school as mostly A’s or B’s (OR: 0.696; p ≤.001).

MSc (Med), Dept of Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand / BACKGROUND: Human Immunodeficiency Virus (HIV) is a global epidemic with growing numbers of people on highly active anti‐retroviral therapy (HAART) programmes. Effectiveness of treatment needs to be monitored to ensure the uncompromised well being of patients. This is currently done using both Viral Load (VL) and CD4 cell counts for HAART initiation and follow‐up. Although VL is the best predictor of disease progression it is often too expensive for monitoring patients in resource‐limited settings. There is thus a need for a cheaper, more accessible alternative to monitor long term patient response to therapy. METHODS: This study evaluated the use of a recently described flow cytometric assay of CD38 expression (previously developed at the Johannesburg Flow Cytometry Reference Laboratory) in a cohort of HIV+ patients failing 1st line therapy, who were subsequently enrolled onto 2nd line HAART. CD38 and CD8 were “piggy ‐backed” onto the PLG/CD4 protocol and mean fluorescence intensity (MFI) of the CD8/38 expression was monitored longitudinally. Patterns of CD38 expression were compared to 1st line treatment observations to establish equivalence in the predictive power of CD38 expression of fluctuation in viral load on 2nd line treatment patients. In addition, the effect of sample age on assay accuracy was tested before implementation of the CD38 assay at a secondary testing site. RESULTS: The patterns observed in the cohort of 2nd line therapy patients mirrored patterns previously seen in 1st line therapy with 55% of patients showing a continuous decline in CD38 MFI that mimicked changes in VL. The remaining 33% of patients had non‐specific increases in CD38 MFI without concurrent increases in VL and one patient showed irregular VL and CD38 MFI (non‐responder). The CD38 assay showed acceptable accuracy and reproducibility up to 48 hours after venesection (%CV<5%). Implementation at the secondary testing site was successful with 98% similarity (%CV<5%) compared to the reference laboratory. CONCLUSION: CD38 monitoring of 2nd line therapy patients showed comparable patterns to observations in 1st line therapy patients. The assay proved stable over time and easy to implement at another PLG/CD4 testing facility. As such, the CD38 assay offers a cost‐effective, reliable real time supplementary test to long‐term VL monitoring of HIV infected patients on the national ART programme.

The purpose of this study was to investigate whether mandatory universal precautions changed nurses' body fluid exposure and reporting rates, hepatitis B vaccination rates, and human immunodeficiency virus (HIV) testing rates. Random cross-sectional surveys of nurses in Tennessee were conducted in 1991 and 1993 (n = 145 in 1991; n = 143 in 1993). The questionnaire in both surveys included frequency of body fluid exposures and reporting in the past year, and whether or not the respondent had received the hepatitis B vaccine or had been HIV tested. Findings indicated that self reported needlestick injuries decreased by 69%, and other sharps injuries decreased by 81%. Only 4.1% of all exposure incidents reported on this anonymous survey were reported to employee health officials, as required. Body fluid exposure incidents were the most common form of exposure (81%) and the most underreported. Hepatitis B vaccinations significantly increased (61.4% to 82.5%), with a nonsignificant increase in HIV testing (47.2% to 55.6%) from 1991 to 1993. Findings of this study suggest that the universal precautions regulatory mandate has been effective in increasing nurses' compliance to universal precautions. Body fluid contacts were significantly underreported and showed no decrease between 1991 and 1993.

No description available.

BACKGROUND: Women represent more than one quarter of all new HIV/AIDS diagnoses; in particular, women of color are disproportionately affected. Early detection and knowledge of HIV status are essential in the management and prevention of the disease. Further research is needed to extensively investigate predictors of HIV/AIDS screening among minority women. OBJECTIVES: 1) To estimate the rate of HIV screening among U.S. adult women, ages 18-64; and 2) to identify determinants of HIV screening among this population. METHODS: The 2006 National Behavioral Risk Factor Surveillance System (BRFSS) was utilized. Female respondents aged 18-64 (N=160,388) were included in the analyses. Multivariate logistic regression was conducted to examine predictors of HIV screening. RESULTS: Nearly 39% of the women reported that they were screened for HIV in their lifetime. Being Black, 25-34 years old, having a lower income, unemployed, unmarried, having fair or poor health and lack of healthcare coverage were significant predictors of having HIV screening. CONCLUSION: Findings of this study suggest that Black, young, unmarried and women with a lower socioeconomic status were more likely to receive HIV screening. However, efforts need to be made to target other populations such as the elderly.

Young African American men who have sex with men (AAMSM) are at greater risk of being infected with the human immunodeficiency virus (HIV) and less likely to seek HIV testing than are members of other demographic groups. This behavior results in a significant public health threat because young AAMSM with an unrecognized HIV infection are less likely to practice safer sex and, therefore, more likely to pass the infection on to their partners. This study is an examination of the social and personality factors that influence HIV testing rates among young AAMSM, using Aday's model of the social determinants of health and the Big Five model of personality as the theoretical frameworks. A cross-sectional design was employed, and social networks were used to recruit study respondents. Forty-three young AAMSM completed online questionnaires, and multiple regression techniques were used to examine relationships among the variables of interest. Statistical analysis indicated that neither the social risk factors derived from Aday's model nor the Big Five model predicted HIV testing. However, it is unknown whether these nonsignificant findings are attributable to a genuine lack of influence or the unique characteristics of the sample. Given the null results of this study and the mixed findings of prior research, further studies are required to draw conclusions regarding the influence of social and personality factors on HIV testing in this high-risk group. Additional research could be helpful in developing more effective strategies for encouraging HIV testing among young AAMSM. The potential for positive social change lies in slowing the spread of HIV through this vulnerable population and in engaging young AAMSM in the medical system to improve their long-term health prospects.

<p>Increased uptake of VCT services by pregnant women may be attributed to the development of counseling services and increased availability of rapid tests at the study clinics by the Namibian Health and Social Services. A high knowledge and understanding of HIV and VCT services by pregnant women also probably contributed.</p>

There is evidence that some sub-Saharan African individuals suspect that they are HIV positive before diagnosis but delay being tested for HIV. This increases the likelihood of being diagnosed late (with a severely compromised immune system), a phenomenon that has been observed in sub-Saharan Africans diagnosed in the UK. Late diagnosis has negative personal and public health consequences. There is a lack of understanding of the psychological processes associated with delayed HIV-testing. This study used a Grounded Theory methodology. It aimed to produce a theoretical model to explain the psychological processes associated with delayed HIV testing in sub-Saharan Africans in the UK but also how these processes changed over time and contributed to the decision to test. Seven HIV-positive sub-Saharan African individuals from a London HIV clinic and one from a HIV charity were interviewed about their experiences. Analysis led to the development of a theoretical model of delayed HIV testing. This model consisted of three theoretical codes: moving in and out of uncertainty about HIV infection; preferring not to know HIV status; and making the decision to test for HIV. Participants' HIV risk perception fluctuated and was characterised by uncertainty. This, in combination with a preference to not know their HIV status due to a number of feared consequences of being HIV-positive, deterred them from testing. Participants' thoughts and feelings about knowing their HIV status changed over time. These changes were that they: wanted certainty, had hope of being HIV-negative and/or a hope for treatment and life and preparing for and accepting a potentially positive result. The findings can inform interventions to reduce delayed testing and suggest: a) intervening with ambivalence on an individual level and b) promoting awareness of HIV c) promoting the benefits of testing/costs of not testing at a population level. The findings are discussed in relation to existing research and theory. Strengths and limitations of the study are discussed, as are clinical implications and suggestions for future research.

Background: Men who have sex with men (MSM) are heterogeneous with respect to sexual behavior. We examined differences in sexual risk behaviors and HIV protective behaviors between men who have sex with men and women (MSMW) and men who have sex with men only (MSMO). Among MSMW, we also examined associations between partner gender and disclosure of same-sex attraction to sexual risk behaviors. Methods: Data for this analysis were from MSM who participated in National HIV Behavioral Surveillance (NHBS) in 2011 and 2014. Prevalence differences comparing MSMW and MSMO were calculated for demographics and behaviors. Adjusted prevalence ratios comparing MSMW to MSMO were calculated for the outcomes condomless sex, exchange sex, testing for HIV, and disclosure of same-sex behavior. Results: MSMW were less likely than MSMO to have condomless sex with male partners (aPR 0.77; 95%CI 0.73-0.80), to have been diagnosed with another STD (aPR 0.83; 95%CI 0.73-0.95), and to disclose their same-sex behavior to healthcare providers (aPR 0.72; 95%CI 0.69-0.76). However, MSMW were more likely than MSMO to engage in exchange sex (aPR 2.43; 95%CI 2.17-2.72) and to have ever injected drugs (aPR 2.00; 95%CI 1.76-2.28) Conclusions: MSMW have distinctive sexual risk behaviors and could benefit from tailored interventions to reduce the prevalence of HIV in this population.