Showing 21 - 40 of 51 Results for "Vietnam"

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Interventions are needed to scale up and increase access to methadone and buprenorphine—effective agonist therapy for the treatment of drug dependence, as well as needle exchange/distribution programs. Studies found only tiny fractions of those who need maintenance medication had access. A study found that user fees for methadone maintenance programs presented a barrier to access to care. In places where no needle exchange programs are operating, high rates of borrowing of used syringes occur, placing IDUs at high risk of acquiring HIV.
Women Who Use Drugs and Female Partners of Men Who Use Drugs
1 study
Interventions are needed to provide women and their partners with a better understanding of the risk of acquiring HIV through sexual practices as well as through injecting drug use (IOM, 2007). Studies found low rates of condom use despite sexual relationships with IDUs, lack of knowledge by IDUs on sexual and reproductive health and lack of access to clean needles. A study also found that many MSM and male intravenous drug users avoid disclosure of their sexual and drug risk behavior along with their HIV status due to stigma and gender norms and that most wives reported violence and little or no condom use. HIV-positive male IDUs want help with disclosure to their wives. Most wives of IDUs reported only a single lifetime sexual partner and only a tiny proportion reported injecting drug use.
Women Who Use Drugs and Female Partners of Men Who Use Drugs
1 study
Interventions to increase the knowledge of people living with HIV — especially women — regarding their rights and provision of resources for them to access and claim these rights need to be scaled up. Studies found that women had insufficient knowledge of their legal rights and no resources to claim their legal rights.
Advancing Human Rights and Access to Justice for Women and Girls
1 study
Expansion and scaling up of interventions promoting economic opportunities for women are needed to increase their ability to refuse unsafe sex and reduce stigma for women living with HIV. Studies found that lack of income, food and jobs forced women to sell sex to survive, placing them at risk of HIV acquisition.
Promoting Women’s Employment, Income and Livelihood Opportunities
1 study
Health care provider training is needed to increase confidentiality and decrease discrimination against sex workers seeking health services. Studies found that significant proportions of female and transgender sex workers did not visit health facilities because of lack of confidentiality, discrimination, and lack of counseling when accessing HIV testing.
Female Sex Workers
1 study
Interventions are needed to support the autonomous decision-making of HIV-positive women who are caught between the contradictory pressures of family, community and health care providers. Studies found that HIV-positive women and men need information and social support to make decisions that reflect their own preferences in the face of pressure to bear children. A review of the published literature from 1990 to 2008 found that the refusal of health workers to discuss reproductive options in a non-biased way negatively impacts HIV-positive women. Studies also found that HIV-positive men lacked information on pre-conception and felt they could not request this information from health providers.
Pre-Conception
1 study
Additional efforts are needed to ensure confidentiality in testing. Studies found that women were tested without their consent and that providers did not protect women’s confidentiality.
Antenatal Care - Testing and Counseling
1 study
Accurate testing techniques for infants may inform infant feeding. Studies note that rapid scale up of early infant diagnosis is needed in low-resource settings in order to access treatment and care as soon as possible. [For WHO guidance on HIV testing in infants see: www.who.int/hiv/topics/vct/toolkit/additional_resources/children/en/]
Postpartum
1 study
Efforts are needed to reform laws that criminalize drug use and/or drug possession for personal use and to eliminate compulsory drug detention and instead, provide people who use drugs with access to HIV and health services, including harm reduction, and voluntary, effective evidence-based drug dependency treatment. Detention centers are administered by police, military or other national government public security authorities and operate outside the formal criminal justice system with detainees held without trial or right of appeal; those detained are not allowed to leave voluntarily (Wolfe, 2012). Studies found that female IDU were not given reproductive health services, including PMTCT services in compulsory detention and/or prison settings. Detoxification programs were substandard and ineffective. Despite high rates of HIV, antiretroviral treatment is largely unavailable in compulsory drug detention centers. IDUs who have started antiretroviral treatment should be able to continue treatment in prison with access to medical supervision. [See also %{s:11}]
Advancing Human Rights and Access to Justice for Women and Girls
1 study
Efforts are needed to eliminate compulsory drug detention and instead, provide PWID with HIV prevention and testing services and effective drug dependency treatment by medical professionals. Detention centers are administered by police, military or other national government public security authorities and operate outside the form criminal justice system with detainees held without trial or right of appeal and those detained do not allow people to leave voluntarily (Wolfe, 2012). Studies found that women who use drugs were not given reproductive health services, including PMTCT services in compulsory detention and/or prison settings. Detoxification programs were substandard and ineffective. Despite high rates of HIV, antiretroviral treatment is largely unavailable in compulsory drug detention centers. One study found high rates of injecting drug use within prison and high rates of syringe sharing within prisons plus incarceration was not associated with reduction in drug use, with over a quarter of these female drug users. PWID in and out of prison who have started antiretroviral treatment should be able to continue treatment with access to medical supervision. Treatment in compulsory drug detention takes the form of sanction rather than therapy, with high relapse rates.
Women Who Use Drugs and Female Partners of Men Who Use Drugs
1 study
Further interventions are needed that support women safely through the disclosure process. [See also %{s:43}] Studies found that women in some settings experienced increased violence and abandonment following disclosure or feared violence as a result of disclosure. Some HIV-positive women wish to disclose their serostatus but want trained health providers to help them do so.
HIV Testing and Counseling for Women
1 study
Women and their sexual partners need access to comprehensive pre-conception care so they can make informed decisions about pregnancy before conception. Studies found that HIV-positive women could not access pre-conception advice on safer pregnancy options, as health providers discouraged pregnancy. Studies found that significant numbers of pregnant women did not know any way to prevent vertical transmission and face dilemmas with balancing the desire for children with fear of risking acquiring HIV or transmitting HIV to their partner or infant. Studies also showed that women did not understand the relationship between high CD4 counts and reducing the risk of HIV transmission.
Pre-Conception
1 study
Increased efforts are needed to retain women on HAART following birth. Studies found that women who initiated ART during pregnancy were more likely to be lost to follow up than non-pregnant women or that pregnant women who were eligible for HAART according to national guidelines were not provided HAART.
Postpartum
1 study
Stigma reduction interventions are needed so that women with HIV can choose replacement feeding, breastfeeding and weaning schedules. Studies found that HIV-positive women feared that if they used infant formula or abruptly weaned, they would be stigmatized for their HIV-positive serostatus.
Postpartum
1 study
Additional efforts are needed to improve information and counseling about HIV during ANC to ensure that pregnant women and their sexual partners have adequate information. Studies found significant numbers of pregnant women received HIV tests with no counseling and reported that HIV testing was a mandatory part of their antenatal care. Studies also found that HIV-positive women feared transmitting HIV to their babies through casual contact. Studies found some providers assured women that treatment guaranteed that there would be no vertical transmission. In addition, studies found that some couples erroneously believed that sex during pregnancy causes miscarriages. Studies have also found that women who have tested HIV-negative at their first antenatal visit had seroconverted to HIV-positive by 12 months following delivery.
Antenatal Care - Testing and Counseling
1 study
HIV-positive mothers, fathers, grandmothers and the larger community need clear, consistent, non-contradictory and nonjudgmental counseling on infant feeding practices. Health care providers need training based on accurate information. Studies found that health care providers gave HIV-positive women conflicting information and that simplified structured counseling tools are needed. Studies found that women reported that providers accused them of killing their infants if they breastfed. Women lack access to infant formula but have been told by providers that it is the only way for their infant to survive. Women were told that breastfeeding is a mode of HIV transmission and exclusive breastfeeding is a mode of prevention. Women fear HIV more than diarrheal disease, even though more deaths occur from diarrheal disease. Women were not given choices. Women did not give providers accurate information on how they were feeding their infant for fear of being denied health care. Women were told to feed their infants formula yet did not have adequate food support, most mothers could not do so with few having an income and most with no access to safe drinking water. Women lacked autonomy to decide infant feeding, which was decided by male partners or grandmothers. "Despite the current WHO recommendations to use extended infant prophylaxis as long as the infant is breastfed, no data are yet available from a clinical trial to confirm effectiveness and safety of this regimen beyond the first six months postpartum" (Taha, 2011: 919).
Postpartum
1 study
Initiatives that provide for early diagnosis and appropriate longitudinal care prior to treatment eligibility are needed to reduce mortality rates and costs among adults accessing treatment. A review found that early mortality among adults accessing antiretroviral therapy can be attributed to late diagnosis of HIV. Despite multiple interactions with parts of the healthcare system, a study of women in Uganda found that late presentation for HIV care resulted largely from the, “inability of the medical system to link women to appropriate care,” (McGrath et al., 2012: 1095). Women entered care only when symptomatic. Another study found that more than a quarter of HIV patients in care prior to ART initiation did not start ART according to national guideline criteria. Another study found that women did not know where to go to access treatment. A review found that a process is needed to optimize transfers of care without treatment interruption and with appropriate medical documentation. Another study found that over half of patients who were not yet known to be eligible for ART at enrollment but who had tested HIV-positive, including a quarter who had CD4 counts taken, were lost to follow up. Another review found that asymptomatic patients perceived little need to initiate ART. Another study found that those with higher CD4 counts who were not yet eligible for ART lacked social support and social capital, yet needed this support.
Provision and Access
1 study
Intensified efforts are needed to increase male and female condom use and reduce multiple partnerships by people who know their HIV-positive status and are not virally suppressed, including young people. Studies found that consistent condom use between discordant couples (or with partners whose serostatus was unknown) was low and, among those on treatment, decreased over time. Lack of condom use was associated with fear of disclosure. People living with HIV as well as couples also believed that treatment with antiretroviral therapy meant that they were either cured of HIV or could no longer transmit the virus and were less likely to disclose their positive serostatus. In some studies, men are more likely to report condom use than women, "given the limited control that women have over the use of the male condom" (Walusaga et al., 2012: 698). Particular attention is also needed to provide condoms to men living with HIV who frequent sex workers, as well as for sex workers themselves to protect themselves (Paz-Bailey et al., 2012). [See %{s:9}]
Staying Healthy and Reducing Transmission
1 study
Making opioid agonist treatment available in prisons can be effective in reducing HIV transmission.
Women Prisoners and Female Partners of Male Prisoners
3 studies Gray I, II, IIIb drug treatment, harm reduction, needles, opioids, prisoners Indonesia, Iran
Women Prisoners and Female Partners of Male Prisoners
Prevention for Key Affected Populations
"... Prisons have been largely neglected in the global response to the HIV pandemic" (Angora et al., 2011: 1244). Comprehensive HIV prevention, voluntary testing, care and treatment are often not provided in pretrial detention, even where these services exist in the community (Csete, 2011). "Many prison systems limit access to antiretroviral therapy, according to country reports to UNAIDS" (UNA...