Introduction: Men who have sex with men (MSM) and transgender women (TW) in Colombia are highly affected by HIV. To improve understanding of the role of HIV risk behaviors in HIV acquisition, we used the syndemic framework, a useful concept to inform prevention efforts.Objective: To examine the effect of four psychosocial conditions, namely, forced sex, history of childhood sexual abuse, frequent alcohol use, and illicit drug use on unprotected sex and the synergistic effects (“syndemic” effects) of these conditions on HIV risk behavior.Materials and methods: We enrolled a total of 812 males (54.7% men who have sex with men, MSM; 7.3% transgender women, and 38% non-MSM). The participants were recruited from neighborhoods of low socioeconomic status through free HIV-counseling and -testing campaigns. We performed Poisson regression analysis to test the associations and interactions between the four psychosocial conditions and unprotected sex with regular, occasional, and transactional partners. To test the “syndemic” model, we assessed additive and multiplicative interactions.Results: The prevalence of any psychosocial condition was 94.9% in transgender women, 60.1% in MSM, and 72.2% in non-MSM. A higher likelihood of transactional sex was associated in MSM (prevalence ratio (PR)=7.41, p<0.001) and non-MSM (PR=2.18, p< 0.001) with three or all four conditions compared to those with one condition. Additive interactions were present for all combinations of psychosocial problems on transactional sex n MSM. No cumulative effect or additive interaction was observed in transgender women.Conclusions: Our study highlights the need for bundled mental health programs addressing childhood sexual abuse, illicit drug use, and frequent alcohol use with other HIV prevention programs.

BackgroundGeneric drug policies are often associated with concerns about the quality and effectiveness of these products. Phase IV clinical trials may be a suitable design to assess the effectiveness and safety of generic drugs. The objective of this study was to describe the effectiveness and the safety of the generic abacavir/lamivudine and efavirenz in treatment-naïve HIV-infected patients.MethodsA monocentric, nonrandomized, open-label, phase IV study in treatment naïve HIV-infected patients 18 years or older with indication to receive abacavir/lamivudine and efavirenz were recruited from a program that provides comprehensive outpatient consultation and continuing care. The primary end-point was to achieve viral load <40 copies/mL at 12 months after baseline to assess effectiveness. Secondary end-point of the study were 1) to asses increasing in T-CD4 lymphocytes levels as accompaniment to asses effectiveness, and 2) to assess both gastrointestinal, skin, and central nervous system symptoms, and lipid profile, cardiovascular risk, renal, and hepatic function as safety profile. Data were determined at baseline, 3, 6, and 12 months. Close clinical monitoring and pharmaceutical care were used for data collection. Wilcoxon matched-pairs signed-rank test was used to compare proportions or medians.ResultsSixty patients were invited to participate in the study; 42 were enrolled and 33 completed the follow-up. Of the nine patients excluded from the study, only one was withdrawn due to adverse events. At 12 months, 31 of 42 patients (73.8 % in intention-to-treat analysis) achieved a viral load of HIV1 RNA <40 copies/mL. There was a significant increase (172 cells/mm3) in the median for CD4 T lymphocyte count. The adverse events were mild and met the safety profile for this antiretroviral regimen, mainly of central nervous system symptoms, skin rash, lipid abnormalities, and an increase of 2 % in the median of the percentage of cardiovascular risk.ConclusionsThe clinical outcomes of generic version of abacavir/lamivudine and efavirenz in HIV treatment naïve patients showed the expected safety and effectiveness profile of proprietary ARV drugs.Trial registrationRegistro Público Cubano de Ensayos Clínicos (RPCEC) ID: RPCEC00000202. Registered 19 November 2015.

Objective: To determine HIV presence and risk behaviors of persons of low socio-economic status in the city of Popayan, Colombia. Methods: Cross-sectional study; between 2008 and 2009, 363 participants of Popayan signed informed consent and received pre and post HIV test counseling. Socio-demographic characteristics and history of STDs, risk behaviors and previous HIV testing were assessed. Descriptive statistics, correlations and multivariate logistic regression were calculated. Results: Mean age 33.5±10.2; 66.0% women. Frequency of HIV positive patients was 3.86% (95% CI: 1.87-5.85), greater in men (7.38%; p= 0.013). Greater frequency of HIV-positive patients was observed in people age 29-37, those without a stable partner, and those with history of risky alcohol consumption (more than five drinks in 2 hrs). Conclusions: HIV-positive patients frequency in this population was greater than national estimate for general population, aged 15-49 in Colombia, with even greater frequency in men. This study suggests that characteristics associated with low socioeconomic status, in economically active population, without a stable partner and with risky alcohol use, can potentially increase risk of HIV infection

Introduction: Depression in people living with HIV/AIDS is associated with poor health outcomes. Despite this, assessment of depressive symptoms is not a routine clinical practice in the care of people with HIV in Colombia. One reason could be the lack of validated depression screening scales for this population.Objective: To test the reliability and construct validity of the 20- and 10-item-Center for Epidemiological Studies Depression Scale in patients attending an HIV clinic in Cali, Colombia.Materials and methods: A non-random sample of 105 adults was enrolled. The 20 item-CES-D (CES-D-20) scale was administered twice: At baseline and 2-4 weeks later. We calculated the Cronbach’s alpha coefficient and the intraclass correlation coefficient. In addition, we used an exploratory and confirmatory factorial analysis, as well as the item response theory to assess the validity of the scale.Results: Most participants were men (73%), with a mean age of 40 years, 53% of whom had not completed high school. Cronbach’s coefficients were 0.92 and 0.94 at baseline and at the second interview, respectively. The intraclass correlation was 0.81 (95% CI: 0.72-0.88). Although all 20 items loaded distinctly in 4 factors, 5 items did not load as expected. The structure factor of the CES-D-20 was not confirmed, as 4 items had poor goodness of fit. The CES-D-10 appeared to perform better in this population. Conclusions: These results support the reliability and validity of the CES-D-10 instrument to screen for depressive symptoms in people living with HIV in Colombia.

Los autores declaran no tener conflicto de intereses alguno en relación con el artículo publicado. Disponibilidad de datos e información adicional. La totalidad de datos que soportan las conclusiones de este artículo están disponibles por solicitud al investigador principal (Dr.

Introduction: HIV-related stigma is detrimental to people living with HIV (PLH), and reducing it is essential for achieving an HIV/AIDS-free generation. Abbreviated stigma scales can improve the feasibility of surveys that broadly explore factors affecting PLH. This study tested the psychometric properties of a Spanish translation of the abbreviated 10-item Berger's HIV stigma scale. Methods: We recruited a sample of 105 PLH regularly attending a specialized clinic in Cali, Colombia. English-to-Spanish and Spanish-to-English back translation was performed of the Berger's 10-item HIV stigma scale. Exploratory and confirmatory factor analyses were carried out to assess its validity. Pre- and post-test reliability (15 days) was estimated with the intra-class correlation coefficient (ICC). Results: The Confirmatory Factor Analysis (CFA) was used to confirm a two-factor solution with three poor items removed, resulting in a 7-item HIV Stigma Scale. The resulting 7-item HIV stigma scale had a Cronbach's alpha of 0.73 with an ICC of 0.83 (CI 95%: 0.75–0.89). One factor loaded three items related to negative self-image (internalised stigma), and the other four items were related to personalized (enacted) HIV stigma. Both factors were related to depression and adherence to antiretroviral therapy. Conclusion: The Spanish translation of the 10-item HIV stigma scale did not perform well due to problems in items 4, 5, and 6. Rather, a modified 7-item version had a good fit with a two-factor loading in which both HIV stigma factors correlated significantly with depression and HIV medication adherence.

ResumenAntecedentes: las tasas de morbilidad y mortalidad entre pacientes VIH+ han disminuido notablemente con la terapia antirretroviral, paradójicamente los problemas nutricionales que enfrentan las personas VIH+ se han multiplicado. Objetivo: determinar conocimientos, actitudes y prácticas sobre la alimentación y su relación con la presencia de síndrome metabólico en pacientes VIH/ SIDA bajo tratamiento antirretroviral. Materiales y métodos: estudio transversal. Se entrevistaron, previo consentimiento informado, 102 pacientes VIH/SIDA mayores de 18 años de una clínica especializada en VIH/SIDA en Cali-Colombia. Se utilizó un cuestionario estructurado para características socio-demográficas y clínicas relacionadas con VIH/SIDA, así como para evaluación conocimientos, actitudes y prácticas de nutrición y medición de marcadores de síndrome metabólico. Se llevó a cabo análisis descriptivo y multivariado. Resultados: adecuado nivel de conocimientos relacionados con nutrición 3,9%; prácticas saludables adecuadas frente a nutrición 2,0% y actitud favorable hacia la alimentación saludable 46,1%. El 36% presentó síndrome metabólico (principalmente colesterol HDL bajo 67,6% y triglicéridos alterados 59,8%). Tener síndrome metabólico se relacionó con algunas características de conocimientos (p<0,021) y actitudes (p=0,006), así como con un IMC≥25 (p=0,001) y contener más de tres años de tratamiento antirretroviral (p=0,003). Conclusiones: es necesario fortalecer estrategias amigables que mejoren conocimientos y comportamientos hacia la nutrición en esta población, sin afectar el control del VIH/SIDA.Palabras clave: conocimientos, actitudes y práctica en salud, síndrome de inmunodeficiencia adquirida, síndrome metabólico, alimentación, conducta alimentaria, nutrición.Conocimientos, actitudes y prácticas frente a la alimentación de personas con VIH/SIDA y su relación con síndrome metabólico, Cali-Colombia paradoxically, nutritional problems in HIV+ people have multiplied. Aim: To determine knowledge, attitudes and practices towards nutrition, and its relation with the prevalence of metabolic syndrome among HIV+ patients receiving antiretroviral treatment. Methods: cross-sectional study, 102 HIV+ patients were interviewed, prior informed consent. Participants were over 18 year's old, and receiving comprehensive care in an HIV outpatient clinic in Cali-Colombia. A structured questionnaire was administered, which included questions about socio-demographic and clinical characteristics related to HIV/AIDS, and knowledge, attitudes and practices related to nutrition, physical activity and cardiac health. The levels of markers of metabolic syndrome were evaluated. Descriptive and multivariate analysis was performed. Results: Inadequate level of knowledge (in 3,9%) and healthy practices towards nutrition (in 2,0%) were identified, although most of the participants reported favorable attitudes regarding healthy eating habits (46,1%). 35,9% were diagnosed with metabolic syndrome (mainly related to low HDL cholesterol in 67,6% or tri...

Objetivo Comparar características de personas con prácticas sexuales de riesgo que acudieron a campañas voluntarias de toma de una primera prueba de Virus de la Inmunodeficiencia Humana (VIH) y el retorno voluntario a repetirse la prueba en meses posteriores.Método Entre 2012 y 2015 en Cali, participaron voluntariamente 82 personas mayores de 18 años. Se implementó un cuestionario estructurado para evaluar características sociodemográficas, conocimientos y comportamientos relacionados con VIH. Se hicieron análisis descriptivos y de comparación de muestras relacionadas.Resultados Edad promedio de participantes 26,9±8,6 años. El 100% eran hombres con orientación sexual homosexual. La mayoría con baja escolaridad e ingresos. Cerca de la mitad reportó consumo riesgoso de alcohol y sustancias psicoactivas. La mayoría tenía bajo conocimiento sobre la transmisión del VIH y bajo uso de condón con pareja estable. La comparación entre el momento de la primera prueba de VIH y la repetición posterior no evidenció cambios significativos en conocimientos y comportamientos, únicamente se observó menor reporte del consumo de sustancias (p=0,0209) y aumento de realización de tatuajes/piercing (p=0,0455). Resultado reactivo en la repetición de la prueba fue 4,9% (I.C95% 0,1%-9,6%).Conclusión Los resultados sugieren que el retorno voluntario a repetirse la prueba del VIH en este grupo de personas que comparten prácticas de riesgo para la infección por VIH no evidencia cambios en los conocimientos o comportamientos.