Increased access to successful antiretroviral therapy (ART) is necessary in order to achieve an AIDS-free generation. Importantly, slightly over half of the people living with HIV are women. Small studies have described many barriers to accessing treatment and care among women living with HIV. This cross-sectional, non-interventional, epidemiological study assessed the prevalence of barriers to accessing care for women living with HIV across 27 countries, divided into four global regions. HIV-positive women attending routine clinical visits were offered the opportunity to participate in the study. Data describing the study sites and demographic characteristics of the participating women were collected. Participating women filled out questionnaires including the Barriers to Care Scale (BACS) questionnaire, on which they reported the extent to which they found each of the 12 potential barriers to accessing health care problematic. A total of 1931 women living with HIV were included in the study: 760 from Western Europe and Canada (WEC), 532 from Central and Eastern Europe (CEE), 519 from Latin America (LA), and 120 from China. The mean age of participating women was 40.1 ± 11.4 years. A total of 88.2% were currently taking ART. A total of 81.8% obtained HIV treatment under a government health plan. The most prevalent barrier to care was community HIV/AIDS stigma. Community HIV/AIDS knowledge, lack of supportive/understanding work environments, lack of employment opportunities, and personal financial resources were also highly prevalent barriers to accessing care. These findings indicate that, more than 30 years after the start of the AIDS epidemic, stigma is still a major issue for women living with HIV. Continued efforts are needed to improve community education on HIV/AIDS in order to maximize access to health care among women living with HIV.

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Among HIV-infected women, several characteristics that may place women at greater risk for unintended pregnancy and its adverse consequences were associated with choice of highly effective contraceptive methods. These findings may aid in the development of interventions to increase use of effective contraception among HIV-infected women.

Generally, women are less likely than men to disclose their HIV status. This analysis examined the relationship between HIV disclosure and (1) perceived barriers to care and (2) quality of life (QoL) for women with HIV. The ELLA (EpidemioLogical study to investigate the popuLation and disease characteristics, barriers to care, and quAlity of life for women living with HIV) study enrolled HIV-positive women aged ≥18 years. Women completed the 12-item Barriers to Care Scale (BACS) questionnaire. QoL was assessed using the Health Status Assessment. BACS and QoL were stratified by dichotomized HIV disclosure status (to anyone outside the healthcare system). Multilevel logistic regression analysis was used to identify factors associated with disclosure. Of 1945 patients enrolled from Latin America, China, Central/Eastern Europe, and Western Europe/Canada between July 2012 and September 2013, 1929 were included in the analysis (disclosed, n = 1724; nondisclosed, n = 205). Overall, 55% of patients lived with a husband/partner, 53% were employed, and 88% were receiving antiretroviral therapy. Patients who were with a serodiscordant partner were more likely to disclose (p = 0.0003). China had a disproportionately higher percentage of participants who did not disclose at all (nearly 30% vs. <15% for other regions). Mean BACS severity scores for medical/psychological service barriers and most personal resource barriers were significantly lower for the disclosed group compared with the nondisclosed group (p ≤ 0.02 for all). Compared with the disclosed group, the nondisclosed group reported statistically significantly higher (p ≤ 0.03) BACS item severity scores for 8 of the 12 potential barriers to care. The disclosed group reported better QoL. Overall, HIV nondisclosure was associated with more severe barriers to accessing healthcare by women with HIV.

Objective To examine the associations between hormonal contraceptive use and measures of HIV disease progression and antiretroviral treatment (ART) effectiveness. Study design A prospective cohort study of women with prevalent HIV infection in St. Petersburg, Russia, was conducted. After contraceptive counseling, participants chose to use combined oral contraceptives (COCs), depot-medroxyprogesterone acetate (DMPA), a copper intrauterine device (IUD) or male condoms for pregnancy prevention. Among participants not using ART at enrollment, we used multivariate Cox regression to assess the association between current (time-varying) contraceptive use and disease progression, measured by the primary composite outcome of CD4 decline to <350 cells/mm3, ART initiation or death. Among participants using ART at enrollment, we used linear mixed models to estimate the predicted mean CD4 change at select time points by contraceptive method. Results During a total of 5233 months follow-up among participants not using ART with enrollment CD4 ≥ 350 cells/mm3 (n=315), 97 experienced disease progression. Neither current use of COCs [adjusted hazard ratio (aHR) 0.91, 95% confidence interval (CI) 0.56–1.48] nor DMPA (aHR 1.28, 95% CI 0.71–2.31) was associated with a statistically significant increased risk for disease progression compared with use of nonhormonal methods (IUD or condoms). Among participants using ART at enrollment (n=77), we found no statistically significant differences in the predicted mean changes in CD4 cell count comparing current use of COCs (p=.1) or DMPA (p=.3) with nonhormonal methods. Conclusion Hormonal contraceptive use was not significantly associated with measures of HIV disease progression or ART effectiveness among women with prevalent HIV infection. Implications Hormonal contraceptive use was not significantly associated with measures of HIV disease progression or ART effectiveness among women with prevalent HIV infection.

IntroductionGlobal HIV-1 prevalence is 35.3 million [1]; women comprise >50% of those infected. The majority of women may lack regular care and only one-fourth are virologically suppressed [2]. ELLA is a cross-sectional, non-interventional study conducted across Europe, Latin America, Canada and Asia that describes barriers to care for HIV-infected women and associations with disease stage, symptoms and health-related quality of life (HRQoL).MethodsHIV-infected women eligible for ELLA (≥18 years) completed: Barrier to Care Scale (BACS) comprising 12 items in four domains (Index range 0–12, Overall range 1–4, greater=more barriers, Overall score ≥2 considered severe); AIDS Clinical Trials Group (ACTG) Health Status Assessment comprising 21 items assessing 9 HRQoL domains (range 0–100, greater=better); and ACTG Symptom Distress Module comprising 20 symptoms rated on bother (range 0–4, greater=more bother). Healthcare providers documented medical history and HIV clinical data. Correlations of BACS response and last reported VL/CD4 count with HIV symptoms and HRQoL were analyzed. Spearman rank order was used to test correlations with statistical significance set at p<0.05.ResultsEnrollment: 1931 women from 30 countries; mean age 40 years (16.9% >50 years); 47.7% education <12 years; 36% unemployed; 82.9% urban residence. HIV was acquired heterosexually in 83.0%; 88.2% of subjects were on ART; 57.5% had VL<50 c/ml; mean CD4 was 540.5 c/µL. Mean [SD] BACS Index and Overall scores were 6.19 [3.47] (N=1818) and 2.09 [0.71] (N=1922), respectively. Stigma was a prominent barrier. Lower (better) BACS Index and Overall scores correlated with better HRQoL on all nine domains (p<0.0001). Lower VL and greater CD4 count were both correlated with better HRQoL for eight of nine domains (p<0.04, p≤0.0002, respectively) excepting pain. Lower BACS Index and Overall scores correlated with fewer symptom count and less symptom bother (p<0.0001). Fewer symptom count and less symptom bother correlated with better HRQoL on all nine domains (p<0.0001). While greater CD4 count correlated with fewer HIV symptoms and less bother (p<0.0001), VL did not significantly correlate with either.ConclusionsIn HIV-infected women, reduced barriers to care correlated with fewer symptoms, less symptom bother and better HRQoL. Improved HRQoL may be mediated by greater CD4 counts and fewer symptoms. Better access to care may improve HRQoL outcomes in this population.

За годы наблюдения в Санкт-Петербурге ВИЧ-инфицированными женщинами рождено 9057 детей, 3241 из которых-за последние 5 лет. Количество родов у ВИЧ-инфицированных женщин в городе остается стабильным в течение нескольких последних лет. Несмотря на низкую частоту перинатальной передачи ВИЧ, анализ ситуации по оказанию помощи ВИЧинфицированным женщинам на этапе планирования беременности и в течение беременности позволит оптимизировать данную работу и в перспективе снизить вероятность перинатального инфицирования. Цель исследования-провести анализ оказания медицинской помощи серодискордантным парам и ВИЧ-инфицированным женщинам на этапе планирования беременности, в течение бе-ременности и родов для дальнейшего снижения частоты перинатальной передачи ВИЧ в Санкт-Петербурге. Материалы и методы Проведен проспективно-ретроспективный анализ медицинских карт 2442 беременных женщин, закончивших беременность родами в Санкт-Петербурге в 2014-2017 гг. В ходе проведения анализа оценены количество желанных беременностей в исследуемой группе, сроки постановки на диспансерный учет при беременности и начала профилактики перинатальной передачи ВИЧ, охват химиопрофилактикой при беременности, в родах и новорожденных. Статистическая обработка материала проводилась с использованием программ Exel, «Statistica 10».

Survey objective: analysis of transmission routes of HIV infection, its course and treatment in children with the aim of determining the common problems and solutions. Materials and methods. Observation of 388 HIV-infected children at the age from month to 17 years was held for the purpose of analysis of common problems on the basis of Motherhood and Childhood Department of State Budgetary Healthcare Institution «St. Petersburg Center on Prevention and Control of AIDS and Infectious Diseases». Statistical processing of data was carried out using Statistica for Windows software (v. 8.0). Survey results. It was found that 363 of children were infected with HIV during perinatal period (93,6%), 23% (5,9%) were infected during childbirth and 2 children — through injected drugs (0,5%). Of the 16 children with perinatally acquired AIDS diagnosed in 2017, breastfeeding was reported in 6 (37,5%) cases that evaluates HIV-screening of sexual partners of pregnant women. 378 (97,4%) of children take ART when clinically, immunologically and virologically indicate. Of this number, first line ART regimen is used in 130 children (34,4%). 199 (80,2%) switched to second-line ART regimen due to adverse effects, 49 (19,8%) after virological failure. Prevailing adverse effects such as dyslipidemia (40,8%), polyneuropathy (22,6%) and anemia (12,6%) were a reason for switching to alternative regimen with combined medications. Presently, it is a great problem that parents or foster parents of a child — HIV-dissidents refuse of children care and treatment that led to lethal outcome in 18 cases. In light of this, pediatricians of Centers on Prevention and Control of AIDS have to protect children’s rights for health by making request and applications to the guardianship authorities, courts, prosecutors, law enforcement agencies. 57 appeals to these authorities have been made in total.