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HIV Seropositivity: HELP
Articles from Scotland
Based on 22 articles published since 2008
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These are the 22 published articles about HIV Seropositivity that originated from Scotland during 2008-2019.
 
+ Citations + Abstracts
1 Review Management of a first seizure. Special problems: adults and elderly. 2008

Stephen, Linda J / Brodie, Martin J. ·Epilepsy Unit, Division of Cardiovascular and Medical Sciences, Western Infirmary, Glasgow, Scotland, United Kingdom. ·Epilepsia · Pubmed #18184155.

ABSTRACT: A first seizure out of a clear blue sky can be a major life-changing event. Careful history-taking and appropriate investigation together with a clear explanation provided to patient and family are an essential requirement. Although for most patients, pharmacotherapy can be withheld and events awaited, there are circumstances where introduction of antiepileptic drug (AED) therapy should be considered. Medical causes of seizures should also be sought and treated. In addition, a first seizure in HIV-positive patients and in those with underlying neurocysticercosis should usually provoke the introduction of AED therapy. Particular problems can occur in patients with a single episode of provoked status epilepticus, a first tonic-clonic seizure during pregnancy and, particularly, an unprovoked event in older and learning disabled people. Treatment following a first seizure should balance risk factors for recurrence with the informed opinion of the patients and their family.

2 Clinical Trial Barriers and facilitators to the uptake of Test and Treat in Mozambique: A qualitative study on patient and provider perceptions. 2018

Nhassengo, Pedroso / Cataldo, Fabian / Magaço, Amilcar / Hoffman, Risa M / Nerua, Lucas / Saide, Mohomede / Cuco, Rosa / Hoek, Roxanne / Mbofana, Francisco / Couto, Aleny / Gudo, Eduardo / Chicumbe, Sergio / Dovel, Kathryn. ·Health System Research Sector, National Institute of Health, Maputo, Mozambique. · Institute for Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom. · David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America. · National STI-HIV/AIDS Program, Ministry of Health, Maputo, Mozambique. · National Council against HIV/AIDS, Maputo, Mozambique. · Research Department, Partners in Hope, Lilongwe, Malawi. ·PLoS One · Pubmed #30586354.

ABSTRACT: BACKGROUND: In mid-2016, Mozambique began phased implementation of the 'Test-and-Treat' policy, which enrolls HIV positive clients into antiretroviral treatment (ART) immediately regardless of CD4 cell count or disease stage. Novel insights into barriers and facilitators to ART initiation among healthy clients are needed to improve implementation of Test and Treat. METHODS AND FINDINGS: A cross-sectional qualitative study was conducted across 10 health facilities in Mozambique. In-depth interviews (IDIs) were conducted with HIV-positive clients (60 who initiated/20 who did not initiate ART within Test and Treat) and 9 focus group discussion (FGDs) were conducted with health care workers (HCWs; n = 53). Data were analyzed using deductive and inductive analysis strategies. Barriers to ART initiation included: (1) feeling 'healthy'; (2) not prepared to start ART for life; (3) concerns about ART side effects; (4) fear of HIV disclosure and discrimination; (5) poor interactions with HCWs; (6) limited privacy at health facilities; and (7) perceptions of long wait times. Facilitators included the motivation to stay healthy and to take care of dependents, as well as new models of ART services such as adaptation of counseling to clients' specific needs, efficient patient flow, and integrated HIV/primary care services. CONCLUSIONS: ART initiation may be difficult for healthy clients in the context of Test-and-Treat. Specific strategies to engage this population are needed. Strategies could include targeted support for clients, community sensitization on the benefits of early ART initiation, client-centered approaches to patient care, and improved efficiency through multi-month scripting and increased workforce.

3 Clinical Trial Four-month moxifloxacin-based regimens for drug-sensitive tuberculosis. 2014

Gillespie, Stephen H / Crook, Angela M / McHugh, Timothy D / Mendel, Carl M / Meredith, Sarah K / Murray, Stephen R / Pappas, Frances / Phillips, Patrick P J / Nunn, Andrew J / Anonymous5290805. ·From the University of St. Andrews Medical School, St. Andrews (S.H.G.), and the Medical Research Council Clinical Trials Unit at University College London (A.M.C., S.K.M., P.P.J.P., A.J.N.) and the Division of Infection and Immunity, University College London (T.D.M.), London - both in the United Kingdom · and the TB Alliance, New York (C.M.M., S.R.M., F.P.). ·N Engl J Med · Pubmed #25196020.

ABSTRACT: BACKGROUND: Early-phase and preclinical studies suggest that moxifloxacin-containing regimens could allow for effective 4-month treatment of uncomplicated, smear-positive pulmonary tuberculosis. METHODS: We conducted a randomized, double-blind, placebo-controlled, phase 3 trial to test the noninferiority of two moxifloxacin-containing regimens as compared with a control regimen. One group of patients received isoniazid, rifampin, pyrazinamide, and ethambutol for 8 weeks, followed by 18 weeks of isoniazid and rifampin (control group). In the second group, we replaced ethambutol with moxifloxacin for 17 weeks, followed by 9 weeks of placebo (isoniazid group), and in the third group, we replaced isoniazid with moxifloxacin for 17 weeks, followed by 9 weeks of placebo (ethambutol group). The primary end point was treatment failure or relapse within 18 months after randomization. RESULTS: Of the 1931 patients who underwent randomization, in the per-protocol analysis, a favorable outcome was reported in fewer patients in the isoniazid group (85%) and the ethambutol group (80%) than in the control group (92%), for a difference favoring the control group of 6.1 percentage points (97.5% confidence interval [CI], 1.7 to 10.5) versus the isoniazid group and 11.4 percentage points (97.5% CI, 6.7 to 16.1) versus the ethambutol group. Results were consistent in the modified intention-to-treat analysis and all sensitivity analyses. The hazard ratios for the time to culture negativity in both solid and liquid mediums for the isoniazid and ethambutol groups, as compared with the control group, ranged from 1.17 to 1.25, indicating a shorter duration, with the lower bounds of the 95% confidence intervals exceeding 1.00 in all cases. There was no significant difference in the incidence of grade 3 or 4 adverse events, with events reported in 127 patients (19%) in the isoniazid group, 111 (17%) in the ethambutol group, and 123 (19%) in the control group. CONCLUSIONS: The two moxifloxacin-containing regimens produced a more rapid initial decline in bacterial load, as compared with the control group. However, noninferiority for these regimens was not shown, which indicates that shortening treatment to 4 months was not effective in this setting. (Funded by the Global Alliance for TB Drug Development and others; REMoxTB ClinicalTrials.gov number, NCT00864383.).

4 Article Toxicity associated with tuberculosis chemotherapy in the REMoxTB study. 2018

Tweed, Conor D / Crook, Angela M / Amukoye, Evans I / Dawson, Rodney / Diacon, Andreas H / Hanekom, Madeline / McHugh, Timothy D / Mendel, Carl M / Meredith, Sarah K / Murphy, Michael E / Murthy, Saraswathi E / Nunn, Andrew J / Phillips, Patrick P J / Singh, Kasha P / Spigelman, Melvin / Wills, Genevieve H / Gillespie, Stephen H. ·MRC Clinical Trials Unit at University College London, London, UK. c.tweed@ucl.ac.uk. · MRC Clinical Trials Unit at University College London, London, UK. · Keya Medical Research Unit, Nairobi, Kenya. · University of Cape Town Lung Institute, Cape Town, South Africa. · TASK Applied Science, Cape Town, South Africa. · Division of Infection and Immunity, University College London, London, UK. · TB Alliance, New York, USA. · Division of Pulmonology, University of San Francisco, San Francisco, USA. · The Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia. · University of St Andrews Medical School, St Andrews, UK. ·BMC Infect Dis · Pubmed #29996783.

ABSTRACT: BACKGROUND: The incidence and severity of tuberculosis chemotherapy toxicity is poorly characterised. We used data available from patients in the REMoxTB trial to provide an assessment of the risks associated with the standard regimen and two experimental regimens containing moxifloxacin. METHODS: All grade 3 & 4 adverse events (AEs) and their relationship to treatment for patients who had taken at least one dose of therapy in the REMoxTB clinical trial were recorded. Univariable logistic regression was used to test the relationship of baseline characteristics to the incidence of grade 3 & 4 AEs and significant characteristics (p < 0.10) were incorporated into a multivariable model. The timing of AEs during therapy was analysed in standard therapy and the experimental arms. Logistic regression was used to investigate the relationship between AEs (total and related-only) and microbiological cure on treatment. RESULTS: In the standard therapy arm 57 (8.9%) of 639 patients experienced ≥1 related AEs with 80 of the total 113 related events (70.8%) occurring in the intensive phase of treatment. Both four-month experimental arms ("isoniazid arm" with moxifloxacin substituted for ethambutol & "ethambutol arm" with moxifloxacin substituted for isoniazid) had a lower total of related grade 3 & 4 AEs than standard therapy (63 & 65 vs 113 AEs). Female gender (adjOR 1.97, 95% CI 0.91-1.83) and HIV-positive status (adjOR 3.33, 95% CI 1.55-7.14) were significantly associated with experiencing ≥1 related AE (p < 0.05) on standard therapy. The most common adverse events on standard therapy related to hepatobiliary, musculoskeletal and metabolic disorders. Patients who experienced ≥1 related AE were more likely to fail treatment or relapse (adjOR 3.11, 95% CI 1.59-6.10, p < 0.001). CONCLUSIONS: Most AEs considered related to standard therapy occurred in the intensive phase of treatment with female patients and HIV-positive patients demonstrating a significantly higher risk of AEs during treatment. Almost a tenth of standard therapy patients had a significant side effect, whereas both experimental arms recorded a lower incidence of toxicity. That patients with one or more AE are more likely to fail treatment suggests that treatment outcomes could be improved by identifying such patients through targeted monitoring.

5 Article The role of the family in HIV status disclosure among women in Vietnam: Familial dependence and independence. 2018

Dinh, H T / White, J L / Hipwell, M / Nguyen, C T K / Pharris, A. ·a Medical Collaboration Center, Bach Mai Hospital , Ha Noi , Vietnam. · b Department of Health and Social Sciences , University of the West of England, Bristol , UK. · c Department of Health and Social Sciences , Queen Margaret University , Edinburgh , Scotland. · d Health Systems Research Project, Hanoi Medical University , Ha Noi , Vietnam. · e Division of International Health (IHCAR), Department of Public Health Sciences , Karolinska Institute , Stockholm , Sweden. ·Health Care Women Int · Pubmed #28812447.

ABSTRACT: Insights into disclosure by people living with HIV and AIDS (PLWHA) can inform strategies for treatment and support, yet Vietnamese women's self-disclosure patterns are poorly understood. We conducted interviews with 12 HIV-positive women, identifying three principal factors influencing disclosure to family members: patrilocal residence, desire to protect own family, and the need for financial support. Women's decision-making about disclosure was significantly affected by dependence on or independence of parents-in-law and their own parents. We believe that our findings reveal the complex interplay of stigma and disclosure within Vietnamese families, highlighting the need for specific social measures that promote self-disclosure combined with family support for female PLWHA.

6 Article A benchmark for evaluation of algorithms for identification of cellular correlates of clinical outcomes. 2016

Aghaeepour, Nima / Chattopadhyay, Pratip / Chikina, Maria / Dhaene, Tom / Van Gassen, Sofie / Kursa, Miron / Lambrecht, Bart N / Malek, Mehrnoush / McLachlan, G J / Qian, Yu / Qiu, Peng / Saeys, Yvan / Stanton, Rick / Tong, Dong / Vens, Celine / Walkowiak, Sławomir / Wang, Kui / Finak, Greg / Gottardo, Raphael / Mosmann, Tim / Nolan, Garry P / Scheuermann, Richard H / Brinkman, Ryan R. ·Terry Fox Laboratory, British Columbia Cancer Agency, Vancouver, British Columbia, Canada. · Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada. · Baxter Laboratory in Stem Cell Biology, Stanford University, Stanford, California. · ImmunoTechnology Section, Vaccine Research Center, National Institutes of Health, Washington, DC. · Department Computational and Systems Biology, University of Pittsburgh, Pittsburg, Pennsylvania. · Department of Information Technology, Ghent University-iMinds, Ghent, Belgium. · Inflammation Research Center, VIB, Ghent, Belgium. · Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium. · Interdisciplinary Centre for Mathematical and Computational Modelling, University of Warsaw, Warsaw, Poland. · Department of Statistics, University of Queensland, St. Lucia, Brisbane, Australia 4072. · J. Craig Venter Institute, La Jolla, California. · Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia. · The John Van Geest Cancer Research Centre, Nottingham Trent University, Nottingham, United Kingdom. · Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom. · Department of Public Health and Primary Care, kU Leuven Kulak, Kortrijk, Belgium. · Department of Mathematics, University of Queensland, St. Lucia, Brisbane, Australia. · School of Medicine, Shihezi University, Xinjiang, 832000, China. · Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, DC. · David H. Smith Center for Vaccine Biology and Immunology, University of Rochester Medical Center, Rochester, New York. · Department of Pathology, University of California, San Diego, California. ·Cytometry A · Pubmed #26447924.

ABSTRACT: The Flow Cytometry: Critical Assessment of Population Identification Methods (FlowCAP) challenges were established to compare the performance of computational methods for identifying cell populations in multidimensional flow cytometry data. Here we report the results of FlowCAP-IV where algorithms from seven different research groups predicted the time to progression to AIDS among a cohort of 384 HIV+ subjects, using antigen-stimulated peripheral blood mononuclear cell (PBMC) samples analyzed with a 14-color staining panel. Two approaches (FlowReMi.1 and flowDensity-flowType-RchyOptimyx) provided statistically significant predictive value in the blinded test set. Manual validation of submitted results indicated that unbiased analysis of single cell phenotypes could reveal unexpected cell types that correlated with outcomes of interest in high dimensional flow cytometry datasets.

7 Article Sexually acquired Salmonella Typhi urinary tract infection. 2016

Wielding, Sally / Scott, Gordon. ·Chalmers Centre, Edinburgh, UK sally.wielding@nhslothian.scot.nhs.uk. · Chalmers Centre, Edinburgh, UK. ·Int J STD AIDS · Pubmed #25953964.

ABSTRACT: We report a case of isolated urinary Salmonella enterica serotype Typhi in an HIV-positive man who has sex with men. He was clinically well and blood and stool cultures were negative, indicating that this may have been a sexually acquired urinary tract infection.

8 Article The Impact of HCV Infection Duration on HIV Disease Progression and Response to cART amongst HIV Seroconverters in the UK. 2015

Inshaw, Jamie / Leen, Clifford / Fisher, Martin / Gilson, Richard / Hawkins, David / Collins, Simon / Fox, Julie / McLean, Ken / Fidler, Sarah / Phillips, Andrew / Lattimore, Sam / Babiker, Abdel / Porter, Kholoud / Anonymous110838. ·MRC Clinical Trials Unit at University College London, London, United Kingdom. · Western General Hospital, Edinburgh, United Kingdom. · Brighton and Sussex University NHS Trust, Brighton, United Kingdom. · Department of Infection and Population Health, University College London, London, United Kingdom. · Chelsea and Westminster Hospital, London, United Kingdom. · HIV i-Base, London, United Kingdom. · Guy's and St. Thomas NHS Trust at Kings College, London, United Kingdom. · Charing Cross Hospital, London, United Kingdom. · Imperial College NHS Trust, London, United Kingdom. · Public Health England, London, United Kingdom. ·PLoS One · Pubmed #26225723.

ABSTRACT: INTRODUCTION: The effect of HCV infection on HIV disease progression remains unclear; the effect of HCV infection duration on HIV disease progression is unknown. METHODS: We used data from a cohort of HIV seroconverters to investigate the effect of HCV infection duration on time from HIV seroconversion to CD4 <350 cells/mm3, AIDS or death, censoring at the earlier of cART initiation or last clinic visit, adjusting for confounders and splitting data into follow up periods from HIV seroconversion (<2, 2-4 and >4 years). We additionally compared CD4 cell decline following HCV infection to that of mono-infected individuals with similar HIV infection duration by fitting a random effects model. In a separate analysis, we used linear mixed models to we examine the effect of HCV infection and its duration on CD4 increase over 48 weeks following cART. RESULTS: Of 1655 individuals, 97 (5.9%) were HCV co-infected. HCV<1 year was associated with a higher risk of endpoint in each follow-up period from HIV seroconversion (HR [95% CI] 2.58 [1.51, 4.41], p = 0.001; 3.80 [1.20, 12.03], p = 0.023; 2.03 [0.88, 4.71], p = 0.098 for <2, 2-4 and >4 years respectively), compared to mono-infected individuals. However, we found no evidence of an association for those with HCV>2 years (all p>0.89). Individuals experienced a somewhat greater decrease in CD4 count following HCV infection lasting 13 months, relative to individuals with HIV alone, (estimate = -3.33, 95% CI [-7.29, 0.63] cells/mm3 per month, p = 0.099). Of 1502 initiating cART, 106 (7.1%) were HCV co-infected, with no evidence of HCV duration at cART being associated with immunological response (p = 0.45). CONCLUSIONS: The impact of HCV co-infection on HIV disease progression appears to be restricted to the first year after HCV infection.

9 Article Adherence in a pragmatic randomized controlled trial on prophylactic iron supplementation during pregnancy in Maputo, Mozambique. 2015

Nwaru, Bright I / Salomé, Graça / Abacassamo, Fatima / Augusto, Orvalho / Cliff, Julie / Sousa, Cesar / Regushevskaya, Elena / Parkkali, Saara / Hemminki, Elina. ·1Centre for Population Health Sciences,The University of Edinburgh,Medical School, Doorway 3,Teviot Place,Edinburgh EH8 9AG,UK. · 3Department of Physiological Sciences,Eduardo Mondlane University,Maputo,Mozambique. · 4Department of Community Health,Eduardo Mondlane University,Maputo,Mozambique. · 5National Institute for Health and Welfare,Health Services and Policy Research,Helsinki,Finland. ·Public Health Nutr · Pubmed #24999785.

ABSTRACT: OBJECTIVE: Assessing the level of adherence and its determinants is important in appraising the overall effectiveness of trials. The present study aimed to evaluate the extent of adherence and its determinants in a pragmatic randomized controlled trial of Fe prophylaxis during pregnancy in Maputo, Mozambique. DESIGN: A pragmatic randomized controlled trial. SETTING: Two health centres (1° de Maio and Machava) in Maputo, Mozambique. SUBJECTS: Pregnant women (≥12 weeks' gestation, ≥18 years old, non-high-risk pregnancy; n 4326) attending prenatal care consultations at two health centres were randomized to receive routine Fe (n 2184; 60 mg ferrous sulfate plus 400 μg folic acid daily throughout pregnancy) or selective Fe (n 2142; screening and treatment for anaemia and daily intake of 1 mg folic acid). RESULTS: The level of adherence was 79% for having two or more visits, 53% for adequate prenatal care and 67% for complete intake of Fe/folic acid tablets during the trial. The correlation between the adherence measures ranged between 0·151 and 0·739. Adherence did not differ by trial arm, but there were centre differences in adequate prenatal visits and intake of tablets. Older women (>20 years) and those with a history of abortion were more likely to achieve greater adherence, whereas an increased number of previous births decreased the likelihood of adherence. HIV positivity decreased the likelihood of adherence in one trial centre and increased it in the other. CONCLUSIONS: The variation in adherence by trial centre, women's characteristics and outcome measures suggests that adherence in trials fully depends on participants' behaviour and can be increased by paying attention to contextual factors.

10 Article A case of multicentric Castleman's disease in HIV infection with the rare complication of acquired angioedema. 2014

Fernando, I / Scott, G. ·Chalmers Sexual Health Centre, NHS Lothian, Edinburgh, UK imali.fernando@live.co.uk. · Chalmers Sexual Health Centre, NHS Lothian, Edinburgh, UK. ·Int J STD AIDS · Pubmed #24352125.

ABSTRACT: Multicentric Castleman's disease (MCD), a polyclonal lymphoproliferative disorder of unknown aetiology, is a well-recognised complication of HIV disease. We present a case of MCD in an HIV-positive patient that is unusual on two counts: our patient's MCD first presented in the context of an immune restoration inflammatory syndrome (IRIS), following the initiation of highly active antiretroviral therapy (HAART). In addition, her MCD was associated with the unusual complication of acquired angioedema (AAE), which resolved following treatment of the MCD. While AAE is frequently found to have an underlying diagnosis of a lymphoproliferative disease, this is the first reported case linking AAE to MCD.

11 Article How important are human immunodeficiency virus (HIV) clinical markers to the long-term formal employment among people living with HIV in developing countries? A study in South Africa. 2014

Odek, W O / Glendinning, A / Charalambous, S. ·Department of Sociology, King's College, University of Aberdeen, Aberdeen, UK. · Aurum Institute for Health Research, Aurum House, The Ridge, Parktown, Johannesburg, South Africa. ·Work · Pubmed #22976157.

ABSTRACT: OBJECTIVE: To examine the relationship of Human Immunodeficiency Virus (HIV) clinical markers and socio-demographic characteristics with long-term formal employment among people living with HIV (PLHIV). PARTICIPANTS: 554 adults, 55% females, on HIV treatment for at least two years at two public hospitals in Johannesburg, South Africa. METHODS: A retrospective cohort design, tracing changes in study participants' formal employment status since the first HIV-positive diagnosis. Data collection included historical medical records review and interviewer-administered questionnaires. RESULTS: 44% of all study participants (39% and 49% among males and females, respectively) were formally employed at the time of the study, primarily in low-skilled jobs in the private sector. The majority (83%) of males and 60% of females remained in formal employment since being diagnosed as HIV-positive. Female gender, education to grade 12 or higher, a smaller household size and being married were significantly associated with current formal employment. Formal employment was unrelated to HIV treatment indicators (CD4 count, viral load and duration since diagnosis). Of those in formal employment, 68 (28%) were aware of HIV policies at their workplaces, which was also positively associated with the duration in their current employment. CONCLUSIONS AND RECOMMENDATIONS: PLHIV in developing country contexts can enter into and maintain formal employment, especially when treatment and workplace support are available. Thus, employer organisations should implement effective workplace HIV policies to enhance employment experiences of their workforce living with HIV. Care and support services for people on HIV treatment should also address their career development needs.

12 Article Clinicopathological review of ocular surface squamous neoplasia in Malawi. 2013

Tiong, T / Borooah, S / Msosa, J / Dean, W / Smith, C / Kambewa, E / Kiire, C / Zondervan, M / Aspinall, P / Dhillon, B. ·University of Edinburgh, Edinburgh, UK. ·Br J Ophthalmol · Pubmed #23613511.

ABSTRACT: BACKGROUND: Ocular surface squamous neoplasia (OSSN) is the most common cause of malignancy of the conjunctiva. Variable clinical presentation means that invasive malignant OSSN is often difficult to discriminate from other similarly presenting differential diagnoses which can be managed more conservatively. AIMS: Identification of clinical factors associated with a histopathological diagnosis of conjunctival squamous cell carcinoma (SCC). METHODS: Prospective consecutive case series of suspected OSSN cases presenting at two hospitals in Central Malawi over a 1 year period. A pro forma was completed assessing preidentified clinical variables. Suspected lesions underwent excisional biopsy followed by histopathological investigation. RESULTS: Fifty-eight patients were recruited. Mean age was 35.8 (range 22-62). 51 cases of histopathologically confirmed OSSN were found. 30 (50%) patients were confirmed HIV seropositive which rose to 86.67% in invasive SCC. Larger size of tumour (p=0.008), male gender (p=0.025) and HIV seropositivity (p=0.010) were associated with invasive SCC pathology. CONCLUSIONS: A clinicopathological study of OSSN has not previously been performed in Malawi. The association of HIV with SCC corresponds to previous reports from sub-Saharan Africa. A new finding in our study is a relationship between larger tumour size and invasive lesions confirmed by histopathology. When integrated into a clinical decision-making model, tumour area provides a simple clinical measure for ophthalmic practitioners to use in order to differentiate higher risk OSSN from more benign pathology. The higher risk lesions can subsequently be treated with greater surgical care and undergo closer follow-up.

13 Article Understanding the biopsychosocial aspects of HIV disclosure among HIV-positive gay men in Scotland. 2013

Flowers, Paul / Davis, Mark D M. ·Department of Psychology and Allied Health Sciences, School of Health and Life Sciences, Glasgow Caledonian University, UK. p.flowers@gcal.ac.uk ·J Health Psychol · Pubmed #22935480.

ABSTRACT: This study presents an interpretative phenomenological analysis of the experiential accounts of HIV-positive gay men. Participants took part in open-ended interviews. Three key-related recurrent themes are presented: 'Disclosure, deliberation and the abject other'; 'Disclosure, care and the valued other' and 'Disclosure and intimate citizenship'. These highlight the complex, situated and mindful ways in which disclosure occurs. They stand in contrast to the understandings of HIV status disclosure as a 'health behaviour' deracinated from its social, relational and emotional dimensions. We explore the findings in relation to contemporary HIV prevention (with its increasing biomedical slant) and in relation to a biopsychosocial framework.

14 Article Has testing been normalized? An analysis of changes in barriers to HIV testing among men who have sex with men between 2000 and 2010 in Scotland, UK. 2013

Flowers, P / Knussen, C / Li, J / McDaid, L. ·Department of Psychology and Allied Health Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK. p.flowers@gcu.ac.uk ·HIV Med · Pubmed #22934820.

ABSTRACT: OBJECTIVES: This paper examines changes in barriers to HIV testing amongst gay men. We compared data collected in 2000 and 2010 to assess changes in HIV testing behaviours, in community-level perceptions of barriers to HIV testing, and in the relative contributions of barrier measures. METHODS: Cross-sectional surveys were conducted within the commercial gay scene in Glasgow with good response rates (78% and 62%) using a form of time and location sampling. RESULTS: Major changes in HIV testing behaviours were observed between 2000 and 2010 (30.6% increase in testing within previous year). At the community level, the perceived benefits of testing [t (1284) = -8.46; P < 0.001] and the norm for HIV testing [t (1236) = -11.62; P < 0.001] increased; however, other perceived barriers did not change (fear of a positive result, clinic-related barriers and attitudes to sex with HIV-positive men). Multinomial logistic regression showed that fear of a positive test result remained a key barrier to HIV testing; however, a significant fear × year of survey interaction indicated that fear played a lesser role in differentiating those who had never been tested from those who had been tested in 2010 than it had in 2000. CONCLUSIONS: These findings suggest the partial normalization of HIV testing. While some barriers have reduced, other key barriers remain important. Interventions should be designed and evaluated that attend to both the biomedical and the psychosocial aspects of HIV testing (e.g. the meaning of positive test results, the sexual exclusion of positive men, and HIV-related stigma).

15 Article Anal cytology screening in HIV-positive men who have sex with men: experience in a city centre HIV clinic. 2012

Goodall, L / Clutterbuck, D. ·Chalmers Sexual Health Centre, Edinburgh EH3 9ES, UK. lisagoodall@doctors.org.uk ·Int J STD AIDS · Pubmed #23033513.

ABSTRACT: The objectives of this study were to describe the findings of anal cytology screening during the first year of a unit protocol offering yearly screening to all HIV-positive men who have sex with men (MSM). Of 285 patients seen, 75% were offered anal cytology screening. Sixty-two percent of patients offered screening accepted and 21% of anal smears performed were reported as abnormal. Anal cytology screening may lead to earlier detection of anal intraepithelial neoplasia allowing for treatment before progression to cancer. This study revealed potential difficulties in follow-up of patients with high-grade precancerous disease and highlighted potential resource implications of implementing a routine screening programme.

16 Article Serosorting and strategic positioning during unprotected anal intercourse: are risk reduction strategies being employed by gay and bisexual men in Scotland? 2012

McDaid, Lisa M / Hart, Graham J. ·MRC/CSO Social and Public Health Sciences Unit, Glasgow, United Kingdom. l.mcdaid@sphsu.mrc.ac.uk ·Sex Transm Dis · Pubmed #22902673.

ABSTRACT: BACKGROUND: Unprotected anal intercourse (UAI) remains the main risk factor for HIV among men who have sex with men (MSM), but risk varies by the sexual position adopted and the risk reduction strategies used. Here, we report on sexual position, and knowledge of partners' HIV status, during UAI to assess whether MSM in Scotland are using sexual risk reduction strategies. METHODS: Anonymous, self-complete questionnaires and Orasure oral fluid specimens (OraSure Technologies, Inc., Bethlehem, Pennsylvania, USA) were provided by 1277 MSM in commercial gay venues in Glasgow and Edinburgh, Scotland, United Kingdom (59.7% response rate). Overall, 488 MSM (39.7%) reported any UAI in the past 12 months; 318 reported on partner HIV status and sexual position and are included in these analyses. RESULTS: Being equally either the insertive or receptive partner during UAI was most commonly reported; 23.1% of HIV-negative MSM reported exclusive insertive UAI, whereas no MSM with diagnosed HIV reported exclusive receptive UAI. Five diagnosed HIV-positive MSM reported always knowing their partners' HIV status and only having HIV-positive partners (50.0% of HIV-positive MSM reporting UAI; 11.9% of the diagnosed HIV-positive sample); 160 HIV-negative MSM reported having had an HIV test (and therefore being aware of their HIV-negative status), always knowing their partners' status, and only having HIV-negative partners (52.8% of HIV-negative MSM reporting UAI; 13.7% of the total HIV-negative sample). CONCLUSIONS: Behavior suggestive of serosorting and strategic positioning (among HIV-negative MSM) was evident in this sample, but inconsistent adoption of these and general versatility in sexual behavior suggest that they have a limited role.

17 Article Premature mortality in Scottish injecting drug users: a life-history approach. 2012

Copeland, L / Robertson, J / McKenzie, J / Kimber, J / Macleod, J / Hickman, M / de Angelis, D. ·Muirhouse Medical Group, 1 Muirhouse Avenue, Edinburgh EH4 4PL, Scotland, UK. lorraine.copeland@lothian.scot.nhs.uk ·Scott Med J · Pubmed #22408214.

ABSTRACT: In Scotland, deaths in drug users are known to be higher than in the rest of the UK and most of Europe. Reducing drug-related deaths is currently a national priority for the Scottish Government.  This study aimed to present a description of the life histories of a group of injecting drug users who have recently died, with a view to highlighting areas for further research. The Edinburgh Addiction Cohort study recently carried out 432 follow-up interviews between the years 2005 and 2007. Thirty-three cases who completed this extensive interview detailing early life, education, employment, drug use, opiate substitution treatment, criminal history, mental health problems and overdose have subsequently died, leaving this source of rich information about their lives. The design of the interview used the life grid approach. Information was also compiled from full primary care records and General Register Office death certificates. Early life adversity was apparent for many cases, with a steady progression into early criminal behaviour and drug misuse. Poor adult life outcomes illustrated the lifelong damaging effects of drug injecting. Death occurred significantly earlier than in the general population or those living in deprived communities who did not use drugs. In conclusion, a clearer understanding of the life histories of problem drug users would be advantageous for health-care professionals and policy-makers. More qualitative research studies are needed to highlight areas which might require early intervention and also complement the existing secondary data studies.

18 Article Increasing cervical cytology uptake in Glasgow HIV cohort. 2012

MacDonald, R / Anderson, P / Winter, A J. ·Brownlee Centre, Glasgow, UK. rmacdonald3@nhs.net ·Int J STD AIDS · Pubmed #22362692.

ABSTRACT: We present an audit of cervical smear uptake in our HIV-positive cohort in Glasgow. Uptake was favourable in comparison with the general population in the rest of Scotland (75% versus 73.4%); however, much lower than the British Association for Sexual Health and HIV (BASHH) recommended standard of 95%. A significant number of patients were incorrectly identified as only requiring three-yearly smears when they attended non-specialist services which may contribute to reduced uptake.

19 Article Improvement is needed in the documentation and HIV testing of children of HIV-positive women. 2012

Astill, N / Anderson, P / Winter, A / Nandwani, R / Fox, R / MacConnachie, A. ·Brownlee Centre for Infectious Diseases, Gartnaval General Hospital, Glasgow, UK. natasha.mcdonald@nhs.net ·Int J STD AIDS · Pubmed #22362691.

ABSTRACT: We assessed our unit's documentation of the HIV status of 146 identifiable existing children of 146 women audited, out of our total cohort of 329 HIV-positive women. For 23 women (16%) there was no documentation of the presence or absence of children. For 81 children of 43 (29%) women the HIV status was unknown. Of these children, at least eight (5.5%) reside in the UK and could be accessed for testing. It is essential that documentation and testing of children of HIV-positive women takes place to prevent potentially fatal late-stage presentations of AIDS and onward transmission of HIV as young people become sexually active.

20 Article Understanding the impact of HIV diagnosis amongst gay men in Scotland: an interpretative phenomenological analysis. 2011

Flowers, Paul / Davis, Mark McGregor / Larkin, Michael / Church, Stephanie / Marriott, Claire. ·Department of Psychology, Glasgow Caledonian University, Glasgow, UK. P.Flowers@gcu.ac.uk ·Psychol Health · Pubmed #22010635.

ABSTRACT: OBJECTIVES: Although a wide literature details the psychological impact of human immunodeficiency virus (HIV) diagnosis, it predates the introduction of effective treatment for HIV (i.e. anti-retroviral therapies, ARTs). This article explores the psychological impact of HIV diagnosis in post-ART accounts. This is important, given the recent policy developments which focus upon increasing HIV testing and thus diagnoses. DESIGN: This study presents a qualitative exploration of the experiential accounts of HIV-positive gay men living in Scotland. A total of 14 HIV-positive gay men took part in open-ended interviews. METHODS: Interpretative phenomenological analysis was employed to identify recurrent themes across the interviews. RESULTS: Our analysis focuses upon the participants' struggles in adjusting to their HIV status. Diagnosis was a deeply shocking and unexpected experience. Stigma and fear of prejudice dominated their accounts. HIV was understood, variously, as a shameful, fatal and life-changing condition. Overall, within these accounts there was little sense of HIV normalisation. CONCLUSIONS: In Scotland, where HIV prevalence is low, and where no accessible HIV-positive sub-culture exists, there is on-going psychological distress and morbidity amongst gay men testing HIV positive. As HIV-related policy increasingly focuses on increasing rates of antibody testing, there is a need to reduce the psychosocial costs associated with HIV-positive diagnoses.

21 Article General practitioner involvement and patient outcomes in HIV management. 2009

Casserly, S M / Scott, G R / Macdougall, M. ·Department of Genitourinary Medicine, Lauriston Building, Lauriston Place, Edinburgh EH3 9HA. ·Int J STD AIDS · Pubmed #19541895.

ABSTRACT: We undertook this study to try to determine whether disease outcomes were poorer in patients with HIV infection whose general practitioner (GP) was unaware of their status compared with those whose GP was aware. The notes of 375 HIV-positive patients attending Edinburgh's genitourinary (GU) medicine clinic were reviewed. The GPs of 292 patients (78%) had been informed of their patient's HIV infection. Advancing disease was associated with disclosure of the status to GPs (P = 0.037) but no significant association was found between informing GPs and the viral load results of treated (P = 0.389) and untreated patients (P = 0.070). Twenty-three percent of patients had had one or more bacterial sexually transmitted infections (STIs) while receiving their HIV care at a GU medicine clinic. Patients diagnosed with an STI were less likely to disclose their HIV status to their GP (P < 0.0005). Non-disclosure of the HIV status to a GP may be a predictor of unsafe sexual practices.

22 Article Dentistry and the ethics of infection. 2008

Shaw, D. ·Dental School, Faculty of Medicine, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ. d.shaw@dental.gla.ac.uk ·J Med Ethics · Pubmed #18316460.

ABSTRACT: Currently, any dentist in the UK who is HIV-seropositive must stop treating patients. This is despite the fact that hepatitis B-infected dentists with a low viral load can continue to practise, and the fact that HIV is 100 times less infectious than hepatitis B. Dentists are obliged to treat HIV-positive patients, but are obliged not to treat any patients if they themselves are HIV-positive. Furthermore, prospective dental students are now screened for hepatitis B and C and HIV, and are not allowed to enrol on Bachelor of Dental Surgery degrees if they are infectious carriers of these diseases. This paper will argue that: (i) the current restriction on HIV-positive dentists is unethical, and unfair; (ii) dentists are more likely to contract HIV from patients than vice versa, and this is not reflected by the current system; (iii) the screening of dental students for HIV is also unethical; (iv) the fact that dentists can continue to practise despite hepatitis B infection, but infected prospective students are denied matriculation, is unethical; and (v) that the current Department of Health protocols, as well as being intrinsically unfair, have further unethical effects, such as the waste of valuable resources on 'lookback' exercises and the even more damaging loss of present and future dentists. Regulation in this area seems to have been driven by institutional fear of public fear of infection, rather than any scientific evidence or ethical reasoning.