Jochen Drewes

More Than 20 Years of Research into the Quality of Life of People with HIV and AIDS—A Descriptive Review of Study Characteristics and Methodological Approaches of Published Empirical Studies

Background: The quality of life of people living with HIV and AIDS (PLWHA) is becoming increasingly important--a fact that is also reflected in extensive research efforts. Owing to the almost complete lack of systematic integration of research findings, it is hardly possible to provide an overview of the current status of research, or to derive valid statements about research results. Methods: A literature search regarding the quality of life of PLWHA was performed in two international research databases. After checking their relevance, 852 publications appearing in scientific journals and explicitly measuring the quality of life of PLWHA were categorized on the basis of various study characteristics. Results: The number of publications per year in our study pool has been rising steadily since 1989. Well over 40 established instruments were used to determine the quality of life, most frequently the MOS-HIV, followed by the SF-36. The great majority of the studies are correlation studies. CD4 cells, gender, and age are the most common variables for which correlations with quality of life are reported. Conclusions: Our descriptive review stresses both the increasing significance and the challenges of research into quality of life of PLWHA such as the great variety of instruments used. The limits of this review are discussed and we conclude with the formulation of research desiderata concerning comparative review studies on instruments and systematic reviews of frequent research questions.

Increased incidence of syphilis in men who have sex with men and risk management strategies, Germany, 2015

In Germany, the number of reported syphilis cases increased between 11% and 22% per year between 2010 and 2014. We analysed syphilis surveillance data and data of four behavioural surveys on men who have sex with men (MSM) in Germany (2003, 2007, 2010, 2013) to assess if this rise is ongoing and to find possible explanations for it. Syphilis notifications increased in 2015 by 19% to a total of 6,834. This was mainly due to increasing notifications in MSM of all age groups in larger German cities. Data from the behavioural surveys on MSM in Germany showed a simultaneous increase of selective condom use as HIV-status-bases risk management strategy and the number of syphilis cases. MSM diagnosed with HIV reported condomless anal intercourse with non-steady partners more frequent than MSM not diagnosed with HIV or untested for HIV, but the latter also reported higher frequencies of this behaviour in the more recent surveys. Transmission in HIV-positive MSM probably plays an important, but not exclusive role, for the syphilis dynamics in Germany. A risk adapted routine screening for sexually active MSM and potentially innovative approaches to increase early screening and treatment of syphilis such as internet counselling, home sampling, home testing and broadening venue-based (rapid) testing, should be critically evaluated to effectively reduce syphilis infections.

The impact of meeting locations for men having sex with men on the risk for bacterial sexually transmitted infections: analyses from a cross-sectional online survey.

Objectives Opportunities for men having sex with men (MSM) to meet each other have very much improved by new communication technologies. Meeting venue-based characteristics can impact how many partners are met and how much sexual risk is taken. We analysed the association between physical and virtual venues and the risk for bacterial sexually transmitted infections (bSTIs) among participants in an MSM online survey. Methods Data were collected during 2013/2014 with a survey targeting MSM living in Germany. The impact of the meeting place with the last non-steady anal sex partner on diagnosis with a bSTI in the previous year was analysed using bivariate and multivariate regression analysis, taking into account self-reported HIV status, serostatus communication, condom use, partner number, age and city size. Results The study sample consisted of 8878 respondents (7799 not diagnosed with HIV; 1079 diagnosed with HIV). Meeting partners online was most common (62% HIV−/51% HIV+), followed by sex venues (11% HIV−/25% HIV+); other venues were each reported by 2–6% of the respondents. Venue-dependent proportions reporting bSTIs in the recent year were 2–4 folds higher among men diagnosed with HIV. In multivariate analysis, HIV status was the strongest predictor for bSTIs (OR=5.0; 95% CI 2.8 to 8.7). Compared with meeting partners online, sex (OR 1.6; 95% CI 1.0 to 2.5) and social venues (OR 1.9; 95% CI 1.4 to 2.6) were associated with increased bSTI risk for men not diagnosed with HIV, but the risk when meeting partners by smartphone apps was only of borderline significance (OR 1.5; 95% CI 0.9 to 2.3). For men diagnosed with HIV, bSTI risk increased for sex venues (OR 1.5; 95% CI 1.1 to 2.1), and was lower for non-gay/other venues (OR 0.2; 95% CI 0.1 to 0.5). Conclusions Venues are connected to social-behavioural facets of corresponding sexual encounters, and may be important arenas for differential HIV and STI education, treatment and prevention.

Contagiousness under antiretroviral therapy and stigmatization toward people with HIV

Perceived contagiousness is a major dimension underlying HIV-related stigmatization. Antiretroviral therapy (ART) can diminish contagiousness by reducing viral load levels in HIV-infected individuals. To test the assumption that reductions in contagiousness can lead to a decrease in stigmatizing reactions, we conducted an experimental online study. A sample of 752 participants (50.9% female) read a short vignette depicting an HIV-positive individual with either a high or a low viral load and were either given or not given information about the association between viral load and contagiousness. Subsequently, participants were asked to rate their willingness to stigmatize this individual by responding to two measures of social and physical distance. Differences between the low and the high viral load information groups and the combined no-information groups (forming a quasi-control group) were analyzed using analysis of covariance (ANCOVA), controlling for gender and baseline perceptions of contagiousness. The covariates, perceived contagiousness at baseline and gender, were associated with social and physical distancing, but the viral load/information factor was only significant in physical distancing. Planned contrast analyses confirmed that physical distancing in the informed group was lower in the low viral load condition compared to the high viral load condition and to the control group. We thus found evidence for the significant role of perceived contagiousness in the HIV-related stigma and were able to experimentally demonstrate the potential of ART to reduce HIV-related stigmatization by lowering viral load and contagiousness, when these changes are accompanied by a decreased perception of contagiousness.

Zur Lebenssituation älterer schwuler Männer – Ergebnisse aus den Wiederholungsbefragungen „Schwule Männer und HIV/AIDS“

Auch wenn die Datenlage zu den Lebenswelten von schwulen Mannern im Vergleich zu denen von lesbischen Frauen und zu bi-, trans- oder intersexuellen Bevolkerungsgruppen besser ist, gibt es uber die Lebenssituation alterer schwuler Manner in Deutschland – im Gegensatz zum angloamerikanischen Sprachraum – noch immer sehr wenig empirisch basierte Publikationen. In der Regel weisen diese zudem nur geringe Fallzahlen auf. In diesem Artikel soll die Lebenssituation alterer schwuler Manner unter Ruckgriff auf die Daten von zwei Erhebungen beleuchtet werden, die im Rahmen der HIV/AIDS-Pravention fur homo- und bisexuelle Manner durchgefuhrt wurden.