Joseph J. Lévy

Romantic relationships and sexual activities of the first generation of youth living with HIV since birth

Abstract HIV-infected children, now maturing into adolescence and adulthood, must cope not only with adolescent developmental issues, but also with a chronic, socially stigmatised and sexually transmittable illness. Little research on this first generation of survivors has focused on romantic involvement and sexuality. This study, which employs a mixed-method embedded strategy (qualitative supported by quantitative), describes the perspectives of youth living with HIV since birth concerning: (1) romantic involvement and sexuality; and (2) risk management including the risk of HIV transmission and partner serostatus disclosure. Eighteen adolescents aged 13–22 from Montreal, Canada, participated in individual semi-structured interviews and completed self-report questionnaires. Most youths participated in non-penetrative sexual activities. Ten participants reported having had vaginal and three anal intercourses, at an average age of 14 for girls and 15 for boys. All sexually active youth reported having used a condom at least once. Of those who reported that their first sexual relationship was protected, over half had taken risks in subsequent relationships (e.g., unprotected sex, multiple partners, etc.). Interviews conducted with sexually inactive youths illustrate the interrelatedness of romantic involvement, sexual initiation and potential serostatus disclosure. Involvement in a sexual relationship would not be conceivable unless the partner was informed of their serostatus. For sexually active participants, risk management implies HIV transmission and partner disclosure. These youths have emotional issues regarding disclosure in romantic relationships and few risked potential rejection by disclosing. Condom use acts as a reminder of the infection and a barrier to intimacy. The narratives illustrate how risk perception changes and becomes relative with time and experience, especially when the viral load is undetectable and when past experience has convinced the adolescent that his/her partner might not become infected. Findings reinforce the need to prioritise sexual health issues for young people with perinatally acquired HIV.

Cerebral and Sex Differences in the Categorization of Haptic Information

This study investigated the extent to which each cerebral hemisphere categorizes stimuli varying in texture and shape. Eighteen right-handed subjects, nine males and nine females, rated the perceived dissimilarity between pairs of stimuli presented to both hands and to the right or left hand, with haptic noise in the contralateral hand. Results suggest a right hemisphere competence in the categorization of both texture and shape information. Furthermore, males showed better separation of categories for stimuli presented to both hands only.

Hemispheric specialization for speech and non-verbal stimuli in Chinese and French Canadian subjects

Dichotic speech (CV syllables) and non-verbal stimuli (melodies, tones and triple tones) were presented to 20 French Canadian (10 men, 10 women) and 19 Chinese (10 men, 9 women) right-handed university students to investigate cultural and sexual differences in auditory functional asymmetry. Analyses of variances on correct scores showed a REA in the perception of speech and a LEA in the perception of melodies and triple tones for both groups. Cross-cultural effects were observed for speech only, indicating a better overall performance on the part of French Canadian students. Moreover, women were better than men in the perception of tones and triple tones, suggesting that women may attend more to intonational information. Finally, the results for both ethnic groups showed the same pattern of interhemispheric functional asymmetry for speech and non-speech material.

French HIV Experts on Early Antiretroviral Treatment for Prevention Uncertainty and Heterogeneity

Early use of highly active antiretroviral treatment (ART) in people living with HIV for HIV prevention has gained legitimacy but remains controversial. Nineteen French HIV experts with diverse specializations (over half of whom were clinicians) were qualitatively interviewed on their views about ART irrespective of CD4 count of more than 500 cells/mm3 for purposes of HIV prevention, which is not systematically recommended in France. Content analysis identified 2 broad categories: individual considerations (subcategories: patient health and well-being; patient preparedness and choice) and collective considerations (subcategories: HIV transmission risk; impact on the epidemic; cost). Uncertainty surrounded many experts’ considerations, and unity was lacking on key issues (eg, candidacy for early preventive treatment, expected clinical- and population-level effects). An umbrella theme labeled “Weighing the merits of early ART in the face of uncertainties” was identified. Our analyses raise doubts about the current acceptability of widespread implementation of early ART for HIV prevention in France.

Hemispheric specialization for tactile perception opposed by contralateral noise.

The aim of this study was to investigate the contribution of each cerebral hemisphere in the categorization of tactile information with and without contralateral tactile noise. Two groups of subjects rated the dissimilarity of paired stimuli varying in shape and texture presented to the left or right hand, with contralateral noise in the other hand for one group only. Analysis of variance on derived structured indices showed a general left hand advantage in the treatment of this haptic information. Moreover, a group by hand interaction revealed that noise-exposed subjects showed better differentiation of tactile information for stimuli presented to the left hand. The data suggest a unidirectional interference by the left hemisphere in the processing of tactile information in noise-free conditions and that quality of interhemispheric transfer of information may modulate cerebral functional lateralization.

Energy Expenditure during Sexual Activity in Young Healthy Couples

Objective To determine energy expenditure in kilocalories (kcal) during sexual activity in young healthy couples in their natural environment and compare it to a session of endurance exercise. Methods The study population consisted of twenty one heterosexual couples (age: 22.6 ± 2.8 years old) from the Montreal region. Free living energy expenditure during sexual activity and the endurance exercise was measured using the portable mini SenseWear armband. Perceived energy expenditure, perception of effort, fatigue and pleasure were also assessed after sexual activity. All participants completed a 30 min endurance exercise session on a treadmill at a moderate intensity. Results Mean energy expenditure during sexual activity was 101 kCal or 4.2 kCal/min in men and 69.1 kCal or 3.1 kCal/min in women. In addition, mean intensity was 6.0 METS in men and 5.6 METS in women, which represents a moderate intensity. Moreover, the energy expenditure and intensity during the 30 min exercise session in men was 276 kCal or 9.2 kCal/min and 8.5 METS, respectively and in women 213 kCal or 7.1 kCal/min and 8.4 METS, respectively. Interestingly, the highest range value achieved by men for absolute energy expenditure can potentially be higher than that of the mean energy expenditure of the 30 min exercise session (i.e. 306.1 vs. 276 kCal, respectively) whereas this was not observed in women. Finally, perceived energy expenditure during sexual activity was similar in men (100 kCal) and in women (76.2 kCal) when compared to measured energy expenditure. Conclusion The present study indicates that energy expenditure during sexual activity appears to be approximately 85 kCal or 3.6 kCal/min and seems to be performed at a moderate intensity (5.8 METS) in young healthy men and women. These results suggest that sexual activity may potentially be considered, at times, as a significant exercise.

Minimal interference: A basis for selecting ART for prevention with positives.

Given international interest in “treatment as prevention” (TasP) and the pertinence of optimizing antiretroviral treatment (ART) regimens for TasP, 19 French HIV experts were interviewed on their criteria for ART if used specifically for prevention with HIV-positive persons. Through content analysis of the interview material, nine criteria were identified. The most endorsed criteria, collectively, suggest a choice of treatment based on “minimal interference” where negative impacts of ART are minimized and ease of treatment integration maximized in the lives of people living with HIV/AIDS (PLHIV) for both the short and long term. These criteria were the tolerance, side effects, and/or toxicity profile of ART, simplicity (e.g., of treatment schedule, dosage form) and the individualization of treatment (e.g., adapted to lifestyle). While virologic efficacy (i.e., a durable, undetectable viral load) was also deemed important, several experts specified that it was virtually assured with current treatments. To a much lesser extent, experts endorsed diffusion of ART into the genital compartments, a strong genetic barrier (against resistance), validated treatments (as opposed to new classes of ART), a rapid reduction in HIV viral load, and treatment cost. Pharmacologically, minimal interference calls for further improvements in the tolerance, side effects and toxicity profile of ART and in the simplicity of ART administration. Clinically, it means avoiding a one-size-fits-all approach to ART in TasP and engagement with and of PLHIV in ART selection and side effects management. Strategically, it emphasises keeping the health and quality of life of PLHIV at the forefront of a TasP-oriented public health intervention.

Sex Differences in Categorization of Tactile Stimuli

This experiment investigated the effect of sex differences in categorization of tactile stimuli. 9 men and 9 women rated the perceived similarity between pairs of stimuli varying in texture and shape. The magnitudes of sex-related differences, using ω2 and d, were relatively large and indicated that men had better categorical abilities in processing haptic information.

Stigma Management Trajectories in Youth with Perinatally Acquired HIV and Their Families: A Qualitative Perspective

This study explores how family, secrecy and silence contribute to the adoption of stigma management strategies among youth with perinatally acquired HIV (PAHIV). A qualitative method was used. Eighteen youths with PAHIV aged 13–22xa0years old took part in a semi-structured interview. An exploratory content analysis was performed. Analyses of interviews allowed identification of two HIV stigma management trajectories, both sensitive to the family context: [1] a consolidation of family ties, which contributes to solidarity in stigma management; and [2] a weakening or dissolution of family ties, which contributes to solitary stigma management strategy. Family conditions that support the children in their efforts to develop active stigma management strategies are described. Children likely to experience weakening or dissolution family ties must build strong bonds in the clinical environment and maintain these into adulthood so as to afford them the support they need.ResumenEste estudio explora cómo la familia, el secreto y el silencio contribuyen a la adopción de estrategias de manejo del estigma entre los jóvenes con HIV adquirido perinatalmente (HIVAP). Se utilizó un método cualitativo. Dieciocho jóvenes con HIVAP y con edades entre los 13 y los 22 años tomaron parte en una entrevista semi-estructurada. Se llevó a cabo un análisis de contenido temático. El análisis de las entrevistas permitió la identificación de dos estrategias de manejo del estigma asociado con el VIH, ambas sensibles al contexto familiar: 1) Consolidación de los lazos familiares, lo cual contribuye a un manejo del estigma de manera solidaria y 2) Debilitamiento o disolución de los lazos familiares, lo cual contribuye a una estrategia de manejo del estigma solitaria. Las condiciones familiares que apoyan a los niños en sus esfuerzos para desarrollar estrategias activas de manejo del estigma, son descritas. Los niños más propensos a experimentar lazos familiares rotos deben construir vínculos fuertes en el entorno clínico y mantener estos hasta la edad adulta de manera que se les preste el apoyo que necesitan.

The Importance of Meanings of Antiretroviral Treatment and Care Providers for Adherence and Transitioning to Adult Services Among Youth With Perinatally Acquired HIV Infection

The transition from pediatric to adult services for youth with perinatally acquired HIV (PaHIV) is a critical period. A successful transition is key to ensuring patient treatment adherence as adults. Eighteen youths with PaHIV, aged 13–22, participated in two individual, semistructured interviews conducted 3 years apart. Results indicate that a key factor appearing to help youth in overcoming barriers to adherence and facilitating coping strategies is the way they perceive their medication: youth with positive perceptions are more likely to overcome the barriers than are those with negative perceptions, such as emphasis on the side effects and stigma associated with the medication. Positive relationships with health professionals allowed youth to face transitioning challenges. Interventions targeting PaHIV should focus on these issues.