Chapter 11 Flashcards
(145 cards)
1
Q
HIV stigma, is a problem for many people living with HIV as it can lead to what?
A
> it can lead to unfair treatment, poorer mental health, and may even contribute to the spread of HIV if people are afraid to get tested.
2
Q
What has HIV stigma contributed to?
A
> contributed to the global spread of HIV and other sexually transmitted infections (STIs).
3
Q
According to the World Health Organization (WHO), how many new cases of four curable STIs occur annually among people aged 15 to 49 years throughout the world? How many people were affected by each?
A
> 357 million new cases of four curable
STIs occur annually
4
Q
The four STIs deemed curable are:
A
> chlamydia, gonorrhea, syphilis, and trichomoniasis.
5
Q
What are the non curable STIs?
A
> human immunodeficiency virus (HIV)/acquired immuno-deficiency syndrome (AIDS)
6
Q
Across the world, what factors affect / influence the susceptibility of HIV/AIDS and STI transmission among a variety of communities and populations?
A
> social, economic, political, and environmental factors, such as poverty, discrimination, and gender inequalities
7
Q
The WHO and UNAIDS established new global HIV targets (also known as 90–90–90 HIV targets) for 2020- what were they?
A
> (1) 90 per cent of all people living with HIV will know their HIV status;
(2) 90 per cent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and
(3) 90 per cent of all people receiving antiretroviral therapy will have viral suppression
8
Q
What happens when the 90-90-90 goal set by the WHO and UNAIDs is reached?
A
> at least 73 per cent of all people living with HIV worldwide will be virally suppressed (very low levels of HIV in one’s blood).
9
Q
How are STIs mainly transmitted? What are other ways that they can be transmitted?
A
> STIs are mainly transmitted through unprotected sexual contact, but can also be transmitted through non-sexual means, such as blood transfusions, contaminated needles (used by infected individuals), and from mother to child during birth or while breastfeeding.
10
Q
he pathogenic agents that cause STIs can be:
A
> viruses, bacteria, or parasites.
11
Q
Which demographic group constitutes the highest STI rates in the US and Canada? What does this group not do according to National Survey Studies?
A
> Adolescents and young adults (15 to 24 years old) in the United States and Canada comprise
> report low rates of condom use during sexual intercourse + low rates of STI testing among adolescents and young adults
12
Q
How can socio-economic status, gender, and ethnicity/race influence whether people are at greater risk of getting an STI?
A
1) Females are more likely to suffer long-term consequences of STIs due to differences in anatomy—bacteria and viruses more easily penetrate + symptoms of STIs may not be seen as quickly and easily
2) African Americans bear a disproportionate burden of STIs due to factors that relate to
- (1) higher prevalence of HIV/STIs within the African-American community;
- (2) stigma from fear of disclosing various risk behaviours or sexual orientation, which impacts health-seeking behaviours; and
- (3) socio-economic factors, which include poverty, racial discrimination, lack of access to health care, and higher rates of incarceration
13
Q
The CDC highlights the distribution and trends of STIs among four population groups that are most vulnerable to help state and local health departments guide and prioritize STI prevention efforts - what are they?
A
> women and infants; adolescents and young adults; racial and ethnic minority groups; and gay, bisexual, and other men who have sex with men)
14
Q
What is HIV and what does it cause?
A
> HIV is a viral infection that weakens the immune system and causes AIDS.
15
Q
When is AIDS diagnosed?
A
> AIDS is diagnosed
when an individual has HIV and/or an opportunistic illness (such as AIDS-related cancer(s), in-cluding Kaposi’s sarcoma, non-Hodgkin lymphoma, and cervical cancer), or an opportunistic infection(s) (infections associated with severe immunodeficiency)
16
Q
What is an AIDS diagnosis (also known as stage 3) is based on in the US?
A
> is based on the CD4+ T-lymphocyte count and the presence of opportunistic illnesses
> A person infected with HIV who is six years of age or older will receive an AIDS diagnosis if his or her CD4+ T-lymphocyte count is less than 200 cells per μL or opportunistic illnesses indicate stage 3.
17
Q
What is an aids diagnosis based on in Canada?
A
> an AIDS diagno-sis in Canada is based on a positive test for HIV infection and the presence of one or more AIDS indicative diseases (i.e., opportunistic illnesses) (PHAC, 2009).
> CD4+ T-cells are responsible for or-chestrating the immune response, so a low number of these cells lead to the poor immune system found in people with HIV/AIDS.
18
Q
Since 2000, what has the rate of HIV infection been?
A
> Since 2000, the rate of HIV infection among adults has been relatively stable.
19
Q
In Canada, what is the most vulnerable populations for HIV infection?
A
> In Canada,
the most vulnerable populations are men who have sex with men (MSM), people who inject drugs, street youth, and Indigenous populations (PHAC, 2016a)
20
Q
A disproportionate number of new US HIV infections are what groups?
A
> are men who have sex with men, African Americans, and Hispanics/Latinos (CDC, 2016d).
21
Q
What are the uncommon forms of transmission for HIV?
A
> less commonly, through tattooing, body piercing, or transfusion of HIV-infected blood + needle stick injuries
22
Q
What cells are affected by the HIV virus and how does it work?
A
> Once the virus enters the body, it invades the CD4+ T-cells
> The virus enters the CD4+ T-cell by first fusing with the outside surface of the cell
> CD4+ T-cells therefore become host cells for HIV and help the virus to self-replicate.
> Once new copies of the virus are produced by the host cell, they leave to enter other CD4+ T-cells.
23
Q
What medications are used to treat HIV? How do they work / do they cure HIV?
A
> Antiretroviral medications, which are used to treat viruses such as HIV, do not cure HIV but instead reduce the ability of HIV to enter cells or replicate itself.
24
Q
Highly active antiretroviral therapy is the use of what? What is it known as?
A
> the use of a combination of antiretroviral medications to treat HIV, which is now often called combination antiretroviral therapy (cART).
25
HIV/AIDS symptoms occur in how many stages?
> 3 primary stages
26
What is the most common STI that is transmitted in the US? How is it transmitted?
> Genital human papillomavirus (HPV) is the most common STI
transmitted in the United States
> it is mainly transmitted through genital contact and oral sex; it can be transmitted even when an infected person is asymptomatic
27
A number of serious health problems can arise from HPV, including:
> genital warts and various types of cancers (i.e., cancers of the head, neck, vagina, cervix, anus, and penis).
28
Does HPV go away?
> However, HPV usually goes away (in 90 per cent of cases) before it causes any serious complications.
29
How is HPV prevented?
> To prevent HPV infection, vaccines are rec-ommended for males and females between 11 and 12 years of age, which could potentially protect people from the most common types of HPV
30
What STIS are Viral Infections?
> HIV/AIDS
> HPV
> Gential Herpes
> HEP A
> HEP B
> HEP C
31
What STIS are bacterial infections?
> Chlamydia
> gonorrhoea
> syphilis
32
What STIS are parasitic infections?
> Trichomoniasis
> pediculosis (pubic lice)
> scabies
33
Breakdown the Proportion of new HIV infections by exposure category (15+ years old), Canada, 2015:
1) Men who have sex with men (MSM) = 45.1%
2) Heterosexual contact =31.9%
3) Injection drug use (IDU) = 16.3%
4) Other 3.6%
5) = MSM + IDU = 3.1%
34
Proportion of new HIV infections by transmission category (13+ years old), United States, 2015:
1) MSM = 67%
2) Heterosexual contact = 23.7%
3) IDU = 6.1%
4) MSM/IDU = 3.15
5) Other = 0.2%
35
What is the 1) pathogen, 2) transmission type, and 3) cure-ability + available treatment for HIV/AIDS?
1) Human immunodeficiency virus
2) Unprotected sexual intercourse; injection drug use; mother to child
3) Not Curable - Treatment available: combination antiretroviral therapy reduces the rate at which the virus will replicate.
36
What is the 1) pathogen, 2) transmission type, and 3) cure-ability + available treatment for HPV?
1) Genital human papillomavirus
2) Unprotected sexual contact
3) Not Curable No specific treatment available. Treatment for the health problems that HPV can cause is available. Vaccine is also available.
37
What is the 1) pathogen, 2) transmission type, and 3) cure-ability + available treatment for genital herpes?
| Herpes_ _ virus _?
1) Herpes simplex virus 2
2) Unprotected sexual contact
3) Not Curable Treatment available for symptom management. Antiviral medications can shorten and prevent outbreaks during period of time person takes medication.
38
What is the 1) pathogen, 2) transmission type, and 3) cure-ability + available treatment for HEP A?
1) Hepatitis A virus
2) Fecal–oral route
3) Curable
No specific treatment available. Recommend bed rest and adequate intake of fluids.
39
What is the 1) pathogen, 2) transmission type, and 3) cure-ability + available treatment for HEP B?
1) Hepatitis B virus
2) Direct blood-to-blood contact; contaminated needles; unprotected sexual intercourse; mother to child
3) Not Curable
No specific treatment available. Recommend bed rest, adequate nutrition, and intake of fluids. Some people may need to be hospitalized. Vaccine available.
40
What is the 1) pathogen, 2) transmission type, and 3) cure-ability + available treatment for HEP C?
1) Hepatitis C virus
2) Direct blood-to-blood contact; contaminated needles; unprotected sexual intercourse
3) Potentially Curable Treatment available. Antiviral medications are taken for as little as eight weeks
41
What is the 1) pathogen, 2) transmission type, and 3) cure-ability + available treatment for Chlymydia?
1) Chlamydia trachomatis
2) Unprotected sexual contact
3) Curable Preferred treatment (antibiotics): single dose of azithromycin or a week of doxycycline twice a day
42
What is the 1) pathogen, 2) transmission type, and 3) cure-ability + available treatment for Gonorrhea?
1) neisseria gonorrhoeae
2) Unprotected sexual contact
3) Curable Preferred treatment (antibiotics): single dose of ceftriaxone plus azithromycin or cefixime plus azithromycin
43
What is the 1) pathogen, 2) transmission type, and 3) cure-ability + available treatment for Syphilis?
| The only one whos pathogen is nothing like it- but it is the next letter
1) Treponemapallidum
2) Direct sexual contact with sore from infected individual
3) Curable
Treatment: a single intramuscular injection of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a yea
44
What is the 1) pathogen, 2) transmission type, and 3) cure-ability + available treatment for Trichomoniasis?
1) Trichomonasvaginalis
2) Direct sexual contact
3) Parasitic Infections Curable
Recommended regime: a single dose of the antibiotics metronidazole or tinidazole
45
What is the 1) pathogen, 2) transmission type, and 3) cure-ability + available treatment for Pediculosis (pubic lice)?
1) Phthirus pubis
2) Sexual contact May also spread by close personal contact or contact with articles used by an infected person
3) Curable Treatment: a lice-killing lotion can be used to treat pubic (“crab”) lice.
46
What is the 1) pathogen, 2) transmission type, and 3) cure-ability + available treatment for Scabies?
1) Sarcoptesscabiei
2) Direct, prolonged, skin-to-skin contact with person infected with scabies; indirectly by sharing articles such as clothing, towels, or bedding used by an infected person
3) Curable
Treatment: products used to treat scabies are called scabicides because they kill scabies mites; some also kill eggs
47
What is the symptomology for genital herpes?
1. Will most experience symptoms?
2. When do they occur and when do they resolve?
3. What are symptoms during the inital episode?
> Most individuals with herpes will never have sores or will experience only very mild symptoms.
> Symptoms usually occur two weeks after transmission and resolve within two to four weeks.
> Symptoms during the initial episode may include secondary sores and flu-like symptoms (i.e., fever, swollen glands).
48
What is the symptomology for genital Hep A? How long do the symptoms last and what percentage relapse or have prolonged disease?
> Individuals generally experience fever, fatigue, loss of appetite, nausea, vomiting, abdom-inal pain, dark urine, clay-coloured bowel movements, joint pain, and jaundice.
> Symptoms usually last less than two months, although 10 to 15 per cent of individuals have prolonged or relapsing disease for up to six months.
49
What is the symptomology for Hep B?
> Some people are asymp-tomatic yet can still spread the virus.
> Symptoms during the acute phase of HBV are similar to those of hepatitis A.
> Symptoms may last from a few weeks to as long as six months.
> Chronic HBV occurs when the disease is left untreated and people may either experience ongoing symptoms or remain symptom-free for as long as 20 to 30 years.
> Approximately 15 to 25 per cent of persons with chronic HBV develop serious liver conditions such as cirrhosis (scarring of the liver) or liver cancer, and some individuals may require hospitalization.
50
What is the first stage of HIV infection?
1) Acute stage of HIV infection:
- Earliest stage of HIV infection where HIV multiplies in the body; many (but not all) people develop flu-like symptoms (e.g., fever, headache, rash, muscle and joint aches and pains, swollen glands, sore throat) within 2–4 weeks.
- Because of the high levels of HIV in the bloodstream, people are at high risk of transmitting HIV during this stage
51
What is the second stage of HIV infection?
2) Chronic HIV infection:
- second stage of HIV infection (also known as clinical latency or asymptomatic HIV) where HIV continues to multiply in the body at very low levels but without producing symptoms.
> People can still spread HIV to others.
> This stage can last up to 10 years for people who are not on antiretroviral therapy but for some people, this stage can progress faster.
> For people who are on antiretroviral therapy, this stage can last for several decades because the treatment helps to control the virus from multiplying.
52
What is the third stage of HIV infection?
3) AIDS:
- Final stage of HIV infection where the immune system is severely damaged.
- Since the body’s immune system has weakened, people become vulnerable to opportunistic illnesses.
- At this stage, CD4+ T-cell count is less than 200 cells per μL or one or more opportunistic illnesses are present.
- Without adequate treatment, people with AIDS typically survive about three years
53
What is the symptomology of hep C?
1. who can spread it?
2. What symptomolgy is it similar to?
3. How long do the symptoms last?
> Some people are asymptomatic yet can spread the virus.
> Symptoms during the acute phase of hepatitis C are similar to those of hepa-titis A and B.
> Symptoms can last indefinitely.
54
What is the symptomolgoy for chlamydia and how does it differentiate between men and women?
> Although most infected individuals are asymptomatic, some may experience symptoms such as painful or difficult urination, inflammation of the rectum, genital discharge, or rectal pain and bleeding.
> For men, testicular pain and swelling are other common symptoms.
> For women, additional symptoms include abnormal vaginal bleeding and lower abdominal pain.
* In rare cases, infected women may experience pelvic inflammatory dis-ease, in which infection of the uterus, fallopian tubes, and other reproductive organs causes lower abdominal pain.
55
What is chlamydia commonly reported as in the US and Canada?
> Chlamydia is prevalent among youth and young adults and is the most commonly reported notifiable disease in the United States and Canada
56
In 2015, the rate of reported cases of chlamydia was higher among what groups compared to caucasian?
> African Americans (5.9 times), American Indians/Alaska Natives (3.8 times), Native Hawaiians/Other Pacific Islanders (3.3 times), and Hispanics (2.0 times) when compared to Caucasian Americans
57
Since 2003, the incidence rates of chlamydia have in-creased in both countries. The increase in chlamydia cases in the last 20 years may be due to what?
| This isn't necessarily negative!
> increases in actual incidence, but also may reflect improved screening, testing, and diagnostic and reporting practices for the disease in medical and public health settings.
58
Describe the symptomology for Gonorrhea and the differences between men and women:
> can lead to severe complications and spread to other parts of the body, such as the eyes, if left untreated.
> Some men and most women never experience any symptoms.
> Some symptomatic men experi-ence a burning sensation when urinating; a yellow, white, or green discharge from the penis; and painful or swollen testicles.
> For women, symptoms may include increased vaginal discharge, burning sensation while urinating, and vaginal bleeding between periods, plus women with gonorrhea are at risk of developing serious complications, even if symptoms are mild or absent.
59
In 2015, the rate of reported cases of gonorrhea was higher among which groups compared to caucasians?
> was higher among African Americans (9.6 times), American Indians/ Alaska Natives (4.4 times), Native Hawaiians/Other Pacific Islanders (2.8 times), and Hispanics (1.8 times) when compared to Caucasian Americans
60
Describe the symptomology for syphilis:
> Most people who
contract syphilis are asymptomatic for years, but remain at risk for later complications if it is left untreated.
61
Are there stages for syphilis?
> Syphilis occurs in three stages: primary, secondary, and late, with a latent stage be-tween the secondary and late stages when the virus remains hidden.
62
What occurs in the primary stage of syphilis?
> In the primary stage, sores appear approximately 21 days after infection and usually last from three to six weeks, healing without treatment.
> If treatment is not administered, infection can progress to the secondary stage.
63
What occurs in the secondary stage of syphilis?
> During the secondary stage, a non-itchy rash appears, as well as other symptoms like fever, swol-len lymph glands, headaches, weight loss, muscle aches, and fatigue.
> Secondary-stage symptoms heal without treatment; however, infection will progress to the latent and late stages of disease.
64
What occurs in the final/latent stage of syphilis?
> The final latent and late stage begins when symptoms of the primary and secondary stages of syph-ilis disappear.
> Without treatment, individuals remain infected yet symptom-free for years. In the late stage of syphilis, internal organs and tissues such as the brain, nerves, eyes, heart, and liver may be damaged.
> Symptoms of late-stage syphilis include paralysis, numbness, gradual blindness, and dementia.
65
What are the symptoms for Trichomoniasis?
> Most individuals have no symptoms, but when symptoms occur they range from mild irritation to severe inflammation of the genital area.
> Without treatment, infection can last for years. Itching or irritation may occur during urination, and for men, during ejaculation.
> A thin discharge with an unusual smell may accompany symptoms.
66
What is the most common symptom of pediculosis?
> the most common symptom of pediculosis is itching in the genital area
67
The spread of scabies may be increased if the person has what type of scabies?
> crusted scabies
68
What symptoms characterize scabies?
> The illness is characterized by intense itching and a rash that may include tiny blisters and scales. Sometimes sores become infected with bacteria due to scratching the rash.
69
Knowing how STIs are transmitted and the level of risk of contracting an STI from a given behav-iour allows people to do what?
> to make informed choices about which sexual activities they feel comfortable performing.
70
Engaging in condomless vaginal or anal sex is considered a high-risk activity for transmission of what sexual disease?
> HIV + STIs
71
What is the most effective method of protection for STIs and unintended pregnancies? Is the use high?
> Condoms
> but use among young adults + adolescents is low.
72
Why do adolescents and young adults not use condoms?
> adolescents and young adults tend to engage in unplanned sexual activity, especially when using alcohol or illicit substances
> adolescents may be uncomfortable obtaining condoms or discussing condom use with sex partners
> cost can be a barrier too.
73
Those that use condoms regularly are those that:
> those that feel confident and that they are capable of + likely to use condoms correctly during sexual activity
+ are more likely to refuse sex when condoms are not available
> Individuals who intend to use condoms during their next sexual en-counter are also less likely ever to have contracted an STI, which suggests that they may use condoms consistently
> report more positive attitudes toward taking responsibility for their health and are less concerned with whether their partner endorses condom use
74
Some condom negotiation skills that have been identified and include
> asking directly,
> introducing condoms nonverbally in the context of sexual behaviour,
> withholding sex unless condoms are used,
> introducing condoms out of concern for one’s partner or relationship,
> presenting HIV/STI risk information to introduce condom use,
> and using false pretences to deceive a partner into condom use, such as expressing fear of pregnancy rather than fear of contracting an STI (may be unethical)
75
People who have a higher number of sexual partners are at greater risk for what?
> at greater risk for acquiring STIs
> Participating in sexual activity with numerous casual partners (e.g., “one-night stands”) increases an individual’s chance of acquir-ing an STI, as the sexual history of each partner then becomes linked to the individual.
> Each partner who has previously engaged in unprotected sex with others exponentially increases the number of partners an individual has indirectly come into contact with.
> Furthermore, condom use declines throughout the duration of a relationship with a primary partner
76
To minimize the chance of acquiring STIs, it is important for individuals to do what two things?
(1) to discuss whether the relationship is monogamous and
(2) to be tested for STIs before making the decision to stop using condoms.
77
Similar to gaining accurate information about the transmission of STIs, it is important to find out about a potential partner’s sexual and drug history. That knowledge allows people to do what?
> hat knowledge allows people to make informed decisions about which activities they are comfortable performing.
* In fact, partners who discuss each other’s sexual history and condom use are more likely to use condoms than those who discuss safe sex in general (those that don't are less likely to use condoms)
78
Illicit drug and alcohol use before or during sexual situations may facilitate sexual activity by causing what?
> lowering in-hibitions, calming anxiety, and improving confidence
79
What kind of sexual activity occurs as a result of illicit drug and alcohol use?
| What are they less likely to do and have?
> individuals who consume alcohol before or during a sexual encounter are less likely to use a condom
> alcohol and substance abus-ers are more likely to have a higher number of casual sexual partners and a history of STIs
80
What personality factors are related to unsafe sexual behaviour?
> sensation-seeking and impulsivity
> Sensation-seeking describes people who search for new, exciting, and intense experiences and are willing to take various risks (e.g., physical, financial, etc.) to attain those experience
81
How do extreme sensation seeking people conduct their sexual behaviour?
> Extreme sensation-seekers are more likely to not use condoms
> to have a greater number of sexual partners
> and to use substances before or during their sexual encounters
82
How do impulsive people conduct their sexual behaviour?
> Impulsive people react in the moment whether or not they recognize the risks associated with their behav-iours
> Highly impulsive persons are more likely to participate in sexual activity without a condom, to use drugs and alcohol before or during sexual encounters, and to have a history of STIs
83
Personality factors associated with distress may also be risk factors for contracting HIV or
STIs. For example, what disorders are associated?
> For example, social anxiety or anxiety about being evaluated in social situations is associated with sexual risk behaviour among gay and bisexual men
84
Socio-cultural and demographic factors also play an important role in risky sexual behaviour, with some groups experiencing higher rates of HIV and STIs than others. What ethnic minortiy groups are disproportionately affected?
> Some minority groups, specifically African-American and Latina women, represent a disproportionate number of new US cases of STIs and HIV
>
85
However, racial and ethnic differences may not be the reason for the increased incidence rate among these groups - what could be the causes?
> persons with lower income experience more stress and are more likely to participate in unsafe sexual practices
> Moreover, poverty is more common among African-American and Latino men + women than Caucasian Americans
> religious affiliation is associated with a higher likelihood of participating in vaginal sex without a condom
> Catholic, non-Catholic Christian, and non-religious or agnostic students are more likely to have vaginal intercourse without a condom compared to students who are Muslim or who practise East Asian religions
> unequal power between partners and age differences of six or more years between sexual partners
86
What is a syndemic?
> A syndemic is defined as “two or more afflictions, interacting synergistically contributing to excess burden of disease in a population
87
According to syndemic theory, cer-tain populations may experience what kind of health outcomes?
> may experience worse health outcomes due to the additive effects of two or more diseases or psychosocial problems
* For instance, gay, lesbian, and bisexual persons experience unique stressors such as stigma and discrimination due to their sexual minority status, which may account for worse health outcomes in this populatio
88
What is internalized homophobia?
> Sexual minority individuals may internalize society’s negative beliefs and assumptions regarding same-sex attraction, which is known as internalized homophobi
89
What is the sexual behavious of gay and bisexual men that have high internalized homophobia?
> are more likely to engage in unprotected anal intercourse
> Gay and bisexual men who experience high internalized homophobia and loneliness also report a greater number of sexual partners
> gay and bisexual men who endorse a higher number of psychosocial problems are more likely to engage in high-risk sexual behaviour
90
Using the Internet to find sexual partners is associated with a number of higher-risk sexual behaviours. Specifically what kind of behaviours?
> individuals who seek sexual partners online are more likely to engage in condomless vaginal and anal intercourse
> are less likely to discuss their own and their partners’ sexual histories
> and report a greater number of sexual partners than those who meet sexual partners offline.
91
What is stigmatizing?
> Stigmatizing is the devaluing or discrediting of an individual (or group) who has an undesirable attribute, such as a physical charac-teristic or behaviour
91
One of the main attributes shared by diseases with the highest level of stigma (Goffman, 1963) is that persons with the disease are viewed as being what?
> responsible for having it.
> Some members of society hold the belief that the ill person is to blame for contracting the disease due to morally rep-rehensible or irresponsible decisions or actions
92
Dis-crimination as a result of the stigma attached to HIV may be perceived as coming from what sources?
> coming from society in general or from specific sources such as family members, friends, employers, colleagues, or even health-care professionals.
93
Does HIV impact hiring decisions?
> Furthermore, HIV stigma may impact employ-ers’ hiring decisions, leading to higher unemployment rates and greater poverty among people living with HIV
94
How does HIV affect mental health?
> stigma has been associated with poorer mental health among people living with HIV.
> those w greater stigma have higher levels of anxiety + more severe depressive symptoms + more likely to seek psychiatric care
> experiencing greater HIV stigma was associ-ated with depression, anxiety, and post-traumatic stress disorder
95
people who experience or internalize HIV stigma show greater levels of what disorders/thoughts?
| What two psychological things and what one isn't (more of an emotion)
> people who ex-perience or internalize HIV stigma show greater levels of depression, anxiety, and hopelessness than those who do not
96
HIV stigma may also contribute indirectly to the severity of what?
> The HIV epidemic
97
What are factors that HIV stigma is associated with perpetrate the epidemic?
> increasing sexual risk behaviour,
> reducing testing for HIV and other STIs,
> inhibiting disclosure of HIV status to sexual partners,
> and reducing treatment adherence.
98
Is there an overarching law of disclosure for HIV in the US? Are there any laws for this at all?
| Do any states have criminalizing laws?
> In the United States, there is no overarching federal law mandating that people living with HIV must disclose their HIV status
> As of 2011, 24 states had enacted laws requiring disclosure of HIV-positive status to sexual partners
> + 14 states had enacted laws requiring disclosure of HIV-positive status to needle-sharing partners
* Among these, 25 states have laws criminalizing behaviours associated with low or negligible risk of HIV transmission
99
Is their an HIV disclosure law in Canada?
> In Canada, federal law states that an HIV-positive status must be disclosed prior to engaging in any sexual activity that poses a “realistic possibility of HIV transmission”; however, the Supreme Court of Canada has character-ized even low-risk sexual activities as involving a “realistic possibility.”
100
What is the punishment of non-disclosure in Canada for HIV? What happened to those that were punished under this law?
> the punishment for non-disclosure in Canada can result in a charge of aggravated sexual assault that carries a maximum sentence of life imprisonment.
> Many individuals charged under this law engaged in behaviour not generally considered to pose a significant risk for HIV transmission, such as having oral sex
101
What does the UNAIDS recommend abour criminal law for non-disclosure?
| What has to occur for it to be criminal?
> there is malicious intent and transmission actually occur
102
In Canada, is there duty to warn for HIV?
> Currently, no universal standard practice exists regarding one’s duty to warn someone in the case of risk of HIV transmission.
> currently run on a case-by-case basis.
103
Is the prevalence of some types of mental disorders (e.g., depression, anxiety, post-traumatic stress disorder, insomnia, schizophrenia, and substance-use disorders) higher among people with what STI?
> is higher among people living with HIV than among the general population
> it is unclear why.
104
Do people with HIV have a higher prevalence of depression? Is there a gender gap?
> the prevalence of major depression among people living with HIV is higher than among the general adult population of the United States
> Gender gap = there is a higher prevalence of depression among women than among men
105
Are HIV and depression related?
| If so, what type of relationship?
> Depression and HIV interact in complex ways and may be interrelated.
* For example, people with depression may be more likely to have unprotected sexual intercourse, putting them at greater risk for contracting HIV or other STIs.
- Alternatively, HIV may damage subcortical brain structures (i.e., parts of the brain beneath the cerebral cortex), thus leading to a sense of hopelessness that is often seen among people who are depressed (Treis-man & Angelino, 2007), and depression may result from HIV
106
Depression negatively impacts what bodily function? With respect to HIV - does it impact that?
> Depression negatively impacts the immune system functioning of people living with HIV and is associated with disease progression and with higher mortality rates
> Depression is also associated with poor HIV medication adherence
107
There is a higher lifetime prevalence of anxiety disorders such as generalized anxiety disorder and panic disorder, as well as a higher rate of anxiety symptoms among people living with what STI relative to the general population?
> HIV
108
How does anxiety affect those with HIV?
> causes avoidance that negatively impacts disease management and may lead to a worsening of symp-toms and a more rapid decline in health
> poorer medication adherence
> increased rate of mood or substance-use disorders
> Furthermore, anxiety, in combina-tion with HIV-associated neurocognitive disorders (see below), is associated with poorer everyday functioning
109
Are the estimates of the prevalence of PTSD among people living with HIV stable?
> NO- the estimates of the prevalence of PTSD among people living with HIV vary widely. (ranges 13% young adults + adolescents to 30% in gay men + 64% for those with low medication adherence)
110
Theuninck and colleagues (2010) reported that half of HIV-infected gay men mentioned receiving an HIV diagnosis as what type of event?
> a traumatic event
111
Although the prevalence rates for insomnia + HIV vary - what is the common rate?
> 73% which is much higher than the rate of the general population + those with medical conditions,
112
Why is insomnia prevalence so high in those living with HIV? (what are some possible explainations)
> it is unknown
> HIV medication side effects,
> increased stress as a result of living with a stigmatizing and chronic medical condition,
> the presence of co-existing mental disorders
> physiological changes resulting from HIV infection
> or any combination of these factors
113
For people living with HIV, having a substance-use disorder diagnosis is associated with a greater likelihood of having what?
> of having a comorbid mood or anxiety disorder
114
Is the prevalence of substance abuse higher in those with HIV than those in the general population?
> yes! (44% compared to 11%)
115
Advanced HIV infection has been shown to impact the central nervous system, and is associated with
> with neuropsychological deficits such as declines in cognitive and behavioural functioning
116
How many people with HIV experience some type of cognitive impairment? Is severe neurocognitive impairment rare?
> half will experience some type
> severe neurocognitive impairment is now rare due to advances
117
HIV-associated neurocognitive disorder includes three categories:
> asymptomatic neurocog-nitive impairment, mild neurocognitive disease, and HIV-associated dementia (HAD)
118
Asymptomatic neurocognitive impairment and mild neurocognitive disease are both associated with lower performance on neurocognitive tests; however, they are differentiated from one another by what?
> differentiated by the degree of impairment in daily activities
> asymptomatic neurocognitive impairment being associated with no functional impairment while mild neurocognitive disease is associated with some functional impairment.
119
What is HAD associated with?
> HAD is associated with worse per-formance on neurocognitive tests and notable functional impairment in daily activities
120
People living with HIV routinely face a number of serious problems simultaneously, such as:
> stig-matization, mental illness, physical health problems, and the stress of living with a chronic and potentially fatal disease.
121
Lazarus and Folkman (1984), pioneers in the field of coping research, identified two main types of coping: problem-focused and emotion-focused - which coping style is better for those with HIV?
> People who use a problem-focused coping style tend to be better adjusted to living with HIV.
> The emotion-focused coping style involves both active (i.e., having a fighting spirit) and passive (i.e., avoiding thinking about problems) strategies. People who use active strategies are better adjusted to living with HIV, whereas those who use more passive strategies have greater distress than those who use other ap-proaches and coping style
122
Aside from problem-focused or emotion focused, what is another type of coping for those with HIV?
> Another form of coping is through the social support of friends, family, and others.
> People living with HIV who are more satisfied with social support report less increase in HIV-related physical health problems over time such as CD4+ T-cell count, diarrhea, fever, night sweats, or persistent fatigue
123
he attitudes people adopt towards their illness may impact their adjustment to living with HIV and STIs. What attitude is best?
> it has been proposed that situational optimism (a person’s optimism in a specific situation) is associated with improved adjustment whereas dispositional optimism (a person’s long-term level of optimism across many situations) is unrelated to adjustment
124
Different types of antiretroviral medications target HIV disease progression by what forms?
> by suppressing the replication of the virus in different ways, such as preventing the virus from entering cells and from replicating itself.
125
Classes of antiretroviral medications include:
> include nucleoside-analog reverse transcriptase in-hibitors, non-nucleoside reverse transcriptase inhibitors, integrase inhibitors, protease inhib-itors, and fusion inhibitors
126
What is the difference between cART and monotherapy? Is one better than the other for HIV?
> Combination antiretroviral therapy (cART) is the use of two or more types of antiretroviral medications simultaneously, often combined into in a single pill, whereas monotherapy is the use of a single antiretroviral medication alone. Monotherapy is associated with medication resistance, and is no longer recommended as a treatment for HIV.
127
People living with HIV who have low adherence to HIV medications have what rate of increase in risk of HIV disease progression compared to those with moderate or high adherence
> have a five-fold in-crease
128
Many factors are associated with poor medication adherence among people living with HIV, such as:
> medication side effects, mental disorders, substance use, HIV stigma, and sexual dysfunction in males
129
Commonly reported rea-sons for missing medication include:
> feeling sick or ill, having too many pills to take, feeling like the drug is toxic or harmful, wanting to avoid side effects, feeling depressed or overwhelmed, and having problems taking pills at specified times
130
Medication side ef-fects associated with poor adherence include:
> fatigue, insomnia, confusion, taste disturbance, nausea, loss of appetite, and diarrhea
131
Although health psychologists working in clinical settings with people who are at risk for or who are living with HIV and STIs tend to use similar measures to assess personality, psychopathology, and other clinically relevant variables, two additional types of measures have been created when working with these populations. What are they?
1) the first type of measures assesses risk behaviour that predis-poses a person to contract HIV and STIs.
2) Injection risk behaviour is also assessed, especially for people at risk for HIV and hepatitis B and C.
* Both are typically done through self reports
132
Many psychological interventions have been developed for HIV and STI prevention as well as to support or treat people living with HIV and STIs. The term “intervention” is used as opposed to “treatment” because of what?
> because many clinicians working in the field of HIV and STIs, such as in public health
clinics, may also be working to prevent new cases among people at higher risk.
133
What are two broader systemic problems that contribute to HIV transmission?
| Think sociology...
> poverty + discrimination
134
The Theory of Reasoned Action and Theory of Planned Behaviour (TPB) have been applied to adress what (through what ype of program)?
Regarding HIV and STI risk behaviours, the theory of reasoned action and theory of planned behaviour have been applied to addressing HIV risk behaviours through culturally sensitive programs.
135
In a South African study (Jemmott, 2012), Xhosa-speaking male and female facilitators delivered a six-session HIV risk reduction intervention to grade six students using comic workbooks, homework assign-ments to engage parents, and other activities. What resulted?
> This intervention resulted in improved condom use self-efficacy and knowledge, increased belief that using condoms would not interfere with sexual pleasure, and decreased belief in cultural myths regarding HIV
136
What is the Information, Motivation, and Behavioural Skills Model for HIV and STIs'?
1. Who developed it
2. What is it reccomended by?
3. What are the core principles?
4. What does it speciify?
5. What has it been used for?
> Developed by Fisher and Fisher (1992), this model is recommended by the Canadian Guidelines for Sexual Health Education (PHAC, 2008).
> The core principles of the model include information, motivation, and behavioural skills.
> specifies that HIV-prevention information, motivation, and behavioural skills directly affect preventive behaviour
> this model has been used effectively to reduce sexual risk behaviours for a variety of populations, including minority youth, young adults, and low-income women
137
Interventions for preventing HIV/STIs and supporting individuals living with HIV/STIs may be approached through one or several levels. What are those levels?
> individual level
> community level
> multi-level
> digital-media level
138
IInterventions that focus on preventing HIV and STIs are delivered in a variety of settings, including:
> educational institutions, community-based organizations, health centres, and sexual health clinics.
139
A meta-analysis on interventions for adolescents concluded that programs focused on sexual behaviour beyond an abstinence-only approach (one that encourages adolescents to abstain from sex), such as encouraging condom use, were more successful in reducing what?
> more successful in reducing risky sex in the long term than were abstinence-only approaches
140
he Study to Reduce Intravenous Exposures is a group-level intervention designed for what?
> designed for injection drug users who are HIV-negative and are living with hepatitis C.
> the sessions focus on knowledge improvement, skills building, hepatitis C management, and peer mentoring to engage other injection drug users in safer injection behaviours
141
What is the Mpowerment Project?
> the Mpowerment Project is a community-level HIV-prevention program aimed at young men who have sex with men.
> The intervention included peer outreach activities in venues frequented by young men who have sex with men, peer-led groups offered in community settings, and a social marketing campaign
142
Most of the focus in HIV prevention has been on working with what population?
> has been on working with HIV-negative populations to reduce sexual and drug-use risk behaviours. However, the benefits of working with people living with HIV to reduce HIV transmission have increasingly been recognized
143
What is another level of intervention for HIV that has slowly been come to be recognized?
> Peer-delivered interventions
> peer interventions have been beneficial to the educators themselves through reciprocal support, learning, and empowerment
144
One intervention with a focus on people living with HIV is called what? What theory is this based on?
> One intervention with a focus on people living with HIV is called Healthy Relationships.
> Based on social cognitive theory, Healthy Relationships is a group-level intervention delivered through five two-hour sessions over two-and-a-half weeks, and is offered for groups of six to ten participants.
> The goals of Healthy Relationships is to develop coping skills related to HIV and situations of sexual risk, improve self-efficacy for decisions to disclose HIV status, and develop and maintain safer sex behaviours.
