Joint United Nations Programme on HIV/AIDS

Abstract Introduction: Despite a zero-stigma target, there has been limited national-level data on HIV stigma and discrimination among Indonesian healthcare workers. Past works were local and focused on individual-level stigma predictors. This study aims to fill in this gap by investigating national-level stigma and its social determinants. Methods A cross-sectional survey was conducted with stratified random sampling between October 2023-January 2024. Stigma was measured by agreement to four statements on attitudes toward PLHIV, while discrimination was measured by self-reported unnecessary extra precautions when caring for PLHIV. Social contexts included witnessing discriminatory care and perceived norms. Covariates included demographics, facility type, location, and work history. Logistic regression models were developed, adjusting for clustering by healthcare facilities. Results The study recruited 2,198 participants from 321 healthcare facilities, including 1,219 healthcare professionals and 979 support staff; 62.0% respondents expressed stigmatising attitudes; and 36.8% of healthcare professionals self-reported discriminatory practices. Participants in North Sumatra, relative to Jakarta, was the most salient for stigma (aOR = 6.15, 95%CI = 3.32–11.36) and East Java for discrimination (aOR = 5.45, 95%CI = 2.70–11.00). History of working in HIV services was a consistent negative predictor (aOR = 0.54, 95%CI = 0.43–0.68 for stigma; aOR = 0.74, 95%CI = 0.56–0.98 for discrimination). Conclusions We observed a considerable level of HIV stigma and discrimination. Structural factors that differ by province were the most salient determinants, along with gaps between perceived norms and best practices for anti-discriminatory HIV care. Future efforts to combat HIV stigma should focus on counteracting the structural factors while instilling the competence and norms for inclusive care for PLHIV and other HIV-affected groups.

Improving antiretroviral therapy (ART) adherence among adolescents living with HIV (ALHIV) improves outcomes, but with resource implications. We conducted a cost-effectiveness analysis extrapolating the costs and benefits of a community-based peer-support intervention (Zvandiri) among ALHIV in Zimbabwe. We used a de-novo multistate Markov decision-analytic model that simulated Zvandiri lifetime costs and benefits on viral suppression, death rates, life-years (LY) and quality-adjusted-life-years (QALYs) gained from the healthcare system perspective. We estimate the incremental cost-effectiveness ratio (ICER) per LY and QALY gained and compare the ICER to proposed cost-effectiveness thresholds of $500 and $700 per LY or QALY gained. We explore parameter uncertainty using probabilistic sensitivity analyses. Cohort-microsimulation suggests that after 40 years under SoC, 21% of 280 ALHIV will have undetectable viral-load (VL), 12% will have low VL (<1000 copies/mL), 10% will have high VL (≥1000 copies/mL) and 57% would have died. With Zvandiri, ART adherence improves, decreasing annual probability of virological failure or death. After 40 years, 65% will have undetectable viral load, 23% low VL, 3% high VL and 9% would have died. Zvandiri results in 1,345 LYs gained at incremental cost of $500,587, yielding a discounted ICER of $372 per LY gained. Zvandiri also results in 1,246 QALYs at incremental cost of $123,645, yielding a discounted ICER of $99 per QALY. The ICER is highly sensitive to programme costs, health-related utilities, and the discount rate. Zvandiri is a cost-effective intervention for reducing virological failure and death in ALHIV. Our analysis likely underestimates the full benefits of the intervention by not accounting for reductions in HIV transmissions resulting from higher virological suppression observed in full transmission models.

IntroductionHIV stigma negatively impacts antiretroviral therapy (ART) adherence in adults, but this relationship remains underexplored within the context of early adulthood. We examined manifestations of stigma and their associations with ART interruptions among young (18–24 years) and older (25 + years) people living with HIV (PLHIV) in Zimbabwe.MethodsThis analysis utilized cross-sectional data from the 2021 PLHIV Stigma Index 2.0, implemented by the Zimbabwe National Network of PLHIV in partnership with Global Network of People Living with HIV, The International Community of Women Living with HIV, and UNAIDS. Treatment interruptions were defined as ever interrupting or stopping HIV treatment. Internalized, anticipated, and enacted stigma scores were categorized as “no”, “low”, “moderate” and “high”. Modified Poisson regression models estimated associations between categorized stigma scores and treatment interruptions, with age-stratified analyses among young and older adults.ResultsAmong 1347 PLHIV who ever initiated ART, 20.9% of young adults and 10.3% of older adults reported treatment interruptions. Experiences of internalized stigma (56.3% versus 41.7%, p < 0.01) and anticipated stigma (73.9% versus 51.8%, p < 0.01) were higher among young adults compared to older adults. Increasing levels of internalized stigma were associated with higher lifetime incidence of treatment interruptions compared to no stigma (low: adjusted risk ratio(aRR)1.67, 95%CI 1.08–2.58, moderate: aRR2.58, 95%CI 1.72–3.87, high: aRR3.54, 95%CI 2.11–5.94). Similar associations were observed with anticipated stigma (low: aRR2.24, 95%CI 1.49–3.36, moderate: aRR3.21, 95%CI 1.82–5.66, high: aRR4.88, 95%CI 2.75–8.67). Treatment interruptions were associated with high (versus no) enacted stigma (aRR 2.75, 95%CI 1.19–6.32).ConclusionYoung adults living with HIV in Zimbabwe reported twice the lifetime incidence of treatment interruptions and greater levels of internalized and anticipated stigma compared to older adults. The associations between stigma and treatment interruptions highlight the opportunity for interventions that address stigma for young adults, which may optimize treatment adherence during early adulthood.

Abstract A new chapter on international crimes was introduced in the Danish Criminal Code on 1 January 2025. The new chapter offers a modernized definition of international crimes, which possibly could inspire other states and contribute to the development of customary international law in this area. The article reviews the new Chapter 13a of the Danish Criminal Code, which contains independent criminal provisions relating to crimes of aggression, genocide, crimes against humanity, war crimes, and torture. It also briefly discusses Denmark’s decision to ratify Article 8bis of the Rome Statute concerning the crime of aggression. The appendix to the article provides an unofficial translation of Chapter 13a of the Danish Criminal Code.

SummaryBackgroundEliminating HIV vertical transmission is a global priority and monitored by estimating paediatric HIV infections with the UNAIDS-supported Spectrum AIDS Impact Module (Spectrum-AIM). Recent innovations in antiretroviral therapy (ART) service-delivery models and first-line regimens aimed to reduce vertical transmission probabilities. We did a systematic review and meta-analysis to estimate vertical transmission probabilities by maternal immunological and treatment status.MethodsIn this systematic review and meta-regression, we combined an updated systematic review with previous data in meta-regression models to estimate vertical transmission probabilities and determinants. We searched PubMed, Embase, the Global Health Database, WHO Global Index Medicus, CINAHL Complete, and Cochrane CENTRAL for peer-reviewed English-language studies from all regions published between Jan 1, 2018 and Feb 8, 2024, with search term domains mentioning “HIV”, “transmission”, “perinatal”, and “breastfeeding periods”, and “infants born to women living with HIV” or related terms from randomised trials, cohort studies, or observational studies. Four meta-regression models estimated vertical transmission probabilities. We assessed model sensitivity and compared estimates to Spectrum-AIM’s previous results. Finally, we fit a meta-regression model to assess the association of ART class and initiation timing on viral load suppression (VLS) at delivery.FindingsOf 12 588 potential studies, we identified 24 new studies, which along with the 86 from previous reviews yielded 110 total studies included in meta-regression analysis. For women not receiving ART, higher CD4 count was associated with lower odds of perinatal vertical transmission (odds ratio [OR] 0·80, 95% CI 0·75–0·84, per 100 cells per μL increase). For pregnant women on ART, each additional week on ART before delivery reduced odds of vertical transmission by 5·6% (95% CI 4·2–7·0). The OR of perinatal vertical transmission among pregnant women initiating integrase inhibitor-based ART 20 weeks before delivery was 0·36 (0·14–0·94) compared with those initiating non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART. This association was confounded by study region. Odds of VLS were lower when ART was initiated late in pregnancy (OR 0·37, 0·21–0·68) for the reference regimen [NNRTI]), without significant difference by ART regimen.InterpretationVertical transmission probability varies by maternal immunological stage, treatment regimen, and timing of treatment initiation. These estimates have been incorporated into Spectrum-AIM for UNAIDS 2025 HIV estimates. Earlier ART initiation is associated with higher odds of VLS at delivery. Further evidence is needed on the effects of recent ART innovations on vertical transmission outcomes.FundingNational Institutes of Health, UNAIDS, and UK Research and Innovation.

partir des annes 1980, le GATT/OMC a t le thtre d'un conflit commercial entre les tats-Unis et l'Union europenne, centr sur le dossier agricole.Huit ans de ngociations ont permis d'aboutir un accord multilatral rvisant les modalits de l'change international de produits agricoles et alimentaires.Cet accord n'a pas pour autant radiqu les sources d'un conflit agricole qui a perdur jusqu' aujourd'hui, opposant ces deux grands protagonistes de l'agriculture que sont les tats-Unis et l'Union europenne.La position des tats-Unis, la fois dfensive et agressive, a volu au cours du temps.Au-del des ngociations en tant que telles, les tats-Unis semblent s'impliquer de plus en plus activement pour manipuler en leur faveur, certaines des rgles de l'OMC (soutiens, couleur des botes, aides de minimis).La vigilance amricaine porte sur l'agriculture dans son ensemble et sur des productions particulires.La position illustre en quoi le secteur agricole continue d'tre l'objet de conflits durables entre les tats-Unis et certains de leurs partenaires.L'rosion de leur comptitivit, enclenche depuis 2018 et qui est prvue pour durer, ne fera que maintenir cette posture dfensive l'OMC.

Abstract Introduction: Screening and surveillance of HIV infected pregnant women remains a public health problem in the Democratic Republic of Congo. This study’s aim was to assess the epidemiological, clinical, and biological profiles of HIV-infected pregnant women in the eastern region of DRC (South Kivu). Methods This was a retrospective cohort study conducted in Panzi Hospital from July 2015 to July 2020. Univariate analysis and multiple logistic regression were used to measure the strength of the association between independent variables and HIV status among pregnant women. Results During the study period, 9143 women were registered for PMTCT, including 6318 pregnant women tested for HIV. Among them 256 were HIV-positive (4.1%) (256/6318), and 112 were pregnant, a rate of 43.7% (112/256). HIV infected pregnant women had lower ANC rate than HIV negative pregnant women. The main opportunistic found among HIV infected women were candidiasis and genital herpes, with 2.7% in both cases. Only 58.03% (65/112) HIV infected pregnant women had available CD4 count and all of them had CD4 count above 500 cells/ml. Viral load was found undetectable (less than 30 copies/l) 60.7% (68/112) HIV infected pregnant women. Liver and renal dysfunctions were estimated at 6.2% and 30.3%, respectively. Lastly, 61.6% HIV infected pregnant women had the heamoglobin of &lt; 12 g/dl. In multivariable logistic regression, HIV infected pregnant women under 20 years of age (aOR = 7.20; 95% CI: 1.78–29.1; p = 0.004), primary level of education (aOR = 5.30; 95% CI: 1.94–14.4; p = 0.001), household income of 50-100U$ per months (aOR = 56.4; 95% CI: 13.1-240.5; p = 0.001), primipara (aOR = 10. 68; 95% CI: 2.17–52.42; p = 0.001), and poverty (aOR = 18; 95% CI: 3.61–89.60; p &lt; 0.001) were all associated with positive HIV status. In contrast, multigravida (aOR = 0.19; 95% CI: 0.09–0.38; p = 0.001), staying in ibanda health zone (aOR = 0.06; 95% CI: 0.01–0.23; p = 0.001), and Kadutu zone (aOR = 0.21; 95% CI: 0.05–0.86; p = 0.037) were associated with lower risk of HIV positive status among pregnant women. Conclusion Our findings highlighted that epidemiological, clinical, and biological profile of HIV-infected pregnant women may an important role in PMTCT. Regular screening of viral load is substantial in HIV infected pregnant women in our setting.