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Open access

Andrew Tam, Jennifer Ho and Annette H. Sohn

Abstract

Background: Across the Asia-Pacific, men who have sex with men (MSM) constitute a growing proportion of those infected with and at risk for HIV/AIDS, but frequently lack access to treatment-related resources because of stigma and discrimination.

Objective: To identify challenges that a community-based organization (CBO) and its corresponding HIV clinic in Bangkok, Thailand, face in order to facilitate access to HIV-related care and treatment services by HIV-positive MSM.

Methods: Data were collected through focus group discussions, semi-structured interviews, and surveys of staff members and volunteers working at the support facilities from April through May 2011.

Results: A total of 21 staff and volunteers working at the support facilities participated. Participants reported various barriers to use of HIV-related services by MSM including fear of stigmatization because of their infection status, limited clinic/hospital hours, and misunderstanding of risks.

Conclusions: In response to these barriers, CBOs implemented solutions ranging from outreach activities to organization of a men’s health clinic targeting MSM.

Open access

Pagakrong Lumbiganon, Pope Kosalaraksa, Torsak Bunupuradah, David Boettiger, Vonthanak Saphonn, Khanh H Truong, Nia Kurniati, Rawiwan Hansudewechakul, Viet C. Do, Tavitiya Sudjaritruk, Nagalingeswaran Kumarasamy, Nantakar Kongstan, Nik K. N. Yusoff, Lam V. Nguyen, Dewi K. Wati, Kamarul Razali, Annette H. Sohn and Azar Kariminia

Abstract

Background

Severe anemia is common among children infected with human immunodeficiency virus (HIV). The choice of antiretroviral (ART) regimen needs careful consideration. No information is available regarding the initial ART regimens used in the Asia-Pacific region and the rate of switch of ART regimens in HIV-infected children with severe anemia.

Objectives

To study the initial ART regimens and the rate of switch of ART regimens used during the first 36 months in HIV-infected children with severe anemia and to evaluate their clinical and laboratory outcomes.

Methods

We analyzed regional cohort data of 130 Asian children aged <18 years with baseline severe anemia (hemoglobin <7.5 g/dl) who started antiretroviral therapy (ART) between January 2003 and September 2013.

Results

At ART initiation, median age was 3.5 years old (interquartile range (IQR) 1.7 to 6.3) and median hemoglobin was 6.7 g/dL (IQR 5.9-7.1, range 3.0-7.4). Initial ART regimens included stavudine (85.4%), zidovudine (13.8%), and abacavir (0.8%). In 81 children with available hemoglobin data after 6 months of ART, 90% recovered from severe anemia with a median hemoglobin of 10.7 g/dL (IQR 9.6-11.7, range 4.4-13.5). Those starting AZT-based ART had a mortality rate of 10.8 (95% confidence interval (CI) 4.8-23.9) per 100 patient-years compared to 2.7 (95% CI 1.6-4.6) per 100 patient-years among those who started d4T-based ART.

Conclusion

With the phase-out of stavudine, age-appropriate non-zidovudine options are needed for younger Asian children with severe anemia.