Conference PAPER: HIV impact on women: gender difference among late testers and advanced HIV infection

HIV impact on women: gender difference among late testers and advanced HIV infection

Reference

Sukmawati, N. M. D. D., Merati, T. P., Somia, A., Utama, S., & Gayatri, Y. (2018, March). HIV impact on women: gender difference among late testers and advanced HIV infection. In IOP Conference Series: Earth and Environmental Science(Vol. 125, No. 1, p. 012004). IOP Publishing.

Abstract

N M D D Sukmawati1* , T P Merati1 , A Somia1 , S Utama1 and Y Gayatri1 1Tropical & Infectious Diseases Division, Department of Internal Medicine, Sanglah Hospital – Faculty of Medicine, Udayana University, Bali, Indonesia *Corresponding author email: dewidian.sukmawati@yahoo.com

Abstract. This study reported the effect of gender difference on HIV seropositive late testers or advanced infection. A retrospective cohort study of newly diagnosed HIV seropositive based on adatabase in the main referral hospital in Denpasar, Bali, Indonesia from 2004 – 2016. Women and man were categorized as late testers (CD4 ≤ 200 cells/uL and/or AIDS diagnosis ≤ 12 months from first HIV test date). Non-late testers (CD4 > 200 cells/uL and/or no AIDS diagnosis during study period or diagnosis of AIDS >12 months from HIV diagnosis), of reproductive age (13 – 49 years old), and not of reproductive age (>49 years old). Logistic regression was used to estimate risk and its statistical significance. The model consists of gender and age correctly classified 83.5% of cases. Women were almost two times more likely to present as non-late testers compared to men, and reproductive age of 15 – 49 years were 1.5 times more likely to present as non-late testers compared to those with age > 49 years. Women affected by HIV almost in equal as for men. Women and those within reproductive age were more likely to present before the advanced stage compared to men and those aged > 49 years.

GAP

We realize that tackling gender inequality is a key in reducing women’s vulnerability to HIV infection and ending the global AIDS epidemic, therefore we need the clear picture on the matter. To address that problem, we need to assess whether gender difference affects late testers and advanced HIV infection. [pp 2]

METHODS

2. Methods We enrolled a cohort of newly diagnosed HIV seropositive cases at the main referral hospital in Denpasar, Bali, Indonesia. The database obtained from 01 January 2004 until 31 December 2016. Diagnosis of HIV infection was made based on HIV 1 & 2 antibody test using three different methods. The CD4 baseline used in theanalysis was the CD4 level when initially diagnosed with HIV infection. Risk factors assessment for HIV transmission and demographic data extraction were done by using a local standard data form and obtained at baseline. Advanced HIV infection defined as HIV seropositive men or women with AIDS-defining illness or WHO clinical stage 3 or 4, or CD4 less than 200 cells/uL. Men and women were categorized as late testers (AIDS diagnosis ≤ 12 months from first HIV test date), non-late testers (no AIDS diagnosis during study period or diagnosis of AIDS >12 months from HIV diagnosis), of adult reproductive age (15 – 49 years old), and not of reproductive age (>49 years old). Mann-Whitney U test was used to the median difference between groups. Logistic regression was used to calculate the likelihood of late testers. [pp 2]

There were 6192 newly diagnosed HIV infection during thestudy period (Table 1) with increasing trend of new seropositive cases over the years (Figure 1). Woman to man ratio of 2: 3 was relatively constant over the years. This last decade, heterosexual activity contacts become the most common risk factor for HIV transmission. IVDU was the leading risk in theearly 2000s and less prominent in recent years. Male homosexual activity as HIV transmission’s risk showed exponential growth with new case finding increase more than five times in the last five years and become the second most common risk for HIV transmission (Figure 2). The median CD 4 level at baseline was 59 cells/uL (range 1 – 1390 cells/uL) [pp 2]

RESULT

The role of Indonesian women today is affected by multiple factors, namely modernization, globalization, improvement in education and advances in technology. In terms of gender equity, both man and women have their own portion of responsibility. Our study shows that women are not less vulnerable as for men an opportunity for HIV testing and medical care. The proportion of late tester was higher among men compared to women, also higher among older adult compared to those aged 15 – 49 years. The likelihood for presented as alate tester is higher in men compared to women and in those aged > 49 years compared to aged 15 – 49 years.

LIMITATION AND FUTURE RESEARCH

There are some limitations in our study: more variables would be beneficial if could be found, especially those that can measure social stigma and knowledge. The results indicate that individual who might present late for HIV diagnosis and care, exist within all risk groups, age, and gender and possibly in any healthcare setting. We endorsed the need to ensure earlier identification and treatment of late testers by reviewing current strategies. Health care providers might also consider routine HIV testing in emergency unit, primary care, and all other healthcare facilities. [pp 4]

CONCLUSION

Women affected by HIV infection in almost equal number as for men. Most women and men diagnosed as late testers and within the reproductive age group. Women more likely to present as nonlate testers compared to men and those within reproductive age also more likely to present as non-late testers.[pp 5]