There is no path to ending AIDS by 2030 without improving human rights.
There is no path to ending AIDS by 2030 without improving human rights.
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DOI：
10.1002/jia2.26197
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发表时间：
2023-12
影响因子：
6
通讯作者：
Schwartz S
中科院分区：
文献类型：
--
作者：
Baral S;Millett G;Syarif O;Turpin N;Schwartz S
一些技术和规范机构已将2030年确定为艾滋病毒不再构成重大公共卫生威胁的目标日期，假设所有基准都得到满足[7]。然而，由于拯救生命的艾滋病毒治疗和新的艾滋病毒采购，艾滋病毒感染者的人数继续增加。因此，很快将有4 000多万艾滋病毒感染者，所有人都需要抗逆转录病毒治疗以维持生命，并具有U= U的次级益处，即艾滋病毒感染者维持病毒抑制没有艾滋病毒传播的风险。此外，世界各地数百万人将继续需要获得不同形式的暴露前预防（PrEP），直到艾滋病毒感染的风险变得微不足道。越来越清楚的是，鉴于其他健康威胁，包括迅速出现的传染病流行、气候变化对健康的影响以及向综合性全民保健系统迈进，用于艾滋病毒的资源水平不会增加。从2020年到2022年收集的艾滋病毒感染者耻辱指数2.0的数据显示，青年人的耻辱感持续存在，特别是耻辱感负担很高[8]。在来自撒哈拉以南非洲11个国家的10，000多名感染艾滋病毒的顺性别妇女的数据中，近十分之一的人经历过与其艾滋病毒状况相关的勒索，这与报告当前ART使用的调整后几率下降35%相关（aOR 0.65，95%CI 0.51-0.85）[9]。此外，18-24岁的年轻艾滋病毒感染者比25岁及以上的人更有可能报告在医疗机构中实施的耻辱。影响年轻人的更高耻辱负担可能是感染艾滋病毒的年轻人病毒抑制率较低和年轻女性PrEP中断率较高的关键驱动因素之一[10-12]。如果青年人感染艾滋病毒的风险不成比例，如果感染艾滋病毒，艾滋病毒的结果也不理想，那么就不可能在连续几代人中消除艾滋病毒对公共卫生的威胁。长期以来，耐药性突变破坏了中低收入国家常用的一线和二线治疗方案，导致按处方接受治疗的艾滋病毒感染者持续死亡。在过去几年中，将dolutegravir作为一种抗逆转录病毒药物，对于改善治疗结果的计划至关重要，因为耐药性水平较低。然而，从历史上看，耐药突变的流行率在艾滋病毒感染者中分布不均，边缘化社区的负担更高，包括性和性别多样化社区，性工作者和吸毒者[14]。污名驱动间歇性护理，导致初级突变的出现，大型性网络促进了这些突变的传播。在一定程度上推动抵抗运动出现的障碍仍然存在，
Several technical and normative agencies have established 2030 as the target date where HIV should no longer represent a major public health threat, assuming that all benchmarks are met [7]. However, the number of people living with HIV continues to grow due to both life-saving treatment for HIV and new HIV acquisitions. Thus, there will soon be over 40 million people living with HIV, all in need of antiretroviral therapy (ART) to preserve life with a secondary benefit of U= U where people living with HIV who sustain viral suppression have no risk of onward HIV transmission. Moreover, millions of people around the world will continue to need access to different forms of pre-exposure prophylaxis (PrEP) until the risk of HIV acquisition becomes negligible. It is increasingly clear that the level of resources for HIV will not increase given other threats to health including rapidly emergent infectious disease epidemics, the health effects of climate change, and the move towards integrated universal healthcare systems. Data from the People Living with HIV Stigma Index 2.0 collected from 2020 to 2022 have demonstrated sustained stigma and particularly high burden of stigma among youth [8]. In data from more than 10,000 cisgender women living with HIV from 11 countries across sub-Saharan Africa, nearly 1 in 10 had experienced blackmail related to their HIV status, and this was associated with 35% decrease in adjusted odds of reporting current ART use (aOR 0.65, 95% CI 0.51–0.85)[9]. Moreover, young people living with HIV aged 18–24 were more likely to report enacted stigma in healthcare settings than people aged 25 and above [8]. Higher burdens of stigma affecting youth may be one of the critical drivers of both lower viral suppression rates among young people living with HIV and higher PrEP discontinuation rates among young women [10–12]. It simply is not possible to end HIV as a public health threat in successive generations when it is youth who are disproportionately at risk of HIV acquisition and experience suboptimal HIV outcomes if living with HIV [13]. Resistance mutations have long undermined commonly used first-and second-line treatment regimens used in lowand middle-income countries, resulting in sustained mortality among people living with HIV who were using treatment as prescribed. The switch to dolutegravir over the past few years as an INSTI is central to the plan to improve treatment outcomes given lower levels of resistance. However, historically, the prevalence of resistance mutations has not been evenly distributed among people living with HIV with higher burdens among marginalized communities, including sexual and gender diverse communities, sex workers, and people who use drugs [14]. Stigma drives intermittent care leading to the emergence of primary mutations and large sexual networks facilitate the propagation of these mutations. The barriers that, in part, drove the emergence of resistance remain present,
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影响因子：
6
作者：
Mishra S;Silhol R;Knight J;Phaswana-Mafuya R;Diouf D;Wang L;Schwartz S;Boily MC;Baral S
通讯作者：
Baral S
影响因子：
4.6
作者：
通讯作者：
--
DOI：
10.1097/qai.0000000000002432
发表时间：
2020-10-01
影响因子：
3.6
作者：
Rucinski, Katherine B.;Schwartz, Sheree R.;Baral, Stefan D.
通讯作者：
Baral, Stefan D.
影响因子：
16.1
作者：
Beyrer, Prof C.;Lyons, Carrie E.;Baral, Stefan
通讯作者：
Baral, Stefan
影响因子：
8.1
作者：
Hinman, Kati;Amon, Joseph J.
通讯作者：
Amon, Joseph J.