Download or read book Disparities in HIV Pre Exposure Prophylaxis Implementation for Black and Latinx Adults Receiving Care in Public Health Clinics written by Julie Kay Schexnayder and published by . This book was released on 2021 with total page 176 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pre-exposure prophylaxis (PrEP) effectively reduces the risk of Human Immunodeficiency Virus (HIV) infection. PrEP implementation in public health clinics is suggested for increasing PrEP access; However, it is unclear if these venues can reduce the disparities in PrEP use that are observed for Black and Latinx adults. We analyzed data from health departments completing their first PrEP program year between June 1, 2016 and June 30, 2019. We estimated PrEP coverage and adherence in Black and Latinx clients. Semi-structured interviews were conducted with multidisciplinary public health workers (n=6). The Consolidated Framework for Implementation guided a thematic analysis of interviews. Of the 433 PrEP clients, 52.0% were non-Hispanic Black and 8.9% were Hispanic/Latinx. PrEP to need ratios were greater for White clients than for Black or Latinx clients at five of the nine health departments. The average medication possession ratio for Black and Latinx PrEP clients (.79) approached effective daily adherence levels. However, a single prescription was filled for 25.0% of Black and Latinx clients. Qualitative data indicated compatibility issues between PrEP services delivery and community preferences and needs. Challenges integrating longitudinal follow-up practices, and complex PrEP re-enrollment procedures emerged as additional factors influencing PrEP outcomes. The results of this dissertation indicate that public health clinics vary in their ability to deliver all components of PrEP clinical monitoring and in their ability to increase PrEP coverage in Black and Latinx adults. Tailoring of PrEP services to Black and Latinx adults may be necessary to optimize PrEP coverage and adherence.

Download or read book HIV in US Communities of Color written by Bisola O. Ojikutu and published by Springer Nature. This book was released on 2020-08-21 with total page 256 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book builds upon its previous edition by comprehensively updating important epidemiologic and clinical content of the HIV continuum amongst Black and Latino individuals of the United States, including the epidemiology, prevention, diagnosis, and treatment of HIV within these diverse communities. Illuminating current diagnostic and prevention considerations, as well as its evidence base, the text highlights important concepts and integrates critical aspects of the structural and social environment, such as mass incarceration and neighborhood-level disadvantage, that compromise our ability to decrease HIV risk and improve outcomes. Discussion regarding significant predictors of health inequity, including discrimination, medical mistrust, and stigma, specifically homophobia and transphobia, are included. The book also reviews the impact of significant advances in HIV prevention, such as pre-exposure prophylaxis (PrEP), within Black and Latino communities. Written by experts in their field, this second edition of HIV in US Communities of Color is a comprehensive and dynamic resource for all health care providers who support the care and treatment of Black and Latino individuals at risk for or living with HIV.

Download or read book Communities in Action written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2017-04-27 with total page 583 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

Download or read book Perceptions of Pre exposure Prophylaxis PrEP and Acceptability of Peer Navigation Among HIV negative Latinx and Black Men who Have Sex with Men MSM in Western Washington written by Jahn Jaramillo and published by . This book was released on 2018 with total page 47 pages. Available in PDF, EPUB and Kindle. Book excerpt: HIV PrEP (pre-exposure prophylaxis) is an effective biomedical approach for HIV prevention. However, PrEP is an underutilized resource among Latinx and Black men who have sex with men (MSM) in the United States. Peer navigation approaches are being widely scaled up to support PrEP uptake and adherence, though it remains unclear what strategies work best to effectively address the diverse social and cultural needs of Latinx and Black MSM. This study is based on qualitative research conducted on a subset of 66 Latinx and Black MSM residing in Western Washington who participated in an online CAPI REDCap survey. We conducted semi-structured in-depth interviews with 21 men selected through purposive sampling methods to evaluate the intersectionality of race, ethnicity, sexual orientation, and other identities men possessed and how this related to their views on PrEP in general, and on peer navigation specifically. Thematic analysis was used to identify and analyze emergent themes. Four major themes emerged as relevant to PrEP interest and uptake: 1) disclosure concerns for bisexual/gay masculine identified men; 2) specific challenges for Latinx MSM, including migration status and need for advocacy; 3) specific challenges for Black MSM, including discrimination and need lack of trust; and 4) special considerations for younger men, including limited knowledge and experience discussing sexual health and an interest in more comprehensive peer intervention content. Interest in peer navigation was high among study participants, particularly for men with limited social support or English proficiency and for men who had moved from out of state or another country. Several potential approaches to improve peer navigation were identified, including developing culturally congruent programming to match peers with men based on various identity considerations and identified needs, employing social media such as chatrooms and informational phone lines as complementary combination strategies, and incorporating trauma-informed care into a peer navigation program for Latinx and Black MSM. Tailored peer navigation approaches may help MSM of color by increasing resilience to societal stigma at the individual level, enhancing social support at the interpersonal level and serving as a bridge to providers at the structural level. These strategies could ultimately reduce racial/ethnic HIV disparities, if implemented.

Download or read book Innovations in HIV Prevention Research and Practice through Community Engagement written by Scott D. Rhodes and published by Springer. This book was released on 2014-07-14 with total page 274 pages. Available in PDF, EPUB and Kindle. Book excerpt: HIV continues to be a profound challenge facing communities nationally and internationally. Until a vaccine or a cure is found, prevention remains a most crucial line of defense. However, the successes made to reduce exposure and transmission have not benefited all communities equally. HIV continues to affect vulnerable communities, and HIV-related health disparities are growing. The work documented in Innovations in HIV Prevention Research and Practice through Community Engagement spotlights the effectiveness of community involvement to reduce HIV infections in the United States. This timely resource introduces the concepts of community engagement, partnership, and community-based participatory research (CBPR). Contributors provide detailed examples of these concepts in which diverse research partners blend their unique insights and skills to arrive at an authentic understanding of phenomena and inform the translation of best practices and processes to enhance equity in HIV prevention and treatment. Equitable interactive collaboration is central to these efforts, in which community members and representatives from organizations, the scientific and medical sectors, and other relevant agencies nurture long-term health improvement through sustained teamwork. Challenges and barriers to effective engagement are identified, as are characteristics of successful partnerships. Included in the book: Details of a multigenerational HIV prevention intervention in a rural southeastern community. The challenges and successes of developing, implementing, and evaluating an intervention for higher-risk predominately heterosexual black men in college. The history of gay community involvement in HIV prevention and its contributions to the theory and current practice of engagement. Next steps in the integration of HIV-related policy change and research. Community engagement within American Indian communities. Keys to sustaining a CBPR partnership to prevent HIV within ethnic, sexual, and gender minority communities. Innovations in HIV Prevention Research and Practice through Community Engagement offers researchers and practitioners in public health, community health, and medicine guidance on community engagement that is both inspiring and realistic. “Community engagement and knowledge continue to be essential to prevent HIV infections. This book is a compilation of the state-of-the-science of engagement and delves deeper into the meaning and utilization of community-based participatory research, with implications that reach beyond the HIV epidemic to public health and medicine in general.” - Laura C. Leviton, PhD, Senior Advisor for Evaluation, Robert Wood Johnson Foundation, Princeton, NJ

Download or read book Evaluation of Oral Pre exposure Prophylaxis prep Implementation in Public HIV Care Clinics in Kenya written by Elizabeth M. Irungu and published by . This book was released on 2021 with total page 138 pages. Available in PDF, EPUB and Kindle. Book excerpt: Daily, oral pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) is a highly potent HIV prevention intervention with potential to reduce HIV incidence among populations at risk of HIV in Africa if delivered with sufficient coverage. There are extensive data from high-income countries describing diverse settings in which PrEP services are offered. However, data describing PrEP scale-up models in low- and middle-income countries are limited. Public HIV care and treatment programs in Africa have been very successful at scaling up antiretroviral therapy (ART) over the last 15 years and are an attractive choice for integration of PrEP delivery. The main objective of the work described in this dissertation was to evaluate the effectiveness of PrEP implementation and integration in public HIV care clinics. The specific aims include to 1) conduct a step wedge cluster randomized trial of PrEP integration in public health HIV care clinics (the Partners Scale-Up Project) and evaluate impact; 2) conduct a process evaluation of PrEP integration in public HIV care clinics in Kenya, focusing on adaptation; 3) develop and evaluate the effectiveness of an on-site modular training approach to amplify the number of health care providers trained to deliver PrEP in public HIV care clinics in Kenya; and 4) summarize early PrEP rollout in African settings, challenges encountered and opportunities to expand implementation. We found evidence that integration of PrEP in public HIV clinics was feasible. By improving the capacity of health providers in those care clinics to offer PrEP services through training and technical support, PrEP uptake increased more than 20-fold and was sustained. With existing personnel and infrastructure, the high-volume HIV care clinics efficiently reached partners of HIV infected persons and other populations at HIV risk. PrEP users had reasonable continuation rates and objective evidence of high adherence. Using qualitative methods, we found that clinics made pragmatic, effective adaptations to non-core components of PrEP delivery services and to their routine practice to address challenges in PrEP delivery. We established that clinics that instituted some of the adaptations had above average monthly PrEP initiation and continuation rates. To amplify PrEP delivery in public health facilities, we developed and evaluated an innovative on-site modular training approach. We found that this approach was acceptable and it enabled many health providers to receive PrEP training conveniently and at a relatively low cost. Finally, our summary of early PrEP roll out in Africa revealed that there was high interest in PrEP among all populations at risk of acquiring HIV, but individuals did not continue use as expected. We suggested strategies to make PrEP delivery efficient, including delivery within community pharmacies, use of peers, services availed in low tier facilities and exploration of one-stop services to make PrEP delivery less burdensome. The collective results presented in this dissertation illustrate that integration of PrEP services in public HIV care clinics in Kenya is a successful and sustainable model for PrEP implementation. We posit that this model can be scaled up in African countries planning to set up PrEP programs.

Download or read book Disease Control Priorities Third Edition Volume 6 written by King K. Holmes and published by World Bank Publications. This book was released on 2017-11-06 with total page 1027 pages. Available in PDF, EPUB and Kindle. Book excerpt: Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.

Download or read book HIV Prevention in Primary Care Practice written by Gregory Felzien, MD, AAHIVS and published by Integritas Communications. This book was released on 2020-10-22 with total page 40 pages. Available in PDF, EPUB and Kindle. Book excerpt: PrEP is a broad set of clinical tools that can be used to reduce the chances of acquiring HIV. Although it is highly effective, many people who could benefit from PrEP lack access or are not familiar with it. However, primary care providers can remedy this situation and truly make a difference in the lives of their patients who may be at risk of acquiring HIV. This eHealth SourceTM educational activity comprises 5 chapters, covering an overview of HIV epidemiology, practical approaches to sexual history-taking and assessing patient risk of HIV acquisition, initiation and monitoring of PrEP medication, and overcoming the bias and stigma surrounding HIV and PrEP. Throughout the program, our expert faculty will provide their unique insights surrounding sexual health, HIV prevention, and PrEP, and how these may be incorporated into primary care practice.

Download or read book Differentiated and simplified pre exposure prophylaxis for HIV prevention written by and published by World Health Organization. This book was released on 2022-07-31 with total page 46 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book How Substance Use Health Insurance and Social Determinants of Health Affect the HIV Prevention Continuum in Los Angeles CA Focus on Pre Exposure Prophylaxis PrEP and Treatment as Prevention written by Chelsea Leigh Shover and published by . This book was released on 2018 with total page 91 pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: Recent advances in biomedical HIV prevention - including pre-exposure prophylaxis (PrEP) and treatment as prevention (TAsP) - are key to ending the HIV epidemic. The analysis examined how social factors that are strongly related to HIV incidence and treatment outcomes (e.g., substance use, access to healthcare, age, race/ethnicity, gender, and geographic location) may affect the HIV prevention continuum. METHODS: Chapters 2 and 3 use data collected as part of clinical care at the Los Angeles LGBT Center. In Chapter 2, a cross-sectional study of HIV-negative men who have sex with men (MSM) and transgender people who have sex with men (TGSM) who visited the Center between August 2015 and April 2017 examined how sexual history, substance use, and demographic factors were associated with initiating PrEP. In Chapter 3, records-based longitudinal study of patients prescribed PrEP at the Center evaluated discontinuation, HIV incidence, and loss to follow-up. Chapter 4 uses data from the mStudy to analyze the relationship between methamphetamine use (urine drug screen and self-reported frequency) patterns and viremia among HIV positive MSM of color. RESULTS: Use of sex drugs, but not alcohol use, was associated with PrEP initiation among MSM and TGSM. Key demographic risks were associated with lower odds of PrEP initiation (Black or Latino race/ethnicity, younger age). About half of patients who started PrEP at the Center discontinued or were lost to follow-up. HIV incidence among those who discontinued was 1.4%, compared to 0.3% among those who were actively attending follow-up appointments. Persistence was highest for those receiving PrEP through a low-cost program, and lowest for younger people. Longitudinal patterns of frequent and/or recent methamphetamine use were associated with a detectable pattern of viremia. CONCLUSION: Because younger people had lower PrEP initiation and more discontinuation compared to older people, strategies to support youth are key to PrEP's success for HIV prevention. The findings that methamphetamine was an obstacle to secondary HIV prevention but not necessarily to PrEP use highlight how facilitating PrEP use among people who use methamphetamine and other substances may be key to HIV prevention.

Download or read book Implementation Science to Address Health Disparities and Improve the Equitable Implementation of Proven Interventions written by Mechelle Sanders and published by Frontiers Media SA. This book was released on 2024-02-08 with total page 144 pages. Available in PDF, EPUB and Kindle. Book excerpt: As health research moves through the translation pipeline, some minoritized groups have been left behind. This gap in translation has worsened, and or become more apparent for many during the COVID-19 pandemic. Implementation science can help address this gap by guiding the equitable dissemination and implementation of health interventions, healthcare policies and practices. With significant research focus on implementation of proven health interventions, there is a tremendous opportunity to ensure all individuals have access to, and benefit from, lifesaving healthcare and health interventions.

Download or read book Optimizing HIV PrEP Implementation in the Primary Care Setting written by Cara P Nalagan and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Despite compelling evidence behind the efficacy of pre-exposure prophylaxis (PrEP) in preventing human immunodeficiency virus (HIV) acquisition and its introduction in 2012, the prescription of PrEP has remained low (Silapaswan, Krakower, & Mayer, 2016). At the Asian and Pacific Islander Wellness Center (API), an urban primary care clinic in San Francisco, suboptimal PrEP implementation was related to a lack of standardized practice and routine HIV risk screening for PrEP provision. A doctorate of nursing (DNP) project was implemented to initiate a standardized HIV risk screening protocol for identifying HIV risk and PrEP eligibility to increase PrEP implementation at API. The impact of this protocol demonstrated an increase in the PrEP implementation cascade, particularly in HIV risk identification, PrEP offer, and evaluation of at-risk patients for PrEP uptake (initiation). During implementation of the HIV risk screening protocol, however, inconsistent clinical staff compliance with the routine screening tool led to an inadequate increase in PrEP offer for patients who tested positive for a sexually transmitted infection (STI). This indicates a need for further reinforcement of standardized practice and clinical staff education on the importance of combining HIV risk screening and PrEP, with emphasis on the significant risk for HIV infection associated with positive STI, to effectively promote patient outcomes. Implications for further research include validation of the HIV PrEP screening tool used in the HIV risk screening protocol as a model for PrEP implementation in the primary care setting.

Download or read book Evaluating HIV Prevention Interventions written by Joanne E. Mantell and published by Springer Science & Business Media. This book was released on 2013-06-29 with total page 288 pages. Available in PDF, EPUB and Kindle. Book excerpt: This user-friendly, comprehensive guide places evaluation in the context of HIV to give all health care professionals the necessary tools for developing and implementing successful HIV interventions. Every aspect of evaluation is discussed, including: the social and political context of evaluation coding and inter-rater reliability procedures barriers to evaluation and solution the dissemination of results the application of theory to HIV interventions. Case studies and examples from both the US and abroad to illustrate practical issues, and numerous tables and figures complement the text.

Download or read book Maximizing Effectiveness of HIV Preexposure Prophylaxis Among Men Who Have Sex with Men written by Julia Lenore Marcus and published by . This book was released on 2013 with total page 75 pages. Available in PDF, EPUB and Kindle. Book excerpt: Despite decades of prevention and treatment efforts, human immunodeficiency virus (HIV) infection is a global pandemic, with HIV/acquired immunodeficiency syndrome (AIDS) among the leading causes of death for children and adults in developing countries. HIV/AIDS disproportionately affects men who have sex with men (MSM), including in the United States, where MSM account for over half of all new HIV infections. Existing HIV prevention tools have not been sufficient to curb the pandemic, and biomedical prevention strategies, such as circumcision and microbicides, had not been shown to be effective in preventing HIV infection in MSM until 2010, when the multi-national iPrEx study found that daily oral preexposure prophylaxis (PrEP) using antiretroviral therapy (emtricitabine/tenofovir, or FTC/TDF) prevented HIV infection among MSM and transgender women. Although the success of FTC/TDF PrEP in such trials has given new hope to the HIV prevention field, excitement has been tempered by concerns about low adherence to daily pill use among trial participants. Adherence, as measured by self-reported pill use, was high among participants in the iPrEx trial, but testing for evidence of the drug in blood specimens from a subset of participants indicated that actual pill use was much lower than reported pill use. Adherence is critical for PrEP effectiveness; iPrEx participants in whom antiretroviral drug was detected in blood experienced a substantially greater reduction in HIV risk than was seen overall. The iPrEx results suggest that low adherence may be a barrier to successful implementation of PrEP as an HIV prevention strategy among MSM. Identification of effective strategies for supporting the consistent use of prophylactic medications could provide much needed guidance in the development of interventions to support adherence to PrEP. In addition to concerns about adherence, there is a widespread concern that PrEP could result in an increase in sexual risk behaviors by lowering users' perception of their risk of acquiring HIV infection; such risk compensation could reduce or even negate the benefits of PrEP. Foundational to most models of health behavior is the hypothesis that perceived risk is a primary motivation for self-protective behavior. Based on this theory, when a new prevention strategy, such as PrEP, is introduced, risk compensation could be prevented by sustaining individuals' perceptions of their own HIV risk. While the act of taking PrEP on a daily basis could result in risk compensation, it could also provide a daily opportunity to contemplate and manage HIV risk, thus motivating condom use and other self-protective behaviors. A better understanding of whether, and how, PrEP use affects sexual risk behavior could inform the development of risk-reduction interventions for individuals prescribed PrEP. In addition to preventing HIV infection, there is evidence that FTC/TDF PrEP may also be protective against infection with Herpes simplex virus type 2 (HSV-2). HSV-2 is the primary cause of genital ulcer disease worldwide, and HSV-2 infection is known to increase the risk of sexual transmission and acquisition of HIV infection. In the CAPRISA 004 study, a topical 1% tenofovir gel used as PrEP against HIV infection also reduced the risk of HSV-2 acquisition by 51% in women. In the Partners PrEP study, oral FTC/TDF reduced HSV-2 acquisition by 35% among heterosexual couples. Protection against HSV-2 acquisition or expression could enhance the public health impact of PrEP, but it is unknown whether FTC/TDF has anti-herpetic properties in men who have sex with men. The effectiveness of FTC/TDF PrEP in protecting against HIV infection depends on individual-level behaviors, including adherence and sustained risk reduction, as well as its effect on other sexually transmitted infections (STI) that increase the risk of HIV acquisition. Chapter 1 of this dissertation describes a systematic review that aimed to identify interventions that have been used to support adherence to daily oral medications prescribed to healthy or asymptomatic individuals. This review found evidence of interventions that demonstrated short-term improvements in medication adherence across a variety of prevention settings, thus identifying potential strategies for adherence support among PrEP users. Chapter 2 describes an analysis of data from the randomized phase of the iPrEx study to determine whether sexual risk compensation occurred among trial participants. Consistent with other PrEP studies, this analysis found no evidence of increased sexual risk behavior or STIs among participants who believed they had been assigned to the FTC/TDF arm and that the drug was highly effective. Finally, Chapter 3 describes an analysis that used data from the randomized phase of iPrEx to measure the effect of FTC/TDF on HSV-2 acquisition and expression among men who have sex with men. Although there was no effect of FTC/TDF on HSV-2 acquisition, participants receiving the active drug had a lower prevalence of herpetic ulcers than participants receiving the placebo. Taken together, these papers contribute to the HIV prevention field by providing guidance on behavioral support strategies for daily oral PrEP and identifying anti-herpetic properties of FTC/TDF that could increase its effectiveness as a novel prevention tool.

Download or read book HIV Pre exposure Prophylaxis PrEP Implementation Guide written by and published by . This book was released on 2022 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The purpose of this implementation guide is to assist clinicians and/or agencies with integrating PrEP services into their current services. This guide will provide step-by-step instructions and resources for offering PrEP services. This guide can be used partly or completely for the implementation of PrEP services

Download or read book Sexually Transmitted Infections written by National Academies of Sciences, Engineering, and Medicine and published by . This book was released on 2021-12-24 with total page 750 pages. Available in PDF, EPUB and Kindle. Book excerpt: One in five people in the United States had a sexually transmitted infection (STI) on any given day in 2018, totaling nearly 68 million estimated infections. STIs are often asymptomatic (especially in women) and are therefore often undiagnosed and unreported. Untreated STIs can have severe health consequences, including chronic pelvic pain, infertility, miscarriage or newborn death, and increased risk of HIV infection, genital and oral cancers, neurological and rheumatological effects. In light of this, the Centers for Disease Control and Prevention, through the National Association of County and City Health Officials, commissioned the National Academies of Sciences, Engineering, and Medicine to convene a committee to examine the prevention and control of sexually transmitted infections in the United States and provide recommendations for action. In 1997, the Institute of Medicine released a report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Although significant scientific advances have been made since that time, many of the problems and barriers described in that report persist today; STIs remain an underfunded and comparatively neglected field of public health practice and research. The committee reviewed the current state of STIs in the United States, and the resulting report, Sexually Transmitted Infections: Advancing a Sexual Health Paradigm, provides advice on future public health programs, policy, and research.

Download or read book HIV AIDS in South Africa 25 Years On written by Poul Rohleder and published by Springer Science & Business Media. This book was released on 2009-09-01 with total page 396 pages. Available in PDF, EPUB and Kindle. Book excerpt: Much has happened since the first appearance of AIDS in 1981: it has been identified, studied, and occasionally denied. The virus has shifted host populations and spread globally. Medicine, the social sciences, and world governments have joined forces to combat and prevent the disease. And South Africa has emerged as ground zero for the pandemic. The editors of HIV/AIDS in South Africa 25 Years On present the South African crisis as a template for addressing the myriad issues surrounding the epidemic worldwide, as the book brings together a widely scattered body of literature, analyzes psychosocial and sexual aspects contributing to HIV transmission and prevention, and delves into complex intersections of race, gender, class, and politics. Including largely overlooked populations and issues (e.g., prisoners, persons with disabilities, stigma), as well as challenges shaping future research and policy, the contributors approach their topics with rare depth, meticulous research, carefully drawn conclusions, and profound compassion. Among the topics covered: The relationship between HIV and poverty, starting from the question, "Which is the determinant and which is the consequence?" Epidemiology of HIV among women and men: concepts of femininity and masculinity, and gender inequities as they affect HIV risk; gender-specific prevention and intervention strategies. The impact of AIDS on infants and young children: risk and protective factors; care of children by HIV-positive mothers; HIV-infected children. Current prevention and treatment projects, including local-level responses, community-based work, and VCT (voluntary counseling and testing) programs. New directions: promoting circumcision, vaccine trials, "positive prevention." South Africa’s history of AIDS denialism. The urgent lessons in this book apply both globally and locally, making HIV/AIDS in South Africa 25 Years On uniquely instructive and useful for professionals working in HIV/AIDS and global public health.