I
n
t
e
r
n
at
ion
al
Jou
r
n
a
l
of
P
u
b
l
ic
Hea
l
t
h
S
c
ience
(
I
JP
HS
)
Vo
l
.
8
,
N
o
.
1,
M
a
r
c
h
2019,
pp.
36~44
I
S
S
N:
2252
-
8806,
DO
I
:
10
.
11591/i
j
p
h
s
.
v
8
i
1.
17081
36
Jou
r
n
al
h
o
m
e
page
:
ht
tps
:
//
w
w
w
.
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c
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om/
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r
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x
.
ph
p/I
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In
s
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De
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m
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c
o
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/
h
a
a
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e
du.
s
a
.
1
1.
I
NT
RO
DU
C
T
I
ON
T
h
e
(
HI
V/A
I
DS)
e
p
i
de
mi
c
h
a
s
b
e
e
n
a
c
c
o
m
pa
ni
e
d
by
s
t
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g
m
a
a
n
d
d
i
s
c
r
i
mi
na
t
i
o
n
s
i
nc
e
i
t
s
i
nc
e
pt
i
o
n
[
1]
a
n
d
t
h
e
i
r
a
s
s
o
c
i
a
t
e
d
r
e
a
l
i
t
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s
h
a
v
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o
m
po
un
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d
t
h
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f
f
e
c
t
s
o
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t
h
e
e
p
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de
mi
c
o
v
e
r
t
h
e
pa
s
t
25
y
e
a
r
s
[
2]
.
I
n
c
r
e
a
s
i
ng
ly
,
HI
V/
A
I
DS
-
r
e
l
a
t
e
d
s
t
i
g
m
a
a
n
d
d
i
s
c
r
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mi
na
t
i
o
n
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r
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k
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o
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dge
d
a
s
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o
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t
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e
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ll
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g
t
h
e
s
pr
e
a
d
o
f
t
h
e
d
i
s
e
a
s
e
[3
-
4]
.
T
h
e
r
a
m
if
i
c
a
t
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o
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o
f
A
I
DS
-
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t
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s
t
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m
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a
n
d
d
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r
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us
.
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a
n
d
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a
c
t
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d
s
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l
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ur
de
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o
n
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n
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n
f
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t
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vi
du
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l
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n
d
t
h
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by
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o
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t
r
i
b
ut
e
to
a
de
c
l
i
ne
i
n
h
e
a
l
t
h
s
t
a
t
us
[5
-
6]
S
t
i
g
m
a
t
i
z
i
ng
a
t
t
i
t
u
de
s
a
nd
d
i
s
c
r
i
mi
na
t
o
r
y
pr
a
c
t
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c
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s
o
f
f
a
mi
ly
m
e
m
be
r
s
a
n
d
h
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a
l
t
h
pr
o
vi
de
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s
pr
e
v
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t
t
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s
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i
nf
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t
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d
f
r
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r
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e
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vi
n
g
a
de
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t
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e
a
t
m
e
n
t
,
c
a
r
e
,
a
n
d
s
uppo
r
t
[
7]
.
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t
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a
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a
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t
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b
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n
pa
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r
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us
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by
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vi
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o
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s
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n
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t
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s
e
t
h
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t
s
a
n
c
t
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o
n
s
e
x
u
a
l
b
e
h
a
vi
o
r
.
HI
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s
a
go
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x
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m
p
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o
f
t
hi
s
t
y
p
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o
f
d
i
s
e
a
s
e
[8
-
9]
.
T
h
e
he
a
l
t
h
c
a
r
e
s
e
t
t
i
n
g
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pa
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ly
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o
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p
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c
uo
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c
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t
e
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a
t
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s
t
i
g
m
a
a
n
d
d
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s
c
r
i
mi
na
t
i
o
n
[
10]
.
I
n
t
hi
s
c
o
n
t
e
x
t
pe
o
pl
e
li
v
i
ng
w
i
t
h
HI
V
o
r
A
I
DS
(
P
L
W
H
A
)
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f
t
e
n
d
i
s
c
o
v
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t
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s
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a
t
us
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n
d
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t
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s
w
h
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pe
o
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ve
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h
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pot
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t
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ga
t
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tr
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s
mi
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s
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l
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tr
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m
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d
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Sti
gma
and
dis
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iminat
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among
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alt
h
c
ar
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pr
ov
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s
to
w
ar
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pe
o
ple
li
v
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w
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(
M
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.
)
37
po
s
i
t
i
v
e
pe
o
p
l
e
r
e
c
e
i
vi
ng
i
n
f
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r
i
o
r
c
a
r
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o
r
b
e
i
ng
de
ni
e
d
c
a
r
e
a
l
t
o
ge
t
h
e
r
[
11
-
12]
.
Va
r
i
o
us
s
t
udi
e
s
ha
v
e
de
m
o
ns
t
r
a
t
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d
t
h
a
t
A
I
DS
-
r
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l
a
t
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d
s
t
i
g
m
a
i
s
a
c
o
m
m
o
n
p
he
n
o
m
e
n
o
n
wo
r
l
dw
i
de
t
h
a
t
o
c
c
ur
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va
r
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y
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f
c
o
n
t
e
x
t
s
,
i
n
c
l
ud
i
ng
t
h
e
f
a
mi
ly
,
c
o
m
m
u
ni
t
y
,
wo
r
kp
l
a
c
e
,
a
n
d
he
a
l
t
h
c
a
r
e
s
e
t
t
i
n
gs
[
13
-
14]
.
A
c
t
i
o
n
s
t
h
a
t
e
x
pr
e
s
s
s
t
i
g
m
a
a
r
e
o
f
t
e
n
r
e
f
e
r
r
e
d
t
o
a
s
“
d
i
s
c
r
i
mi
na
t
i
o
n
”
o
r
“
b
e
ha
vi
o
r
i
n
w
hi
c
h
a
d
i
s
t
i
n
c
t
i
o
n
i
s
m
a
d
e
a
ga
i
ns
t
pe
o
pl
e
t
h
a
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s
ul
t
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n
t
h
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p
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o
n
b
e
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ng
t
r
e
a
t
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d
unf
a
i
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ly
o
r
unj
us
t
l
y
o
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t
h
e
b
a
s
i
s
o
f
t
h
e
m
b
e
l
o
n
g
i
ng,
o
r
b
e
i
ng
p
e
r
c
e
i
v
e
d
to
b
e
l
o
n
g
t
o
a
pa
r
t
i
c
u
l
a
r
gr
o
up”
[
14
-
15]
.
F
e
a
r
o
f
s
t
i
g
m
a
a
n
d
d
i
s
c
r
i
mi
na
t
i
o
n
ke
e
ps
pe
o
p
l
e
f
r
o
m
l
e
a
r
ni
ng
t
h
e
i
r
HI
V
s
t
a
t
us
,
a
n
d
i
f
po
s
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t
i
ve
,
f
r
o
m
d
i
s
c
l
o
s
i
ng
t
h
e
i
r
s
t
a
t
us
to
ot
h
e
r
s
a
n
d
a
c
c
e
s
s
i
ng
h
e
a
l
t
h
s
e
r
vi
c
e
s
.
S
i
nc
e
t
h
e
n
u
m
be
r
o
f
pe
o
p
l
e
li
v
i
ng
w
i
t
h
h
u
m
a
n
im
m
u
n
o
de
f
ic
i
e
n
c
y
v
i
r
u
s
(
HI
V)
/ac
qu
i
r
e
d
im
m
u
n
o
de
f
i
c
i
e
n
c
y
s
y
ndr
o
m
e
(
A
I
DS)
(
P
L
W
H
A
)
i
s
i
nc
r
e
a
s
i
ng
a
ll
o
v
e
r
t
h
e
wo
r
l
d,
m
e
d
i
c
a
l
c
a
r
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pr
o
vi
de
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s
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r
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po
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d
t
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pon
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w
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h
n
e
e
d
e
d
s
e
r
vi
c
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s
a
n
d
c
a
r
e
[
14]
.
Ho
we
v
e
r
,
a
c
c
e
s
s
i
ng
h
e
a
l
t
h
c
a
r
e
c
a
n
b
e
a
c
h
a
ll
e
n
ge
f
o
r
pe
o
p
l
e
w
h
o
a
r
e
HI
V
po
s
i
t
i
v
e
b
e
c
a
u
s
e
he
a
l
t
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s
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c
t
o
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h
a
s
b
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n
i
de
n
t
i
f
i
e
d
a
s
o
n
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o
f
t
h
e
a
r
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s
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n
w
hi
c
h
s
t
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g
m
a
a
n
d
d
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s
c
r
im
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na
t
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c
ur
to
wa
r
d
pe
o
pl
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l
i
v
i
ng
w
i
t
h
HI
V/A
I
DS
wo
r
l
d
w
i
de
[
16]
.
S
t
i
g
m
a
a
n
d
d
i
s
c
r
i
mi
na
t
i
o
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a
g
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t
P
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W
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he
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f
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m
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f
f
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ve
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s
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t
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d
t
r
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a
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m
e
n
t
e
f
f
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t
s
by
d
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s
c
o
ur
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g
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n
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n
d
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vi
du
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l
s
f
r
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m
be
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t
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d
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t
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to
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t
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t
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o
f
h
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a
l
t
h
c
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r
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s
e
r
vi
c
e
[
17
-
19]
.
S
t
i
g
m
a
a
n
d
d
i
s
c
r
im
i
na
t
i
o
n
ha
v
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m
a
ny
n
e
ga
t
i
v
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c
o
n
s
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que
n
c
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s
i
n
t
h
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li
f
e
qua
li
t
y
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f
P
L
W
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A
a
n
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r
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duc
e
t
h
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qua
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r
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m
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h
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a
l
t
h
c
a
r
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h
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y
r
e
c
e
iv
e
d
[
20]
.
I
n
S
uda
n
,
W
HO
s
ugge
s
t
gr
o
wi
n
g
a
nd
hi
dde
n
e
p
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de
mi
c
a
n
d
f
o
r
e
v
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r
y
k
n
o
wn
c
a
s
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,
15
c
a
s
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s
li
e
u
n
de
t
e
c
t
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d.
W
HO
c
o
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ga
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P
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W
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f
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c
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t
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s
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m
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j
o
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f
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c
t
or
r
e
s
p
o
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bl
e
f
o
r
i
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c
r
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s
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ng
r
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k
b
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vi
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r
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d
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de
r
r
e
p
o
r
t
i
n
g
o
f
c
a
s
e
s
i
n
S
uda
n
[
21
-
22
]
.
Due
to
t
h
e
i
m
po
r
t
a
n
c
e
o
f
t
hi
s
i
s
s
ue
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d
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s
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r
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s
u
l
t
o
f
S
uda
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e
go
v
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r
nm
e
n
t
'
s
c
o
m
mi
t
m
e
n
t
to
HI
V/A
I
DS
a
n
d
S
T
D
P
r
e
v
e
n
t
i
o
n
a
n
d
C
a
r
e
,
l
e
g
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s
l
a
t
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n
a
ge
n
t
s
d
i
s
c
r
im
i
na
t
i
o
n
t
o
wa
r
d
P
L
W
H
A
(
i
n
c
l
ud
i
ng
h
e
a
l
t
h
f
i
e
l
d)
wa
s
r
e
l
e
a
s
e
d
i
n
2009
[
23
-
24]
.
On
t
h
e
ot
h
e
r
ha
n
d
M
C
P
s
i
n
t
h
e
c
a
s
e
o
f
de
a
li
n
g
w
i
t
h
HI
V
pa
t
i
e
n
t
s
put
t
h
e
m
s
e
l
ve
s
a
t
hi
g
h
r
i
s
k
o
f
t
h
r
ough
l
a
c
k
o
f
pr
ot
e
c
t
i
v
e
de
vi
c
e
s
,
o
r
n
ot
a
dh
e
r
i
n
g
t
o
kn
o
wn
s
a
f
e
t
y
m
e
a
s
ur
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s
o
r
ot
h
e
r
u
nf
o
r
e
s
e
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n
c
i
r
c
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m
s
t
a
n
c
e
s
a
n
d
t
h
e
i
r
pe
r
c
e
pt
i
o
n
o
f
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x
po
s
ur
e
to
r
i
s
k
c
a
n
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n
f
luen
c
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t
h
e
m
a
n
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ge
m
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t
o
f
pa
t
i
e
n
t
s
a
n
d
d
i
s
e
a
s
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s
[
25]
.
S
o
t
h
e
i
n
t
e
r
e
s
t
s
a
n
d
we
ll
-
be
i
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o
f
M
C
P
s
a
r
e
ve
r
y
i
m
po
r
t
a
n
t
f
o
r
e
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t
a
bli
s
hi
ng
a
n
e
nvi
r
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nm
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n
t
f
r
e
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f
s
t
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g
m
a
a
n
d
d
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s
c
r
i
mi
na
t
i
o
n
i
n
he
a
l
t
h
f
i
e
l
d
[
26
-
28]
.
S
i
n
c
e
t
h
e
l
e
v
e
l
d
i
s
c
r
i
mi
na
t
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r
y
pr
a
c
t
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c
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s
,
k
n
o
w
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d
ge
,
a
tt
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t
ude
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pe
r
c
e
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v
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V
pa
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R
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r
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hi
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w
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c
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R
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,
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d
d
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ga
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t
P
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T
h
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t
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t
t
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ude
s
(
s
t
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g
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a
)
to
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r
d
P
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m
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r
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pr
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de
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w
il
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b
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qua
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t
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d;
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v
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[
29
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we
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n
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n
d
bl
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d
do
n
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t
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o
n
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t
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30%
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n
d
po
or
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1.
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e
pr
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t
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d
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f
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r
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pa
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s
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4
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pa
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c
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s
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v
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t
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r
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s
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t
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n
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r
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d
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f
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r
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c
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pa
nt
s
(
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.
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a
d
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s
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v
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t
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ude
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or
e
s
)
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57
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a
d
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n
c
l
e
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ude
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n
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s
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o
r
e
s
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6
(
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a
d
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t
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t
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r
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5.
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6
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phic
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r
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p
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Sti
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T
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Evaluation Warning : The document was created with Spire.PDF for Python.
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P
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c
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N:
2252
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8806
Sti
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among
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(
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41
T
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7.4
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a
r
e
c
o
n
s
i
s
t
e
n
t
w
i
t
h
m
a
ny
s
t
ud
i
e
s
c
o
n
duc
t
e
d
e
l
s
e
w
h
e
r
e
s
uc
h
t
h
a
t
o
f
S
uda
n
[
33]
,
T
a
n
z
a
ni
a
[
34
]
,
N
i
ge
r
i
a
[
35
]
a
n
d
R
wa
n
da
[
36
]
.
T
h
e
s
t
udy
i
n
S
uda
n
s
h
o
we
d
s
o
m
e
d
i
s
c
r
i
mi
na
t
o
r
y
pr
a
c
t
i
c
e
s
a
ga
i
ns
t
P
L
W
H
A
whe
r
e
27.
1%
o
f
r
e
s
po
n
de
n
t
s
o
b
s
e
r
v
e
d
he
a
l
t
h
wo
r
ke
r
s
a
v
o
i
d
i
ng
HI
V
pa
t
i
e
n
t
s
,
18.
8
-
30.
4
%
o
b
s
e
r
v
e
d
l
e
s
s
c
a
r
e
pr
ovi
de
d
t
o
HI
V
po
s
i
t
i
v
e
pa
t
i
e
n
t
s
,
44.
9%
o
b
s
e
r
v
e
d
h
e
a
l
t
h
w
o
r
ke
r
s
go
s
s
i
p
i
ng
a
b
o
ut
t
h
e
HI
V
s
t
a
t
us
o
f
pa
t
i
e
n
t
s
,
72.
5%
r
e
por
t
e
d
s
e
e
i
n
g
e
qu
i
p
m
e
n
t
b
e
i
ng
s
t
e
r
i
l
i
z
e
d
w
i
t
h
e
x
t
r
a
c
a
ut
i
o
n
f
r
o
m
HI
V
po
s
i
t
i
v
e
pa
t
i
e
n
t
s
a
n
d
87.
4
%
o
f
H
C
P
we
a
r
g
l
o
v
e
s
t
o
c
a
r
r
y
o
ut
s
i
m
p
l
e
e
x
a
mi
na
t
i
o
n
pr
o
c
e
dur
e
s
o
n
P
L
W
H
A
[
33]
.
As
f
o
r
T
a
n
z
a
ni
a
,
t
h
e
s
t
ud
y
s
h
o
we
d
t
h
a
t
47%
o
f
pr
o
vi
de
r
s
s
a
i
d
t
h
a
t
a
t
l
e
a
s
t
o
n
e
d
i
s
c
r
i
mi
na
t
o
r
y
b
e
h
a
vi
o
r
o
c
c
ur
r
e
d
a
m
o
n
g
t
h
e
i
r
pe
e
r
s
[
34
].
T
h
e
N
i
ge
r
i
a
s
t
ud
y
s
h
o
we
d
d
i
s
c
r
i
mi
na
t
o
r
y
pr
a
c
t
i
c
e
s
whe
r
e
9%
o
f
h
e
a
l
t
h
c
a
r
e
pr
o
f
e
s
s
i
o
n
a
l
s
h
a
d
r
e
f
u
s
e
d
c
a
r
e
f
o
r
HI
V
/A
I
DS
pa
t
i
e
n
t
s
a
n
d
9%
h
a
d
r
e
f
us
e
d
a
d
mi
s
s
i
o
n
to
h
o
s
p
i
t
a
l
s
.
M
o
s
t
o
f
HC
P
(
66%
)
o
b
s
e
r
ve
d
ot
h
e
r
s
r
e
f
u
s
i
ng
to
c
a
r
e
a
n
d
43%
r
e
f
us
i
ng
a
d
mi
s
s
i
o
n
.
F
o
ur
f
a
c
t
o
r
s
t
h
a
t
m
a
y
c
o
n
t
r
i
b
ut
e
to
t
hi
s
b
e
h
a
vi
o
r
a
c
c
o
r
d
i
n
g
to
t
h
e
s
t
udy
i
nc
l
ude
l
a
c
k
o
f
c
o
r
r
e
c
t
i
nf
o
r
m
a
t
i
o
n
a
b
o
ut
H
I
V/A
I
DS
a
n
d
pr
e
v
e
n
t
i
o
n
o
f
i
n
f
e
c
t
i
o
n
,
l
a
c
k
o
f
p
r
ot
e
c
t
i
v
e
m
a
t
e
r
i
a
l
s
n
e
e
de
d
f
o
r
t
h
e
pr
a
c
t
i
c
e
o
f
u
ni
ve
r
s
a
l
pr
e
c
a
ut
i
o
ns
,
l
a
c
k
o
f
m
a
t
e
r
i
a
l
s
ne
e
de
d
t
o
c
a
r
e
f
o
r
a
n
d
t
r
e
a
t
pa
t
i
e
n
t
s
w
i
t
h
HI
V/
A
I
DS
a
n
d
pr
e
v
a
i
li
ng
a
t
t
i
t
ude
s
a
b
o
ut
P
L
W
H
A
[
35
]
.
I
n
c
a
s
e
o
f
R
wa
n
d
a
,
t
h
e
s
t
udy
r
e
v
e
a
l
e
d
t
h
a
t
89.
1
%
o
f
pa
r
t
i
c
i
pa
n
t
s
we
r
e
a
wa
r
e
o
f
c
o
m
m
o
n
pr
a
c
t
i
c
e
s
t
h
a
t
o
c
c
ur
r
e
d
by
h
e
a
l
t
hc
a
r
e
pr
o
vi
de
r
s
w
h
o
d
i
s
c
r
i
mi
na
t
e
a
ga
i
ns
t
HI
V
pa
t
i
e
n
t
s
.
T
h
e
s
t
ud
y
s
h
o
we
d
s
t
r
o
n
g
a
s
s
o
c
i
a
t
i
o
n
s
be
t
we
e
n
pr
o
vi
de
r
a
t
t
i
t
ude
s
a
n
d
f
e
a
r
s
a
n
d
t
h
e
i
r
a
wa
r
e
n
e
s
s
o
f
d
i
s
c
r
im
i
na
t
o
r
y
pr
a
c
t
i
c
e
s
t
h
a
t
o
c
c
ur
i
n
f
a
c
il
i
t
i
e
s
[
36
].
T
h
e
o
v
e
r
a
ll
k
n
o
w
l
e
dge
o
f
HI
V
wa
s
s
a
t
i
s
f
a
c
t
o
r
y
(
6
8.
2%
)
o
f
p
a
r
t
i
c
i
pa
n
t
s
,
t
hi
s
r
e
s
u
l
t
s
i
s
s
im
il
a
r
t
o
t
h
e
s
t
udy
c
o
n
duc
t
e
d
i
n
Ye
m
e
n
by
R
a
j
a
'
a
a
n
d
c
o
l
l
e
a
gu
e
s
a
m
o
n
g
211
h
e
a
l
t
h
c
a
r
e
g
i
ve
r
s
i
n
t
h
e
c
hil
d
de
ve
l
o
p
m
e
n
t
pr
o
j
e
c
t
t
h
a
t
s
h
o
we
d
h
a
lf
o
f
t
h
e
s
u
bj
e
c
t
s
(
50%
)
h
a
d
s
a
t
i
s
f
a
c
t
o
r
y
kn
o
w
l
e
dge
a
b
o
ut
H
I
V/A
I
DS
[
2
6]
whi
c
h
d
i
f
f
e
r
s
f
r
o
m
a
T
a
nz
a
ni
a
,
s
t
ud
y
do
ne
a
m
o
n
g
204
HC
P
s
t
h
a
t
s
h
o
we
d
f
a
i
r
l
e
v
e
l
o
f
k
n
o
w
l
e
dge
w
h
e
r
e
37
%
a
nd
26%
h
a
d
s
a
t
i
s
f
a
c
t
or
y
a
n
d
go
o
d
kn
o
wl
e
dge
r
e
s
pe
c
t
i
v
e
ly
.
Al
t
h
o
ugh
m
a
j
o
r
i
t
y
83.
8%
o
f
M
C
P
s
ha
d
po
s
i
t
i
v
e
a
tt
i
t
ude
,
14.
6
%
h
a
d
u
n
c
l
e
a
r
a
t
t
i
t
ude
,
a
n
d
1.
5%
h
a
d
n
e
ga
t
i
v
e
a
t
t
i
t
ude
to
wa
r
ds
HI
V
pa
t
i
e
n
t
s
.
T
h
e
l
e
v
e
l
o
f
bl
a
m
e
wa
s
hi
g
h
a
m
o
n
g
M
C
P
s
a
n
d
r
e
pr
e
s
e
n
t
e
d
by
57.
7%
.
Ot
h
e
r
s
t
udi
e
s
r
e
c
o
r
de
d
n
e
ga
t
i
v
e
a
t
t
i
t
ude
s
to
w
a
r
ds
P
L
W
H
A
by
he
a
l
t
h
c
a
r
e
s
t
a
f
f
l
o
o
k
i
n
g
a
f
t
e
r
t
h
e
m
.
F
o
r
e
x
a
m
p
l
e
,
i
n
S
uda
n
[
33
]
,
i
n
Ye
m
e
n
[
37
]
,
i
n
S
a
ud
i
A
r
a
bi
a
[
38
]
,
i
n
K
uwa
i
t
[
39]
,
i
n
E
g
y
pt
[
40]
i
n
I
r
a
n
[
41
]
a
n
d
i
n
I
n
d
i
a
[
42]
t
h
a
t
r
e
v
e
a
l
e
d
n
e
ga
t
i
v
e
a
tt
i
t
ude
a
m
o
n
g
78
%
o
f
266
HC
W
s
w
h
o
b
e
li
e
v
e
d
t
h
a
t
HI
V
pa
t
i
e
n
t
s
s
h
o
u
l
d
b
e
i
s
o
l
a
t
e
d
f
r
o
m
ot
h
e
r
p
a
t
i
e
n
t
s
a
n
d
77.
9%
f
e
l
t
wor
r
i
e
d
a
b
o
ut
c
a
r
i
n
g
o
f
P
L
W
H
A
.
4.
CONC
L
USI
ON
M
e
d
i
c
a
l
c
a
r
e
pr
o
vi
d
e
r
s
h
a
v
e
o
v
e
r
a
ll
s
a
t
i
s
f
a
c
t
or
y
kn
o
w
l
e
dge
a
b
o
u
t
HI
V
wi
t
h
s
o
m
e
a
m
o
u
n
t
o
f
po
o
r
kn
o
w
l
e
dge
r
e
l
a
t
e
d
to
pr
e
s
e
n
t
i
n
g
s
ym
pt
o
m
s
,
vi
r
o
l
o
gy
,
a
n
d
pr
e
v
e
n
t
i
o
n
s
t
r
a
t
e
gi
e
s
.
T
h
e
hi
g
h
e
r
k
n
o
w
l
e
dge
wa
s
a
tt
a
i
n
e
d
by
do
c
to
r
s
,
whi
l
e
t
h
e
l
o
we
r
kn
o
wl
e
dg
e
wa
s
a
tt
a
i
n
e
d
by
m
i
dw
if
e
s
a
n
d
n
ur
s
e
s
.
M
e
d
i
c
a
l
c
a
r
e
pr
o
vi
de
r
s
h
a
v
e
o
ve
r
a
l
l
po
s
i
t
i
ve
a
tt
i
t
ude
to
wa
r
d
P
L
W
H
A
w
it
h
s
o
m
e
a
m
o
un
t
o
f
u
n
c
l
e
a
r
a
t
t
i
t
ude
a
n
d
v
e
r
y
m
u
c
h
l
o
we
r
a
m
o
un
t
o
f
n
e
ga
t
i
v
e
a
t
t
i
t
ude
.
T
h
e
r
e
wa
s
a
s
s
o
c
i
a
t
i
o
n
b
e
t
we
e
n
k
n
o
w
l
e
dge
,
pe
r
c
e
i
v
e
d
r
i
s
k
a
n
d
a
tt
i
t
ude
.
T
h
e
po
or
kn
o
wl
e
dg
e
a
n
d
hi
g
h
e
r
pe
r
c
e
i
ve
d
r
i
s
k
we
r
e
t
h
e
l
o
we
r
po
s
i
t
i
v
e
a
t
t
i
t
ude
.
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i
s
c
r
im
i
na
t
or
y
pr
a
c
t
i
c
e
a
m
o
n
g
a
ll
m
e
d
i
c
a
l
c
a
r
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pr
o
vi
de
r
s
wa
s
c
o
m
m
o
n
,
a
n
d
t
h
e
wo
r
s
t
pr
a
c
t
i
c
e
s
we
r
e
a
m
o
n
g
M
C
P
s
w
h
o
wo
r
k
i
n
o
b
s
t
e
t
r
i
c
d
e
pa
r
t
m
e
n
t
.
F
ur
t
h
e
r
qua
li
t
a
t
i
v
e
s
t
udy
i
s
r
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qu
i
r
e
d
t
o
de
t
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r
m
i
ne
t
h
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a
u
s
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o
f
d
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s
c
r
im
i
na
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pr
a
c
t
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a
m
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g
m
e
d
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c
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r
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vi
d
e
r
s
t
o
wa
r
d
P
L
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A
.
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nf
o
r
m
a
t
i
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b
o
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V/A
I
DS
i
n
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h
e
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ur
r
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c
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l
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m
o
f
t
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h
e
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t
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a
t
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o
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i
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o
ul
d
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e
i
n
t
e
gr
a
t
e
d
a
n
d
s
t
r
e
n
gt
h
e
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e
d.
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o
m
e
e
m
p
h
a
s
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s
o
n
c
o
nv
e
r
t
i
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g
un
c
l
e
a
r
a
tt
i
t
ude
to
po
s
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t
i
v
e
a
t
t
i
t
ude
s
h
o
u
l
d
b
e
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43
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[1
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[3
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[6
]
Mark
L
.
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C.
Ph
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4
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6
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