The HIV Stigma Scale (HSS) is a 40-item psychometrically sound measure capturing four domains of perceived stigma. A 25-item version has been validated in South India. However, the HSS has not been validated among pregnant women with HIV (WWH) in South Africa, a population facing significant stigma. Moreover, they could benefit from the abridged measure to be more efficiently connected to related interventions. Analyzing data from a sample of pregnant WWH (N = 472) recruited from an antenatal care clinic in eThekweni, Kwazulu-Natal Province, we: (1) conducted confirmatory factor analyses (CFA) to determine if the 4-factor structure of the original 40-item scale holds for the 25-item version in this sample; (2) further shortened the 25-item version using data-driven item reduction, and (3) conducted a comprehensive psychometric evaluation on the abridged version that included internal consistency and construct validity. The CFA confirmed a four-factor structure of the 25-item scale (CFI = 1.00, RMSEA = 0.03, SRMR = 0.04) in pregnant WWH. For model identification, we retained three items per factor. CFA of this 12-item version revealed model fit (CFI = 1.00, RMSEA = 0.01, SRMR = 0.03). All four subscales in the abridged scale showed satisfactory internal consistency (Cronbach's α > 0.80) and construct validity. This is the first study validating the HSS among pregnant WWH in an HIV-endemic setting and developing a psychometrically robust 12-item version, maintaining the four-factor structure of the original measure. Clinically, the abridged HSS enables more efficient screening and reduces participant burden, which could improve reporting and early implementation of stigma reduction interventions in resource-limited settings.

Toxoplasmosis is a common opportunistic infection in immunocompromised patients. Cerebral toxoplasmosis can be the initial manifestation of acquired immunodeficiency syndrome (AIDS). We report a case diagnosed at autopsy as the primary presentation of an undiagnosed human immunodeficiency virus (HIV)-positive patient. Histological examination revealed a prominent rim of periventricular necrosis involving the frontal, temporal, and occipital horns of the lateral ventricle, third and fourth ventricle. The ependymal lining was denuded with numerous encysted bradyzoites and scattered tachyzoites of Toxoplasma dispersed in the necro-inflammatory areas. Hydrocephalus due to cerebral toxoplasmic ventriculitis is very rare in adults. Mortality was significantly higher in cases with ventriculitis as compared to patients with only hydrocephalus due to mass lesions. Choroid plexus involvement in toxoplasmic ventriculitis could indicate a hematogenous spread from reactivation of latent systemic infection rather than reactivation of latent brain lesion. This case report emphasizes the importance of evaluation of HIV status in the presence of complex periventricular enhancement and the importance of a high degree of clinical suspicion for toxoplasmic ventriculitis in HIV patients with hydrocephalus, as an early institution of empirical anti-toxoplasma treatment could play a crucial role in cure.

Toxoplasmic encephalitis (TE) is an opportunistic infection that typically manifests in immunocompromised individuals, such as those with HIV infection or AIDS. The characteristic imaging finding is a mass-like lesion with ring enhancement. We report a rare case of TE in a patient who was not infected with HIV with atypical imaging features. An 81-year-old woman developed progressive impaired consciousness over several weeks. Initially, the brain MRI revealed multiple lesions resembling cerebral infarctions, which gradually enlarged and increased in number. Subsequently, gadolinium-enhanced MRI showed ring-enhancing mass-like lesions in the pons and left parietal lobe. Blood tests indicated elevated inflammatory markers and a mildly increased Toxoplasma IgG level. Given the progressive course, empiric therapy with trimethoprim-sulfamethoxazole and clindamycin was initiated, leading to marked improvement in consciousness by the fourth day. Toxoplasma DNA was later detected in the blood, confirming the diagnosis of TE.

Cervical cancer (CC) and HIV pose two major public health challenges, with low and middle-income countries (LMICs) exhibiting the highest disease burden and mortality rate for both HIV and CC-related deaths worldwide. Populations with HIV in LMICs are six times more likely to develop CC compared to the general population. Further, CC is the most frequently detected cancer and leading cause of death among women with HIV (WWH). This systematic review synthesized the literature and identified key elements of interventions to increase CC awareness, screening, treatment, and retention in care among persons with HIV in LMICs. Four databases were searched for peer reviewed articles in the last 10 years that described and assessed the effectiveness of these interventions, and 10 articles were identified and reviewed. Interventions that included community/spiritual leaders, trained non-physician medical providers, used pre-existing facilities (e.g. HIV, family planning, reproductive health), integrated "screen and treat" approaches, and used visual inspection methods (VIA/VILI; excluding Pap smears) were associated with higher rates of CC awareness, screening, engagement in subsequent treatment, and overall retention in care. Most studies focused on increasing awareness, screening, and engagement in care, demonstrating the need for interventions that are also designed to increase retention in the CC continuum of care among WWH. Additionally, few interventions had long follow-up periods, which should be included to effectively track sustained retention in care.