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  1. Aigbe FR, Munavvar ASZ, Rathore H, Eseyin O, Pei YP, Akhtar S, et al.
    J Tradit Complement Med, 2018 Jan;8(1):72-80.
    PMID: 29321992 DOI: 10.1016/j.jtcme.2017.02.006
    Aristolochia ringens Vahl. (Aristolochiaceae (AR); mǎ dōu líng) is used traditionally in Nigeria for the management of various disorders including oedema. Preliminary investigation revealed its modulatory effect on the cardiovascular system. This study was aimed at investigating the effect of the aqueous root extract of A. ringens (AR) on haemodynamic parameters of spontaneously hypertensive rats (SHRs). The effect of oral subacute (21 days) and intravenous acute exposure of SHRs to the extract were assessed using tail cuff and carotid artery canulation methods respectively. In the latter, the effect of chloroform, butanol and aqueous fractions of AR were also evaluated. The extract significantly reduced systolic and diastolic blood pressures in SHRs, with peak reductions of 20.3% and 26.7% respectively at 50 mg/kg by the 21st day of oral subacute exposure. Upon intravenous exposure, AR (50 mg/kg) reduced systolic and diastolic blood pressure by as much as 53.4 ± 2.2 and 49.2 ± 2.8 mmHg respectively. A dose-dependent reduction in heart rate, significant at 25 and 50 mg/kg was also observed. Hexamethonium (20 mg/kg) and atropine (1 mg/kg) inhibited the extract's reduction of systolic blood pressure, diastolic blood pressure and heart rate significantly. The extract's butanol fraction produced the greatest systolic and diastolic blood pressures reduction of 67.0 ± 3.8 and 68.4 mmHg respectively at 25 mg/kg and heart rate reduction of 40 ± 7 beats per minute at 50 mg/kg. HPLC analysis revealed the presence of 4-hydroxybenzoic acid and quercetin in AR. The extract's alterations of haemodynamic parameters in this study show that it has hypotensive effect on spontaneously hypertensive rats.
  2. Jin H, Earnshaw VA, Wickersham JA, Kamarulzaman A, Desai MM, John J, et al.
    AIDS Care, 2014;26(10):1223-8.
    PMID: 24625279 DOI: 10.1080/09540121.2014.894616
    Stigma perpetuated by health-care providers has been found to be a barrier to care for vulnerable populations, including HIV-infected, people who inject drugs (PWIDs), and men who have sex with men (MSM) in multiple clinical contexts and remains unexamined among professional health-care students in Malaysia. This cross-sectional, anonymous, and Internet-based survey assessed the attitudes of medical and dental students toward HIV-infected, PWID, and MSM patients. Survey invitation was emailed to 3191 students at 8 professional schools; 1296 (40.6%) responded and scored their attitudes toward these patient groups using a feeling thermometer, indicating their attitudes on a sliding scale from 0 (most negative) to 100 (most positive). Compared to general patients (mean = 76.50), the mean scores for HIV-infected (mean = 54.04; p < 0.001), PWID (mean = 37.50; p < 0.001), and MSM (mean = 32.13; p < 0.001) patients were significantly lower and significantly different between each group comparison. Within group differences, most notably religion, ethnicity, and personally knowing someone from these populations were associated with significant differences in attitudes. No differences were noted between pre-clinical and clinical year of training. Health-care students represent the next generation of clinicians who will be responsible for future HIV prevention and treatment efforts. Our findings suggest alarmingly negative attitudes toward these patients, especially MSM, necessitating prompt and effective interventions designed to ameliorate the negative attitudes of health-care students toward vulnerable populations, specifically HIV-infected, PWID, and MSM patients in Malaysia.
  3. Tee YC, Earnshaw VA, Altice FL, Jin H, Kamarulzaman A, Wickersham JA
    AIDS Behav, 2019 Apr;23(4):1039-1047.
    PMID: 30560483 DOI: 10.1007/s10461-018-2362-4
    People with HIV (PWH) in Malaysia experience high levels of stigma, which may act as a barrier to accessing healthcare. Stigma against PWH in medical settings is understudied in Malaysia. In the present study, we examine factors associated with physicians' intention to discriminate against PWH in Malaysia. A cross-sectional online survey was emailed to all 1431 physicians at two major university hospitals in Malaysia; 568 (39.6%) participants completed the survey and were included in this analysis. Measures included intention to discriminate against PWH, stigma-related constructs, and socio-demographic characteristics. Multivariate linear regression was used to identify factors associated with intention to discriminate against PWH. Participants were comprised of women (53.5%), Malays (43.1%), and Chinese (35.0%) with nearly 10 years of clinical experience. Most participants were from non-surgical specialties (77.6%). The final multivariate linear regression showed that physicians who expressed greater discriminatory intent against PWH also expressed more negative feelings toward PWH, more HIV-related shame, were more fearful of HIV, and believed that PWH do not deserve good care. Physicians from surgical-based specialties were also significantly more likely to endorse discriminatory intent toward PWH. Stigma and intentions to discriminate against a class of patients, including PWH, can undermine engagement in care, which is central to international HIV prevention and treatment strategies. Interventions that reduce stigma toward PWH among physicians are crucial to ensuring equitable and stigma-free healthcare.
  4. Earnshaw VA, Jin H, Wickersham J, Kamarulzaman A, John J, Altice FL
    Trop. Med. Int. Health, 2014 Jun;19(6):672-679.
    PMID: 24666546 DOI: 10.1111/tmi.12306
    OBJECTIVES: Stigma towards people living with HIV/AIDS (PLWHA) is strong in Malaysia. Although stigma has been understudied, it may be a barrier to treating the approximately 81 000 Malaysian PLWHA. The current study explores correlates of intentions to discriminate against PLWHA among medical and dental students, the future healthcare providers of Malaysia.
    METHODS: An online, cross-sectional survey of 1296 medical and dental students was conducted in 2012 at seven Malaysian universities; 1165 (89.9%) completed the survey and were analysed. Socio-demographic characteristics, stigma-related constructs and intentions to discriminate against PLWHA were measured. Linear mixed models were conducted, controlling for clustering by university.
    RESULTS: The final multivariate model demonstrated that students who intended to discriminate more against PLWHA were female, less advanced in their training, and studying dentistry. They further endorsed more negative attitudes towards PLWHA, internalised greater HIV-related shame, reported more HIV-related fear and disagreed more strongly that PLWHA deserve good care. The final model accounted for 38% of the variance in discrimination intent, with 10% accounted for by socio-demographic characteristics and 28% accounted for by stigma-related constructs.
    CONCLUSIONS: It is critical to reduce stigma among medical and dental students to eliminate intentions to discriminate and achieve equitable care for Malaysian PLWHA. Stigma-reduction interventions should be multipronged, addressing attitudes, internalised shame, fear and perceptions of deservingness of care.
    KEYWORDS: HIV/AIDS; Malaisie; Malasia; Malaysia; VIH/SIDA; cuidados sanitarios profesionales; discriminación; discrimination; estigma; homosexuality; professional healthcare students; stigma; stigmatisation; substance abuse; étudiants en profession de soins de santé
  5. Klionsky DJ, Abdelmohsen K, Abe A, Abedin MJ, Abeliovich H, Acevedo Arozena A, et al.
    Autophagy, 2016;12(1):1-222.
    PMID: 26799652 DOI: 10.1080/15548627.2015.1100356
  6. Jin H
    Objective: Stigma endorsed by healthcare providers has been found to be a barrier to care for vulnerable populations, including HIV-infected, people who inject drugs (PWID), and men who have sex with men (MSM) in multiple clinical contexts. We therefore sought to better understand the extent to which stigma is levied toward these three populations by medical and dental students.
    Design: This cross-sectional study assessed the attitudes of 1,296 medical and dental students towards HIV-infected, PWID, and MSM patients.
    Methods: Students were asked to score their attitudes towards these patient groups using a feeling thermometer, indicating their attitudes on a sliding scale from 0, meaning very negative, to 100, meaning very positive.
    Results: The mean attitude score towards the general patient population (M = 76.50, SD = 20.35) was significantly higher than the scores for HIV-infected patients (M = 54.04, SD = 20.99), PWID patients (M = 37.50, SD = 24.41), and MSM patients (M = 32.13, SD = 29.33).Further, certain demographic variables, most notably religion, ethnicity, and personally knowing someone of these populations, were associated with significant differences in attitudes.
    Conclusion: Healthcare students represent the next generation of clinicians who will be responsible for HIV prevention and treatment efforts in the future. Our findings suggest that negative attitudes towards these patients is extremely high, and it is therefore crucial to design interventions to ameliorate the negative attitudes of medical students towards vulnerable populations.
  7. Earnshaw VA, Jin H, Wickersham JA, Kamarulzaman A, John J, Lim SH, et al.
    AIDS Behav, 2016 Jan;20(1):98-106.
    PMID: 26324078 DOI: 10.1007/s10461-015-1168-x
    Men who have sex with men (MSM) living in countries with strong stigma toward MSM are vulnerable to HIV and experience significant barriers to HIV care. Research is needed to inform interventions to reduce stigma toward MSM in these countries, particularly among healthcare providers. A cross-sectional survey of 1158 medical and dental students was conducted at seven Malaysian universities in 2012. Multivariate analyses of variance suggest that students who had interpersonal contact with MSM were less prejudiced toward and had lower intentions to discriminate against MSM. Path analyses with bootstrapping suggest stereotypes and fear mediate associations between contact with prejudice and discrimination. Intervention strategies to reduce MSM stigma among healthcare providers in Malaysia and other countries with strong stigma toward MSM may include facilitating opportunities for direct, in-person or indirect, media-based prosocial contact between medical and dental students with MSM.
  8. Jin H, Friedman MR, Lim SH, Guadamuz TE, Wei C
    LGBT Health, 2016 Dec;3(6):465-471.
    PMID: 26982598
    PURPOSE: Men who have sex with men and are sex workers (MSMSW) are disproportionately affected by the growing and emerging HIV epidemic. As sex work and same-sex behavior are heavily stigmatized and often illegal in most Asian countries, HIV research focusing on MSMSW has been limited. The goal of this analysis is to examine HIV testing practices and identify correlates of HIV testing among MSMSW in Asia.

    METHODS: The Asia Internet MSM Sex Survey, an online cross-sectional survey of 10,861 men who have sex with men (MSM), was conducted in 2010. Data on sociodemographic characteristics, HIV testing behaviors, and sexual behaviors were collected. Five hundred and seventy-four HIV-negative/unknown respondents reported receiving payment for sex with men at least once in the past 6 months and were included in this analysis. Multivariable logistic regression was conducted to identify independent correlates of HIV testing in the past year.

    RESULTS: About half (48.6%) of the participants had been tested for HIV at least once within the past year, and 30.5% had never been tested. We also found that MSMSW participants who engaged in risky behaviors were less likely to be tested.

    CONCLUSION: While one might expect a high HIV testing rate among MSMSW due to the risks associated with engaging in sex work, we found that HIV testing uptake is suboptimal among MSMSW in Asia. These results suggest that targeted HIV prevention and testing promotion among MSMSW are needed.

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