ObjectiveTo conduct a systematic review and series of meta-analyses on the association between HIV-related stigma and health among people living with HIV.Data sourcesA structured search was conducted on 6 electronic databases for journal articles reporting associations between HIV-related stigma and health-related outcomes published between 1996 and 2013.Study eligibility criteriaControlled studies, cohort studies, case-control studies and cross-sectional studies in people living with HIV were considered for inclusion.Outcome measuresMental health (depressive symptoms, emotional and mental distress, anxiety), quality of life, physical health, social support, adherence to antiretroviral therapy, access to and usage of health/social services and risk behaviours.Results64 studies were included in our meta-analyses. We found significant associations between HIV-related stigma and higher rates of depression, lower social support and lower levels of adherence to antiretroviral medications and access to and usage of health and social services. Weaker relationships were observed between HIV-related stigma and anxiety, quality of life, physical health, emotional and mental distress and sexual risk practices. While risk of bias assessments revealed overall good quality related to how HIV stigma and health outcomes were measured on the included studies, high risk of bias among individual studies was observed in terms of appropriate control for potential confounders. Additional research should focus on elucidating the mechanisms behind the negative relationship between stigma and health to better inform interventions to reduce the impact of stigma on the health and well-being of people with HIV.ConclusionsThis systematic review and series of meta-analyses support the notion that HIV-related stigma has a detrimental impact on a variety of health-related outcomes in people with HIV. This review can inform the development of multifaceted, intersectoral interventions to reduce the impact of HIV-related stigma on the health and well-being of people living with HIV.

Radix Astragali (root of Astragalus; Huangqi) is a popular traditional Chinese medicine, and Astragalus membranaceus and A. membranaceus var. mongolicus are two commonly used species; however, there are many Astragalus species that could act as adulterants of Radix Astragali. To find the chemical composition of Radix Astragali, the main constituents including flavonoids, saponins, polysaccharides, amino acids, and trace elements were determined in two Radices Astragali, A. membranaceus and A. membranaceus var. mongolicus, and its eight adulterants, Astragalus propinquus, Astragalus lepsensis, Astragalus aksuensis, Astragalus hoantchy, Astragalus hoantchy subsp. dshimensis, Astragalus lehmannianus, Astragalus sieversianus, and Astragalus austrosibiricus. The results showed that the amounts of main constituents such as isoflavonoids and astragalosides varied in different species. In distinction, A. membranaceus and A. membranaceus var. mongolicus contained a higher amount of astragaloside I and IV. In addition, the main constituents of A. membranaceus var.mongholicus changed according to seasonal variation and age of the plant. The chemical composition of different species of Astragalus would provide useful information for the quality control of Radix Astragali.

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