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Girma S, Amogne W. Investigating latent syphilis in HIV treatment-experienced Ethiopians and response to therapy. PLoS One 2022; 17:e0270878. [PMID: 35819944 PMCID: PMC9275702 DOI: 10.1371/journal.pone.0270878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 06/17/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives We investigated people with HIV (PWH) receiving combination antiretroviral therapy (cART) for latent syphilis infection prevalence, risk factors, treatment response, and neurosyphilis. Methods A prospective follow-up study was conducted on PWH and latent syphilis. The cases were randomly assigned to receive either benzathine penicillin G (BPG) or doxycycline (DOXY), and the posttreatment response was evaluated after 12 and 24 months. The traditional algorithm was used for serodiagnosis, and a semi-quantitative rapid plasma reagin (RPR) test monitored disease activity and treatment effectiveness. Results Of the 823 participants, 64.8% were women, and the mean age was 41.7±10 years. Thirty-one (3.8%) of the participants (22 males and nine females) had latent syphilis. The risk factors were male sex (aOR = 3.14), increasing age (aOR = 1.04 per year), and cART duration (aOR = 1.01 per month). Baseline RPR titers were: ≤1:4 in 19 (61.3%), between 1:8 and 1:32 in 10 (32.2%), and >1:32 in 2 (6.4%). None of the seven cerebrospinal fluid analyses supported a neurosyphilis diagnosis. In the 12th month of treatment, 27 (87.1%) had adequate serological responses, three (9.7%) had serological nonresponse, and one (3.2%) had treatment failure. Syphilis treatment was repeated in the last four cases with the alternative drug. In terms of adequate serologic response, both therapies were comparable at the 12th month, p = 0.37. All cases responded to treatment in the 24th month. Conclusion In PWH receiving cART, latent syphilis occurred more in men than women, suggesting an investigation of sexual practices and the impact of antenatal syphilis screening. Syphilis disease activity reduces in the latent stage. Therefore, the routine cerebrospinal fluid analysis contributes little to the diagnosis of asymptomatic neurosyphilis and the treatment success of latent syphilis. DOXY is an alternative to BPG, and cART improves serologic response to latent syphilis treatment.
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Affiliation(s)
- Selamawit Girma
- College of Health Sciences, School of Medicine, Department of Dermatovenerology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondwossen Amogne
- College of Health Sciences, School of Medicine, Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail: ,
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Choi EPH, Fong DYT, Wong JYH. The use of the Multidimensional Condom Attitude Scale in Chinese young adults. Health Qual Life Outcomes 2020; 18:331. [PMID: 33032622 PMCID: PMC7545565 DOI: 10.1186/s12955-020-01577-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/23/2020] [Indexed: 12/24/2022] Open
Abstract
Background Attitude towards condom use is an important predictor of consistent condom use. However, this topic is an understudied area in Chinese populations, and no validated Chinese instrument is available to capture condom attitude. To fill this research gap, the present study aimed to evaluate the psychometric properties of the University of California, Los Angeles (UCLA) Multidimensional Condom Attitudes Scale (MCAS) and assessed the attitudes towards condom use amongst Chinese adults aged 18–29 years old.
Methods In this cross-sectional study, a total of 500 people aged 18–29 years old were randomly recruited in Hong Kong. The primary outcome was the attitude towards condom use as measured by the UCLA MCAS. Factor structure, internal construct validity, known-group validity and internal consistency were assessed. Results Instead of the five-factor structure designed by the original developers of the MCAS questionnaire, this study proposed a novel six-factor scale: (1) Reliability and Effectiveness, (2) Excitement, (3) Displeasure, (4) Identity Stigma, (5) Embarrassment about Negotiation and (6) Embarrassment about Purchase. The internal construct validity and reliability of the new scale were high. The revised MCAS could differentiate between subgroups, including gender, sexual orientation and sexual experience. In terms of attitudes, over 40% of the participants believed that condoms are not reliable, though the vast majority of the sample did not perceive any stigma related to condom use. In addition, more than half (55.4%) of the respondents felt embarrassed to be seen when buying condoms while a quarter (25.8%) felt uncomfortable buying condoms at all. Conclusions Overall, the psychometric analysis found that attitude to condom use is culturally specific. The study also highlighted the need for more public health campaigns and interventions to help people cope with the embarrassment of purchasing condoms.
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Affiliation(s)
- Edmond Pui Hang Choi
- School of Nursing, The University of Hong Kong, Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pok Fu Lam, Hong Kong.
| | - Daniel Yee Tak Fong
- School of Nursing, The University of Hong Kong, Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pok Fu Lam, Hong Kong
| | - Janet Yuen Ha Wong
- School of Nursing, The University of Hong Kong, Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pok Fu Lam, Hong Kong
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RETRACTED: No glove, no love: General intelligence predicts increased likelihood of condom use in response to HIV threat. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020. [DOI: 10.1016/j.paid.2020.109813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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4
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Diverging trends in incidence of HIV versus other sexually transmitted infections in HIV-negative MSM in Amsterdam. AIDS 2020; 34:301-309. [PMID: 31714354 DOI: 10.1097/qad.0000000000002417] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We investigated changes in incidence rates of HIV and sexually transmitted infections (STIs) and trends in sexual behavior in MSM from 2009 to 2017. DESIGN Open prospective cohort study. METHODS HIV-negative MSM enrolled in the Amsterdam Cohort Studies were included. Participants semiannually completed a questionnaire on sexual behavior and were tested for HIV-1, syphilis, and urethral, anal and pharyngeal chlamydia and gonorrhea. Time trends in incidence rates were analyzed using exponential survival models. RESULTS During follow-up, 42 of 905 MSM acquired HIV. The HIV incidence rate was 1.9/100 person-years [95% confidence interval (CI) 1.0-3.7] in 2009 and decreased to 0.5/100 person-years (95% CI 0.2-1.4) in 2017 (P = 0.03). The largest decrease was observed in participants aged at least 35 years (P = 0.005), while the trend remained stable in 18-34 year olds (P = 0.4). The incidence rate for any bacterial STI was 16.8/100 person-years (95% CI 13.4-21.0) in 2010, and increased to 33.1/100 person-years (95% CI 29.0-37.9) in 2017 (P < 0.001). Between 2009 and 2017, the percentage reporting condomless anal sex with casual partners increased from 26.9 to 39.4% (P < 0.001), and the mean number of casual partners from eight (95% CI 8-8) to 11 (95% CI 10-11) (P = 0.05). Condomless anal sex with steady partner(s) remained stable over time (P = 0.5). CONCLUSION Among MSM in Amsterdam, incidence rates of HIV versus other STI show diverging trends. The increase in STI incidence coincides with a decrease in condom use with casual partners. The decrease in HIV incidence, despite increased sexual risk behavior, suggests that other HIV prevention methods have been successful in reducing HIV transmission among MSM.
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Dieckhaus KD, Ha TH, Schensul SL, Sarna A. Modeling HIV Transmission from Sexually Active Alcohol-Consuming Men in ART Programs to Seronegative Wives. J Int Assoc Provid AIDS Care 2020; 19:2325958220952287. [PMID: 32851898 PMCID: PMC7457687 DOI: 10.1177/2325958220952287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The rollout of antiviral therapy in Low and Middle Income Countries (LMICs) has reduced HIV transmission rates at the potential risk of resistant HIV transmission. We sought to predict the risk of wild type and antiviral resistance transmissions in these settings. METHODS A predictive model utilizing viral load, ART adherence, genital ulcer disease, condom use, and sexual event histories was developed to predict risks of HIV transmission to wives of 233 HIV+ men in 4 antiretroviral treatment centers in Maharashtra, India. RESULTS ARV Therapy predicted a 5.71-fold reduction in transmissions compared to a model of using condoms alone, with 79.9%, of remaining transmissions resulting in primary ART-resistance. CONCLUSIONS ART programs reduce transmission of HIV to susceptible partners at a substantial increased risk for transmission of resistant virus. Enhanced vigilance in monitoring adherence, use of barrier protections, and viral load may reduce risks of resistant HIV transmissions in LMIC settings.
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Affiliation(s)
- Kevin D. Dieckhaus
- University of Connecticut Division of Infectious Diseases,
Farmington, CT, USA
| | - Toan H. Ha
- University of Pittsburgh Graduate School of Public Health,
Pittsburgh, PA, USA
| | - Stephen L. Schensul
- University of Connecticut Department of Community Medicine and
Healthcare, Farmington, CT, USA
| | - Avina Sarna
- Population Council, India Habitat Centre, New Delhi, India
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Rojas Castro D, Delabre RM, Molina J. Give PrEP a chance: moving on from the "risk compensation" concept. J Int AIDS Soc 2019; 22 Suppl 6:e25351. [PMID: 31468693 PMCID: PMC6715948 DOI: 10.1002/jia2.25351] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/24/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION While bio-behavioural interventions (BIs) for sexually transmitted infections (STIs) and HIV prevention have shown their effectiveness (e.g. treatment for syphilis, HPV vaccination or pre-exposure prophylaxis [PrEP]), they have also aroused major concerns regarding behavioural changes that could counteract their benefit. Risk compensation (RC) fears concerning BIs in the HIV/STIs prevention field are intimately linked to representations, judgements and social control on sexual behaviour. With an increasing number of PrEP studies describing a rise in STIs due to RC, this paper argues for a shift away from the focus on RC and proposes a more constructive approach to respond to the needs of people living with HIV and populations most at risk. DISCUSSION The concept of RC, stemming from road safety and derived from economic theory, relies on rational theoretical models of human behaviour. Although widely applied in several contexts its use has been reasonably questioned. Major methodological issues regarding RC have been raised within HIV/AIDS literature. Although behavioural changes (e.g. condomless sex and number of sexual partners) are often erroneously assimilated with RC, there is no evidence that behavioural changes have undermined the effectiveness of previous and current BIs. Still, PrEP has not escaped RC concerns. Increases in condomless sex within the context of growing uptake of PrEP signals a continued need for integrated and innovative HIV and STI prevention strategies and a comprehensive sexual health approach. Routine HIV/STI testing, peer-led counselling, and identification of sexual health needs within the PrEP model of care could become a gold standard in the sexual health field for all populations. CONCLUSIONS RC remains a frequent argument against the availability and provision of prevention methods for vulnerable populations. Individuals should be able to benefit from the full panel of BIs options available, to find and adapt methods according to their needs. Current, past and future PrEP users, with other stakeholders, may provide valuable insight into innovative solutions and programmes to control HIV and other STIs.
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Affiliation(s)
- Daniela Rojas Castro
- Coalition PLUSCommunity‐based Research LaboratoryPantinFrance
- Aix Marseille UnivINSERM, IRD, SESSTIMSciences Economiques & Sociales de la Santé & Traitement de l'Information MédicaleMarseilleFrance
| | | | - Jean‐Michel Molina
- Department of Infectious DiseasesHôpital Saint‐LouisAssistance Publique Hôpitaux de ParisParisFrance
- INSERM, UMR 941Université de Paris Diderot Paris 7Sorbonne Paris CitéParisFrance
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Grillová L, Oppelt J, Mikalová L, Nováková M, Giacani L, Niesnerová A, Noda AA, Mechaly AE, Pospíšilová P, Čejková D, Grange PA, Dupin N, Strnadel R, Chen M, Denham I, Arora N, Picardeau M, Weston C, Forsyth RA, Šmajs D. Directly Sequenced Genomes of Contemporary Strains of Syphilis Reveal Recombination-Driven Diversity in Genes Encoding Predicted Surface-Exposed Antigens. Front Microbiol 2019; 10:1691. [PMID: 31417509 PMCID: PMC6685089 DOI: 10.3389/fmicb.2019.01691] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/09/2019] [Indexed: 11/13/2022] Open
Abstract
Syphilis, caused by Treponema pallidum subsp. pallidum (TPA), remains an important public health problem with an increasing worldwide prevalence. Despite recent advances in in vitro cultivation, genetic variability of this pathogen during infection is poorly understood. Here, we present contemporary and geographically diverse complete treponemal genome sequences isolated directly from patients using a methyl-directed enrichment prior to sequencing. This approach reveals that approximately 50% of the genetic diversity found in TPA is driven by inter- and/or intra-strain recombination events, particularly in strains belonging to one of the defined genetic groups of syphilis treponemes: Nichols-like strains. Recombinant loci were found to encode putative outer-membrane proteins and the recombination variability was almost exclusively found in regions predicted to be at the host-pathogen interface. Genetic recombination has been considered to be a rare event in treponemes, yet our study unexpectedly showed that it occurs at a significant level and may have important impacts in the biology of this pathogen, especially as these events occur primarily in the outer membrane proteins. This study reveals the existence of strains with different repertoires of surface-exposed antigens circulating in the current human population, which should be taken into account during syphilis vaccine development.
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Affiliation(s)
- Linda Grillová
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia.,Biology of Spirochetes Unit, Institut Pasteur, Paris, France
| | - Jan Oppelt
- CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czechia.,National Centre for Biomolecular Research, Faculty of Science, Masaryk University, Brno, Czechia
| | - Lenka Mikalová
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Markéta Nováková
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States.,Department of Global Health, Harborview Medical Center, University of Washington, Seattle, WA, United States
| | - Anežka Niesnerová
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Angel A Noda
- Department of Mycology-Bacteriology, Instituto de Medicina Tropical "Pedro Kourí", Havana, Cuba
| | - Ariel E Mechaly
- Plateforme de Cristallographie, Institut Pasteur, Paris, France
| | - Petra Pospíšilová
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Darina Čejková
- Department of Immunology, Veterinary Research Institute, Brno, Czechia
| | - Philippe A Grange
- Faculté de Médecine, Laboratoire de Dermatologie-CNR IST Bactériennes, Institut Cochin U1016, Université Sorbonne Paris Descartes, Paris, France
| | - Nicolas Dupin
- Faculté de Médecine, Laboratoire de Dermatologie-CNR IST Bactériennes, Institut Cochin U1016, Université Sorbonne Paris Descartes, Paris, France.,AP-HP, Service de Dermatologie et Vénéréologie, Groupe Hospitalier Paris Centre Cochin-Hôtel Dieu-Broca, Paris, France
| | - Radim Strnadel
- Department of Dermatovenerology, University Hospital Brno, Brno, Czechia
| | - Marcus Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Ian Denham
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Natasha Arora
- Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | | | | | - R Allyn Forsyth
- GeneticPrime Dx, Inc., La Jolla, CA, United States.,Department of Biology, San Diego State University, San Diego, CA, United States
| | - David Šmajs
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia
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8
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Stenger MR, Baral S, Stahlman S, Wohlfeiler D, Barton JE, Peterman T. As through a glass, darkly: the future of sexually transmissible infections among gay, bisexual and other men who have sex with men. Sex Health 2019; 14:18-27. [PMID: 27585033 DOI: 10.1071/sh16104] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/28/2016] [Indexed: 12/24/2022]
Abstract
The trajectory of sexually transmissible infection (STI) incidence among gay and other men who have sex with men (MSM) suggests that incidence will likely remain high in the near future. STIs were hyperendemic globally among MSM in the decades preceding the HIV epidemic. Significant changes among MSM as a response to the HIV epidemic, caused STI incidence to decline, reaching historical nadirs in the mid-1990s. With the advent of antiretroviral treatment (ART), HIV-related mortality and morbidity declined significantly in that decade. Concurrently, STI incidence resurged among MSM and increased in scope and geographic magnitude. By 2000, bacterial STIs were universally resurgent among MSM, reaching or exceeding pre-HIV levels. While the evidence base necessary for assessing the burden STIs among MSM, both across time and across regions, continues to be lacking, recent progress has been made in this respect. Current epidemiology indicates a continuing and increasing trajectory of STI incidence among MSM. Yet increased reported case incidence of gonorrhoea is likely confounded by additional screening and identification of an existing burden of infection. Conversely, more MSM may be diagnosed and treated in the context of HIV care or as part of routine management of pre-exposure prophylaxis (PrEP), potentially reducing transmission. Optimistically, uptake of human papillomavirus (HPV) vaccination may lead to a near-elimination of genital warts and reductions in HPV-related cancers. Moreover, structural changes are occurring with respect to sexual minorities in social and civic life that may offer new opportunities, as well as exacerbate existing challenges, for STI prevention among MSM.
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Affiliation(s)
- Mark Richard Stenger
- US Centers for Disease Control and Prevention - Division of STD Prevention, Mail Stop E-63 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Stefan Baral
- Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, 615N. Wolfe Street, Baltimore, MD 21205, USA
| | - Shauna Stahlman
- Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, 615N. Wolfe Street, Baltimore, MD 21205, USA
| | - Dan Wohlfeiler
- University of California San Francisco, San Francisco, CA 94143, USA
| | - Jerusha E Barton
- US Centers For Disease Control and Prevention - Division of STD Prevention (ORISE Fellow), Mailstop E-63, Atlanta, GA 30333, USA
| | - Thomas Peterman
- Centers for Disease Control and Prevention - Division of STD Prevention, Mailstop E-02 CDC, Atlanta, GA 30333, USA
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Almeida VCD, Donalisio MR, Cordeiro R. Factors associated with reinfection of syphilis in reference centers for sexually transmitted infections. Rev Saude Publica 2017; 51:64. [PMID: 28678903 PMCID: PMC5477707 DOI: 10.1590/s1518-8787.2017051006432] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 06/25/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We aim to analyze trend of syphilis and factors associated with recurrent episodes of syphilis among adults and adolescents attended in a STI/AIDS reference centers in Campinas, state of São Paulo, 2004 to 2012. METHODS Medical records, pharmacy data, and notification database were accessed to analyze trends of syphilis and sociodemographic, epidemiological and clinical variables associated with reinfection of syphilis. After univariate analysis, a hierarchical logistic regression model was adjusted to analyze variables associated with more than one episode of syphilis (dependent variable). First step (sex, age, and years of schooling) were tested and in the second, epidemiological and clinical variables. RESULTS A total of 1,009 episodes of syphilis were identified among 860 adolescents and adults, 117 individuals (13.6%) presented with more than one episode of syphilis. Factors associated with more than one episode of syphilis were sex (male) (OR = 4.28; 95%CI 1.31–14.0), age (OR = 1.02; 95%CI 1.00–1.04), homosexual/bisexual orientation (OR = 2.29; 95%CI 1.22–4.32), HIV coinfection (OR = 3.54; 95%CI 2.22–5.63), and absence of STI symptoms at the time of syphilis diagnostic (OR = 1.70; 95%CI 1.03–2.80). CONCLUSIONS The number of cases of syphilis and proportion in relation to STI increased in recent years in a specific population attended in a STI/AIDS reference centers in Campinas. Association with HIV, homosexual/bisexual orientation and the silent clinical characteristic of cases confirm the necessity to implement more aggressive strategies to prevent the occurrence of syphilis and other STI in specific populations with higher disease risk.
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Affiliation(s)
- Valéria Correa de Almeida
- Faculdade de Medicina São Leopoldo Mandic.,Secretaria Municipal de Saúde de Campinas. Campinas, SP, Brasil
| | - Maria Rita Donalisio
- Departamento de Saúde Coletiva. Faculdade de Ciências Médicas da Unicamp. Campinas, SP, Brasil
| | - Ricardo Cordeiro
- Departamento de Saúde Coletiva. Faculdade de Ciências Médicas da Unicamp. Campinas, SP, Brasil
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Masuda N, Holme P. Toward a Realistic Modeling of Epidemic Spreading with Activity Driven Networks. TEMPORAL NETWORK EPIDEMIOLOGY 2017. [PMCID: PMC7123080 DOI: 10.1007/978-981-10-5287-3_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Models of epidemic spreading are widely used to predict the evolution of an outbreak, test specific intervention scenarios, and steer interventions in the field. Compartmental models are the most common class of models. They are very effective for qualitative analysis, but they rely on simplifying assumptions, such as homogeneous mixing and time scale separation. On the other end of the spectrum, detailed agent-based models, based on realistic mobility pattern models, provide extremely accurate predictions. However, these models require significant computing power and are not suitable for analytical treatment. Our research aims at bridging the gap between these two approaches, toward time-varying network models that are sufficiently accurate to make predictions for real-world applications, while being computationally affordable and amenable to analytical treatment. We leverage the novel paradigm of activity driven networks (ADNs), a particular type of time-varying network that accounts for inherent inhomogeinities within a population. Starting from the basic incarnation of ADNs, we expand on the framework to include behavioral factors triggered by health status and spreading awareness. The enriched paradigm is then utilized to model the 2014–2015 Ebola Virus Disease (EVD) spreading in Liberia, and perform a what-if analysis on the timely application of sanitary interventions in the field. Finally, we propose a new formulation, which is amenable to analytical treatment, beyond the mere computation of the epidemic threshold.
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Affiliation(s)
- Naoki Masuda
- Department of Engineering Mathematics, University of Bristol, Bristol, United Kingdom
| | - Petter Holme
- Institute of Innovative Research, Tokyo Institute of Technology, Yokohama, Japan
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11
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Rietmeijer CA, Donnelly J, Bernstein KT, Bissette JM, Martins S, Pathela P, Schillinger JA, Stenger MR, Weinstock H, Newman LM. Here Comes the SSuN: Early Experiences with the STD Surveillance Network. Public Health Rep 2016; 124 Suppl 2:72-7. [PMID: 27382657 DOI: 10.1177/00333549091240s211] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In 2005, the Centers for Disease Control and Prevention established the STD Surveillance Network (SSuN), a sentinel surveillance system comprising local, enhanced sexually transmitted disease (STD) surveillance systems that follow common protocols. The purpose of SSuN is to improve the capacity of national, state, and local STD programs to detect, monitor, and respond rapidly to trends in STDs through enhanced collection, reporting, analysis, visualization, and interpretation of clinical, behavioral, and geographic information obtained from a geographically diverse sample of individuals diagnosed with STDs. To demonstrate the utility of a national sentinel surveillance network, this article reviews the lessons learned from the first three years of SSuN, which, through its enhanced gonorrhea and genital warts sentinel surveillance projects, has proved to be a useful adjunct to routine STD surveillance in the U.S. that can be expanded into other areas of STD public health interest.
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Affiliation(s)
- Cornelis A Rietmeijer
- Denver Public Health Department, Denver, CO; University of Colorado Denver, School of Public Health, Denver, CO
| | | | | | | | | | - Preeti Pathela
- New York City Department of Health and Mental Hygiene, New York, NY
| | - Julia A Schillinger
- New York City Department of Health and Mental Hygiene, New York, NY; Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Lori M Newman
- Centers for Disease Control and Prevention, Atlanta, GA
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12
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Sewell J, Speakman A, Phillips AN, Lampe FC, Miltz A, Gilson R, Asboe D, Nwokolo N, Scott C, Day S, Fisher M, Clarke A, Anderson J, O'Connell R, Apea V, Dhairyawan R, Gompels M, Farazmand P, Allan S, Mann S, Dhar J, Tang A, Sadiq ST, Taylor S, Collins S, Sherr L, Hart G, Johnson AM, Miners A, Elford J, Rodger A. A Cross-Sectional Study on Attitudes to and Understanding of Risk of Acquisition of HIV: Design, Methods and Participant Characteristics. JMIR Res Protoc 2016; 5:e58. [PMID: 27091769 PMCID: PMC4858591 DOI: 10.2196/resprot.4873] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 11/05/2015] [Accepted: 11/29/2015] [Indexed: 11/13/2022] Open
Abstract
Background The annual number of new human immunodeficiency virus (HIV) infections in the United Kingdom among men who have sex with men (MSM) has risen, and remains high among heterosexuals. Increasing HIV transmission among MSM is consistent with evidence of ongoing sexual risk behavior in this group, and targeted prevention strategies are needed for those at risk of acquiring HIV. Objective The Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) study was designed to collect information on HIV negative adults at risk of HIV infection in the United Kingdom, based on the following parameters: physical and mental health, lifestyle, patterns of sexual behaviour, and attitudes to sexual risk. Methods Cross-sectional questionnaire study of HIV negative or undiagnosed sexual health clinic attendees in the United Kingdom from 2013-2014. Results Of 2630 participants in the AURAH study, 2064 (78%) were in the key subgroups of interest; 580 were black Africans (325 females and 255 males) and 1484 were MSM, with 27 participants belonging to both categories. Conclusions The results from AURAH will be a significant resource to understand the attitudes and sexual behaviour of those at risk of acquiring HIV within the United Kingdom. AURAH will inform future prevention efforts and targeted health promotion initiatives in the HIV negative population.
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Affiliation(s)
- Janey Sewell
- Institute of Epidemiology and Health Care, Research Department of Infection and Population Health, UCL, London, United Kingdom.
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13
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Saad-Roy CM, Shuai Z, van den Driessche P. A mathematical model of syphilis transmission in an MSM population. Math Biosci 2016; 277:59-70. [PMID: 27071977 DOI: 10.1016/j.mbs.2016.03.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 02/01/2016] [Accepted: 03/31/2016] [Indexed: 10/22/2022]
Abstract
Syphilis is caused by the bacterium Treponema pallidum subspecies pallidum, and is a sexually transmitted disease with multiple stages. A model of transmission of syphilis in an MSM population (there has recently been a resurgence of syphilis in such populations) that includes infection stages and treatment is formulated as a system of ordinary differential equations. The control reproduction number is calculated, and it is proved that if this threshold parameter is below one, syphilis dies out; otherwise, if it is greater than one, it is shown that there exists a unique endemic equilibrium and that for certain special cases, this equilibrium is globally asymptotically stable. Using data from the literature on MSM populations, numerical methods are used to determine the variation and robustness of the control reproduction number with respect to the model parameters, and to determine adequate treatment rates for syphilis eradication. By assuming a closed population and no return to susceptibility, an epidemic model is obtained. Final outbreak sizes are numerically determined for various parameter values, and its variation and robustness to parameter value changes is also investigated. Results quantify the importance of early treatment for syphilis control.
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Affiliation(s)
- C M Saad-Roy
- Department of Mathematics and Statistics, University of Victoria, Victoria, BC V8W 2Y2, Canada.
| | - Zhisheng Shuai
- Department of Mathematics, University of Central Florida, Orlando, FL 32816, USA.
| | - P van den Driessche
- Department of Mathematics and Statistics, University of Victoria, Victoria, BC V8W 2Y2, Canada.
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Giuliani M, Vescio MF, Donà MG, Latini A, Frasca M, Colafigli M, Farinella M, Rezza G, Cristaudo A. Perceptions of Human Papillomavirus (HPV) infection and acceptability of HPV vaccine among men attending a sexual health clinic differ according to sexual orientation. Hum Vaccin Immunother 2016; 12:1542-50. [PMID: 26752151 DOI: 10.1080/21645515.2015.1115935] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Our aim was to gain a better understanding of the knowledge about Human Papillomavirus (HPV) infection and attitudes toward the HPV vaccine among men at risk for sexually transmitted infections (STI). A self-administered questionnaire was completed by attendees of the largest STI Center in Rome, Italy, from April to June 2013. Determinants of vaccine acceptability were investigated using a Structured Equation Model. A total of 423 males participated in the survey: 296 (70.0%) men who have sex with men (MSM) and 127 (30.0%) men who have sex with women (MSW). Only one half of the participants knew that HPV is the cause of genital warts (56.9% of MSM vs. 49.5% of MSW, p=0.28). Even less were aware that HPV causes cancer in men (37.2% vs. 27.3%, p=0.08). MSW were more likely to indicate HPV as a cause of cervical cancer (80.8% vs. 69.3%, p=0.03) and to have heard about the vaccine (58.3 vs. 43.6%, p=0.01). Moreover, 72.1% of MSM and 70.3% of MSW were willing to be vaccinated. A rise of one-unit in the HPV awareness score increased the OR of vaccine acceptability among MSM by 25% (OR 1.25, 95%CI: 1.05-1.49; p=0.013). Differently, only attitudes had a relevant effect on willingness to be vaccinated among MSW (OR 3.32, 95%CI: 1.53-7.17; p=0.002). Efforts should be made to maximize awareness of HPV, especially as a causative agent of genital warts and male cancers, and to reinforce positive attitudes toward vaccination among men visiting STI centers.
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Affiliation(s)
- Massimo Giuliani
- a STI/HIV Unit, UOC Dermatologia Infettiva e Allergologica, San Gallicano Dermatological Institute (IRCCS) , Rome , Italy
| | - Maria Fenicia Vescio
- b Infectious, Parasitic and Immunomediated Diseases Department , Istituto Superiore di Sanità , Rome , Italy
| | - Maria Gabriella Donà
- a STI/HIV Unit, UOC Dermatologia Infettiva e Allergologica, San Gallicano Dermatological Institute (IRCCS) , Rome , Italy
| | - Alessandra Latini
- a STI/HIV Unit, UOC Dermatologia Infettiva e Allergologica, San Gallicano Dermatological Institute (IRCCS) , Rome , Italy
| | - Mirko Frasca
- a STI/HIV Unit, UOC Dermatologia Infettiva e Allergologica, San Gallicano Dermatological Institute (IRCCS) , Rome , Italy
| | - Manuela Colafigli
- a STI/HIV Unit, UOC Dermatologia Infettiva e Allergologica, San Gallicano Dermatological Institute (IRCCS) , Rome , Italy
| | | | - Giovanni Rezza
- b Infectious, Parasitic and Immunomediated Diseases Department , Istituto Superiore di Sanità , Rome , Italy
| | - Antonio Cristaudo
- a STI/HIV Unit, UOC Dermatologia Infettiva e Allergologica, San Gallicano Dermatological Institute (IRCCS) , Rome , Italy
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Wang LH, Yan J, Yang GL, Long S, Yu Y, Wu XL. Prevalence of consistent condom use with various types of sex partners and associated factors among money boys in Changsha, China. J Sex Med 2015; 12:936-45. [PMID: 25615688 DOI: 10.1111/jsm.12821] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Money boys with inconsistent condom use (less than 100% of the time) are at high risk of infection by human immunodeficiency virus (HIV) or sexually transmitted infection (STI), but relatively little research has examined their risk behaviors. AIM We investigated the prevalence of consistent condom use (100% of the time) and associated factors among money boys. METHODS A cross-sectional study using a structured questionnaire was conducted among money boys in Changsha, China, between July 2012 and January 2013. MAIN OUTCOME MEASURE Independent variables included socio-demographic data, substance abuse history, work characteristics, and self-reported HIV and STI history. Dependent variables included the consistent condom use with different types of sex partners. RESULTS Among the participants, 82.4% used condoms consistently with male clients, 80.2% with male sex partners, and 77.1% with female sex partners in the past 3 months. A multiple stepwise logistic regression model identified four statistically significant factors associated with lower likelihoods of consistent condom use with male clients: age group, substance abuse, lack of an "employment" arrangement, and having no HIV test within the prior 6 months. In a similar model, only one factor associated significantly with lower likelihoods of consistent condom use with male sex partners was identified in multiple stepwise logistic regression analyses: having no HIV test within the prior six months. As for female sex partners, two significant variables were statistically significant in the multiple stepwise logistic regression analysis: having no HIV test within the prior 6 months and having STI history. CONCLUSIONS Interventions which are linked with more realistic and acceptable HIV prevention methods are greatly warranted and should increase risk awareness and the behavior of consistent condom use in both commercial and personal relationship.
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Affiliation(s)
- Lian-Hong Wang
- Nursing School of Central South University, Changsha, China; Nursing School of ZunYi Medical College, ZunYi, China
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Hu QH, Xu JJ, Zou HC, Liu J, Zhang J, Ding HB, Qian HZ, Li SR, Liu Y, Jiang YJ, Shang H, Wang N. Risk factors associated with prevalent and incident syphilis among an HIV-infected cohort in Northeast China. BMC Infect Dis 2014; 14:658. [PMID: 25471736 PMCID: PMC4265485 DOI: 10.1186/s12879-014-0658-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/24/2014] [Indexed: 11/23/2022] Open
Abstract
Background Sexually transmitted infections (STIs) increase HIV infectivity through local inflammatory processes. Prevalent and incident STIs among people who live with HIV/AIDS (PLWHA) are indicators of high-risk sexual behaviors and imply potential spread of HIV. Little is known about the prevalence and incidence of concurrent syphilis and associated risk behaviors among PLWHA in China. Methods A retrospective cohort study was conducted among PLWHA who attended the outpatient clinic of a designated AIDS treatment hospital in Shenyang, China, between March 2009 and May 2013. Physical examinations and syphilis serology were conducted at each visit. A questionnaire on demographic characteristics was also collected. Results A total of 1010 PLWHA were enrolled, of whom 77.0% were men who have sex with men (MSM). The baseline syphilis prevalence among PLWHA was 19.8% (95% confidence interval [CI]:17.3–22.3%). During follow-up, 78.3% retained in the cohort, and contributed a median follow-up of 9.4 months (interquartile range: 5.9-18.7 months). Syphilis incidence among PLWHA was 18.7 (95% CI: 15.5–21.8) per 100 person years. Mulitvariate logistic analysis showed that receiving antiretroviral therapy (ART) (adjusted OR [aOR] = 0.48), older age (≥40 years vs. ≤24 years, aOR = 2.43), being MSM (aOR = 2.30) and having higher baseline HIV viral load (>100000 copies/mL vs. ≤100000 copies/mL, aOR = 1.56) were independent predictors for syphilis infection among PLWHA at enrollment (p < 0.05 for all). Mulivariate Cox regression found that receiving ART (adjusted hazard ratio [aHR] = 1.81), older age (≥40 years vs. ≤24 years, aHR: 5.17) and MSM status (aHR = 2.68) were independent risk factors for syphilis seroconversion (each p < 0.05). Conclusions Syphilis prevalence and incidence were high among PLWHA in Shenyang. A campaign focusing on detection and treatment of syphilis among PLWHA is urgently needed, especially one with a focus on MSM who are at a higher risk for syphilis. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0658-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Qing-hai Hu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Jun-jie Xu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Hua-chun Zou
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, 2052, Australia.
| | - Jing Liu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Jing Zhang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Hai-bo Ding
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA.
| | - Si-ruo Li
- English Department, University of Tennessee at Chattanooga, Chattanooga, TN, USA.
| | - Yu Liu
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA.
| | - Yong-jun Jiang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Hong Shang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Ning Wang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. .,National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Chang YH, Liu WC, Chang SY, Wu BR, Wu PY, Tsai MS, Hung CC, Lew-Ting CY. Associated factors with syphilis among human immunodeficiency virus-infected men who have sex with men in Taiwan in the era of combination antiretroviral therapy. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 47:533-41. [DOI: 10.1016/j.jmii.2013.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 09/04/2013] [Accepted: 11/04/2013] [Indexed: 10/25/2022]
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Giuliani M, Vescio MF, Latini A, Palamara G, Pimpinelli F, Dona MG, Stivali F, Carduccelli F, Ensoli F, Di Carlo A, Rezza G. Continuous increase in HIV-1 incidence after the year 2000 among men who have sex with men in Rome: insights from a 25-year retrospective cohort study. ACTA ACUST UNITED AC 2014; 19:20969. [PMID: 25443035 DOI: 10.2807/1560-7917.es2014.19.47.20969] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To assess trends in HIV-1 incidence and risk factors for seroconversion among men who have sex with men (MSM) resident in Rome, Italy, a retrospective longitudinal cohort study was conducted over 25 years. Incidence rates and trends were modelled using Poisson regression and risk factors were assessed by multivariate Cox models. Of 1,862 HIV-1-negative individuals, 347 seroconverted during follow-up. HIV-1 incidence rates increased from 5.2/100 persons/year (p/y) in 1986 (95% confidence interval (CI): 2.3–11.5) to 9.2/00 p/y in 1992 (95% CI: 6.4–13.0), decreased to 1.3/100 p/y in 2001 and increased until 2009 (11.7/100 p/y; 95% CI: 7.4–18.6). The risk of HIV-1 seroconversion increased during the study period in younger MSM (incidence rate ratio (IRR) = 17.18; 95% CI: 9.74–30.32 in 16–32 year-olds and IRR = 5.09; 95% CI: 2.92–8.87 in 33–41 year-olds) and in those who acquired syphilis (IRR = 7.71; 95% CI: 5.00–11.88). In contrast, the risk of seroconversion decreased among highly educated MSM (IRR = 0.54; 95% CI: 0.35–0.82) and those without Italian citizenship (IRR = 0.45; 95% CI: 0.28–0.71). The HIV epidemic in MSM living in Rome continues to expand. Targeted prevention programmes against sexually transmitted infections to enhance knowledge transfer and behavioural skills are urgently required.
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Affiliation(s)
- M Giuliani
- STI/HIV Unit, San Gallicano Dermatological Institute, Rome, Italy
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Rizzo A, Frasca M, Porfiri M. Effect of individual behavior on epidemic spreading in activity-driven networks. PHYSICAL REVIEW. E, STATISTICAL, NONLINEAR, AND SOFT MATTER PHYSICS 2014; 90:042801. [PMID: 25375543 DOI: 10.1103/physreve.90.042801] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Indexed: 05/03/2023]
Abstract
In this work we study the effect of behavioral changes of individuals on the propagation of epidemic diseases. Specifically, we consider a susceptible-infected-susceptible model over a network of contacts that evolves in a time scale that is comparable to the individual disease dynamics. The phenomenon is modeled in the context of activity-driven networks, in which contacts occur on the basis of activity potentials. To offer insight into behavioral strategies targeting both susceptible and infected individuals, we consider two separate behaviors that may emerge in respiratory syndromes and sexually transmitted infections. The first is related to a reduction in the activity of infected individuals due to quarantine or illness. The second is instead associated with a selfish self-protective behavior of susceptible individuals, who tend to reduce contact with the rest of the population on the basis of a risk perception. Numerical and theoretical results suggest that behavioral changes could have a beneficial effect on the disease spreading, by increasing the epidemic threshold and decreasing the steady-state fraction of infected individuals.
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Affiliation(s)
- Alessandro Rizzo
- Department of Mechanical and Aerospace Engineering, New York University Polytechnic School of Engineering, Six MetroTech Center, Brooklyn, New York 11201, USA
| | - Mattia Frasca
- Dipartimento di Ingegneria Elettrica, Elettronica e Informatica Università degli Studi di Catania, Viale A. Doria 6, 95126 Catania, Italy
| | - Maurizio Porfiri
- Department of Mechanical and Aerospace Engineering, New York University Polytechnic School of Engineering, Six MetroTech Center, Brooklyn, New York 11201, USA
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Where does treatment optimism fit in? Examining factors associated with consistent condom use among people receiving antiretroviral treatment in Rio de Janeiro, Brazil. AIDS Behav 2014; 18:1945-54. [PMID: 24531794 DOI: 10.1007/s10461-014-0711-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the era of highly active antiretrovirals, people living with HIV (PLWH) have resumed sexual activity in the context of longer and healthier lives, and thus the chances of transmitting the HIV virus, as well as the potential to be re-infected also increase. HIV treatment optimism has been found to be associated with sexual risk behaviors among PLWH in different settings. A cross sectional survey was conducted to examine the relationship between treatment optimism, safer sex burnout and consistent condom use as well as variables associated with treatment optimism in a sample of PLWH on antiretrovirals (ARVs) in Rio de Janeiro, Brazil (n = 604). Seventy-two percent of participants always used a condom in the last 6 months. Homosexual, bisexual, transexual persons were less likely to use condoms consistently than heterosexuals (AOR .58 CI .42-.78). Those who were treatment optimistic (AOR .46 CI .25-.88) were more likely not use a condom consistently in the past 6 months, as were participants who reported safer sex burnout (AOR .58 CI .36-.90). Sexual orientation, safer sex burnout, and lower education levels were significantly associated with higher treatment optimism in multivariate analysis. Study findings highlight the need to address psychosocial factors such as treatment optimism and safer sex burnout associated with lower consistent condom use among PLWH in Rio de Janeiro, Brazil.
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Koedijk FD, van Benthem BH, Vrolings EM, Zuilhof W, van der Sande MA. Increasing sexually transmitted infection rates in young men having sex with men in the Netherlands, 2006-2012. Emerg Themes Epidemiol 2014; 11:12. [PMID: 25170341 PMCID: PMC4147385 DOI: 10.1186/1742-7622-11-12] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/01/2014] [Indexed: 11/21/2022] Open
Abstract
Background Men having sex with men (MSM) remain the largest high-risk group involved in on-going transmission of sexually transmitted infections (STI), including HIV, in the Netherlands. As risk behaviour may change with age, it is important to explore potential heterogeneity in risks by age. To improve our understanding of this epidemic, we analysed the prevalence of and risk factors for selected STI in MSM attending STI clinics in the Netherlands by age group. Methods Analysis of data from the national STI surveillance system for the period 2006–2012. Selected STI were chlamydia, gonorrhoea, infectious syphilis and/or a new HIV infection. Logistic regression was used to identify factors associated with these selected STI and with overall STI positivity. Analyses were done separately for MSM aged younger than 25 years and MSM aged 25 years and older. Results In young MSM a significant increase in positivity rate was seen over time (p < 0.01), mainly driven by increasing gonorrhoea diagnoses, while in MSM aged 25 and older a significant decrease was observed (p < 0.01). In multivariate analyses for young MSM, those who were involved in commercial sex were at higher risk (OR: 1.5, 95% CI: 1.2-1.9). For MSM aged 25 years and older this was not the case. Having a previous negative HIV test was protective among older MSM compared to those not tested for HIV before (OR: 0.8, 95% CI: 0.8-0.8), but not among younger MSM. Conclusions MSM visiting STI clinics remain a high-risk group for STI infections and transmission, but are not a homogenous group. While in MSM aged older than 25 years, STI positivity rate is decreasing, positivity rate in young MSM increased over time. Therefore specific attention needs to be paid towards targeted counselling and reaching particular MSM sub-groups, taken into account different behavioural profiles.
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Affiliation(s)
- Femke Dh Koedijk
- Centre for Infectious Disease Control, RIVM National Institute of Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, Utrecht, The Netherlands ; Municipal Health Service Twente, Enschede, The Netherlands
| | - Birgit Hb van Benthem
- Centre for Infectious Disease Control, RIVM National Institute of Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, Utrecht, The Netherlands
| | | | - Wim Zuilhof
- STI AIDS Netherlands, Amsterdam, The Netherlands
| | - Marianne Ab van der Sande
- Centre for Infectious Disease Control, RIVM National Institute of Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, Utrecht, The Netherlands ; Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
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Montaner JS, Lima VD, Harrigan PR, Lourenço L, Yip B, Nosyk B, Wood E, Kerr T, Shannon K, Moore D, Hogg RS, Barrios R, Gilbert M, Krajden M, Gustafson R, Daly P, Kendall P. Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: the "HIV Treatment as Prevention" experience in a Canadian setting. PLoS One 2014; 9:e87872. [PMID: 24533061 PMCID: PMC3922718 DOI: 10.1371/journal.pone.0087872] [Citation(s) in RCA: 245] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 12/30/2013] [Indexed: 12/26/2022] Open
Abstract
Background There has been renewed call for the global expansion of highly active antiretroviral therapy (HAART) under the framework of HIV treatment as prevention (TasP). However, population-level sustainability of this strategy has not been characterized. Methods We used population-level longitudinal data from province-wide registries including plasma viral load, CD4 count, drug resistance, HAART use, HIV diagnoses, AIDS incidence, and HIV-related mortality. We fitted two Poisson regression models over the study period, to relate estimated HIV incidence and the number of individuals on HAART and the percentage of virologically suppressed individuals. Results HAART coverage, median pre-HAART CD4 count, and HAART adherence increased over time and were associated with increasing virological suppression and decreasing drug resistance. AIDS incidence decreased from 6.9 to 1.4 per 100,000 population (80% decrease, p = 0.0330) and HIV-related mortality decreased from 6.5 to 1.3 per 100,000 population (80% decrease, p = 0.0115). New HIV diagnoses declined from 702 to 238 cases (66% decrease; p = 0.0004) with a consequent estimated decline in HIV incident cases from 632 to 368 cases per year (42% decrease; p = 0.0003). Finally, our models suggested that for each increase of 100 individuals on HAART, the estimated HIV incidence decreased 1.2% and for every 1% increase in the number of individuals suppressed on HAART, the estimated HIV incidence also decreased by 1%. Conclusions Our results show that HAART expansion between 1996 and 2012 in BC was associated with a sustained and profound population-level decrease in morbidity, mortality and HIV transmission. Our findings support the long-term effectiveness and sustainability of HIV treatment as prevention within an adequately resourced environment with no financial barriers to diagnosis, medical care or antiretroviral drugs. The 2013 Consolidated World Health Organization Antiretroviral Therapy Guidelines offer a unique opportunity to further evaluate TasP in other settings, particularly within generalized epidemics, and resource-limited setting, as advocated by UNAIDS.
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Affiliation(s)
- Julio S.G. Montaner
- BC Centre for Excellence in HIV/AIDS, Providence Health Care, Vancouver, British Columbia, Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
| | - Viviane D. Lima
- BC Centre for Excellence in HIV/AIDS, Providence Health Care, Vancouver, British Columbia, Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - P. Richard Harrigan
- BC Centre for Excellence in HIV/AIDS, Providence Health Care, Vancouver, British Columbia, Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lillian Lourenço
- BC Centre for Excellence in HIV/AIDS, Providence Health Care, Vancouver, British Columbia, Canada
| | - Benita Yip
- BC Centre for Excellence in HIV/AIDS, Providence Health Care, Vancouver, British Columbia, Canada
| | - Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Evan Wood
- BC Centre for Excellence in HIV/AIDS, Providence Health Care, Vancouver, British Columbia, Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Kerr
- BC Centre for Excellence in HIV/AIDS, Providence Health Care, Vancouver, British Columbia, Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Shannon
- BC Centre for Excellence in HIV/AIDS, Providence Health Care, Vancouver, British Columbia, Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Moore
- BC Centre for Excellence in HIV/AIDS, Providence Health Care, Vancouver, British Columbia, Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert S. Hogg
- BC Centre for Excellence in HIV/AIDS, Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Rolando Barrios
- BC Centre for Excellence in HIV/AIDS, Providence Health Care, Vancouver, British Columbia, Canada
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Mark Gilbert
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mel Krajden
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Reka Gustafson
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Patricia Daly
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Perry Kendall
- Ministry of Health, Province of British Columbia, Victoria, British Columbia, Canada
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de Wit JBF, Adam PCG. Can treatment-based HIV prevention curb the epidemic among gay and other men who have sex with men? A narrative synthesis of increasing evidence for moderating and countervailing effects. Sex Health 2014; 11:137-45. [DOI: 10.1071/sh13142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 01/13/2014] [Indexed: 11/23/2022]
Abstract
As HIV epidemics among gay and other men who have sex with men (GMSM) persist worldwide, the importance of novel prevention approaches is recognised. Evidence that antiretroviral therapy (ART) can decrease the likelihood of infection is informing emerging HIV prevention approaches, encompassing early initiation of treatment as prevention by people living with HIV and use of antiretroviral drugs as pre-exposure prophylaxis for people presumed to be uninfected. Despite widespread excitement, robust evidence of the beneficial effects of ART-based HIV prevention for GMSM remains limited. Also, theoretical models project widely varying effects of ART-based prevention on the future course of HIV epidemics among GMSM, drawing attention to the possible moderating role of differences in the achievements of local HIV responses and the critical importance of sustained protective sexual practices into the future. Ecological analyses and simulations of ongoing epidemics in major gay communities illustrate that the preventive effects of ART in many settings are being offset by increased sexual risk-taking, as reflected in stable or increasing HIV infection rates. Also, the effects of scaling up HIV testing and treatment among GMSM in settings that are often considered prime examples of the success of ART-based prevention may be levelling as ‘scope for improvement’ diminishes. ART-based approaches further extend the HIV prevention toolkit and substantially increase people’s options to protect themselves and others. The future impact of ART-based prevention on HIV epidemics among GMSM ultimately depends on whether heralded responses offset, attenuate or compound the ongoing social and behavioural changes that drive increased sexual risk.
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He H, Wang M, Zaller N, Wang J, Song D, Qu Y, Sui X, Dong Z, Operario D, Zhang H. Prevalence of syphilis infection and associations with sexual risk behaviours among HIV-positive men who have sex with men in Shanghai, China. Int J STD AIDS 2013; 25:410-9. [DOI: 10.1177/0956462413512804] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The aims of this study were to understand the prevalence and correlates of syphilis infection among HIV-positive men who have sex with men (MSM) in Shanghai, China. A total of 200 HIV-positive MSM participants were recruited using “snowball” sampling. Participants were tested for syphilis and completed a one-time questionnaire which included demographic characteristics, sexual behaviours with male and female sexual partners, substance use, and use of antiretroviral medications. Prevalence of syphilis infection was 16.5%. Among HIV/syphilis co-infected participants, 63.6% reported having anal sex with male partners and 24.2% did not use condoms consistently during the past six months; 66.7% reported having oral sex with male partners and 51.5% reported unprotected oral sex during the past six months. Factors associated with testing seropositive for syphilis infection included receptive anal sex with a male partner in the past six months (AOR = 12.61, 90% CI = 2.38–66.89), illicit drug use in the past six months (AOR = 11.47, 90% CI = 2.47–53.45), and use of antiretroviral medication (AOR = 4.48, 90% CI = 1.43–14.05). These data indicate a need for “positive prevention” interventions targeting HIV-positive MSM in China.
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Affiliation(s)
- Huan He
- Department of Epidemiology and Health statistics, School of Public Health, Anhui Medical University, Hefei, PR China
| | - Min Wang
- Department of Epidemiology and Health statistics, School of Public Health, Anhui Medical University, Hefei, PR China
| | - Nickolas Zaller
- Department of Infectious Diseases, Alpert Medical School, Brown University, Providence, RI, USA
| | - Jun Wang
- Department of Epidemiology and Health statistics, School of Public Health, Anhui Medical University, Hefei, PR China
| | - Dandan Song
- Department of Epidemiology and Health statistics, School of Public Health, Anhui Medical University, Hefei, PR China
| | - Yuhuang Qu
- Beautiful Life Health Promotion Center, Shanghai, PR China
| | - Xin Sui
- Beautiful Life Health Promotion Center, Shanghai, PR China
| | - Zhengxin Dong
- Department of Epidemiology and Health statistics, School of Public Health, Anhui Medical University, Hefei, PR China
| | - Don Operario
- Program in Public Health, Brown University, Providence, USA
| | - Hongbo Zhang
- Department of Epidemiology and Health statistics, School of Public Health, Anhui Medical University, Hefei, PR China
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de Coul ELMO, Warning TD, Koedijk FDH. Sexual behaviour and sexually transmitted infections in sexually transmitted infection clinic attendees in the Netherlands, 2007-2011. Int J STD AIDS 2013; 25:40-51. [PMID: 23970630 DOI: 10.1177/0956462413491736] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
High annual figures of sexually transmitted infections (STIs) are diagnosed in the Netherlands despite significant efforts to control them. Herein, we analyse trends and determinants of STI diagnoses, co-infections, and sexual risks among visitors of 26 STI clinics between 2007 and 2011. We recorded increased positivity rates of STIs (chlamydia, syphilis, gonorrhoea, and/or HIV) in women and heterosexual men up to 12.6% and 13.4%, respectively, in 2011, while rates in men having sex with men (MSM) were stable but high (18.8%) through the documented years. Younger age, origin from Surinam/Antilles, history of previous STI, multiple partners, or a previous notification are the identified risk factors for an STI in this population. Known HIV-infected men (MSM and heterosexuals) were at highest risk for co-infections (relative rate heterosexual men: 15.6; MSM: 11.6). STI positivity rates remained high (MSM) or increased over time (women and heterosexual men), a fact that highlights the importance of continuing STI prevention. Most importantly, the very high STI co-infection rates among HIV-positive men requires intensified STI reduction strategies to put an end to the vicious circle of re-infection and spread of HIV and other STIs.
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Affiliation(s)
- E L M Op de Coul
- Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
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Man WYN, Kelly A, Worth H, Frankland A, Shih P, Kupul M, Lwin T, Mek A, Kepa B, Emori R, Akuani F, Cangah B, Walizopa L, Pirpir L, Nosi S, Siba PM. Sexual risk behaviour, marriage and ART: a study of HIV-positive people in Papua New Guinea. AIDS Res Ther 2013; 10:17. [PMID: 23805823 PMCID: PMC3699368 DOI: 10.1186/1742-6405-10-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 06/19/2013] [Indexed: 11/19/2022] Open
Abstract
Background The prevention of intimate partner transmission of HIV remains an important component of comprehensive HIV prevention strategies. In this paper we examine the sexual practices of people living with HIV on antiretroviral therapy (ART) in Papua New Guinea (PNG). Method In 2008, a total of 374 HIV-positive people over the age of 16 and on ART for more than two weeks were recruited using a non-probability, convenience sampling methodology. This accounted for around 18% of adults on ART at the time. A further 36 people participated in semi-structured interviews. All interviews were thematically analysed using NVivo qualitative data analysis software. Results Less than forty per cent (38%) of participants reported having had sexual intercourse in the six months prior to the survey. Marital status was by far the most important factor in determining sexual activity, but consistent condom use during vaginal intercourse with a regular partner was low. Only 46% reported consistent condom use during vaginal intercourse with a regular partner in the last six months, despite 77% of all participants reporting that consistent condom use can prevent HIV transmission. Consistent condom use was lowest amongst married couples and those in seroconcordant relationships. The vast majority (91.8%) of all participants with a regular heterosexual partner had disclosed their status to their partner. Qualitative data reinforced low rates of sexual activity and provided important insights into sexual abstinence and condom use. Conclusions Considering the importance of intimate partner transmission of HIV, these results on the sexual practices of people with HIV on ART in PNG suggest that one-dimensional HIV prevention messages focussing solely on condom use fail to account for the current practices and needs of HIV-positive people, especially those who are married and know their partners’ HIV status.
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Wang XB, Tucker JD, Yang L, Zheng H, Zhang F, Cohen MS, Yang B, Cai W. Unsafe Sex and STI Prevalence Among HIV-Infected Adults in Guangzhou, China: Opportunities to Deamplify Sexual HIV Transmission. AIDS Behav 2013; 17:1137-43. [PMID: 23054038 DOI: 10.1007/s10461-012-0322-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This project examined sexual behavior and STI prevalence among HIV-infected individuals in South China. Adult HIV-infected outpatients in Guangzhou, Guangdong Province, China completed a self-administered survey about behaviors and antiretroviral treatment. Participants were screened for syphilis, gonorrhea, and chlamydia. Univariate and multivariate relationships with any STI were calculated using logistic regression. 810 HIV-infected individuals participated and 3 refused. 52.5 % (n = 415) of individuals reported having sex in the past 3 months, among whom 26.4 % (n = 111) reported inconsistent condom use. 10.4 % (n = 84) of all individuals had at least one sexually transmitted infection (STI). HIV-infected individuals not on antiretroviral treatment had an increased STI risk (aOR 2.5, 95 % CI: 1.4-4.5, P = 0.002). Unsafe sex was markedly reduced among HIV-infected individuals on treatment, possibly a reflection of integrated ART initiation counseling. Improved STI services among HIVinfected individuals are urgently needed to deamplify sexual HIV transmission.
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Affiliation(s)
- Xiao B Wang
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Salado-Rasmussen K, Katzenstein TL, Gerstoft J, Cowan SA, Knudsen TB, Mathiesen L, Hoffmann S, Obel N. Risk of HIV or second syphilis infection in Danish men with newly acquired syphilis in the period 2000–2010. Sex Transm Infect 2012; 89:372-6. [DOI: 10.1136/sextrans-2012-050580] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Changes in sexual and drug-related risk behavior following antiretroviral therapy initiation among HIV-infected injection drug users. AIDS 2012; 26:2383-91. [PMID: 23079804 DOI: 10.1097/qad.0b013e32835ad438] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate whether HAART is associated with subsequent sexual and drug-related risk behavior compensation among injection drug users (IDUs). DESIGN A community-based cohort study of 362 HIV-infected IDUs initiating HAART in Baltimore, Maryland. METHODS HAART use and risk behavior was assessed at 8316 biannual study visits (median 23). Using logistic regression with generalized estimating equations (GEE), we examined the effect of HAART initiation on changes in risk behavior while adjusting for sociodemographics, alcohol use, CD4 cell count, year of initiation and consistency of HAART use. RESULTS At HAART initiation, participants were a median of 44.4 years old, 71.3% men and 95.3% African-American. In multivariable analysis, HAART initiation was associated with a 75% reduction in the likelihood of unprotected sex [adjusted odds ratio (aOR) 0.25; 95% confidence interval (CI), 0.19-0.32] despite no change in overall sexual activity (aOR 0.95; 0.80-1.12). Odds of any injecting decreased by 38% (aOR 0.62; 0.51-0.75) after HAART initiation. Among the subset of persistent injectors, needle-sharing increased nearly two-fold (aOR 1.99; 1.57-2.52). Behavioral changes were sustained for more than 5 years after HAART initiation and did not differ by consistency of HAART use. Reporting specific high-risk behaviors in the year prior to initiation was a robust predictor of engaging in those behaviors subsequent to HAART. CONCLUSION Overall, substantial declines in sexual risk-taking and active injecting argue against significant behavioral compensation among IDUs following HAART initiation. These data also provide evidence to support identifying persons with risky pre-HAART behavior for targeted behavioral intervention.
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Abstract
OBJECTIVE To review the evidence for antiretroviral 'treatment as prevention' for HIV transmission among MSM. METHODS We reviewed studies that assess the biological plausibility that virally suppressive antiretroviral therapy (ART) reduces HIV infectiousness via anal intercourse and the epidemiologic evidence of whether ART has played a role in attenuating HIV incidence among MSM. RESULTS Although ART treatment among MSM is likely to provide some preventive benefit, it is unknown whether it will reduce HIV infectiousness via anal intercourse to the same extent as via penile-vaginal intercourse. Additional research is needed on the pharmacokinetic properties of specific antiretroviral agents in the gastrointestinal tract. Estimates of risk behaviors and the incidence of HIV among MSM before and after the introduction and expansion of ART suggest that the population-level protective benefits of ART may be attenuated by a number of factors, most notably, continuing or increasing frequency of condomless anal intercourse and incidence of other sexually transmitted infections (STIs). Additional studies are needed on the impact of ART on HIV sexual risk behaviors and transmission among MSM outside of developed countries in North America, western Europe, and Australia. CONCLUSION The benefits of treatment as prevention for MSM are highly plausible, but not certain. In the face of these unknowns, treatment guidelines for earlier ART initiation should be considered within a combination prevention strategy that includes earlier diagnosis, expanded STI treatment, and structural and behavioral interventions.
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Heymans R, A Matser A, Bruisten SM, Heijman T, Geskus RB, Speksnijder AGCL, Davidovich U, de Vries HJC, Coutinho RA, Schim van der Loeff MF. Distinct Neisseria gonorrhoeae transmission networks among men who have sex with men in Amsterdam, The Netherlands. J Infect Dis 2012; 206:596-605. [PMID: 22693236 DOI: 10.1093/infdis/jis399] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Molecular typing was used to elucidate Neisseria gonorrhoeae transmission networks among men who have sex with men (MSM) in Amsterdam, the Netherlands. We determined whether clusters of patients infected with specific N. gonorrhoeae genotypes were related to various epidemiological characteristics. METHODS MSM (age ≥18 years) visiting the sexually transmitted infections (STI) clinic between July 2008 and August 2009 were eligible. After STI screening, participants completed a behavioral questionnaire concerning the previous 6 months. N. gonorrhoeae cultures were genotyped using multiple-locus variable-number tandem repeat analysis typing. RESULTS We obtained 278 N. gonorrhoeae-positive isolates from 240 MSM. Five large clusters (≥10 isolates), a unique sixth cluster (n = 9), and 8 smaller clusters (5-9 isolates) were identified. Prevalence of human immunodeficiency virus differed between clusters I and VI (P = .003), ranging from 27.8% to 100%. Receptive unprotected anal intercourse was frequently reported by MSM (51.8%) but did not differ significantly among clusters. Significant differences were identified concerning the participant's history of syphilis (P = .030), having met partners at a popular sex venue in Amsterdam (P = .048), and meeting partners outside Amsterdam (P = .036). CONCLUSIONS Distinct N. gonorrhoeae transmission networks were present in a mixed high-risk MSM population; concordance between clusters and epidemiological characteristics was present but not marked.
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Affiliation(s)
- Raymond Heymans
- Public Health Service (GGD) of Amsterdam, Cluster of Infectious Diseases, Department of Research, Postbox 2200, 1000 CE Amsterdam, The Netherlands
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Epidemiology of gonorrhoea-related hospitalisations in Spain between 1997 and 2006. SEXUAL & REPRODUCTIVE HEALTHCARE 2012; 3:89-92. [DOI: 10.1016/j.srhc.2011.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 11/29/2011] [Accepted: 12/02/2011] [Indexed: 11/23/2022]
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Heijman T, Geskus RB, Davidovich U, Coutinho RA, Prins M, Stolte IG. Less decrease in risk behaviour from pre-HIV to post-HIV seroconversion among MSM in the combination antiretroviral therapy era compared with the pre-combination antiretroviral therapy era. AIDS 2012; 26:489-95. [PMID: 22156971 DOI: 10.1097/qad.0b013e32834f9d7c] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To gain insight in the ongoing HIV transmission, we compared sexual risk behaviour pre-HIV and post-HIV seroconversion in 206 MSM participating in the Amsterdam Cohort Studies (1984-2008) before and after the introduction of combination antiretroviral therapy (cART). DESIGN AND METHODS MSM completed behavioural questionnaires and were tested for HIV antibodies every 6 months. Trends in anal intercourse and number of sex partners from 4 years before HIV seroconversion until 4 years after diagnosis were analysed with latent class random effects logistic regression models. RESULTS The risk of having unprotected anal intercourse (UAI) 1 year after HIV diagnosis decreased significantly when compared with 1 year before diagnosis in both the pre-cART era [difference, 30%; 95% confidence interval (CI), 22-36%] and cART era (difference, 19%; 95% CI, 9-30%). In contrast to a continuing decrease of UAI in the pre-cART era, the probability of UAI in the cART era increased again to preseroconversion levels (61%; 95% CI, 48-74%)) 4 years after diagnosis. CONCLUSION This study provides evidence that recently seroconverted MSM reduce their sexual risk behaviour following HIV diagnosis both in the pre-cART as well as the cART period. However, in the cART period this reduction in sexual risk behaviour is less and returns to pre-cART levels within 4 years. These findings not only confirm the need for early HIV testing but also make it clear that much more effort should go into identifying, counselling, and possibly treating recently seroconverted MSM who have been found to be one of the most important drivers of HIV transmission among MSM.
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Turchetti P, Pacella F, Pacella E, Mirisola C, Uccella I. An immunocompetent migrant presenting with neurosyphilis with an unusual unilateral papillitis: a case report. Eur J Med Res 2012; 17:3. [PMID: 22472320 PMCID: PMC3337542 DOI: 10.1186/2047-783x-17-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 02/14/2012] [Indexed: 11/13/2022] Open
Abstract
Unilateral papillitis caused by Treponema pallidum was found in an immunocompetent homosexual patient with severe vision loss who had received previous antibiotics treatment. Syphilis-related ocular manifestation is more common in the early stages of the disease and it can be associated with a central nervous system localization. In this patient, neurosyphilis was diagnosed on the basis of clinical and laboratory findings. Optical examination revealed unilateral papillitis in the left eye and no relative afferent pupillary defects. The patient underwent visual field examinations with conventional perimetry using the 30-2 program of the Humphrey Visual Field Analyzer, which indicated a blind spot enlargement in the left eye. Optical coherence tomography, visual evoked potentials (VEP), and fluorescein angiograms revealed inflammation of the optic nerve head with edematous and blurred margins. A reactive T. pallidum hemagglutination assay with low rapid plasma reagin (RPR) serum titer was performed; an HIV antibody test and MRI of the orbits and head with contrast gave negative results. Resolution of the ocular inflammation after intravenous penicillin treatment was obtained. The reported case illustrates the importance of early recognition of this treatable disease. The rise of syphilis, especially in urban areas, necessitates a high level of suspicion when dealing with patients with intraocular inflammation of unknown origin. Lues serology should be incorporated into routine laboratory diagnostics to aid in the detection of such cases. Considering the re-emergence of syphilis, screening of migrants from countries with high syphilis seroprevalences should be recommended.
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Affiliation(s)
- Paolo Turchetti
- National Institute for Health, Migration and Poverty (INMP/NIHMP), Rome, Italy
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35
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Clinical Guidelines for the Treatment and Prevention of Opportunistic Infections in HIV-infected Koreans. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.3.93] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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36
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Njabanou NM, Atashili J, Mbanya D, Mbu ER, Ikomey GM, Kefie CA, Kinge TN, Etogo D, Adimora AA, Ndumbe PM. Sexual behavior of HIV-positive women in Cameroon. J Int Assoc Provid AIDS Care 2011; 12:98-102. [PMID: 21951727 DOI: 10.1177/1545109711421640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed at describing the sexual behavior of HIV-positive women in Cameroon. In a cross-sectional study, 282 HIV-infected women were enrolled in 3 HIV-treatment clinics in Cameroon. Of the 282 participants, 257 had been diagnosed with HIV for more than 6 months. Approximately half (46.8%) of these 257 women reported no sex partners in the 6 months before the study; 42.9% had 1 partner; and 1.5% had more than 1 partner. There was a significant decrease in the number of partners, new partners, and an increase in condom use with these partners following HIV diagnosis (P value < .05). However, more than half (55.2%) of the sexually active participants reported inconsistent or no condom use during sexual intercourse. Although HIV-positive women tend to adopt less risky behavior after HIV diagnosis, a substantial proportion of sexually active ones still have risky behaviors. Reinforcing risk reduction programs for these women is imperative.
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Affiliation(s)
- Noella M Njabanou
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
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37
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Ramjee G. Antiretroviral-based microbicides and oral pre-exposure prophylaxis for HIV prevention. Future Virol 2011. [DOI: 10.2217/fvl.11.64] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Numerous HIV prevention options have been tested, with limited success. Microbicides have been the focus of research specifically targeted to prevent new infections among women. After decades of research using non-HIV-specific microbicides, we now have proof of concept for antiretroviral-based microbicides. Issues of drug resistance, frequency of HIV testing and adherence to treatment remain to be explored. Drugs used for HIV treatment and with good safety profiles have been shown to provide protection to men who have sex with men. Ethical issues surrounding cost, access, future design of HIV prevention trials and composition of the prevention package offered to trial participants remain. The role of advocacy and market research will be crucial to ensure effective interventions are accessed and supported. There is renewed hope in the HIV prevention field with collective efforts needed to ensure we get the new prevention tools and options into the hands of men and women at risk of HIV infection. The purpose of this paper is to provide a review of existing research and identify issues for future enquiry.
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Affiliation(s)
- Gita Ramjee
- HIV Prevention Research Unit, Medical Research Council, Durban, South Africa and Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Smith K, Powers KA, Kashuba AD, Cohen MS. HIV-1 treatment as prevention: the good, the bad, and the challenges. Curr Opin HIV AIDS 2011; 6:315-25. [PMID: 21646878 PMCID: PMC3666589 DOI: 10.1097/coh.0b013e32834788e7] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This work focuses on the use of antiretroviral agents to prevent the sexual transmission of HIV-1. RECENT FINDINGS Two randomized clinical trials demonstrated that antiretroviral agents provided before exposure to HIV-1 offer substantial protection, ostensibly directly proportional to the concentration of antiretroviral therapy (ART) in the genital secretions. Intense focus on the use of HIV treatment as prevention has led to publication of modeling exercises, ecological studies, and observational studies, most of which support the potential benefits of ART. However, the logistical requirements for successful use of ART for prevention are considerable. SUMMARY ART will serve as a cornerstone of combination prevention of HIV-1. Continued research will be essential to measure anticipated benefits and to detect implementation barriers and untoward consequences of such a program, especially increases in primary ART resistance.
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Affiliation(s)
- Kumi Smith
- Department of Epidemiology, University of North Carolina
| | - Kimberly A. Powers
- Department of Epidemiology, University of North Carolina
- Department of Medicine, University of North Carolina
| | - Angela D.M. Kashuba
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Myron S. Cohen
- Department of Epidemiology, University of North Carolina
- Department of Medicine, University of North Carolina
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, USA
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Nagelkerke NJD, Hontelez JAC, de Vlas SJ. The potential impact of an HIV vaccine with limited protection on HIV incidence in Thailand: a modeling study. Vaccine 2011; 29:6079-85. [PMID: 21718745 DOI: 10.1016/j.vaccine.2011.06.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 04/21/2011] [Accepted: 06/14/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND The RV144 trial on the ALVAC/AIDSVAX candidate HIV vaccine, carried out in Thailand, showed short-lived protection against infection. METHODS Using a deterministic compartmental model we explored the potential impact of this vaccine on heterosexual HIV transmission in Thailand. Both one-off vaccination strategies, as well as strategies with regular boosting, either annually or every two years, were explored. Both targeting the general adult population and prioritizing sex workers were modeled. The impact of risk compensation among high risk groups, as well as whether higher levels of safe sex in high risk groups could be an alternative to vaccination, was studied. RESULTS One-off vaccination campaigns had only transient effects, and boosting appears to be a key component of successful vaccination campaigns. Intensive vaccination campaigns may reduce HIV incidence by up to 75% after 10 years of vaccination. Targeting only sex workers has a smaller impact but has a more favorable cost-benefit ratio. Risk compensation has the potential of undoing much of the benefits of a vaccination program and may even increase incidence. In contrast, higher levels of safe sex among sex workers would provide a viable alternative to vaccinating this group. DISCUSSION The new vaccine holds promise for controlling HIV in Thailand and similar countries. In view of the short lived protection of the vaccine, regular boosting of immunity as well as avoidance of risk compensation are essential. Targeting sex workers would achieve the greatest reduction in incidence per vaccination and may be considered for expensive vaccines but its cost-effectiveness has to be compared to alternatives.
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Affiliation(s)
- Nico J D Nagelkerke
- Department of Community Medicine, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates.
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40
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Pearson CR, Cassels S, Kurth AE, Montoya P, Micek MA, Gloyd SS. Change in sexual activity 12 months after ART initiation among HIV-positive Mozambicans. AIDS Behav 2011; 15:778-87. [PMID: 21082338 PMCID: PMC3357499 DOI: 10.1007/s10461-010-9852-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We assessed sexual behaviors before and 12-months after ART initiation among 277 Mozambicans attending an HIV clinic. Measured behaviors included the number of sexual partners, condom use, concurrent relationships, disclosure of HIV status, alcohol use, and partners' serostatus. Compared to before ART initiation, increases were seen 12 months after ART in the proportion of participants who were sexually active (48% vs. 64% respondents, P < 0.001) and the proportion of participants with HIV-negative or unknown serostatus partners (45% vs. 80%, P < 0.001). Almost all (96%) concurrent partnerships reported at 12 months formed after ART initiation. Although reported correct and consist condom use increased, the number of unprotected sexual relationships remained the same (n = 45). Non-disclosure of HIV-serostatus to sexual partners was the only significant predictor of practicing unprotected sex with partners of HIV-negative or unknown serostatus. Sexual activity among HIV-positive persons on ART increased 12 months after ART initiation. Ongoing secondary transmission prevention programs addressing sexual activity with multiple partners, disclosure to partners and consistent condom use with serodisconcordant partners must be incorporated throughout HIV care programs.
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Affiliation(s)
- Cynthia R Pearson
- School of Social Work, Indigenous Wellness and Research Institute, University of Washington, Seattle, WA 98195-1525, USA.
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Segura M, Bautista CT, Marone R, Sosa Estani S, Rey J, Montano SM, Griemberg G, Weissenbacher M, Avila MM. HIV/STI co-infections, syphilis incidence, and hepatitis B vaccination: the Buenos Aires cohort of men who have sex with men. AIDS Care 2011; 22:1459-65. [PMID: 21154033 DOI: 10.1080/09540121003758556] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In a previous cohort study among 327 men who have sex with men (MSM) in Buenos Aires, an HIV incidence rate of 3.9 per 100 persons-year was reported. Using data from this study, we determined: (a) HIV/STI co-infections; (b) clinical manifestations of incident HIV infections; (c) syphilis incidence and its associated risk factors; and (d) adherence and immune response to hepatitis B virus (HBV) vaccine. During the cohort study, 12 incident HIV infections were found. Within this group, HIV infection alone was most frequent (42%), followed by co-infection of HIV/HBV (33%), and triple co-infection of HIV/HBV/syphilis (25%). The most frequent clinical manifestations among incident HIV cases were: pharyngitis, fever, lymphadenopathy, asthenia, and myalgia. Seven new syphilis infections were detected yielding an incidence rate of 2.4 (95% CI=1.07 - 4.73) per 100 persons-year. Sex work was the only significant risk factor associated with syphilis seroconversion (hazard rate=10.93, p-value=0.033). Only 7% of cohort participants reported having received HBV vaccine. Ninety-percent of the 204 cohort members who agreed to be vaccinated completed the HBV vaccination schedule with an immune response rate of 85%. Our findings suggest the need to increase the access to serologic testing for STI and HBV immunization, as well as the developing of effective HIV/STI behavioral and educational prevention programs among MSM in Buenos Aires.
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Affiliation(s)
- Marcela Segura
- Departamento de Microbiologia, Parasitologia e Inmunologia, Centro Nacional de Referencia para el SIDA, Universidad de Buenos Aires, Argentina
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Ongoing HIV-1 transmission among men who have sex with men in Amsterdam: a 25-year prospective cohort study. AIDS 2011; 25:493-501. [PMID: 21192230 DOI: 10.1097/qad.0b013e328342fbe9] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To examine the suggested resurgence of the HIV epidemic among men who have sex with men (MSM), we studied trends in HIV-1 incidence rates, sexual risk behaviour, risk factors for HIV-1 seroconversion, and source of HIV-1 infection among MSM in the Amsterdam Cohort Studies from 1984 to 2009. METHODS Trends in HIV-1 incidence and risk factors for HIV-1 infection were studied using Poisson regression. Trends in sexual risk behaviour were evaluated using logistic regression, correcting for intra-individual correlation via generalized estimating equations. Trends in the source of HIV-1 infection were modelled via logistic regression. RESULTS Of 1642 HIV-1-negative individuals, 217 seroconverted during follow-up. HIV-1 incidence rates strongly decreased from 8.6/100 person-years in 1985 to 1.3/100 person-years in 1992; remained relatively stable around 1.0/100 person-years between 1992 and 1996, and slowly increased to 2.0/100 person-years in 2009 (P = 0.14; linear trend 1996-2009). Reports of unprotected anal intercourse (UAI) increased significantly from 1996 onwards. HIV-1 seroconversion was associated with receptive UAI with casual partners, more than five sexual partners, a history of gonorrhoea (all in the preceding 6 months), and a lower educational level. Currently, MSM are more likely to have contracted HIV-1 from casual partners than from steady partners, but trends of recent years suggest that steady partners became a growing source with increasing age. CONCLUSIONS Following increases in sexual risk behaviour from 1996 onwards, HIV-1 continues to spread among MSM. Targeted prevention messages should continue to focus on sexual behaviour with casual partners, but also on sexual behaviour within steady relationships.
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Factors associated with condom use among HIV clients in stable relationships with partners at varying risk for HIV in Uganda. AIDS Behav 2010; 14:1055-65. [PMID: 20180008 DOI: 10.1007/s10461-010-9673-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In Africa, HIV infections occur mostly in stable relationships, yet little is known about the determinants of condom use in this context. We examined condom use among 272 coupled HIV clients in Uganda who had just screened for ART eligibility; 128 had an HIV-positive partner, 47 HIV-negative, and 97 a partner with unknown HIV status. Sixty-six percent reported unprotected sex with their partner over the past 6 months (57-70% across the three subgroups). Multiple variables among socioeconomic characteristics, physical health, social support, and psychosocial adjustment were correlated with condom use in bivariate analysis, but in multivariate analysis, condom use self-efficacy was the only predictor of condom use in the total sample and subgroups; church attendance and physical functioning were also predictors among unknown status couples. This analysis reveals high rates of unprotected sex among coupled HIV clients, regardless of partner's HIV status, and suggests multiple targets for prevention.
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Tawk HM, Simpson JM, Mindel A. Condom use in multi-partnered males: importance of HIV and hepatitis B status. AIDS Care 2010; 16:890-900. [PMID: 15385244 DOI: 10.1080/09540120412331290185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective of the research was to determine the demographic, sexual and social risk factors associated with condom use in 7,089 multi-partnered men attending the Sydney Sexual Health Centre. A review of computerized medical records from 1991 to 1999 was carried out. Males with two or more partners in the last three months were divided into three condom use groups: consistent, sometimes and never. Men reporting sex with men (MSM) were more likely to use condoms than men having sex with only women (p=0.001). HIV positive men were more likely to use condoms consistently than those who were negative (p=0.001). In HIV negative non-hepatitis-B carriers, factors independently associated with inconsistent condom use included alcohol consumption, intravenous drug use (odds ratio (OR) 0.6 (95% confidence interval (CI) 0.47-0.77)) and being married (OR 0.2 (95% CI 0.21-0.31)). Factors associated with consistent condom use were MSM (OR 1.8 (95% CI 1.26-2.49)) and having three or more partners in the last 3 months (OR 2.4 (95% CI 2.023-2.83)). In the 508 hepatitis B carriers, consistent condom users were less likely to be married or intravenous drug users (OR 0.4 (95% CI 0.23-0.85)). In the 200 HIV antibody positive men, those with three or more partners were less likely to be consistent condom users than those with two (OR 0.3 (95% CI 0.11-0.82)). The conclusions are that a small number of HIV positive men report unsafe sex with multiple partners. Health promotion activities should be directed at this group.
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Affiliation(s)
- H M Tawk
- Sexually Transmitted Infections Research Centre, University of Sydney, Westmead, Australia
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Ariza-Mejía MC, García-García L, Alvaro-Meca A, Gil-de-Miguel A, Gil-Prieto R. [Gonococcal infection related hospital admissions in Madrid: 1997-2006]. ENFERMERIA CLINICA 2010; 20:222-8. [PMID: 20619715 DOI: 10.1016/j.enfcli.2010.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 03/19/2010] [Accepted: 03/25/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Gonorrhoea is one of the most frequent sexually transmitted diseases in the world. It is a serious problem due to its morbidity, complications and associated sequelae. This study aims to estimate the frequency of hospitalisations due to gonococcal infection in Madrid between 1997 and 2006. METHOD A retrospective epidemiological study was performed using data from the National Epidemiological Surveillance System for hospital data (Minimum Basic Data Set, [MBDS]). All hospitalisations related to gonococcal infection in Madrid were analysed. Information on hospitalisation rates, mortality, fatality and stay were obtained and gathered by year, sex and age. RESULTS During this study period, 113 hospitalisations related to gonococcal infection were recorded (Spanish Version of the International Classification of Diseases, 9th Revision, Clinical Modification: ICD-9-CM codes 098.0 and 098.89, any diagnostic position) representing a hospitalisation rate of 0.21 per 100,000, mortality rate of 0.02 per 100,000 people and case-fatality rate of 9.73%. An increased rate of hospitalisation in children up to 4 years and adults older than 65 years was observed. CONCLUSION The hospitalisation rate in patients with gonococcal infection has decreased in recent years, but it is important to continue with existing public health and control policies and create new ones to reduce these figures.
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Affiliation(s)
- María Carmen Ariza-Mejía
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España.
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Gray RH, Tobian A, Kigozi G, Wawer MJ, Serwadda D. Commentary: male circumcision for prevention of heterosexual acquisition of HIV in men: perspective from a trial team. Int J Epidemiol 2010; 39:970-1. [PMID: 20624821 DOI: 10.1093/ije/dyq108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R H Gray
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
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Abstract
Antiretroviral therapy (ART) has the potential to prevent human immunodeficiency virus (HIV) transmission by reducing the concentration of HIV in blood and genital secretions. Indeed, mathematical models with favorable assumptions suggest the potential of ART to stop the spread of HIV infection. Empirical results from ecological and population-based studies and from several short-term observational studies involving HIV status-discordant heterosexual couples suggest that ART reduces the rate of HIV transmission. A multinational, randomized, controlled trial (National Institutes of Health HPTN052) examining the reliability and durability of ART as prevention of transmission in HIV status-discordant couples is under way. The latter and other studies also consider sexual risk-taking behavior and transmission of HIV-resistant variants when ART is used as prevention. Early HIV detection and treatment (ie, test and treat) are being considered as an important prevention strategy. In this article, we review the data supporting the use of ART to prevent HIV transmission and critically examine the public health implications of this strategy.
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Affiliation(s)
- Myron S Cohen
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7030, USA.
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“Ophthalmia Venerea”: A Dreadful Complication of Fluoroquinolone-Resistant Neisseria gonorrhoeae. Sex Transm Dis 2010. [DOI: 10.1097/olq.0b013e3181c95dc6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Syphilis epidemiology and clinical outcomes in HIV-infected and HIV-uninfected patients in Kaiser Permanente Northern California. Sex Transm Dis 2010; 37:53-8. [PMID: 19734820 DOI: 10.1097/olq.0b013e3181b6f0cc] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Syphilis rates are rising in California, but the impact of HIV infection on syphilis infection remains uncertain. We describe differences between HIV-infected and HIV-uninfected patients diagnosed with syphilis within Kaiser Permanente Northern California. METHODS We performed retrospective analyses of patients diagnosed with incident syphilis from 1995 to 2005 (622 cases/9989 HIV-infected patients and 3584/4,442,780 HIV-uninfected). Among cases, we ascertained demographic, clinical characteristics, and laboratory (including baseline labs and repeated RPR titers) data. We performed Poisson regression (incidence) and Cox proportional hazard modeling (reduction in RPR and serologic failure after syphilis therapy) adjusting for age, gender, and HIV status and among HIV-infected cases only by use of antiretroviral therapy (ART). RESULTS HIV-infected patients had incident syphilis rates of 62.3/1000 person-years compared with 0.8/1000 HIV-uninfected patients, corresponding to an adjusted rate ratio of 86.0 (P <0.001); rate differences increased significantly over time. HIV-infected patients had a greater likelihood of reduction in RPR and serologic failure after syphilis therapy (HR = 2.5 and 2.6 respectively [P <0.001 both]). Among HIV-infected only, patients on ART had lower rates of infection but higher likelihood of reduction in RPR after syphilis therapy and serologic failure compared with patients not on ART. CONCLUSIONS HIV-infected patients had greater rate of incident syphilis compared with HIV-uninfected, a disparity which increased over time. HIV-infected patients had greater likelihood of decline in RPR and serologic failure. HIV-infected patients should be screened for syphilis regularly.
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Anal sexually transmitted infections and risk of HIV infection in homosexual men. J Acquir Immune Defic Syndr 2010; 53:144-9. [PMID: 19734801 DOI: 10.1097/qai.0b013e3181b48f33] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We examined a range of common bacterial and viral sexually transmitted infections as risk factors for HIV seroconversion in a community-based cohort of HIV-negative homosexual men in Sydney, Australia. METHODS Detailed information about HIV risk behaviors was collected by interview twice yearly. Participants were tested annually for HIV, anal and urethral gonorrhea and chlamydia, herpes simplex virus types 1 and 2, and syphilis. In addition, they reported annual diagnoses of these conditions and of genital and anal warts. RESULTS Among 1427 enrolled participants, 53 HIV seroconverters were identified, giving an incidence of 0.78 per 100 person-years. After controlling for number of episodes of insertive and receptive nonseroconcordant unprotected anal intercourse, there were independent associations with anal gonorrhea (adjusted hazard ratio = 7.12, 95% confidence interval: 2.05 to 24.79) and anal warts (hazard ratio = 3.63, 95% confidence interval: 1.62 to 8.14). CONCLUSIONS Anal gonorrhea and anal warts were independently associated with HIV acquisition. The added HIV prevention value of more frequent screening of the anus to allow early detection and treatment of anal sexually transmitted infections in homosexual men should be considered.
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