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Zeng W, Wu H, Jiang L, Li Q, Zhao Y, Zhao X, Han Z. Molecular networks reveal complex interactions with MSM in heterosexual women living with HIV-1 who play peripheral roles in Guangzhou, China. Acta Trop 2023:106953. [PMID: 37224988 DOI: 10.1016/j.actatropica.2023.106953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND With the number of newly diagnosed HIV-positive heterosexual women increasing yearly, it is urgent to understand HIV-1 transmission among heterosexual women in Guangzhou, China. METHODS HIV-1 pol sequences were obtained from people living with HIV-1 during 2008 to 2017 in Guangzhou, China. A molecular network was constructed using HIV-1 TRAnsmission Cluster Engine with 1.5% genetic distance. Potential linkage and centrality metric were measured with Cytoscape. Transmission pathways between heterosexual women and men who have sex with men (MSM) were determined using Bayesian phylogenetic analysis. RESULTS In the network, 1799 (62.6%) MSM, 692 (24.1%) heterosexual men and 141 (4.9%) heterosexual women formed 259 clusters. Molecular clusters including MSM and heterosexuals were more likely to form larger networks (P<0.001). Nearly half of the heterosexual women (45.4%) were linked to heterosexual men and 17.7% to MSM, but only 0.9% of MSM were linked to heterosexual women. Thirty-three (23.4%) heterosexual women linked to at least one MSM node and were in peripheral role. Compared to general heterosexual women, the proportion of heterosexual women linked to MSM infected with CRF55_01B (P<0.001) and CRF07_BC (P<0.001) was higher than that of other subtypes, and the proportion diagnosed between 2012-2017 (P=0.001) was higher than that in 2008-2012. In MCC trees, 63.6% (21/33) of the heterosexual women differentiated from the heterosexual evolutionary branch, while 36.4% (12/33) differentiated from the MSM evolutionary branch. CONCLUSION Heterosexual women living with HIV-1 were mainly linked to heterosexual men and were in peripheral positions in the molecular network. The role of heterosexual women in HIV-1 transmission was limited, but the interaction between MSM and heterosexual women were complex. Awareness of the HIV-1 infection status of sexual partners and active HIV-1 detection are needed for women.
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Affiliation(s)
- Wenting Zeng
- Huangpu District Center for Disease Control and Prevention, Guangzhou, China
| | - Hao Wu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Liyun Jiang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Qingmei Li
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Yuteng Zhao
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Xinhua Zhao
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhigang Han
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China; Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou, China..
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Malekinejad M, Jimsheleishvili S, Barker EK, Hutchinson AB, Shrestha RK, Volberding P, Kahn JG. Sexual Practice Changes Post-HIV Diagnosis Among Men Who Have Sex with Men in the United States: A Systematic Review and Meta-analysis. AIDS Behav 2023; 27:257-278. [PMID: 35829969 PMCID: PMC9834435 DOI: 10.1007/s10461-022-03761-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 01/24/2023]
Abstract
Men who have sex with men (MSM) often change sexual behaviors following HIV diagnosis. This systematic review examined such changes, including sero-adaptive behaviors (i.e., deliberate safer-sex practices to reduce transmission risk) to better understand the magnitude of their association with HIV diagnosis. We searched four databases (1996-2017) and reviewed references from other systematic reviews. We included studies conducted in the United States that compared sexual behavior among HIV-infected "aware" versus "unaware" MSM. We meta-analytically pooled RRs and associated 95% confidence intervals (CI) using random-effects models, and assessed risk of bias and evidence quality. Twenty studies reported k = 131 effect sizes on sexual practices outcomes, most of which reported changes in unprotected sex (k = 85), and on sex with at-risk partners (k = 76); 11 reported sero-adaptive behaviors. Unprotected anal intercourse with an HIV-uninfected/unknown-status partner was less likely among aware MSM (insertive position: k = 2, RR 0.26, 95% CI 0.17, 0.41; receptive position: k = 2, RR 0.53, 95% CI 0.37, 0.77). Risk of not always serosorting among aware MSM (k = 3) was RR = 0.92 (0.83, 1.02). Existing evidence, although low-quality, suggests that HIV-infected MSM tend to adopt safer sexual practices once aware of their diagnosis. Variation in reporting of outcomes limits their comparability. Sero-adaptive behavior data are sparse.
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Affiliation(s)
- Mohsen Malekinejad
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA USA ,Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA USA ,Consortium to Assess Prevention Economics, University of California, San Francisco, San Francisco, CA USA ,550 16th Street, San Francisco, CA 94158 USA
| | - Sopiko Jimsheleishvili
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA USA
| | - Erin K. Barker
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA USA
| | - Angela B. Hutchinson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Ram K. Shrestha
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Paul Volberding
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA USA
| | - James G. Kahn
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA USA ,Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA USA ,Consortium to Assess Prevention Economics, University of California, San Francisco, San Francisco, CA USA
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3
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Zhang Kudon H, Mulatu MS, Song W, Heitgerd J, Rao S. Trends in Condomless Sex Among MSM Who Participated in CDC-Funded HIV Risk-Reduction Interventions in the United States, 2012-2017. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:170-173. [PMID: 32332483 DOI: 10.1097/phh.0000000000001143] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Consistent and correct use of condoms can reduce the risk for sexually transmitted diseases, including HIV/AIDS. Studies have reported that condomless sex among men who have sex with men (MSM) has steadily increased in recent years. We analyzed data reported by 51 health departments regarding 82 556 HIV-positive and HIV-negative MSM 13 years or older and participated in Centers for Disease Control and Prevention-funded behavioral risk-reduction intervention programs during 2012-2017. The percentages of condomless sex increased from 56.3% to 72.0% (estimated annual percent change [EAPC] = 7.1%) among HIV-positive MSM and from 46.0% to 70.5% (EAPC = 4.1%) among HIV-negative MSM. Continued increases in condomless sex might disrupt progress in ending the HIV/AIDS epidemic. Transmission risk associated with condomless sex can be reduced by ensuring that HIV-positive persons know their status early and are linked to care to achieve viral suppression and those at risk for acquiring HIV/AIDS can readily access preexposure prophylaxis.
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Affiliation(s)
- Hui Zhang Kudon
- Program Evaluation Branch, Division HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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4
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Skeen SJ, Starks TJ, Jimenez RH, Rendina HJ, Cain D. Heterosexual Cisgender Men Partnered with Transgender Women Exhibit Higher HIV/STI Sexual Risk than Their Gay, Bisexual, and Queer Counterparts: Findings from a U.S.-Based Convenience Sample Recruited Online. AIDS Behav 2021; 25:3279-3291. [PMID: 34050403 PMCID: PMC10062375 DOI: 10.1007/s10461-021-03314-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 01/15/2023]
Abstract
Cisgender men are frequently vectors for HIV transmission among transgender women. Despite this, the correlates of sexual risk among these men remain under-examined. The purpose of the present study was to explore potential differences in relationship characteristics, sexual risk-taking, and risk-reduction strategies among cisgender men partnered with transgender women. The study utilized secondary screening data provided by adult cis men who reported being in a primary relationship with a trans woman (N = 710). Gay men (18%) were comparatively older, and most likely to report both HIV seropositivity and committed pairings. Heterosexual men (14%) were more likely to report exchange sex, briefer relationships, extra-dyadic sex, lesser serostatus awareness or PrEP uptake. Queer men (7%) were youngest, and most likely to access PrEP. Heterosexual cis men with trans women partners may be subject to unique socio-cultural drivers of sexual risk, such as heteronormative pressures and relationship stigma.
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Affiliation(s)
- Simone J Skeen
- Department of Psychology, Hunter College, City University of New York (CUNY), New York, NY, USA.
- School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA, 70112, USA.
| | - Tyrel J Starks
- Department of Psychology, Hunter College, City University of New York (CUNY), New York, NY, USA
- Health Psychology and Clinical Science PhD Program, The Graduate Center, CUNY, New York, NY, USA
| | - Ruben H Jimenez
- Department of Psychology, Hunter College, City University of New York (CUNY), New York, NY, USA
| | - H Jonathon Rendina
- Department of Psychology, Hunter College, City University of New York (CUNY), New York, NY, USA
- Health Psychology and Clinical Science PhD Program, The Graduate Center, CUNY, New York, NY, USA
| | - Demetria Cain
- Department of Psychology, Hunter College, City University of New York (CUNY), New York, NY, USA
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D’Souza G, Benning L, Stosor V, Witt MD, Johnson J, Friedman M, Abraham AG. The shifting picture of HIV treatment, comorbidity and substance use among US MSM living with HIV. HIV Med 2021; 22:538-546. [PMID: 33751813 PMCID: PMC8295172 DOI: 10.1111/hiv.13082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES People living with HIV (PLWH) have increased risk of chronic disease and poor mental health. We aimed to explore HIV disease indicators, comorbidity, and risk behavior of recent antiretroviral therapy (ART) initiators to inform current needs of PLWH. METHODS Men who have sex with men (MSM) in the Multicenter AIDS Cohort Study (MACS) who initiated ART between 2010 and 2018 (recent initiators) were compared with age-, race- and geographic location-matched men who initiated ART during 2000-2009 (early initiators). Measures of HIV disease, behavior, comorbidity and mental health were collected prospectively every 6 months using standardized forms. RESULTS Recent initiators had higher current CD4 (median CD4 451 vs. 307 cells/μL, P < 0.0001) and nadir CD4 (451 vs. 300 cells/μL, P < 0.0001) than earlier initiators. The proportion achieving viral suppression within a year of starting ART was significantly higher in recent compared with earlier initiators (92% vs. 74%, P < 0.0001). Median [interquartile range (IQR)] time from HIV diagnosis to ART initiation was 5.4 (1.7-23.1) months in recent initiators. Comorbidity prevalence was high in recent initiators, including obesity (24%), hypertension (25%) and kidney disease (15%). Substance use continues to be common, including cigarette use (40%), daily alcohol use (88%) and marijuana use (46%). CONCLUSIONS Improvements in getting individuals onto ART at an early stage have led to substantially higher CD4 cell counts at initiation. However, the high burden of comorbidity, substance use and poor mental health affecting MSM living with HIV in the US underscore ongoing challenges and our need to adapt and coordinate care.
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Affiliation(s)
- Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Lorie Benning
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Valentina Stosor
- Department of Medicine, Northwestern University Feinberg School of Medicine, USA
| | - Mallory D. Witt
- Department of Medicine, The Lundquist Institute at Harbor-UCLA, USA
| | - Jacquett Johnson
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Mackey Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, USA
| | - Alison G Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
- Department of Ophthalmology, Johns Hopkins School of Medicine
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Malekinejad M, Blodgett J, Horvath H, Parriott A, Hutchinson AB, Shrestha RK, McCabe D, Volberding P, Kahn JG. Change in Condom Use in Populations Newly Aware of HIV Diagnosis in the United States and Canada: A Systematic Review and Meta-Analysis. AIDS Behav 2021; 25:1839-1855. [PMID: 33389321 DOI: 10.1007/s10461-020-03113-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
HIV-infected individuals "aware" of their infection are more likely to use condoms, compared to HIV-infected "unaware" persons. To quantify this likelihood, we undertook a systematic review and meta-analysis of U.S. and Canadian studies. Twenty-one eligible studies included men who have sex with men (MSM; k = 15), persons who inject drugs (PWID; k = 2), and mixed populations of high-risk heterosexuals (HRH; k = 4). Risk ratios (RR) of "not always using condoms" with partners of any serostatus were lower among aware MSM (RR 0.44 [not significant]), PWID (RR 0.70) and HRH (RR 0.27); and, in aware MSM, with partners of HIV-uninfected or unknown status (RR 0.46). Aware individuals had lower "condomless sex likelihood" with HIV-uninfected or unknown status partners (MSM: RR 0.58; male PWID: RR 0.44; female PWID: RR 0.65; HRH: RR 0.35) and with partners of any serostatus (MSM only, RR 0.72). The association diminished over time. High risk of bias compromised evidence quality.
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Chen S, Owolabi Y, Dulin M, Robinson P, Witt B, Samoff E. Applying a machine learning modelling framework to predict delayed linkage to care in patients newly diagnosed with HIV in Mecklenburg County, North Carolina, USA. AIDS 2021; 35:S29-S38. [PMID: 33867487 DOI: 10.1097/qad.0000000000002830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Machine learning has the potential to help researchers better understand and close the gap in HIV care delivery in large metropolitan regions such as Mecklenburg County, North Carolina, USA. OBJECTIVES We aim to identify important risk factors associated with delayed linkage to care for HIV patients with novel machine learning models and identify high-risk regions of the delay. METHODS Deidentified 2013-2017 Mecklenburg County surveillance data in eHARS format were requested. Both univariate analyses and machine learning random forest model (developed in R 3.5.0) were applied to quantify associations between delayed linkage to care (>30 days after diagnosis) and various risk factors for individual HIV patients. We also aggregated linkage to care by zip codes to identify high-risk communities within the county. RESULTS Types of HIV-diagnosing facility significantly influenced time to linkage; first diagnosis in hospital was associated with the shortest time to linkage. HIV patients with lower CD4+ cell counts (<200/ml) were twice as likely to link to care within 30 days than those with higher CD4+ cell count. Random forest model achieved high accuracy (>80% without CD4+ cell count data and >95% with CD4+ cell count data) to predict risk of delay in linkage to care. In addition, we also identified top high-risk zip codes of delayed linkage. CONCLUSION The findings helped public health teams identify high-risk communities of delayed HIV care continuum across Mecklenburg County. The methodology framework can be applied to other regions with HIV epidemic and challenge of delayed linkage to care.
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Affiliation(s)
- Shi Chen
- Department of Public Health Sciences, College of Health and Human Services
- School of Data Science, UNC Charlotte, Charlotte, North Carolina
| | - Yakubu Owolabi
- Department of Public Health Sciences, College of Health and Human Services
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Dulin
- Department of Public Health Sciences, College of Health and Human Services
- Academy for Population Health Innovation, UNC Charlotte
| | - Patrick Robinson
- Academy for Population Health Innovation, UNC Charlotte
- Mecklenburg County Health Department, Charlotte
| | - Brian Witt
- Academy for Population Health Innovation, UNC Charlotte
- Mecklenburg County Health Department, Charlotte
| | - Erika Samoff
- HIV/STD Prevention and Care Branch, North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
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Horvath KJ, Lammert S, Danh T, Mitchell JW. The Feasibility, Acceptability and Preliminary Impact of Mobile Application to Increase Repeat HIV Testing Among Sexual Minority Men. AIDS Behav 2020; 24:1835-1850. [PMID: 31823111 DOI: 10.1007/s10461-019-02755-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We pilot tested the Status Update Project (SUP) mobile app intervention to promote repeat HIV testing among HIV-negative US MSM. Participants (Mean age = 29 years; 51% racial/ethnic minority; 63% single) who were eligible and enrolled were randomized to either the SUP mobile app or a no-treatment condition, with assessments at baseline and month 4 and 8. Eighty-three percent of men were retained at the 8-month follow up. Among men randomized to the SUP arm, the app's ease and simplicity, health information, HIV testing locator, and HIV test reminders were most liked. At month 4, men randomized to the SUP arm were more likely to be repeat testers compared to those in the control arm (RR = 4.4; 95% CI 0.9, 19.9), although differences diminished by month 8 (RR = 1.2; 95% CI 0.8, 2.0). These findings add to our understanding of how mHealth interventions may play an important role in encouraging repeat HIV testing among MSM.
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Affiliation(s)
- Keith J Horvath
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, Department of Psychology, San Diego State University, 6363 Alvarado Court, San Diego, CA, 92120, USA.
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
| | - Sara Lammert
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Thu Danh
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Jason W Mitchell
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI, USA
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Weiss KM, Goodreau SM, Morris M, Prasad P, Ramaraju R, Sanchez T, Jenness SM. Egocentric sexual networks of men who have sex with men in the United States: Results from the ARTnet study. Epidemics 2020; 30:100386. [PMID: 32004795 PMCID: PMC7089812 DOI: 10.1016/j.epidem.2020.100386] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 01/13/2023] Open
Abstract
In this paper, we present an overview and descriptive results from one of the first egocentric network studies of men who have sex with men (MSM) from across the United States: the ARTnet study. ARTnet was designed to support prevention research for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) that are transmitted across partnership networks. ARTnet implemented a population-based egocentric network study design that sampled egos from the target population and asked them to report on the number, attributes, and timing of their sexual partnerships. Such data provide the foundation needed for parameterizing stochastic network models that are used for disease projection and intervention planning. ARTnet collected data online from 2017 to 2019, with a final sample of 4904 participants who reported on 16198 sexual partnerships. The aims of this paper were to characterize the joint distribution of three network parameters needed for modeling: degree distributions, assortative mixing, and partnership age, with heterogeneity by partnership type (main, casual and one-time), demography, and geography. Participants had an average of 1.19 currently active partnerships ("mean degree"), which was higher for casual partnerships (0.74) than main partnerships (0.45). The mean rate of one-time partnership acquisition was 0.16 per week (8.5 partners per year). Main partnerships lasted 272.5 weeks on average, while casual partnerships lasted 133.0 weeks. There was strong but heterogenous assortative mixing by race/ethnicity for all groups. The mean absolute age difference for all partnership types was 9.5 years, with main partners differing by 6.3 years compared to 10.8 years for casual partners. Our analysis suggests that MSM may be at sustained risk for HIV/STI acquisition and transmission through high network degree of sexual partnerships. The ARTnet network study provides a robust and reproducible foundation for understanding the dynamics of HIV/STI epidemiology among U.S. MSM and supporting the implementation science that seeks to address persistent challenges in HIV/STI prevention.
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Affiliation(s)
- Kevin M Weiss
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States
| | - Steven M Goodreau
- Department of Anthropology, University of Washington, Seattle, Washington, United States
| | - Martina Morris
- Departments of Statistics and Sociology, University of Washington, Seattle, Washington, United States
| | - Pragati Prasad
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States
| | - Ramya Ramaraju
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States
| | - Travis Sanchez
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States
| | - Samuel M Jenness
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States.
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