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He Y, Qin J, Zhou X, Peng J, Zhang J, Li J. Prevalence of HIV-1 infection among foreign applicant to residency in Shanghai, China, 2005-2016. PSYCHOL HEALTH MED 2024; 29:254-260. [PMID: 36260478 DOI: 10.1080/13548506.2022.2132407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/28/2022] [Indexed: 10/24/2022]
Abstract
Shanghai is one of the largest cities in China and has the highest proportion of inbound travelers in the world. The HIV (human immunodeficiency virus) infection status of this population can reflect the global HIV epidemic trend to a certain extent. Therefore, we conducted a retrospective epidemic survey to clarify the prevalence and characteristics of HIV-1 infection among inbound travelers applying for Shanghai residency. The retrospective cohort analysis included a total of 50,830 inbound tourists/travelers who applied for Shanghai residency from 2005 to 2016. HIV-1 infection rates were determined based on HIV-1 antibody testing. Among all the recruited inbound travelers, 245 were HIV-1 positive, with an infection rate of 0.48%. The detection rate of HIV in males was significantly higher than in females (χ2 = 62.584, P < 0.0001). Those aged 18-30 years, 31-40 years, and >40 years accounted for 34.3%, 39.6%, and 26.1% of the infected population, respectively. Although the annual detection rates were different, the trend analysis results showed no increase in HIV-1 prevalence rates among the sampling years (Cochran-Armitage Z = 2.543, P = 0.111). Proportions of individuals infected through homosexual transmission increased over the study period (Cochran-Armitage Z = 5.41, P < 0.001), while the proportion infected through heterosexual declined over time (Cochran-Armitage Z = 3.38, P = 0.001). The rate and characteristics of HIV-1 infection among foreign applicants for residency in Shanghai were identified in the study. The results provide the necessary epidemiological data for monitoring the HIV-1 epidemic among international entry travelers and contribute to establishing relevant policies and regulations for HIV control and prevention.
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Affiliation(s)
- Yuping He
- Health Assessment Department, Shanghai International Travel Healthcare Center, Shanghai, China
| | - Jia Qin
- Health Assessment Department, Shanghai International Travel Healthcare Center, Shanghai, China
| | - Xuan Zhou
- Health Assessment Department, Shanghai International Travel Healthcare Center, Shanghai, China
| | - Jingxin Peng
- Health Assessment Department, Shanghai International Travel Healthcare Center, Shanghai, China
| | - Jing Zhang
- Health Assessment Department, Shanghai International Travel Healthcare Center, Shanghai, China
| | - Jun Li
- Health Assessment Department, Shanghai International Travel Healthcare Center, Shanghai, China
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Wilson EC, Turner CM, Dhakal M, Sharma S, Rai A, Lama R, Banik S, Arayasirikul S. Stigma as a barrier and sex work as a protective factor for HIV testing among trans women in Nepal. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001098. [PMID: 36963013 PMCID: PMC10022763 DOI: 10.1371/journal.pgph.0001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/28/2023] [Indexed: 03/19/2023]
Abstract
Stigma towards trans women in Nepal creates individual and system-level risks for HIV. A critical protective factor is access to HIV prevention. Research is needed to determine the impact of stigma on HIV testing among trans women in Nepal. We conducted a secondary analysis of data collected using respondent driven sampling in 2019 on HIV risk among trans women in Nepal. Data analysis was restricted to trans women who were HIV negative at testing through the parent study. Descriptive statistics, tests for bivariable associations between HIV testing and stigma variables, and binomial Poisson regression were conducted to examine HIV testing outcomes. There were 173 participants who tested negative for HIV in our sample. The majority were under age 35 (59%) and most had a grade school education or less (64.7%). No trans women were homeless and most rented a room (70.5%) or owned their home (19.7%). The majority were currently sex workers (57.8%). Almost all HIV-negative trans women had ever been tested for HIV (90.8%), but only 53.5% in the last 3 months. The most frequently cited reason for not having been tested was thinking they were at low risk for HIV (40.9%) and being afraid of receiving a positive test result (22.7%). HIV and anti-trans stigma were high across most measures, including that almost all (94.2%) believed that most people in Nepal would discriminate against people with HIV. And most participants thought trans women were not accepted in Nepali Society (65.9%). Most participants also reported high social support (70.5%). Social cohesion among participants varied, with most experiencing medium (41.6%) or high (33.5%) social cohesion. Just over half had high social participation (55.5%). Participants who reported current sex work had lower prevalence of not testing for HIV in the last 3 months (prevalence ratio, PR = 0.54, 95% confidence interval, 95%CI = 0.32-0.92, p = 0.02). Every one-unit increase in social cohesion was associated with 1.05 times the prevalence of not testing for HIV in the last 3 months (95%CI = 1.01-1.09, p-value = 0.02). Trans women who did sex work were more likely to be HIV tested while those who were more socially connected to peers were less likely to have recently been tested for HIV. HIV stigma may result in fear of social rejection from peers if one tests positive. Interventions that focus on addressing stigma within trans women's social networks and strategies to mitigate HIV stigma in society may result in increased frequency of HIV testing among trans women in Nepal.
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Affiliation(s)
- Erin C. Wilson
- San Francisco Department of Public Health, Trans Research Unit for Equity (TRUE), Center for Public Health Research, San Francisco, California, United States of America
- * E-mail:
| | - Caitlin M. Turner
- San Francisco Department of Public Health, Trans Research Unit for Equity (TRUE), Center for Public Health Research, San Francisco, California, United States of America
| | | | | | - Anuj Rai
- Blue Diamond Society, Kathmandu, Nepal
| | | | - Swagata Banik
- Department of Public Health & Prevention Sciences, Baldwin Wallace University, Berea, Ohio, United States of America
| | - Sean Arayasirikul
- San Francisco Department of Public Health, Trans Research Unit for Equity (TRUE), Center for Public Health Research, San Francisco, California, United States of America
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Nepal G, Balayar R, Bhatta S, Acharya S, Gajurel BP, Karn R, Rajbhandari R, Paudel S, Gautam N, Shrestha A, Ojha R. Neurobrucellosis: A differential not to be missed in patients presenting with neuropsychiatric features. Clin Case Rep 2021; 9:e04190. [PMID: 34194775 PMCID: PMC8222759 DOI: 10.1002/ccr3.4190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 12/22/2022] Open
Abstract
When a patient presents with undulating fever and neuropsychiatric features, neurobrucellosis should be considered as a differential diagnosis. If diagnosed early, neurobrucellosis is a treatable disease with a favorable outcome.
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Affiliation(s)
- Gaurav Nepal
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineMaharajgunjNepal
| | - Ramesh Balayar
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineMaharajgunjNepal
| | - Suraj Bhatta
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineMaharajgunjNepal
| | - Sulav Acharya
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineMaharajgunjNepal
| | | | - Ragesh Karn
- Department of NeurologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Reema Rajbhandari
- Department of NeurologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Sunanda Paudel
- Department of NeurologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Niraj Gautam
- Department of NeurologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Ashish Shrestha
- Department of NeurologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Rajeev Ojha
- Department of NeurologyTribhuvan University Teaching HospitalMaharajgunjNepal
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Hogan S, Page A, Ogbo F, Dixit S, Rajbhandari RM, Rawal B, Deuba K. Trends and determinants of HIV transmission among men who inject drugs in the Pokhara Valley, Nepal: analysis of cross-sectional studies. BMC Public Health 2021; 21:269. [PMID: 33530983 PMCID: PMC7856790 DOI: 10.1186/s12889-021-10331-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 01/25/2021] [Indexed: 12/04/2022] Open
Abstract
Background HIV is a major public health issue around the world, especially in developing countries. Although the overall prevalence of HIV in Nepal is relatively low, there are specific sub-populations where the prevalence is far higher than the national average. One of these sub-groups is male people who inject drugs (male PWIDs). In order to understand the reasons for the differences in prevalence, a series of socio-demographic, behavioural and knowledge-based risk factors need to be assessed. Methods The study used a series of 7 cross-sectional survey datasets from Pokhara (Nepal), collected between 2003 and 2017 (N = 2235) to investigate trends in HIV prevalence among male PWIDs by socio-demographic and behavioural and knowledge-based risk factors. A series of logistic regression models were conducted to investigate the association between study factors and HIV. Results HIV prevalence decreased from the levels seen in 2003 (22.0%) and 2005 (21.7%), with the lowest prevalence recorded in 2015 (2.6%), however prevalence has increased in the most recent period (4.9%). A lower risk of HIV was associated with younger age (<=24 years compared to > 24 years, OR = 0.17, 95% CI = 0.10–0.31), being married (OR = 1.91, 95% CI = 1.25–3.02) and shorter duration of drug use (<=4 years compared to > 4 years, OR = 0.16, 95% CI = 0.09–0.29). A higher risk of HIV was associated with low (compared to secondary or higher) education level (OR = 2.76, 95% CI = 1.75–4.36), a lack of addiction treatment (OR = 2.59, 95% CI = 1.64–4.08), and recent use of unsterilized injection equipment (OR = 2.22, 95% CI = 1.20–4.11). Conclusion The prevalence of HIV in male PWIDs in Pokhara has been variable, but overall has reduced in recent years to 2.6% before increasing in 2017 to 4.9%. The main determinants which increase the risk of HIV among male PWIDs in Pokhara are low education level, a lack of treatment for drug addiction and the recent use of unsterilised equipment. Each of these indicate the need to improve addiction treatment and education programs for intra-venous drug use to aid this key population in avoiding risk-taking behaviours. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10331-9.
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Affiliation(s)
- Sam Hogan
- Translational Health Research Institute, Western Sydney University Sydney, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University Sydney, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
| | - Felix Ogbo
- Translational Health Research Institute, Western Sydney University Sydney, Locked Bag 1797, Penrith, NSW, 2751, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | | | | | - Bir Rawal
- National Center for AIDS and STD Control, Kathmandu, Nepal
| | - Keshab Deuba
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,National Centre for AIDS & STD Control/ Global Fund Programs, Kathmandu, Nepal
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Wilson EC, Dhakal M, Sharma S, Rai A, Lama R, Chettri S, Turner CM, Xie H, Arayasirikul S, Lin J, Banik S. Population-based HIV prevalence, stigma and HIV risk among trans women in Nepal. BMC Infect Dis 2021; 21:128. [PMID: 33514346 PMCID: PMC7845103 DOI: 10.1186/s12879-021-05803-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transgender women (trans women) in Nepal are underserved in the HIV response. Data are needed to determine the HIV prevalence disaggregated from other key populations and to identify the particular risks faced by this community. Trans women are marginalized around the world and research is also needed to determine the impact of stigma on HIV risk to inform trans-specific interventions. METHODS In 2019, we conducted the first population-based HIV behavioral surveillance study of trans women disaggregated from other key populations using respondent driven sampling (RDS). We estimated the HIV prevalence for trans women, and bivariate and multivariate Poisson binomial regression models were constructed to examine the relationship between HIV risk and stigma. RESULTS Trans women participants (N = 200) had a mean age of 33 years old (SD = 10.96). We found a weighted HIV prevalence of 11.3% (95% CI 6·82% - 18·13). We found that depression and anxiety (aPR 0.81; 95% CI 0.67-0.97; p = 0·02) and current engagement in sex work (aPR 1.31; 95% CI 1.01-1.71; p = 0·046) were significantly associated with greater prevalence of condomless receptive anal intercourse. We found that experienced stigma of ever being verbally abused due to gender identity was significantly associated with lower prevalence of depression and anxiety (aPR 0.42; 95% CI 0.20-0.87; p = 0·002). Feeling unaccepted in Nepali society and believing people thought they were a criminal because of their trans identity was significantly associated greater prevalence of current sex work (aPR 1.36; 95% CI 1.03-1.78; p = 0·03; aPR 1.45; 95% CI 1.03-2.07; p = 0.04). Every measure of experienced stigma assessed was significantly associated with greater prevalence of current engagement in sex work. CONCLUSIONS Trans women are highly stigmatized in Nepal, leading to individual and systems factors that impact their risk for HIV. Interventions are needed that support the economic and mental wellbeing of trans women to prevent their heighted risk of HIV from stigma.
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Affiliation(s)
- Erin C. Wilson
- San Francisco Department of Public Health, 25 Van Ness Ave., Suite 500, San Francisco, CA 94102 USA
| | - Manisha Dhakal
- Blue Diamond Society, Dhumbarahi Height, Kathmandu, Nepal
| | - Sanjay Sharma
- Blue Diamond Society, Dhumbarahi Height, Kathmandu, Nepal
| | - Anuj Rai
- Blue Diamond Society, Dhumbarahi Height, Kathmandu, Nepal
| | - Rajesh Lama
- Blue Diamond Society, Dhumbarahi Height, Kathmandu, Nepal
| | - Sirish Chettri
- Blue Diamond Society, Dhumbarahi Height, Kathmandu, Nepal
| | - Caitlin M. Turner
- San Francisco Department of Public Health, 25 Van Ness Ave., Suite 500, San Francisco, CA 94102 USA
| | - Hui Xie
- San Francisco Department of Public Health, 25 Van Ness Ave., Suite 500, San Francisco, CA 94102 USA
| | - Sean Arayasirikul
- San Francisco Department of Public Health, 25 Van Ness Ave., Suite 500, San Francisco, CA 94102 USA
| | - Jess Lin
- San Francisco Department of Public Health, 25 Van Ness Ave., Suite 500, San Francisco, CA 94102 USA
| | - Swagata Banik
- Baldwin Wallace University, 275 Eastland Rd., Berea, OH 44017 USA
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Acharya K, Thapa R, Bhattarai N, Bam K, Shrestha B. Availability and readiness to provide sexually transmitted infections and HIV testing and counselling services in Nepal: evidence from comprehensive health facility survey. BMJ Open 2020; 10:e040918. [PMID: 33323441 PMCID: PMC7745329 DOI: 10.1136/bmjopen-2020-040918] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE We assessed the availability and readiness of health facilities to provide sexually transmitted infections (STI) and HIV testing and counselling (HTC) services in Nepal. DESIGN This was a cross-sectional study. SETTING We used data from the most recent nationally representative Nepal Health Facility Survey (NHFS) 2015. A total of 963 health facilities were surveyed with 97% response rate. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome of this study was to assess the availability and readiness of health facilities to provide STI and HTC services using the WHO Service Availability and Readiness Assessment (SARA) manual. RESULTS Nearly three-fourths (73.8%) and less than one-tenth (5.9%) of health facilities reported providing STI and HTC services, respectively. The mean readiness score of STI and HTC services was 26.2% and 68.9%, respectively. The readiness scores varied significantly according to the managing authority (private vs public) for both STI and HTC services. Interestingly, health facilities with external supervision had better service readiness scores for STI services that were almost four points higher than compared with those facilities with no external supervision. Regarding HTC services, service readiness was lower at private hospitals (32.9 points lower) compared to government hospitals. Unlike STI services, the readiness of facilities to provide HTC services was higher (4.8 point higher) at facilities which performed quality assurance. CONCLUSION The facility readiness for HTC service is higher than that for STI services. There are persistent gaps in staff, guidelines and medicine and commodities across both services. Government of Nepal should focus on ensuring constant supervision and quality assurance, as these were among the determining factors for facility readiness.
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Affiliation(s)
| | - Rajshree Thapa
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Navaraj Bhattarai
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
| | - Kiran Bam
- Public Health Professional, Kathmandu, Nepal
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Storm M, Deuba K, Damas J, Shrestha U, Rawal B, Bhattarai R, Marrone G. Prevalence of HIV, syphilis, and assessment of the social and structural determinants of sexual risk behaviour and health service utilisation among MSM and transgender women in Terai highway districts of Nepal: findings based on an integrated biological and behavioural surveillance survey using respondent driven sampling. BMC Infect Dis 2020; 20:402. [PMID: 32513134 PMCID: PMC7282139 DOI: 10.1186/s12879-020-05122-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 05/27/2020] [Indexed: 11/16/2022] Open
Abstract
Background Men who have sex with men (MSM) and transgender people are disproportionately affected by HIV and sexually transmitted infections. MSM and transgender people in Nepal experience considerable discrimination and marginalisation, they are subject to abuse from legal authorities and suffer from mental health issues. These social and structural factors can lead to increased sexual risk behaviour, barriers to accessing health care and result in adverse health outcomes. This study aims to assess the prevalence of HIV and syphilis, and how individual and socio-structural factors influence sexual risk behaviour and health care service uptake, among MSM and transgender women in the Terai highway districts of Nepal. Methods A cross-sectional survey was conducted in June 2016 in eight Terai highway districts of Nepal, recruiting 340 MSM and transgender women through respondent driven sampling. The primary outcome variables were HIV and syphilis prevalence. The secondary outcome variables were sexual risk behaviour and health care service uptake. Logistic regression models were used to assess the individual and socio-structural determinants of sexual risk behaviour and health care service uptake. Results The prevalence of HIV among MSM was 5%, whereas it was 13% in transgender women. The prevalence of active syphilis was 4% in MSM and 11% among transgender women. Among transgender women, 76% were involved in sex work, and 51% had experienced discrimination in one or more settings. In multivariable analysis, having visited an outreach centre was positively associated with condom use in the last sexual encounter among both MSM (AOR: 5.37, 95% CI: 2.42–11.94, p < 0.001) and transgender women (AOR: 2.37, 95% CI: 1.12–5.02, p = 0.025). Moreover, transgender women who reported being open towards family about sexual identity/behaviour were 2.4 more likely to have visited an outreach centre (AOR: 2.40, 95% CI: 1.04–5.57, p = 0.041). Conclusions The high prevalence of HIV and syphilis, as well as indicators of marginalisation and discrimination among transgender women, highlights the increased burden transgender women in Nepal are facing and the need for tailored interventions. Moreover, since health care service uptake is an important factor in determining sexual risk behaviour among MSM and transgender women in Nepal, outreach services should be scaled up.
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Affiliation(s)
- Margrethe Storm
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Keshab Deuba
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden. .,National Centre for AIDS and STD Control, Kathmandu, Nepal.
| | - Jose Damas
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Bir Rawal
- National Centre for AIDS and STD Control, Kathmandu, Nepal
| | | | - Gaetano Marrone
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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