Epidemiology of sexually transmitted infections in global indigenous populations: data availability and gaps

Perspectives on digital testing services for sexually transmitted and blood-borne infections from Two-Spirit, gay, bisexual, transgender, and other queer Black, Indigenous, people of colour living in Ontario, Canada

OBJECTIVES

Increased sexually transmitted and blood-borne infections (STBBI) testing can reduce the burden of disease among Two-Spirit, gay, bisexual, transgender, and other queer Black, Indigenous, people of colour (2SGBTQ+ BIPOC). However, this population encounters barriers, such as discrimination, when accessing in-person STBBI testing services. Digital STBBI testing, such as self-testing/collection kits ordered online and digital requisitions, may address some of these barriers. Our aim was to understand acceptability of free digital STBBI testing among 2SGBTQ+ BIPOC living in Ontario, Canada.

DESIGN

We approached this analysis using Implementation Science and Critical Race Theory. We conducted interviews and focus groups with 21 2SGBTQ + BIPOC individuals from 2020-2021. Participants were asked about their perceptions of the benefits and drawbacks of digital STBBI testing, populations that would benefit from using these services, and recommendations for how these services may be implemented in Ontario. Interviews and focus groups were transcribed verbatim and analyzed using reflexive thematic analysis.

RESULTS

Six themes emerged. Digital STBBI testing services: (1) May reduce oppression experienced by 2SGBTQ + BIPOC when testing in-person; (2) Should address the unique needs that 2SGBTQ + BIPOC experience due to other intersecting identities they possess; (3) Should adapt their services to suit the varying cultural contexts and living circumstances of 2SGBTQ + BIPOC; (4) Should be accessible to 2SGBTQ + BIPOC who hold diverse or no documentation; (5) Should be offered in multiple languages; (6) May be inaccessible to those without Internet access or devices.

CONCLUSION

Digital STBBI testing is one strategy that may reduce discrimination experienced by 2SGBTQ + BIPOC when getting tested in-person. However, digital STBBI testing services may not address all the needs of 2SGBTQ + BIPOC. Racism and other forms of oppression embedded into in-person and digital testing services will need to be addressed to meet the needs of this diverse population.

Interventions in maternal syphilis care globally: A scoping review

Infectious and Congenital Syphilis rates continue to rise globally. Current recommendations for syphilis screening and treatment may be insufficient, and there is a pressing need for improved programs and services to address the increase in cases. A scoping review was conducted to examine approaches to maternal syphilis screening and treatment. Theoretical underpinnings and the key characteristics of these interventions were studied to identify gaps in the existing literature to guide future research. Developing a modified version of the socio-ecological model to guide data analysis, we included 33 academic studies spanning 31 years, covering a range of interventions, programs, and policies globally. We highlight key facets of interventions aligning with the five levels of the modified model that include: individual, interpersonal, institutional, community and policy. In this review, we provide valuable insights into the characteristics and principles of maternal syphilis screening and treatment interventions.

Maternal and congenital syphilis in Indigenous Peoples: a scoping review of the worldwide literature

BACKGROUND

Syphilis is among the most common sexually transmitted infections worldwide. When it occurs during pregnancy, it can seriously affect the fetus and newborn`s health. The scarcity of studies on maternal and congenital syphilis in Indigenous Peoples remains an obstacle to its control in these populations. This study aimed to explore the breadth of the literature, map updated evidence, and identify knowledge gaps on maternal and congenital syphilis in Indigenous Peoples worldwide.

METHODS

We conducted a Scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews. In March 2021, we collected data through a priority search on PubMed, Web of Science, Embase, and SciELO.

RESULTS

The strategy yielded 24 studies for analysis. Data in the articles were collected from 1989 to 2020, half from 2015 onwards. Studies were in Oceania and the Americas, mainly in South America (66.7%), particularly in Brazil (50.0%). The topics assessed were Data quality related to maternal and congenital syphilis (20.8%); Diagnosis, provision, access, and use of health services (62.5%); Disease frequency and health inequities (54.2%); Determinants of maternal syphilis and congenital syphilis (20.8%); and Outcomes of maternal and congenital syphilis in the fetus (20.8%). The results show that the available literature on maternal and congenital syphilis is sparse and concentrated in some geographic areas; the frequency of these diseases in Indigenous Peoples varies but is generally higher than in the non-indigenous counterparts; the quality of surveillance data and health information systems is poor; multiple healthcare barriers exist; and the diversity of terms to identify Indigenous Peoples is a challenge to mapping scientific outputs on Indigenous Peoples' health.

CONCLUSIONS

Maternal and congenital syphilis in Indigenous Peoples is a double-neglected condition and research in this area should be given the priority and encouragement it deserves globally. Reliable data and improving access to health care are needed to reduce the burden of syphilis and correctly inform policies and health services response to mitigate ethnic-racial inequalities in maternal and congenital syphilis.

The Application of Systems Thinking to the Prevention and Control of Sexually Transmissible Infections among Adolescents and Adults: A Scoping Review

Systems thinking is a mechanism for making sense of complex systems that challenge linear explanations of cause-and-effect. While the prevention and control of sexually transmissible infections (STIs) has been identified as an area that may benefit from systems-level analyses, no review on the subject currently exists. The aim of this study is to conduct a scoping review to identify literature in which systems thinking has been applied to the prevention and control of STIs among adolescent and adult populations. Joanna Briggs Institute guidelines for the conduct of scoping reviews were followed. Five databases were searched for English-language studies published after 2011. A total of n = 6102 studies were screened against inclusion criteria and n = 70 were included in the review. The majority of studies (n = 34) were conducted in African nations. Few studies focused on priority sub-populations, and 93% were focused on HIV (n = 65). The most commonly applied systems thinking method was system dynamics modelling (n = 28). The review highlights areas for future research, including the need for more STI systems thinking studies focused on: (1) migrant and Indigenous populations; (2) conditions such as syphilis; and (3) innovations such as pre-exposure prophylaxis and at-home testing for HIV. The need for conceptual clarity around 'systems thinking' is also highlighted.

Screening of Schistosomiasis, Strongyloidiasis and Sexually Transmitted Infections in Nigerian Female Sex Workers Living in Rome

BACKGROUND

Female Sex Workers (FSWs) are at high risk for acquisition and transmission of sexually transmission infections (STIs). Although several studies investigated the diffusion of STIs in this population, none of them investigated the occurrence of helminth infections in FSW coming from endemic regions. This study aims to assess the prevalence of STIs and helminth infections in a cohort of FSWs.

METHOD

authors conducted a prevalent, observational, and descriptive study on 97 Nigerian FSWs aged 17 to 52 years from January to December 2020.

RESULTS

a total of 97 FSWs were recruited. Of these, only 82 had completed screening for hepatitis B, C, syphilis, and HIV, while all 97 were screened for schistosomiasis and strongyloidiasis. The prevalence of STIs among FSWs in Rome was lower than in other European countries. The overall prevalence of HIV and HBsAg were 1.2%, (1/82) and 2.4% (2/82), respectively, while no case of hepatitis C and syphilis was found. Regarding parasitological screening, the overall prevalence of schistosoma species was 4.1% (4/97) while 5.15% (5/97) were positive for strongyloidiasis.

CONCLUSIONS

our study shows a low prevalence of STIs in Nigerian FSWs except for Hepatitis B and a higher prevalence of schistosomiasis and strongyloidiasis. The permanent monitoring of STI and parasitic infections in sex workers coming from Africa is strongly warranted, especially for hepatitis B, schistosomiasis and strongyloidiasis, to allow a timely diagnosis and treatment, and to plan preventive strategies.

Interpersonal violence victimisation, HIV-related behaviours and STIs among adult, urban Indigenous and non-Indigenous gay, bisexual and other men who have sex with men in Guatemala

Gay, bisexual and other men who have sex with men are disproportionately affected by HIV in Guatemala; interpersonal violence may increase behaviours that augment the risk of HIV in this group. Although 44% of Guatemalans identify as Indigenous, little information exists on the experiences of Indigenous sexual minority individuals. In this study, we sought to compare different forms of violence and HIV-related behaviours by Indigenous identity among gay, bisexual and other men who have sex with men; and determine if associations between violence and HIV-related behaviours differed by Indigenous identity. We used cross-sectional survey data from 716 Spanish-speaking, adult men recruited from urban centres to examine the prevalence of and relationship between different forms of interpersonal violence and HIV-related behaviours using logistic regression analyses, including the moderating effect of Indigenous identity. In general, fewer Indigenous participants reported interpersonal violence victimisation and HIV-related behaviours compared to their non-Indigenous counterparts. In weighted multivariable analyses, non-Indigenous participants who reported physical and/or sexual violence were over five times as likely to report transactional sex (OR = 5.17, 95% CI 2.11-12.68, p < 0.001), but the relationship was not significant for Indigenous participants. Findings suggest that Indigenous sexual minority men have unique contexts and that additional strengths-based research is needed to ensure that actions and efforts to promote violence and HIV prevention meet their needs.

Global occurrence of SARS-CoV-2 in environmental aquatic matrices and its implications for sanitation and vulnerabilities in Brazil and developing countries

This paper includes a systematic review of the SARS-CoV-2 occurrence in environmental aquatic matrices and a critical sanitation analysis. We discussed the interconnection of sanitation services (wastewater, water supply, solid waste, and stormwater drainage) functioning as an important network for controlling the spread of SARS-CoV-2 in waters. We collected 98 studies containing data of the SARS-CoV-2 occurrence in aquatic matrices around the world, of which 40% were from developing countries. Alongside a significant number of people infected by the virus, developing countries face socioeconomic deficiencies and insufficient public investment in infrastructure. Therefore, our study focused on highlighting solutions to provide sanitation in developing countries, considering the virus control in waters by disinfection techniques and sanitary measures, including alternatives for the vulnerable communities. The need for multilateral efforts to improve the universal coverage of sanitation services demands urgent attention in a pandemic scenario.

Prevalence of Common Diseases in Indigenous People in Colombia

The Indigenous tribe called the Wiwa lives retracted in the Sierra Nevada de Santa Marta, Colombia. Little is known about their health status and whether the health care system in place covers their needs. In 2017 and 2018, a permanent physician was in charge for the Wiwa. Diseases and complaints were registered, ranked, and classified with the ICD-10 coding. Datasets from the Indigenous health care provider Dusakawi, collected from local health points and health brigades travelling sporadically into the fields for short visits, were compared. Furthermore, a list of provided medication was evaluated regarding the recorded needs. The most common complaints found were respiratory, infectious and parasitic, and digestive diseases. The top ten diagnoses collected in the health points and in the health brigade datasets were similar, although with a different ranking. The available medication showed a basic coverage only, with a critical lack of treatment for many severe, chronic, and life-threatening diseases. Most of the detected diseases in the Indigenous population are avoidable by an improvement in health care access, an expansion of the provided medication, and an increase in knowledge, hygiene, and life standards.

Galectins as potential therapeutic targets in STIs in the female genital tract

Every day, more than one million people worldwide acquire a sexually transmitted infection (STI). This public health problem has a direct effect on women's reproductive and sexual health as STIs can cause irreversible damage to fertility and can have negative consequences associated with discrimination and social exclusion. Infection with one sexually transmitted pathogen predisposes to co-infection with others, suggesting the existence of shared pathways that serve as molecular links between these diseases. Galectins, a family of β-galactoside-binding proteins, have emerged as endogenous mediators that facilitate cell-surface binding, internalization and cell invasion of many sexually transmitted pathogens, including Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Candida albicans, HIV and herpes simplex virus. The ability of certain galectins to dimerize or form multimeric complexes confers the capacity to interact simultaneously with glycosylated ligands on both the pathogen and the cervico-vaginal tissue on these proteins. Galectins can act as a bridge by engaging glycans from the pathogen surface and glycosylated receptors from host cells, which is a mechanism that has been shown to be shared by several sexually transmitted pathogens. In the case of viruses and obligate intracellular bacteria, binding to the cell surface promotes pathogen internalization and cell invasion. Inflammatory responses that occur in cervico-vaginal tissue might trigger secretion of galectins, which in turn control the establishment, evolution and severity of STIs. Thus, galectin-targeted therapies could potentially prevent or decrease STIs caused by a diverse array of pathogenic microorganisms; furthermore, anti-galectin agents might reduce treatment costs of STIs and reach the most vulnerable populations.

Prevalence of Self-Reported Symptoms of Sexually Transmitted Infection among Establishment-Based Female Sex Workers in Ethiopia

INTRODUCTION

In spite of the fact that female sex workers being regarded as core transmitters of sexually transmitted infections to the general population, previous studies undertaken around STIs in Ethiopia fail to consider this segment of the population. Hence, the present study investigated the prevalence of self-reported symptoms of STIs and the risk factors among FSWs in Adama Town, Ethiopia.

METHOD

A cross-sectional study was conducted from May 01, 2017, to April 30, 2017, in Adama Town. Three hundred ninety female sex workers were selected from 120 licensed drinking establishments by using simple random sampling technique. The interviewer-administered structured tool was used to collect data. Data were entered using EPI data version 3.1 and exported to SPSS version 20 for analysis. Bivariate and multivariable logistic regression analyses were used to identify factors associated with the outcome variable.

RESULT

Among the requested 423 female sex workers, 390 willingly responded to the interviewer-administered structured questionnaires making a response rate of 92.2%. One hundred thirty-nine (35.6%, 95% CI (33.8%-37.4%) of the female sex workers reported one or more STI symptoms. Several risk factors were identified including inconsistent condom use with a nonpaying client (AOR = 5.43, 95% CI: 2.73, 10.80), alcohol use before sex (AOR = 2.41, 95% CI: 1.35, 4.30), longer duration of sex work (AOR = 2.27, 95% CI: 1.26, 4.08), and having poor knowledge of STIs (AOR = 2.44, 95% CI: 1.31, 4.54).

CONCLUSION

Self-reported symptom of STI among female sex workers in Adama Town is relatively high when compared with previous studies. Hence, health education programs should address the issue of inconsistent condom use with nonpaying clients, alcohol consumption before sex, and knowledge of STIs, with a particular emphasis on those female sex workers who stayed longer in the business.

Strategies to improve control of sexually transmissible infections in remote Australian Aboriginal communities: a stepped-wedge, cluster-randomised trial

BACKGROUND

Remote Australian Aboriginal communities have among the highest diagnosed rates of sexually transmissible infections (STIs) in the world. We did a trial to assess whether continuous improvement strategies related to sexual health could reduce infection rates.

METHODS

In this stepped-wedge, cluster-randomised trial (STIs in remote communities: improved and enhanced primary health care [STRIVE]), we recruited primary health-care centres serving Aboriginal communities in remote areas of Australia. Communities were eligible to participate if they were classified as very remote, had a population predominantly of Aboriginal people, and only had one primary health-care centre serving the population. The health-care centres were grouped into clusters on the basis of geographical proximity to each other, population size, and Aboriginal cultural ties including language connections. Clusters were randomly assigned into three blocks (year 1, year 2, and year 3 clusters) using a computer-generated randomisation algorithm, with minimisation to balance geographical region, population size, and baseline STI testing level. Each year for 3 years, one block of clusters was transitioned into the intervention phase, while those not transitioned continued usual care (control clusters). The intervention phase comprised cycles of reviewing clinical data and modifying systems to support improved STI clinical practice. All investigators and participants were unmasked to the intervention. Primary endpoints were community prevalence and testing coverage in residents aged 16-34 years for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. We used Poisson regression analyses on the final dataset and compared STI prevalences and testing coverage between control and intervention clusters. All analyses were by intention to treat and models were adjusted for time as an independent covariate in overall analyses. This study was registered with the Australia and New Zealand Clinical Trials Registry, ACTRN12610000358044.

FINDINGS

Between April, 2010, and April, 2011, we recruited 68 primary care centres and grouped them into 24 clusters, which were randomly assigned into year 1 clusters (estimated population aged 16-34 years, n=11 286), year 2 clusters (n=10 288), or year 3 clusters (n=13 304). One primary health-care centre withdrew from the study due to restricted capacity to participate. We detected no difference in the relative prevalence of STIs between intervention and control clusters (adjusted relative risk [RR] 0·97, 95% CI 0·84-1·12; p=0·66). However, testing coverage was substantially higher in intervention clusters (22%) than in control clusters (16%; RR 1·38; 95% CI 1·15-1·65; p=0·0006).

INTERPRETATION

Our intervention increased STI testing coverage but did not have an effect on prevalence. Additional interventions that will provide increased access to both testing and treatment are required to reduce persistently high prevalences of STIs in remote communities.

FUNDING

Australian National Health and Medical Research Council.

Prevalence of Syphilis and Related Risk Behaviors Among Women in 5 Distinct Indigenous Populations in Paraguay

BACKGROUND

The objective of this study was to measure the prevalence of syphilis among women of reproductive age from 5 distinct indigenous populations in Paraguay. We also sought to identify the demographic profile and behaviors of women with elevated prevalence of syphilis.

METHODS

We conducted a population-based, cross-sectional survey among women aged 15 to 49 years from 5 distinct language families in Paraguay in 2016. The 5 language families were Guaraní, Maskoy, Mataco, Guaicurú, and Zamuco, sampled through a probability-based, multistage cluster design. Participants completed a questionnaire on demographic characteristics and risk-related behavior. Blood samples were drawn for rapid testing for syphilis with confirmation and titers. Participants provided written informed consent; minors had written parental consent and provided their own assent.

RESULTS

A total of 1732 indigenous women were enrolled. Overall syphilis prevalence was 6.8% (95% confidence interval [CI], 5.6-8.0). Syphilis prevalence varied by language family/ethnic group (P = 0.010), with Mataco having the highest prevalence (8.2%; 95% CI, 5.3-11.9) and Maskoy having the lowest (2.5%; 95% CI, 1.1-4.7). Women reporting multiple partners (11.3%; 95% CI, 6.9-17.1; P = 0.031) and transactional sex in the last year (18.7%; 95% CI, 7.2-36.4; P = 0.010) had higher prevalence of syphilis.

CONCLUSIONS

Our survey found high prevalence of syphilis in indigenous women in Paraguay, in association with transactional sex and multiple partners. Interventions to reduce sexual behaviors associated with an increased risk of sexually transmitted infections (STI) in indigenous women must be carried out with programs aimed at addressing transactional sex, appropriately framed to respect interculturality and an indigenous worldview.

Assessment of Maya women's knowledge, attitudes, and beliefs on sexually transmitted infections in Guatemala: a qualitative pilot study

Background

Despite Guatemala’s large indigenous population, indigenous health is often neglected in reported health data and interventions. Although this data is limited in scope, it shows that indigenous people have poorer health outcomes. Sexually transmitted infections (STIs) are now a growing threat in Guatemala and pose great risk to the wellbeing of its indigenous population.

Methods

This qualitative pilot study assessed the knowledge, attitudes, and beliefs of STIs through semi-structured interviews among a previously unstudied population of indigenous Maya women (n = 35, ages 18–50) in the six municipalities of Santa Cruz La Laguna, Guatemala.

Results

Four key themes were identified: 1) indigenous Maya women have limited factual knowledge about sex and STIs; 2) widespread partner infidelity minimizes women’s control over preventing STI contraction; 3) close-knit communities and the resulting heightened fear of gossip prevents communication and hinders care seeking; and 4) lack of quality medical care and inaccessibility of biomedical healthcare systems pose barriers to seeking care for potential STIs.

Conclusions

To address these findings, we suggest methods to improve sexual education, combat male infidelity, promote condom use, and improve health services to reduce the incidence of STIs in Maya Guatemala.

A diagnostic evaluation of a molecular assay used for testing and treating anorectal chlamydia and gonorrhoea infections at the point-of-care in Papua New Guinea

OBJECTIVES

Papua New Guinea has among the highest prevalences of sexually transmissible infections (STIs) globally with no services able to accurately test for anorectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections. Here we prospectively evaluated the diagnostic performance of a molecular CT/NG assay used at the point-of-care (POC) with the aim of enhancing anorectal STI screening and same-day treatment.

METHODS

Men who have sex with men, transgender women and female sex workers taking part in Papua New Guinea's first large-scale biobehavioural study were enrolled and asked to provide a self-collected anorectal swab for POC GeneXpert CT/NG testing. Same-day treatment was offered if positive. A convenience sample of 396 unique and randomly selected samples were transported to Australia for comparison using the Cobas 4800 CT/NG test (Roche Molecular Diagnostics, Pleasanton, CA, USA).

RESULTS

A total of 326 samples provided valid results by Cobas whereas 70 samples provided invalid results suggesting inhibition. The positive, negative and overall percentage agreements of GeneXpert CT/NG for the detection of C. trachomatis were 96.7% (95% CI 92.3%-98.9%), 95.5% (95% CI 91.3%-98.0%) and 96.0% (95% CI 93.3%-97.8%), and for N. gonorrhoeae were 93.0% (95% CI 86.1%-97.1%), 100.0% (95% CI 98.3%-100.0%) and 97.8% (95% CI 95.6%-99.1%), respectively.

CONCLUSIONS

The overall rate of agreement between the GeneXpert and Cobas CT/NG assays was high with 96.0% for C. trachomatis and 97.8% for N. gonorrhoeae. Results from this study data suggest that the GeneXpert CT/NG assay is suitable for testing self-collected anorectal specimens at the POC and that same-day treatment was feasible.

Concurrence and selection of sexual partners as predictors of condom use among Mexican indigenous migrant workers

OBJECTIVE

To identify if the selection of mixed sexual partners and the existence of concurrent partners are predictors of condom use in indigenous migrant agricultural workers from Colima, Mexico.

METHODS

Analytical cross-sectional study using an egocentric sexual network approach. Community interviewers applied a structured questionnaire to 192 indigenous migrant workers in a sugarcane agro-industrial context. Data were analyzed with binary logistic regression; odds ratios (OR) and 95% confidence intervals (CI 95%) were estimated.

RESULTS

In the logistic regression model, adjusted odds (OR; 95% CI) of steady condom use were lower within partnerships of the same indigenous ethnicity compared to other partnerships (0.30; 0.17-0.53), partnerships that were concurrent to other partnerships (0.27; 0.15-0.50), and partnerships that used illegal drugs during sex to other partnerships (0.23; 0.11-0.49). Those variables were actually associated with increased risk of unprotected sex (occasionally or never using condoms), and therefore exposures were unprotected.

CONCLUSION

Sexual partners of the same ethnicity, concurrent partnerships and partnerships that use illegal drugs favor the low frequency of constant condom use and, in turn, the vulnerability to STIs and HIV transmission in indigenous migrant agricultural workers.

HIV, syphilis, and viral hepatitis among Latin American indigenous peoples and Afro-descendants: a systematic review

Objective

To identify and summarize existing literature on the burden of HIV, sexually transmitted infections (STIs), and viral hepatitis (VH) in indigenous peoples and Afro-descendants in Latin America to provide a broad panorama of the quantitative data available and highlight problematic data gaps.

Methods

Published and grey literature were systematically reviewed to identify documents published in English, Spanish, or Portuguese with data collected between January 2000 and April 2016 on HIV, STI, and VH disease burden among indigenous peoples and Afro-descendants in 17 Latin American countries.

Results

Sixty-two documents from 12 countries were found. HIV prevalence was generally low (< 1%) but pockets of high prevalence (> 5%) were noted in some indigenous communities in Venezuela (Warao) (9.6%), Peru (Chayahuita) (7.5%), and Colombia (Wayuu females) (7.0%). High active syphilis prevalence (> 5%) was seen in some indigenous communities in Paraguay (11.6% and 9.7%) and Peru (Chayahuita) (6.3%). High endemicity (> 8%) of hepatitis B was found in some indigenous peoples in Mexico (Huichol) (9.4%) and Venezuela (Yanomami: 14.3%; Japreira: 29.5%) and among Afro-descendant quilombola populations in Brazil (Frechal: 12.5%; Furnas do Dionísio: 8.4% in 2008, 9.2% in 2003).

Conclusions

The gaps in existing data on the burden of HIV, STIs, and VH in indigenous peoples and Afro-descendants in Latin America highlight the need to 1) improve national surveillance, by systematically collecting and analyzing ethnicity variables, and implementing integrated biobehavioral studies using robust methodologies and culturally sensitive strategies; 2) develop a region-wide response policy that considers the needs of indigenous peoples and Afro-descendants; and 3) implement an intercultural approach to health and service delivery to eliminate health access barriers and improve health outcomes for these populations.

Risk Behaviors and Perceptions Among Self-identified Men Who Have Sex with Men (MSM), Bisexuals, Transvestites, and Transgender Women in Western Guatemala

Guatemala has a concentrated HIV epidemic disproportionately affecting men who have sex with men (MSM) and transgender women. We recruited 205 self-identified MSM, bisexuals, transvestites, and transgender women in western Guatemala using long-chain peer referral, wherein "seed" participants were asked to invite as many as three acquaintances to participate in the study. Self-reported sexual or gender identity was MSM, 46%; bisexual, 28%; transvestite, 21%, and transgender woman, 5%. Median age of the participants was 23 years, and 36% self-identified as being indigenous. Indigenous persons were more likely to self-identity as transvestite (32.9% vs 13.8%, P = 0.04), strongly perceive themselves at risk for HIV (87.7% vs 51.5%, P = 0.001), have had an HIV test in the last 12 months and know the result (97.3% vs 85.4%, P = 0.008), and experience barriers to testing and treatment (86.3% vs 67.7%, P = 0.004). HIV prevention services for indigenous MSM should especially target transvestites and how to overcome stigmatization and barriers to care.

Syphilis and HIV infections among pregnant women attending antenatal clinics in Republic of Congo

Introduction

HIV and syphilis during pregnancy remain a public health concern especially in developing countries. Pregnant women attending antenatal clinics sites for the first time between September and December 2011 and who accepted to participate in the study were enrolled. The objective was to estimate the syphilis and HIV infection rate in this population.

Methods

A study was conducted in 44 selected ANCs from 12 departments (5 urban and 7 rural). Pregnant women who accepted to participate in the study, attending selected sentinel ANCs sites for the first time between September and December 2011 were enrolled. To detect HIV antibodies, two consecutive ELISA assays were used (Genscreen Ultra HIV Ag/Ac, (BioRad, France) and Enzygnostic Intergral II (Siemens, GMBH, Marbug-Germany). In case of discordant results, the Western blot test II, HIV1 and 2 (Bio-Rad, Marne la Coquette, France) was used as the reference method. The RPR (Bio-Scan, Karnataka, India) test was performed to detect syphilis infection. The RPR positive results were confirmed using the TPHA test (Biotech, Cambridge, UK). Data were analyzed using SPSS 17.0 software.

Results

A total of 2979 pregnant women attending ANCs were enrolled. The global HIV infection rate was estimated to be 3.6% (CI: 95%; 3.0-4.4). As expected, HIV prevalence was significantly higher in women aged above 25 years (4.4% (3.4-5.6), p = 0.026) and those attending urban ANCs (5.04%, p < 0.01). Also, women living in the urban area are more at risk to be infected (5.04 VS 2.38, p < 0.01). The RPR test was positive in 117 pregnant women (3.92%). The risk for syphilis occurrence was significantly higher among the single women compared to the married ones (4.4% VS 2.7%; p < 0.01). It was also estimated that the HIV and syphilis coinfection occurred in 22 cases (0.73%).

Conclusion

The prevalence's of syphilis and HIV were relatively low. Marital status and sentinel site location were a risk factor associated with HIV and syphilis infections respectively. Therefore, substantial effort is needed to reinforce prevention strategies in this population to prevent mother-to-child and further horizontal transmissions of these infections.

HIV and syphilis in the context of community vulnerability among indigenous people in the Brazilian Amazon

BACKGROUND

Contextual factors shape the risk of acquiring human immunodeficiency virus (HIV) and syphilis. We estimated the prevalence of both infections among indigenous people in nine indigenous health districts of the Brazilian Amazon and examined the context of community vulnerability to acquiring these infections.

METHODS

We trained 509 health care workers to screen sexually active populations in the community for syphilis and HIV using rapid testing (RT). We then assessed the prevalence of HIV and syphilis using RT. A multivariable analysis was used to identify factors associated with syphilis infection (sociodemographic, condom use, intrusion, population mobility, and violence).

RESULTS

Of the 45,967 indigenous people tested, the mean age was 22.5 years (standard deviation: 9.2), and 56.5% were female. Overall, for HIV, the prevalence was 0.13% (57/43,221), and for syphilis, the prevalence was 1.82% (745/40,934). The prevalence in men, women, and pregnant women for HIV was 0.16%, 0.11%, and 0.07%, respectively, and for syphilis, it was 2.23%, 1.51%, and 1.52%, respectively. The district Vale do Javari had the highest prevalence of both infections (HIV: 3.38%, syphilis: 1.39%). This district also had the highest population mobility and intrusion and the lowest availability of prenatal services. Syphilis infection was independently associated with age (odds ratio [OR] 1.04, 95% confidence interval [CI]: 1.03-1.05), male sex (OR 1.32, 95% CI: 1.14-1.52), and mobility (moderate: OR: 7.46, 95% CI: 2.69-20.67; high: OR 7.09, 95% CI: 3.79-13.26).

CONCLUSIONS

The large-scale integration of RT in remote areas increased case detection among pregnant women, especially for syphilis, in districts with higher vulnerability. Mobility is an important risk factor, especially in districts with higher vulnerability. Contextually appropriate approaches that address this factor could contribute to the long-term success of HIV and syphilis control programs.

A study on HIV, Syphilis, and Hepatitis B and C virus infections among female sex workers in the Republic of Congo

BACKGROUND

Female Sex Workers (FSWs) are considered to be at high risk for transmission of Sexually Transmitted Infections (STIs) and are defined as a priority of the national HIV/AIDS response in the Republic of Congo (RoC). However, no data are available regarding STIs in this group. This study aimed to determine the prevalences of HIV, syphilis and hepatitis B and C among FSWs in five cities in the country.

METHODS

A cross-sectional study was conducted from November 2^nd 2011 to May 15^th 2012. Participants were recruited in Brazzaville, Pointe-Noire, Dolisie, Nkayi and Pokola using a respondent-driven sampling method.

RESULTS

A total of 805 FSWs were recruited with an average age of 28.31 ± 9.15 years. The overall prevalences of HIV, syphilis, HBV and HCV were 7.50%, 2.20%, 4.20% and 0.70%, respectively. The age groups 35-39 (20.51% [0%-36.93%], p = 0.0057) and greater than 40 years (16.67% [0%-34.93%], P = 0.016) were positively associated with behaviors at high risk of HIV infection. For syphilis, the most infected age group was the one greater than 40 years, at 6.25% ([1.06% -72.37%] p = 0.04). Pointe-Noire was the most infected city for syphilis and HBV, with 5.15% (p = 0.0061) and 4.22% (p˂0.001), respectively. No risk factors were associated with HCV infection. FSWs practicing in mobile prostitution sites had a significantly higher infection rate (2.1% [0%-11.09%] p = 0.04).

CONCLUSION

This study shows that the prevalence of HIV and other STIs in FSWs is high. Therefore, a combination of individual and structural interventions could reduce the risk of an STI "reservoir" among this population.

Low HIV testing rates among people with a sexually transmissible infection diagnosis in remote Aboriginal communities

OBJECTIVE

To determine the rates of HIV testing among people who had received positive test results for chlamydia, gonorrhoea and trichomoniasis, or who had been tested for syphilis.

DESIGN, SETTING AND PARTICIPANTS

Pathology data for the period January 2010 - December 2014 from 65 remote Aboriginal communities participating in the STRIVE trial of sexually transmissible infection (STI) control were analysed.

MAIN OUTCOME MEASURES

Rates of HIV testing within 30 and 90 days of an STI test (for chlamydia, gonorrhoea or trichomoniasis), the result of which was positive, and within 30 days of a test for syphilis; factors independently associated with concurrent HIV testing.

RESULTS

31.8% of 15 260 positive STI test results were linked with an HIV test within 30 days of the test (including 5.6% not on the same day), and 34.8% within 90 days; 44.1% were linked with syphilis testing within 30 days. 53.4% of all those tested for syphilis were also tested for HIV within 30 days. Multivariate analysis found that HIV testing was more likely for men, in geographical regions 3 and 4, in association with positive STI test results during 2012, 2013 or 2014 (v 2010), and in association with positive test results for gonorrhoea or chlamydia. Similar associations with these factors were found for syphilis testing.

CONCLUSIONS

A significant challenge in Aboriginal health is avoiding an increase in the number of HIV infections. One critical intervention in this regard is timely and appropriate testing. Adhering to screening recommendations is clearly an aspect of the delivery of sexual health services to remote communities that can be improved in striving to achieve this aim.

Sexually transmitted diseases among female commercial sex workers in Finote Selam town, northwest Ethiopia: a community-based cross-sectional study

Background

Female commercial sex workers (FCSWs) are considered a high-risk group for acquiring sexually transmitted diseases (STDs), yet the reported prevalence varies in studies around the world. The aim of this study was to determine the magnitude and associated factors of STDs among female sex workers.

Methods

A community-based cross-sectional study was conducted among female sex workers in Finote Selam town. A total of 389 sex workers were studied using census method. Data were collected using an interview with structured questionnaires. The data were entered and analyzed by using SPSS version 20 software package.

Results

The findings of this study showed that the overall prevalence of STDs was 20.6%. The reported prevalence of genital discharge, ulcer, and bubo was 15.9%, 15.2%, and 11.6%, respectively. In the multivariable logistic regression analysis, respondents who did not use a condom were about four times at higher risk of STDs than those who were using a condom consistently (adjusted odds ratio [AOR] = 4.07; 95% confidence interval [CI]: 1.812, 9.139). Respondents who experienced condom breakages were more than 12 times more likely to report STDs than those who never experienced condom breakages (AOR = 12.291, 95% CI: 5.701, 26.495).

Conclusion

The findings of this study showed that one in five commercial sex workers in Finote Selam town had STDs. Sex without a condom and condom breakage during sexual intercourse showed a significant association with STDs. Therefore, the Woreda Health Office in collaboration with nongovernmental organizations in the area should work on safe sex promotion to enhance consistent condom use and reduce condom breakage through continuous education among commercial sex workers.

Abuse of power in relationships and sexual health

STI rates are high for First Nations in Canada and the United States. Our objective was to understand the context, issues, and beliefs around high STI rates from a nêhiyaw (Cree) perspective. Twenty-two in-depth interviews were conducted with 25 community participants between March 1, 2011 and May 15, 2011. Interviews were conducted by community researchers and grounded in the Cree values of relationship, sharing, personal agency and relational accountability. A diverse purposive snowball sample of community members were asked why they thought STI rates were high for the community. The remainder of the interview was unstructured, and supported by the interviewer through probes and sharing in a conversational style. Modified grounded theory was used to analyze the narratives and develop a theory. The main finding from the interviews was that abuse of power in relationships causes physical, mental, emotional and spiritual wounds that disrupt the medicine wheel. Wounded individuals seek medicine to stop suffering and find healing. Many numb suffering by accessing temporary medicines (sex, drugs and alcohol) or permanent medicines (suicide). These medicines increase the risk of STIs. Some seek healing by participating in ceremony and restoring relationships with self, others, Spirit/religion, traditional knowledge and traditional teachings. These medicines decrease the risk of STIs. Younger female participants explained how casual relationships are safer than committed monogamous relationships. Resolving abuse of power in relationships should lead to improvements in STI rates and sexual health.

Health of Indigenous Peoples

Indigenous populations worldwide are experiencing social, cultural, demographic, nutritional, and psychoemotional changes that have a profound impact on health. Regardless of their geographical location or sociopolitical situation, health indicators are always poorer for indigenous populations than for nonindigenous ones. The determinants of this gap are multiple and interactive, and their analysis requires a biocultural framework. Indigenous populations suffer from lower life expectancy, high infant and child mortality, high maternal morbidity and mortality, heavy infectious disease loads, malnutrition, stunted growth, increasing levels of cardiovascular and other chronic diseases, substance abuse, and depression. The devastating effects of colonization, the loss of ancestral land, and language and cultural barriers for access to health care are among the most salient themes characterizing the poor health situation of indigenous people. Anthropology is extremely well suited to address the interplay among social, economic, and political forces that shape the local experiences of illness.

HIV Among Indigenous peoples: A Review of the Literature on HIV-Related Behaviour Since the Beginning of the Epidemic

From the early days of the HIV epidemic, Indigenous peoples were identified as a population group that experiences social and economic determinants-including colonialism and racism-that increase exposure to HIV. There are now substantial disparities in HIV rates between Indigenous and non-Indigenous peoples in some countries. We conducted a comprehensive literature review to assess the evidence on HIV-related behaviors and determinants in four countries-Australia, Canada, New Zealand and the United States-in which Indigenous peoples share important features of colonization and marginalization. We identified 107 articles over more than 20 years. The review highlights the determinants of HIV-related behaviors including domestic violence, stigma and discrimination, and injecting drug use. Many of the factors associated with HIV risk also contribute to mistrust of health services, which in turn contributes to poor HIV and health outcomes among Indigenous peoples.

Methods of a national survey of young Aboriginal and Torres Strait Islander people regarding sexually transmissible infections and bloodborne viruses

OBJECTIVE

To describe the methods and basic demographics of participants in a national survey of Aboriginal and Torres Strait Islander (Aboriginal) people specific to sexually transmissible infections and bloodborne viruses.

METHODS

A national cross-sectional survey of Aboriginal people aged 16-29 years in all Australian jurisdictions between 2011 and 2013 conducted at Aboriginal community events. Questions comprised demographic information, knowledge, risk behaviours and health service utilisation. Questionnaires were completed on personal digital assistants (PDAs).

RESULTS

A total of 2,877 people at 21 unique community events completed the questionnaire. A total of 59% of participants were female, median age was 21 years and more than 60% were single at the time of the survey. Just over half the participants were resident in an urban area (53%) and 38% were from a regional area. Aboriginal health organisations played an important role in implementing the research. PDAs were found to be an acceptable method for collecting health information.

CONCLUSION

This survey has recruited a large representative sample of Aboriginal people aged 16-29 years using a methodology that is feasible, acceptable and repeatable.

IMPLICATIONS

The methodology provides a model for ongoing monitoring of this population as programs and policies are implemented to address young Aboriginal people's STI and BBV risks.

Magnitude of HIV and syphilis seroprevalence among pregnant women in Gondar, Northwest Ethiopia: a cross-sectional study

Background

Human immunodeficiency virus (HIV) and syphilis are major public health problems in sub-Saharan Africa, causing numerous adverse pregnancy outcomes. The aim of study was to assess the magnitude of HIV and syphilis seroprevalence among pregnant women at University of Gondar Teaching Hospital.

Method

The study was conducted between March and May, 2012. Sociodemographic data were collected through face-to-face interview. HIV1/2 was tested following current national HIV1/2 testing algorithm. Syphilis infection was also tested using the rapid plasm reagin test for screening and Treponema pallidum hemagglutination as a confirmatory test. Both bivariate and multivariate analysis were used to identify factors associated with HIV and syphilis seroprevalence from selected sociodemographic variables.

Results

Of 300 women, 31 (10.33%), eleven (3.7%), and three (1%) were seroreactive for HIV, syphilis, and HIV–syphilis coinfection, respectively. High seroprevalence of HIV was found in women ages 25–30 years (13.4%), and women whose husbands attended primary school (19.7%). Syphilis was high in women occupationally housewives (15.2%) and whose husbands were illiterate (11.5%). HIV was associated with husband illiteracy (AOR [adjusted odds ratio] of 4.13, 95% CI [confidence interval] [1.01, 16.95]) and primary educational level of husbands (AOR [95% CI] =3.83 [1.50, 9.90]), whereas syphilis was associated with illiteracy of husband (AOR [95% CI] =7.25 [1.74, 30.30]).

Conclusion

Seroprevalence of HIV and syphilis was high. Low husband educational status was a risk factor for HIV and syphilis. Therefore, substantial efforts have to be made to reinforce prevention strategies and to screen as early as possible to prevent mother-to-child and further horizontal transmission.

The changing face of HIV in Latin America and the Caribbean

Latin America and the Caribbean (LAC) is a region with similarities and important disparities. In recent years LAC has witnessed achievements, with HIV prevalence rates relatively stable for LA and decreasing for the Caribbean. However average values hide differences. General population HIV prevalence in LAC is 0.4 % on average. In the Caribbean there are fewer new HIV infections but HIV prevalence among adults exceeds 1 % in several countries. It is estimated that 31 % of adults living with HIV in LA and 52 % of adults in the Caribbean are women. Unprotected sex is the main route of HIV transmission in LAC. Men who have sex with men and transgender women are the populations with the highest prevalence (10.6 % and 17.7 % respectively); however other key populations such as female sex workers (4.9 %), drug users (range 1 %-49.7 % for intravenous drug users), prisoners and indigenous populations are also important. LAC has the highest anti-retroviral treatment coverage of any low- and middle-income region in the world, but women and children are less likely than men to receive treatment. There is an important pending agenda to address the gaps in information, prevention, and care for HIV in LAC.