Estimation of Potential HIV Transmission Risk in Recent Anal Intercourse Events among Men Who Have Sex with Men and Transgender Women in Bali, Indonesia

Characterizing Socioecological Markers of Differentiated HIV Risk Among Men Who Have Sex with Men in Indonesia

HIV prevention programs typically focus on changing individuals' risk behaviors, often without considering the socioecological factors that can moderate this risk. We characterized HIV risk among men who have sex with men (MSM) in Indonesia (n = 1314) using latent class analysis and used multinomial logistic regression to identify latent class relationships with demographics, social/sexual networks, and community-level socioecological indicators of HIV risk. Three HIV risk latent classes were identified-"Sexually Moderate" (n = 333), "Sexual Explorative" (n = 575), and "Navigating Complexities" (n = 406). Using "Sexually Moderate" (lowest risk) as the reference group, MSM in the "Sexual Explorative" class had additional social/sexual network-level risks (meeting partner(s) using both online and offline methods [RR = 3.8; 95%CI 1.7-8.6] or general social media and gay-specific online platforms [RR = 2.6; 95%CI 1.9-3.6] to meet partners, group sex [RR = 10.9; 95%CI 4.5-25.4], transactional sex [RR = 1.6; 95%CI 1.2-2.2]), and community-level risks (experiencing homosexual-related assaults [RR = 1.4; 95%CI 1.1-1.9]). MSM in the "Navigating Complexities" class had additional social/sexual network-level risks (low social support [RR = 1.6; 95%CI 1.1-2.5], less disclosure of their sexuality [RR = 1.4; 95%CI 1.0-1.9]) and community-level risks (higher internalized homonegativity scores [RR = 1.2; 95%CI 1.1-1.4], ever experiencing homosexual-related assaults [RR = 1.4:95%CI 1.1-1.9], less exposure to HIV/STI health promotion [RR = 0.7; 95%CI 0.5-0.9], attending STI-related services in the past 6 months [RR = 0.6; 95%CI 0.4-0.8]). Co-occurring individual and socioecological risk recommend holistic HIV prevention strategies tailored to consider the social and structural conditions of MSM in Indonesia are needed.

Understanding Women's Knowledge, Awareness, and Perceptions of STIs/STDs in Asia: A Scoping Review

OBJECTIVE

This study aimed to conduct a scoping review to collect current literature on the knowledge, awareness, and perception (KAP) of sexually transmitted infections/diseases (STIs/STDs) among women in Asia.

METHODOLOGY

The PRISMA-Scoping methodology was used in this study to extract papers from four databases published between 2018 and 2022. Sixty-eight articles were included after screening and elimination.

RESULTS

The studies on KAP of STIs/STDs among women were largely undertaken in Southeast Asia (Indonesia, Malaysia, and Vietnam) and South Asia (India, Pakistan, and Bangladesh). Regardless of the specific cohort of women studied, research indicates consistently low levels of knowledge and awareness across Asia. This trend seems to be more prevalent among female commercial sex workers, women with lower educational levels, and those in poorer socioeconomic positions. In South Asia, cultural, sociological, economic, and gender inequalities, particularly male domination, all have a significant impact on KAP levels.

CONCLUSION

As education is a major factor that influences health behaviour, this review underscores the need to allocate more resources to educational initiatives, particularly targeting vulnerable groups such as sex workers, transgender women, pregnant women, and rural housewives. This strategic focus may contribute significantly to preventing STIs/STDs, particularly in less developed regions/countries.

Inconsistent condom use with casual partners among men who have sex with men in Brazil: a cross-sectional study

OBJECTIVE

This study aimed to evaluate factors associated with inconsistent condom use with casual partners in a population of men who have sex with men (MSM) in Brazil.

METHODS

In 2016, 4,176 MSM >18 years were enrolled in 12 capitals of Brazil using a Respondent Driven Sampling (RDS) method. For the construction of the outcome, we evaluated questions about condom use in all anal intercourse (receptive and insertive) in the previous six months and the last sexual intercourse. Estimates were calculated using a weighted complex sample design. We performed a logistic regression analysis to determine the associations between sociodemographic and behavioral factors and inconsistent condom use in sexual relationships with casual male partners.

RESULTS

More than half of our sample (50.8%) had not used condoms consistently with casual partners in the previous six months. Inconsistent condom use was significantly associated with: low education (weighted odds ratio - wOR: 1.55; 95% confidence interval - CI 0.99-2.40), lack of counseling on sexually transmitted infections STI (wOR: 1.51; 95%CI 1.05-2.17), non-use of condoms at sexual debut (wOR: 3.05; 95%CI 2.12-4.40) and moderate and high perceived risk for HIV (wOR: 1.51; 95%CI 1.07-2.14). Higher age was negatively associated with inconsistent condom use (wOR=0.97, 95%CI 0.89-0.99).

CONCLUSION

Despite being an individual behavior, condom use is related to factors beyond the individual scope. HIV/Aids prevention policies should focus on younger MSM, providing qualified information about condom use, preferably before the beginning of their sexual life.

Effect of alcohol exposure on the efficacy and safety of tenofovir alafenamide fumarate, a major medicine against human immunodeficiency virus

Human immunodeficiency virus (HIV) continues to be a major health concern. AIDS-related deaths (acquired immunodeficiency syndrome) have decreased recently, but chronic liver disease is now a major cause of mortality among HIV patients. Widespread alcohol use is recognized to be a major contributing factor. Tenofovir alafenamide fumarate (TAF), one of the most used HIV drugs, requires hydrolysis followed by phosphorylation to produce tenofovir diphosphate, the ultimate anti-HIV metabolite. Carboxylesterase-1 (CES1), established to hydrolyze TAF, is known to catalyze transesterification in the presence of ethanol. The aim of the study was to test the hypothesis that metabolism-based interactions between TAF and ethanol negatively impact both efficacy and safety of TAF. To test this hypothesis, the metabolism of TAF was determined in human primary hepatocytes and with a large number of human liver samples (S9 fractions) in the presence or absence of ethanol. The metabolism was monitored by LC-MS/MS (liquid chromatography with tandem mass spectrometry) and the level of CES1 or CES2 was determined by Western blotting. Consistent with the hypothesis, TAF underwent transesterification in the presence of ethanol accompanied by decreased hydrolysis. The formation of tenofovir diphosphate (the therapeutically active metabolite) was significantly decreased. In addition, TAF but not its hydrolytic metabolite, was found to increase intracellular lipid retention, and the increase was enhanced by ethanol. These findings conclude that alcohol consumption, beyond commonly accepted poor adherence to HIV medications, directly impacts the efficacy and safety of TAF.