Predictors and Barriers to Condom Use in the African Cohort Study

Consistent condom use is an inexpensive and efficacious HIV prevention strategy. Understanding factors associated with condom use and barriers to use can inform strategies to increase condom uptake. The ongoing African Cohort Study prospectively enrolls adults at 12 clinical sites in Uganda, Kenya, Tanzania, and Nigeria. At enrollment, participants are asked about condom use at last sex with a regular partner. Robust Poisson regression models were used to evaluate predictors of self-reported condom use. Participants who reported not using condoms were asked to provide reasons. From January 2013 to September 2019, 2482 participants reported having at least one regular sexual partner in the preceding 6 months. Of those, 1577 (63.5%) reported using a condom at last sex. Condom use was more common among older participants, males, HIV-infected participants, and those with an HIV-infected partner. Married participants, those with a partner of unknown HIV status, and those reporting alcohol use were less likely to report condom use at last sex. Condom use at last sex also varied significantly by clinical site. Partner disapproval or refusal to use a condom was a consistent driver of disparities in condom use among participants who were HIV infected, female, and aged 18-24 years. Effective HIV prevention programs should integrate condom education with the tools necessary to negotiate condom use with regular partners.

[Uncertain neurological status in a depressed patient]

Vorstellung eines 70-jährigen Patienten, der vom Hausarzt wegen eines akut aufgetretenen, unklaren neurologischen Zustandsbildes zugewiesen wird. Aufgrund der klinischen Symptomatik, der Anamnese und nach Ausschluss einer anderen Ursache, wird die Diagnose eines malignen Neuroleptika-Syndroms (MNS) gestellt. Trotz Standard-Therapie kam es zu einer Verschlechterung des Allgmeinzustandes mit Intubationsbedürftigkeit und schliesslich Exitus, wahrscheinlich infolge einer unkontrollierbaren Sepsis mit sekundärer Hirnblutung. Epidemiologie, Ätiologie, Kinik, diagnostische Kriterien, Differentialdiagnose und Therapie des MNS werden vorgestellt und diskutiert. Das maligne neuroleptische Syndrom ist eine seltene aber höchst gefährliche Komplikation einer Neuroleptika-Therapie und sollte deshalb erkannt werden.