HIV Post-exposure Prophylaxis Research Articles

Physician Attitudes Towards Pharmacist-Prescribed HIV Post-Exposure Prophylaxis (PEP): A Survey of a State Medical Association.

Timely initiation of antiretroviral therapy (ART) for non-occupational post-exposure prophylaxis (nPEP) is crucial in preventing HIV infection and advancing efforts to end the HIV epidemic (EHE). nPEP must be administered within 72h of high-risk exposure, ideally within 24h. Pharmacies may play a role in increasing access to nPEP and facilitating referrals for additional care, such as PrEP. Recent legislation permits pharmacist-prescribed nPEP (PDP), though provider attitudes toward this change have not been studied. A survey querying physicians and medical trainees (students and residents) was conducted in 2024 during an annual state medical association conference. The survey included 24 questions on nPEP knowledge and attitudes towards pharmacist-prescribed nPEP (PDP). The survey was administered in person using electronic tablets, with voluntary participation incentivized by a monetary reward. Statistical analysis was conducted using SAS (9.4 version) software, with differences in responses between physicians and trainees evaluated. P values < 0.05 were considered statistically significant. Of 89 respondents (56% of attendees), 61 were physicians and 28 were trainees. Notably, 28% of licensed providers indicated that pharmacist-directed prescribing (PDP) should not be allowed in the State of Ohio, while no trainees expressed this same opposition (p = 0.001). Trainees were more likely to view pharmacist prescribing as safe and appropriate ((p = 0.0135, p = 0.013). Urban-based providers were more supportive of pharmacist prescribing than their rural counterparts (p = 0.0195). Trainees showed little opposition to PDP, whereas physicians expressed concerns about safety and appropriateness. Addressing these concerns is essential for integrating pharmacists into the EHE strategy.

Awareness and Uptake of HIV Preexposure Prophylaxis and Postexposure Prophylaxis Among College Students With Sexual Experiences: Institutional-Based Cross-Sectional Study.

Evidence has shown that HIV prevalence among young people, especially college students, has increased disproportionately. Preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) are two of the most effective ways to prevent HIV, which are vital for college students with sexual experiences who have sexual risks. To provide evidence for effective intervention to reduce the risk of HIV infection among young students, this study aimed to analyze the awareness and uptake of HIV PrEP and PEP among college students with sexual experiences. An institutional-based cross-sectional study design was used to collect data through an electronic questionnaire from college students in 5 colleges located in Zhejiang Province. A total of 21,962 college students were investigated, of which 2605 students with sexual experiences were included in the data analysis with the following information collected: sociodemographic characteristics, awareness and uptake of HIV PrEP and PEP, sexual behaviors, and HIV tests. Binary logistic regression analysis was used to explore the factors on seeking PrEP and PEP. The average age of college students with sexual experiences was 21.25 (SD 2.75) years. Overall, 61.4% (n=1600) of the participants were aware of PrEP, and 53.0% (n=1380) of them were aware of PEP. Moreover, 5.6% (n=146) of them have sought PrEP or/and PEP, and 89.1% (n=2321) have not sought PrEP or PEP. College students who had more than 6 sexual partners, have always had unprotected sex, have subjective perceived risk behavior, and undergo HIV testing were more likely to seek PrEP or/and PEP. The main ways for the participants to learn PrEP and PEP were through school clubs, the internet, and the Centers for Disease Control and Prevention. Moreover, senior students and those who had not undergone an HIV test had a lower likelihood of seeking PrEP and PEP. College students who did not have risky sexual behaviors (odds ratio 0.468, P=.004) and homosexual students (odds ratio 0.318, P=.03) were more likely not to seek PEP. College students with sexual experiences rarely seek PrEP and PEP, with a relatively low awareness of PrEP and PEP. It is very important to increase the knowledge and uptake of PrEP and PEP by educational and behavioral interventions among young students at risk for HIV infection.

Updated guidelines on HIV post-exposure prophylaxis: continued efforts towards increased accessibility.

HIV transmission is ongoing in both high- and low-resource settings. Post-exposure prophylaxis (PEP) remains an important tool in preventing HIV; however, PEP is significantly underutilized. The multitude of barriers to PEP implementation include low patient and provider awareness and acceptability, limited access to treatment and prevention services, and high rates of stigma. The World Health Organization (WHO) recently released updated guidance on the delivery of HIV PEP. This commentary aims to highlight the salient changes, evaluate how such recommendations can overcome the existing barriers to PEP implementation and discuss strategies needed to put the updated guidance into practice. The 2024 WHO PEP guidelines continue a trend towards increasing access to PEP. Most notably, the WHO now provides strong recommendations that: (1) PEP be delivered in community settings (e.g. pharmacies, police stations and online platforms), and (2) PEP delivery and monitoring be done via task sharing involving non-specialist health workers (e.g. pharmacists or community health workers). The guidelines also emphasize that the PEP encounter is an important educable moment whereby a transition to pre-exposure prophylaxis among individuals at continued risk for HIV infection should be discussed. The decentralization of PEP delivery has the potential to overcome numerous barriers to PEP implementation, reduce time to initiation and support adherence with the 28-day course. To translate the recommendations into delivery programmes, however, much more work is needed. Detailed templates can help overcome the heterogeneity of both the community settings in which PEP can now be provided and the populations (e.g. survivors of sexual assault, healthcare workers, sex workers, etc.) among whom PEP may be indicated. Training of the workforce will be essential, which should include, as emphasized by the WHO, training in trauma-based care. Novel formulations of and delivery mechanisms for PEP are also emerging, and how such iterations can synergize with decentralized PEP delivery programmes remains to be seen. The updated WHO PEP guidelines make major strides towards increasing access to PEP. Realization of such aims will require ongoing evaluation and support given the heterogeneity in who benefits most from PEP.

Scoping Review of Pre-Exposure Prophylaxis and Post-Exposure Prophylaxis in HIV Prevention in Türkiye

Abstract Background Pre-Exposure Prophylaxis (PrEP) is a medical -antiretroviral- prevention method that reduces the risk of HIV transmission during sexual intercourse or injection drug use. Post-exposure prophylaxis (PEP) refers to taking medicine after risky exposure. The European Centre for Disease Prevention and Control (ECDC) has recommended the integration of PrEP into the existing HIV prevention packages since 2015. In Türkiye, first PrEP Guideline was published in 2022. The aim of this study is to evaluate the literature gap on the PrEP and PEP for HIV prevention research in Türkiye. Methods This study was conducted in October 2023. Searches were performed using the keywords ‘HIV, AIDS’ and ‘Pre-exposure prophylaxis, PrEP, Post-exposure prophylaxis, PEP’ in PubMed, Web of Science, Scopus, TRDizin, and Dergipark for all years. ‘Türkiye, Turkey, Turkish’ were added into the keywords in international indexes, without using country filters. Inclusion criteria were research on PrEP or PEP for HIV, research conducted in or using data from Türkiye, publications in English/Turkish. Exclusion criteria were non-HIV topics, non-Turkish data, non-English/Turkish publications. Lists were merged, duplicates were removed. Inclusion-exclusion criteria were conducted at title and abstract level. Full texts of the included articles examined for bibliometric characteristics, study types, and key results. Results 1014 publications yielded, 993 evaluated, and 17 fully reviewed. Four discussed Türkiye’s PrEP practices (2018-2023); three analyzed PEP regimens; three were reviews on PrEP/PEP in Türkiye (2016-2022). Two original research articles explored PrEP awareness among Türkiye’s men having sex with men (2022) and infectious disease physicians’ attitudes toward PrEP (2020). Studies showed gaps in PrEP information and service access. Conclusions There are limited studies published on PrEP and PEP in HIV prevention in Türkiye. This study highlights the need for local research on the topic. Key messages • Evaluation of Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) publications highlights gaps in HIV prevention research. • Limited literature on PrEP and PEP in HIV prevention emphasizing the need for further studies and improved access to PrEP information.

Combined HIV prevention: knowledge and attitudes among higher education students in Portugal

Abstract Introduction Combined Prevention is a strategy that combines different methods of HIV prevention that can be used simultaneously or sequentially, depending on the characteristics and life stage of everyone. Among the methods are condom use, regular HIV testing, pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP). Combined prevention is particularly important for more vulnerable groups, such as adolescents and young adults. Objectives To investigate the knowledge and attitudes related to combined HIV prevention among college students. Methods A cross-sectional study was conducted with college students from two institutions in a Portuguese city in the year 2022. Sampling was non-probabilistic, by convenience. Students aged 18 to 29 who had initiated sexual activity were included. The data collection instrument was a structured questionnaire sent to students online. Data were analyzed descriptively. Ethical aspects were respected. Results A total of 424 students participated in the study; majority were female (79.2%), white (92.9%), single (96.7%), Catholic (67.2%), with a mean age of 20.8 years (SD = 2.3). The number of sexual partners in the last semester ranged from none to 19, with an average of two partners (SD = 1.9). Nearly all students (94.3%) agreed that condoms are the main form of HIV prevention, however, 45.2% did not use condoms in their last casual sexual encounter. Only 15.5% and 13.9% of participants reported knowing about pre- and post-exposure prophylaxis, respectively. The majority had never been tested for HIV (81.8%) and did not know where tests could be done for free (70.9%). Conclusions Despite higher education, students are vulnerable to HIV and have unsatisfactory knowledge about combined prevention measures. Key messages • College students are young individuals with high vulnerability to contracting HIV and other sexually transmitted infections. • Universities should assume their role as promoters of health and develop strategies that contribute to students’ knowledge and reflection on HIV and its prevention methods.

Dynamic choice HIV prevention with cabotegravir long-acting injectable in rural Uganda and Kenya: a randomised trial extension

HIV infections are ongoing globally despite efficacious biomedical prevention options. We sought to determine whether an HIV prevention package providing choice of daily pills or long-acting injectable cabotegravir and opportunities to change prevention options could increase biomedical prevention coverage and reduce new HIV infections. This study was an extension of three randomised trials that used SEARCH dynamic choice HIV prevention to recruit adults (aged ≥15 years) at risk for HIV from antenatal, outpatient, and community settings in rural Uganda and Kenya. In this 48-week open-label extension, participants maintained their original (1:1) randomisation group; the option to choose cabotegravir long-acting injectable was added for intervention participants. Inclusion criteria for the extension were previous enrolment in a SEARCH dynamic choice HIV prevention trial, negative HIV rapid test, and residence in study region. The intervention provided person-centred choice of oral pre-exposure prophylaxis (PrEP) or post-exposure HIV prophylaxis (PEP) or cabotegravir long-acting injectable, with the option to switch according to participant preference. The control provided standard-of-care access to oral PrEP and PEP, but not cabotegravir long-acting injectable. Biomedical prevention coverage (proportion of follow-up covered by oral PrEP, PEP, or cabotegravir long-acting injectable; primary outcome) and HIV incidence (secondary outcome) were compared between groups using targeted minimum loss-based estimation. The trial (NCT05549726) is closed to recruitment. Of 1534 participants initially randomly assigned (from April 15, 2021 to Sept 29, 2022), 984 (487 in the intervention group and 497 in the standard-of-care group) reconsented to the extension (from Jan 2 to March 3, 2023). The mean proportion of follow-up covered by biomedical HIV prevention was 69·7% (95% CI 64·9-74·5) in the intervention group versus 13·3% (10·2-16·3) in the standard-of-care group, corresponding to an absolute difference of 56·4 percentage points (95% CI 50·8-62·1; p<0·0001). The intervention significantly improved coverage across prespecified subgroups (sex and age groups). During the study, 274 (56%) of 485 intervention participants used cabotegravir long-acting injectable, 255 (53%) used oral PrEP, and ten (2%) used PEP. Among cabotegravir long-acting injectable initiators, 118 (43%) of 274 were not previously using oral PrEP or PEP. There were seven incident HIV infections in 390 person-years of follow-up in the standard-of-care group and no infections in 400 person-years of follow-up in the intervention group (incidence rate difference per 100 person-years 1·8, 95% CI 0·4-3·2; p=0·014). Offering people the choice of HIV biomedical prevention options including cabotegravir long-acting injectable in a flexible model can increase prevention coverage and reduce incident HIV infections. HIV programmes should support dynamic choice HIV prevention programmes that include effective oral and injectable long-acting products. National Institutes of Health.

Prevalence and Demographic Determinants of HIV Pre-Exposure and Post-Exposure Prophylaxis Use in Khwisero Sub-County, Kenya

Prevalence and Demographic Determinants of HIV Pre-Exposure and Post-Exposure Prophylaxis Use in Khwisero Sub-County, Kenya

Management of occupational exposure to blood and body fluids in primary care.

Primary care workplaces where occupational exposure to blood and body fluids may occur should have policies and procedures in place to manage such incidents. All healthcare workers should be immunised against hepatitis B and ideally should have documentation of their antibody response to vaccination. Knowledge of hepatitis B immune status helps streamline the response to any exposure. Most occupational exposures carry a low risk of transmission of bloodborne viruses, and management can often be undertaken in general practice. Urgent risk assessment and management is crucial. If postexposure prophylaxis for hepatitis B or HIV is required, the earlier it is given, the more likely it is to be effective. Two-drug HIV postexposure prophylaxis is now more accessible because generic formulations of the drug combination are available, and general practitioners can prescribe this on a private prescription.

Missed Opportunities: A Narrative Review on Why Nonoccupational Postexposure Prophylaxis for HIV Is Underutilized.

Postexposure prophylaxis (PEP) is an important tool for preventing HIV infection but remains underutilized. In this narrative review, we aim to summarize the frequency of missed opportunities for prescribing PEP among studies from around the world, discuss the complexities of the challenges facing PEP provision, and describe possible solutions. We identified 20 studies published in the last 10 years among 43 832 individuals, of whom an estimated 41 477 were eligible for PEP. Of those eligible for PEP, PEP was prescribed among 27 705 (66.8%). There was a significant difference in PEP prescriptions in acute compared with non-acute care settings (63.5% vs 94.5%; P < .001). Emergent themes contributing to PEP underutilization included lack of provider and patient awareness, reduced PEP acceptability, HIV stigma and homophobia, lack of access (either to care or to medication), and stigmatizing policies. Each of those issues should be the focus of future PEP implementation efforts.

Readiness for HIV Postexposure Prophylaxis (PEP) Decision Making Following Sexual Violence

HIV post-exposure prophylaxis (PEP) can reduce the risk of acquiring HIV infection following sexual assault. However, only about half of people offered HIV PEP will initiate the medication. Factors associated with patient readiness for HIV PEP following sexual assault have been attributed to structural and clinical barriers. This study utilized the Theory of Reasoned Action and Planned Behavior to better understand how personal factors, cognitive factors, mental health, barriers and facilitators that could influence a patient’s decision to start HIV PEP post sexual assault. A web-based cross sectional survey was conducted from October 2017 to January 2020 and a total of 228 responses were included from participants that had experienced sexual assault in the previous 3 months. Using linear regression modeling fear of HIV, post-traumatic stress symptoms, validating social responses to disclosure, and having someone else pay for HIV PEP were all associated with feeling better prepared for HIV PEP decision making. Results indicate that structural, social, and individual factors impact patient decision making. These findings highlight opportunities for health systems and providers to improve HIV education and the importance of initiating HIV PEP following sexual assault.

Post-exposure HIV prophylaxis adherence to full 28-day course versus weekly therapy in Tehran

Post-exposure HIV prophylaxis adherence to full 28-day course versus weekly therapy in Tehran

Evaluation of Pediatric HIV Postexposure Prophylaxis Guideline Following Child Sexual Assault in Western Australia.

HIV postexposure prophylaxis (PEP) following child sexual assault (CSA) is recommended in select cases. High rates of poor adherence to PEP are reported. We evaluated adherence to the recommended management of children following CSA at the tertiary pediatric facility in Western Australia and compared our approach with international guidelines. Medical records were reviewed for all children <16 years old assessed at Perth Children's Hospital between October 1, 2016 and November 30, 2020 following alleged CSA. Data, including exposure type, PEP adherence and follow-up, were collected. A review of contemporary national and international PEP guidelines was undertaken in parallel. There were 511 alleged CSA events over the study period; 62/511 (12%) were appropriately risk-assessed as requiring PEP by the treating clinician. PEP was not prescribed in 8/62 (13%) events, with a reason documented for 6/8 (75%). Overall, less than half of children who were eligible for PEP were adherent to the 28-day regimen (23/54, 43%). Gastrointestinal upset contributed to early cessation in 5/54 (9%). Final 3-month blood-borne virus serology results were available in less than one in 3 children. A review of international clinical practice revealed significant heterogeneity of criteria for the provision of PEP and a paucity of pediatric-specific data. We identified several areas of our PEP management that required strengthening, with limited direction available in current international guidelines. We have adopted a broader use of fixed drug combinations and implemented a multifaceted follow-up program. It will be essential to review the impact of these changes.

Exploring the universe of HIV post-exposure prophylaxis in trans women: A qualitative analysis of access, use and adherence

Introduction Post-exposure prophylaxis (PEP) for HIV, a form of emergency prevention, has been available for more than two decades. However, information about its use among trans women, a group disproportionately affected by HIV, is limited. Objective To explore knowledge, barriers, access facilitators, and use of PEP in trans women. Method A qualitative study was carried out with 90 trans women in Goiânia, Central-West of Brazil, using semi-structured interviews and analyzed using thematic analysis. Results Participants had prior knowledge about PEP, although many did not understand its application and effectiveness. Despite knowing there were structural and psychosocial barriers that proved to be significant impediments to access and effective use of PEP. Conclusion There is a need to develop inclusive public health strategies that meet the needs of trans women to improve access to and use of PEP. Continuing education and awareness initiatives are crucial to dispelling myths and providing accurate information about prophylaxis options. These are essential for both the trans community and health professionals, aiming to reduce the incidence of HIV in this vulnerable and often marginalized group. The implementation of such measures can facilitate greater adherence to PEP, contributing to the health and well-being of trans women.

MHealth-Based Gamification Interventions Among Men Who Have Sex With Men in the HIV Prevention and Care Continuum: Systematic Review and Meta-Analysis.

In the past few years, a burgeoning interest has emerged in applying gamification to promote desired health behaviors. However, little is known about the effectiveness of such applications in the HIV prevention and care continuum among men who have sex with men (MSM). This study aims to summarize and evaluate research on the effectiveness of gamification on the HIV prevention and care continuum, including HIV-testing promotion; condomless anal sex (CAS) reduction; and uptake of and adherence to pre-exposure prophylaxis (PrEP), postexposure prophylaxis (PEP), and antiretroviral therapy (ART). We comprehensively searched PubMed, Embase, the Cochrane Library, Web of Science, Scopus, and the Journal of Medical Internet Research and its sister journals for studies published in English and Chinese from inception to January 2024. Eligible studies were included when they used gamified interventions with an active or inactive control group and assessed at least one of the following outcomes: HIV testing; CAS; and uptake of and adherence to PrEP, PEP, and ART. During the meta-analysis, a random-effects model was applied. Two reviewers independently assessed the quality and risk of bias of each included study. The systematic review identified 26 studies, including 10 randomized controlled trials (RCTs). The results indicated that gamified digital interventions had been applied to various HIV outcomes, such as HIV testing, CAS, PrEP uptake and adherence, PEP uptake, and ART adherence. Most of the studies were conducted in the United States (n=19, 73%). The most frequently used game component was gaining points, followed by challenges. The meta-analysis showed gamification interventions could reduce the number of CAS acts at the 3-month follow-up (n=2 RCTs; incidence rate ratio 0.62, 95% CI 0.44-0.88). The meta-analysis also suggested an effective but nonstatistically significant effect of PrEP adherence at the 3-month follow-up (n=3 RCTs; risk ratio 1.16, 95% CI 0.96-1.38) and 6-month follow-up (n=4 RCTs; risk ratio 1.28, 95% CI 0.89-1.84). Only 1 pilot RCT was designed to evaluate the effectiveness of a gamified app in promoting HIV testing and PrEP uptake. No RCT was conducted to evaluate the effect of the gamified digital intervention on PEP uptake and adherence, and ART initiation among MSM. Our findings suggest the short-term effect of gamified digital interventions on lowering the number of CAS acts in MSM. Further well-powered studies are still needed to evaluate the effect of the gamified digital intervention on HIV testing, PrEP uptake, PEP initiation and adherence, and ART initiation in MSM.

Management of acute sexual assault presenting to a large Australian sexual health clinic in 2012-2021: a retrospective clinical audit.

Background The incidence of sexual assault continues to rise in Australia. This study aimed to describe the nature of assault, HIV/STI positivity, and its management at a sexual health clinic. Methods We performed a chart review of 516 sexual assault cases presenting to Melbourne Sexual Health Centre between 2012 and 2021, collecting data on victim demographics, details of assault, HIV/STI testing and positivity, police involvement, and offer of counselling. Results We included 516 cases: 124 males (24.0%); 384 females (74.4%); and eight transgender (1.6%) victims. The proportion of assault cases presenting to Melbourne Sexual Health Centre increased from 0.1% (37/37,070) in 2012 to 0.2% (56/36,514) in 2021 (P trend =0.006). HIV post-exposure prophylaxis was prescribed for 64.5% (80/124) of males and 12.5% (48/384) of females. Among victims, 69.4% (358/516) were tested for HIV and no one tested positive, while 71.9% (371/516) were tested for syphilis, with 1.6% (6/371) positive. Gonorrhoea and chlamydia were tested at the oropharynx (44.8% [231/516] vs 28.7% [148/516]), genitals (83.7% [432/516] vs 92.4% [477/516]) and anorectum (35.3% [182/516] vs 35.3% [182/516]). Positivity for gonorrhoea and chlamydia were: 2.6% (6/231) vs 2.0% (3/148) at oropharynx, 1.4% (6/432) vs 2.9% (14/477) at genitals, and 5.5% (10/182) vs 7.1% (13/182) at anorectum. According to clinical records, 25.2% (130/516) of victims sought police involvement, and 71.7% (370/516) were offered counselling. Conclusions Sexual assault was an uncommon presentation at Melbourne Sexual Health Centre, with diverse circumstances surrounding assault; however, clinical documentation varied, indicating a need for a standard primary care protocol for clients presenting with acute sexual assault.

Sexual Health Needs Among Men Who Engage in Transactional Sex with Men in the UK.

Men who engage in transactional sex with men (MTSM) are a high-risk population for HIV and other sexually transmitted infections. Epidemiological data have so far included them in the broad category of men who have sex with men (MSM), while research on transactional sex typically focused on female sex workers. The internet has substantially changed sex work practices and earlier findings concerning the sexual health needs of MTSM may no longer be applicable. We analyzed quantitative data from MSM based in the UK (n = 11629) taking part in the European MSM Internet Survey (EMIS-2017). Compared to non-MTSM, MTSM (n = 230; 2%) were younger, more likely to self-identify as an ethnic minority, be single, have lower education levels, struggle financially, and-controlling for age-more likely to be living with diagnosed HIV. Commonly unmet needs among all MSM were a lack of confidence in accessing HIV post-exposure prophylaxis, uncertainty about HIV status, and ignorance of where to access hepatitis vaccinations. Compared with other MSM, MTSM were notably less satisfied with the safety of their sexual practices, less confident in their ability to maintain sexual boundaries, and more likely to engage in risk because of absent precautionary resources. Given their greater opportunity for sexual risk, as well as fewer resources for negotiating safety, our findings suggest that services should prioritize MTSM in HIV prevention and sexual health promotion, including assertiveness and social skills training, in addition to knowledge-based education.

Slovenia's national HIV PrEP programme: Evaluation of real-world implementation.

The aim of our study was to evaluate real-world implementation of Slovenia's national HIV PrEP programme, which is fully covered by our national health insurance. In retrospective cohort study we analysed the data from all men who have sex with men (MSM) who were enrolled in PrEP programme of our clinic between 1 January 2022 and 31 December 2022. A total of 190 MSM with an average age of 36.7years were included in our analysis. 151 (79.5%) decided for event-driven PrEP and 39 (20.5%) opted for daily PrEP. Self-reported adherence was 95%. Among eligibility criteria, unprotected sex was the most common one, followed by one or more STIs in the past, use of chemsex and use of HIV post-exposure prophylaxis in the past. No new cases of HIV infection and no significant deterioration of kidney or liver function were observed during the follow-up. Sixty-seven episodes of STIs were diagnosed and treated. Gonorrhea (32), chlamydia (14), and Mpox (10) were the most common ones. PrEP was successfully implemented into everyday clinical practice, proving to be both safe and effective. High number of diagnosed STIs suggests that the PrEP programme, combined with STI screening and vaccination, provides a strong public health impact among MSM in Slovenia.

(274) Sexual Assault Resulting in Hemoperitoneum and Multiple Genital Tract Injuries

Abstract Introduction The sexual experience ought to be pleasant and desirable, this case however demonstrates one of such unusual sexual events with catastrophic ending that may have resulted in fatality but for timely surgical intervention. The first coital experience for women may be associated with discomfort but when it is non-consensual the damaging effect of the trauma is deeper and may last for a lifetime. Objective To demonstrate unusual presentation of coital injuries with hemoperitoneum and its management in low resource settings to reduce immediate and long-term effects including death. Methods A case report of an 18-year old nulliparous lady with no prior sexual exposure who presented with vagina bleeding of 18hours following non-consensual penetrative sexual intercourse perpetrated by her religious cleric. Bleeding was in excess of 500mLs with associated lower abdominal pain and dizziness. She presented in hypovolaemic shock with severe anemia (hematocrit - 15%). There was ongoing vagina bleeding with mild abdominal distension. No skin injuries. Results She had genital tract exploration with findings of a 3cm peri-urethral vaginal laceration and a 6cm longitudinal rent on the posterior upper vagina extending to the cervix. The apex of the vaginal laceration could not be visualized from the vagina, necessitating exploratory laparotomy. Findings at surgery include 1.7L of hemoperitoneum and a transverse laceration on the posterior cervix extending into the lower uterine segment about 5cm long. The lacerations were repaired per vagina and per abdomen respectively with hemostasis secured. She had other supportive care including antibiotics, blood transfusion, analgesics, tetanus prophylaxis, Post-exposure prophylaxis for HIV and Hepatitis B immunoglobulin as well as emergency contraceptives. She was counselled with empathy and referred to the clinical psychologist for mental health support to prevent long term mental health effects. The assailant was arrested by the police and charged to court Conclusions Sexual assault may be associated with significant morbidities including unusual presentation such as hemoperitoneum and cervico-uterine laceration even in the absence of obvious skin injuries. Early presentation and appropriate intervention can help limit the adverse outcomes that may be associated as well as long term sequelae. Disclosure No.

Analysis on the use of HIV post-exposure prophylaxis and related factors in men who have sex with men in Qingdao

Objective: To understand the use of post-exposure prophylaxis (PEP) and analyze related factors among men who have sex with men (MSM) in Qingdao, and provide a reference for the AIDS prevention and control in this population. Methods: A cross-sectional survey conducted from April 2022 to February 2023. Relying on MSM social groups in Qingdao, a snowball sampling method was applied to recruit research subjects who met the inclusion criteria of age ≥18 years old, having had homosexual anal or oral sex in the past six months, and HIV-negative or infection status unknown. The sample size was estimated at 566. Data on demographic characteristics, sexual behavior characteristics, PEP use, and others of the research subjects was collected through on-site questionnaires. The logistic regression model was used to analyze the factors associated with using PEP. Results: A total of 811 participants were recruited, mainly aged 25-34 (53.6%, 435/811), unmarried (74.7%, 606/811), with an average monthly income of ≥5 000 yuan (52.2%, 423/811), and having lived in Qingdao for ≥10 years (75.6%, 613/811). The proportion of those who knew the HIV status of their sexual partners in the last six months was 67.1% (544/811), and those with HIV-positive partners were 3.6% (29/811). In the last six months, the proportion of participants who had group sex (86.4%, 701/811), unprotected anal sex (98.2%, 796/811), and use of club drugs (80.3%, 651/811) was high. Moreover, 28.4% (230/811) had used PEP. The multivariate logistic regression analysis showed that the factors related to the use of PEP included divorced or widowed (aOR=5.46,95%CI:1.96-15.17), average monthly income ≥5 000 yuan (aOR=2.04,95%CI:1.44-2.89), same-sex sexual orientation (aOR=0.40,95%CI:0.22-0.71), having HIV-positive sexual partners in the last six months (aOR=2.54,95%CI:1.13-5.71) and having been tested for HIV ≥3 times in the last six months (aOR=1.46,95%CI:1.04-2.06). Conclusions: The prevalence of risk behaviors among MSM in Qingdao was high, and the use of PEP was low. In the future, it is essential to increase HIV/AIDS prevention education among MSM, promote MSM to know the HIV status of their sexual partners, and reduce the prevalence of risk behaviors among this population. Additionally, explore medical insurance reimbursement plans for PEP to reduce utilization costs and promote the use of PEP by MSM after HIV exposure occurs as soon as possible.

Factors associated with university students' knowledge about HIV and preand post-exposure prophylaxis.

to analyze the factors associated with university students' knowledge about HIV and preand post-exposure prophylaxis. a cross-sectional study was conducted with 503 university students from a southern state in Brazil; data were collected using a characterization tool and a questionnaire containing 16 statements about the topic; descriptive measures and Poisson regression models with robust variance were used for analysis. the prevalence of adequate knowledge (i.e., scoring more than 12 correct answers) was 27.83%; students older than 24 years, enrolled in health-related courses, who had not engaged in sexual relations in the last quarter, with a history of rapid HIV testing, and who knew or had heard about the prophylaxes showed a higher likelihood of scoring more than 12 correct answers. generally, the knowledge of young people about HIV and its prophylaxes was found to be inadequate and influenced by sociodemographic, educational, and behavioral factors.