HIV Prevalence Rates Research Articles

Depression and HIV transmission risk among methamphetamine-using men who have sex with men

Background Methamphetamine use is associated with disproportionate risk of HIV infection and increased risk of depression among sexual minority men. The purpose of the study was to estimate the association between clinical depression diagnoses and sexual risk-taking among cisgender men who have sex with men (MSM) who use methamphetamine. Method From March 2014 through January 2016, 286 MSM who use methamphetamine but were not seeking treatment for methamphetamine use disorder were enrolled to participate in a technology-based randomized controlled trial to reduce methamphetamine use and HIV sexual risk behaviors; participants were assessed for major depressive episodes (MDE) and persistent depressive disorder (PDD) at baseline. Multivariate clustered zero-inflated negative binomial regression analyses of condomless anal intercourse (n = 282; 1,248 visits) estimated the association between this baseline diagnostic result and engagement in sexual risk-taking over time. Results Participants predominantly identified as nonwhite (80%), averaged 42 years of age, and reported a HIV prevalence rate of 46%. Engagement in sexual risk-taking consistently demonstrated a positive curvilinear relationship with clinical depression severity, such that, for example, participants without clinical depression (59% of the sample; coef. = 1.16) and those with MDE (36% of the sample; coef. = 1.45) both demonstrated elevated rates of condomless anal sex with anonymous partners relative to participants with PDD (5% of the sample; analytical reference category; both coef. p < 0.05). Data also demonstrated a trend (p = 0.053) of reduced sexual risk-taking with main partners among participants diagnosed with MDE (coef. = −0.94). Conclusions Methamphetamine use among participants in this study inverted the functional form of the relationship between depression and sexual risk among MSM observed in prior studies. Whereas low-grade depression has been associated with increased sexual risk-taking in prior samples of MSM, methamphetamine upends this relationship, such that the greatest engagement in sexual risk-taking occurred among those diagnosed with MDE at baseline. Additional research is warranted to clarify how methamphetamine influences sexual risk-taking among MSM with/without comorbid depression.

Early Appraisal of Option B+ In Tiko Health District- Cameroon

Introduction: Cameroon in 2014 had a HIV prevalence rate of 4.6 %. It is estimated that about 90% of new infections occur as a result of heterosexual relations. In 2010 in Cameroon, 7,300 babies were estimated to be born HIV positive due to mother-to-child transmission (MTCT). Faced with these realities, Cameroon has been stepping up its response steadily from Option A then B and now Option B+. To have an early appraisal of the Option B+ approach as far as the prevention of mother to child transmission of HIV (PMTCT) is concerned in the Tiko health district- Cameroon.&#x0D; Methodology: This cross-sectional hospital based study was carried out in Tiko from the 1st of December 2015 to the 31st of August 2016. With the use of a questionnaire, a total of 111 women whose infants underwent the polymerase chain reaction (PCR) test at six weeks were surveyed. Univariate and bivariate data analysis were performed with CDC- Epi-Info 7.2.2.6.&#x0D; Results: Out of 111 women included in this study, only 2 (1.8%) babies had a positive PCR test. Two cases of infected babies were realised in the study, 1 in each of the first two trimesters of pregnancy. It could probably be due to the fact that, these women got infected while they were already pregnant or maybe before their introduction to the Option B+. However, the infectious rate was similar to that of women on tritherapy. Interventions like the use of Antiretroviral (ART) drugs by infected pregnant women, safe delivery practices and safe infant feeding helped reduce the risk of transmission to infants (from 40% to 5%).&#x0D; Conclusion: The infection rate of 1.8 % is similar to those of women who are on tritherapy in many studies. Despite the fact that the implementation of option B+ looks more onerous, the long term benefits as far as cost effectiveness is concerned looks laudable. Thus this strategy should be adopted in resource restricted countries.

County-level factors affecting Latino HIV disparities in the United States.

To determine which county-level social, economic, demographic, epidemiologic and access to care factors are associated with Latino/non-Latino White disparities in prevalence of diagnosed HIV infection. We used 2016 county-level prevalence rates of diagnosed HIV infection rates for Latinos and non-Latino Whites obtained from the National HIV Surveillance System and factors obtained from multiple publicly available datasets. We used mixed effects Poisson modeling of observed HIV prevalence at the county-level to identify county-level factors that explained homogeneous effects across race/ethnicity and differential effects for Latinos and NL-Whites. Overall, the median Latinos disparity in HIV prevalence is 2.4; 94% of the counties have higher rates for Latinos than non-Latinos, and one-quarter of the counties' disparities exceeded 10. Of the 41 county-level factors examined, 24 showed significant effect modification when examined individually. In multi-variable modeling, 11 county-level factors were found that significantly affected disparities. Factors that increased disparity with higher, compared to lower values included proportion of HIV diagnoses due to injection drug use, percent Latino living in poverty, percent not English proficient, and percent Puerto Rican. Latino disparities increased with decreasing percent severe housing, drug overdose mortality rate, percent rural, female prevalence rate, social association rate, percent change in Latino population, and Latino to NL-White proportion of the population. These factors while significant had minimal effects on diminishing disparity, but did substantially reduce the variance in disparity rates. Large differences in HIV prevalence rates persist across almost all counties even after controlling for county-level factors. Counties that are more rural, have fewer Latinos, or have lower NL-White prevalence rates tend to have higher disparities. There is also higher disparity when community risk is low.

HIV, syphilis and hepatitis B coinfections in Mkushi, Zambia: a cross-sectional study.

ABSTRACTBackground: Human Immunodeficiency Virus, syphilis and Hepatitis B Virus are major global public health problems, they are sexually transmitted infections with overlapping modes of transmission and affected populations. Objective: The aim of this study is to assess the seroprevalence of HIV 1, hepatitis B virus and syphilis coinfections among newly diagnosed HIV individuals aged 16 to 65 years, initiating on antiretroviral therapy, in Mkushi, Zambia. Methods: A total number of 126 sera were collected from HIV 1 infected patients attending Mkushi district hospital/ART clinic for antiretroviral therapy initiation. Hepatitis B surface antigen test and serologic test for syphilis were conducted between March and May 2018. Results: Of the 126 participants (out of 131 enrollments), Hepatitis B surface antigen (HBsAg) was detected with a prevalence of 9.5% among newly diagnosed HIV infected patients, while that of syphilis was as high as 40.5% in this same population group. Three patients recorded HIV coinfections with both syphilis and hepatitis B virus (2.4%) at the same time. After analysis, the results indicate that there was no significant association between gender for both dependent variables: HIV/syphilis or HIV/hepatitis B virus coinfections (alpha significance level > 0.05). Those who had a history of syphilis infection in the past were more likely than those who had none to be HIV-syphilis coinfected (53.6% vs 34%, respectively; odd ratio [OR] 2.236; 95% confidence interval [CI] 1.045 - 4.782). Conclusion: The high prevalence rates for HIV, HBV, and syphilis coinfections strongly indicate the need for HBV and syphilis screening for HIV infected individuals. Furthermore, the high number of patients previously treated for syphilis who retest positive for syphilis in this study calls for use of the Venereal Disease Research Laboratory test to identify true syphilis infection (titers ≥ 1:8 dilutions, strongly suggestive).

Work System and Process Designs for Community Pharmacy-Medical Clinic Partnerships to Improve Retention in Care, Antiretroviral Adherence, and Viral Suppression in Persons with HIV.

The objective of this project was to collect and analyze information about work systems and processes that community pharmacy-medical clinic partnerships used for implementing the Patient-Centered HIV Care Model (PCHCM). Paired collaborations of 10 Walgreens community pharmacies and 10 medical clinics were formed in 10 cities located throughout the United States that had relatively high HIV prevalence rates and existing Walgreens HIV Centers of Excellence. Patient service provision data and most significant change stories were collected from key informants at each of the clinic and pharmacy sites over an 8 week period in 2016 and through in-depth phone interviews. Written notes were reviewed by two authors (J.C.S. and O.W.G.) and analyzed using the most significant change technique. The findings showed that half of the partnerships (n = 5) were unable to fully engage in service implementation due to external factors or severe staff turnover during the project period. The other half of the partnerships (n = 5) were able to engage in service implementation, with the most impactful changes being related to strong patient care systems, having a point person at the clinic who served as a connector between sites, and having pharmacists integrated fully into the health care team.

HIV, syphilis and hepatitis B coinfections in Mkushi, Zambia: a cross-sectional study

ABSTRACT Background: Human Immunodeficiency Virus, syphilis and Hepatitis B Virus are major global public health problems, they are sexually transmitted infections with overlapping modes of transmission and affected populations. Objective: The aim of this study is to assess the seroprevalence of HIV 1, hepatitis B virus and syphilis coinfections among newly diagnosed HIV individuals aged 16 to 65 years, initiating on antiretroviral therapy, in Mkushi, Zambia. Methods: A total number of 126 sera were collected from HIV 1 infected patients attending Mkushi district hospital/ART clinic for antiretroviral therapy initiation. Hepatitis B surface antigen test and serologic test for syphilis were conducted between March and May 2018. Results: Of the 126 participants (out of 131 enrollments), Hepatitis B surface antigen (HBsAg) was detected with a prevalence of 9.5% among newly diagnosed HIV infected patients, while that of syphilis was as high as 40.5% in this same population group. Three patients recorded HIV coinfections with both syphilis and hepatitis B virus (2.4%) at the same time. After analysis, the results indicate that there was no significant association between gender for both dependent variables: HIV/syphilis or HIV/hepatitis B virus coinfections (alpha significance level > 0.05). Those who had a history of syphilis infection in the past were more likely than those who had none to be HIV-syphilis coinfected (53.6% vs 34%, respectively; odd ratio [OR] 2.236; 95% confidence interval [CI] 1.045 – 4.782). Conclusion: The high prevalence rates for HIV, HBV, and syphilis coinfections strongly indicate the need for HBV and syphilis screening for HIV infected individuals. Furthermore, the high number of patients previously treated for syphilis who retest positive for syphilis in this study calls for use of the Venereal Disease Research Laboratory test to identify true syphilis infection (titers ≥ 1:8 dilutions, strongly suggestive).

Antiretroviral Adherence, Drug Resistance, and the Impact of Social Determinants of Health in HIV-1 Patients in the US.

Adherence to antiretroviral therapy (ART) is critical to achieving viral suppression. However, social determinants of health (SDoH) can undermine patient adherence to ART, resulting in drug resistance that compromises future treatment options. We assessed ART adherence and HIV-1 drug resistance at the national and state levels in the US and investigated their associations with SDoH and other HIV-related outcomes. Data were obtained from Symphony Health's Integrated Dataverse (IDV), Monogram/LabCorp Database, as well as national and publicly available databases, including Centers for Disease Control and Prevention (CDC), American Community Survey (ACS), and J. Kaiser Family Foundation (KFF). Inferential analyses were performed to investigate associations using patient-level data, and the results were reported by state and overall within the nation. Correlations between continuous variables were estimated by the Spearman's test, and that between continuous variable and categorical variable were estimated using one-way analysis of variance (ANOVA). State-level rates of poor adherence and resistance ranged from 26 to 55% and 20 to 54%, respectively. Female gender, non-white race, low education, poverty, and unemployment were associated with poor adherence; female gender was associated with drug resistance. Both adherence and resistance were correlated to HIV prevalence rates. Our findings suggest that US patients living with HIV face great challenges associated with poor ART adherence and HIV-1 drug resistance.

P-04-15 From Spain to Colombia: Adaptation Process of Competences for Adolescents With a Healthy Sexuality Program (COMPAS)

In Latin America, unplanned pregnancies and sexually transmitted infections (STIs) in youth are two main public health problems. Colombia accounts for one of the highest prevalence rate of HIV and STIs in this population; however, a national standardized sex education program for adolescents is still not available. Competences for adolescents with a Healthy Sexuality (COMPAS for its acronym in Spanish) - a school-based sexual health promotion intervention for Spanish adolescents - was adapted for Colombian youth. We hypothesized that COMPAS key elements would be translated and its effectiveness would be retained. This research describes the adaptation process that resulted in an adapted version for youth in Colombia. A mixed-method approach was used to conduct this systematic cultural adaptation process that involved 100 Colombian young girls and boys. Adaptation process included these steps: 1) Consulting international researchers and community stakeholders, 2) Capturing the lived experiences of a diverse sample of Colombian youth,

Empirical Contributions of International Non-Governmental Organizations (INGOs) to Development: A Reference to World Vision HIV Programmes in Kenya

This study sought to examine the empirical contributions of INGOs on development in regard to health programmes by World Vision Kenya. Studies show that since 1970s INGOs have strongly been recognized as key Third Sector Actors (TSA) on development globally as part of neo- liberal policy. INGOs emerged in Kenya and became part of the development agenda from early 1990s. HIV/AIDS has remained a major setback to development in many countries with Kenya severely affected. There is limited evidence on the empirical contribution of INGOs to development through tackling HIV problems; hence negatively affecting future funding decisions and development operations of INGOs. This study; assessed the role of INGOs in development though economic empowerment and reduction of HIV prevalence rate with reference to World Vision HIV/AIDS programmes in Tinderet Sub-County. The study used Transnationalism Theory (TT) by Robert Keohane and Joseph Nye (1971) to understand the role of INGOs as transnational actors involved in the process of accelerating development through interdependence and cooperation with States to handle global problems. In this study, mixed method was used involving systematic sampling techniques to select 114 beneficiaries of World Vision and purposively selecting key informant respondents. The data collection methods included use of personal interviews, in- depth interviews, and key informant interviews. Both quantitative and qualitative approaches were used for data analysis. The Statistical Package for Social Sciences (SPSS version 20) was used to run descriptive statistics and merged with qualitative data according to the emerging themes using illustrations from the transcripts. The study found that; World Vision empowered HIV infected and affected persons economically and contributed to reduction of HIV prevalence rate in Tinderet Sub- County. The study concluded that INGOs have a role in development by addressing negative effect on health. Keywords: INGOs,Transnationalism,World Vision,MNCs,TNCs. DOI: 10.7176/IAGS/83-03 Publication date: June 30 th 2020

Should We Screen HIV-Positive Migrants for Strongyloidiasis?

Background: Strongyloides stercoralis, a nematode endemic in all (sub)tropical regions, can cause life-threatening disease, especially in immunosuppressed patients. Many countries with high HIV-prevalence rates are also highly S. stercoralis endemic, and co-infection may occur. Methods: Retrospective study based on serological testing for S. stercoralis in all HIV-infected migrants followed at the Institute of Tropical Medicine, Antwerp, Belgium. If untested, serologic testing was performed on stored samples, dating from the first HIV viral load determination. The epidemiological, clinical and laboratory features of patients with and without strongyloidiasis were retrieved from the electronic medical files. Results: Of the 2846 HIV patients in active follow-up, 723 (25.4%) had a migration background. Thirty-six patients (5.1%) were diagnosed with Strongyloides co-infection, including 29 during their medical evaluation and seven retrospectively. Patients had a median age of 35.3 years (IQR 30.3–44.4), 28 patients (78%) originated from Sub-Saharan Africa and median time in Belgium was 3.5 years (IQR 0.8–5.7). Symptoms compatible with strongyloidiasis were present in 17 (47%) patients, of whom two were diagnosed retrospectively. Eosinophilia (eosinophil cell count > 450/µL) was observed in 19 (53%) participants. Median CD4 level was 386 /µL (IQR 299–518) at diagnosis of co-infection. Of note, 8 (22%) patients with strongyloidiasis had no reported symptoms nor eosinophilia. None of the patients developed hyperinfection syndrome. There were no differences in age, gender, geographic origin, clinical presentation, CD4 level or viral load between patients with and without strongyloidiasis. Only eosinophilia was strongly correlated with the presence of Strongyloides in multivariate analysis (OR 10.74 (95% CI 5.19–22.25), p < 0.001); the positive likelihood ratio (LR+) of eosinophilia for strongyloidiasis was 5.38 (95% CI 3.66–7.91). Conclusion: Strongyloidiasis was diagnosed in 5.1% of HIV-infected migrants. Eosinophilia had good confirming power for the presence of the disease. However, a sizeable proportion (22%) of co-infected individuals were asymptomatic and had normal eosinophil count, supporting universal screening of all HIV-positive patients native to tropical countries.

Time series analysis of Nevirapine syrup consumption in prevention of mother-tochild transmission and optimal supply chain model in Oshana region, Namibia.

HIV/AIDS continue to be serious communicable disease whose impact on public health in Namibia is massive. It is estimated that the prevalence rate of HIV in Namibia is 17.2%, ranking the country as the fifth highest in sub-Saharan Africa (SSA). Some improvement in reducing the number of cases of HIV/AIDS has been made in the country, but the sporadic shortage of medicines continues to slow down government efforts to foster the emergence of an HIVfree generation of Namibians. Develop and demonstrate a mathematical supply-chain model, which can establish parameters to prevent stock-outs of NVP suspension. The study adopted retrospective approach to acquire data from 2012-2016. Gamma supply chain model was developed as the optimal model for NVP syrup and forecasted consumption for 2017-2018 was determined. It is a recommendation of this study that new guidelines for implementation of optimal supply-chain models at the regional medical store, health centers and clinics be implemented for Nevirapine syrup.

Are migration routes disease transmission routes? Understanding Hepatitis and HIV transmission amongst undocumented Pakistani migrants and asylum seekers in a Parisian suburb

Drawing on hospital-based interviews and fieldwork in a deprived Parisian suburb, this paper analyses the spatio-temporal dynamics of risk, exposure, and mobilities in individual stories of undocumented Pakistani male migrants, and asylum seekers—receiving treatment for single and combined diagnoses of HIV, and Hepatitis C and B. Inviting alignments with the ‘sexual’ turn in mobility studies, it prioritises the interface of all-male undocumented migration, mobility, sexuality, and homosociality in circumscribing disease transmission geneaologies. It questions the extent to which illegal migration routes are transmission routes, and risk environments assume different levels of intensity in everyday life in Pakistan, during the journey, and in France. It emphasises inadequately addressed epidemics of HIV and hepatitis in Pakistan, the significance of unequal routes to migrant healthcare in France, and the transnational adaptation of homosocial and sexual behaviours, including MSM. These factors interplay with intensified vulnerabilities relating to childhood sexual abuse, family traumas, sexual risks related to illegal migration and undocumented status in France, chronic stresses leading to depleted mental and physical health, and restrictions on heterosexual sex facing marginalised migrants. Further, temporal vulnerabilities relate to the colonial criminalisation of homosexuality in Pakistan, widespread sexual violence—and forms of contemporary exclusion and hostility regarding Muslim migrants in Europe. Particularly, we emphasise the paradox, and need to sensitively address, a complex confluence of hidden risks that are deeply embedded in ethnic communities of solidarity and support. The findings trouble the tendency to partition global hepatitis and HIV prevalence rates by ‘developed’ and ‘developing’ country variation.

Impact of Information and Communication Technology Diffusion on HIV and Tuberculosis Health Outcomes among African Health Systems

Debate regarding the impact of information and communication technology (ICT) on health outcomes has prompted researchers to conduct analyses across many parts of the globe, yet, still little is known about the ICT impact in the African continent. Using a robust multivariate approach, this study examined system-wide impact of ICT diffusion on multiple health outcomes for HIV and tuberculosis among sovereign countries of Africa. This study utilized longitudinal panel data from the World Bank and International Telecommunication Union databases between 2000 and 2016. We relied on a robust linear dynamic panel model to incorporate lagged time variables to estimate the relationships between ICT infrastructure (mobile phone use, internet access, and fixed-telephone subscriptions) and HIV and tuberculosis outcomes. Econometric analyses found that the coefficients of the aggregate ICT variables were all negative (except for fixed telephones) for tuberculosis health measures and HIV prevalence, and positive for access to antiretroviral therapy. The diffusion of mobile phones and internet was associated with decreased incidence of tuberculosis, HIV prevalence, and tuberculosis mortality rates. However, increased diffusion of these three ICT tools was associated with increased access to antiretroviral therapy. Thus, African governments should identify investment strategies for adopting and implementing ICT to improve population health outcomes.

The geographic distribution of priority population groups for the elimination of mother-to-child transmission of HIV in South Africa

BackgroundWomen of reproductive age living with HIV (WRLHIV), HIV-positive pregnant women, adolescent girls and young women (AGYW) are key populations for eliminating mother-to-child of HIV (eMTCT) in South Africa. We describe the geographical distribution of WRLHIV, their pregnant counterparts and AGYW for risk-adjusted allocation of eMTCT interventions.MethodsFor the year 2018, we triangulated data from the Thembisa Model with five routine HIV-related and demographic data sources to determine the distribution of WRLHIV (15–49 years) and AGYW (15–24 years) nationally and by province. Data analysed included total population estimates, number of live-births, live-births to HIV-positive women, age-specific HIV prevalence rates, intrauterine (IU)-transmission rates and IU-case rates/100 000 live-births. IU-transmission rates and IU-case rates were calculated from de-duplicated routine HIV test-data for neonates (aged <7days). Data de-duplication was achieved by a patient-linking algorithm that uses probabilistic matching of demographics (name, surname, date of birth), supplemented by manual matching to account for spelling errors.ResultsThere were 58 million people in South Africa in 2018. Females (all ages) constituted 51% of the population. Women of reproductive age constituted 27% and AGYW constituted 8% of the total population. WRLHIV, AGYW living with HIV and HIV-positive pregnant women accounted for 7%, 0.8% and 0.4% of the total population respectively. Gauteng was the most populous province followed by KwaZulu-Natal, with Western Cape and Eastern Cape in third and fourth positions. The distribution of WRLHIV and AGYW followed a similar trend. However, Mpumalanga and Limpopo provinces had higher proportions of WRLHIV and AGYW living with HIV ahead of Western Cape. KwaZulu-Natal had the highest number of live-births to HIV-positive women. The national IU-transmission rate of <1% translated into 241 cases/100 000. While provincial IU-case rates were fairly similar at 179–325, districts IU-case rates varied, ranging from 87–415 cases/100 000 live-births.ConclusionFindings suggest that the need for eMTCT interventions is greatest in Gauteng, KwaZulu-Natal, Western Cape and Eastern Cape. Limpopo and Mpumalanga provinces may require more HIV prevention and family planning services because of high fertility rates, high number of WRLHIV and AGYW living with HIV. eMTCT will require robust viral load monitoring among WRLHIV, pregnant and breastfeeding women. The national laboratory database can provide this service near-real time.

Counseling on injectable contraception and HIV risk: Evaluation of a pilot intervention in Tanzania.

In a context of high rates of HIV prevalence, concerns over hormonal contraceptive use and the potential for increased risk of HIV acquisition have led to increased attention to counseling messages, particularly for users of the injectable. However, the consequence of adding additional HIV risk messages to family planning counseling sessions was not well understood. This evaluation assessed the effect of providing revised injectable and HIV risk counseling messages on contraceptive knowledge and behavior during a three month pilot intervention. The pilot intervention was conducted September-November 2018 with all eligible family planning clients in ten healthcare facilities located in the Iringa and Njombe regions of Tanzania. Data collection for the evaluation occurred November-December 2018 and included 471 client exit interviews, 26 healthcare provider interviews, and the extraction of service statistics for 12 months prior to the intervention and three months of the intervention. Univariate and bivariate analyses were used to assess quantitative interview data. Thematic qualitative assessment was used to assess qualitative interview data from healthcare providers. Interrupted time series analysis was used to assess changes in the trend of contraceptive uptake. Results indicate that the counseling messages did not cause a decrease in the uptake of injectables (Depo-Provera): 97 percent of interviewed clients received Depo-Provera at their visit; sixty percent reported an intention to use condoms for dual protection. The analysis of service statistics showed no statistical difference in the trend of Depo-Provera uptake between the pre-intervention and intervention periods (p = 0.116). Overall knowledge of counseling messages by clients was good; however only 64.8% of women correctly responded that women at risk of getting HIV can use any method of family planning. Providers’ knowledge of the messages was high, though it appears that not all messages were consistently provided during the counseling sessions. The findings from this evaluation provide evidence that complex HIV counseling messages can be implemented in family planning programs in Tanzania, and potentially in other countries that are considering how to better integrate HIV risk messages into family planning counseling.

Aquatic yeasts: diversity, characteristics and potential health implications.

There has been a rising interest in the levels, diversity and potential impacts of yeasts in aquatic environments. Some of the species isolated from such niches are known pathogens or have pathogenic and antifungal resistance features. This deems it necessary to understand the characteristics and potential health implications of such environmental yeasts species. Studies on these subjects are limited. Most studies on aquatic yeasts have linked them to water pollution. However, the current gold standards to determine microbial pollution of water use bacteria as the main indicator organisms. Including yeasts in water quality standards may provide a different dimension on the quality of water when determining its fit-for-use properties. Pathogenic yeasts cause superficial infections or life-threatening infections, especially in immunocompromised people. Some of the yeast species isolated in recent studies were resistant to commonly used antifungal agents of clinical and veterinary relevance. With the high prevalence rate of HIV in sub-Saharan Africa, particularly in South Africa, antifungal resistance is a public concern as it poses serious medical and economic challenges. Most available studies are concerned with clinical environments only. There is, thus, a need to review the literature that also focuses on aquatic environments.

The HIV epidemic in Latin America: a time to reflect on the history of success and the challenges ahead.

The HIV epidemic in Latin America: a time to reflect on the history of success and the challenges ahead.

Significant decrease in injection risk behaviours among participants in a needle exchange programme

Background and aims: Sharing of unsterile injection equipment contributes to transmission of hepatitis C virus (HCV), HIV and hepatitis B virus (HBV) among people who inject drugs (PWID) but is largely preventable through needle exchange programmes (NEP). Sweden has been one of the last countries in Europe to scale up access to NEP for PWID, who consequently have high prevalence rates of HCV and HIV. The aim of the study was to investigate demographic and drug-related determinants of injection risk behaviours, sharing of needle/syringe and paraphernalia, and patterns of change over time in subgroups of PWID participating in the Stockholm NEP.Methods: The Stockholm NEP started in 2013 as the first formal NEP in the region. A total of 2860 PWID were included in this prospective open cohort study. The association between demographic and drug-related determinants and injection risk behaviours were analysed at baseline and followed up at 6, 12, 24, 36 and 48 months post-enrolment.Results: The following factors were associated with high levels of injection risk behaviours at inclusion: female gender, homelessness, low education level, younger age, amphetamine use, not in opioid substitution therapy (OST), being HIV negative and being HCV positive. We found an overall significant decrease in injection risk behaviours over time among participants. Not previously investigated in depth, we found that subgroups of participants varied in degrees of injection risk behaviour reduction over time and that women decreased injection risk behaviours faster than men. Enrolment in OST, HIV positive and age <25 years at inclusion were not associated with a decrease in injection risk behaviours over time.Conclusions: In this prospective cohort study over 4 years, we found that NEP participation was associated with a significant decrease in injection risk behaviours.

Reducing HIV misconceptions among females and males in Malawi: are we making progress?

ABSTRACT Policy response to endemic HIV prevalence rates in Malawi has prioritised reducing HIV misconceptions through dissemination of factual information about HIV transmission. Yet, over three decades after the implementation of these strategies, we know little about how effective they have been in dispelling misconceptions that may be associated with new HIV infections. Using the 2004, 2010 and 2015/16 Malawi Demographic and Health Surveys and applying multivariate logistic regression, this study examined how endorsement of HIV misconceptions among males and females have changed over time. For women, we found at the bivariate level that the odds of endorsing misconception about HIV transmission were higher in 2004 (OR = 1.38, p < 0.001) but lower in 2015–16 (OR = 0.92, p < 0.001) compared to 2010. We also observed that the difference between 2015–16 and 2010 in misconception endorsement was largely supressed by socioeconomic characteristics (OR = 1.06, p < 0.01). It is also found at the bivariate level that, compared to men in 2010, men in 2004 (OR = 1.23, p < 0.05) were more likely to endorse misconception about HIV transmission although those in 2015–16 (OR = 0.92, p < 0.05) were less likely to do so. Once we accounted for behavioural variables, the significant impact for 2015–16 (OR = 0.98, p > 0.05), compared to 2010, was fully attenuated. Based on our findings, we recommend increasing efforts at reaching women and men with HIV information. It is also crucial to improve women's socioeconomic status to ensure a substantial reduction in their endorsement of HIV misconceptions in Malawi.

Voluntary medical male circumcision and sexual practices among sexually active circumcised men in Mzuzu, Malawi: a cross-sectional study

BackgroundVoluntary Medical Male Circumcision (VMMC) is one of the strategies being promoted to prevent sexual heterosexual transmission of HIV. It has been adopted by 14 countries with high HIV prevalence and low circumcision rates. The 60.0% protective efficacy of VMMC has come with misconceptions in some societies in Malawi, hence VMMC clients may opt for risky sexual practices owing to its perceived protective effect. The study estimated proportion of circumcised men engaging in risky sexual behaviors post-VMMC, assessed knowledge on VMMC protective effect and identified socio-demographic factors associated with risky sexual practices.MethodA cross sectional study was conducted at two sites of Mzuzu city. Systematic random sampling was used to select 322 participants aged 18–49 who had undergone VMMC. The independent variables included age, location, occupation, religion, marital status and education. Outcome variables were non condom use, having multiple sexual partners and engaging in transactional sex. Data from questionnaires was analyzed using Pearson’s chi square test and logistic regression.ResultsOut of 322 respondents, 84.8% (273) understood the partial protection offered by VMMC in HIV prevention. Ninety-six percent of the participants self-reported continued use of condoms post VMMC. Overall 23.7–38.3% participants self-reported engaging in risky sexual practices post VMMC, 23.7% (76) had more than one sexual partner; 29.2% (94) paid for sex while 39.9% (n = 187) did not use a condom. Residing in high density areas was associated with non-condom use, (p = 0.043). Being single (p < 0.001), and residing in low density areas (p = 0.004) was associated with engaging in transactional sex.ConclusionRisky sexual practices are evident among participants that have undergone VMMC. Messages on safer sexual practices and limitations of VMMC need to be emphasized to clients, especially unmarried or single and those residing in low density areas.