HIV-related Risk Research Articles

Attitudes, Norms and Self-Efficacy: Examining Socio-Cognitive Correlates and Sexual Abstinence Among Ugandan Youth Ages 16–18 years, in the Slums of Kampala, Uganda

Sex-related beliefs, attitudes, and perceptions have been shown to be associated with HIV-related behaviors. However, little is known about the factors associated with delayed sexual activity among older adolescents in sub-Saharan Africa. This study examined potentially protective beliefs, attitudes, and perceptions associated with delayed sexual initiation among Ugandan youth. Secondary analyses were based on data from the 2014 Kampala Youth Survey, in which 1137 youth aged 12–18, living in 6 slum communities throughout Kampala, Uganda, were surveyed about sociodemographic factors and various health outcomes including drinking patterns, sexual behavior, HIV status, and violence exposure. Participants were recruited, consented, and interviewed by trained by Uganda Youth Development Link staff. After controlling for significant sociodemographic factors, older adolescent (aged 15–18 years old, n = 757, males = 44%, female 56%) sexual abstainers (never had sexual intercourse) were more likely than sexually active youth to (1) perceive HIV as a serious health issue; (2) have positive perceptions of condom use; (3) believe that their friends planned to delay sex and; (4) be confident in their ability to avoid or refuse sex. Sexual abstinence was also associated with lower odds of reporting drunkenness. Study findings revealed that abstainers held more protective beliefs and attitudes for HIV-related risk, compared to sexually active youth. Identifying predictors for early sexual activity provides opportunities for the development of HIV prevention strategies that encourage the delay of sexual debut.

Kidney tubule health scores and their associations with incident CKD in women living with HIV.

Individual kidney tubule biomarkers are associated with chronic kidney disease (CKD) risk in people living with HIV (PLWH). Whether a combination of kidney biomarkers can be integrated into informative summary scores for PLWH is unknown. We measured eight urine biomarkers of kidney tubule health at two visits over a 3-year period in 647 women living with HIV in the Women's Interagency Health Study. We integrated biomarkers into factor scores using exploratory factor analysis. We evaluated associations between CKD risk factors and factor scores, and used generalized estimating equations to determine associations between factor scores and risk of incident CKD. Factor analysis identified two unique factor scores: a tubule reabsorption score comprising alpha-1-microglobulin, beta-2-microglobulin and trefoil factor-3; and a tubule injury score comprising interleukin-18 and kidney injury molecule-1. We modelled the two factor scores in combination with urine epidermal growth factor (EGF) and urine albumin. Predominantly HIV-related CKD risk factors were independently associated with worsening tubule reabsorption scores and tubule injury scores. During a median follow-up of 7years, 9.7% (63/647) developed CKD. In multivariable time-updated models that adjusted for other factor scores and biomarkers simultaneously, higher tubule reabsorption scores [risk ratio (RR)=1.27, 95% confidence interval (CI): 1.01-1.59 per 1SD higher time-updated score], higher tubule injury scores (RR=1.36, 95% CI: 1.05-1.76), lower urine EGF (RR=0.75, 95% CI: 0.64-0.87), and higher urine albumin (RR=1.20, 95% CI: 1.02-1.40) were jointly associated with risk of incident CKD. We identified two novel and distinct dimensions of kidney tubule health that appear to quantify informative metrics of CKD risk in PLWH.

Intersecting stigma and HIV testing practices among urban refugee adolescents and youth in Kampala, Uganda: qualitative findings.

IntroductionHIV‐related risks may be exacerbated in humanitarian contexts. Uganda hosts 1.3 million refugees, of which 60% are aged under 18. There are knowledge gaps regarding HIV testing facilitators and barriers, including HIV and intersecting stigmas, among urban refugee youth. In response, we explored experiences and perspectives towards HIV testing strategies, including HIV self‐testing, with urban refugee youth in Kampala, Uganda.MethodsWe implemented a qualitative study with refugee cisgender youth aged 16 to 24 living in Kampala's informal settlements from February‐April 2019. We conducted five focus groups with refugee youth, including two with adolescent boys and young men, two with adolescent girls and young women and one with female sex workers. We also conducted five key informant (KI) interviews with government, non‐government and community refugee agencies and HIV service providers. We conducted thematic analyses to understand HIV testing experiences, perspectives and recommendations.ResultsParticipants (n = 49) included young men (n = 17) and young women (n = 27) originally from the Democratic Republic of Congo [DRC] (n = 29), Rwanda (n = 11), Burundi (n = 3) and Sudan (n = 1), in addition to five KI (gender: n = 3 women, n = 2 men; country of origin: n = 2 Rwanda, n = 2 Uganda, n = 1 DRC). Participant narratives revealed stigma drivers included fear of HIV infection; misinformation that HIV is a “Ugandan disease”; and blame and shame for sexual activity. Stigma facilitators included legal precarity regarding sex work, same‐sex practices and immigration status, alongside healthcare mistreatment and confidentiality concerns. Stigma experiences were attributed to the social devaluation of intersecting identities (sex work, youth, refugees, sexual minorities, people living with HIV, women). Participants expressed high interest in HIV self‐testing. They recommended HIV self‐testing implementation strategies to be peer supported and expressed concerns regarding sexual‐ and gender‐based violence with partner testing.ConclusionsIntersecting stigma rooted in fear, misinformation, blame and shame, legal precarity and healthcare mistreatment constrain current HIV testing strategies with urban refugee youth. Findings align with the Health Stigma and Discrimination Framework that conceptualizes stigma drivers and facilitators that devalue intersecting health conditions and social identities. Findings can inform multi‐level strategies to foster enabling HIV testing environments with urban refugee youth, including tackling intersecting stigma and leveraging refugee youth peer support.

Understanding constraints on integrated care for people with HIV and multimorbid cardiovascular conditions: an application of the Theoretical Domains Framework

BackgroundPeople with HIV (PWH) experience increased cardiovascular disease (CVD) risk. Many PWH in the USA receive their primary medical care from infectious disease specialists in HIV clinics. HIV care teams may not be fully prepared to provide evidence-based CVD care. We sought to describe local context for HIV clinics participating in an NIH-funded implementation trial and to identify facilitators and barriers to integrated CVD preventive care for PWH.MethodsData were collected in semi-structured interviews and focus groups with PWH and multidisciplinary healthcare providers at three academic medical centers. We used template analysis to identify barriers and facilitators of CVD preventive care in three HIV specialty clinics using the Theoretical Domains Framework (TDF).ResultsSix focus groups were conducted with 37 PWH. Individual interviews were conducted with 34 healthcare providers and 14 PWH. Major themes were captured in seven TDF domains. Within those themes, we identified nine facilitators and 11 barriers to CVD preventive care. Knowledge gaps contributed to inaccurate CVD risk perceptions and ineffective self-management practices in PWH. Exclusive prioritization of HIV over CVD-related conditions was common in PWH and their providers. HIV care providers assumed inconsistent roles in CVD prevention, including for PWH with primary care providers. HIV providers were knowledgeable of HIV-related CVD risks and co-located health resources were consistently available to support PWH with limited resources in health behavior change. However, infrequent medical visits, perceptions of CVD prevention as a primary care service, and multiple co-location of support programs introduced local challenges to engaging in CVD preventive care.ConclusionsBarriers to screening and treatment of cardiovascular conditions are common in HIV care settings and highlight a need for greater primary care integration. Improving long-term cardiovascular outcomes of PWH will likely require multi-level interventions supporting HIV providers to expand their scope of practice, addressing patient preferences for co-located CVD preventive care, changing clinic cultures that focus only on HIV to the exclusion of non-AIDS multimorbidity, and managing constraints associated with multiple services co-location.Trial registrationClinicalTrials.gov, NCT03643705

HIV related risk factors among adolescents and young adults

Adolescents and young adults are getting to becoming full-fledged adults, along with the maturity of physical bodies, the mentality is going to be matured. Adolescents and young adults are prone to unsafe sexual conducts which may lead to higher risks of HIV. The number of HIV newly reported cases has been increasing in adolescents and young adults and has attracted attention by people from all walks of life. This paper reviews the current status of HIV infection, routes of transmission, ways of case-finding and risk factors related to the susceptibility of HIV etc.,aiming to provide evidence for reducing the risk of HIV infection in adolescents and young adults.

High population-attributable fractions of traditional risk factors for non-AIDS-defining diseases among people living with HIV in China: a cohort study

ABSTRACT Morbidity and mortality of non-AIDS-defining diseases (NADs) have become the increasing burden of people living with HIV (PLWH) with long-term antiretroviral therapy (ART). We aimed to quantify the contribution of modifiable risk factors to NADs. We included PLWHs starting ART at the Third People’s Hospital of Shenzhen (China) from Jan 1, 2010 to Dec 31, 2017. We defined NAD outcomes of interest as cardiovascular disease (CVD), end-stage liver disease (ESLD), advanced renal disease (ARD), and non-AIDS-defining cancers (NADCs). We estimated incidence of outcomes and population-attributable fractions (PAFs) of modifiable traditional and HIV-related risk factors for each outcome. Overall, 8,301 participants (median age at study entry, 31 years) contributed 33,146 person-years of follow-up (PYFU). Incidence of CVD (362/100,000 PYFU) was the highest among outcomes, followed by that of ARD (270/100,000 PYFU), ESLD (213/100,000 PYFU), and NADC (152/100,000 PYFU). Totally, 34.14% of CVD was attributable to smoking, 7.98% to hypertension, and 6.44% to diabetes. For ESLD, 24.57% and 25.04% of it could be avoided if chronic hepatitis B and C virus infection, respectively, did not present. The leading PAFs for ARD were declined estimated glomerular filtration rate (eGFR) (39.68%) and low CD4 count (39.61%), followed by diabetes (10.19%). PAFs of hypertension, diabetes, and smoking for CVD, and declined eGFR and diabetes for ARD increased with age. The contribution of traditional risk factors for these NADs far outweighed the HIV-related risk factors. Individual-level interventions and population-level policy-making is needed to focus on these factors to prevent NADs in long-term management of HIV infection.

Risk factors affecting adherence to antiretroviral therapy among HIV patients in Manila, Philippines: a baseline cross-sectional analysis of the Philippines Connect for Life Study.

This cross-sectional analysis describes HIV-related risk behaviours and adherence to antiretroviral therapy (ART) in a population of HIV-positive patients at a clinic in Metro Manila, Philippines participating in the Philippines Connect for LifeTM cohort study. Among 426 HIV-positive adults taking ART, 79% reported ≥95% adherence over the prior 30 days. Longer time on treatment was associated with reduced adherence to ART (adjusted odds ratio (AOR) = 0.87 per year, P = 0.027). Being in a serodiscordant relationship, in which the subject's primary partner was HIV negative, increased adherence (AOR = 3.19, P = 0.006). Inconsistent condom use (AOR = 0.50, P = 0.103) and injection drug use (AOR = 0.54, P = 0.090) are potentially associated with reduced adherence to ART. Patients used drugs and alcohol at significantly higher rates than the general population.? The study found that patients in this setting require intervention to address treatment fatigue. Interventions to improve social support of PLHIV, as well as harm-reduction approaches for drug and alcohol use, could improve adherence in this population, strengthening the test-and-treat strategy to control the epidemic.

Disparities in HIV-related risk and socio-economic outcomes among trans women in the sex trade and effects of a targeted, anti-sex-trafficking policy.

Marginalization of sex work presents numerous risks for trans women (TW) engaged in the sex trade, including criminalization, traumatization, and contracting HIV. We identified socio-economic and HIV risk disparities among trans women sex workers and others who do sex work (TWSW/OWSW), and evaluated these disparities for TWSW/OWSW compared to TW not engaged in sex work from pre- and post-implementation of the US 2018 "Allow States and Victims to Fight Online Sex Trafficking Act" and "Stop Enabling Sex Traffickers Act" (FOSTA-SESTA). We analyzed 429 trans women (TW) from the Trans*National cohort study (2016-2019). Generalized estimating equations (GEE) characterized differences in socio-economic and HIV risk outcomes for TWSW/OWSW compared to TW not engaged in sex work over the study period. Adjusted, pre-to-post law changes in these outcomes for TWSW/OWSW versus TW not engaged in sex work were compared using difference-in-differences GEE regression analyses. Over 18 months, TWSW/OWSW had higher adjusted odds of being unstably housed, having income from criminalized sources, experiencing transphobic hate crimes, experiencing discrimination from police/courts, being incarcerated, meeting sex partners in the street/public settings, meeting sex partners on Craigslist or other online forums (except dating apps), or engaging in condomless anal intercourse, (p<0.01 for all comparisons); TWSW/OWSW also had a higher mean number of income sources (p=0.03). One difference-in-differences analysis showed additive interaction: the adjusted mean number of income sources reported by TWSW/OWSW compared to those not engaged in sex work decreased from pre-to post-FOSTA-SESTA (from 1.79 to 1.48 for TWSW/OWSW and from 1.52 to 1.47 for TW not engaged in sex work; p=0.01). Disparities in socio-economic and HIV-related risk outcomes exist for TWSW/OWSW in San Francisco. There is an urgent need for comprehensive, long-term follow-up data of TW to accurately analyze policy effects, especially given the recent enactment of a number of other policies targeting TW.

Utilization of absolute monocyte counts to predict cardiovascular events in people living with HIV

Cardiovascular risk is increased in people living with HIV (PLWH). In HIV-uninfected populations, total absolute monocyte count (AMC) has been shown to be predictive of future cardiovascular events (CVEs). We sought to determine whether AMC predicts CVEs in PLWH independent of established and HIV-related cardiovascular risk factors. We identified all PLWH within the Partners HIV Cohort without factors that could confound the monocyte count. CVE was defined as fatal or non-fatal acute myocardial infarction or ischaemic stroke. Baseline-measured AMC was defined as the average of all outpatient AMC counts a year before and after the baseline date. Multivariable Cox proportional hazards models were used to assess the association of baseline AMC with CVEs. Our cohort consisted of 1980 patients, with median follow-up of 10.9years and 182 CVEs. Mean (±SD) age was 41.9±9.3 years; 73.0% were male. Mean CD4 count was 506.3±307.1cells/µL, 48% had HIV viral load (VL) <400 copies/mL, and 87% were on antiretroviral therapy. Mean AMC was 0.38×103 ±0.13 cells/µL. In multivariable modelling adjusted for traditional CV risk factors, CD4 cell count, and HIV VL, AMC quartile 2 (Q2) (HR = 1.01, P=0.98), Q3 (HR = 1.07, P=0.76), and Q4 (HR = 0.97, P=0.89) were not significantly predictive of CVE compared with Q1. Baseline AMC was not associated with long-term CVEs in PLWH. AMC obtained in routine clinical encounters does not appear to enhance CV risk stratification in PLWH.

A qualitative study on HIV related risk behaviors, current status and need for prevention services among 28 money boys

Objective: To understand the characteristics of HIV-related risk behaviors and needs for prevention services among males who sell sex for money or anything of value (commonly known as money boys or MB), and to provide evidence for the development of targeted interventions. Methods: Using non-probability purposive sampling method and one-on-one interviews. Results: A total of 28 MBs were interviewed, with age range between 20 and 67, and education primarily at junior high school level. Among them 6 were married. Their household registration for residency cut across 15 provinces, and their sexual orientation is diverse. They migrate primarily among tier one cities and provincial capitals. Most enter the trade for economic reasons, relying on clubs and personal networks to find clients, and on word of mouth to obtain knowledge and skills. In addition to their primary clientele of the male homosexual community, 5 out of 28 serve male heterosexuals and 6 out of 28 also serve females. They have some awareness of self protection from diseases, primarily from word of mouth. Nevertheless, over half of them cannot maintain consistent condom use, and 12 out of 28 have a history of illegal drug use. Three of them reported being tested positive for HIV, and all continue to engage in sex work. They prefer their communication messages to be simple and straight-forward. Privacy comes first when they are accessing testing and treatment services. Conclusion: The bridge role of the MB community in transmitting HIV to the general population cannot be ignored, and interventions targeting the MB population need to be strengthened.

HIV and HCV infection status and related risk factors in drug users at the Sino-Vietnamese border in Guangxi, 2012 — 2019

Objective To understand the prevalence rates and the related risk factors of HIV, HCV and HIV/HCV coinfection in drug users in the Sino-Vietnamese border areas of Guangxi, and we provide reference for high-risk intervention in this population. Methods From April to June every year from 2012 to 2019, a questionnaire developed by the state was used to carry out continuous cross-sectional surveys on the post surveillance sites in Guangxi border areas, community drug addicts and morphine urine test positive persons in methadone clinics in the past month, and blood samples were taken from them for the detections of HIV and hepatitis C virus (HCV) antibodies. Results A total of 12 842 drug users were monitored from 2012 to 2019. The overall positive rates of HIV, HCV and HIV/HCV co-infection were 3.84%, 43.34% and 3.14%, respectively. HIV, HCV and HIV/HCV co-infection rates showed an decrease trend year by year. The prevalence differed in drug users with different demographic characteristics. Logistic regression analysis showed that HIV infection related risk factors included being female, primary education and injecting drug use. HCV infection related risk factors included 20 years old or more, divorced or widowed, minorities other than Han and Zhuang, being traditional drug user or mixed drug user, and injecting drug use. HIV/HCV co-infection related risk factors included being female, primary education and injecting drug use. Conclusion The HIV infection rate and HCV antibody positive rate in drug users in border areas of Guangxi were relatively high, and the infection rate of HIV/HCV combined infection were low. The use of novel type drugs was in increase. Targeted effective interventions should be conducted in female and older drug users as well as drug users having a history of injection drug use. 摘要:目的 了解广西中越边境地区吸毒人群中HIV、丙肝病毒(HCV)及HIV/HCV合并感染情况及其影响因素, 为在该人群中开展髙危行为干预提供参考依据。 方法 2012—2019年间每年4一6月, 采用国家统一制定的问卷对广 西中越边境哨点监管场所、社区和美沙酮门诊最近1个月吗啡尿检阳性者开展连续横断面调査, 并采集调査对象血液 标本进行HIV和HCV抗体检测。 结果 2012—2019年共监测12 842名毒品使用者。HIV感染率为3.84%, HCV抗体 阳性率为43.34%, HIV/HCV合并感染率为3.14%。HIV、HCV及HIV/HCV合并感染率整体上呈逐年下降的趋势。不同 行为特征的吸毒人群感染情况不同。Logistic回归分析显示, 女性、小学学历、有注射吸毒史是感染HIV的危险因素。年龄>20岁、离异或丧偶、除汉族和壮族外的其他少数民族、传统毒品和混合毒品使用者、有注射毒品史是感染HCV的 危险因素。而女性、小学文化、有注射毒品史是HIV/HCV合并感染的危险因素。 结论 广西边境吸毒人群整体HIV感 染率和HCV抗体阳性率较髙, HIV/HCV合并感染率较低, 新型毒品使用者比例呈上升趋势。提示需针对女性、髙年龄 组及有注射吸毒史的吸毒人群开展有效干预措施。

Screening of HIV and identifying risk factors among premedical students, Kafr El-Sheikh University, Egypt

Background and aim: HIV is a global public health problem. Many people in Egypt are afraid to get tested for HIV so the real situation remains unknown. The aim of this article was to determine HIV status and HIV related risk factor among Egyptian premedical students. Patients and Methods: A cross-sectional survey using a self-administered structured questionnaire was used to collect data to identify HIV related risk factor beside serosurvey to detect HIV antibodies among 737 from a total of 1123 pre medical students in Kafr El Sheikh University (KFU) who agreed to participate in the study. Results: The mean age of screened students was 18 ± 0.26 years. In total, 333 (45.2%) were males and 403 (54.8%) were females. Using HIV antibody testing; we did not find any positive HIV cases in our study. (7.5%) underwent any surgical procedure, (0.4%) received blood or blood product transfusions, and (0.1%) shared needle or syringe with others. While (42.8%) shared scissors, razors, and nail clippers with others and (57.3%) went ever to the dentist but none of them had any sexual relationships or HIV patient within the family. Conclusion: We detected no cases of HIV or risky behaviors among Egyptian premedical students.

Sexual Pleasure in Transgender and Gender Diverse Individuals: an Update on Recent Advances in the Field

The goal of the current publication was to review literature on sexual pleasure in transgender people published in the past 3 years. An additional aim of the review was to determine whether recent literature differed from the traditionally narrow focus of transgender sexual health research, which has clustered almost exclusively in three topics: (1) orgasmic potential for transgender people who have undergone gender-affirmative genital surgery, (2) sexual desire in relation to gender-affirmative hormone therapy, and (3) HIV-related risk. Twelve recent studies were included in the review. The disciplinary focus of the articles included biomedical interventions, including sexual pleasure in relation to gender-affirmative hormone therapy and surgeries; psychology/sexology, including basic and applied research on transgender people’s sexual pleasure and health; sex education, including pleasure-based and transgender-inclusive curricula; and HIV and sexual health, including the role of sexual pleasure in facilitating or preventing disease transmission. Recent literature builds upon existing bodies of research in meaningful ways. However, the subject matter of recent literature did not stray from the traditionally narrow focus of this research area. Additionally, the vast majority of research was conducted in wealthy, industrialized countries (mostly North America and the Netherlands). Implications for research and clinical practice are explored.

Mak Nyahs in Malaysia: Does HIV/AIDS Knowledge Really Reduce HIV-Related Risk Behaviours?

Introduction. Male-to-female transgender individuals are known as mak nyahs in Malaysia. Akin to many other countries, mak nyahs face discriminations in securing proper employment, thus many end up in sex trade, exposing them to HIV-related high risk behaviours. This paper aims to investigate the knowledge, attitude, and risk behaviours in HIV/AIDS among mak nyahs in Malaysia. Method. Validated questionnaires in local language were used. Knowledge, attitude, and HIV-related risk behaviours were measured. With respondent-driven sampling method, 54 subjects participated in the survey. IBM SPSS was used for data analysis. Results. Majority of the subjects reported to have HIV-related sexual risk, although only a quarter were sex workers. Misconceptions still remained among the subjects. Inconsistent condom use was common. Adequate knowledge did result in better attitude towards HIV/AIDS. However, multiple regression analysis showed that subjects with higher knowledge in HIV/AIDS tend to have higher sexual risks (β = 0.320, p = 0.030). Conclusion. Educating the transgender community about HIV/AIDS does not seem to adequately reduce the HIV-related sexual risks. Other approaches, i.e. socio-cultural values and religious practices may be effective to instil higher levels of awareness and self-responsibility in this community to eliminate HIVrelated high risk behaviours.

Coronavirus Disease 2019 and Vaccination of Children and Adolescents: Prospects and Challenges

Coronavirus Disease 2019 and Vaccination of Children and Adolescents: Prospects and Challenges

Examining patient characteristics and HIV-related risks among women with syphilis as indicators for pre-exposure prophylaxis in a nurse-led program (PrEP-RN).

Current HIV pre-exposure prophylaxis (PrEP) guidelines primarily target men who have sex with men (MSM) as candidates for HIV prevention; however, such recommendations often come at the expense of other ethnic and gender minorities, including women. To address barriers to PrEP care among non-MSM, we developed and implemented the first nurse-led PrEP program in Canada, known as PrEP-RN. As part of PrEP-RN, patients who meet objective indicators of HIV risk are offered a referral for PrEP, regardless of sexual orientation. One such measure is syphilis, which has increased in incidence among various population groups and is known to cause biological vulnerabilities to HIV. To better understand HIV-related risks and assess intentions for PrEP use among women, we undertook an 18-month retrospective review of syphilis diagnoses within this group in Ottawa, Canada. As part of this review, we examined 23 patient files, noting their unique characteristics, socio-behavioural risk factors, and noted barriers to PrEP uptake. While none of the women diagnosed with syphilis were diagnosed with HIV, the findings raise some important considerations to facilitate opportunities for HIV prevention among non-MSM, which must take into consideration individual risk practices, sexual health histories, and population groups.

High HIV prevalence among transgender women in Paraguay.

Transgender women have been understudied and underserved in Paraguay; data are urgently needed to understand their HIV prevention and care needs. To estimate HIV prevalence and related risk and preventive behaviors among trans women in Paraguay, we conducted a cross-sectional survey in 2017. We employed starfish sampling - a hybrid venue-based and peer-referral method combining recruitment at randomly sampled venues and randomly selected clients from program lists, followed by short-chain referrals of eligible peers. Among 304 trans women enrolled, HIV prevalence was 24.8% (95% confidence interval [CI] 18.5-31.2%), with risk increasing with age (adjusted odds ratio [AOR] 1.06 per year, 95% CI 1.03-1.10), residence in Asunción department (AOR 4.75, 95% CI 1.57-14.36), and cocaine use (AOR 2.09, 95% CI 1.11-3.95). Trans women in Paraguay need to be prioritized for interventions with high HIV prevention efficacy. Substance use interventions to address cocaine use may also yield prevention benefits for trans women in our context.

Family Factors and HIV-Related Risk Behaviors Among Adolescent Sexual Minority Males in Three United States Cities, 2015.

Purpose: We examined the relationship between family factors and HIV-related sexual risk behaviors among adolescent sexual minority males (ASMM) who are affected disproportionately by HIV. Methods: We analyzed results from the National HIV Behavioral Surveillance among Young Men Who Have Sex with Men. Adolescent males ages 13-18 who identified as gay or bisexual, or who reported attraction to or sex with males were interviewed in 2015 in Chicago, New York City, and Philadelphia. Separate log-linked Poisson regression models were used to estimate associations between family factors and sexual risk behaviors. Results: Of the 569 ASMM, 41% had condomless anal intercourse in the past 12 months, 38% had ≥4 male sex partners in the past 12 months, and 23% had vaginal or anal sex before age 13. ASMM who had ever been kicked out of their house or run away, those who were out to their mother, and those who were out to their father, were more likely to engage in sexual risk behaviors. ASMM who were currently living with parents or guardians and those who received a positive reaction to their outness by their mother were less likely to engage in sexual risk behaviors. Conclusion: Our findings highlight the important role of family factors in HIV risk reduction among ASMM. A better understanding of the complex dynamics of these families will help in developing family-based interventions.

Hepatitis B, hepatitis C and HIV prevalence and related sexual and substance use risk practices among key populations who access HIV prevention, treatment and related services in South Africa: findings from a seven-city cross-sectional survey (2017)

BackgroundPeople who use drugs including people who inject drugs (PWUD/ID), sex workers (SWs) and men who have sex with men (MSM) are at increased risk of HIV and viral hepatitis infection. Limited epidemiological data on the infections exists in key populations (KPs) in South Africa. We investigated the prevalence of hepatitis B (HBV), hepatitis C (HCV) and HIV and selected risk factors among these KPs to inform effective responses.MethodsWe used convenience sampling to recruit a targeted 3500 KPs accessing HIV-related health services across Cape Town (SWs, MSM, PWUD/ID), Durban (SWs, PWUD/ID), Pietermaritzburg (SWs), Mthatha (SWs), Port Elizabeth (SWs), Johannesburg (MSM) and Pretoria (MSM and PWUD/ID) into a cross-sectional survey. An interviewer questionnaire to assess socio-demographic characteristics, drug use and sexual risk practices, was administered. HBV surface antigen (HBsAg); HCV antibody, viral load and genotype, and HIV antibody, was tested.ResultsAmong the 3439 people included in the study (1528 SWs, 746 MSM, 1165 PWUD/ID) the median age was 29 years, most participants were black African (60%), and 24% reported homelessness. 82% reported substance use in the last month, including alcohol (46%) and heroin (33%). 75% were sexually active in the previous month, with condom use at last sex at 74%. HIV prevalence was 37% (highest among SWs at 47%), HBsAg prevalence 4% (similar across KPs) and HCV prevalence was 16% (highest among PWUD/ID at 46%).ConclusionsHBV, HCV and HIV pose a health burden for KPs in South Africa. While HIV is key for all included KPs, HCV is of particular importance to PWUD/ID. For KPs, HBV vaccination and behavioural change interventions that support consistent condom and lubricant access and use are needed. Coverage of opioid substitution therapy and needle and syringe services, and access to HCV treatment for PWUD/ID need to be expanded.

Efficacy of HIV interventions among factory workers in low- and middle-income countries: a systematic review

BackgroundFactory workers in low- and middle-income countries (LMICs) are vulnerable to HIV transmission. Interventions are needed to prevent HIV in this population. We systematically reviewed published literature on the efficacy of various HIV interventions in reducing stigma, risk behaviors and HIV transmission among factory workers.MethodsA systematic review was performed using predefined inclusion and exclusion criteria. Four databases (PubMed, PsycINFO, Scopus and EMBASE) were searched for relevant publications between January 1, 1990 and December 31, 2018. Two independent reviewers assessed the methodological quality of studies.ResultsThirteen articles were included, with 2 randomized controlled trials and 11 cohort studies. Five interventions and their combinations were summarized. Educational intervention increased condom use and reduced the use of recreational drugs and alcohol before sex. Community intervention that proactively provide HIV counselling and testing (HCT) services could increase the detection rate of HIV and other sexually transmitted diseases (STDs). Lottery intervention increased HCT uptake and decreased HIV public stigma. Education combined with community intervention reduced the proportion of workers with casual sex and enhanced HIV knowledge. Peer education combined with community intervention increased the proportion of workers who were willing to take their partners to HCT. Policy intervention combined with peer education enhanced HIV knowledge, perceived condom accessibility and condom use with regular partners.ConclusionsVarious interventions improved HIV knowledge, decreased HIV stigma and reduced HIV-related risk behaviors among factory workers in LMICs. The combination of multiple interventions tended to achieve better efficacy than a single intervention. Persistent combination interventions are essential to address HIV in this population.