HIV Seroprevalence Rates Research Articles

Scope and mortality of adult medical ICU patients in an Eastern Cape tertiary hospital.

The characteristics and mortality outcomes of patients admitted to South African intensive care units (ICUs) owing to medical conditions are unknown. Available literature is derived from studies based on data from high-income countries. To determine ICU utilisation by medical patients and evaluate the scope of admissions and clinical associations with hospital mortality in ICU patients 12 years and older admitted to an Eastern Cape tertiary ICU, particularly in the subset with HIV disease. A retrospective descriptive one-year cohort study. Data were obtained from the LivAKI study database and demographic data, comorbidities, diagnosis, and mortality outcomes and associations were determined. There were 261 (29.8%) medical ICU admissions. The mean age of the cohort was 40.2 years; 51.7% were female. When compared with the surgical emergencies, the medical subgroup had higher sequential organ failure assessment (SOFA) scores (median score 5 v. 4, respectively) and simplified acute physiology score III (SAPS 3) scores (median 52.7 v. 48.5), a higher incidence of acute respiratory distress syndrome (ARDS) (7.7% v. 2.9%) and required more frequent dialysis (20.3% v. 5.5%). Of the medical admissions, sepsis accounted for 32.4% of admission diagnoses. The HIV seroprevalence rate was 34.0%, of whom 57.4% were on antiretroviral therapy. ICU and hospital mortality rates were 11.1% and 21.5% respectively, while only acute kidney injury (AKI) and sepsis were independently associated with mortality. The HIV-positive subgroup had a higher burden of tuberculosis (TB), higher admission SOFA and SAPS 3 scores and required more organ support. Among medical patients admitted to ICU, there was a high HIV seroprevalence with low uptake of antiretroviral therapy. Sepsis was the most frequently identified ICU admission diagnosis. Sepsis and AKI (not HIV) were independent predictors of mortality. Co-infection with HIV and TB was associated with increased mortality. The epidemiology and outcomes of adults who are critically ill from medical conditions in South African intensive care units was previously unknown but has been described in this study. The association of sepsis, TB, HIV and acute kidney injury with mortality is discussed.

Etiological Surveillance of Male Urethritis Syndrome in South Africa: 2019 to 2020.

In South Africa, male urethritis syndrome (MUS) is the most common sexually transmitted infection (STI) syndrome in men. We determined the distribution of STI etiologies and the susceptibility profiles of Neisseria gonorrhoeae isolates from men presenting with MUS to 3 sentinel surveillance health care facilities. Secondary objectives were to determine the seroprevalence of coinfections (HIV, syphilis, herpes simplex virus 2). Consecutive, consenting men with symptomatic urethral discharge were enrolled between January 1, 2019, and December 31, 2020. Genital discharge swab and blood specimens were collected and transported to a central STI reference laboratory in Johannesburg, South Africa. Among 769 men enrolled, N. gonorrhoeae was the commonest cause of MUS (674 [87.8%]; 95% confidence interval [CI], 85.2%-89.9%), followed by Chlamydia trachomatis (161 [21.0%]; 95% CI, 18.2%-24.0%). Of 542 cultivable N. gonorrhoeae isolates, all were susceptible to ceftriaxone (modal minimum inhibitory concentration, 0.004 mg/L) and azithromycin (modal minimum inhibitory concentration, 0.128 mg/L). Seroprevalence rates of HIV, syphilis, and HSV-2 were 21.4% (95% CI, 18.5%-24.5%), 2.3%, and 50.1%, respectively. Condom use at last sexual encounter was reported by only 7%, less than 50% had been medically circumcised, and only 66.7% (58 of 87) who self-reported an HIV-positive status were adherent on antiretroviral drugs. Neisseria gonorrhoeae and C. trachomatis were the predominant causes of MUS. Currently recommended dual ceftriaxone and azithromycin therapy are appropriate for MUS syndromic management; however, surveillance must be maintained to timeously detect emerging and increasing gonococcal resistance. Clinic-based interventions must be intensified in men seeing sexual health care to reduce the community transmission and burden of STI and HIV.

Prevalence of sexually transmitted infections in patients with schizophrenia in Morocco

People with schizophrenia are likely to be overrepresented in high-risk categories for sexually transmitted infections (STIs). We aimed to determine the seroprevalence of HIV, HBV, HBC, and syphilis in these patients. Sociodemographic and clinical characteristics of 444 patients were collected, as well as risk factors for STIs. Serological tests were performed. Lifetime seroprevalence rates were 0.0% for HIV, 1.6% for HBV, 0.9% for HBC, and 3.6% for syphilis. These figures are lower than those reported in the general population except for syphilis. Only 0.45% of patients were seropositive for both HBV and syphilis. No higher rates of HBV, HBC, and HIV seroprevalence were observed compared with the general population, except for syphilis.

Geographical Disparities in HIV Seroprevalence Among Men Who Have Sex with Men and People Who Inject Drugs in Nigeria: Exploratory Spatial Data Analysis.

BackgroundThe assessment of geographical heterogeneity of HIV among men who have sex with men (MSM) and people who inject drugs (PWID) can usefully inform targeted HIV prevention and care strategies.ObjectiveWe aimed to measure HIV seroprevalence and identify hotspots of HIV infection among MSM and PWID in Nigeria.MethodsWe included all MSM and PWID accessing HIV testing services across 7 prioritized states (Lagos, Nasarawa, Akwa Ibom, Cross Rivers, Rivers, Benue, and the Federal Capital Territory) in 3 geographic regions (North Central, South South, and South West) between October 1, 2016, and September 30, 2017. We extracted data from national testing registers, georeferenced all HIV test results aggregated at the local government area level, and calculated HIV seroprevalence. We calculated and compared HIV seroprevalence from our study to the 2014 integrated biological and behavioural surveillance survey and used global spatial autocorrelation and hotspot analysis to highlight patterns of HIV infection and identify areas of significant clustering of HIV cases.ResultsMSM and PWID had HIV seroprevalence rates of 12.14% (3209/26,423) and 11.88% (1126/9474), respectively. Global spatial autocorrelation Moran I statistics revealed a clustered distribution of HIV infection among MSM and PWID with a <5% and <1% likelihood that this clustered pattern could be due to chance, respectively. Significant clusters of HIV infection (Getis-Ord-Gi* statistics) confined to the North Central and South South regions were identified among MSM and PWID. Compared to the 2014 integrated biological and behavioural surveillance survey, our results suggest an increased HIV seroprevalence among PWID and a substantial decrease among MSM.ConclusionsThis study identified geographical areas to prioritize for control of HIV infection among MSM and PWID, thus demonstrating that geographical information system technology is a useful tool to inform public health planning for interventions targeting epidemic control of HIV infection.

Transfusion Transmissible Infections Among Voluntary Blood Donors at Dessie Blood Bank, Northeast Ethiopia: Cross-Sectional Study.

BackgroundThe prevalence of transfusion transmitted infections (TTIs) among blood donors varies across different geographical populations. Establishing the sero-prevalence of the disease among blood donors is important to informing the direction of preventive and control strategies.ObjectiveThe aim of this study was to determine the sero-prevalence of transfusion transmitted infections among voluntarily blood donors at Dessie Blood Bank, North East Ethiopia.Methods and MaterialsA cross-sectional study was conducted from November 10 to December 12, 2018. A total of 384 blood donors were conveniently included in this study. Socio-demographic data and other factors were collected using a pre-tested structured questionnaire. Five milliliters of venous blood was collected using a sterile test tube from each blood donor and the blood was allowed to clot; then, serum was separated by centrifugation for laboratory investigation. Serum samples from blood donors were tested by enzyme-linked immunosorbent assays (ELISA) for the presence of hepatits B surface antigen (HBsAg), and antibodies to human immunodeficiency virus (HIV-1/2), hepatits C virus (HCV), and Treponema pallidum. Logistic regression was used to explore risk factors associated with each transfusion transmissible infection.ResultsFrom a total of 384 blood donors, 24 (6.25%) of them had serological evidence for at least one infection. The overall sero-prevalence rates of HBV, HCV, HIV, and syphilis among blood donors were 4.2%, 0%, 0.26%, and 1.82%, respectively. Educational status was significantly associated with HBV infection. Multiple sexual behaviors had statistically significant association with syphilis.ConclusionIn conclusion, 6.25% of blood donors still harbor transfusion transmissible infections despite recent blood donation safety improvements with the greater majority (4.2%) of cases caused by HBV infection.

Undiagnosed HIV, hepatitis B, and hepatitis C infections in people with severe psychiatric disorders in Ethiopia

BackgroundWorldwide, there is limited epidemiologic evidence on the seroprevalence of undiagnosed chronic viral infections including HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among patients with severe psychiatric disorders. To our knowledge, this is the first study to explore and compare undiagnosed seroprevalence rates of HIV, HBV, and HCV infections among patients with severe psychiatric disorders.MethodIn this study, we included a random sample of 309 patients with severe psychiatric disorders selected by systematic sampling technique. We used a structured clinical interview for DSM-IV (SCID) to confirm the diagnosis of severe psychiatric disorders among the participants. Binary and multivariable logistic regression models, adjusting for the potential confounding factors was used to explore the potential determinants of chronic viral infections.ResultThe prevalence estimates of HIV infection among patients with severe psychiatric disorders in this study (3.24%) was roughly 3 times the estimated population prevalence of HIV infection in Ethiopia (1.1%). This study showed that the prevalence rates of HBV and HCV infections among patients with severe psychiatric disorders were 4.85 and 1.29%, respectively. Our results also showed that among patients with chronic viral infections, HIV, HBV and HCV, 76.92, 60, 80, and 75% respectively were undiagnosed. Regarding associated factors, the presence of chronic viral infection was found to be significantly associated with the age of the participants (ranging between 30 and 40 years) after adjusting for the possible confounding factors [AOR = 3.95 (95%CI.18–13.17)].ConclusionEven though the prevalence estimates of HIV (3.24%), HBV (4.85%), and HCV (1.29%) infections were high among patients with severe psychiatric disorders, the majority of them remained undiagnosed. HBV was found to be the commonly undiagnosed infection (4 out of 5) followed by HCV (3 out of 4) and HIV (6 out of 10). The present study provided evidence of a significant association between the age of the participant (between 30 and 40 years) and chronic viral infections in patients with severe psychiatric disorders. Increasing the awareness of psychiatry professionals and early screening, as well as interventions of chronic viral infections among patients with severe psychiatric disorders are imperative.

Adjournment in Community HIV Prevention: Exploring Transitions in Community-Academic Partnerships.

Barbershop-based interventions have been increasingly implemented as a means to support culturally relevant and community-accessible health promotion and disease prevention efforts. Specifically, in neighborhoods of Brooklyn, New York, with high HIV seroprevalence rates, barbers have volunteered to support an initiative to help reduce sexual risk behavior. After implementing the Barbershop Talk With Brothers program for 5 years, we explored how program participation has affected barbers' HIV prevention and counseling skills to promote their clients' health, and assessed their views of next stages of the community-academic partnership, once the specific project ended. Through employing rigorous qualitative research methods with personnel at participating barbershops, key results include that although barbers self-identify as community leaders and even as health educators, they want ongoing support in educating customers about other topics like nutrition and physical activity, including upstream social determinants of health, such as housing and employment. They are also concerned regarding how best to support continuity of efforts and maintenance of partnerships between projects. These findings provide insight toward adjourning community-based participatory research projects, which can inform other academic researchers, organizations, and businesses that partner with community members.

Prevalence and Trends of HIV and Syphilis Among Blood Donors in the Northern Region of Ghana; A Five-year Retrospective Study

Blood transfusion is considered a life-saver in health care settings, but could potentially pose as a risk factor for transmission of life-threatening viral infections, including HIV, HBsAg, HCV and Syphilis infections. This study was carried out to find out the prevalence and trends of HIV and Syphilis infections among blood donors in the Northern Region of Ghana. Blood screening data of blood donors recorded in blood transfusion centers in the Northern region between 2011 and 2015 were collected and analyzed anonymously. Screening results for HIV and Syphils infections were sorted and analyzed from a total of 198,229 blood donors in the region within the period under consideration. Majority of the donors were female and aged between 20–39 years. The overall seroprevalence rates of HIV and Syphilis were 30.77% (7319) and 27.78% (4893) respectively. The highest seroprevalence was found for HIV followed by Syphilis. These infections were more prevalent in female donors. Highest seroprevalence for both HIV and Syphilis was observed among donors in their youthful ages, i.e. between 20 to 49 years, while Syphilis seroprevalence increased with age. There exists a decreasing trend of transfusion-transmissible viral infections (i.e. HIV and Syphilis) in blood donations. This indicates that the Ghana National Blood Service mandate of ensuring the safety of blood supply has been successful. Even though available statistics show that the prevalence rates of viral infections detected during blood donations has reduced drastically, there is still more to be done, especially using robust and efficient techniques like polymerase chain reaction (PCR). This, the researchers think could guarantee more safety blood for transfusion.

Profile of HIV positive clients: an ICTC record based retrospective study

Background: Deaths in productive age group due to HIV/AIDS have damaging impact on families and communities, skills are lost, workforce shrinks &amp; children's are orphaned. Our study reports the socio-demographic characteristics of HIV/ AIDS clients from one of the Integrated Counselling &amp; Testing Centre (ICTC) situated at Amtala, West Bengal. This will give us an insight on the distribution of various epidemiological characteristics of the HIV positive clients in this region thus help in formulating strategies for effective implementation of its prevention. The objective was to study socio-demographic profile and risk behavior pattern of HIV positive clients attending ICTC.Methods: It was an observational study cross sectional in design. Records of last eight years of HIV positive clients were accessed from ICTC centre at Amtala hospital, rural training centre, Department of community medicine, ESI PGIMSR medical college, Joka, Kolkata. Data was entered in SPSS for Windows version 20 software. Data was presented in percentages, mean with standard deviation etc.Results: Retrospective record of 62 HIV positive clients was studied, of them 37 were males (5 pediatric cases) and 25 females (7 ANC).Excluding pediatric clients, mean age of clients was 32 years. It was observed that majority of clients were illiterate and were on daily wages. Except one male client who was homosexual rest were heterosexual. Majority of clients 71.9% males and 92% females were married, of them 45.3% males and 34.7% females were sero concordant with their spouse. Seventeen subjects were co infected with TB.Conclusions: HIV sero prevalence rate has inverse relation with literacy level. Majority of male clients were daily wagers who act as link between high risk populations to general population i.e. their spouse, which in turn can pass on the infection to her baby. Lack of knowledge on mode of spread and preventive measures against HIV infection devastate the families making many children orphaned. There is need to carry out intense IEC activities for behavior change at grass root level.

Prevalence and Trends of Transfusion-Transmissible Viral Infections among Blood Donors in South of Iran: An Eleven-Year Retrospective Study.

BackgroundBlood transfusion is considered a potential risk factor for transmission of life-threatening viral infections, including HIV, HCV and HBV infections. This study was performed to find out the prevalence and trends of these infections among blood donors in Southern Iran.MethodsThe blood donor data recorded in twelve regional blood transfusion centers from 2004 to 2014 were analyzed in an anonymous way with respect to the results of serological screening for HBV, HCV, and HIV infections. Overall, 293454 donors were screened for viral infections.ResultsMost of the donors were male, married, aged between 20–40 years, educated, and regular donors. The overall seroprevalence rates of HBV, HCV and HIV were 0.15%, 0.1% and 0.004%, respectively. The highest seroprevalence was found for HBV, followed by HCV and HIV. These infections were more prevalent in male, low educated and first time donors. The highest HCV seroprevalence was observed among donors aged 20 to 40 years, while HBV seroprevalence increased with age. The seroprevalence rates of HBV and HCV from 2004 to 2014 showed significant decreasing trends from 0.460% to 0.060% (P < 0.001) and 0.329% to 0.045% (P < 0.001), respectively. Whereas HIV infection had a slight but not significant decline from 0.0173% in 2004 to 0.0028% in 2014 (P = 0.087).ConclusionsThe decreasing trends of transfusion-transmissible viral infections in blood donations indicate that the attempts of IBTO were successful in improving the safety of the blood supply, since the prevalence rates of viral infections have been reduced to very low levels in blood donations over the years. However, still more effective techniques such as polymerase chain reaction (PCR) are needed to guarantee blood safety.

Partner HIV serostatus disclosure and determinants of serodiscordance among prevention of mother to child transmission clients in Nigeria

BackgroundSerodiscordance exists when the known HIV result of one member of a couple pair is positive while that of his/her partner is negative. In sub-Saharan Africa, in stable long-term couple partnerships (married or cohabiting), serodiscordance is a growing source of HIV-transmissions. This study aimed to ascertain across Nigeria, serodiscordance prevalence, partner HIV status disclosure and explore associations between suspected determinants and serodiscordance among PMTCT enrolled HIV positive pregnant women and their partners.MethodsA retrospective Quality of Care performance evaluation was conducted in July 2013 among 544 HIV positive pregnant enrolees of PMTCT services in 62 comprehensive facilities across 5 of Nigeria’s 6 geo-political zones. Data of client-partner pairs were abstracted from pre-existing medical records and analysed using chi-square statistics and logistic regression.ResultsA total of 544 (22 %) of 2499 clients with complete partner details were analysed. Clients’ age ranged from 15 to 50 years with a mean of 30 years. Serodiscordant prevalence was 52 % and chi-square test suggests no significant difference between serodiscordant and seroconcordant clients and their partners (p = 0.265). Serodiscordant rates were closely associated trend wise with national HIV sero-prevalence rates and the median CD4+ count was 425 ul/mm3 (IQR: 290–606 ul/mm3). Similar proportion of clients (99 %) received testing and agreed to disclose status to their partners. Yet, there was no association between clients agreement to disclose HIV status to their partners and these partners getting tested and receiving results (p = 0.919). Significantly, 87 % of clients in concordant HIV positive relationships appeared to be symptomatic (WHO clinical stage 3 or 4) compared to 13 % clients in HIV-discordant relationships (p < 0.003). Client’s age and CD4+ count did not aptly predict serodiscordance (Wald = 0.011 and 0.436 respectively). However, the WHO clinical staging appeared to be a better predictor of serodiscordance and concordance than other variables (Wald = 3.167).ConclusionsThe results suggest that clinical staging (WHO) could be a better predictor of client- partner pair discordant or concordant HIV serostatus. Early partner testing and notification can avert seroconversion, hence properly designed and mainstreamed interventions that target serodiscordant couples are essential.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2155-x) contains supplementary material, which is available to authorized users.

Treatment outcome of tuberculosis patients at National Hospital Abuja Nigeria: a five year retrospective study

Background: The HIV/AIDS epidemic in Nigeria has militated against efforts to control TB. This study determined the differences in TB treatment outcome between patients with TB/HIV co-infection and those without HIV co-infection in National Hospital Abuja, Nigeria.Methods: This was a retrospective cohort study on pulmonary TB patients that were treated in National Hospital Abuja, Nigeria from January 2007 to December 2012. Data was collected from the Directly Observed Treatment Shortcourse (DOTS) clinic and hospital records and analysed using stata version 12. The HIV sero-prevalence was determined and TB treatment outcomes in patients co-infected with TB and HIV was compared to that of HIV negative patients. The t-test and chi square test was used to verify differences in means and proportions and multiple logistic regression to adjust for potential confounders. Sensitivity analysis was done to address the problems of loss to follow up and missing data.Results: A total of 389 cases were assessed. The HIV sero-prevalence rate in the study was 42.7%. Fifty-three percent of the study population were within the age category 30–49 years. There was strong evidence of an association between TB/HIV co-infection rate among the various age categories (p = 0.01). HIV positive cases had a lower treatment success rate, 48.8% vs. 78.5% (p < 0.001), a higher rate of treatment failure, 10.8% vs. 4% (p = 0.01), and a higher rate of default, 38.6% vs. 17% (p < 0.001).Conclusion: The study provides evidence that TB/HIV co-infection impacts negatively on TB treatment outcome.

Utilization of the prevention of parent-to-child transmission of HIV (PPTCT) services in a tertiary care hospital, Odisha, India

Aims: To assess seroprevalence of HIV among antenatal women and the extent of utilization of interventions to minimize the risk of mother-to-child transmission. Study Design: Descriptive cross-sectional study was carried out among antenatal women who attended integrated counseling and testing center (ICTC) of HIV. Sample sizes were determined from the number of pregnant women that attended ICTC. Place and Duration of Study: Data and samples were collected from a tertiary care hospital, Odisha, India during January 2009 to December 2012. Methodology: All pregnant women were counseled and tested for HIV by rapid test. All HIV-seropositive antenatal women (ANW) were linked to services and followed up for institutional delivery, single-dose nevirapine (sdNVP) prophylaxis, infant feeding options and testing of children at 18 months. Results: Out of 11,508 ANW registered and pretest counseled, 11,390 (98.97%) accepted HIV testing. Sixty women were found to be seropositive, thus showed seroprevalence rate of 0.53% (60/11,390). CD4 testing was carried out in all ANW and five (8.33%) were eligible for antiretroviral therapy (ART). Seven (11.67%) had opted for medical termination of pregnancy (MTP). All 48 ANW delivered institutionally, only 7 (14.58%) received cesarean delivery. Out of 46 live births, 5 (10.87%) ANW were on ART, 35/41 (85.37%) received sdNVP mother baby-pair prophylaxis and only 8/46 (17.39%) mother opted for replacement feeding. Twenty one children have reached 18 months till date and among them three (14.29%) were HIV-seropositive. All three were delivered vaginally, received sdNVP prophylaxis and were exclusively breast fed for 6 months. Conclusion: The HIV-seroprevalence rate among antenatal women was 0.53% and mother-to-child transmission (MTCT) rate was 14.29%. Reduction in MTCT rate needs pre or early antenatal HIV testing, prenatal antiretroviral medication, preference for cesarean delivery, 100% antiretroviral prophylaxis coverage and education on avoidance of breast-feeding. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18300 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.163-169

Global Epidemiology of Tuberculosis: Past, Present and Future

Tuberculosis (TB), one of the most widespread infectious diseases, is the leading cause of death in the world and has been known in humans since ancient time. The epidemi trends of tuberculosis since the pre-chemotherapy era to the current both in developed countries and developing countries are presented in this review. A declining trend of magnitude of TB have been observed in most of the developed countries since the beginning of 20 th century with modification of life standard but after the introduction of chemotherapy, it changed in to upward trend because of HIV epidemic, socio emergence of multi-drug resistance TB (MDR observed in most of the developing countries including Ethiopia even after the introduction of chemotherapy, and those factors that have been led to i developed countries further also led to worsening of the problem in developing countries. The Global incidence of TB showed a decline between the years of 2000 expected to increase further in the coming years, more significantly in the countries of Africa and South-East Asia including Ethiopia because of change in demographic factors (population growth), increase in the global incidence of mycobacterium and changes in age structure of the population and increase in HIV sero prevalence rates, especially in developing countries of South Africa. This calls for more intensive and su infection and reducing transmission through increasing health service facility and decreased contributing factories, run all the research activities will up strategies adequate to overcome the challenges in TB control

Knowledge and Perceptions of HIV/AIDS among Cameroonian Nursing Students

The HIV/AIDS pandemic impacts people throughout the world and is complicated by fear, prejudice, and stigma. Nurses play a major role in the health care delivery systems, yet in many parts of the world with high HIV sero-prevalence rates, nurses lack sufficient training and education to provide care to patients with HIV/AIDS. In an effort to build capacity and improve knowledge, attitudes and beliefs regarding care of patients with HIV/AIDS, a 4-day workshop was provided by American nursing students for Cameroonian nursing students. The training program included HIV epidemiology, disease management, and natural course of the disease, testing, legal and ethical issues, and infection control practices. Pre- and post-test scores were calculated using a series of surveys that measured HIV-related knowledge, attitudes, and beliefs. Results indicated that these measures of HIV-related perceptions improved due to the train-the-trainer workshop.

Methamphetamine and other substance use trends among street-recruited men who have sex with men, from 2008 to 2011

BackgroundIt is particularly important to survey substance use trends in populations most impacted by the consequences of substance use. Men who have sex with men (MSM) exhibit rates of methamphetamine and other substance use that exceeds those observed among other populations in the United States. Such substance use has been associated with numerous negative health sequelae. MethodsAn outreach program performed street encounters with 5599 unique substance-using MSM from January 1, 2008 through December 31, 2011 to collect data on self-reported sociodemographics and recent substance use. Data were aggregated into six-month cohorts for comparisons of recent substance use patterns across time ResultsParticipants averaged 33 years of age (SD=8), most were Caucasian/white (47%) or Hispanic/Latino (32%), and the self-reported HIV seroprevalence rate was 13.4%. Across cohorts, reported use of alcohol (range=91–93%), marijuana (range=36–46%), and/or methamphetamine (range=23–27%) was common; prevalence of amyl nitrite (max=14%), ecstasy (max=12%), powder cocaine (max=8%) and/or crack cocaine (max=4%) use, although less common, were still elevated relative to the United States general population. ConclusionsMethamphetamine and other substance use remained common among substance-using MSM, demonstrating the need for continued substance use interventions geared toward this high-risk population.

Syphilis and HIV-1 among parturient women in Salvador, Brazil: low prevalence of syphilis and high rate of loss to follow-up in HIV-infected women

BackgroundThe occurrence of syphilis and HIV-1 infections during pregnancy are major risks to the fetus due to mother-to-child transmission (MTCT). ObjectivesTo determine peripartum seroprevalence and risk factors of syphilis and HIV-1 infection among pregnant women in Salvador, Brazil, and the rate of HIV-1 MTCT. MethodsCross-sectional study of pregnant women who were admitted for delivery in a reference maternity hospital between May 2008 and March 2009 was conducted. Women were screened for HIV-1 infection and syphilis, and interviewed regarding demographic, behavioral and obstetric data. Newborns to HIV-infected mothers were tested by b-DNA and DNA-PCR to detect HIV-1. ResultsA total 3300/8516 women were evaluated. Mean age was 25.8±7.3 years. HIV-1 and syphilis seroprevalence rates were 0.84% (28/3300) and 0.51% (17/3300), respectively. HIV-1 infection was associated with: low education (p=0.04), having a partner with known HIV infection (p<0.0001) or with previous sexually transmitted infection (p<0.0001), blood transfusion (p=0.003), or accidental exposure to blood (p=0.003). Syphilis was associated with being Caucasian (p=0.02), having no steady partner (p=0.02), being a housewife (p=0.01), having an intravenous drug user (IVDU) sexual partner (p=0.04) or a sexual partner with previous STI (p<0.001). Higher education (p=0.04) was protective against HIV-infection. Attending a prenatal care program was protective against syphilis (p=0.008) and HIV-1 (p=0.02). No case of HIV-1 MTCT was detected, but 25% of children born to HIV-infected mothers were lost to follow up. ConclusionsIn Salvador, peripartum prevalence of syphilis and HIV-1 infection among pregnant women were low, and associated with classic risk factors for both infections. The great proportion of very late diagnosis of HIV infection, and the high rate of loss of follow-up among positive mothers and their infants are of high concern.

The burden of HIV infection among women attending antenatal clinic in a semi-urban Nigerian town.

Stable heterosexual relationships are a major determinant of the HIV epidemic and seroprevalence rate of HIV amongst antenatal women is a reflection of what is happening in the larger society. This study aims to determine the HIV seroprevalence rate and to identify factors responsible for this rate among pregnant women. The study was a three-year (July 2008-June 2011) cross-sectional evaluation of cases of HIV in pregnancy. Data were collected with the aid of a closed structured self-administered questionnaire for all the positive women and randomly selected negative cases. The study was carried out at Niger Delta University Teaching Hospital in Bayelsa State, Nigeria. The seroprevalence rate during the study period was 4.9%. Parity, age at first coitus, educational status, marital status and occupation do not seem to increase the risk. However, partner being unemployed, hospital/clinic delivery, the route of last delivery, previous induced abortion and the number of lifetime partners were identified as risk for HIV seropositivity (all p-values < 0.005). Sex education on the dangers of sexual promiscuity, availability of barrier methods of contraception, delivery with strict adherence to the principles of universal precaution and routine screening of all pregnant women during the antenatal period will help to decrease the prevalence of HIV in our environment.

The relationship between age of coital debut and HIV seroprevalence among women in Durban, South Africa: a cohort study

ObjectivesTo investigate the impact of early sexual debut on HIV seroprevalence and incidence rates among a cohort of women.DesignProspective study.SettingKwaZulu-Natal, South Africa.ParticipantsA total of 3492 sexually active women who consented...

Barriers to Prevention of HIV Type 1 Mother-to-Child-Transmission in Bahia, Brazil

Editor: In Brazil, the AIDS epidemic has recently spread to small towns and the peripheral areas of large cities, involving mostly people younger than 21 or older than 50 years.1 In addition, the number of infected women (through the sexual route) is also increasing, mostly in the poorest areas of the country (the North and Northeast regions), but also in some well-developed areas, such as the South region.1 Brazil provides universal access to antiretroviral drugs, as well as to viral load, CD4+ cell count, and resistance tests. However, most of the patients are still being diagnosed late in the course of the disease, which increases hospitalization rates and morbidity/mortality.1 This is especially important for pregnant women, since a delay in diagnosis may increase the likelihood of mother-to-child transmission (MTCT).2 In Brazil, around 3 million deliveries occur every year. Since the estimated prevalence rate of HIV-1 infection in pregnant women is 0.42%, we should expect at least 12,000 new cases of HIV infection per year in this specific population. However, only 4980 cases were reported in 2008, 125 of them in Bahia, a Northeast state of Brazil.3 This suggests that only half of the cases are diagnosed and/or reported. The incidence rate of HIV infection for children younger than 5 years is 3.0 cases per 100,000 inhabitants, in Bahia (over 90% due to MTCT).1,3 As part of a study conducted to identify the prevalence and risk factors for acquiring HIV-1 infection, we interviewed 3300 parturient women who attended the main public maternity hospital of Bahia state from May 2008 to April 2009.4 The maternity hospital is used by about 40% of all parturient women in Salvador and the surrounding area, and is the referral hospital for complex cases, which includes parturient women with AIDS. As part of the routine care, all parturient women are tested for HIV-1 (two different rapid tests) when they are admitted to the maternity unit. Positive samples are retested by enzyme immunoassay. We found an HIV-1 seroprevalence rate of 0.84% (28/3300, 95% CI: 0.57–1.24). Of note, 8 out of 28 (28.6%) women were already diagnosed as HIV positive before pregnancy and were receiving regular care in a public HIV referral center. The remaining 20 (71.4%) were diagnosed during pregnancy: 10/28 (35.7%) during prenatal care, 9/28 (32.1%) by rapid testing during admission for labor and delivery, and 1/28 (3.5%) immediately after delivery. Ten (35.7%) cases of HIV infection were detected only on admission to the maternity hospital. Of concern, among those with a late diagnosis, only one (10%) received proper HIV-1 prophylaxis during labor. As a referral hospital for complex cases, antiretroviral drugs are readily available, and the staff was previously trained, as part of a national program for the prevention of HIV-1 MTCT. Moreover, after discharge from the hospital, 7/28 (25%) of the diagnosed women (and their newborns) were lost to follow-up. They never returned for scheduled medical visits, the home addresses and telephone numbers they provided when admitted to the hospital were not valid, and they could not be traced. As far as we could determine, they had not been reported to the Public Health authorities, and no effort to locate them was done by hospital/health authorities. All 21 newborns tested for HIV-1 by b-DNA, and proviral DNA, were negative at 4 and 12 weeks of age. Among the seven lost mother–newborn pairs, six mothers (86%) were diagnosed only upon hospital admission. These data reveal that regardless of the great effort made by Brazilian health authorities to control the AIDS epidemic, several problems are still occurring, and many opportunities are lost. Our report clearly identifies some serious failures in the process: most of the parturient women were diagnosed only at the hospital, and even among those already known to be HIV positive, antiretroviral drugs were prescribed in only 72% of the cases. Most importantly, barely 10% of late-diagnosed women received any type of prophylaxis for MTCT, and 86% of them were lost to follow-up, resulting in a likely increase in the chance of MTCT through breastfeeding, as well as the probability of transmission to their sexual partners. Better surveillance of HIV-1 infections in pregnancy and careful follow-up of positive mothers and their infants are mandatory.