Sexual Transmission Of HIV Research Articles

A Phylogenetic Assessment of HIV-1 Transmission Trends among People Who Inject Drugs from Coastal and Nairobi, Kenya

ABSTRACT Background Although recent modeling suggests needle-syringe programs have reduced parenteral HIV transmission among people who inject drugs (PWID) in Kenya, the prevalence in this population remains high (~14-20%, compared to ~4% in the larger population). Reducing transmission or acquisition requires understanding historic and modern transmission trends, but the relationship between the PWID HIV-1 sub-epidemic and the general epidemic in Kenya is not well understood. Methods We incorporated 303 new (2018-2021) HIV-1 pol sequences from PWID and their sexual and injecting partners with 2,666 previously published Kenyan HIV-1 sequences to quantify relative rates and direction of HIV-1 transmissions involving PWID from the coast and Nairobi regions of Kenya. We used genetic similarity cluster analysis (thresholds: patristic distance <0.045 & <0.015) and maximum likelihood and Bayesian ancestral state reconstruction to estimate transmission histories at the population group (female sex workers, men who have sex with men, PWID, or general population) and regional (coast or Nairobi) levels. Results Of 1,081 participants living with HIV-1, 274 (25%) were not virally suppressed and 303 (28%) had sequences available. Of new sequences from PWID, 58% were in phylogenetic clusters at distance threshold <0.045. Only 21% of clusters containing sequences from PWID included a second PWID sequence. Sequences from PWID were similarly likely to cluster with sequences from female sex workers, men who have sex with men, and the general population. Ancestral state reconstruction suggested transmission to PWID from other populations was more common than from PWID to other populations. Conclusion This study expands our understanding of the HIV-1 sub-epidemic among PWID in Kenya by incorporating 4-times more HIV-1 sequences from this population than prior studies. Despite recruiting many PWID from local sexual and injecting networks, we found low levels of linked transmission in this population. This may suggest lower relative levels of parenteral transmission in recent years and supports maintaining needle-syringe programs among PWID while also strengthening interventions to reduce HIV-1 sexual acquisition and transmission for this population.

Association between different levels of suppressed viral load and the risk of sexual transmission of HIV among serodiscordant couples on antiretroviral therapy: a protocol for a two-step systematic review and individual participant data meta-analysis

IntroductionHIV is a major global public health issue. The risk of sexual transmission of HIV in serodiscordant couples when the partner living with HIV maintains a suppressed viral load of...

Preconception care use and associated factors among HIV positive reproductive age women attending ART clinics at public hospitals in the Hadiya zone, southern Ethiopia: a mixed method approach

BackgroundGlobally, the HIV pandemic makes preconception care even more crucial due to the additional risks for sexual and vertical transmission of HIV. However, there is limited evidence on the utilization of preconception care among high-risk women in Ethiopia. The purpose of this research is to assess preconception care utilization and associated factors among HIV-positive women of reproductive age who attend ART clinics in public hospitals in the Hadiya zone of Southern Ethiopia in 2023.MethodsA cross-sectional study design employing a mixed methods approach was used among 297 study participants from July 1-Semptember 1, 2022. Data were collected by pretested structured questionnaires. The data were analyzed by SPSS statistical software version 25. Logistic regression, Adjusted Odds Ratio (AOR) with a 95% confidence interval was computed, and variables with a p-value < 0.05 were considered statistically significant. Qualitative data were analyzed using open code version 4.03.ResultsThis study revealed that 19.9% (95%Cl: 15.4, 24.2) of study participants use preconception care. Women’s autonomy (AOR = 3.65; 95% CI: 1.14, 11.68;P = 0.03), knowledge of PCC (AOR = 3.05; 95% CI: 1.13, 8.22; P = 0.001), getting family/husband support (AOR = 4.06; 95% CI: 1.56, 10.53;P = 0.022), discussions with healthcare providers (AOR = 5.60; 95% CI: 2.26, 13.90;P = 0.002), availability of room for PCC (AOR = 3.77; 95% CI: 1.38, 10.31;P = 0.009), getting all laboratory services (AOR = 4.19; 95% CI: 1.61, 10.94; P = 0.002), and history of medical problems (AOR = 2.94; 95% CI: 11.01, 8.62;P = 0.036) were significantly associated with PCC use.ConclusionThe level of PCC use in the current study area is low. Women’s autonomy, knowledge of PCC, obtaining support from family or husband, engaging in discussions with healthcare providers, having access to a PCC room, access to all laboratory services, and having a history of medical problems are significantly associated with PCC use. Our findings suggest integrating PCC into routine HIV care, boosting women’s autonomy, and integrating family support with healthcare providers.

Optimizing Individual HIV Testing and Counseling for Emerging Adult Sexual Minority Men (Aged 18 to 24) in Relationships: A Pilot Randomized Controlled Trial of Adjunct Communication Components.

The majority of new HIV infections in the US occur among sexual minority men (SMM) with older adolescent and emerging adult SMM at the highest risk. Those in relationships face unique HIV prevention challenges. Existing sexual HIV transmission risk interventions for male couples often encounter implementation challenges and engaging younger SMM early in relationships may be particularly difficult. This pilot randomized controlled trial evaluated the acceptibility and feasibility of We Test HIV testing - a behavioral health intervention tailored for younger SMM in realtionships - and generated preliminary estimates of effect size. The intervention comprises two adjunct moduls - video-based communication skills training as well as communication goal setting and planning - delivered in conjunction with routine HIV testing and counseling in individual or dyadic formats. A sample of 69 SMM aged 17 to 24 were recruited online. Following baseline assessment, youth were randomized to receive either the experimental, We Test, intervention or routine HIV testing (the control condition). Follow-up assessments were completed 3 and 6 months post-baseline. Results suggested the study was feasible and the individually delivered format was acceptible. We Test HIV testing was associated with significant improvements in communication skills. In addition, youth who remained in a relationship experienced an increase in communal coping to reduce HIV infection risk and relationship power. While groups did not differ with respect to condomless anal sex with casual partners, these psycho-social constructs (communication, communal coping with HIV prevention, and relationship power) may serve as mediators of intervention effects on sexual risk reduction in a larger study.

A study of sexually transmitted infections among men who have sex with men (MSM) in a coastal city Mangaluru, Karnataka

BackgroundSTI (Sexually Transmitted Infections) is common among ‘high-risk groups’ in India, a term used by the National AIDS Control Organization (NACO) which includes men who have sex with men (MSM) and others. Sexual transmission of HIV, most prominent STI between men could be a major cause for concern in most parts of India. HIV infection among MSM has been increasing in recent years round the world, particularly in Asia. Objectives1. To determine the sociodemographic characteristics of men who have sex with men. 2. To estimate the magnitude of sexually transmitted infections (STI) in men who have sex with men. MethodsA cross sectional study was carried out using structured, pretested questionnaire at Hind Kusht Nivaran Sangh, Mangaluru. Face to face interviews of the selected participants was done and data were recorded after obtaining their consent. ResultsA total of 102 MSM were interviewed and the data was collected. The common presenting symptoms were pain while urinating (33.33 %) and least common was bleeding while defecating (1.9 %). The most common morbidity of study population was urinary tract infection (38.23 %) and proctitis (25.4 %) and 3.92 % subjects had HIV/AIDS. ConclusionHealth sector should include safe access to information and education about HIV and other STIs, condoms, water-based lubricants, HIV testing and counselling, and STI services.

Messaging About HIV Transmission Risk When Viral Load Is Undetectable: Reactions and Perceived Accuracy Among US Sexual Minority Men.

Scientific evidence indicates that HIV viral suppression to an undetectable level eliminates sexual transmission risk ("Undetectable=Untransmittable" or "U=U"). However, U=U messaging has been met with skepticism among sexual minority men (SMM) and others. In this survey-based experiment, we manipulated messaging about HIV risk and examined reactions and perceived message accuracy among US SMM. SMM living with HIV (n = 106) and HIV-negative/status-unknown SMM (n = 351) participated in an online survey (2019-2020). Participants were randomly assigned to 1 of 3 messaging conditions, which varied by level of HIV sexual transmission risk associated with an undetectable viral load (No Risk [U=U]/Low Risk/Control). Participants reported reactions, message accuracy, and reasons for perceiving inaccuracy. We coded open-response data (reactions and reasons) into conceptual categories (eg, "Enthusiasm"). We compared reactions, accuracy ratings, and reasons by condition and serostatus. In the No Risk Condition, common reactions were Enthusiasm (40.0%), Skepticism/Disagreement (20.0%), and Agreement (19.4%), reactions common to comparison conditions. A higher percentage of HIV-negative/status-unknown participants (24.1%) expressed Skepticism/Disagreement in the No Risk Condition compared with other conditions (3.2%-9.7%). Participants living with HIV were more likely than HIV-negative/status-unknown participants to perceive the message as accurate in all conditions. In the No Risk Condition, common reasons for perceiving inaccuracy were Risk Misstated (46.1%), Oversimplified/Caveats Needed (17.1%), and Personal Unfamiliarity/Uncertainty (14.5%), reasons common to comparison conditions. Across conditions, 10.3% of participants attributed message inaccuracy to undetectable being misdefined. Most SMM reacted favorably to U=U messaging. However, many-especially HIV-negative/status-unknown SMM-expressed skepticism. Interventions are needed to enhance U=U understanding and acceptance.

HIV and Undetectable = Untransmittable (U=U)

Abstract Advances in development of antiretroviral therapy and increased utilization of pre-exposure prophylaxis agents have effectively decreased the incidence of HIV sexual transmission. Conversely, at the same moment, there is an epidemic of other sexually transmitted infections in similar high-risk populations that is increasing at an alarming rate. This review aims to provide a summary of the origins and benefits of the Undetectable = Untransmittable (U=U) HIV campaign and the positive impact it has had on HIV prevention, while addressing the concomitant need for implementation of effective strategies to prevent further rise in sexually transmitted infections.

Microbicides for Topical HIV Immunoprophylaxis: Current Status and Future Prospects.

Microbicides, which are classified as topical antiseptic agents, are a revolutionary advancement in HIV prevention aimed to prevent the entry of infectious agents into the human body, thus stopping the sexual transmission of HIV and other sexually transmitted diseases. Microbicides represent the promise of a new age in preventive measures against one of the world's most pressing health challenges. In addition to their direct antiviral effects during HIV transmission, microbicides also influence vaginal mucosal immunity. This article reviews microbicides by presenting different drug classifications and highlighting significant representatives from each group. It also explains their mechanisms of action and presents information about vaginal mucosal immune responses, emphasizing the critical role they play in responding to HIV during sexual transmission. The article discusses the following groups of microbicides: surfactants or membrane disruptors, vaginal milieu protectors, anionic polymers, dendrimers, carbohydrate-binding proteins, HIV replication inhibitors (reverse transcriptase inhibitors), and multi-purpose prevention technologies, which combine protection against HIV, other sexually transmitted diseases, and contraception. For each chemical compound, the article provides a brief overview of relevant preclinical and clinical research, emphasizing their potential as microbicides. The article offers insights into the multifaceted impact of microbicides, which signify a pivotal step forward in the pursuit of effective and accessible pre-exposure prophylaxis (PrEP).

Prevotella timonensis bacteria associated with vaginal dysbiosis enhance HIV-1 susceptibility of vaginal CD4+ T cells.

Dysbiosis of the vaginal microbiome poses a serious risk for sexual HIV-1 transmission. Prevotella spp. are abundant during vaginal dysbiosis and associated with enhanced HIV-1 susceptibility; however, underlying mechanisms remain unclear. Here, we investigated the direct effect of vaginal bacteria on HIV-1 susceptibility of vaginal CD4+ T cells. Notably, pre-exposure to Prevotella timonensis enhanced HIV-1 uptake by vaginal T cells, leading to increased viral fusion and enhanced virus production. Pre-exposure to antiretroviral inhibitors abolished Prevotella timonensis-enhanced infection. Hence, our study shows that the vaginal microbiome directly affects mucosal CD4+ T cell susceptibility, emphasising importance of vaginal dysbiosis diagnosis and treatment.

Simulation of Full HIV Cluster Networks in a Nationally Representative Model Indicates Intervention Opportunities.

Clusters of rapid HIV transmission in the United States are increasingly recognized through analysis of HIV molecular sequence data reported to the National HIV Surveillance System. Understanding the full extent of cluster networks is important to assess intervention opportunities. However, full cluster networks include undiagnosed and other infections that cannot be systematically observed in real life. We replicated HIV molecular cluster networks during 2015-2017 in the United States using a stochastic dynamic network simulation model of sexual transmission of HIV. Clusters were defined at the 0.5% genetic distance threshold. Ongoing priority clusters had growth of ≥3 diagnoses/year in multiple years; new priority clusters first had ≥3 diagnoses/year in 2017. We assessed the full extent, composition, and transmission rates of new and ongoing priority clusters. Full clusters were 3-9 times larger than detected clusters, with median detected cluster sizes in new and ongoing priority clusters of 4 (range 3-9) and 11 (range 3-33), respectively, corresponding to full cluster sizes with a median of 14 (3-74) and 94 (7-318), respectively. A median of 36.3% (range 11.1%-72.6%) of infections in the full new priority clusters were undiagnosed. HIV transmission rates in these clusters were >4 times the overall rate observed in the entire simulation. Priority clusters reflect networks with rapid HIV transmission. The substantially larger full extent of these clusters, high proportion of undiagnosed infections, and high transmission rates indicate opportunities for public health intervention and impact.

Population-level effectiveness of pre-exposure prophylaxis for HIV prevention among men who have sex with men in Montréal (Canada): a modelling study of surveillance and survey data.

HIV pre-exposure prophylaxis (PrEP) has been recommended and partly subsidized in Québec, Canada, since 2013. We evaluated the population-level impact of PrEP on HIV transmission among men who have sex with men (MSM) in Montréal, Québec's largest city, over 2013-2021. We used an agent-based mathematical model of sexual HIV transmission to estimate the fraction of HIV acquisitions averted by PrEP compared to a counterfactual scenario without PrEP. The model was calibrated to local MSM survey, surveillance, and cohort data and accounted for COVID-19 pandemic impacts on sexual activity, HIV prevention, and care. PrEP was modelled from 2013 onwards, assuming 86% individual-level effectiveness. The PrEP eligibility criteria were: any anal sex unprotected by condoms (past 6 months) and either multiple partnerships (past 6 months) or multiple uses of post-exposure prophylaxis (lifetime). To assess potential optimization strategies, we modelled hypothetical scenarios prioritizing PrEP to MSM with high sexual activity (≥11 anal sex partners annually) or aged ⩽45 years, increasing coverage to levels achieved in Vancouver, Canada (where PrEP is free-of-charge), and improving retention. Over 2013-2021, the estimated annual HIV incidence decreased from 0.4 (90% credible interval [CrI]: 0.3-0.6) to 0.2 (90% CrI: 0.1-0.2) per 100 person-years. PrEP coverage among HIV-negative MSM remained low until 2015 (<1%). Afterwards, coverage increased to a maximum of 10% of all HIV-negative MSM, or about 16% of the 62% PrEP-eligible HIV-negative MSM in 2020. Over 2015-2021, PrEP averted an estimated 20% (90% CrI: 11%-30%) of cumulative HIV acquisitions. The hypothetical scenarios modelled showed that, at the same coverage level, prioritizing PrEP to high sexual activity MSM could have averted 30% (90% CrI: 19%-42%) of HIV acquisitions from 2015-2021. Even larger impacts could have resulted from higher coverage. Under the provincial eligibility criteria, reaching 10% coverage among HIV-negative MSM in 2015 and 30% in 2019, like attained in Vancouver, could have averted up to 63% (90% CrI: 54%-70%) of HIV acquisitions from 2015 to 2021. PrEP reduced population-level HIV transmission among Montréal MSM. However, our study suggests missed prevention opportunities and adds support for public policies that reduce PrEP barriers, financial or otherwise, to MSM at risk of HIV acquisition.

The risk of sexual transmission of HIV in individuals with low-level HIV viraemia: a systematic review

The risk of sexual transmission of HIV from individuals with low-level HIV viraemia receiving antiretroviral therapy (ART) has important public health implications, especially in resource-limited settings that use alternatives to plasma-based viral load testing. This Article summarises the evidence related to sexual transmission of HIV at varying HIV viral load levels to inform messaging for people living with HIV, their partners, their health-care providers, and the wider public. We conducted a systematic review and searched PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, Embase, Conference Proceedings Citation Index-Science, and WHO Global Index Medicus, for work published from Jan 1, 2010 to Nov 17, 2022. Studies were included if they pertained to sexual transmission between serodiscordant couples at various levels of viraemia, the science behind undetectable=untransmittable, or the public health impact of low-level viraemia. Studies were excluded if they did not specify viral load thresholds or a definition for low-level viraemia or did not provide quantitative viral load information for transmission outcomes. Reviews, non-research letters, commentaries, and editorials were excluded. Risk of bias was evaluated using the ROBINS-I framework. Data were extracted and summarised with a focus on HIV sexual transmission at varying HIV viral loads. 244 studies were identified and eight were included in the analysis, comprising 7762 serodiscordant couples across 25 countries. The certainty of evidence was moderate; the risk of bias was low. Three studies showed no HIV transmission when the partner living with HIV had a viral load less than 200 copies per mL. Across the remaining four prospective studies, there were 323 transmission events; none were in patients considered stably suppressed on ART. Among all studies there were two cases of transmission when the index patient's (ie, patient with previously diagnosed HIV infection) most recent viral load was less than 1000 copies per mL. However, interpretation of both cases was complicated by long intervals (ie, 50 days and 53 days) between the transmission date and the most recent index viral load result. There is almost zero risk of sexual transmission of HIV with viral loads of less than 1000 copies per mL. These data provide a powerful opportunity to destigmatise HIV and promote adherence to ART through dissemination of this positive public health message. These findings can also promote access to viral load testing in resource-limited settings for all people living with HIV by facilitating uptake of alternative sample types and technologies. Bill & Melinda Gates Foundation.

Spermine and spermidine bind CXCR4 and inhibit CXCR4- but not CCR5-tropic HIV-1 infection

Semen is an important vector for sexual HIV-1 transmission. Although CXCR4-tropic (X4) HIV-1 may be present in semen, almost exclusively CCR5-tropic (R5) HIV-1 causes systemic infection after sexual intercourse. To identify factors that may limit sexual X4-HIV-1 transmission, we generated a seminal fluid–derived compound library and screened it for antiviral agents. We identified four adjacent fractions that blocked X4-HIV-1 but not R5-HIV-1 and found that they all contained spermine and spermidine, abundant polyamines in semen. We showed that spermine, which is present in semen at concentrations up to 14 mM, binds CXCR4 and selectively inhibits cell-free and cell-associated X4-HIV-1 infection of cell lines and primary target cells at micromolar concentrations. Our findings suggest that seminal spermine restricts sexual X4-HIV-1 transmission.

HIV Focused Sexual Risk-Reduction Interventions Targeting Adolescent Boys and Young Men in Sub-Saharan Africa: A Scoping Review

Adolescent girls and young women’s exceptionalism with HIV interventions has left adolescent boys and young men (ABYM) trailing behind, thus becoming a marginalized and underserved population. The scoping review aimed to provide an overview of interventions that have targeted sexual risk behaviors in ABYM in Sub-Saharan Africa (SSA) over the previous 21 years with critical insights on ‘what works’ in preventing the sexual transmission of HIV. A scoping review guided by Arksey and O’Malley’s (in Int J Soc Res Methodol 8(1):19–32, 16) framework and the 2015 Johanna Briggs Institute’s guidelines was conducted. A search of literature published between 2000 and 2020 was reviewed and twenty nine interventions from nine Sub Saharan African countries that met the eligibility criteria were reviewed. The review provides evidence on the successes and the limitations of sexual risk behavior interventions for ABYM in SSA. There is clear and consistent evidence that interventions reduce sexual risk behaviors in adolescent boys and young men. Their efficiency seems to grow with the length and intensity of the intervention. Positive effects were generally observed in condom use and on measures of HIV knowledge, attitudes and sexual behaviors as well as uptake of HIV tests and voluntary male circumcision. This review shows that sexual-risk interventions engaging men and boys in SSA are promising and warrant further rigorous development in terms of conceptualization, design and evaluation.

Substance Use, Sexual Agreements, and Sexual Risk Behaviors Among Adolescent Sexual Minority Males (Aged 13–17) in the United States

PurposeDespite the fact that adolescence represents a distinct developmental period wherein dating and sexual relationships are emergent, much of what is known about substance use, sexual agreements, and sexual risk behaviors among adolescent sexual minority males (ASMM) is extrapolated from research on adults. This study tested associations between substance use and sexual risk behaviors among ASMM and examined whether relationship status and sexual agreements moderated these associations. MethodsCross-sectional online survey data were collected from 2,892 HIV negative ASMM aged 13–17 years between November 2017 and March 2020. All were sexually active with male partners and not on pre-exposure prophylaxis. A multigroup hurdle model predicted the occurrence and frequency of condomless anal sex (CAS) with casual partners. ResultsNon-monogamous ASMM were more likely to use illicit drugs and more likely to have CAS with casual partners compared with single ASMM and those in monogamous relationships. Among ASMM who had CAS at least once, those in relationships (both monogamous and nonmonogamous) had CAS more frequently than single ASMM. Binge drinking (odds ratio (OR) = 1.47, p < .001), cannabis (OR = 1.30, p < .001), and illicit drug use (including prescription drug misuse) (OR = 1.77, p < .001) were associated with the occurrence of CAS with casual partners but only binge drinking (rate ratio (RR) = 1.23, p = .027) and illicit drugs (RR = 1.75, p < .001) were associated with its frequency. DiscussionWhile results aligned with adult studies in many respects, unlike adult sexual minority males, these findings suggest partnered ASMM–particularly those in nonmonogamous relationships–were at highest risk of substance use and associated sexual HIV transmission risk.

Plasma metabolomics by nuclear magnetic resonance reveals biomarkers and metabolic pathways associated with the control of HIV-1 infection/progression.

How the human body reacts to the exposure of HIV-1 is an important research goal. Frequently, HIV exposure leads to infection, but some individuals show natural resistance to this infection; they are known as HIV-1-exposed but seronegative (HESN). Others, although infected but without antiretroviral therapy, control HIV-1 replication and progression to AIDS; they are named controllers, maintaining low viral levels and an adequate count of CD4+ T lymphocytes. Biological mechanisms explaining these phenomena are not precise. In this context, metabolomics emerges as a method to find metabolites in response to pathophysiological stimuli, which can help to establish mechanisms of natural resistance to HIV-1 infection and its progression. We conducted a cross-sectional study including 30 HESN, 14 HIV-1 progressors, 14 controllers and 30 healthy controls. Plasma samples (directly and deproteinized) were analyzed through Nuclear Magnetic Resonance (NMR) metabolomics to find biomarkers and altered metabolic pathways. The metabolic profile analysis of progressors, controllers and HESN demonstrated significant differences with healthy controls when a discriminant analysis (PLS-DA) was applied. In the discriminant models, 13 metabolites associated with HESN, 14 with progressors and 12 with controllers were identified, which presented statistically significant mean differences with healthy controls. In progressors, the metabolites were related to high energy expenditure (creatinine), mood disorders (tyrosine) and immune activation (lipoproteins), phenomena typical of the natural course of the infection. In controllers, they were related to an inflammation-modulating profile (glutamate and pyruvate) and a better adaptive immune system response (acetate) associated with resistance to progression. In the HESN group, with anti-inflammatory (lactate and phosphocholine) and virucidal (lactate) effects which constitute a protective profile in the sexual transmission of HIV. Concerning the significant metabolites of each group, we identified 24 genes involved in HIV-1 replication or virus proteins that were all altered in progressors but only partially in controllers and HESN. In summary, our results indicate that exposure to HIV-1 in HESN, as well as infection in progressors and controllers, affects the metabolism of individuals and that this affectation can be determined using NMR metabolomics.

RESULTS OF LONG-TERM FOLLOW-UP OF PATIENTS WITH HIV/TUBERCULOSIS COINFECTION

The problem of combined HIV/tuberculosis infection is characterized by a broad social orientation, a serious risk factor for the development of the disease and a factor of death is the use of narcotic substances. The number of patients with HIV/tuberculosis co-infection in the Russian Federation remains high, the majority of cases of tuberculosis in patients with HIV infection are detected in the late stages of the disease, mainly when patients turn to the general treatment network. In recent years, the situation has been complicated by an increase in the proportion of cases of sexual transmission of HIV, the number of infected among young women is growing. The problem of drug resistance of Mycobacterium tuberculosis creates many difficulties in terms of diagnosis and treatment. The course of the tuberculosis process in HIV patients, due to pronounced immunosuppression, is often atypical, TB diagnosis is especially difficult at the stage of severe immunodeficiency, the tuberculosis process often proceeds in a generalized form. Treatment of comorbid patients is also a big problem due to the simultaneous administration of a large number of anti-tuberculosis drugs in addition to their lifelong HIV treatment, which leads to a decrease in adherence to treatment. The article presents data from an 11-year follow-up of a cohort of patients with HIV infection and tuberculosis. The clinical and anamnestic data, the experience of HIV infection, the timing and causes of deaths were evaluated. The patients were mainly young men (70%) with a high level of intravenous drug use (77.5%), high hepatitis C virus infection (55%), severe immunosuppression (60.1%), a significant proportion of MDR (43.8%), lack of adherence to antiretroviral therapy (58.8%). 51.25% of patients died during the follow-up period. Due to the high risks of death and other failures of tuberculosis treatment in patients with HIV/TB comorbidity, studies of the results of management of such patients in the long term remain a priority for all regions of the country. The problem of detecting tuberculosis in patients with HIV-infection remains urgent, which requires the interaction of both the phthisiological service and infectious disease specialists, narcologists and primary health care.

Risk of Sexual Transmission of HIV with Antiretroviral Therapy and Variable or Suppressed Viral Load

&#x0D; The absolute risk of HIV transmission through sexual activity, reported as incidence rates of observed seroconversions across person-years of follow-up, ranged widely across the included studies of sex partners living with HIV with variable (or unreported) viral loads.&#x0D; Two studies included sex partners living with HIV with suppressed viral loads of fewer than 200 copies/mL, reporting no phylogenetically linked seroconversions in either study.&#x0D; Most studies in this report included data from heterosexual serodiscordant sex partners and did not report follow-up viral loads of sex partners living with HIV.&#x0D; The included studies incorporated variable methods, investigated a broad variety of populations and exposures, and demonstrated a wide range of methodological strengths and limitations.&#x0D;

Using Hierarchical Regression to Examine the Predictors of Sexual Risk-Taking Attitudes among Adolescents Living with Human Immunodeficiency Virus in Uganda

PurposeWe explored the factors influencing sexual risk-taking attitudes—defined as beliefs and values regarding sexual activity—among adolescents living with human immunodeficiency virus (ALHIV) in Uganda. MethodsThe study used baseline data from a five-year cluster-randomized control trial (2012–2018) among 702 ALHIV in Uganda. Participants were aged 10–16 years, HIV-positive, taking antiretroviral therapy, and living within a family. We fitted hierarchical regression models to assess the demographic, economic, psychological, and social predictors of sexual risk-taking attitudes. Using R2, the final model explained 11.4% of the total variance. ResultsUnder economic factors, caregiver being formally employed (β = −0.08, 95% confidence interval [CI]: −0.10–0.06, p < .001), and the ALHIV working for pay (β = 1.78, 95% CI: 0.28–3.29, p = .022), were associated with sexual risk-taking attitudes. Among the psychological factors, more depressive symptoms (β = 0.22, 95% CI: 0.11–0.32, p < .001) were associated with more approving attitudes toward sexual risk-taking. Family and social factors including communicating with the caregiver about HIV (β = 1.32, 95% CI: 0.56–2.08, p = .001), sex (β = 1.09, 95% CI: 0.20–1.97, p = .017), and experiencing peer pressure (β = 3.37, 95% CI: 1.85–4.89, p < .001) were also associated with more approving attitudes toward sexual risk-taking. The final model explained 11.54% of the total variance. DiscussionEconomic, psychological, and social factors influence sexual risk-taking attitudes among ALHIV. There is a need for more research to understand why discussing sex with caregivers improves adolescents' positive attitudes toward sexual risk-taking. These findings have significant ramifications in preventing sexual transmission of HIV among adolescents in low-income settings.

Barriers to Voluntary Medical Male Circumcision Uptake to Prevent HIV Transmission: A Qualitative Study among Married Men

Background: Voluntary medical male circumcision (VMMC) is a relatively new intervention that has been found to reduce sexual transmission of HIV among heterosexual partners by 60% when properly practiced. However, the poor acceptance of VMMC makes it difficult to accomplish the objectives of health policy to boost uptake. The purpose of this study was to explore the barriers to VMMC Uptake among married men in Kitgum municipality. Methods: The qualitative descriptive design was employed in this study. The purposive sampling method was used to recruit 30 married men who lived within any of the three divisions of the municipality and had been married for at least one year. Data collection was done using an in-depth interview method. Inductive content analysis was used to generate the themes and categories. Results: The study findings revealed that fear, financial uncertainty, involvement of female health workers, cultural beliefs, religious belief, sexual dissatisfaction and advanced age were barriers to voluntary medical male circumcision uptake among the married men in Kitgum municipality. Conclusion: In Kitgum municipality, VMMC Uptake is still low, but the majority of the males had sufficient knowledge about it. We found the low uptake was primarily attributed to anxiety, involvement of female health workers, financial instability, sexual unhappiness, and advanced age. There is a need for proper re-packaging of the health education messages during mobilisations to address the anticipated side effects and to clearly state the reasons for the VMMC program. There is a need for proper re-packaging of the health education messages during mobilisations to address the communication gaps and to clearly state the reasons for VMMC program. Adequate psychological preparation of the men to expect any sex of staffs working in these clinics.