Human Immunodeficiency Virus Prevention Programs Research Articles

Intra- and inter-subtype HIV diversity between 1994 and 2018 in southern Uganda: a longitudinal population-based study.

There is limited data on human immunodeficiency virus (HIV) evolutionary trends in African populations. We evaluated changes in HIV viral diversity and genetic divergence in southern Uganda over a 24-year period spanning the introduction and scale-up of HIV prevention and treatment programs using HIV sequence and survey data from the Rakai Community Cohort Study, an open longitudinal population-based HIV surveillance cohort. Gag (p24) and env (gp41) HIV data were generated from people living with HIV (PLHIV) in 31 inland semi-urban trading and agrarian communities (1994-2018) and four hyperendemic Lake Victoria fishing communities (2011-2018) under continuous surveillance. HIV subtype was assigned using the Recombination Identification Program with phylogenetic confirmation. Inter-subtype diversity was evaluated using the Shannon diversity index, and intra-subtype diversity with the nucleotide diversity and pairwise TN93 genetic distance. Genetic divergence was measured using root-to-tip distance and pairwise TN93 genetic distance analyses. Demographic history of HIV was inferred using a coalescent-based Bayesian Skygrid model. Evolutionary dynamics were assessed among demographic and behavioral population subgroups, including by migration status. 9931 HIV sequences were available from 4999 PLHIV, including 3060 and 1939 persons residing in inland and fishing communities, respectively. In inland communities, subtype A1 viruses proportionately increased from 14.3% in 1995 to 25.9% in 2017 (P < .001), while those of subtype D declined from 73.2% in 1995 to 28.2% in 2017 (P < .001). The proportion of viruses classified as recombinants significantly increased by nearly four-fold from 12.2% in 1995 to 44.8% in 2017. Inter-subtype HIV diversity has generally increased. While intra-subtype p24 genetic diversity and divergence leveled off after 2014, intra-subtype gp41 diversity, effective population size, and divergence increased through 2017. Intra- and inter-subtype viral diversity increased across all demographic and behavioral population subgroups, including among individuals with no recent migration history or extra-community sexual partners. This study provides insights into population-level HIV evolutionary dynamics following the scale-up of HIV prevention and treatment programs. Continued molecular surveillance may provide a better understanding of the dynamics driving population HIV evolution and yield important insights for epidemic control and vaccine development.

A 13-Year Trend Analysis of HIV Epidemiology in the Philippines (2010 to 2022)

ABSTRACT Purpose This article describes the trends and contributing factors in the human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) epidemiology in the Philippines from 2010 to 2022. This is the first trend analysis of the Philippine HIV/AIDS situation. Design Using time trend research design, 13-year longitudinal epidemiological data were collected and analyzed to present a dynamic perspective of the Philippine HIV/AIDS epidemic. Methods Secondary data analysis of HIV surveillance public documents from 2010 to 2022 was conducted. The Centers for Disease Control’s socioecological model was used to guide the literature and interpretation of findings. Frequency, percentage distribution, and Sieve-bootstrap t-test for linear trends were used to analyze the results. Findings There is an increased trend in HIV incidence, late diagnosis, and AIDS-related mortality in all geographical regions in the country from 2010–2022. The majority of HIV cases are males, ages 25–34, and reside in the nation’s capital. Increased HIV incidence among overseas workers, sex workers, and HIV-positive blood products were noted. Conclusion Trends in Philippine HIV epidemiology are contrary to global trends. Community-based HIV prevention programs targeting specific high-risk populations are needed. Clinical Evidence Community health nurses in the Philippines play a critical role in reversing the rising trend of HIV/AIDS. They are positioned to lead targeted education and prevention programs for high-risk groups using the socioecological model to implement community-based strategies that address factors contributing to the epidemic. Their efforts in early detection and linkage to care are essential in reducing late diagnosis and AIDS-related mortality.

Behavioral Modeling and its Association with PrEP and ART Use in Ugandan HIV-Serodifferent Couples

Integrating Pre-Exposure Prophylaxis (PrEP) delivery into Antiretroviral Therapy (ART) programs bridges the Human Immunodeficiency Virus (HIV) prevention gap for HIV-serodifferent couples prior to the partner living with HIV achieving viral suppression. Behavioral modeling is one mechanism that could explain health-related behavior among couples, including those using antiretroviral medications, but few tools exist to measure the extent to which behavior is modeled. Using a longitudinal observational design nested within a cluster randomized trial, this study examined the factor structure and assessed the internal consistency of a novel 24-item, four-point Likert-type scale to measure behavioral modeling and the association of behavioral modeling with medication-taking behaviors among heterosexual, cis-gender HIV-serodifferent couples. In 149 couples enrolled for research, a five-factor model provided the best statistical and conceptual fit, including attention to partner behavior, collective action, role modeling, motivation, and relationship quality. Behavioral modeling was associated with medication-taking behaviors among members of serodifferent couples. Partner modeling of ART/PrEP taking could be an important target for assessment and intervention in HIV prevention programs for HIV serodifferent couples.

HIV Voluntary Counselling and Testing Utilisation among School of Healthcare Sciences Undergraduate Students at the University of Limpopo.

Existing evidence indicates that South African university students have low utilisation of Human Immunodeficiency Virus (HIV) Voluntary Counselling and Testing (VCT). A cross-sectional survey was conducted to determine the utilisation of HIV VCT among undergraduate students in the School of Healthcare Sciences. Structured questionnaires were used to collect data through Google Forms. The results are presented through descriptions and percentages and illustrated in tables. Out of 389 undergraduate students, only 324 completed the questionnaire. The majority (97.2%) were aware of the health centre on campus, while only (74.7%) knew about the HIV VCT services offered on campus. Despite the awareness, many (36.7%) do not utilise the campus HIV VCT services, and some (9.6%) have never tested for HIV. There was an association between awareness of Voluntary Counselling and Testing of HIV services offered at the campus health and wellness centre and utilisation of HIV Voluntary Counselling and Testing at (<0.001). Therefore, it is imperative to urgently escalate the level of HIV/AIDS education in higher institutions of learning and emphasise the mounting danger of HIV infection and the immense importance of regular HIV testing. The findings of this study could serve as a foundation for creating HIV prevention and control programmes for youth, particularly in higher education institutions.

A Mixed Method Assessment of the Fertility Preferences of Clients Using Antiretroviral Therapy in Ilorin, Nigeria - A Descriptive Cross-sectional Survey.

The burden of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome in Nigeria remains one of the highest in the world, with the country having the highest number of people living with the infection in the West African subregion. Recent estimates put the HIV prevalence rate in Nigeria at 1.9%. In the early years of the HIV epidemic, attention on the reproductive preferences of people living with HIV was not really considered because of the high risk of mortality and few options to reduce mother-to-child transmission. A descriptive cross-sectional study was carried out in November 2018 using quantitative and qualitative methods. A total of 400 participants were recruited for the quantitative part of the study and 10 respondents for each of the focus group discussion (FGD) sessions. Data were collected using an interviewer-administered questionnaire and a FGD guide. Frequencies and percentages were determined using descriptive analysis. Univariate analysis was used to explore the association between the outcome variables and the independent variables. The independent variables which showed a significant association in the univariate analysis were further subjected to multivariate analysis. The desire to have children since their HIV diagnosis had been mooted by 255 (63.8%) respondents in the past and 64.5% of the respondents admitted to wanting to have children at some point in the future. More than half of the respondents (61%) currently wanted more children while a significant proportion of the respondents who wanted children (68.4%) wanted more than one child. The study observed that the desire to have children had largely not been affected by the HIV infection as respondents still had a fairly strong desire to continue to have more children in spite of the risks of transmission involved. The study recommended that government and HIV policymakers need to ensure that HIV prevention messages and programmes adopt cultural and socio-economic considerations when designing and planning HIV prevention programmes.

Spatial heterogeneity in relationship between district patterns of HIV incidence and covariates in Zimbabwe: a multi-scale geographically weighted regression analysis.

A study was conducted to investigate the district-level patterns of incidence of the human immunodeficiency virus (HIV) in Zimbabwe in the period 2005-2015 and explore variations in the relationship between covariates and HIV incidence across different districts. Demographic health survey data were analysed using hotspot analysis, spatial autocorrelation, and multi-scale geographically weighted regression (MGWR) techniques. The analysis revealed hotspots of the HIV epidemic in the southern and western regions of Zimbabwe in contrast to the eastern and northern regions. Specific districts in Matabeleland South and Matabeleland North provinces showed clusters of HIV incidence in 2005-2006, 2010-2011 and 2015. Variables studied were multiple sex partners and sexually transmitted infections (STI) condom use and being married. Recommendations include implementing targeted HIV prevention programmes in identified hotspots, prioritising interventions addressing the factors mentioned above as well as enhancing access to HIV testing and treatment services in high-risk areas, strengthening surveillance systems, and conducting further research to tailor interventions based on contextual factors. The study also emphasizes the need for regular monitoring and evaluation at the district level to inform effective responses to the HIV epidemic over time. By addressing the unique challenges and risk factors in different districts, significant progress can be made in reducing HIV transmission and improving health outcomes in Zimbabwe. These findings should be valuable for policymakers in resource allocation and designing evidence-based interventions.

Prevalence of risk factors for human immunodeficiency virus among sexually active women in Rwanda: a nationwide survey

BackgroundThe Human Immunodeficiency Virus (HIV) remains a global health burden, and despite the advancements in antiretroviral therapy and various strategies employed to curb HIV infections, the incidence of HIV remains disproportionately high among women. Therefore, this study aimed to determine the prevalence of the risk factors for the acquisition of HIV among sexually active women in Rwanda.MethodsSecondary data from the 2020 Rwanda Demographic Health Survey, comprising 10,684 sexually active women, was used. Multistage stratified sampling was employed to select the study participants. Multivariable logistic regression was conducted to determine the associated risk factors using the SPSS (version 25).ResultsOf the 10,684 sexually active women, 28.7% (95% confidence interval (CI): 27.5–29.4) had at least one risk factor for HIV acquisition. Having no education (AOR = 3.65, 95%CI: 2.16–6.16), being unmarried (AOR = 4.50, 95%CI: 2.47–8.21), being from female-headed households (AOR = 1.75, 95%CI: 1.42–2.15), not having health insurance (AOR = 1.34, 95%CI: 1.09–1.65), no HIV test history (AOR = 1.44, 95%CI: 1.01–2.08), being from the poorest wealth quintile (AOR = 1.61, 95%CI: 1.14–2.27) and lack of exposure to mass media (AOR = 1.30, 95%CI: 1.07–1.58) were associated with higher odds of exposure to at least one HIV acquisition risk factor. In contrast, age groups of 25–34 (AOR = 0.56, 95%CI: 0.44–0.71) and 35–44 years (AOR = 0.62, 95%CI: 0.48–0.80), rural residence (AOR = 0.63, 95%CI: 0.49–0.81) and being from the western region (AOR = 0.67, 95%CI: 0.48–0.94) were associated with less odds of exposure to at least one HIV acquisition risk factor.ConclusionMore than a quarter of sexually active women in Rwanda had exposure to at least one risk factor for HIV acquisition. There is a need to maximize the use of mass media in disseminating HIV prevention and behavioral change messages. Engagement of religious leaders and promotion of HIV testing, especially among the never-testers, may be vital strategies in successful HIV prevention programs.

Mental Health Needs of Adolescent and Young Adult PrEP Users in South Africa: Implications for Sexual and Reproductive Health Programming

PurposePoor mental health is associated with sexual and reproductive health (SRH) risks, including human immunodeficiency virus (HIV) and pre-exposure prophylaxis discontinuation. Adolescents and young people (AYP) are vulnerable to HIV and depression. This paper describes the prevalence and severity of depression and associated factors in AYP accessing SRH services in South Africa. MethodsA cross-sectional analysis of enrollment data (January 2019 to December 2021) from a cohort of individuals receiving pre-exposure prophylaxis services at eight clinics in three provinces in South Africa was conducted. Females (n = 1,074) and males (n = 231) aged 15–24 years were included. Interviewer-administered questionnaires were conducted, and the prevalence and severity of depression assessed using the Patient Health Questionnaire-9. Multivariate analysis was used to identify factors associated with depression. ResultsOver 40% of participants had experienced any depression symptoms (43.7% of females, 38.5% of males). For males, experiencing intimate partner violence was the only predictor of depression symptoms (adjusted odds ratio (AOR) 8.81, 95% confidence intervals (CI) 1.03–75.44). For females, living with both parents (AOR 1.70, 95% CI 1.15–2.51), having transactional sex (AOR 1.63, 95% CI 1.00–2.65), experiencing any intimate partner violence (AOR 1.96, 95% CI 1.34–2.89), and using drugs (AOR 1.78, 95% CI 1.03–3.11) were all positively associated with depression symptoms. Resilience was a protective factor against depression symptoms for both sexes (males: AOR 0.96, 95% CI 0.93–0.98; females: AOR 0.96, 95% CI 0.95–0.97). DiscussionThere is a high burden of depression among AYP accessing SRH services in South Africa. Mental health screening should be integrated into SRH and HIV prevention programs for AYP.

The association between all-cause mortality and HIV acquisition risk groups in the United States, 2001-2014.

To investigate associations between all-cause mortality and human immunodeficiency virus (HIV) acquisition risk groups among people without HIV in the United States. We used data from 23,657 (NHANES) participants (2001-2014) and the Linked Mortality File to classify individuals without known HIV into HIV acquisition risk groups: people who ever injected drugs (ever-PWID); men who have sex with men (MSM); heterosexually active people at increased risk for HIV (HIH), using low income as a proxy for increased risk. We used Cox proportional hazards models to estimate adjusted and unadjusted all-cause mortality hazard ratios (HR) with 95% confidence intervals (CI). Compared with sex-specific heterosexually active people at average risk for HIV (HAH), the adjusted HR (95% CI) were: male ever-PWID 1.67 (1.14, 2.46), female ever-PWID 3.50 (2.04, 6.01), MSM 1.51 (1.00, 2.27), male HIH 1.68 (1.04, 2.06), female HIH 2.35 (1.87, 2.95), and male ever-PWID 1.67 (1.14, 2.46). Most people at increased risk for HIV in the US experience higher all-cause mortality than people at average risk. Strategies addressing social determinants that increase HIV risk should be incorporated into HIV prevention and other health promotion programs.

Inclusion of a Parental Component in a Sports-Based HIV Prevention Program for Dominican Youth.

Underprivileged youth in the Dominican Republic (DR) are at high risk of acquiring the human immunodeficiency virus (HIV). Protective parenting practices may inhibit sexual risk-taking. We investigated whether parental involvement in a sports-based HIV prevention program increased self-efficacy to prevent HIV and safe sex behavior among Dominican youth. The study had a quasi-experimental design with repeated measures. N = 90 participants between 13 and 24 years of age participated in the program through two different trainings, UNICA and A Ganar, both of which had an experimental (i.e., program with parental component) and a control (i.e., program without parental component) condition. Self-efficacy to prevent HIV significantly increased among participants in the experimental condition of UNICA. Self-efficacy for safe sex increased among sexually active participants in the experimental condition of A Ganar. Implications for Impact: These findings are important to meet the United Nations' Sustainable Development Goal of good health and wellbeing, as they suggest that parental involvement in sports-based HIV prevention programs can enhance their positive effects for increasing youth's self-efficacy to practice HIV-preventive behaviors. Randomized control trials and longitudinal studies are needed.

Listening to the Voices of Gay and Bisexual Men and Other Men Who Have Sex with Men in Kenya: Recommendations for Improved HIV Prevention Programming.

Young gay and bisexual men and other men who have sex with men (GBMSM) are a key population at high risk for new human immunodeficiency virus (HIV) infections in Kenya; thus, increased efforts are necessary to reduce their health risks. This qualitative study describes recommendations offered by young GBMSM in Kenya regarding the development and delivery of culturally appropriate HIV prevention services. Both young GBMSM Community Members and Peer Educators recommend that future HIV prevention efforts enhance economic empowerment, provide mental health and substance use services, and incorporate arts-based health promotion strategies. In addition, participants recommended that public health professionals increase the ease of access to HIV prevention services for GBMSM and that researchers disseminate findings from HIV prevention research back to the community.

HIV knowledge and protective factors among racial-ethnic minority youth: moderation by ethnic identity and LGBQ+ identity

Due to systemic racism and homophobia, Lesbian, Gay, Bisexual, and Queer (LGBQ+) youth of color are disproportionately affected by HIV (human immunodeficiency virus)/AIDS (acquired immunodeficiency syndrome) and viral hepatitis (VH). Innovative approaches that acknowledge strengths such as ethnic identity need to be examined to understand specific protective factors that can support LGBQ + youth of color. This study aimed to examine the moderating effects of ethnic identity and LGBQ + identity on indicators of HIV knowledge (i.e., VH knowledge, sexual negotiation skills, and perception of sexual risk). Youth who identified as Hispanic/Latinx, African American/Black, and mixed racial-identity (N = 564) were included in the delimited sample. Using linear regression modeling, results showed that there was a positive association between sexual negotiation skill, sexual risk perception, ethnic identity and HIV knowledge. Ethnic identity displayed a positive and significant moderating effect between predictors and HIV knowledge. Three-way interactions between predictors by ethnic identity × LGBQ + interaction showed equally interesting associations with HIV knowledge. Study implications include the need for strengthening ethnic identity and pride among LGBQ + youth of color within HIV prevention programming.

Circulation of Human Immunodeficiency Virus 1 A6 Variant in the Eastern Border of the European Union-Dynamics of the Virus Transmissions Between Poland and Ukraine.

The human immunodeficiency virus (HIV) type 1 A6 variant is dominating in high-prevalence Eastern European countries, with increasing prevalence over the remaining regions of Europe. The recent war in Ukraine may contribute to further introductions of this A6 lineage. Our aim was to model the transmission dynamics of the HIV-1 A6 variant between Poland and Ukraine. HIV-1 A6 partial pol sequences originating from Poland (n = 1185) and Ukraine (n = 653) were combined with publicly available sequences (n = 7675) from 37 other countries. We used maximum likelihood-based tree estimation followed by a bayesian inference strategy to characterize the putative transmission clades. Asymmetric discrete phylogeographic analysis was used to identify the best-supported virus migration events across administrative regions of Poland and Ukraine. We identified 206 clades (n = 1362 sequences) circulating in Poland or Ukraine (63 binational clades, 79 exclusively Polish, and 64 exclusively Ukrainian). Cross-border migrations were almost exclusively unidirectional (from Ukraine to Poland, 99.4%), mainly from Eastern and Southern Ukraine (Donetsk, 49.7%; Odesa, 17.6% regions) to the Central (Masovian, 67.3%; Lodz, 18.2%) and West Pomeranian (10.1%) districts of Poland. The primary sources of viral dispersal were the Eastern regions of Ukraine, long affected by armed conflict, and large population centers in Poland. The Polish outbreak of the A6 epidemic was fueled by complex viral migration patterns across the country, together with cross-border transmissions from Ukraine. There is an urgent need to include war-displaced people in the national HIV prevention and treatment programs to reduce the further spread of transmission networks.

The imbalance of body electrolytes in HIV patients using highly active antiretroviral therapy

The retrovirus named HIV (Human Immunodeficiency Virus) targets the immune system, which makes it more vulnerable to numerous illnesses and some cancers that healthy immune systems can combat. The worst phase of HIV infection, AIDS (Acquired Immunodeficiency Syndrome), can take a variety of people between one and twenty years to emerge if untreated. HIV is frequently spread by unprotected sexual contact, blood transfusions, mother-to-child transmission, etc. HIV/AIDS symptoms include weight loss, skin problems, achy muscles, recurrent fevers. Prevention of HIV/AIDS includes use of condom, avoidance of exposure to implicated body fluids, HIV prevention programs to stop vertical HIV transmission. Highly active antiretroviral therapy (HAART), which reduces the disease's progression, is the main form of treatment. The HAART's effect on the kidney results in electrolytes imbalance. Electrolytes are substances that, when dissolved in water, transmit electricity and control blood pressure, pH level, neuron and muscle activity, and maintain tissues hydrated. Irregularity in the body's electrolyte content is known as an electrolyte imbalance which can be caused by fluid lose, inadequate water consumption, certain medications. Symptoms of electrolyte imbalances include, irregular heartbeat, fatigue, headaches, confusion, numbness and tingling. Diagnosis of Electrolyte Imbalance in HIV/AIDS Patients are done using kidney function test, pinch test and electrocardiogram. Treatment and management of electrolytes imbalance in HIV/AIDS patients include drinking water, oral rehydration drinks, sodium chloride, intravenous fluids, oral medications and supplements such as gluconate, magnesium oxide, use of dialysis. HAART induced electrolytes imbalance are seen in Tenofovir, which is associated with severe hypokalemia and hypophosphatemia.

Persistently Elevated Risk of Syphilis Among Human Immunodeficiency Virus-Positive Men Receiving Care in a Status-Neutral Setting: A Retrospective Analysis.

Over the past decade, the incidence of primary and secondary syphilis has increased dramatically in the United States and Western Europe. Men living with human immunodeficiency virus (HIV) and those at risk of HIV infection experience disproportionately high rates of early syphilis (ES). We compared the odds of ES among HIV-positive and HIV-negative men participating in a status-neutral comprehensive HIV prevention and treatment program (CHP). We conducted a retrospective analysis of men aged 18 to 65 years with ≥ 1 CHP visit and ≥2 rapid plasma reagin (RPR) tests performed between January 1, 2018, and December 31, 2021. Early syphilis was defined as newly reactive RPR with a minimum titer of ≥1:4 or a ≥ 4-fold increase in the RPR titer. Multiple logistic regression analyses were performed to determine predictors of ES. A total of 2490 men met the inclusion criteria, of whom 1426 (57.3%) were HIV-positive and 1064 (42.7%) were HIV-negative. Of the 393 men with ES, 284 (72.3%) were HIV-positive and 109 (27.7%) were HIV-negative. Human immunodeficiency virus-positive men had higher adjusted odds of ES (adjusted odds ratio, 2.86; 95% confidence interval, 2.45-3.27) than HIV-negative men did. Chlamydia or gonorrhea infection did not differ according to HIV status (adjusted odds ratio, 0.93; 95% confidence interval, 0.82-1.04). In our status-neutral care setting, HIV-positive status was associated with significantly higher odds of ES, but not chlamydia or gonorrhea. Our findings emphasize the vulnerability of HIV-positive men to syphilis in an era of effective HIV biomedical prevention.

Assessing spatial patterns of HIV prevalence and interventions in semi-urban settings in South Africa. Implications for spatially targeted interventions.

Equitable allocation of resources targeting the human immunodeficiency virus (HIV) at the local level requires focusing interventions in areas of the greatest need. Understanding the geographical variation in the HIV epidemic and uptake of selected HIV prevention and treatment programmes are necessary to identify such areas. Individual-level HIV data were obtained from a 2012 national HIV survey in South Africa. Spatial regression models on each outcome measure (HIV infection, sub-optimal condom use or non-anti-retroviral treatment (ART) adjusted for spatial random effects at the ward level were fitted using WINBUGS software. In addition, ward-level data was utilized to estimate condom use coverage and ART initiation rates which were obtained from routinely collected data in 2012. Ordinary Kriging was used to produce smoothed maps of HIV infection, condom use coverage and ART initiation rates. HIV infection was associated with individuals undertaking tertiary education [posterior odds ratio (POR): 19.53; 95% credible intervals (CrI): 3.22- 84.93]. Sub-optimal condom use increased with age (POR: 1.09; 95%CrI: 1.06-1.11) and was associated with being married (POR: 4.14; 95%CrI: 1.23-4.28). Non-ART use was associated with being married (POR: 6.79; 95%CrI: 1.43-22.43). There were clusters with high HIV infection, sub-optimal condom use, and non- ART use in Ekurhuleni, an urban and semi-urban district in Gauteng province, South Africa. Findings show the need for expanding condom programmes and/or strengthening other HIV prevention programmes such as pre-exposure prophylaxis and encouraging sustained engagement in HIV care and treatment in the identified areas with the greatest need in Ekurhuleni Metropolitan Municipality.

HIV Testing Strategies for Health Departments to End the Epidemic in the U.S.

An important goal of the Ending the HIV Epidemic in the U.S. initiative is the timely diagnosis of all people with HIV as early as possible after infection. To end the HIV epidemic, health departments were encouraged to propose new and innovative HIV testing strategies and improve the reach of existing programs. These activities were divided into 3 core strategies: expansion of routine screening in healthcare settings, locally tailored HIV testing initiatives in nonhealthcare settings, and specific efforts to increase the frequency of testing for individuals with increased potential for acquiring HIV. Because HIV testing is such a crucial part of the core activities of the Centers for Disease Control and Prevention's HIV prevention programs, there are many examples of evidence-based programs and best practices for HIV testing in both clinical and nonclinical settings. This article reviews the evidence base for these strategies and some of the activities proposed under the Diagnose pillar to achieve the goal of diagnosing all HIV infections as early as possible. All other Ending the HIV Epidemic in the U.S. activities start with an awareness of HIV status, which is actually the indicator for which most health departments are closest to the proposed targets. There are both proven and emerging approaches to increasing HIV screening and increasing the frequency of HIV screening available. The Ending the HIV Epidemic in the U.S. initiative provides the motivation, the resources, and a coordinated plan to bring them to scale.

High risk sexual behaviours associated with traditional beliefs about gender roles among men interested in medical male circumcision in South Africa

BackgroundBeliefs about gender roles and high-risk sexual behaviours underlie the human immunodeficiency virus (HIV) epidemic in South Africa. Yet, there is limited information on the relationships between beliefs about gender roles and risky sexual behaviours. Few studies have explored the association between beliefs about gender roles, high risk sexual behaviour, and health-seeking behaviour among men.MethodsWe investigated associations between gender beliefs (dichotomised as traditional or progressive) and high-risk sexual behaviour among South African men presenting for medical male circumcision (Apr 2014 to Nov 2015).ResultsOf 2792 enrolled men, 47.4% reported traditional gender beliefs. Participant ages ranged between 18–46 years (median age 26 years; interquartile range, 21–31 years). Most participants had at least one sex partner over the last 12 months (68.2%). Younger men (18–24 years old vs. 25–46 years old) (odds ratio [OR], 1.5 [95% confidence interval (CI) 1.0–2.0]), those with multiple partners ([OR], 1.5 (CI) 1.3–1.8]) and participants unsure of their last partner’s HIV status (OR, 1.4 [95% CI 1.1–1.7]) were more likely to have traditional beliefs on gender roles.ConclusionYoung men with traditional beliefs on gender roles may be more likely to engage in high-risk sexual behaviour and could be good candidates for HIV prevention programmes. N = 206 (max 350)Trial registration Name of registry: Clinicaltrials.gov; Trial registration number: NCT02352961; Date of registration: 30 January 2015 “Retrospectively registered”; URL of trial registry record: https://www.clinicaltrials.gov/

Trends in HIV pre-exposure prophylaxis use in eight Canadian provinces, 2014-2018.

: Canada has endorsed the Joint United National Programme on HIV and AIDS global targets to end the acquired immunodeficiency syndrome (AIDS) epidemic, including reducing new human immunodeficiency virus (HIV) infections to zero, by 2030. Given the effectiveness of pre-exposure prophylaxis (PrEP) to prevent new infections, it is important to measure and report on PrEP utilization to help inform planning for HIV prevention programs and policies. : Annual estimates of persons using PrEP in Canada were generated for 2014-2018 from IQVIA's geographical prescription monitor dataset. An algorithm was used to distinguish users of tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for PrEP versus treatment or post-exposure prophylaxis. We provide the estimated number of people using PrEP in eight Canadian provinces by sex, age group, prescriber specialty and payment type. : The estimated number of PrEP users increased dramatically over the five-year study period, showing a 21-fold increase from 460 in 2014 to 9,657 in 2018. Estimated PrEP prevalence was 416 users per million persons across the eight provinces in 2018. Almost all PrEP users were male. Use increased in both sexes, but increase was greater for males (23-fold) than females (five-fold). Use increased across all provinces, although there were jurisdictional differences in the prevalence of use, age distribution and prescriber types. : The PrEP use in Canada increased from 2014 to 2018, demonstrating increased awareness and uptake of its use for preventing HIV transmission. However, there was uneven uptake by age, sex and geography. Since new HIV infections continue to occur in Canada, it will be important to further refine the use of PrEP, as populations at higher risk of HIV infection need to be offered PrEP as part of comprehensive sexual healthcare.

"I want to perform and succeed more than those who are HIV-seronegative" Lived experiences of youth who acquired HIV perinetally and attend Zewditu Memorial Hospital ART clinic, Addis Ababa, Ethiopia.

In Ethiopian Human Immunodeficiency Virus (HIV) prevention program one of the focusing areas is prevention of mother-to-child transmission and decreasing morbidity and mortality among those who already acquired it. However, the needs and the sexual behavior of children who acquired HIV perinatally was not given due attention. Therefore, we conducted this study with the aim of exploring the lived experiences of youth who acquired HIV perinatally to contribute to HIV prevention and control program. We conducted a qualitative study using a phenomenological approach from March to May 2018 among 16 purposively selected youth who were infected with HIV vertically and receive ART services at Zewditu Memorial Hospital, Addis Ababa, Ethiopia. They were recruited based on their willingness after obtaining written informed consent and assent. Data were audio taped, transcribed verbatim in Amharic and later translated to English, and coded using Open Code version 4.02 software. Findings were summarized under four themes by applying interpretative phenomenological analysis. Seven males and nine females, aged 16 to 22 years have participated in the study. These youth reported as they had support from families and ART clinics, while pill-load, and fear of stigma are some of challenges they have faced, especially majorities don't want to disclose their status because of fear of stigma and discrimination. Half of them have ever had sexual relations usually with a seronegative partner and most of these had their first sex in their17-18 years of age. Unsafe sex was common among them where four girls reported to have had unprotected sex with their seropositive or seronegative sexual partners. Most wish to have purposeful life and love mate of the same serostatus but also fear they may remain alone. Youth who had acquired HIV from parents are challenged due to their serostatus and were not sure what type of life they may have in the future. They were also not comfortable in disclosing their serostatus and also engaged in unsafe sexual relation. This calls for an urgent intervention among HIV infected youth and their families; health care providers, and young people in general to halt HIV transmission. Special attention should be given on sexual behavior of all young people (10-24) and in disclosure of HIV status to children and life skills education to cop-up with stigma and discrimination.