Low HIV Prevalence Research Articles

Higher risks of mother-to-child HIV transmission in countries with lower HIV prevalence: UNAIDS 2013 results for 32 countries with generalised epidemics

ObjectivesDiagnosis and treatment of HIV-infected mothers significantly lower rates of mother-to-child transmission (MTCT) of HIV. Early infant diagnosis (EID) is required to monitor success of prevention of MTCT (pMTCT) programmes. Our aim was to compare rates of MTCT, EID and pMTCT in countries with generalised epidemics. MethodsThe UNAIDSinfo database includes country-level information on epidemic size, prevalence of HIV infection, EID rates and pMTCT coverage. The AIDS Spectrum model was used to estimate the number of children infected with HIV in 2013, for 32 countries with generalised epidemics. Least squares linear regression, weighted by epidemic size and controlling for GDP/capita, was used to correlate national adult HIV prevalence with estimated MTCT rates. ResultsThere were 32 countries with generalised epidemics included in the analysis (31 in Africa). Higher-prevalence countries (≥5%) had significantly lower rates of MTCT (P<0.01) than lower-prevalence countries (<5%). For 20 lower-prevalence countries (total 7.4 million HIV-infected people), there were 105,300 childhood (0–14 years) infections in 2013. In 12 higher-prevalence countries (total 17.1 million HIV-infected people), there were an estimated 107,500 childhood infections in 2013. Regression analysis suggests that if all countries achieved the same MTCT rate as Botswana (2.0%), childhood HIV infections could be cut by 88% (from 105,300 to 12,300 per year) in lower-prevalence countries, and by 82% (from 107,500 to 19,700 per year) in higher-prevalence countries. ConclusionsIn this analysis of 32 countries with generalised HIV epidemics, 49.5% (105,500/213,000) of childhood HIV infections in 2013 were in lower-prevalence countries. Targeting of prevention of MTCT in lower-prevalence countries needs to be prioritised, despite challenges, to reduce the number of children infected.

A Latent Class Analysis of Risk Factors for Acquiring HIV Among Men Who Have Sex with Men: Implications for Implementing Pre-Exposure Prophylaxis Programs.

Current Centers for Disease Control and Prevention (CDC) guidelines for prescribing pre-exposure prophylaxis (PrEP) to prevent HIV transmission are broad. In order to better characterize groups who may benefit most from PrEP, we reviewed demographics, behaviors, and clinical outcomes for individuals presenting to a publicly-funded sexually transmitted diseases (STD) clinic in Providence, Rhode Island, from 2012 to 2014. Latent class analysis (LCA) was used to identify subgroups of men who have sex with men (MSM) at highest risk for contracting HIV. A total of 1723 individuals presented for testing (75% male; 31% MSM). MSM were more likely to test HIV positive than heterosexual men or women. Among 538 MSM, we identified four latent classes. Class 1 had the highest rates of incarceration (33%), forced sex (24%), but had no HIV infections. Class 2 had <5 anal sex partners in the previous 12 months, the lowest rates of drug/alcohol use during sex and lower HIV prevalence (3%). Class 3 had the highest prevalence of HIV (7%) and other STDs (16%), > 10 anal sex partners in the previous 12 months (69%), anonymous partners (100%), drug/alcohol use during sex (76%), and prior STDs (40%). Class 4 had similar characteristics and HIV prevalence as Class 2. In this population, MSM who may benefit most from PrEP include those who have >10 sexual partners per year, anonymous partners, drug/alcohol use during sex and prior STDs. LCA is a useful tool for identifying clusters of characteristics that may place individuals at higher risk for HIV infection and who may benefit most from PrEP in clinical practice.

Trends in HIV prevalence from 2008 to 2012 among young adults in Port Harcourt, Nigeria.

The pandemic of HIV lines amongst the utmost infectious disease menaces in antiquity. HIV remains a problem worldwide and it's a grave health snags in developing nations particularly in Nigeria. This study focused on "trends in HIV reporting from 2008 to 2012 among young adults in Port Harcourt, Nigeria. Secondary data were collected from BMSH, Port Harcourt using a Performa specifically intended for this determination. Socio-demographic data for the subjects were recovered from coded patients' medical records kept at BMSH. The data generated was exposed to Fisher's Exact Test. The study showed that a total of 3081 HIV-positive cases were reported between 2008 and 2012. The HIV trend were not well defined, it peaked in 2009(36.6%) and 2008(32.8%) and a decrease in 2011(16.6%), 2012(8.3%) and 2010(5.7%). A 3.8% increase was observed between 2008 and 2009 and 30.9% decrease between 2009 and 2010. However, the prevalence seemed to stabilize between 2009 and 2012. HIV patterns among various age-groups is not well-defined, it rose with increasing age and peaked at 26-30 years (35.7%) after which it declined. Sex differences (P<0.05) in the trend was observed. Males ages 26-30 years showed uniform pattern with an increasing trend while 36-40 years showed decreasing trend except in 2009(34.1%). Females ages 26-30 years showed uniform pattern with an increasing trend from 2008(21.7%) to 2010(41.9%) and decreased from 41.9% (2010) to 36.5%(2012). The low HIV prevalence in 2010 could be attributed to the fact that the proportion of centers giving ART enlarged from 2005 to date. Health care facilities providing HIV/AIDS counselling and testing services also increased. The long decades fight against HIV especially in Rivers State is making progress, though an unstable one. The observed increase in years with high HIV prevalences calls for an intensified focus of intervention.

Evaluating the Impact of Health System Strengthening on HIV and Sexual Risk Behaviors in Nigeria.

We evaluated the impact of health system strengthening (HSS) on HIV prevalence and sexual risk behaviors in Nigeria. Impact of HSS was evaluated in a cross-sectional analysis using 2 rounds of HIV biobehavioral surveys. Logistic regression was used to assess the impact of the HSS program on HIV and risk behaviors. Study was conducted between 2007 and 2012 in 16 states in Nigeria. Using a multistage selection criterion for households, a total of 4856 and 11,712 respondents were surveyed in 2007 and 2012, respectively. HSS for state agencies for the control of AIDS was conducted in 7 states. Overall change in HIV prevalence between 2007 and 2012 was 6·3% vs. 5·3% (P = 0·113) and 3·0% vs. 5·1% (P < 0·001) in the HSS and non-HSS states, respectively. When controlled for age, gender, HSS intervention, location (rural vs. urban), and year (2007 vs. 2012), respondents in the HSS states were less likely to have acquired HIV (adjusted odds ratio [AOR]: 0.78; 95% confidence interval (CI): 0.63 to 0.96), more likely to have comprehensive HIV knowledge (AOR: 1.28; 95% CI: 1.06 to 1.54), and to use a condom consistently in the past 3 months with boy/girlfriends (AOR: 1.35; 95% CI: 1.03 to 1.79). HIV prevalence decreased in HSS states between 2007 and 2012. Respondents in HSS states were more likely to have lower HIV prevalence and reduced sexual risk behaviors. There seems to be progress in mitigating the burden of HIV by the reduction of HIV-related risk behaviors through HSS. Thus, HSS intervention needs to be sustained and replicated to achieve a wider impact and coverage.

P04.31 Study among injectable drugs users (idus)

Background Afghanistan is a country of low HIV prevalence but high risk factors for a number of reasons: There is no information on the prevalence rates of HIV amongst general population- there are neither HIV sentinel surveillance sites nor case reporting system. There have also been no general population household studies of Behavioural surveillance in general population. Methodology Rapid Assessment techniques comprising qualitative methods were used, in the first instance, to elicit salient key themes to inform questionnaire design for the quantitative component of the study. Key information interview were conducted in each five research sites with administrator and services provides who had knowledge of injecting drug use. Secondly, the free list technique was employed with information in all five research area to elicit responses to thematically- focused question on injecting drug use and lifestyle. Blood sample were drawn from each 250 participants to test HIV, HCV, HBS and Syphilis Study aims Describe the range of characteristics of IDUs in major cities of Afghanistan. Examine the injecting –related HIV risk behaviours of IDUs. Suggest necessary intervention to prevent HIV transmission among IDUs and their family and sex partners. Conclusion Study of characteristics and drug user pattern of IDUs conducted through in- depth interview with 250 IDUs in five area: Herat; Kabul; Bamyan; Jalalabad and Mazar-e-Sharif by the criteria of: demographics; ethnicity; place of birth; time spent outside Afghanistan during the past ten years; length of time of return to Afghanistan; education and literacy level; marital status; income; drug availability; drugs use and injection; condom use; sexual history and practices; knowledge and attitudes about HIV; services use and satisfaction. Disclosure of interest statement I would like to clear that I was the principle investigator of this study, I have approval letter from ministry of Public Health of Afghanistan.

P17.39 Monitoring of the scale-up of antiretroviral therapy programmes in sri lanka: experience from a resouece limitted and low prevalence setting

<h3>Introduction</h3> Currently Sri Lanka uses a paper based monitoring and evaluation (M&amp;E) system for the antiretroviral therapy (ART) program which was adapted and modified from the system introduced by the World Health Organization (WHO). These modifications have been adapted keeping in mind that significant disparities exist in different regions in the same country. This paper summarises the findings of the M&amp;E system of the ART program in Sri Lanka where HIV epidemic is considered as low prevalent. <h3>Methods</h3> Information sources of the current ART M&amp;E system was reviewed. Data generated by the M&amp;E system is analysed to evaluate the ART program of the country. <h3>Results</h3> A cumulative total of 812 people living with HIV (PLHIV) were started on ART since the beginning of the ART program in 2004. Currently there are 647 PLHIV on ART. Of the patients who initiated ART, 75% of PLHIV are on first line ARVs and 5% are switched to second line ARV. The balance 20% comprised of loss-to-follow ups and deaths. The cohorts analysis of PLHIV on ART showed that after 12 months of ART initiation, 91% are Alive and on ART while 86% and 76% are Alive and on ART after 24 months and 60 months respectively. <h3>Conclusion</h3> A paper based M&amp;E system can give very useful M&amp;E information in a resource poor and low HIV prevalence setting. However, a development of a suitable online M&amp;E system would greatly improve the data collection process as ART provision is a lifelong monitoring process. <h3>Disclosure of interest statement</h3> No grants were received in the development of this study.

Determinants of consistent condom use among female sex workers in Savannakhet, Lao PDR.

BackgroundFemale sex workers (FSWs) are a high-risk population for HIV. Correct and consistent use of condoms is the most effective measure for reducing transmission of HIV. Lao PDR is a low HIV-prevalence country, but FSWs have a relatively high HIV prevalence. To be able to make recommendations for condom promotion interventions in Lao PDR it is important to know more about the context specific situation. This study looked at reasons for and associated factors of consistent condom use among FSWs.MethodsA cross-sectional survey among 258 FSWs in Kaysone Phomvihan district in Savannakhet province was performed.ResultsAlmost all FSWs had enough condoms (94 %), condoms always available (100 %) and could always afford condoms (92 %). Consistent condom use was 97% with non-regular partners and 60% with regular partners. Almost all respondents (95 %) had received information about condoms from the drop-in centre. Stated reasons for consistent condom use were prevention of HIV (94 %), STIs (88 %) and pregnancy (87 %). Most reasons for inconsistent condom use were related to partners not wanting to use condoms because of reduced sexual pleasure. Some FSWs reported that they were physically abused and forced not to use condoms. Shorter time in sex work, higher education and FSW not having regular partners were significantly associated with consistent condom use.ConclusionsConsistent condom use was very high with non-regular partners, but less frequent with regular partners. The main reason for inconsistent condom use was that the partner did not want to use a condom. Associated factors for consistent condom use were not having regular partners, higher education and shorter time in sex work. Condom promotion programs should include both FSWs and their partners and female condoms should be included in condom intervention efforts. Future studies should investigate the validity of self-reported sexual practices, partners’ reasons for inconsistent condom use, risk of violence in sex work and why shorter time in sex work is associated with consistent condom use.

In developed countries male circumcision prevalence is inversely related to HIV prevalence.

A study by Chemtob and co-workers found significantly lower prevalence of HIV amongst heterosexual men and women in Israel compared with the Netherlands and France. Risk factors for heterosexual HIV infection in these countries were similar, apart from one, namely, a strikingly higher prevalence of male circumcision (MC) in Israel compared with the Netherlands and France. It is now well established that MC protects heterosexual men against becoming infected with HIV during sexual intercourse with an infected woman. In epidemic settings, such as countries in sub-Saharan Africa, in which heterosexual contact is the primary driver for HIV infection, MC is being implemented to reduce HIV prevalence. The results of the new study by Chemtob and co-workers support the evidence and recent polices in the United States advocating MC to reduce the spread of HIV. While prevalence in developed countries is generally low, it is rising. In the long term, neonatal MC is the most desirable option, since not only is it simpler, safer, cheaper and more convenient than MC later, it provides immediate protection from infections, penile inflammation, genital cancers and physical problems. It is also cost-effective. European countries have not supported MC for its public health benefits. The new findings add to calls for European and other countries with low MC prevalence to consider developing evidence-based policies favoring MC in order to reduce HIV and other infections and diseases and at the same time reduce suffering, mortality and the cost of treating these.

Impact of Male Circumcision among heterosexual HIV cases: comparisons between three low HIV prevalence countries.

BackgroundStudies performed in high-HIV prevalence countries showed a strong epidemiological association between male circumcision (MC) and the prevention of HIV transmission. We estimated the potential impact of MC on the general heterosexual population in low-HIV prevalence countries.MethodsCross-national comparisons, including data on newly diagnosed HIV cases among heterosexuals living in Israel (where almost all males undergo MC), to similar data from the Netherlands and France (where <10 % of males are circumcised) were performed. National data from HIV registers and Bureaus of Statistics for the period of 2004–2010, global rates, rates by sex, age, and year of HIV-diagnosis were compared. MC and potential biases were examined.ResultsAnnual rates of new HIV diagnoses per 100,000 were significantly lower in Israel compared to the Netherlands and France (for men: 0.26–0.70, 1.91–2.28, and 2.69–3.47, respectively; for women: 0.10–0.34, 1.10–2.10 and 2.41–3.08, respectively). Similarly, HIV-rates were much lower in Israel when comparing by age groups. Although Gross National Income per capita in 2010 was lower in Israel compared to the Netherlands and France, access to HIV testing and treatment were not different between countries. Also, the number of sexual-partners and condom-use in the general population showed a high similarity between the countries.ConclusionsThe lower rate of HIV among heterosexuals in Israel compared to the Netherlands and France might be explained by MC routinely practiced in Israel, since other parameters of influence on HIV transmission were rather similar between the countries. However, recommendation for systematic MC in low HIV prevalence countries requires further investigations.

HIV/AIDS prevalence in Israeli prisons: Is there a need for universal screening?

This study aimed to assess HIV/AIDS point-prevalence among inmates and evaluate costs related to universal screening as currently practiced and appraise its necessity. All inmates newly incarcerated in Israel (2003-2010) underwent HIV tests and their medical files were cross-matched the with the national HIV/AIDS registry to who had been newly infected and detected on prison entry. They were classified by key risk-groups. Of 108,866 new inmates during the period, 215 (0.2 per cent) were diagnosed with HIV/AIDS, 44 of those (0.04 per cent) were not aware of their infection. A large majority (94.2 per cent) of the infected inmates were members of a key-risk group: drug-users, homosexuals, or originating from a high-HIV prevalence country. The direct cost of detecting a single HIV-infected inmate who was not previously recorded was [euro ]12,386. The HIV/AIDS-screening process can be improved by interviewing the new inmates and performing targeted HIV-testing for those who are members of a known risk-group. These data from Israel are pertinent to developed countries with low HIV prevalence, because they present a picture of all newly infected inmates over an 8-year period within the paradigm of a fully functional HIV surveillance system.

HIV-related stigmatized attitudes among health care providers in Aceh, Indonesia: The findings from a very low HIV case-load region

Abstract Introduction Study of HIV-related stigmatized and discriminatory attitudes is predominantly conducted in the regions with high HIV prevalence; therefore, understanding about stigmatized and discriminatory attitudes dynamic in the region with a very low HIV prevalence is needed. Aim To identify the levels of stigmatized attitudes toward people living with HIV (PLHIV) and their predictors among health care providers (HCPs) in Aceh, the lowest HIV prevalence province in Indonesia. Material and methods A cross-sectional study was conducted in seven regencies in Aceh. Structured questionnaires were used to collect data from 589 HCPs (doctors, nurses, midwifes and supporting staffs). Univariate analyses including one-way analysis of variance, t-test and correlation test were performed according to data type. Multiple linear regression was conducted to identify the predictors of stigmatized attitudes. Results and discussion The level of HIV-stigmatized attitudes among HCPs in Aceh was high. Univariate analysis revealed that location, experience of direct contact with PLHIV, knowledge on HIV transmission and prevention, value-driven stigma and overestimated risk to HIV transmission were associated significantly with stigmatized attitudes levels (P Conclusions This study demonstrates that the value-driven stigma and overestimated risk to HIV transmission are the major predictors of stigmatized attitudes toward PLHIV among HCPs in Aceh. Therefore, programs to reduce value-driven stigma and overestimated risk are needed.

Characteristics of Bi-attracted Men Who Have Sex with Men: Findings from Three Internet-based Studies on HIV

Bisexual identities and attractions are seldom discussed in HIV research, despite the fact that bi individuals might be facing significant health disparities. In this article, the authors harmonized and pooled data from three Internet-based, HIV-focused studies of men who have sex with men (MSM) and, given the complexities of categorizing bisexuality and limitations of the existing samples examined, the authors decided to use bi attraction to identify bi men. The authors found that between 21.8% and 35% of participants in the three samples were bi-attracted. Bi-attracted MSM were significantly younger, more likely to be Black in two out of the three samples, less likely to be out, and more likely to experience internalized homonegativity. There was lower HIV prevalence among bi-attracted MSM when compared to homo-attracted MSM in this sample, but this could be related to the significantly lower levels of HIV testing we found amongst bi-attracted MSM. We hope that these findings will spur on more research in these areas.

Correlates of previous couples’ HIV counseling and testing uptake among married individuals in three HIV prevalence strata in Rakai, Uganda

BackgroundStudies show that uptake of couples’ HIV counseling and testing (couples’ HCT) can be affected by individual, relationship, and socioeconomic factors. However, while couples’ HCT uptake can also be affected by background HIV prevalence and awareness of the existence of couples’ HCT services, this is yet to be documented. We explored the correlates of previous couples’ HCT uptake among married individuals in a rural Ugandan district with differing HIV prevalence levels.DesignThis was a cross-sectional study conducted among 2,135 married individuals resident in the three HIV prevalence strata (low HIV prevalence: 9.7–11.2%; middle HIV prevalence: 11.4–16.4%; and high HIV prevalence: 20.5–43%) in Rakai district, southwestern Uganda, between November 2013 and February 2014. Data were collected on sociodemographic and behavioral characteristics, including previous receipt of couples’ HCT. HIV testing data were obtained from the Rakai Community Cohort Study. We conducted multivariable logistic regression analysis to identify correlates that are independently associated with previous receipt of couples’ HCT. Data analysis was conducted using STATA (statistical software, version 11.2).ResultsOf the 2,135 married individuals enrolled, the majority (n=1,783, 83.5%) had been married for five or more years while (n=1,460, 66%) were in the first-order of marriage. Ever receipt of HCT was almost universal (n=2,020, 95%); of those ever tested, (n=846, 41.9%) reported that they had ever received couples’ HCT. There was no significant difference in previous receipt of couples’ HCT between low (n=309, 43.9%), middle (n=295, 41.7%), and high (n=242, 39.7%) HIV prevalence settings (p=0.61). Marital order was not significantly associated with previous receipt of couples’ HCT. However, marital duration [five or more years vis-à-vis 1–2 years: adjusted odds ratio (aOR): 1.06; 95% confidence interval (95% CI): 1.04–1.08] and awareness about the existence of couples’ HCT services within the Rakai community cohort (aOR: 7.58; 95% CI: 5.63–10.20) were significantly associated with previous receipt of couples’ HCT.ConclusionsPrevious couples’ HCT uptake did not significantly differ by HIV prevalence setting. Longer marital duration and awareness of the existence of couples’ HCT services in the community were significantly correlated with previous receipt of couples’ HCT. These findings suggest a need for innovative demand–creation interventions to raise awareness about couples’ HCT service availability to improve couples’ HCT uptake among married individuals.

Rising School Enrollment and Declining HIV and Pregnancy Risk Among Adolescents in Rakai District, Uganda, 1994-2013.

Poverty, family stability, and social policies influence the ability of adolescents to attend school. Likewise, being enrolled in school may shape an adolescent's risk for HIV and pregnancy. We identified trends in school enrollment, factors predicting school enrollment (antecedents), and health risks associated with staying in or leaving school (consequences). Data from the Rakai Community Cohort Study (RCCS) were examined for adolescents 15-19 years (n=21,735 person-rounds) from 1994 to 2013. Trends, antecedents, and consequences were assessed using logistic and linear regression with robust variance estimation. Qualitative data were used to explore school leaving among HIV+ and HIV- youth (15-24 years). School enrollment and socioeconomic status (SES) rose steadily from 1994 to 2013 among adolescents; orphanhood declined after availability of antiretroviral therapy. Antecedent factors associated with school enrollment included age, SES, orphanhood, marriage, family size, and the percent of family members <20 years. In qualitative interviews, youth reported lack of money, death of parents, and pregnancy as primary reasons for school dropout. Among adolescents, consequences associated with school enrollment included lower HIV prevalence, prevalence of sexual experience, and rates of alcohol use and increases in consistent condom use. Young women in school were more likely to report use of modern contraception and never being pregnant. Young men in school reported fewer recent sexual partners and lower rates of sexual concurrency. Rising SES and declining orphanhood were associated with rising school enrollment in Rakai. Increasing school enrollment was associated with declining risk for HIV and pregnancy.

Strengthening capacity for local evidence to inform local responses to HIV in a remote Solomon Islands health service.

Documenting specific knowledge and attitudes about HIV in the culturally diverse nation of Solomon Islands is essential to inform locally targeted public health responses. As part of a large capacity-strengthening project at Atoifi Adventist Hospital in East Kwaio, Solomon Islands, researchers, using a 'learn-by-doing' process, worked with participants in public health research methods. Overall, 43 people attended research capacity building workshops in 2011; eight joined the HIV study group. A cross-sectional survey including semi-structured interviews on HIV was conducted by the group. In February 2014, a hospital administrator was interviewed about how the 2011 study informed local HIV responses. Of the 53 survey participants, 64% self-assessed as having little or no HIV knowledge, but 90% knew HIV could be transmitted between men and women during sex. Less than 50% knew HIV could be transmitted between two men having sex, 45% thought HIV could be transmitted by mosquitoes and 55% agreed condoms help protect from HIV. Most participants reported negative attitudes towards people with HIV. Three years later the health administrator reported ad hoc responses to HIV because of low HIV prevalence, increasing noncommunicable diseases, staff turnover and resource shortages. This HIV study was used to strengthen research skills in local health professionals and community members in Solomon Islands. It showed that community members require accurate information about HIV transmission and that entrenched stigma is an issue. Although results provided local evidence for local response, ongoing health system challenges and little local HIV transmission meant HIV services remain rudimentary.

New arrivals to New York City: vulnerability to HIV among urban migrant young gay men.

This qualitative study explored the social experiences and HIV-related sexual practices of 30 young gay and bisexual men who moved to New York City in the past 3years from other countries or elsewhere in the United States. For many migrants, a key basis of vulnerability to HIV was their engagement with New York City's unfamiliar sexual culture. Many recent arrivals migrated from places with small gay communities and low HIV prevalence, and some came with a practice of limited condom use. Participants described encountering an abundance of sexual opportunity in New York City, accessible to even the newest arrivals through internet sex sites. Some migrants expressed surprise that few men they met were interested in dating or establishing trust before having sex. Although frequent HIV testing was common, HIV status, testing history, and condom use were seldom discussed with sex partners for some men even with new partners or before sex without condoms. International and in-country migrants who are beginning to navigate New York City's gay sexual culture may be more vulnerable to HIV infection than established residents if they are inexperienced in encountering vast sexual opportunity, are less practiced in local norms of sexual communication, or if their lack of economic resources or social connections encourages them to have sex for money or shelter. This article suggests HIV prevention interventions for urban migrants and other men who have sex with men.

ASPECTE PARTICULARE ALE BOLILOR DERMATOLOGICE LA PACIENŢII CU INFECŢIE HIV

Objectives. To describe particular aspects of dermatoses in HIV-positive patients and assess clinical and therapeutical correlations. Material and methods. A systematic review was performed of the medical literature, totaling 49 works, to evaluate information on the following dermatological diseases: syphilis malignant, pruritic papular eruption of HIV, molluscum contagiosum, infection due to varicella-zoster virus or human papilloma virus, cutaneous histoplasmosis, Kaposi’s sarcoma, non-melanoma skin carcinomas, skin and soft tissue infections, HIV associated pruritus, HIV immune reconstruction syndrome (IRIS) associated dermatoses, vitiligo, lupus erythematosus, and Norwegian scabies. Results. Dermatological conditions are among the first clinical manifestations of AIDS, the number of patients with dermatitis being inversely proportional to the CD4 + count and proportionate to the stage of disease. Mucocutaneous manifestations associated with HIV-1 infection are classified into primary and secondary, but their pathogenesis is not completely elucidated, and secondary complications are associated with a lower HIV prevalence since HAART has become available. Conclusions. The majority of dermatological diseases in HIV positive patients have a clinically more severe course, with a prolonged evolution, are more resistant to treatment, tend to recur more frequently and may exacerbate during the first months of initiating HAART, due to immune reconstruction inflammatory syndrome.

Burden of substance use disorders, mental illness, and correlates of infectious diseases among soon-to-be released prisoners in Azerbaijan.

Despite low HIV prevalence in the South Caucasus region, transmission is volatile. Little data are available from this region about addiction and infectious diseases among prisoners who transition back to communities. A nation-wide randomly sampled biobehavioral health survey was conducted in 13 non-specialty Azerbaijani prisons among soon-to-be-released prisoners. After informed consent, participants underwent standardized health assessment surveys and testing for HIV, hepatitis B and C, and syphilis. Of the 510 participants (mean age = 38.2 years), 11.4% were female, and 31.9% reported pre-incarceration drug injection, primarily of heroin. Prevalence of HCV (38.2%), HIV (3.7%), syphilis (3.7%), and HBV (2.7%) was high. Among the 19 HIV-infected inmates, 14 (73.7%) were aware of their HIV status, 12 (63.2%) were receiving antiretroviral therapy (ART), and 5 (26.3%) had CD4 < 350 cells/mL (4 of these were on ART). While drug injection was the most significant independent correlate of HCV (AOR = 12.9; p = 0.001) and a significant correlate of HIV (AOR = 8.2; p = 0.001), both unprotected sex (AOR = 3.31; p = 0.049) and working in Russia/Ukraine (AOR = 4.58; p = 0.008) were also correlated with HIV. HIV and HCV epidemics are concentrated among people who inject drugs (PWIDs) in Azerbaijan, and magnified among prisoners. A transitioning HIV epidemic is emerging from migration from high endemic countries and heterosexual risk. The high diagnostic rate and ART coverage among Azerbaijani prisoners provides new evidence that HIV treatment as prevention in former Soviet Union (FSU) countries is attainable, and provides new insights for HCV diagnosis and treatment as new medications become available. Within prison evidence-based addiction treatments with linkage to community care are urgently needed.

Achieving high acceptability of HIV testing in a population-based survey among immigrants in Finland.

The aim of this study was to assess the acceptability of human immunodeficiency virus (HIV) testing among migrants in Finland and the factors contributing to non-acceptance. The Finnish Migrant Health and Wellbeing Study 'Maamu' was the first national population-based Health Interview and Examination Survey (HIS/HES) among migrants in Finland. A total of 386 Kurdish, Russian and Somali immigrants in Helsinki participated in the study. Despite the participants' different sociodemographic backgrounds, a high rate of test acceptability (92%, 95% CI 90-95) was achieved. HIV test acceptance was associated with pretest counselling, ability to understand spoken Finnish or Swedish and employment status. No participants tested positive for HIV. The results imply that a universal HIV testing strategy is well accepted in a low-HIV prevalence immigrant population and can be included in a general health examination in immigrant population-based surveys.

Knowledge of HIV and willingness to conduct oral rapid HIV testing among dentists in Xi'an China.

IntroductionChina is considered a country of low HIV prevalence (780,000 people living with HIV), however, HIV infections among high-risk populations continue to grow at alarming rates. Voluntary Counseling and Testing services were first implemented in 2003, and oral rapid HIV testing (ORHT) began in 2012. Dentists, as oral health experts, would be well placed to conduct ORHT. We assessed willingness of dentists to undertake ORHT in their clinical practice.MethodsA cross-sectional, paper-based survey of dentists from the Xi’an region of China was conducted from April to June 2013. Dentists were recruited from Shaanxi Stomatological Association using a stratified sampling methodology. A 40-item survey was used to measure knowledge of HIV, attitudes toward people living with HIV and willingness to conduct ORHT.Results477 dentists completed the survey with a mean HIV knowledge test score of 13.2/18 (SD 1.9). If made available in the dental setting, 276 (57.9%) preferred to use blood to diagnose HIV, only 190 (39.8%) preferred saliva or both. Four hundred and thirty-five (91.2%) thought that ORHT was needed in dental clinics. Female dentists felt more accepting of ORHT than males (93.8% vs. 87.8%; χ2=5.145; p<0.05). 42.6% of the participants who responded thought that lack of education on ORHT for dentists was the most urgent problem to solve for ORHT, 144 (31.3%) thought that lack of support for ORHT from patients was the most urgent problem. There was statistically significant difference among dental hospital, dentistry and department of dentistry (χ2=24.176; p<0.05).ConclusionsThe majority of Chinese dentists thought that ORHT was needed in the dental setting. Providing opportunities for dentists and dental students to learn about HIV testing guidelines and practices is needed as well as feasibility and implementation science research.