Men In Prevention Research Articles

Meso-American Nephropathy in El Salvador: Increasing Farmer Participation in MeN Prevention Efforts

Objectives: This paper highlights and discusses major factors affecting Salvadoran farmers’ involvement in National Health System-led efforts to prevent MeN in El Salvador and includes some recommendations to enhance their involvement. Methods: The study, conducted in El Salvador in June 2018, involved 10 life-long farmers residing in five MeN-affected communities in Chalatenango and Usulutan Departments who were either MeN-free or MeN-controlled, to understand through semi-structured, qualitative interviews their experience of participation in broader epidemic control efforts. Complementary interviews held with two nephrology teams and a senior representative of the grassroots-level National Health Forum operating in the same area, provided necessary contrast. Interview questions were informed by reference to the Adaptation and Development after Persecution and Trauma (ADAPT) model [1] as applicable in post-conflict environments like El Salvador to analyze contextual factors influencing community participation. Findings: Farmers are scarcely involved in wider MeN prevention efforts in El Salvador despite greater National Health System emphasis on encouraging community participation since the approval of the 2009 Health Reform [2]. This study found that widespread insecurity due to gang warfare, declining family and social networks due to high murder rates and international migration, and unresolved sense of injustice over unremitting poverty are among major factors with potential destructive effect on farmer participation. Conclusions: Health system-led MeN prevention responses need to encompass attention to persisting social vulnerabilities in economically and socially marginalized communities in order to enhance farmer participation in this effort. This paper concludes with some recommendations on how this can be done.

Genre, inégalités et promotion de la santé à l’échelle locale. L’exemple gennevillois

Social inequalities in health and access to care remain significant in France. Cultural and socioeconomic dimensions of health inequalities are often studied, but gender-specific behaviors and local dynamics are rarely investigated. This article aims to examine the role of municipal representatives, public health policies and local communities in unequal access to prevention for men and women. We analyze the relationship between gender, space and health through the case study of health promotion in the town of Gennevilliers (Paris region). We rely on data from over six months of field work based on semi-structured interviews with elected officials, health professionals, social field and civil society actors as well as archival consultations and field observations. We show that the town of Gennevilliers, by the age of the inclusion of health in local policies, the dynamism of the associative network and local players or the number of innovative actions, is a relevant and inspiring example for analyzing the obstacles and means of health interventions. But, this article also demonstrates that the promotion of preventive health, rooted in long-term and complex territorial dynamics, can also contribute to the strengthening of gender roles and differences between men and women. Finally, this study pinpoints the need for an approach integrating both gender and territorial questions in the analysis as well as the development of health promotion campaigns.

Clusters and components of the metabolic syndrome are associations with the prevalence of depression in open urban male population

Aim. To establish associations of the frequency of detection of clusters and components of the metabolic syndrome (MS) with the prevalence of depression in open male population of moderately urbanized Siberian city.Material and methods. Cross-sectional epidemiological survey included 1000 individuals formed from the election list of males in one of the Tyumen administrative districts. The response rate was 85,0%. MS was assessed using the International Diabetes Federation (IDF) criteria. A self-administered WHO MONICA-psychosocial questionnaire was used to assess the levels of depression. Statistical analysis was conducted using a package of software program for medical data IBM SPSS Statistics 21.0.Results. In the open population of moderately urbanized Siberian city in men (age 25-64) with depression the following clusters of MS are prevalent: abdominal obesity (AO) + hypertriglyceridemia (HTG) + decrease of high-density lipoprotein cholesterol (hypoHDL-C) and AO + hypoHDL-C + arterial hypertension (AH); in the presence of a high level of depression AO + HTG + hypoHDL-C and AO + hypoHDL-C + AH are prevalent. A direct correlation was established between the prevalence of depression and abdominal obesity and hypertension, as well as the prevalence of a high level of depression with HTG and hypo-HDL cholesterol. In the open urban population in men (age 25-64) with high level of depression the following clusters of MS are prevalent: AO + HTG + hypoHDL-C and AO + HTG + hypoHDL-C + AH. We established an increase in the chances of developing a high level of depression with following MS clusters: AO + HTG + hypoHDL-C. According to IDF criteria, the prevalence of MS components in male population (age 25-64) in Tyumen was: AO — 42,6%; AH — 59,8%; hyperglycemia — 17,4%; HTG — 10,5%; hypoHDL-C — 4,6%. With a primary prevalence of MS components in men (age 25-64) with a low level of depression, the prevalence of HTG and hypoHDL-C in open population of moderately urbanized Siberian city prevails in men with high and mean levels of depression.Conclusion. The strategies for MS prevention in men of moderately urbanized city should contain measures to optimize nutrition regarding psychosocial determinants. This is due not only to the wide prevalence of overweight and obesity in Tyumen population but also to dyslipidemia associated with these factors.

The contradictory possibilities of engaging men and boys in the prevention of men’s violence against women in the UK

Contemporary initiatives to engage men and boys in preventing men’s violence against women in the UK are modest but growing in prominence, and attracting increasing interest from policymakers. This article discusses findings from qualitative research in which expert-informant interviews were carried out with activists playing an influential role in the development of such efforts. It explores how, despite its potential, there are a number of policy obstacles facing work with men in the UK, including ongoing neoliberal austerity, the influence of ‘gender neutral’ conceptions of abuse, and political inertia towards prevention. In addition, the interviews highlighted some of the political contradictions that lie within work which encourages men to question their own power and privilege, and critically evaluate their own practices and those of their peers. These include the need to support rather than supersede the women’s movement, simultaneously appealing to and challenging men, bringing about both individual and structural social change, and building pro-feminist engagements without diluting them. The article argues that, if these contradictions are addressed and pro-feminist equilibriums found within them, then work with men has the potential to make an important contribution as part of efforts to prevent men’s violence against women in the UK.

Does pre-exposure prophylaxis for HIV prevention in men who have sex with men change risk behaviour? A systematic review.

To review the literature regarding PrEP and sexual behaviour change in MSM. Pre-exposure prophylaxis for HIV has been available since 2012. Even so, pre-exposure prophylaxis has not been widely accepted among healthcare providers and men who have sex with men some of whom are convinced that pre-exposure prophylaxis decreases condom use and increases sexually transmitted infections. A systematic review of the state of the evidence regarding the association of pre-exposure prophylaxis with condom use, sexually transmitted infection incidence and change in sexual risk behaviours in men who have sex with men. A structured search of databases resulted in 142 potential citations, but only 10 publications met inclusion criteria and underwent data abstraction and critical appraisal. An adapted Cochrane Collaboration domain-based assessment tool was used to critically appraise the methodological components of each quantitative study, and the Mixed Methods Appraisal Tool was used to critically appraise qualitative and mixed-methods studies. Condom use in men who have sex with men using pre-exposure prophylaxis is influenced by multiple factors. Studies indicate rates of sexually transmitted infections in treatment and placebo groups were high. Pre-exposure prophylaxis did not significantly change sexually transmitted infection rates between baseline and follow-up. Reporting of sexual risk improved when questionnaires were completed in private by clients. Our review found that pre-exposure prophylaxis may provide an opportunity for men who have sex with men to access sexual health care, testing, treatment and counselling services. We did not find any conclusive evidence that pre-exposure prophylaxis users increase sexual risk behaviours. The perception among healthcare providers that pre-exposure prophylaxis leads to increased sexual risk behaviours has yet to be confirmed. In order to provide effective sexual health services, clinicians need to be knowledgeable about pre-exposure prophylaxis as an HIV prevention tool. In an era where HIV prevention methods are rapidly improving, strategies for sexually transmitted infection testing, treatment, counselling and prevention remain vital to improve health. All healthcare providers are uniquely positioned to promote sexual health through the dissemination of accurate information.

Quantifying the drivers of HIV transmission and prevention in men who have sex with men: a population model-based analysis in Switzerland.

Despite the huge success of antiretroviral therapy (ART), there is an ongoing HIV epidemic among men who have sex with men (MSM) in resource-rich countries. Understanding the driving factors underlying this process is important for curbing the epidemic. We simulated the HIV epidemic in MSM in Switzerland by stratifying a mathematical model by CD4 count, the care cascade and condom use. The model was parametrised with clinical, epidemiological and behavioural data from the Swiss HIV Cohort Study and surveys in the HIV-negative population. According to our model, 3.4% of the cases that would otherwise have occurred in 2008-2015 were prevented by early initiation of ART. Only 0.6% of the cases were attributable to a change in condom use in the HIV-positive population, as less usage is mainly seen in virally suppressed MSM. Most new infections were attributable to transmission from recently infected undiagnosed individuals. It was estimated that doubling the diagnosis rate would have resulted in 11.8% fewer cases in 2001-2015. Moreover, it was estimated that introducing pre-exposure prophylaxis (PrEP) for 50% of those MSM not using condoms with occasional partners would have resulted in 22.6% fewer cases in 2012-2015. By combining observational data on the relevant epidemiological and clinical processes with a mathematical model, we showed that the 'test and treat' approach is most effective in reducing the number of new cases. Only a moderate population-level effect was estimated for early initiation of ART and a weak effect for the change in condom use of diagnosed MSM. Protecting HIV-negative individuals who are not using condoms with PrEP was shown to have a major impact.

Potential effectiveness of long-acting injectable pre-exposure prophylaxis for HIV prevention in men who have sex with men: a modelling study

Oral pre-exposure prophylaxis (PrEP) prevents HIV infection in men who have sex with men (MSM); however, adherence is an ongoing concern. Long-acting injectable PrEP is being tested in phase 3 trials and could address challenges associated with adherence. We examined the potential effectiveness of long-acting injectable PrEP compared with oral PrEP in MSM. We used an agent-based model to simulate HIV transmission in a dynamic network of 11 245 MSM in Atlanta, GA, USA. We used raw data from studies in macaque models and pharmacokinetic data from safety trials to estimate the time-varying efficacy of long-acting injectable PrEP. The effect of long-acting injectable PrEP on the cumulative number of new HIV infections over 10 years (2015-24) was compared with no PrEP and daily oral PrEP across a range of coverage levels. Sensitivity analyses were done with varying maximum efficacy and drug half-life values. In the absence of PrEP, the model predicted 2374 new HIV infections (95% simulation interval [SI] 2345-2412) between 2015 and 2024. The cumulative number of new HIV infections was reduced in all scenarios in which MSM received long-acting injectable PrEP compared with oral PrEP. At a coverage level of 35%, compared with no PrEP, long-acting injectable PrEP led to a 44% reduction in new HIV infections (1044 new infections averted [95% SI 1018-1077]) versus 33% (792 infections averted [763-821]) for oral PrEP. The relative benefit of long-acting injectable PrEP was sensitive to the assumed efficacy of injections received every 8 weeks, discontinuation rates, and terminal drug half-life. Long-acting injectable PrEP has the potential to produce larger reductions in HIV transmission in MSM than oral PrEP. However, the real-world, population-level impact of this approach will depend on uptake of this prevention method and its effectiveness, as well as retention of patients in clinical care. National Institute on Drug Abuse and National Institute of Mental Health.

Coronary heart disease mortality in treated familial hypercholesterolaemia: Update of the UK Simon Broome FH register

Background and aimsPatients with familial hypercholesterolaemia (FH) have an elevated risk of coronary heart disease (CHD). Here we compare changes in CHD mortality in patients with heterozygous (FH) pre 1992, before lipid-lowering therapy with statins was used routinely, and in the periods 1992–2008 and 2008–2016. Methods1903 Definite (DFH) and 1650 Possible (PFH) patients (51% women) aged 20–79 years, recruited from 21 lipid clinics in the United Kingdom and followed prospectively between 1980 and 2016 for 67,060 person-years. The CHD standardised mortality ratio (SMR) compared to the population in England and Wales was calculated (with 95% Confidence intervals). ResultsThere were 585 deaths, including 252 from CHD. Overall, the observed 2.4-fold excess coronary mortality for treated DFH post-1991 was significantly higher than the 1.78 excess for PFH (35% 95% CI 3%–76%). In patients with DFH and established coronary disease, there was a significant excess coronary mortality in all time periods, but in men it was reduced from a 4.83-fold excess (2.32–8.89) pre-1992 to 4.66 (3.46–6.14) in 1992–2008 and 2.51 (1.01–5.17) post-2008, while in women the corresponding values were 7.23 (2.65–15.73), 4.42 (2.70–6.82) and 6.34 (2.06–14.81). Primary prevention in men with DFH resulted in a progressive reduction in coronary mortality over the three time-periods, with no excess mortality evident post-2008 (0.89 (0.29–2.08)), although in women the excess persisted (post-2008 3.65 (1.75–6.72)). ConclusionsThe results confirm the benefit of statin treatment in reducing CHD mortality, but suggest that FH patients with pre-existing CHD and women with FH may not be treated adequately.

Combination methods for HIV prevention in men who have sex with men (MSM)

Combination methods for HIV prevention in men who have sex with men (MSM)

Cost-effectiveness of pre-exposure prophylaxis for HIV prevention in men who have sex with men in the UK: a modelling study and health economic evaluation

In the UK, HIV incidence among men who have sex with men (MSM) has remained high for several years, despite widespread use of antiretroviral therapy and high rates of virological suppression. Pre-exposure prophylaxis (PrEP) has been shown to be highly effective in preventing further infections in MSM, but its cost-effectiveness is uncertain. In this modelling study and economic evaluation, we calibrated a dynamic, individual-based stochastic model, the HIV Synthesis Model, to multiple data sources (surveillance data provided by Public Health England and data from a large, nationally representative survey, Natsal-3) on HIV among MSM in the UK. We did a probabilistic sensitivity analysis (sampling 22 key parameters) along with a range of univariate sensitivity analyses to evaluate the introduction of a PrEP programme with sexual event-based use of emtricitabine and tenofovir for MSM who had condomless anal sexual intercourse in the previous 3 months, a negative HIV test at baseline, and a negative HIV test in the preceding year. The main model outcomes were the number of HIV infections, quality-adjusted life-years (QALYs), and costs. Introduction of such a PrEP programme, with around 4000 MSM initiated on PrEP by the end of the first year and almost 40 000 by the end of the 15th year, would result in a total cost saving (£1·0 billion discounted), avert 25% of HIV infections (42% of which would be directly because of PrEP), and lead to a gain of 40 000 discounted QALYs over an 80-year time horizon. This result was particularly sensitive to the time horizon chosen, the cost of antiretroviral drugs (for treatment and PrEP), and the underlying trend in condomless sex. This analysis suggests that the introduction of a PrEP programme for MSM in the UK is cost-effective and possibly cost-saving in the long term. A reduction in the cost of antiretroviral drugs (including the drugs used for PrEP) would substantially shorten the time for cost savings to be realised. National Institute for Health Research.

Does Peak Urine Flow Rate Predict the Development of Incident Lower Urinary Tract Symptoms in Men with Mild to No Current Symptoms? Results from REDUCE

We determined whether decreased peak urine flow is associated with future incident lower urinary tract symptoms in men with mild to no lower urinary tract symptoms. Our population consisted of 3,140 men from the REDUCE (Reduction by Dutasteride of Prostate Cancer Events) trial with mild to no lower urinary tract symptoms, defined as I-PSS (International Prostate Symptom Score) less than 8. REDUCE was a randomized trial of dutasteride vs placebo for prostate cancer prevention in men with elevated prostate specific antigen and negative biopsy. I-PSS measures were obtained every 6 months throughout the 4-year study. The association between peak urine flow rate and progression to incident lower urinary tract symptoms, defined as the first of medical treatment, surgery or sustained and clinically significant lower urinary tract symptoms, was tested by multivariable Cox models, adjusting for various baseline characteristics and treatment arm. On multivariable analysis as a continuous variable, decreased peak urine flow rate was significantly associated with an increased risk of incident lower urinary tract symptoms (p = 0.002). Results were similar in the dutasteride and placebo arms. On univariable analysis when peak flow was categorized as 15 or greater, 10 to 14.9 and less than 10 ml per second, flow rates of 10 to 14.9 and less than 10 ml per second were associated with a significantly increased risk of incident lower urinary tract symptoms (HR 1.39, p = 0.011 and 1.67, p <0.001, respectively). Results were similar on multivariable analysis, although in the 10 to 14.9 ml per second group findings were no longer statistically significant (HR 1.26, p = 0.071). In men with mild to no lower urinary tract symptoms a decreased peak urine flow rate is independently associated with incident lower urinary tract symptoms. If confirmed, these men should be followed closer for incident lower urinary tract symptoms.

Aspirin for Primary and Secondary Prevention of Cardiovascular Disease.

The first reported use of salicylate-rich plants as an analgesic and anti-inflammatory agent comes from the Ebers Papyrus, an Egyptian medical text from ca. 1,543 bc.1 It wasn't until the mid-1800s that silicon was isolated as the active component from willow tree bark extract, and then purified to acetylsalicylic acid. Bayer patented the compound in 1900, after the German chemist Felix Hoffmann's successful use of it to treat his father's severe arthritis. Finally, in 1950, the physician Lawrence Craven recognized that aspirin reduced the risk of heart attacks in men.2

HIV treatment as prevention in men who have sex with men: examining the evidence.

The potential for antiretroviral therapy to reduce HIV transmission, a strategy known as “treatment as prevention,”[1][1]–[4][2] is important in light of unrelenting HIV transmission. The Public Health Agency of Canada has estimated that the number of new cases of HIV infection in Canada in

Vijana Vijiweni II: a cluster-randomized trial to evaluate the efficacy of a microfinance and peer health leadership intervention for HIV and intimate partner violence prevention among social networks of young men in Dar es Salaam.

BackgroundIntimate partner violence (IPV) and sexually transmitted infections (STIs), including HIV, remain important public health problems with devastating health effects for men and women in sub-Saharan Africa. There have been calls to engage men in prevention efforts, however, we lack effective approaches to reach and engage them. Social network approaches have demonstrated effective and sustained outcomes on changing risk behaviors in the U.S. Our team has identified and engaged naturally occurring social networks comprised mostly of young men in Dar es Salaam in an intervention designed to jointly reduce STI incidence and the perpetration of IPV. These stable networks are locally referred to as “camps.” In a pilot study we demonstrated the feasibility and acceptability of a combined microfinance and peer health leadership intervention within these camp-based peer networks.Methods designWe are implementing a cluster-randomized trial to evaluate the efficacy of an intervention combining microfinance with health leadership training in 60 camps in Dar es Salaam, Tanzania. Half of the camps have been randomized to the intervention arm, and half to a control arm. The camps in the intervention arm will receive a combined microfinance and health leadership intervention for a period of two years. The camps in the control arm will receive a delayed intervention. We have enrolled 1,258 men across the 60 study camps. Behavioral surveys will be conducted at baseline, 12-months post intervention launch and 30-month post intervention launch and biological samples will be drawn to test for Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), and Trichomonas vaginalis (TV) at baseline and 30-months. The primary endpoints for assessing intervention impact are IPV perpetration and STI incidence.DiscussionThis is the first cluster-randomized trial targeting social networks of men in sub-Saharan Africa that jointly addresses HIV and IPV perpetration and has both biological and behavioral endpoints. Effective approaches to engage men in HIV and IPV prevention are needed in low resource, high prevalence settings like Tanzania. If we determine that this approach is effective, we will examine how to adapt and scale up this approach to other urban, sub-Saharan African settings.Trial registrationClinical Trials.gov: NCT01865383. Registration date: May 24, 2013.

Patients’ perception of long-term, low-molecular weight heparins for cancer-associated thrombosis (CAT): Treatment expectations, convenience, and satisfaction related to patient profile.

88 Background: In the TROPIQUE study CAT pts had high expectations for anticoagulant treatment &amp; long-term LMWH was perceived as convenient with high degree of treatment satisfaction. In this study, using the Perception of Anti-Coagulant Treatment Questionnaires (PACT-Q), we assessed the inpact of patient profile on treatment expectations, convenience and satisfaction. Methods: PACT-Q (1&amp;2) were proposed on a voluntarily basis to cancer pts recently diagnosed with symptomatic venous thromboembolism; the global mean scores±SD was correlated to pts characteristics. Results: 269 PACT-Q1 &amp; 139 PACT-Q2 were analysed &amp;135 pts done both of them. In all pts, the highest mean scores were for expectations of symptom relief (4.22±0.9), confidence in preventing clots (3.98±1.04) &amp; importance of simplicity of use (3.94±0.75). For clot prevention men were more confident (4.06±0.81) vs women (3.85±0.88). Expectations of symptom relief was higher in women (4.07±0.98) vs men (3.89±1.09). Importance of ease of use was higher in treated pts (4.27±0.89) vs no therapy (4.00±0.99) &amp; pts with age ≥ 49 (4.46±0.59) vs &lt; 49 years (3.98±1.07). At the end of the study, PACT-Q2 answers showed, an Anticoagulant Treatment Satisfaction scores of 62.9±16.7. 67.2% of pts felt strongly reassured &amp; 48.5% were satisfied with symptom decrease. 69.1% of pts were satisfied / very satisfied with their anticoagulant treatment. Treatment-related side effects were as expected (41.7%), better/much better than expected (45.5%). 80.6% of pts reported higher ease with tinzaparin and 76.2% with other LMWH. According to pts characteristics, satisfaction was higher in men (64.4±17.7) vs women (61.0±15.0), in non-metastatic (64.6±16.9) vs metastatic (61.1±16.2). ECOG (3-4) pts reported lower treatment convenience with higher satisfaction vs ECOG (0-1); 80.0% of ECOG (3-4) pts were satisfied/very satisfied with anticoagulant treatment. 70.0% of ECOG (1-0) patients stated symptom decrease &amp; 80.0 % a feeling of reassurance. Conclusions: pt’s profile influenced positively the perception of long-term LMWH treatment but not the convenience &amp; treatment satisfaction.

The invisibility of heterosexuality in HIV/AIDS prevention for men.

Heterosexual men have been a forgotten group for HIV/AIDS interventions and research. Our goal was to identify the different elements that interfere in the prevention of HIV/AIDS among heterosexual men, covering both traditional methods of prevention (especially safe sex practices and testing) and new strategies for prevention (pre- and post-sexual exposure prophylaxis, prevention treatment, and circumcision) in this population. This exploratory article consists of a nonsystematic review of the literature. We discuss the invisibility of heterosexual men in policies, in programs, and in health services. The several interventions analyzed are still poorly monitored and evaluated, so there is a lack of consistent evidence regarding the impact of prevention strategies in this population. Different masculinities, including hegemonic conceptions of masculinity, must be the foundation for interventions targeting men. Men must not be seen merely as a "bridge" in the spread of the HIV/AIDS epidemic, but also as victims of gender patterns that make them vulnerable.

Different preventions methods lead to different choices? Questions on HIV/AIDS prevention for men who have sex with men and other vulnerable populations.

On the basis of an ethnographic narrative on sexual interactions observed in urban parks in large Brazilian cities, the article discusses the adoption of new strategies and methods for AIDS prevention in vulnerable populations, especially in men who have sex with men (MSM). By following some guiding questions, the text debates when, why, with whom, and in which context the new prevention methods should be adopted. It emphasizes, in agreement to the initial narrative, the importance of taking into account the prevention strategies created by the population itself to manage HIV risk infection. It also addresses how prevention practices and messages are adapted and recreated by individuals and groups in an attempt to suit them to their sexual desires, practices, and choices. In this perspective, the article recommends the inclusion of the experiences and voices of individuals and groups considered vulnerable in the new AIDS prevention methods and programs targeted to them.

Osteoporosis-preventive behaviors and their promotion for young men.

Osteoporosis in men is a major and neglected public health issue. An experimental study with a sample of 37 young men tested an osteoporosis prevention education intervention to alter osteoporosis health beliefs and to increase osteoporosis-preventive behaviors, in order to determine effectiveness and make public health recommendations. After pretest, control and treatment interventions were administered, with the administration of a posttest 2 weeks later. For all osteoporosis health beliefs and osteoporosis-preventive behaviors measured, no group and time interaction was found to be statistically significant. Both groups had low perceived susceptibility to osteoporosis, low to moderate perceived severity of osteoporosis, high perceived benefits of exercise and calcium to prevent osteoporosis, low perceived barriers to exercise and calcium, and moderate to high levels of confidence in self-efficacy for exercise and calcium. Bouts of exercise per week were adequate; however, consumption of good sources of calcium per day appeared to be low. More research is needed for the promotion of osteoporosis prevention in men. Recommendations promoting preventive behaviors for men have been provided.

Pre-exposure prophylaxis for men and transgender women who have sex with men in Brazil: opportunities and challenges.

IntroductionThe World Health Organization recently released guidelines on the use of pre-exposure prophylaxis (PrEP) for prevention of HIV infection among men and transgender women (TGW) who have sex with men based on results of randomized clinical trials. The aim of this commentary is to discuss the opportunities and challenges of incorporating PrEP into the Brazilian continuum of HIV care and prevention for men who have sex with men (MSM) and TGW.DiscussionKey aspects of the AIDS epidemic among MSM and TGW in Brazil and the comprehensive Brazilian response to the epidemic are presented. The universal access to health care provided through the Brazilian Unified Health System (SUS) and the range of prevention and care services already available countrywide to HIV-positive individuals and at-risk MSM and TGW are identified as the main facilitators for the implementation of PrEP. Limited PrEP awareness among MSM, TGW and health care providers, low HIV testing frequency and low HIV risk perception among MSM and TGW represent the core challenges to be addressed. Data generated by demonstration projects in Brazil will provide an important contribution to PrEP rollout in Brazil.ConclusionsThe implementation of PrEP in Brazil is feasible. A synergistic rollout of treatment as prevention and PrEP will maximize public health and individual benefits of the country's comprehensive response to the AIDS epidemic.

Improvements in weight, HbA1C and fitness following lifestyle intervention: The PULSE trial for type 2 diabetes prevention in men

Introduction: Intensive lifestyle interventions have been successful in reducing the incidence of type 2 diabetes (T2D) though their feasibility on a larger scale has been debated. The aim of this study is to determine the feasibility and efficacy of the PULSE program (Prevention Using LifeStyle Education) – a self-administered lifestyle intervention for T2D prevention tailored for men.