Prevent HIV Infection Research Articles

HIV risk assessment tools for identifying individuals who could benefit from pre-exposure prophylaxis: a systematic review protocol

BackgroundPre-exposure prophylaxis (PrEP) is a highly effective, safe and acceptable intervention for preventing HIV infection. However, identifying individuals who could best benefit from PrEP remains a significant challenge. Existing HIV...

State of the ART (antiretroviral therapy): Long-acting HIV-1 therapeutics.

Human immunodeficiency virus (HIV) impacts millions of individuals worldwide, and well over 2/3 of those living with HIV are accessing antiviral therapies that are successfully repressing viral replication. Most often, HIV treatments and prevention are administered in the form of daily pills as combinations of multiple drugs. An emergent and effective strategy for suppressing viral replication is the application of long-acting antiretroviral therapy (LAART), or antivirals that require less-frequent, non-daily doses. Thus far, the repertoire of LAARTs includes the widely used antiviral classes of non-nucleoside reverse transcriptase inhibitors (NNRTIs) and integrase strand transfer inhibitors (INSTIs) and has recently expanded to include a capsid-targeting antiviral. Possible future additions are nucleoside reverse transcriptase inhibitors (NRTIs) and nucleoside reverse transcriptase translocation inhibitors (NRTTIs). Here, we discuss the different strategies of using long-acting compounds to treat or prevent HIV-1 infection by targeting reverse transcriptase, integrase, and capsid.

Human genital dendritic cell heterogeneity confers differential rapid response to HIV-1 exposure.

Dendritic cells (DCs) play critical roles in HIV pathogenesis and require further investigation in the female genital tract, a main portal of entry for HIV infection. Here we characterized genital DC populations at the single cell level and how DC subsets respond to HIV immediately following exposure. We found that the genital CD11c+HLA-DR+ myeloid population contains three DC subsets (CD1c+ DC2s, CD14+ monocyte-derived DCs and CD14+CD1c+ DC3s) and two monocyte/macrophage populations with distinct functional and phenotypic properties during homeostasis. Following HIV exposure, the antiviral response was dominated by DCs' rapid secretory response, activation of non-classical inflammatory pathways and host restriction factors. Further, we uncovered subset-specific differences in anti-HIV responses. CD14+ DCs were the main population activated by HIV and mediated the secretory antimicrobial response, while CD1c+ DC2s activated inflammasome pathways and IFN responses. Identification of subset-specific responses to HIV immediately after exposure could aid targeted strategies to prevent HIV infection.

Dinámica de los receptores de quimioquinas en la membrana celular

Chemokines are chemotactic cytokines that control the migratory patterns and positioning of many cells, including immune cells. Although chemokines were initially considered to be important mediators of acute inflammation, we now know that this complex system of ligands and receptors is essential for the generation of primary and secondary adaptive cellular and humoral immune responses. In addition, they also trigger other biological responses ranging from cell polarization or movement or the prevention of HIV-1 infection. Chemokine-mediated cell activation was believed to be due to the binding of a monomeric chemokine to its monomeric receptor. However, the biology of these mediators is more complex than initially anticipated, as several studies indicate that chemokines dimerize. In addition, the use of new advanced optical imaging techniques have made possible to determine that the receptors also form dimers, homo- and heterodimers, as well as higher order oligomers at the cell surface. These are very dynamic and plastic structures/conformations, influenced by the presence of ligands, the co-expression of other receptors and proteins, the lipid composition of the cell membrane or the environment where cells perform their function. Keywords: Chemokines; Chemokine receptors; Receptor conformation; Molecular dynamics; Signaling

The Effect of Age on Human Immunodeficiency Virus Risk Related Behaviors among Undergraduate Students at a Historically Black College and University in the United States of America

Objective: HIV infections have taken a heavy toll on young adults in the USA. Most undergraduate students fall within the age group who are at high risk of HIV infections. The effect of age on HIV risk related behaviors among African American undergraduate students has never been investigated before. Thus, this study assessed the effect of age on HIV risk related behaviors among African American undergraduate students at a Historically Black College and University. Methods: A total of 400 respondents were randomly selected from Jackson State University of the USA, a Historically Black College and University. A cross-sectional study design was utilized from January to September, 2016. Data were collected using a validated self-administered standardized questionnaire. Chi-square test was used to see the association between age and HIV risk related behaviors. Results: Over seventy five percent of the study participants have had at least one risk behavior related to HIV infection transmission and there was significant statistical difference between students aged 18-24 years and students aged 25 years and above (p<0.05). The students aged 18-24 years were more likely to participate in risk behaviors that could predispose them to HIV infections (P = 0.02). Conclusions: As the HIV related risk behaviors was higher among students aged 18-24 years old, age appropriate HIV preventive programs that are appealing to young people will be required to effectively prevent HIV infection among this vulnerable population.

Perspectives on a peer-driven intervention to promote pre-exposure prophylaxis (PrEP) uptake among men who have sex with men in southern New England: a qualitative study

BackgroundPre-exposure prophylaxis (PrEP) is a highly effective pharmaceutical intervention that prevents HIV infection, but PrEP uptake across the US has been slow among men who have sex with men (MSM), especially among Black/African American (B/AA) and Hispanic /Latino (H/L) MSM. This study investigates the acceptability and essential components of a peer-driven intervention (PDI) for promoting PrEP uptake among MSM, with a specific focus on B/AA and H/L communities.MethodsWe conducted 28 semi-structured, qualitative interviews with MSM in southern New England to explore the components of a PDI, including attitudes, content, and effective communication methods. A purposive sampling strategy was used to recruit diverse participants who reflect the communities with the highest burden of HIV infection. ResultsOf 28 study participants, the median age was 28 years (interquartile range [IQR]: 25, 35). The sample comprised B/AA (39%, n = 11) and H/L (50%, n = 14) individuals. Notably, nearly half of the participants (46%) were current PrEP users. We found that many participants were in favor of using a PDI approach for promoting PrEP. Additionally, several participants showed interest in becoming peer educators themselves. They emphasized the need for strong communication skills to effectively teach others about PrEP. Moreover, participants noted that peer education should cover key topics like how PrEP works, how effective it is, and any possible side effects.ConclusionsOur study shows that effective PDIs, facilitated by well-trained peers knowledgeable about PrEP, could enhance PrEP uptake among MSM, addressing health disparities and potentially reducing HIV transmission in B/AA and H/L communities.

Lenacapavir to prevent HIV infection: current prices versus estimated costs of production.

Despite improvements in treatment and oral pre-exposure prophylaxis (PrEP) access, 1.3 million people acquired HIV in 2022. Six-monthly lenacapavir PrEP could benefit tens of millions of people at high risk of infection. However, prices are currently up to $44 819 per person per year (pppy). We projected minimum lenacapavir pricing based on generic mass production and a Cost-Plus (Cost+) model. Current active pharmaceutical ingredient (API) and key starting materials (KSMs) costs were obtained from export databases. The routes of synthesis (ROS) were analysed to project a cost of goods (COGs). Formulation, vials and profit margin costs were included using standardized algorithms and Cost+ pricing. We estimated prices with scale-up to supply 1 million then 10 million treatment-years, comparing this with national list prices. The lenacapavir API is currently exported from India for $64 480/kg on 1 kg scale. Based on the ROS and KSMs, API COGs of $25 000/kg and $10 000/kg are achievable for a committed demand of 1 million (2 million tonnes/annum of API) and 10 million treatment-years, respectively. Including formulation steps, injectable lenacapavir could be mass produced for approximately $94 pppy for 1 million and $41 for 10 million treatment-years, if voluntary licences are in place and competition between generic suppliers substantially improves. Greater scale-up with improvements in manufacturers' ROS could reduce prices further. Currently lenacapavir costs $25 395-44 819 pppy. Lenacapavir could be mass produced for <$100 pppy at launch. Voluntary licensing and multiple suppliers are required to achieve these low prices. This mechanism is already in place for other antiretrovirals. To date, Gilead has not agreed lenacapavir voluntary licences with the Medicines Patent Pool.

Sexual behaviors and HIV-related knowledge among GBMSM: evidence from 2011 to 2021 in Hangzhou, China.

Considering that many new HIV infections are transmitted by homosexual behaviors, gay, bisexual, and other men who have sex with men (GBMSM) are more likely to be infected with HIV than other groups due to the higher risk associated with unprotected anal intercourse. It is important to explore the changes in sexual behaviors and HIV-related knowledge among GBMSM in the last 10 years, which could provide evidence for improving public health interventions to reduce HIV infections. The study sought to explore the changes of 3 sexual behaviors and HIV knowledge among men who have sex with men from 2011 to 2021. Data were collected from national HIV sentinel surveillance among GBMSM in Hangzhou conducted between 2011 and 2021. Univariate and multivariate logistic regression were used to analyze the associated factors of sexual behaviors. The variation trend of variables was evaluated based on the linear trend test in the regression model. A total of 5111 GBMSM with an average age of 32.00years were incorporated in the analysis. From 2011 to 2021, the HIV-related knowledge score of GBMSM ranged from 6 to 7.5, and it increased significantly (P trend < .001). The rate of homosexual sex in the past 6months remained at a high level (75.06%-82.75%). Homosexual behavior was associated with a higher HIV-related knowledge score (P = .004). Heterosexual sex was associated with an increase in the old age, married persons, and domicile outside the province (P < .05). Commercial sex was associated with an increase in drug users (P <.001). In the past 10 years, HIV-related knowledge of GBMSM increased and the rate of unprotected sex was at a high level among GBMSM, especially in heterosexual behaviors. Moreover, the likelihood of having homosexual behaviors is raised with the increasing HIV-related knowledge. Conducting precise behavioral interventions for GBMSM are crucial for preventing HIV infection.

Acetylation of SAMHD1 at lysine 580 is crucial for blocking HIV-1 infection.

In humans, sterile alpha motif (SAM) domain- and histidine-aspartic acid (HD) domain-containing protein 1 (SAMHD1) is a dNTPase enzyme that prevents HIV-1 infection in non-cycling cells, such as differentiated THP-1 cells and human primary macrophages. Although phosphorylation of threonine 592 (T592) in SAMHD1 is recognized as the primary regulator of the ability to prevent HIV-1 infection, the contributions of SAMHD1 acetylation to this ability remain unknown. Mass spectrometry analysis of SAMHD1 proteins derived from cycling and non-cycling THP-1 cells, primary cycling B cells, and primary macrophages revealed that SAMHD1 is preferentially acetylated at lysine residues 354, 494, and 580 (K354, K494, and K580). In non-cycling cells, SAMHD1 is preferentially acetylated at K580, suggesting that this post-translational modification may contribute to the ability of SAMHD1 to block HIV-1 infection. Consistent with this finding, we found that mutations in K580 disrupted the ability of SAMHD1 to block HIV-1 infection without affecting the ability of SAMHD1 to deplete cellular dNTP levels. Gene editing of SAMHD1 in macrophage-like cells revealed that an intact K580 is required for HIV-1 restriction. This finding suggests that K580 acetylation in SAMHD1 is essential for blocking HIV-1 infection. More importantly, we found that a larger proportion of SAMHD1 featuring K580 acetylation could be detected in human primary macrophages when compared to human primary monocytes. In agreement, we found that SAMHD1 is acetylated during the monocyte-to-macrophage differentiation process. This finding agrees with the idea that the blockade of HIV-1 infection in macrophages requires SAMHD1 acetylation.IMPORTANCEThe natural inhibitor of HIV-1, sterile alpha motif (SAM) domain- and histidine-aspartic acid (HD) domain-containing protein 1 (SAMHD1), plays a pivotal role in preventing HIV-1 infection of macrophages and dendritic cells, which are vital components of the immune system. This study unveils that SAMHD1 undergoes post-translational modifications, specifically acetylation at lysines 354, 494, and 580. Our research underscores the significance of these modifications, demonstrating that acetylation at residue K580 is indispensable for SAMHD1's efficacy in blocking HIV-1 infection. Notably, K580 is found in a critical regulatory domain of SAMHD1, highlighting acetylation as a novel layer of SAMHD1 regulation for HIV-1 restriction in humans. A comprehensive understanding of the regulation mechanisms governing this anti-HIV-1 protein is crucial for leveraging nature's defense mechanisms against HIV-1 and could pave the way for innovative therapeutic strategies.

Asymptomatic Rectal Bacterial Pathogens Show Large Prospective Relationships With HIV Incidence in a Cohort of Young Sexual and Gender Minorities: Implications for STI Screening and HIV Prevention.

We estimated the predictive value of rectal (bacterial sexually transmitted infection [bSTI]) pathogen detection for future HIV seroconversion among young adult sexual and gender minorities (YSGMs) assigned male at birth (AMAB). Data were collected between March 2018 and August 2022 from RADAR, a longitudinal cohort study of YSGMs AMAB living in the Chicago metropolitan area (n = 1022). Rates of rectal bSTIs and the proportion of self-reported rectal bSTI symptoms are reported. We examined whether the presence of rectal bSTIs predicted HIV seroconversion using generalized estimating equations (GEEs). Participants tested reactive for rectal Mycoplasma genitalium (MGen), Neisseria gonorrhoeae (NG), and Chlamydia trachomatis (CT) at a rate of 20.8 (95% CI, 18.4-23.5), 6.5 (95% CI, 5.0-8.2), and 8.4 (95% CI, 6.8-10.3) cases per 100 persons, respectively. There were no statistically significant pairwise differences in self-reported rectal bSTI symptoms between participants with self-collected swabs testing nonreactive vs reactive for rectal MGen (χ2 = 0.04; P = .84), NG (χ2 = 0.45; P = .37), or CT (χ2 = 0.39; P = .46). In multivariate GEE analysis, rectal NG (adjusted odds ratio, 5.11; 95% CI, 1.20-21.77) was a statistically significant predictor of HIV seroconversion after controlling for other bSTIs, demographics, and sexual risk behavior. Our findings provide a robust longitudinal estimation of the relationship between primarily asymptomatic rectal NG nucleic acid detection and HIV infection. These findings highlight the importance of asymptomatic screening for bSTIs and targeting biobehavioral intervention to prevent HIV infection among YSGMs with rectal bSTI agents detected.

How the Use of prep (Pre-exposure Prophylaxis) Helps to Prevent HIV Infection in Malaysia

Background: HIV remains a significant public health challenge in Malaysia, affecting key populations such as men who have sex with men (MSM), transgender individuals, sex workers, and people who inject drugs (PWID). Despite advancements in prevention and treatment, HIV continues to be a leading cause of morbidity and mortality. Pre-exposure prophylaxis (PrEP) has emerged as a promising biomedical intervention, utilizing antiretroviral tablets (ARVs) to significantly reduce the risk of HIV infection in HIV-negative individuals. Methods and Materials: This study investigates the effectiveness of PrEP in preventing HIV transmission among high-risk groups in Malaysia. The research examines the mechanism of action of the two primary drugs used in PrEP—tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC)—and analyzes data from various studies, including the iPrEx, Partners PrEP, PROUD, and IPERGAY studies. Additionally, it addresses the challenges of implementing PrEP in Malaysia, such as stigma, adherence issues, and integration with existing HIV services. Results: PrEP has shown to reduce the risk of HIV infection by more than 90% when used consistently. The iPrEx study demonstrated a 44% reduction in HIV risk, increasing to 92% with consistent use. The Partners PrEP study indicated a 75% reduction, with a potential 90% decrease with strict adherence. The PROUD and IPERGAY studies reinforced these findings, showing 86% reductions in HIV risk. Despite its proven efficacy, the implementation of PrEP in Malaysia faces barriers such as stigma, prejudice, and adherence challenges. Conclusion: PrEP is a highly effective strategy for reducing HIV transmission among high-risk populations in Malaysia. To maximize its potential impact, it is crucial to address barriers to implementation, including stigma, adherence issues, and integration with existing healthcare services. Mathematical modeling suggests that widespread PrEP use could lead to a significant decrease in new HIV infections, potentially reducing cases among MSM by 30% over a decade. Learning from successful PrEP programs in other countries, Malaysia should focus on supportive policies, community engagement, affordability, and adherence support to effectively combat the HIV epidemic.

HIV broadly neutralizing antibody escapability drives the therapeutic efficacy of vectored immunotherapy.

Broadly neutralizing antibodies (bNAbs) have shown great promise for prevention and treatment of HIV infection. Breadth of bNAb neutralization, measured in vitro across panels of diverse viral isolates, is often used as a predictor of clinical potential. However, recent prevention studies demonstrate that the clinical efficacy of a broad and potent bNAb (VRC01) is undermined by neutralization resistance of circulating strains. Using HIV-infected humanized mice, we find that therapeutic efficacy of bNAbs delivered as Vectored ImmunoTherapy (VIT) is a function of both the fitness cost and resistance benefit of mutations that emerge during viral escape, which we term 'escapability'. Applying this mechanistic framework, we find that the sequence of the envelope V5-loop alters the resistance benefits of mutants that arise during escape, thereby impacting the therapeutic efficacy of VIT-mediated viral suppression. We also find that an emtricitabine-based antiretroviral drug regimen dramatically enhances the efficacy of VIT, by reducing the fitness of mutants along the escape path. Our findings demonstrate that bNAb escapability is a key determinant to consider in the rational design of antibody regimens with maximal efficacy and illustrates a tractable means of minimizing viral escape from existing bNAbs.

Online health information seeking, health anxiety and cyberchondria among men who engage in sexual risk taking: The mediating role of medical consultation about HIV/AIDS

AbstractThe rapid development of electronic communication technology has brought about a revolutionary transformation in health information seeking and medical consultation. Beyond traditional avenues like seeking assistance from doctors in hospitals, individuals now have the option to engage in online medical consultations, enhancing their ability to manage routine health effectively. However, an overreliance on online medical consultations driven by heightened health anxiety may contribute to the surge in online health information inquiries, a phenomenon positively associated with the emergence of cyberchondria. In the context of China, where HIV/AIDS is socially stigmatised, cyberchondria related to HIV infection becomes particularly noteworthy. This study delves into the potential consequences of online health information seeking (OHIS) with a specific focus on Kongai BBS, a platform catering for individuals with a fear of AIDS. Our research collected data from 309 male users actively participating in the BBS, who had engaged in high‐risk sexual behaviours in the past 6 months. Applying structural equation modelling (SEM), this study examines the intricate relationships between OHIS, health anxiety, online and offline medical consultations, and cyberchondria. The results indicate that online medical consultation serves as a mediator in the relationship between OHIS and cyberchondria, whereas offline medical consultation does not significantly impact this relationship. These findings contribute valuable insights into the interactive dynamics between online and offline medical consultations, offering practical implications for the prevention of HIV infection in China. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

Acceptability and appropriateness of information sessions to increase knowledge and awareness of PrEP and TelePrEP among Latina Women

ABSTRACT Women of color are disproportionately impacted by HIV. Although PrEP effectively prevents HIV infection, PrEP coverage and knowledge remain low in this population. To address barriers to PrEP, we implemented women-centered and culturally appropriate Information Sessions (IS) delivered by staff from the population they serve to increase knowledge, awareness, and use of PrEP through telemedicine (e.g., PlushCare). Our analysis focuses on Latina women (LW) participants, given the dearth of literature dedicated to the needs of LW. We partnered with a woman-led community-based organization (CBO) to implement the strategy with LW clients. Health educators conducted 26 IS with 94 LW (20 in Spanish and 6 in English). Participants who completed the IS were invited for interviews to assess the acceptability and appropriateness of the IS to increase knowledge and awareness of PrEP and PlushCare. Four themes emerged from the thematic analysis: (1) IS increased knowledge and awareness of PrEP and PlushCare; (2) perceived acceptability and appropriateness of IS; (3) insufficient reasons to warrant use of PrEP; and (4) positive attitudes about PlushCare. Our findings suggest that a women-centered and culturally appropriate IS implemented through a trusted, woman-led CBO is an acceptable and appropriate implementation strategy to inform LW about PrEP.

RAIN: machine learning-based identification for HIV-1 bNAbs

Broadly neutralizing antibodies (bNAbs) are promising candidates for the treatment and prevention of HIV-1 infections. Despite their critical importance, automatic detection of HIV-1 bNAbs from immune repertoires is still lacking. Here, we develop a straightforward computational method for the Rapid Automatic Identification of bNAbs (RAIN) based on machine learning methods. In contrast to other approaches, which use one-hot encoding amino acid sequences or structural alignment for prediction, RAIN uses a combination of selected sequence-based features for the accurate prediction of HIV-1 bNAbs. We demonstrate the performance of our approach on non-biased, experimentally obtained and sequenced BCR repertoires from HIV-1 immune donors. RAIN processing leads to the successful identification of distinct HIV-1 bNAbs targeting the CD4-binding site of the envelope glycoprotein. In addition, we validate the identified bNAbs using an in vitro neutralization assay and we solve the structure of one of them in complex with the soluble native-like heterotrimeric envelope glycoprotein by single-particle cryo-electron microscopy (cryo-EM). Overall, we propose a method to facilitate and accelerate HIV-1 bNAbs discovery from non-selected immune repertoires.

Missed Opportunities: A Narrative Review on Why Nonoccupational Postexposure Prophylaxis for HIV Is Underutilized.

Postexposure prophylaxis (PEP) is an important tool for preventing HIV infection but remains underutilized. In this narrative review, we aim to summarize the frequency of missed opportunities for prescribing PEP among studies from around the world, discuss the complexities of the challenges facing PEP provision, and describe possible solutions. We identified 20 studies published in the last 10 years among 43 832 individuals, of whom an estimated 41 477 were eligible for PEP. Of those eligible for PEP, PEP was prescribed among 27 705 (66.8%). There was a significant difference in PEP prescriptions in acute compared with non-acute care settings (63.5% vs 94.5%; P < .001). Emergent themes contributing to PEP underutilization included lack of provider and patient awareness, reduced PEP acceptability, HIV stigma and homophobia, lack of access (either to care or to medication), and stigmatizing policies. Each of those issues should be the focus of future PEP implementation efforts.

Scaling up a brief alcohol intervention to prevent HIV infection in Vietnam: a cluster randomized, implementation trial

BackgroundEvidence-based interventions (EBIs) often address normative behaviors. If a behavior is also common among clinicians, they may be skeptical about the necessity or effectiveness of an EBI. Alternatively, clinicians’ attitudes and behaviors may be misaligned, or they may lack the knowledge and self-efficacy to deliver the EBI. Several EBIs address unhealthy alcohol use, a common and often culturally acceptable behavior. But unhealthy alcohol use may be particularly harmful to people with HIV (PWH). Here, we present an implementation trial using an experiential implementation strategy to address clinicians’ knowledge, attitudes, and behaviors. Clinicians receive the experiential intervention before they begin delivering an evidence-based brief alcohol intervention (BAI) to PWH with unhealthy alcohol use.MethodsDesign: In this hybrid type 3 implementation-effectiveness cluster randomized controlled trial, ART clinics (n = 30) will be randomized 1:1 to facilitation, a flexible strategy to address implementation barriers, or facilitation plus the experiential brief alcohol intervention (EBAI). In the EBAI arm, clinicians, irrespective of their alcohol use, will be offered the BAI as experiential learning. EBAI will address clinicians’ alcohol-related attitudes and behaviors and increase their knowledge and confidence to deliver the BAI.Participants: ART clinic staff will be enrolled and assessed at pre-BAI training, post-BAI training, 3, 12, and 24 months. All PWH at the ART clinics who screen positive for unhealthy alcohol use will be offered the BAI. A subset of PWH (n = 810) will be enrolled and assessed at baseline, 3, and 12 months.Outcomes: We will compare implementation outcomes (acceptability, fidelity, penetration, costs, and sustainability) and effectiveness outcomes (viral suppression and alcohol use) between the two arms. We will assess the impact of site-level characteristics on scaling-up the BAI. We will also evaluate how experiencing the BAI affected clinical staff’s alcohol use and clinic-level alcohol expectations in the EBAI arm.DiscussionThis trial contributes to implementation science by testing a novel strategy to implement a behavior change intervention in a setting in which clinicians themselves may engage in the behavior. Experiential learning may be useful to address normative and difficult to change lifestyle behaviors that contribute to chronic diseases.Trial RegistrationNCT06358885 (04/10/2024), https://clinicaltrials.gov/study/NCT06358885.

Joint modeling of correlated binary outcomes using multivariate logistic regression: contraception and HIV knowledge in Sri Lanka

Reproductive health significantly contributes to the overall well-being and social welfare of women. Within the spectrum of modern and traditional contraceptive methods in use, condoms have been strongly advocated by numerous HIV programs as a primary means of preventing HIV infection in Sri Lanka. Given the intrinsic relationship between contraceptive utilization and HIV awareness, our study aims to concurrently analyze the patterns of contraceptive usage and HIV knowledge, while accounting for their potential correlation. In this study, we introduced the application of the Gumbel type II distribution to effectively capture the interdependence of these joint probabilities, accounting for various covariates. The outcome of simulation studies demonstrated the superior performance of the integrated joint model, in comparison to the separate univariate models. Our findings highlighted several noteworthy risk factors associated with both contraceptive usage and HIV prevention knowledge. These included variables such as residence, level of education, wealth quintile, husband's education level, number of children, engagement with the newspapers, television viewership, and mobile phone usage. The Result indicates a positive association between the adoption of contraception and the awareness of HIV prevention measures, suggesting that individuals who actively embrace contraception are more likely to possess knowledge about preventing HIV transmission.

Associations between perceived and actual risk of HIV infection and HIV prevention services uptake among men who have sex with men in Shandong province, China: a cross-sectional study

BackgroundAssociations between perceived and actual risk of HIV infection and HIV prevention services uptake are inconclusive. This study aimed to evaluate the discrepancy between the perceived and actual HIV risk, and quantify the associations between perceived and actual risk of HIV infection and three HIV prevention services utilization among men who have sex with men (MSM) in Shandong province, China.MethodsA cross-sectional study was conducted in Shandong province in June 2021. Participants were eligible if they were born biologically male, aged 18 years or older, had negative or unknown HIV status, and had sex with men in the past year. Participants were recruited online. The discrepancy between their perceived and actual risk of HIV infection was evaluated by calculating the Kappa value. Bayesian model averaging was used to assess the associations between perceived and actual risk of HIV infection and HIV prevention services uptake.ResultsA total of 1136 MSM were recruited, most of them were 30 years old or younger (59.9%), single (79.5%), with at least college education level (74.7%). Most participants (97.4%) perceived that they had low risk of HIV infection, and 14.1% were assessed with high actual risk. The discrepancy between their perceived and actual risk of HIV infection was evaluated with a Kappa value of 0.076 (P < 0.001). HIV testing uptake had a weak association with perceived high HIV prevalence among social networks (aOR = 1.156, post probability = 0.547). The perceived high HIV prevalence among national MSM was positive related to willingness to use PrEP (aOR = 1.903, post probability = 0.943) and PEP (aOR = 1.737, post probability = 0.829). Perceived personal risk (aOR = 4.486, post probability = 0.994) and perceived HIV prevalence among social networks (aOR = 1.280, post probability = 0.572) were related to history of using PrEP. Perceived personal risk (aOR = 3.144, post probability = 0.952), actual risk (aOR = 1.890, post probability = 0.950), and perceived risk among social networks (aOR = 1.502, post probability = 0.786) were related to history of using PEP.ConclusionsThere is discordance between perceived and actual personal risk of HIV infection among MSM in China. HIV risk assessment and education on HIV prevalence among MSM should be strengthened to assist high-risk populations aware their risk accurately and hence access HIV prevention services proactively.

Efficacy of Voluntary Medical Male Circumcision to Prevent HIV Infection Among Men Who Have Sex With Men : A Randomized Controlled Trial.

Observational studies suggest that voluntary medical male circumcision (VMMC) may lower HIV risk among men who have sex with men (MSM). A randomized controlled trial (RCT) is needed to confirm this. To assess the efficacy of VMMC in preventing incident HIV infection among MSM. An RCT with up to 12 months of follow-up. (Chinese Clinical Trial Registry: ChiCTR2000039436). 8 cities in China. Uncircumcised, HIV-seronegative men aged 18 to 49 years who self-reported predominantly practicing insertive anal intercourse and had 2 or more male sex partners in the past 6 months. VMMC. Rapid testing for HIV was done at baseline and at 3, 6, 9, and 12 months. Behavioral questionnaires and other tests for sexually transmitted infections were done at baseline, 6 months, and 12 months. The primary outcome was HIV seroconversion using an intention-to-treat analysis. The study enrolled 124 men in the intervention group and 123 in the control group, who contributed 120.7 and 123.1 person-years of observation, respectively. There were 0 seroconversions in the intervention group (0 infections [95% CI, 0.0 to 3.1 infections] per 100 person-years) and 5 seroconversions in the control group (4.1 infections [CI, 1.3 to 9.5 infections] per 100 person-years). The HIV hazard ratio was 0.09 (CI, 0.00 to 0.81; P = 0.029), and the HIV incidence was lower in the intervention group (log-rank P = 0.025). The incidence rates of syphilis, herpes simplex virus type 2, and penile human papillomavirus were not statistically significantly different between the 2 groups. There was no evidence of HIV risk compensation. Few HIV seroconversions and limited follow-up period. Among MSM who predominantly practice insertive anal intercourse, VMMC is efficacious in preventing incident HIV infection; MSM should be included in VMMC guidelines. The National Science and Technology Major Project of China.