Men In Prevention Research Articles

Michel Caraël and Judith R. Glynn (editors) HIV, Resurgent Infections and Population Change in Africa

Studies in Family PlanningVolume 41, Issue 3 p. 238-240 Free Access Michel Caraël and Judith R. Glynn (editors)HIV, Resurgent Infections and Population Change in Africa Audrey Pettifor, Audrey Pettifor Assistant Professor, Department of Epidemiology, Gillings School of Global Public, Health University of North Carolina at Chapel HillSearch for more papers by this author Audrey Pettifor, Audrey Pettifor Assistant Professor, Department of Epidemiology, Gillings School of Global Public, Health University of North Carolina at Chapel HillSearch for more papers by this author First published: 22 September 2010 https://doi.org/10.1111/j.1728-4465.2010.00249.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References Auvert, Bertran, Dirk Taljaard, Emmanuel Lagarde, Joëlle Sobngwi-Tambekou, Rémi Sitta, and Adrian Puren. 2005. “Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 Trial.” PLoS Medicine 2(11): e298. Bailey, Robert C., Stephen S. Moses, Corette B. Parker, et al. 2007. “Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial.” Lancet 369(9,562): 643– 656. Celum, Connie, Anna Wald, James Hughes, et al. 2008. “Effect of aciclovir on HIV-1 acquisition in herpes simplex virus 2 seropositive women and men who have sex with men: A randomised, double-blind, placebo-controlled trial.” Lancet 371(9,630): 2,109– 2,119. Celum, C., A. Wald, J.R. Lingappa, et al. 2010. “Acyclovir and transmission of HIV-1 from persons infected with HIV-1 and HSV-2.” New England Journal of Medicine 362(5): 427– 439. Dunkle, Kristin L., Rob Stephenson, Etienne Karita, et al. 2008. “New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda: An analysis of survey and clinical data.” Lancet 371(9,631): 2,183– 2,191. Gray, Ronald H., Godfrey Kigozi, David Serwadda, et al. 2007. “Male circumcision for HIV prevention in men in Rakai, Uganda: A randomised trial.” Lancet 369(9,562): 657– 666. Gregson, Simon, Geoffrey P. Garnett, Constance A. Nyamukapa, et al. 2006. “HIV decline associated with behavior change in eastern Zimbabwe.” Science 311(5,761): 664– 666. Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization, WHO). 2009. AIDS Epidemic Update '09. Geneva : UNAIDS. Volume41, Issue3September 2010Pages 238-240 ReferencesRelatedInformation

Which strategy best for fracture prevention in men after ADT?

Which strategy best for fracture prevention in men after ADT?

Male circumcision to reduce the risk of HIV and sexually transmitted infections among men who have sex with men

The success of male circumcision in reducing HIV acquisition among African heterosexuals has led to renewed interest in this biological intervention for HIV/sexually transmissible infection (STI) prevention in men who have sex with men (MSM). This review summarizes the available data on the association of circumcision and HIV/STI among MSM populations. Results of observational studies indicate that circumcision has limited impact on HIV/STI acquisition among MSM populations overall. Longitudinal data suggest that circumcision may reduce the risk of incident syphilis, but there is little evidence of a protective effect for other STIs. The subgroup of MSM who predominantly practise the insertive role in anal intercourse may be at lower risk of HIV, although the relative inefficiency of HIV acquisition for insertive compared with receptive partners has resulted in imprecise estimates of effect. The evidence that circumcision reduces HIV and other STIs among MSM is weak and inconsistent. However, recent studies have found that circumcised MSM who predominantly take the insertive role in anal intercourse may be at a lower risk of HIV infection. Although MSM may be willing to undergo adult circumcision, should it be proven to reduce HIV acquisition risk, there is substantial potential that behavioural disinhibition could offset any benefits achieved by a circumcision intervention.

Fracture prevention in men

The lifetime risk of experiencing a fracture in 50-year-old men is lower (20%) than the risk in women (50%). Consequently, much less research has been carried out on osteoporosis and fracture risk in men. Differences in the risk and incidence of fractures between men and women are related to differences in bone-related and fall-related factors between the sexes. During the past decade, progress has been achieved in case finding and fracture prevention in men. Epidemiology studies have better specified the prevalence and incidence of fractures, and insight into the pathophysiology of osteoporosis and fractures in men has progressed considerably. Case finding for men and women at the highest risk of fracture is now possible using the FRAX algorithm, which includes clinical risk factors, with and without bone mineral density, and allows calculation of an individual's 10-year fracture risk. Although strategies to prevent fractures are much less common in men than in women, several treatment options are now available for this purpose. Bisphosphonates, in particular, consistently demonstrate a positive effect on bone mineral density, and some data also indicate decreased rates of vertebral fractures. For men with severe osteoporosis, treatment with the anabolic agent teriparatide might be an effective option.

Aspirin for the Prevention of Cardiovascular Disease: U.S. Preventive Services Task Force Recommendation Statement

Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation about the use of aspirin for the prevention of coronary heart disease. Review of the literature since 2002, focusing on new evidence on the benefits and harms of aspirin for the primary prevention of cardiovascular disease, including myocardial infarction and stroke. The new evidence was reviewed and synthesized according to sex. Encourage men age 45 to 79 years to use aspirin when the potential benefit of a reduction in myocardial infarctions outweighs the potential harm of an increase in gastrointestinal hemorrhage. (A recommendation) Encourage women age 55 to 79 years to use aspirin when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage. (A recommendation) Evidence is insufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older. (I statement) Do not encourage aspirin use for cardiovascular disease prevention in women younger than 55 years and in men younger than 45 years. (D recommendation).

Response to Letter by Mascitelli et al

Response: Dr Mascitelli and colleagues indicate that our exploratory analysis of the relative effects of high dose atorvastatin on secondary stroke prevention in men and women1 did not mention an increased risk of hemorrhagic stroke with treatment. The stroke outcomes included all strokes (ischemic and hemorrhagic). It is not appropriate to perform analyses of subgroups of subgroups.2 Caution must always be used when conducting exploratory analyses.3 In this report, we appropriately tested for statistical interactions between treatment and gender for the SPARCL prespecified primary and secondary end points and found no statistical heterogeneity in the benefit of treatment. In …

Intakes of fruit, vegetables, and specific botanical groups in relation to lung cancer risk in the NIH-AARP Diet and Health Study.

Increased fruit and vegetable consumption may protect against lung cancer, although epidemiologic findings are inconclusive. The authors prospectively examined associations between lung cancer risk and intakes of fruit, vegetables, and botanical subgroups in 472,081 participants aged 50-71 years in the National Institutes of Health (NIH)-AARP Diet and Health Study. Diet was assessed at baseline (1995-1996) with a 124-item dietary questionnaire. A total of 6,035 incident lung cancer cases were identified between 1995 and 2003. Total fruit and vegetable intake was unrelated to lung cancer risk in both men and women. Higher consumption of several botanical subgroups, however, was significantly inversely associated with risk, but only in men. For example, the relative risks of lung cancer among men in the highest versus lowest quintiles of intake of rosaceae, convolvulaceae, and umbelliferae were 0.82 (95% confidence interval (CI): 0.73, 0.91), 0.86 (95% CI: 0.75, 0.96), and 0.86 (95% CI: 0.78, 0.96), respectively; corresponding relative risks in women were 0.97 (95% CI: 0.85, 1.12), 0.95 (95% CI: 0.83, 1.09), and 0.92 (95% CI: 0.80, 1.06). These results provide support for a protective role of specific botanical subgroups of fruits and vegetables in lung cancer prevention in men, although the findings could also be due to residual confounding by smoking or chance.

Combination Polypharmacy for Cardiovascular Disease Prevention in Men: A Decision Analysis and Cost‐Effectiveness Model

Pharmacotherapies to lower blood pressure and cholesterol are effective in the primary prevention of cardiovascular disease (CVD). The use of fixed-dose medication combinations has not been well studied. The authors created a Markov model to analyze the cost-effectiveness of 4 fixed-dose medications for primary CVD prevention in men. The initial decision node was to treat or not treat men older than 55 years, without CVD, hypertension, or dyslipidemia with a combination of simvastatin, captopril, hydrochlorothiazide, and atenolol. Probability, costs, and effectiveness were derived from the literature. The outcome variable was marginal cost per quality-adjusted life-year (QALY). Sensitivity analyses were performed. The average cost of treatment was $70,000 compared with $93,000 for non-treatment. Treatment resulted in 13.62 QALYs vs 12.96 QALYs without treatment. Primary prevention of CVD with fixed-dose medications dominated "no-treatment." The use of a fixed-dose polypharmacy approach to CVD prevention in men older than 55 years may be cost-effective.

Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial

Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial

Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial

Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial

Value of Prevention for Men and Their Families

Value of Prevention for Men and Their Families

Psychosocial and behavioral aspects of cardiovascular disease prevention in men and women

Cardiovascular disease is a serious threat to population health. The true causes are not fully known, but a number of biological and behavioral risk factors have been identified. In this review we aim at understanding psychosocial, behavioral and lifestyle factors and their role in clinical care of patients with cardiovascular disease. We describe recent scientific evidence of psychosocial and life style risk and behavioral interventions to reduce risk in cardiovascular disease. We also discuss whether intervention programs are effective against cardiovascular disease and its risk factors, and whether they are of benefit to the patients. Gender aspects and ethnic variations are highlighted. In recent European Guidelines of CVD Prevention in Clinical Practice, behavioral factors have become recognized to be true risk factors and identified as important barriers to lifestyle change for patients with cardiovascular disease. Lifestyle changes play a pivotal role in clinical prevention of cardiovascular disease, as they are recommended as the first choice of intervention modalities before pharmacological treatment is initiated. While there is now common agreement about the importance of psychosocial risk factors for cardiovascular disease, a better consensus about intervention methods is needed in order to evaluate and appreciate the future scientific evidence from behavioral cardiovascular preventive efforts.

Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial

Ecological and observational studies suggest that male circumcision reduces the risk of HIV acquisition in men. Our aim was to investigate the effect of male circumcision on HIV incidence in men. 4996 uncircumcised, HIV-negative men aged 15-49 years who agreed to HIV testing and counselling were enrolled in this randomised trial in rural Rakai district, Uganda. Men were randomly assigned to receive immediate circumcision (n=2474) or circumcision delayed for 24 months (2522). HIV testing, physical examination, and interviews were repeated at 6, 12, and 24 month follow-up visits. The primary outcome was HIV incidence. Analyses were done on a modified intention-to-treat basis. This trial is registered with ClinicalTrials.gov, with the number NCT00425984. Baseline characteristics of the men in the intervention and control groups were much the same at enrollment. Retention rates were much the same in the two groups, with 90-92% of participants retained at all time points. In the modified intention-to-treat analysis, HIV incidence over 24 months was 0.66 cases per 100 person-years in the intervention group and 1.33 cases per 100 person-years in the control group (estimated efficacy of intervention 51%, 95% CI 16-72; p=0.006). The as-treated efficacy was 55% (95% CI 22-75; p=0.002); efficacy from the Kaplan-Meier time-to-HIV-detection as-treated analysis was 60% (30-77; p=0.003). HIV incidence was lower in the intervention group than it was in the control group in all sociodemographic, behavioural, and sexually transmitted disease symptom subgroups. Moderate or severe adverse events occurred in 84 (3.6%) circumcisions; all resolved with treatment. Behaviours were much the same in both groups during follow-up. Male circumcision reduced HIV incidence in men without behavioural disinhibition. Circumcision can be recommended for HIV prevention in men.

The ABCs of HIV Prevention in Men

To elucidate associations between beliefs in abstinence, fidelity, and condom use (the "ABCs" of preventing HIV and other sexually transmitted infections) and associated self-reported risk behaviors among Kenyan men. We assessed associations of beliefs in the ABCs with sociodemographic characteristics and sexual risk behaviors in a respondent-driven sample of 500 men in Nairobi. Younger age, single marital status, and higher education were associated with beliefs in abstinence and condom use as "best" prevention methods; and older age and marriage were associated with belief in fidelity. Many of these and other associations persisted in multivariate models. Men citing abstinence or fidelity belief less often reported sex with a female sex worker (FSW) ever or recent concurrent partnerships less often. Belief in fidelity was negatively associated with reported use of condoms ever. Belief in condom use to prevent HIV was most common among those having recent concurrent partnerships. Beliefs in abstinence, fidelity ("being faithful"), or condom use were associated, in plausible directions, with life stages and other demographic factors and with corresponding risk and preventive behaviors. Context-specific and selective educational promotion of individual ABC components rather than comprehensive education from an early age in a wide repertoire of prevention strategies ignores the evolution of sexual behaviors and the relative utility of different approaches throughout the life course.

Prevention With HIV-Infected Men: Recommendations for Practice and Research

In the United States in 2004, 74% of the new AIDS cases and 70% of the new HIV cases were in men; in addition, 75% of the cases of HIV in women were classified as heterosexually acquired. These numbers make it clear that expanded prevention efforts for men who are infected with HIV would make a large contribution to containing the epidemic. This report explores epidemiologic and psychosocial issues related to prevention in men with HIV and compares how those variables relate to prevention efforts. The report ends with a discussion of a method to approach HIV risk reduction in clinical care settings.

What’s new in stroke prevention and treatment

This review summarizes the latest results and developments in stroke prevention and acute treatment studies published in 2004 and 2005. In contrast to primary prevention in men, aspirin did not significantly reduce the risk of myocardial infarction or death from cardiovascular causes in women over 45 years of age. Patients with symptomatic intracranial stenosis do not benefit from secondary prevention with oral anticoagulation. Magnetic resonance-based acute stroke studies with recombinant tissue plasminogen activator (rtPA) or with desmoteplase, a new thrombolytic agent, showed similar safety and potential benefit beyond the 3-h time window, as with the established inclusion criteria of rtPA. The surgical trial in intracerebral hemorrhage (STICH) failed to demonstrate any benefit for early operative evacuation of hematoma. The authors aim to provide a wide overview of stroke prevention and acute treatment studies published in 2004 and 2005. Relevant journals were hand-searched to compile a broad, but not comprehensive, summary of innovative and clinically relevant findings. A short critical evaluation at the end of selected reviews should encourage the reader to further reading of studies of interest.

We-W45:2 Dietary counseling for coronary prevention in men with long standing hyperlipidemia

We-W45:2 Dietary counseling for coronary prevention in men with long standing hyperlipidemia

Male involvement in cardiovascular preventive healthcare in two rural Costa Rican communities

Background Gender differences in health system usage can lead to differences in the incidence of morbidity and mortality. We conducted a pilot screening targeted towards men to evaluate gender differences in cardiovascular disease risk factor detection and time since last clinic visit. Methods Three evening sessions in two communities screened 148 people, mean age 47.7 years. Height, weight, body mass index, blood pressure, blood glucose, and total cholesterol were measured. A questionnaire on past medical history was administered. Participants with elevated measurements were referred to appropriate care. Results Men accounted for 60.1% of those screened; 65.5% of the group was overweight, and 22.3% was obese with 42.6% hypertension, 39.2% hypercholesterolemia, and 2.7% high blood glucose. Among men aged 35 to 65, 65.2% were overweight, 20.3% obese, 46.4% hypertensive, 42.0% hypercholesterolemic, and 1.5% with high blood glucose. Within the last 2 years, 53.3% of men and 9.1% of women aged 35 to 65 had not visited a doctor ( P = 0.004). Conclusions A significant portion of those screened had elevated cardiovascular disease risk factors. Given that men visited doctors significantly less frequently, efforts to involve men in prevention of cardiovascular disease within these communities are warranted.

Testosterone for secondary prevention in men with ischaemic heart disease?

Atherosclerotic coronary artery disease (CAD) is a leading cause of mortality and morbidity in the western world. It is a chronic progressive condition, and treatment is required indefinitely. Men are more than twice as likely as women to develop CAD:1 this ratio is consistent in all populations and is not related to differences in risk factors. Pre-menopausal females have a lower incidence of CAD, but this rises after the menopause, so that the risk of CAD rapidly approaches that of males after about 10 years. One explanation for these epidemiological observations is that female hormones protect against the development of CAD. Observational studies of hormone replacement therapies in women have suggested some benefit,2 but large randomized controlled trials have failed to show protective effects.3,,4 Little attention has been paid to the role of testosterone in the pathogenesis of CAD. Males do not have a menopause equivalent, but sex hormones do fall with advancing age.5,,6 The more elderly population, in which the prevalence of CAD is highest, has relatively low testosterone levels. Furthermore, males with CAD have lower testosterone levels than men with normal coronary angiograms males of the same age.7 Moreover, there is evidence that testosterone therapy delays the onset of cardiac ischaemia,8 probably as a consequence of a coronary vasodilator mechanism,8 improving the symptom of angina.8,,10 The ability of testosterone replacement therapy to alter disease progression to reduce events or mortality has not been examined. In this article, we review the effects of testosterone therapy on factors known to influence cardiovascular risk, and propose a justification for further studies into its use for males with coronary disease as secondary prevention. Testosterone has well-established functions in the adult male. It induces secondary sexual characteristics, and is …

Anthropological assessment for culturally appropriate interventions targeting men who have sex with men.

Although social and cultural factors play a fundamental role in the health of sexual minority populations and the development of culturally appropriate interventions, public health activities and research have sometimes lacked appropriate sophistication or attention to issues of cultural competency. In areas such as HIV prevention for men who have sex with men (MSM), biomedical interpretations of same-sex phenomena should be applied with caution. Communities and societies may broadly understand same-sex desire, attraction, behavior, and identity through age-structured/initiatory, gender-defined, profession/social role-defined, or egalitarian/gay frameworks. When more detailed, locally specific information is required, such as for youth, ethnic minorities, or urban versus rural populations, the approach to rapid anthropological assessment presented can provide nuanced insights for effective health programs targeting MSM.