Risk Factors For HIV Infection Research Articles

P09.33 Sexual behaviours and unprotected sex with casual and commercial partners among polysubstance users in brazil: findings from a respondent driven sampling study

Introduction Unprotected sexual intercourse (USI) is a known risk factor for HIV infection. And bisexual men (BSM) who engage in USI with casual and commercial partners may be at a higher risk. Our aim is to estimate prevalence of men having sex with men (MSM), BSM, and USI to guide prevention via sexual route among polysubstance users (PSUs). Methods A total of 3.449 PSUs were recruited in a cross-sectional study in 10 Brazilian cities through respondent driven sampling in 2009. Data was collected using audio computer-assisted self-interview. Estimates were weighted by the inverse of the participant’s social network size. Results Among 2,682 (73.7% of the sample) males, 4.4% referred having sex only with men (MSM), 16.2% with both men and women (BSM). 64.8% engaged in USI with commercial partnerships; whereas 47.1% of those exchanged sex for money/drugs 12 months before the interview. Casual partnerships 12 months before the interview were reported by 47.9% of men; whereas 62.3% of those reported USI with that casual partners. Conclusion It is urgent to design interventions among males PSUs in Brazil who engage in commercial and casual USI. Social interventions, education in health, and linkage to health services are needed to prevent sexual transmission of HIV in this group most at risk. Disclosure of interest statement This study was funded by the Brazilian Ministry of Health/Department of SDT/AIDS and viral hepatitis, with technical advisor from CDC Brazil. The first author is supported by a grant from the Brazilian National Research Council (CNPq) for his PhD studies.

P16.02 Predictors of hiv acquisition within 12 months of an hiv negative test in men who have sex with men

Introduction Studies of risk factors for HIV infection usually ascertain these at the time of diagnosis, when they are subject to multiple biases. This study aimed to identify factors present at the time of the last negative HIV test that could predict the risk of HIV acquisition within the next 12 months among men who have sex with men (MSM) attending a sexual health service in Australia. This may allow prioritisation of MSM for preventive interventions, which are becoming increasingly expensive. Methods We conducted a retrospective cohort study of MSM attending Melbourne Sexual Health Centre between 1 January 2007 and 31 December 2013 with at least two HIV tests within 12 months. Age, sexual behaviour, and bacterial STI diagnoses were extracted from the date of the last negative HIV test and HIV incidence rate ratios (RR) were calculated for each risk factor. Risk factor prevalence was compared among all MSM and those subsequently infected. Results Of 14745 MSM, 5262 were eligible, contributing 6525 person-years follow-up. 85 new HIV diagnoses were identified within 12 months of a HIV negative test with an incidence of 1.3 (95% CI: 1.0–1.6) per 100 person-years. Significant associations with subsequent HIV infection were: gonorrhoea at any site (RR: 4.1, 95% CI: 2.3–7.0), chlamydia RR: 3.9 (2.3–6.3), inconsistent condom use RR 2.7 (1.6–4.5), and injecting drugs RR 4.1 (1.7–8.6). Risk factor prevalences in tested MSM compared to those subsequently infected were: any bacterial STI (26% vs. 42%), inconsistent condom use (49% vs. 73%), any significant risk factors (60% vs. 83%). Conclusion This analysis of a large clinic cohort identified significant predictors of subsequent HIV infection that were present at the last negative HIV test, when preventive intervention would still be possible. These could be used to prioritise MSM for potentially costly interventions. Disclosure of interest statement We declare no conflict of interest.

P16.13 Epidemiology of hiv prevalence among urban women in tanzania

Introduction Tanzania is the country that was the hardest hit by the HIV epidemic in Sub-Saharan Africa. The present study was carried out to examine the risk factors of HIV infection among women who lived in an urban area in Tanzania. Methods The Tanzania HIV/AIDS and Malaria Indicator Survey (2011–12) data has been used. The sample size for urban and rural women who were tested for HIV and ever had sex was 2227 and 6210 respectively. Bivariate and multivariate analyses like logistic regression analyses were used. Results The present study found that rural women were significantly less likely to be HIV-infected compared to urban women (OR = 0.612, p Conclusion The present study results suggested that less-educated women, women belong to poor or poorer quintile, women spent night outside, had more sex partners were significantly more likely to had HIV infection among urban women compared to rural women. There is an urgent need for a short and effective program to control the HIV epidemic in urban areas of Tanzania especially for less-educated urban women. Disclosure of interest Nothing to Disclose.

P16.24 A 20-year retrospective cohort study of tb infection among the hill tribe hiv/aids populations, thailand

Background A retrospective cohort study was conducted to determine the situation, trend, and possible risk factors of TB infection, and factors related to the health status among the HIV/AIDS hill tribe in northern Thailand. Methods A systematic data-reviewing approach was used to identify the information from the rosters of ARV clinics, OPD cards, and laboratory reports from 16 hospitals in Chiang Rai Province, Thailand. The data were collected from the first reported HIV/AIDS case of the hill tribe to the end of 2010. A chi-square test and logistic regression models were used to identify associations at the significance level of alpha = 0.05. Results A total of 3,130 cases were included in the study. The majority of patients were Akha (46.0%) followed by Lahu (19.7%), 54.6% were males, 44.6% were 26–35 years old, and 25.2% were 36–45 years old. The peak period of HIV/AIDS infection among the hill tribes was from 2001–2005, during which occurred in 43.9% of all cases, followed by 33.7% from 2006–2010. The recorded occupations were 44.8% agricultural and 32.2% traders. The major risk factor of HIV infection was sexual intercourse (91.7%); 33.3% were still alive at the date of data collection, 30.7% were diagnosed with pulmonary TB, 76.0% did not receive ARV and 9.1% had been checked for CD4 level. The Lisu hill tribe HIV/AIDS individuals had a greater risk of TB infection than did Lahu individuals (OR adj = 1.50, 95% CI = 1.04–2.16). Females had a greater risk of TB infection than did males (OR adj = 1.22, 95% CI = 1.01–1.49); being classified as symptomatic HIV group was a protective factor of TB with OR adj = 0.18 (95% CI = 0.11–0.29); and not having received the ARV was also a protective factor with OR adj = 0.06 (95% CI = 0.05–0.08). The patients who had been diagnosed with HIV infection during 2001–2005 and 2006–2010 had a greater risk of TB infection than did those who were diagnosed from 1990–1995, with OR adj = 21.39 (6.59–69.42) and 13.70 (4.19–44.73), respectively. Conclusions Thailand needs to create a TB and HIV/AIDS surveillance system for hill tribe populations to determine the situation and trend and to develop an appropriate model for providing care at the earlier stage of HIV/AIDS infection to prevent later TB infection.

Characterization of copy number variations (CNV) in the NKG2C receptor gene

The cytolytic function of natural killer (NK) cells is controlled by a balance of activatory and inhibitory signals transduced by specific NK-cell receptors. NKG2 family is one of the superfamilies of these receptor genes located on chromosome 12 in the NKC gene complex. NKG2C is expressed as heterodimers with CD94 and they deliver activating signals upon contacting HLA-E via adaptor molecules. NKG2C genes are not only polymorphic and also NKG2C gene deletion was identified. The aim of the study was to develop a genotyping assay for the detection of the wild type and the deletion of the NKG2C gene. Method Copy numbers of the NKG2C genes were genotyped and assessed in 352 subjects by PCR-SSP method using a set of primer pairs described previously (Mararu M & Miyashita R, etc.). Two pairs of primers are used to detect the NKG2C genotypes: one pairs to amplify a 201 bp fragment from NKG2C wild type (wt) carrier; and the second pairs to amplify a 411 bp fragment from NKG2C deletion (del) carrier. A single-tube PCR-SSP genotyping strategy combining the two sets of primers was modified from Moraru M, etc. (Tissue Antigens, 2012). Results The presence or absence of NKG2C gene was determined by the single-tube PCR-SSP assay. Three genotypes were observed in the study subjects: wild type homozygous carrier (wt/wt), wild type and deletion heterozygous carrier (wt/del), and deletion homozygous carrier (del/del). Copy number of NKG2C in 3 International Histocompatibility Workshop (IHW) cells was assessed and confirmed: IHW 9043 as NKG2C wt/wt , IHW 9047 as NKG2C wt/del , and IHW 9044 as NKG2C del/del . Of the 352 subjects, wt/wt genotype accounted for 62.82% ( n = 221), wt/del for 32.88% ( n = 116), and del/del for 4.3% ( n = 15). The allele frequency of NKG2C deletion was 20.74% in this study group. Conclusion Studies have shown that NK cells expressing the activating receptor NKG2C preferentially expand after coculture with cytomegalovirus (CMV) infected fibroblasts and CMV-induced innate memory cells may contribute to malignant disease relapse protection and infectious disease control after transplantation. NKG2C deletion was shown to be a risk factor of HIV infection. Further study of the impact of the NKG2C CNV on outcomes of stem cell transplants with umbilical cord blood, related or unrelated donors would be warranted.

Risk Factors for HIV Infection among Young Thai Men during 2005-2009.

BackgroundThailand is one of several countries with a continuing generalized HIV epidemic. We evaluated the risk factors for HIV prevalence among 17–29 year old men conscripted by a random process into the Royal Thai Army (RTA) in 8 cohorts from 2005–2009.MethodsA series of case-cohort studies were conducted among the male RTA conscripts who had been tested for HIV seroprevalence after they were inducted. Men who were HIV positive were compared with a systematic random sample (1 in 30–40) of men from the total population of new conscripts. Each subject completed a detailed risk factor questionnaire.ResultsA total of 240,039 young Thai men were conscripted into the RTA and were screened for HIV seroprevalence between November 2005 and May 2009. Of 1,208 (0.5%) HIV positive cases, 584 (48.3%) men were enrolled into the study. There were 7,396 men who were enrolled as a comparison group. Among conscripts who had an education lower than a college-level, the independent risk factors for HIV infection were age in years (AOR 1.38, 95% CI 1.28–1.48), a history of sex with another man (AOR 3.73, 95% CI 2.70–5.13), HCV infection (AOR 3.89, 95% CI 2.56–5.90), and a history of sex with a female sex worker (FSW) (AOR 1.35, 95% CI 1.10–1.66). Among conscripts who had a college degree, the independent risk factor for HIV infection was a history of sex with another man (AOR 23.04, 95% CI 10.23–51.90). Numbers of sexual partners increased and the age at first sex, as well as the use of condoms for sex with a FSW decreased in successive cohorts.ConclusionThe HIV seroprevalence among cohorts of 17–29 years old men has remained at about 0.5% overall during 2005–2009. The most significant behavior associated with HIV prevalence was a history of sex with another man. Our data indicate continuing acquisition of HIV among young men in Thailand in recent years, especially among men with a history of same sex behavior.

Antiretroviral treatment use, co-morbidities and clinical outcomes among Aboriginal participants in the Australian HIV Observational Database (AHOD).

BackgroundThere are few data regarding clinical care and outcomes of Indigenous Australians living with HIV and it is unknown if these differ from non-Indigenous HIV-positive Australians.MethodsAHOD commenced enrolment in 1999 and is a prospective cohort of HIV-positive participants attending HIV outpatient services throughout Australia, of which 20 (74 %) sites report Indigenous status. Data were collected up until March 2013 and compared between Indigenous and non-Indigenous participants. Person-year methods were used to compare death rates, rates of loss to follow-up and rates of laboratory testing during follow-up between Indigenous and non-Indigenous participants. Factors associated with time to first combination antiretroviral therapy (cART) regimen change were assessed using Kaplan Meier and Cox Proportional hazards methods.ResultsForty-two of 2197 (1.9 %) participants were Indigenous. Follow-up amongst Indigenous and non-Indigenous participants was 332 & 16270 person-years, respectively. HIV virological suppression was achieved in similar proportions of Indigenous and non-Indigenous participants 2 years after initiation of cART (81.0 % vs 76.5 %, p = 0.635). Indigenous status was not independently associated with shorter time to change from first- to second-line cART (aHR 0.95, 95 % CI 0.51-1.76, p = 0.957). Compared with non-Indigenous participants, Indigenous participants had significantly less frequent laboratory monitoring of CD4 count (rate:2.76 tests/year vs 2.97 tests/year, p = 0.025) and HIV viral load (rate:2.53 tests/year vs 2.93 tests/year, p < 0.001), while testing rates for lipids and blood glucose were almost half that of non-indigenous participants (rate:0.43/year vs 0.71 tests/year, p < 0.001). Loss to follow-up (23.8 % vs 29.8 %, p = 0.496) and death (2.4 % vs 7.1 %, p = 0.361) occurred in similar proportions of indigenous and non-Indigenous participants, respectively, although causes of death in both groups were mostly non-HIV-related.ConclusionsAs far as we are aware, these are the first data comparing clinical outcomes between Indigenous and non-Indigenous HIV-positive Australians. The forty-two Indigenous participants represent over 10 % of all Indigenous Australians ever diagnosed with HIV. Although outcomes were not significantly different, Indigenous patients had lower rates of laboratory testing for HIV and lipid/glucose parameters. Given the elevated risk of cardiovascular disease in the general Indigenous community, the additional risk factor of HIV infection warrants further focus on modifiable risk factors to maximise life expectancy in this population.

High HIV Burden in Men Who Have Sex with Men across Colombia's Largest Cities: Findings from an Integrated Biological and Behavioral Surveillance Study.

BackgroundAmong Latin America’s concentrated HIV epidemics, little is known about men who have sex with men (MSM) in Colombia, the region’s third largest country. To date, surveillance studies have been limited to Bogota, while 80% of HIV cases and deaths originate from Colombia’s other cities and departments. The extent to which interventions should prioritize MSM outside of Bogota is unknown.MethodsWe recruited 2603 MSM using respondent-driven sampling from seven of Colombia’s largest cities. HIV prevalence was estimated by site from dried blood spot samples. Behavioral data were collected through face-to-face interviews and risk factors for HIV infection analyzed using weighted, multi-level logistical regression models accounting for recruitment patterns.ResultsAcross cities, HIV prevalence averaged 15%, varied from 6% to 24% and was highest in Cali, Bogota, and Barranquilla. In the past 12 months, 65% of MSM had ≥ 5 casual male partners and 23% had a female partner. Across partnerships (i.e., casual, stable, and commercial), the proportion of MSM engaging in unprotected sex was ≥ 52% with male partners and ≥ 66% with female partners. Self-reported history of STI (24%) and past-year illicit drug use (38%) were also common. In multivariate analysis, age ≥ 35 (adjusted odds ratio [AOR], 19.2) and 25–39 (AOR, 5.6) relative to ≤ 18–24 years, identifying as homosexual relative to heterosexual (AOR 0.1), meeting casual partners on the Internet (adjusted odds ratio [AOR], 3.1) and age of sexual debut of ≤ 13 years (AOR, 3.1) predicted HIV infection. HIV testing and prevention messaging reached just 24% of MSM in the past year.ConclusionsFindings support consistently elevated HIV burden among MSM throughout Colombia’s largest cities and a need for enhanced behavioral prevention and HIV testing, emphasizing men who use the Internet as well as physical venues to meet sex partners.

Benzodiazepine use as an independent risk factor for HIV infection in a Canadian setting

BackgroundAlthough the harms of prescription drug diversion are of growing international concern, the potential impact of prescription drug use on HIV infection has not been well assessed. We evaluated whether benzodiazepine use was associated with HIV seroconversion among a cohort of persons who inject drugs (PWID) in a Canadian setting. MethodsBetween May, 1996 and November, 2013, data were derived through a prospective cohort study of PWID in Vancouver, Canada. A total of 1682 baseline HIV negative participants were followed for a median of 79.5 months (interquartile range: 32.1–119.1), among whom 501 (29.8%) reported benzodiazepine use at baseline, and 176 seroconverted during follow-up, equal to an incidence density of 1.5 (95% Confidence Interval [CI]: 1.3–1.7) cases per 100 person-years. Poisson regression with time-dependent variables was used to assess whether benzodiazepine use was associated with the time to HIV seroconversion. ResultsAfter adjustment for potential confounders, benzodiazepine use (Adjusted Rate Ratio: 1.50; 95% CI: 1.01–2.24) was independently associated with a higher rate of HIV seroconversion. ConclusionsBenzodiazepine use was an independent risk factor for HIV seroconversion among PWID in this setting. Greater recognition of the safety concerns related to benzodiazepine medications including diversion are needed.

Design and baseline findings of a large-scale rapid response to an HIV outbreak in people who inject drugs in Athens, Greece: the ARISTOTLE programme.

To (i) describe an intervention implemented in response to the HIV-1 outbreak among people who inject drugs (PWIDs) in Greece (ARISTOTLE programme), (ii) assess its success in identifying and testing this population and (iii) describe socio-demographic characteristics, risk behaviours and access to treatment/prevention, estimate HIV prevalence and identify risk factors, as assessed at the first participation of PWIDs. A 'seek, test, treat, retain' intervention employing five rounds of respondent-driven sampling. Athens, Greece (2012-13). A total of 3320 individuals who had injected drugs in the past 12 months. ARISTOTLE is an intervention that involves reaching out to high-risk, hard-to-reach PWIDs ('seek'), engaging them in HIV testing and providing information and materials to prevent HIV ('test') and initiating and maintaining anti-retroviral and opioid substitution treatment for those testing positive ('treat' and 'retain'). Blood samples were collected for HIV testing and personal interviews were conducted. ARISTOTLE recruited 3320 PWIDs during the course of 13.5 months. More than half (54%) participated in multiple rounds, resulting in 7113 visits. HIV prevalence was 15.1%. At their first contact with the programme, 12.5% were on opioid substitution treatment programmes and the median number of free syringes they had received in the preceding month was 0. In the multivariable analysis, apart from injection-related variables, homelessness was a risk factor for HIV infection in male PWIDs [odds ratio (OR) yes versus no = 1.89, 95% confidence interval (CI) = 1.41, 2.52] while, in female PWIDS, the number of sexual partners (OR for > 5 versus one partner in the past year = 4.12, 95% CI = 1.93, 8.77) and history of imprisonment (OR yes versus no = 2.76, 95% CI = 1.43, 5.31) were associated with HIV. In Athens, Greece, the ARISTOTLE intervention for identifying HIV-positive people among people who inject drugs (PWID) facilitated rapid identification of a hidden population experiencing an outbreak and provided HIV testing, counselling and linkage to care. According to ARISTOTLE data, the 2011 HIV outbreak in Athens resulted in 15% HIV infection among PWID. Risk factors for HIV among PWID included homelessness in men and history of imprisonment and number of sexual partners in women.

Meta-analysis of HIV infection incidence and risk factors among men who have sex with men in China

To understand the incidence of HIV infection among men who have sex with men (MSM) in China. Meta-analysis was performed to systematically and quantitatively review all the original research papers and reports published during 2010-2015 on the incidence of HIV infection among MSM in China. Pooled incidence, pooled hazard ratios, publication bias, heterogeneity and sensitivity analysis for those studies were calculated or analyzed by using Stata 12.0 software. A total of 24 studies were analyzed. Pooled incidence of HIV infection among MSM in China was 5.0/100 person year; Based on HIV case report, severe epidemic areas had higher HIV incidence than other areas (4.9/100 person year vs. 3.4/100 person year). Low education level (HR = 1.61, 95% CI: 1.21-2.15), syphilis prevalence (HR = 3.22, 95% CI: 2.21-4.70), unprotected anal sex (HR = 2.92, 95% CI: 1.51-5.63), minority ethnic group (HR = 4.01, 95% CI: 1.96-8.21), commercial sex (HR = 4.11, 95% CI: 1.47-11.46) and multiple sexual partners (HR = 2.31, 95% CI: 1.60-3.34) were the risk factors for HIV incidence. Pooled incidence of HIV infection among MSM was 5.0% in China. Low education level, syphilis prevalence, unprotected anal sex, minority ethnic group, commercial sex and multiple sexual partners were the risk factors for HIV infection.

Is having sex with other men a risk factor for transfusion-transmissible infections in male blood donors in Western countries? A systematic review.

BackgroundAlthough increased prevalence of transfusion transmissible infections (TTI) among “men who have sex with men” (MSM) has been well documented, the exclusion of MSM as blood donors is contested. The aim of this systematic review is to find studies that describe the risk of TTI in MSM blood donors.MethodsWe searched MEDLINE, Embase, The Cochrane Central Register of Controlled Trials, Cinahl, and Web of Science, and used GRADE for determining evidence quality. We included studies comparing MSM and non-MSM blood donors (or people eligible to give blood), living in areas most relevant for our Blood Service.ResultsOut of 18 987 articles, 14 observational studies were included. Two studies directly compared MSM with non-MSM donors showing that MSM donors have a statistically significant higher risk of HIV-1 infections. In one of these studies it was shown that this was related to recent (< 12 months) MSM contact. In two additional studies no evidence was shown in favour of a certain deferral period for MSM. Ten studies, applying permanent deferral for MSM, compared infected versus non-infected donors. One study found that MSM is a statistically significant risk factor for HIV-1 infection in blood donors. For other TTI such as HBV or HCV, an increased risk of infection could not be demonstrated, because the precision of the results was affected by the low numbers of donors with MSM as risk factor, or because of risk of bias in the included studies. All studies included low level evidence, because of risk of bias and imprecision of the results.ConclusionsHigh-quality studies investigating the risk of TTI in MSM who donate blood are scarce. The available evidence suggests a link between MSM blood donors and HIV-1 infection, but is too limited to be able to unambiguously/clearly recommend a certain deferral policy.

Gender Expression and Risk of HIV Infection Among Black South African Men Who Have Sex with Men.

To explore demographic, behavioral and psychosocial risk factors for HIV infection in South African MSM we recruited 480 MSM (aged 18 and 44years) using respondent-driven sampling. Data were collected through individual computer-assisted face-to-face interviews. Participants were tested for HIV. RDS-adjusted HIV prevalence is 30.1% (unadjusted 35.6%). Few participants had ever engaged in both receptive and insertive anal sex; sex with women was frequently reported. Independent demographic and behavioral correlates of HIV infection include age, education, number of male sexual partners, ever having been forced to have sex, and ever having engaged in transactional sex; engagement in sex with women was a protective factor. Psychosocial risk factors independently associated with HIV infection were feminine identification, internalized homophobia, and hazardous drinking. Our findings confirm what has been found in other studies, but also suggest that the dynamics and context of sexual transmission among MSM in South Africa differ from those among MSM in Western countries.

High risks of HIV transmission for men who have sex with men--a comparison of risk factors of HIV infection among MSM associated with recruitment channels in 15 cities of China.

ObjectiveWhile the HIV epidemic varies greatly by region and population group throughout China, the HIV incidence among men who have sex with men (MSM) continues to rise at an alarmingly fast pace. We seek to analyze the risk factors associated with HIV infection among MSM recruited from different channels in large urban centers across China, in an attempt to shed light on the design of future targeted intervention strategies.MethodsA total of 33,684 MSM from 14 cities and one province were recruited from July to December 2011. Demographic (e.g. age, marital status, education) and behavioral (e.g. condom use, HIV testing history) data were collected using information collection cards. Blood samples were also collected to test for HIV and Syphilis.ResultsParticipants were recruited from five different channels, and all demonstrated distinct characteristics. The overall rate of positive HIV screening was 6.27% and the rate of syphilis infection was 6.50%. Participants recruited from bathhouses had the highest HIV (11.80%) and syphilis infection rates (11.20%). Participants who were infected with syphilis had the highest HIV-positive screening rate (13.75%; 95% CI OR, 2.33-3.06). living in the southwest region of the country (11.64%; OR=2.76, 95%CI OR 2.19-3.47), Being >20 years of age (P<0.001), living in the southwest region of the country (OR=2.76, 95%CI 2.19-3.47), not having sex with female over the previous 3 months (OR=1.27, 95%CI 1.09-1.48), no condom use during the last anal intercourse (OR=1.54, 95%CI 1.39-1.70) and other factors were all associated with a higher probability of having an HIV-positive test result.ConclusionDepending on the way they are recruited, more targeted interventions are required to prevent the spread of HIV/AIDS among MSM with different characteristics and behaviors. Results from this study could provide evidence for researchers to conduct further studies and policy-makers to establish more effective and strategic interventions for MSM in China.

Factors Associated With Visible Anogenital Warts Among HIV-Uninfected Peruvian Men Who Have Sex With Men and Transwomen

Visible, anogenital warts may be associated with risk factors for HIV infection. This cross-sectional study examined the factors associated with visible anogenital warts among HIV-uninfected Peruvian men who have sex with men (MSM) and transwomen. Six hundred HIV-uninfected MSM and transwomen were recruited from a community-based setting in metropolitan Lima, Peru, through outreach activities. Participants were tested for syphilis, completed a behavioral questionnaire, and were examined for visible anogenital warts. Logistic regression was used to assess the independent association between sample characteristics, HIV-related risk factors, and visible anogenital warts. A tertiary education versus a primary/secondary (adjusted odds ratio [AOR], 1.79; 95% confidence interval [CI], 1.07-2.99), a first experience of anal intercourse at age 20 years or older versus younger ages (AOR, 2.80; 95% CI, 1.45-5.38), and self-reporting of current sexually transmitted infection symptoms (AOR, 2.38; 95% CI, 1.61-3.52) were significant correlates of visible anogenital warts, whereas syphilis infection, transactional sex, receptive anal intercourse, and self-identifying as a transwoman were not. Although not associated with key risk factors for HIV infection in Peruvian MSM and transwomen, the presence of visible anogenital warts should prompt clinicians to consider the possibility of unreported same-sex sexual behaviors and other risk sexually transmitted infection/HIV risk factors.

Hypertension—an emerging cardiovascular risk factor in HIV infection

Patients with HIV may have an increased risk of hypertension and cardiovascular disease (CVD). The objective of this study was to determine the prevalence and risk factors for hypertension in a population of HIV–infected patients at an HIV/AIDS clinic in southern Brazil. We reviewed medical records of 1009 HIV–infected patients aged 18 years or more in an urban HIV/AIDS clinic based in Porto Alegre, southern Brazil. Hypertension was defined according to the Eighth Joint National Committee criteria. The prevalence of hypertension in this study cohort was 22.5% (95% confidence interval, 20%–25.2%). Individuals were significantly older in the hypertensive group (P < .001). After adjustment using a Poisson regression model of all variables that presented P < .2 in the univariate analysis, the variables that were significantly associated with hypertension were only age ≥40 years and obesity. Also in this setting, dyslipidemia (P = .068) showed a tendency of association with hypertension. Compared with HIV–infected persons aged 18–39 years, those aged 40–59 years presented a 2–fold higher prevalence of hypertension (95% confidence interval, 1.2–3.3).The present study showed a high prevalence of hypertension among HIV–infected persons, similar to other studies, ranging from 13% to 45%, and also similar to the HIV–negative general population. Age and obesity were the factors associated with hypertension. Finally, the present study indicates a similar pattern of behavior and comorbidities for HIV–positive and –negative patients in relation to hypertension.

The epidemic of HIV, syphilis, chlamydia and gonorrhea and the correlates of sexual transmitted infections among men who have sex with men in Jiangsu, China, 2009.

BackgroundIn China, the HIV/AIDS epidemic is expanding among men who have sex with men (MSM). As independent risk factors of HIV infection, the epidemics of Chlamydia (CT) and Gonorrhea (NG) in MSM were not well studied, particular for the risk factors of these infectious. The objectives of current reported study were to understand the dynamics of HIV and other sexual transmitted infections (STIs) among MSM in Jiangsu, China, and to measure factors that correlated with STIs.MethodsIn order to gain more participants, a multisite cross-sectional study design was used in our study, by using convenience-sampling to recruit MSM in two Changzhou and Yangzhou, Jiangsu, China, between the July and October of 2009.ResultsIn this comprehensive survey involving MSM in two cities of Jiangsu province of China, the prevalence of STIs of CT (6.54%), NG (3.63%), syphilis (20.34%) and HIV (11.62%) were measured. Overall, the STIs prevalence (CT, NG or syphilis) for the participants in our study was 26.39%, meanwhile, 3.4% (14 out of the 413) participants had at least two kinds of STIs. Meeting casual partners at parks, public restrooms or other public areas, having had anal sex with men in the past six months, having had STI symptoms in the past year were positively correlated with STIs positive, with adjusted ORs of 4.61(95%CI 1.03–20.75), 1.91(95%CI 1.14–3.21) and 2.36(95%CI 1.07,5.24).ConclusionOur study findings reiterate the fact that Chinese MSM are highly susceptible to acquiring syphilis, CT, NG and HIV, and there is an urgent need for intervention targeted towards this population. Behavioral measures should constitute an important part of the targeted intervention. Furthermore, the already implemented preventive and diagnostic services for HIV should be expanded to include syphilis CT and NG, too.

History of sexual abuse, depression, and alcohol use as risk factors for HIV infection in high HIV prevalence fishing communities in rural Uganda

History of sexual abuse, depression, and alcohol use as risk factors for HIV infection in high HIV prevalence fishing communities in rural Uganda

Hypersexual, Sexually Compulsive, or Just Highly Sexually Active? Investigating Three Distinct Groups of Gay and Bisexual Men and Their Profiles of HIV-Related Sexual Risk.

Emerging research supports the notion that sexual compulsivity (SC) and hypersexual disorder (HD) among gay and bisexual men (GBM) might be conceptualized as comprising three groups-Neither SC nor HD; SC only, and Both SC and HD-that capture distinct levels of severity across the SC/HD continuum. We examined data from 370 highly sexually active GBM to assess how the three groups compare across a range of risk factors for HIV infection. Comparisons focused on psychosexual measures-temptation for condomless anal sex (CAS), self-efficacy for avoiding CAS, sexual excitation and inhibition-as well as reports of actual sexual behavior. Nearly half (48.9%) of this highly sexually active sample was classified as Neither SC nor HD, 30% as SC Only, and 21.1% as Both SC and HD. While we found no significant differences between the three groups on reported number of male partners, anal sex acts, or anal sex acts with serodiscordant partners, the Both SC and HD group reported higher numbers of CAS acts and CAS acts with serodiscordant partners and also had a higher proportion of their anal sex acts without condoms compared to the SC Only group. Our findings support the validity of a three-group classification system of SC/HD severity in differentiating psychosexual and HIV-related sexual risk behavior outcomes in a sample of GBM who report similarly high levels of sexual activity. Notwithstanding the need for sex positive HIV prevention programs, interventions that attempt to help Both SC and HD men deal with distress and address their psychosexual needs specifically may derive HIV prevention benefits.

Correlates of HIV infection among female sex workers in Vietnam: Injection drug use remains a key risk factor

ObjectiveWomen who sell sex and use drugs have dual risks for HIV infection. Despite increasing reports of drug use among female sex workers (FSW) in Vietnam, FSW HIV interventions remain focused mainly on sexual risk reduction. We assessed the impact of drug use and inconsistent condom use on HIV infection among FSW in Vietnam, which few studies have quantified. MethodsWe surveyed 5298 women aged ≥18 years who had sold sex in the past month from ten geographically dispersed provinces. We performed multivariate logistic regression on data from provinces with high (≥10%) or low (<10%) HIV prevalence among FSW. ResultsCompared to FSW who never used illicit drugs, the odds of HIV infection among FSW who had ever injected drugs and those who reported non-injection drug use were 3.44 (CI 2.32–5.09) and 1.76 (CI 1.14–2.71), respectively, in high-prevalence provinces. FSW who always used condoms with clients had lower odds of HIV infection than those who did not (AOR=0.71; CI 0.52–0.98). In low-prevalence provinces lifetime injection drug use (AOR 22.05, CI 12.00–40.49), but not non-injecting drug use or inconsistent condom use, was significantly associated with HIV infection. ConclusionsBecause injection drug use and inconsistent condom use were key risk factors for HIV infection in high-prevalence provinces, drug injection risk reduction should be as much a focus of HIV prevention as sexual risk reduction. Where HIV prevalence remains low in FSW, a more general emphasis on harm reduction for all drug users will benefit FSW.