Self-reported HIV Infection Research Articles

Correlates of Neisseria gonorrhoeae antimicrobial resistance: cross-sectional results from an open cohort sentinel surveillance network in Québec, Canada, 2016–2019

ObjectivesTo examine correlates of Neisseria gonorrhoeae antimicrobial resistance (AMR) to first-line antimicrobials (azithromycin, cefixime and ceftriaxone).Design and settingThe sentinel surveillance network is an open cohort of gonococcal infection cases from...

Knowledge and vaccination acceptance toward the human monkeypox among men who have sex with men in China.

MSM individuals are at high risk of monkeypox infection, and judicious use of vaccines can control the outbreak. Therefore, we conducted a national cross-sectional survey to assess the vaccination willingness, associated factors, and related knowledges of monkeypox among MSM individuals in China. This anonymous cross-sectional study was conducted in China from July 1 to July 3, 2022, and electronic questionnaires were sent online to MSM individuals of specific institutions. Men, aged 18 or older, who had anal sex in the past year were recruited. Multivariable logistic regression models and univariable logistic regression models were performed in different groups of participants, including all eligible respondents, people with or without self-reported HIV infection, and people who had sex with at least one male sexual partner in last month. A total of 2,618 male respondents, including 2,134 homosexuals and 484 bisexuals, were enrolled in our final analysis. Most of the respondents had a certain understanding of the source of infection, transmission route, and preventive measures, but lacked knowledge of the susceptible population, clinical manifestations, vaccination, and treatment. In total, 90.2% of all respondents were willing to receive the vaccines against monkeypox. Among people with self-reported HIV infection, the vaccination acceptance rate was 91.7%, while it was 89.7% in the rest. The main influencing factors were knowledge about monkeypox (moderate: aOR = 1.47, 95% CI: 1.04-2.08; high: aOR = 2.03, 95% CI: 1.23-3.34), knowledge about prevention measures (moderate: aOR = 3.52, 95% CI: 2.51-4.94; high: aOR = 5.32, 95% CI: 2.98-9.47), concerns about their susceptibility to monkeypox infection (aOR = 4.37, 95% CI: 3.29-5.80), and possible contact with people and animals in epidemic areas (aOR = 0.42, 95% CI: 0.25-0.70). For self-reported HIV-infected individuals, education (bachelor degree: aOR = 0.40, 95% CI: 0.18-0.89) and poor condom use (sometimes: aOR = 2.18, 95% CI: 1.06-4.47) may also affect the vaccination. There was still a lack of knowledge about the human monkeypox among MSM individuals in China. The vaccination acceptance rate of this high-risk population was high, and it was closely related to the knowledge factors, fear of infection, and possible contact with people or animals in affected areas. Targeted publicity and education of the high-risk groups, vaccination pre-arranged planning should be formulated to cope with the further development of this infectious disease.

Characteristics and depressive symptoms among self-reported HIV infection through heterosexual transmission men who have sex with men

Objective: To understand the characteristics and depressive status of men who have sex with men (MSM) who self-reported HIV infection through heterosexual transmission and to provide evidence for personalized management of HIV infected people. Methods: A cross-sectional survey was carried out in Shandong province from September to December in 2019. Male HIV patients aged ≥15 years who self-reported HIV infection through heterosexual transmission were selected to verify the route of infection by one-to-one interview in Ji'nan, Qingdao, Weifang and Linyi cities of Shangdong province. According to the 1∶1 ratio, local HIV patients with age difference ≤3 years who self-reported MSM were selected as controls. A questionnaire survey was conducted, including data on demographic characteristics, behavior status, CES-D and PSSS. The related factors of the depressive symptoms and characteristics were analyzed. Results: A total of 373 male HIV patients were interviewed, and 39.7%(148/373) were confirmed as MSM after reexamination. The interviewers were: aged (40.3±12.0) years old, 41.9% (62/148) married/cohabiting. 27.0% (40/148) had been tested before HIV diagnosis, 71.6% (106/148) had homosexual partners ≥2 and 55.4% (82/148) had depressive symptom. Multivariate analysis showed that the MSM without HIV testings before diagnosis, had homosexual partners ≥2 before diagnosis, had first homosexual behavior at the age >30 years old and with depressive symptoms were more likely to conceal the true infection route. The incidence of depression among MSM who self-reported HIV infection through heterosexual transmission was related to physical health status social support and occupational stability. Conclusions: Some male HIV persons self-reported as being heterosexually transmitted were really transmitted through homosexual behavior. There were high-risk behaviors such as multiple partners and intersex among this group, and with high incidence of depression. It is necessary to encourage the reexamination program during follow-up and target on psychological and behavioral interventions, continuously.

Sisonke: reaching several goals together

Sisonke: reaching several goals together

HIV infection and related factors among men who have sex with men aged 50 and above

Objectives: To explore the HIV prevalence and related factors among MSM aged 50 and above and provide evidence on the prevention and control of HIV/AIDS. Methods: Based on an MSM social application software Blued 7.1.6, we recruited participants through online convenience sampling to collect demographic variables, behavioral and self-reported HIV infection status, etc. Univariate χ2 test and multivariate logistic regression were used to analyze the related factors of self-reported HIV infection. Results: Self-reported HIV infection rate was 17.6%(126/714) among the participants. In multivariable analysis, participants who got divorced or widowed had a 2.07(95%CI: 1.34-3.21) times greater risk of self-reported HIV-positive than those who were married. Participants unaware of HIV-related knowledge showed a 1.92(95%CI:1.21-3.04) times greater risk of self-reported HIV-positive than those with better HIV-related knowledge. Participants who have ever been diagnosed with sexually transmitted disease (STD) showed a 3.17(95%CI:2.09-4.83) times greater risk of self-reported HIV-positive than those without STD infection history. Conclusion: Our findings indicated that the self-reported HIV infection rate was high among MSM aged 50 and above. Being divorced or widowed, being unaware of HIV-related knowledge and STD infection history was proved related with self-reported HIV infection.

Correlates of Transactional Sex and Violent Victimization among Men Who Inject Drugs in Los Angeles and San Francisco, California.

Men who inject drugs (MWID) and engage in transactional sex (i.e., receive money or drugs in exchange for sex) are vulnerable to HIV and violence. However, MWID who engage in transactional sex have been less studied than women. We examine factors associated with transactional sex among MWID in Los Angeles and San Francisco and whether transactional sex is associated with violent victimization. MWID were recruited using targeted sampling methods in 2011-2013 and completed surveys that covered demographics, drug use, HIV risk, violence, transactional sex, and other items. Multivariable logistic regression was used to (1) determine factors independently associated with transactional sex and (2) determine if transactional sex was independently associated with violence victimization in the last 6months among MWID. An interaction term between income source and sexual identity was included in the transactional sex model. Of the 572 male PWID in the sample, 47 (8%) reported transactional sex in the past 6months. Self-reported HIV infection was 7% for MWID who did not report transactional sex, 17% for MWID who reported transactional sex, and 24% for MWID who reported transactional sex and reported gay or bisexual identity. In multivariable analysis, transactional sex was positively associated with gay or bisexual identity (GB without illegal income adjusted odds ratio [AOR] = 5.16; 95% confidence interval [CI] = 1.86-14.27; GB with illegal income AOR = 13.55, CI = 4.57-40.13), coerced sex in the last 12months (AOR = 11.66, CI = 1.94-70.12), and violent victimization in the last 12months (AOR = 2.31, CI = 1.13-4.75). Transactional sex was negatively associated with heroin injection (last 30days) (AOR = 0.37; 95% CI = 0.18-0.78). Transactional sex was independently associated with violent victimization in the last 12months (AOR = 2.04; 95% CI = 1.00-4.14) while controlling for confounders. MWID who engaged in transactional sex are at elevated risk for HIV and multiple forms of violent victimization. Interventions focused on this at-risk subpopulation are urgently needed and should include access to substance use disorder treatment, victimization services, and harm reduction services across the HIV care continuum.

Prevalence of drug-resistant tuberculosis in Zimbabwe: A health facility-based cross-sectional survey

ObjectiveTo determine the prevalence of resistance to rifampicin alone; rifampicin and isoniazid, and second-line anti-TB drugs among sputum smear-positive tuberculosis patients in Zimbabwe. DesignA health facility-based cross-sectional survey. ResultsIn total, 1114 (87.6%) new and 158 (12.4%) retreatment TB patients were enrolled. MTB was confirmed by Xpert MTB/RIF among 1184 (93%) smear-positive sputum samples. There were 64 samples with Xpert MTB/RIF-determined rifampicin resistance. However, two were rifampicin susceptible on phenotypic drug susceptibility testing. The prevalence of RR-TB was [4.0% (95% CI, 2.9, 5.4%), n=42/1043) and 14.2% (95% CI, 8.9, 21.1%; n=20/141) among new and retreatment patients, respectively. The prevalence of MDR-TB was 2.0% (95% CI, 1.3, 3.1%) and 6.4% (95% CI, 2.4, 10.3%) among new and retreatment TB patients, respectively. Risk factors for RR-TB included prior TB treatment, self-reported HIV infection, travel outside Zimbabwe for ≥one month (univariate), and age <15 years. Having at least a secondary education was protective against RR-TB. ConclusionThe prevalence of MDR-TB in Zimbabwe has remained stable since the 1994 subnational survey. However, the prevalence of rifampicin mono-resistance was double that of MDR-TB.

Investigating the addition of oral HIV self-tests among populations with high testing coverage - Do they add value? Lessons from a study in Khayelitsha, South Africa.

IntroductionHIV self-testing (HIVST) offers a useful addition to HIV testing services and enables individuals to test privately. Despite recommendations to the contrary, repeat HIV testing is frequent among people already on anti-retroviral treatment (ART) and there are concerns that oral self-testing might lead to false negative results. A study was conducted in Khayelitsha, South Africa, to assess feasibility and uptake of HIVST and linkage-to-care following HIVST.MethodsParticipants were recruited at two health facilities from 1 March 2016 to 31 March 2017. People under 18 years, or with self-reported previously-diagnosed HIV infection, were excluded. Participants received an OraQuick Rapid HIV-1/2 Antibody kit, and reported their HIVST results by pre-paid text message (SMS) or by returning to the facility. Those not reporting within 7 days were contacted by phone. Electronic and paper-based clinical and laboratory records were retrospectively examined for all participants to identify known HIV outcomes, after matching for name, date of birth, and sex. These findings were compared with self-reported HIVST results where available.ResultsOf 639 participants, 401 (62.8%) self-reported a negative HIVST result, 27 (4.2%) a positive result, and 211 (33.0%) did not report. The record search identified that of the 401 participants self-reporting a negative HIVST result, 19 (4.7%) were already known to be HIV positive; of the 27 self-reporting positive, 12 (44%) were known HIV positive. Overall, records showed 57/639 (8.9%) were HIV positive of whom 39/57 (68.4%) had previously-diagnosed infection and 18/57 (31.6%) newly-diagnosed infection. Of the 428 participants who self-reported a result, 366 (85.5%) reported by SMS.ConclusionsHIVST can improve HIV testing uptake and linkage to care. SMS is acceptable for reporting HIVST results but negative self-reports by participants may be unreliable. Use of HIVST by individuals on ART is frequent despite recommendations to the contrary and its implications need further consideration.

Medical Reasons for Limiting Drinking: Data from a Sexual Health Clinic

Background: Heavy drinking poses health risks for individuals with HIV, and some individuals with HIV attempt to reduce drinking. Little is known about whether medical reasons motivate HIV-infected individuals to reduce drinking. Objectives: We evaluated medical reasons for limiting drinking among patients in a sexual health clinic, and explored whether these reasons could be operationalized as a new scale for research and clinical use in sexual health clinics. Methods: A sample of 70 patients in a sexual health clinic who reported efforts to limit drinking in the past month (84% with self-reported HIV; 81% male; 50% Black) completed a nine-item medical reasons for limiting drinking scale on a tablet while waiting for their appointment. Exploratory factor analysis was performed to evaluate psychometric properties of the scale. Results: Patients most commonly endorsed general concerns about health, and concerns about alcohol’s effect on the liver. Support was found for a unidimensional (one-factor) eight-item scale, which evidenced good internal consistency (α = 0.84). Results were identical when analyses were restricted to the subset of 59 individuals who self-reported HIV infection. Conclusions/Importance: This study suggests that individuals in a sexual health clinic most commonly endorse broad nonspecific concerns about drinking and health, as well as concerns about their liver. This study yields an 8-item scale to measure medical reasons for limiting drinking in sexual health clinics and among individuals with HIV. This scale should enhance researchers’ ability to study this important construct and may facilitate discussion of drinking reduction with HIV-infected heavy drinkers, requiring future study.

Estimating the Prevalence of HIV and Sexual Behaviors Among the US Transgender Population: A Systematic Review and Meta-Analysis, 2006-2017.

Background. Transgender women (transwomen) in the United States have been shown to have high HIV risk with Black and Hispanic transwomen being particularly vulnerable. Growing research on transgender men (transmen) also shows increased HIV risk and burden, although not as much is known for this transgender population.Objectives. This systematic review estimates the prevalence of self-reported and laboratory-confirmed HIV infection, reported sexual and injection behaviors, and contextual factors associated with HIV risk of transgender persons living in the United States.Search Methods. We searched the HIV Prevention Research Synthesis database and MEDLINE, EMBASE, PsycINFO, CINAHL, and Sociological Abstracts databases from January 2006 to March 2017 and January 2006 to May 2017, respectively. Additional hand searches were conducted in December 2017 to obtain studies not found in the literature searches.Selection Criteria. Eligible reports were published US-based studies that included transgender persons and reported HIV status.Data collection and analysis. Data were double-coded and quality assessed. We used random-effects models employing the DerSimonian-Laird method to calculate overall prevalence of HIV infection, risk behaviors, and contextual factors for transwomen, transmen, and race/ethnicity subgroups.Main Results. We reviewed 88 studies, the majority of which were cross-sectional surveys. Overall laboratory-confirmed estimated prevalence of HIV infection was 9.2% (95% confidence interval [CI] = 6.0%, 13.7%; κ = 24). Among transwomen and transmen, HIV infection prevalence estimates were 14.1% (95% CI = 8.7%, 22.2%; κ = 13) and 3.2% (95% CI = 1.4%, 7.1%; κ = 8), respectively. Self-reported HIV infection was 16.1% (95% CI = 12.0%, 21.2%; κ = 44), 21.0% (95% CI = 15.9%, 27.2%; κ = 30), and 1.2% (95% CI = 0.4%, 3.1%; κ = 7) for overall, transwomen, and transmen, respectively. HIV infection estimates were highest among Blacks (44.2%; 95% CI = 23.2%, 67.5%; κ = 4). Overall, participation in sex work was 31.0% (95% CI = 23.9%, 39.0%; κ = 39). Transwomen (37.9%; 95% CI = 29.0%, 47.7%; κ = 29) reported higher participation in sex work than transmen (13.1%; 95% CI = 6.6%, 24.3%; κ = 10; P = .001). Most outcomes indicated high heterogeneity in the overall and subgroup analyses.Conclusions. The availability of more data allowed us to calculate estimates separately for transwomen and transmen. HIV prevalence estimates for US transwomen were lower than previous estimates, but estimates for HIV prevalence and participation in sex work were higher when compared with transmen. Evidence gaps remain for transmen and the syndemic relationship of HIV, risky behaviors, and contextual factors specific to the transgender experience.Public Health Implications. This study highlights gender disparities for HIV and risky sexual behavior, as well as evidence gaps that exist for transmen. Tailored programs and services for the transgender population need to be developed to encourage use of and access to HIV prevention services.

Factors associated with physical violence by a sexual partner among girls and women in rural Kenya.

BackgroundIntimate partner physical violence increases women’s risk for negative health outcomes and is an important public health concern. The purpose of the present study was to determine 1) the proportion of girls (≤18 years) and women (>18 years) who experienced physical violence by a sexual partner, and 2) factors (including self–reported HIV infection) associated with girls and women who experienced physical violence by a sexual partner.MethodsCross–sectional surveys conducted in the Gem Health and Demographic Surveillance System (HDSS) area in Siaya County, western Kenya in 2011–2012 (Round 1) and 2013–2014 (Round 2).FindingsAmong 8003 unique participants (582 girls and 7421 women), 11.6% reported physical violence by a sexual partner in the last 12 months (girls: 8.4%, women: 11.8%). Three factors were associated with physical violence by a sexual partner among girls: being married or cohabiting (nearly 5–fold higher risk), low education, and reporting forced sex in the last 12 months (both with an approximate 2–fold higher risk). Predictive factors were similar for women, with the addition of partner alcohol/drug use and deliberately terminating a pregnancy. Self–reported HIV status was not associated with recent physical violence by a sexual partner among girls or women.ConclusionsGender–based physical violence is prevalent in this rural setting and has a strong relationship with marital status, low education level, and forced sex among girls and women. Concerted efforts to prevent child marriage and retain girls in school as well as implementation of school and community–based anti–violence programs may help mitigate this risk.

Increasing Human Papillomavirus Vaccine Coverage Among Men Who Have Sex With Men-National HIV Behavioral Surveillance, United States, 2014.

Human papillomavirus (HPV) can cause oropharyngeal and anogenital cancers among men who have sex with men (MSM). In 2011, the Advisory Committee on Immunization Practices (ACIP) extended HPV vaccine recommendations to males through age 21 and MSM through age 26. Because of this distinction, vaccination for some MSM might rely on sexual behavior disclosure to health care providers. Receipt of ≥1 HPV vaccination among MSM aged 18-26 in National HIV Behavioral Surveillance (NHBS) was 4.9% in 2011. We evaluated HPV vaccine coverage and associated factors among MSM in 2014. Twenty US metropolitan statistical areas in 2014. Coverage was calculated as percentage of MSM self-reporting ≥1 HPV vaccination. Adjusted prevalence ratios were calculated from Poisson regression models to estimate associations of demographic and behavioral characteristics with HPV vaccination. Among 2892 MSM aged 18-26 years, HPV vaccine coverage was 17.2%. Overall, 2326 (80.4%) reported a health care visit within 12 months, and 2095 (72.4%) disclosed MSM attraction or behavior to a health care provider. Factors associated with vaccination included self-reported HIV infection; having a health care visit within 12 months, health insurance, or a usual place of care; and disclosing MSM attraction or behavior to a health care provider. Since the 2011 recommendation for vaccination of males, HPV vaccine coverage among MSM increased, but remains low. Most MSM reported a recent health care visit and disclosed sexual behavior, indicating opportunities for vaccination. Potential strategies for increasing MSM coverage include improving access to recommended care, and offering education for providers and patients.

Bayesian Approaches to Racial Disparities in HIV Risk Estimation Among Men Who Have Sex with Men.

Men who have sex with men (MSM) continue to be overrepresented for new HIV infections compared with non-MSM. This disparity becomes even more alarming when considering racial groups. We describe the race-specific effects in HIV prevalence among MSM relative to non-MSM and explore the causes of disagreement among estimates. We used data from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative longitudinal survey conducted in the US Bayesian learning corrected for potential misclassification of MSM status and adjusted for residual confounding, hypothesized to explain the MSM racial disparity in HIV. We articulated the structure and strength of the latent confounders that would make race-specific risk gradients equivalent. Compared with non-MSM, the adjusted prevalence odds ratio (POR) and 95% credible interval for black MSM having self-reported HIV infection was 5.8 (2.0, 16), while the POR for white MSM was 12 (4.2, 31). For all MSM, the POR for HIV infection was 9.3 (3.6, 23) with black men having 2.6 times the odds of prevalent infection compared with white men. The observed race-specific associations in MSM are likely not due to misclassification alone, but represent a constellation of factors that differ between racial groups. We recommend specific risk factors in surveys needed to further identify the behavioral characteristics that lead to the observed differences when the estimates are stratified by race.

Contextual, experiential, and behavioral risk factors associated with HIV status: a descriptive analysis of transgender women residing in Atlanta, Georgia.

This study assessed the prevalence of self-reported HIV infection among a community sample of transgender women and identified associated contextual, experiential, and behavioral factors. Ninety-two transgender women completed a self-administered interview. Recruitment occurred through an LGBT service organization, a transgender support group, transgender advocates, and informal communications. Eighty-two percent were African American/Black. Of 83 who knew their status, 60% reported being HIV infected. High rates of childhood sexual abuse (52%), rape (53%), intimate partner violence (56%), and incarceration (57%) were reported. Many did not have health insurance (53%), were not employed full-time nor in school (63%) and had been recently homeless (49%). HIV-infected transgender women as compared to HIV-uninfected transgender women were more likely to be African American/Black ( P = 0.04), and older than 34 years ( P = 0.01), unemployed/not in school ( P < 0.001). HIV-infected transgender women also experienced less trans-related discrimination ( P = 0.03), perceived less negative psychosocial impact due to trans status ( P = 0.04) and had greater happiness with their physical appearance ( P = 0.01). HIV-infected transgender women may experience relatively less trans-related stress compared to their HIV-uninfected counterparts. High rates of HIV, trauma, and social marginalization raise concerns for this population and warrant the development of structural and policy-informed interventions.

Structural and Behavioral Correlates of HIV Infection among Pregnant Women in a Country with a Highly Generalized HIV Epidemic: A Cross-Sectional Study with a Probability Sample of Antenatal Care Facilities in Swaziland

IntroductionHIV disproportionately affects women in Sub-Saharan Africa. Swaziland bears the highest HIV prevalence of 41% among pregnant women in this region. This heightened HIV-epidemic reflects the importance of context-specific interventions. Apart from routine HIV surveillance, studies that examine structural and behavioral factors associated with HIV infection among women may facilitate the revitalization of existing programs and provide insights to inform context-specific HIV prevention interventions.Methods and FindingsThis cross-sectional study employed a two-stage random cluster sampling in ten antenatal health care facilities in the Hhohho region of Swaziland in August and September 2015. Participants were eligible for the study if they were 18 years or older and had tested for HIV. Self-administered tablet-based questionnaires were used to assess HIV risk factors. Of all eligible pregnant women, 827 (92.4%) participated, out of which 297 (35.9%) were self-reportedly HIV positive. Among structural factors, family function was not significantly associated with self-reported HIV positive status, while lower than high school educational attainment (AOR, 1.65; CI, 1.14–3.38; P = 0.008), and income below minimum wage (AOR, 1.81; CI, 1.09–3.01; P = 0.021) were significantly associated with self-reported HIV positive status. Behavioral factors significantly associated with reporting a positive HIV status included; ≥2 lifetime sexual partners (AOR, 3.16; CI, 2.00–5.00; P<0.001), and ever cohabited (AOR, 2.39; CI, 1.66–3.43; P = 0.00). The most cited reason for having multiple sexual partners was financial gain. HIV/AIDS-related knowledge level was high but not associated to self-reported HIV status (P = 0.319).ConclusionsStructural and behavioral factors showed significant association with self-reported HIV infection among pregnant women in Swaziland while HIV/AIDS-related knowledge and family function did not. This suggests that HIV interventions should be reinforced taking into consideration these findings. The findings also suggest the importance of future research sensitive to the Swazi and African sociocultural contexts, especially research for family function.

Multiplex crack smoking and sexual networks: associations between network members' incarceration and HIV risks among high-risk MSM.

This study examined HIV risks in the multiplex crack-smoking and sexual networks of incarcerated drug-using men who have sex with men (MSM) and their associates. We estimated the associations between the network members' incarceration, self-reported HIV infection, and trading sex for money. Our analytic sample consisted of 508 crack-smoking or sexual partnerships of 273 high-risk MSM. Network members were specified by (1) crack smoking and sexual behavior or (2) crack smoking only. Longer incarceration of the crack-smoking and sexual network members was associated with self-reported HIV infection (AOR=1.61, p<0.05), which extended up to one's partners' partners' partners (AOR=1.63, p<0.05). Similar results were found for trading sex (AOR=2.77, p<0.05). The findings of the study call for the development of a system-level HIV intervention among former incarcerated MSM and their associates.

To Be or Not to Be

Inferring sexual behavior of a stigmatized minority through self-reported sexual identity is subject to misclassification and can lead to biased results. We quantify the degree of this misclassification and perform a Bayesian correction of the risk of HIV infection in relation to self-reported sexual behavior. Sensitivity and specificity of self-reported men who have sex with men in ascertaining sexual behavior was derived from validation data, as was the informative prior on the association of same-sex behavior with self-reported HIV infection. Using these priors, we performed two separate Bayesian analyses of National Epidemiologic Survey on Alcohol and Related Conditions data for the odds of self-reported HIV positivity, adjusting for differential misclassification of self-reported same-sex behavior indicated by either partner gender or sexual identity. We found differential exposure misclassification with specificity exceeding sensitivity, and higher misclassification rates based on sexual identity compared with partner gender. Sexual identity and partner gender displayed different associations with HIV infection in the raw data but these became virtually identical when adjusted for estimates of misclassification of sexual behavior by these two indicators. The estimate of prevalence of same-sex behavior associated with an elevated risk of HIV infection decreased after adjustment for misclassification. Studies of risk due to same-sex behavior are likely biased when they rely on self-identification for ascertainment of risk factors, especially when self-reported identity is used. The implications of our findings on risk modeling cannot be assumed to be trivial due to substantial shifts in distributions of risk and prevalence of exposure.

Molecular epidemiology of Mycobacterium tuberculosis among South African gold miners.

HIV-associated tuberculosis remains a major health problem among the gold-mining workforce in South Africa. We postulate that high levels of recent transmission, indicated by strain clustering, are fueling the tuberculosis epidemic among gold miners. To combine molecular and epidemiologic data to describe Mycobacterium tuberculosis genetic diversity, estimate levels of transmission, and examine risk factors for clustering. We conducted a cross-sectional study of culture-positive M. tuberculosis isolates in 15 gold mine shafts across three provinces in South Africa. All isolates were subject IS6110-based restriction fragment length polymorphisms, and we performed spoligotyping analysis and combined it with basic demographic and clinical information. Of the 1,602 M. tuberculosis patient isolates, 1,240 (78%) had genotyping data available for analysis. A highly diverse bacillary population was identified, comprising a total of 730 discrete genotypes. Four genotypic families (Latin American Mediterranean spoligotype family; W-Beijing; AH or X; and T1-T4) accounted for over 50% of all strains. Overall, 45% (560/1,240) of strains were genotypically clustered. The minimum estimate for recent transmission (n - 1 method) was 32% (range, 27-34%). There were no individual-level risk factors for clustering, apart from borderline evidence for being non-South African and having self-reported HIV infection. The high M. tuberculosis genetic diversity and lack of risk factors for clustering are indicative of a universal risk for disease among gold miners and likely mixing with nonmining populations. Our results underscore the urgent need to intensify interventions to interrupt transmission across the entire gold-mining workforce in South Africa.

Social and structural factors associated with vulnerability to HIV infection among young adults in South Africa

There is increasing focus on social and structural factors following the marginal success of individual-level strategies for HIV prevention. While there is evidence of decreased HIV prevalence among young individuals in South Africa, there is still a need to monitor HIV incidence and prevalence in this vulnerable group as well as track and prevent high-risk sexual behavior(s). This study investigated the social and structural factors that shape the context of vulnerability to increased risk of exposure to HIV infection. A mixed-methods approach including qualitative and quantitative design components was employed. Young adults in the age group 18–24 were interviewed from four provinces in South Africa. The qualitative results produced strong support for the effectiveness of loveLife’s HIV prevention programs. The household-based survey results showed that the strongest predictors of self-reported HIV infection (indicating a greater chance of being infected) using adjusted odds ratios (aOR) are: being diagnosed with an STI in a lifetime (aOR 13.68 95% Confidence Interval (CI) [4.61–40.56]; p < .001), inconsistent condom use (aOR 6.27 95% CI [2.08–18.84]; p < .01), and difficulty in accessing condoms (aOR 2.86 95% CI [1.04–7.88]; p < .05). The strongest predictors that indicated a decreased chance of being infected with the HI virus are: talking with partner about condom use in the past 12 months (aOR .08 95% CI [.02–.36]; p < .001) and having a grade 8 (aOR .04 95% CI [.01–.66]; p < .05) and higher educational level (aOR .04 95% CI [.01–.43]). These results show that social and structural factors serve as risk and protective factors for HIV prevention among young people. Intervention programs need to continue to focus on effective communication strategies and healthy relationships. Structural adjustments have to be made to encourage school attendance. Finally, social/health policies and health service delivery have to also be refined so that young people have access to youth friendly health services.

Optimism and Education Buffer the Effects of Syndemic Conditions on HIV Status Among African American Men Who Have Sex with Men

The present study sought to replicate effects of the number of syndemic psychosocial health conditions on sexual risk behavior and HIV infection among a sample of high-risk African American men who have sex with men (MSM) and to identify resilience factors that may buffer these effects. We used baseline data from an HIV risk-reduction trial to examine whether a higher number of syndemic conditions was associated with higher rates of self-reported sexual risk behavior and HIV infection. Using logistic regression models, we tested for interactions between number of syndemic conditions and several potential resilience factors to identify buffering effects. Replicating previous studies, we found significant associations between numbers of syndemic conditions and higher rates of sexual risk behavior and HIV infection. Surprisingly, we also replicated a previous finding (Stall et al., Am J Public Health, 93(6):939-942, 2003) that the effects of syndemic burden on HIV status fell off at the highest levels of syndemic conditions. Among a variety of potential resilience factors, two-optimism and education-buffered the syndemic effect on HIV prevalence. This is, to our knowledge, the first paper to identify resilience factors buffering against syndemic effects among MSM. It also constitutes a significant contribution to the literature regarding prevention among black MSM. These results point to the need to identify HIV-positive black MSM and provide effective treatment for them and to develop interventions addressing both syndemic and resilience factors.