Sexual Transmission Of HIV Research Articles

Characterization of the Epidemic Process of HIV Infection in a Region With a High Level of HIV Prevalence Over a Long Period of Time (Example of the Tyumen Region)

The purpose of the study is to analyze the dynamics of the development of the HIV epidemic process in the Tyumen region in 1993–2018 (without autonomous okrugs).Materials and methods. The work used epidemiological, descriptive-evaluative, analytical and statistical research methods, with the calculation of intensive (incidence, incidence) and extensive indicators (structure of incidence, incidence), determining the trend of the epidemic process.Results and conclusions. As of the end of 2018, more than 1,2% of the population is infected with HIV in the Tyumen region. The average long-term growth rate is +259,9% (expressed). Over the 26 years of HIV registration, men have been predominantly infected, the route of infection is parenteral (narcotic). Since 2002, the proportion of sexual transmission of HIV has doubled, sexual heterosexual transmission has become the leading one at the present stage of the development of the epidemic process (59,8%). A «portrait» of a modern HIV-infected person in the region can be considered a predominantly unemployed man or woman (taking into account the trend) aged 40–49 years and older, with a secondary specialized education, subject to deviant behavior (including when using drugs). At the present stage, there is an obvious redistribution of the structure of the identified HIV-infected people towards the predominance of older age groups and pensioners with an increase in HIV +52,8%. The decrease in the growth rate and the incidence rate of HIV over the past 3 years is a positive trend amid the generalized nature of the spread of HIV.

Randomized controlled trial protocol for project BRIDGE: A telephone-administered motivational interviewing intervention targeting risky sexual behavior in older people living with HIV

PurposeBy 2020, 70% of people living with HIV in the United States will be greater than 50 years of age. As many as 37% of sexually active older people living with HIV (OPLWH) engage in HIV transmission sexual behaviors. In spite of repeated calls for secondary prevention interventions to reduce condomless sex in OPLWH, no age-appropriate, evidence-based secondary prevention interventions exist for this group. Furthermore, many OPLWH face barriers to engaging in face-to-face secondary prevention services because of HIV- and age-related stigma, comorbid mental and physical health conditions that complicate travel, or geographic isolation. High rates of depression in OPLWH may further complicate engagement in interventions intended to reduce HIV transmissions. Telephone-administered motivational interviewing may be a feasible and efficacious intervention for this population. MethodsThis randomized controlled trial will test the efficacy of a 5-session telephone-administered motivational interviewing plus behavioral skills training (teleMI+BST) intervention versus a 5-session telephone-administered coping effectiveness training (teleCET) control intervention to reduce condomless sex in OPLWH. A diverse sample of 336 OPLWH will be recruited across the U.S. The primary analysis will test the efficacy of teleMI+BST to reduce occasions of non-condom protected anal and vaginal intercourse with HIV serodiscordant sex partners. Secondary analyses will examine the efficacy of teleMI+BST to reduce depressive symptoms in mildly depressed OPLWH. ConclusionThis is the first large-scale RCT intended to reduce HIV sexual transmission risk behavior in OPLWH and will add to the literature on secondary prevention telehealth interventions for people living with HIV.ClinicalTrials.gov Identifier: NCT03004170. This trial has been conducted by the approval of the Institutional Review Board. Participants provided verbal consent to participate in this trial.

Human immunodeficiency virus, acquired immunodeficiency syndrome (HIV/AIDS): awareness and attitude among school teachers

Introduction: Awareness and attitude regarding human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) can play a crucial role in providing health education and prevention of HIV/AIDS. This study aims to find out awareness and attitude regarding HIV/AIDS amongst secondary level school teacher.
 Method: During 3-months period in 2018, secondary level school teachers in Lalitpur district in Kathmandu valley, Nepal, were randomly selected by lottery to find out their awareness and attitude regarding HIV/AIDS. A self-administered structured questionnairesand a five-points Likert attitude scale was used to collect data. Data was analysed with SPSS version 16.
 Result: Among 116 school teachers included in the study, 94 (81%) had adequate level of awareness on HIV/AIDS, 115(99.1%) were aware about sexual transmission of HIV, 112 (96.6%) about not being transmitted by eating drinking from same utensils and 113 (97.4%) knew commercial sex workers as high-risk group. Overall, 106 (91.4%) had favourable attitude regarding HIV/AIDS. There was no significant correlation between awareness and attitude.
 Conclusion: The HIV/AIDS awareness among secondary level school teachers was adequate, their attitude was favorable. There was no association between awareness and attitude.

The High Content of Fructose in Human Semen Competitively Inhibits Broad and Potent Antivirals That Target High-Mannose Glycans.

Semen is the primary transmission vehicle for various pathogenic viruses. Initial steps of transmission, including cell attachment and entry, likely occur in the presence of semen. However, the unstable nature of human seminal plasma and its toxic effects on cells in culture limit the ability to study in vitro virus infection and inhibition in this medium. We found that whole semen significantly reduces the potency of antibodies and microbicides that target glycans on the envelope glycoproteins (Envs) of HIV-1. The extraordinarily high concentration of the monosaccharide fructose in semen contributes significantly to the effect by competitively inhibiting the binding of ligands to α1,2-linked mannose residues on Env. Infection and inhibition in whole human seminal plasma are accurately mimicked by a stable synthetic simulant of seminal fluid that we formulated. Our findings indicate that, in addition to the protein content of biological secretions, their small-solute composition impacts the potency of antiviral microbicides and mucosal antibodies.IMPORTANCE Biological secretions allow viruses to spread between individuals. Each type of secretion has a unique composition of proteins, salts, and sugars, which can affect the infectivity potential of the virus and inhibition of this process. Here, we describe HIV-1 infection and inhibition in whole human seminal plasma and a synthetic simulant that we formulated. We discovered that the sugar fructose in semen decreases the activity of a broad and potent class of antiviral agents that target mannose sugars on the envelope protein of HIV-1. This effect of semen fructose likely reduces the efficacy of such inhibitors to prevent the sexual transmission of HIV-1. Our findings suggest that the preclinical evaluation of microbicides and vaccine-elicited antibodies will be improved by their in vitro assessment in synthetic formulations that simulate the effects of semen on HIV-1 infection and inhibition.

Social representations of the prevention of heterosexual transmission of HIV among young Africans from five countries, 1997-2014.

HIV prevention has evolved dramatically since the 1990s. The ABC trilogy (abstinence, be faithful, use a condom) has expanded to incorporate a range of biomedical prevention strategies, including voluntary medical male circumcision, pre- and post-exposure prophylaxis, and treatment-as-prevention, and to accommodate structural and combination prevention approaches. This study examines how young Africans from five epidemiologically and socio-culturally diverse countries (Swaziland, Kenya, Nigeria, Burkina Faso and Senegal) made sense of the evolving prevention of sexual transmission of HIV between 1997 and 2014. It uses a distinctive data source: 1,343 creative narratives submitted to HIV-themed scriptwriting competitions by young people aged 10–24. The study triangulates between analysis of quantifiable characteristics of the narratives, thematic qualitative analysis, and narrative-based approaches. Over time, HIV prevention themes become less prominent. Condoms are represented less often from 2008, though representations become more favourable. Biomedical prevention is all but absent through 2014. While prevention strategies may be described as effective in narratorial commentary, they are rarely depicted as preventing HIV, but are evoked instead in moralistic cautionary tales or represented as ineffective. Over time, an increasing proportion of protagonists are female. One in five narratives acknowledge structural drivers of HIV, but these are generally either disempowering or condemn characters for failing to prevent HIV in the face of often overwhelming structural challenges. In the context of combination prevention, there is a need to disseminate an empowering cultural narrative that models successful use of HIV prevention strategies despite structural constraints and avoids blaming and stigma.

HIV Status Disclosure and Sexual Transmission Risks Among People Who Are Living With HIV and Receiving Treatment for Non-HIV Sexually Transmitted Infections, Cape Town, South Africa.

HIV status disclosure to sex partners potentially reduces the risk of sexually transmitting HIV. However, there is limited information on the associations between HIV status disclosure in types of sexual partnerships and ensuing sexual practices. We examined HIV status disclosure to sex partners among 205 men and women living with HIV and receiving diagnostic and treatment services for a co-occurring sexually transmitted infection (STI) in Cape Town, South Africa. Participants completed partner-by-partner sexual behavior interviews and provided permission to extract recurrent STI clinic visits over the subsequent 12 months. Three groups were formed on the basis of HIV status disclosure to sex partners: (1) 22% reported only HIV same-status partners, (2) 26% had HIV-negative or unknown HIV status (HIV different status) sex partners to whom they had disclosed their HIV status, and (3) 52% had at least one HIV different-status partner to whom they had not disclosed. There were no associations between HIV status disclosure and demographic characteristics, sexual practices, or recurrent STI clinic visits. Undisclosed HIV status to at least one HIV different-status sex partner was associated with greater alcohol use and less likelihood of receiving antiretroviral therapy; participants who were least likely to disclose their HIV status to partners drank more alcohol and were less likely to be taking antiretroviral therapy. High prevalence of partner nondisclosure and lack of significant correlates to HIV status disclosure indicate a need for further research with an eye toward identifying disclosure processes and mechanisms that may ultimately lead to effective interventions.

Investigation of an extensive outbreak of HIV infection among children in Sindh, Pakistan: protocol for a matched case–control study

IntroductionIn April 2019, 14 children were diagnosed with HIV infection by a private healthcare provider in Larkana district, Sindh province, Pakistan. Over the next 3 months, 930 individuals were diagnosed...

Voluntary medical male circumcision and sexual practices among sexually active circumcised men in Mzuzu, Malawi: a cross-sectional study

BackgroundVoluntary Medical Male Circumcision (VMMC) is one of the strategies being promoted to prevent sexual heterosexual transmission of HIV. It has been adopted by 14 countries with high HIV prevalence and low circumcision rates. The 60.0% protective efficacy of VMMC has come with misconceptions in some societies in Malawi, hence VMMC clients may opt for risky sexual practices owing to its perceived protective effect. The study estimated proportion of circumcised men engaging in risky sexual behaviors post-VMMC, assessed knowledge on VMMC protective effect and identified socio-demographic factors associated with risky sexual practices.MethodA cross sectional study was conducted at two sites of Mzuzu city. Systematic random sampling was used to select 322 participants aged 18–49 who had undergone VMMC. The independent variables included age, location, occupation, religion, marital status and education. Outcome variables were non condom use, having multiple sexual partners and engaging in transactional sex. Data from questionnaires was analyzed using Pearson’s chi square test and logistic regression.ResultsOut of 322 respondents, 84.8% (273) understood the partial protection offered by VMMC in HIV prevention. Ninety-six percent of the participants self-reported continued use of condoms post VMMC. Overall 23.7–38.3% participants self-reported engaging in risky sexual practices post VMMC, 23.7% (76) had more than one sexual partner; 29.2% (94) paid for sex while 39.9% (n = 187) did not use a condom. Residing in high density areas was associated with non-condom use, (p = 0.043). Being single (p < 0.001), and residing in low density areas (p = 0.004) was associated with engaging in transactional sex.ConclusionRisky sexual practices are evident among participants that have undergone VMMC. Messages on safer sexual practices and limitations of VMMC need to be emphasized to clients, especially unmarried or single and those residing in low density areas.

Sexual Anxiety Among Women Living with HIV in the Era of Antiretroviral Treatment Suppressing HIV Transmission

Sustained undetectable viral loads (UDVLs) on antiretroviral therapy (ART) eliminate sexual HIV transmission. We measured prevalence and correlates of sexual anxiety among women living with HIV. We used questionnaire data collected between August 2013 and May 2015 from 1422 women ≥ 16 years in the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study. Among women reporting consensual sex in the past month (n = 474), we determined the proportion who reported high anxiety (“always/usually became anxious or inhibited during sexual activity with a partner”), low anxiety (“sometimes/seldom”), and no anxiety. Logistic regression identified medical, psychological, relational, and social correlates, including awareness of ART prevention benefits (i.e., “makes the risk of transmitting HIV a lot lower”). Cohort diversity is reflected in age (range 17–66; median 39), gender (5.7% trans), ethnicity (41.6% White, 24.5% Indigenous, 27.0% African/Caribbean/Black), sexual orientation (14.2% lesbian/queer), and time living with HIV (range 18 days–30 years.). Overall, 58.6% reported feeling no sexual anxiety, while the remainder said that they always/usually (14.6%) or sometimes/seldom (26.8%) became anxious or inhibited during sex. Current sex work, previous illicit drug use, and depression were associated with higher adjusted odds of sexual anxiety, while greater emotional closeness and more equitable relationship power were associated with lower odds. There was no correlation between awareness of ART prevention benefits and sexual anxiety. Relatively few women reported high anxiety during sex with a partner. This was more socially and relationally influenced than linked to understanding ART prevention benefits. Women living with HIV should be supported to have great sex, free from worry, by tackling unequal power in women’s intimate relationships, lack of access to resources, and mental health difficulties.

Disclosure of HIV Status and HIV Sexual Transmission Behaviors among HIV-Positive Black Men Who Have Sex with Men in the BROTHERS (HPTN 061) Study.

We assessed whether disclosure of HIV status is significantly associated with reported HIV sexual risk behaviors among HIV positive Black/African American men who have sex with men (MSM) (Black MSM) in six cities in the USA. Participants from the BROTHERS (HIV Prevention Trials Network [HPTN 061]) study focused on assessing the feasibility and acceptability of a multifaceted HIV prevention intervention to reduce HIV infections among Black MSM enrolled between July 2009 and October 2010. All participants completed a behavioral assessment using an audio computer-assisted self-interview that included questions about HIV status disclosure, HIV sexual risk behaviors, and other behaviors. Biological samples were also collected. This analysis focused on baseline data of HIV-positive Black MSM in the HPTN 061 study. Of the 143 HIV-positive Black MSM (majority ≥ 35years of age) included in this analysis, 58% reported disclosing their HIV status to their last male anal sex partner. Forty-three percent and 42% reported condomless insertive and receptive anal intercourse respectively with their last male partner; whereas, 17% and 18% of the sample engaged in condomless insertive and receptive anal intercourse with a serodiscordant/unknown status partner, respectively. In multivariable logistic regression models, there was no statistically significant association between HIV status disclosure and condomless insertive anal intercourse (aOR = 0.35, 95% CI 0.11, 1.08; p = 0.30), condomless receptive anal intercourse (aOR = 2.48, 95% CI 0.94, 6.52; p = 0.20), or condomless receptive anal intercourse with a serodiscordant/unknown status partner (aOR = 0.55, 95% CI 0.20, 1.49; p = 0.45). However, HIV status disclosure was significantly associated with lower odds of reporting condomless insertive anal intercourse with a serodiscordant/unknown status partner (aOR = 0.19, 95% CI 0.06, 0.68; p ≤ 0.01). Among this multi-city sample of HIV-positive Black MSM, disclosure of HIV status was common and associated with lower HIV sexual risk behaviors. These findings should motivate and guide research to develop prevention messages to increase HIV status disclosures.

Investigating possible syndemic relationships between structural and drug use factors, sexual HIV transmission and viral load among men of colour who have sex with men in Los Angeles County.

Past research investigating syndemic factors and HIV-related outcomes has overlooked the impact of structural conditions on behaviours linked with HIV transmission and disease progression. Given prevalent substance use among our sample, we explored whether four structural conditions indicative of social marginalisation and previously correlated with increased risk for HIV infection demonstrated syndemic (additive/synergistic) effects on: (i) HIV viral suppression; and (ii) self-reported involvement in sexual HIV transmission behaviours among a prospective cohort mostly comprising men of colour who have sex with men (MCSM; i.e. Latino/Hispanic and African American/black men) in Los Angeles County. Data were collected between August 2014 and March 2017. The structural conditions of interest were: current unemployment, recent (≤6 months) incarceration history, 'unstable' accommodation (past month) and remote (>6 months) contact with health-care providers. Generalised estimating equations assessed possible additive effects of experiencing multiple structural conditions, and possible synergistic effects on the HIV-related outcomes. Of 428 participants, nearly half (49%) were HIV-positive at baseline. Involvement in sexual HIV transmission risk behaviours varied over follow-up (22-30%). Reporting ≥2 structural syndemic conditions was significantly associated with reporting sexual HIV transmission risk behaviours among HIV-negative participants, and detectable viral load among HIV-positive participants. Frequent methamphetamine use was consistently associated with the HIV-related outcomes across the final multivariate models. When developing initiatives to address HIV transmission among marginalised sub-populations including MCSM, we must holistically consider systemic and structural issues (e.g. unemployment and homelessness), especially in the context of prevalent substance use.

Phylogenomic analysis of Neisseria gonorrhoeae transmission to assess sexual mixing and HIV transmission risk in England: a cross-sectional, observational, whole-genome sequencing study

SummaryBackgroundCharacterising sexual networks with transmission of sexually transmitted infections might allow identification of individuals at increased risk of infection. We aimed to investigate sexual mixing in Neisseria gonorrhoeae transmission networks between women, heterosexual men, and men who report sex with men (MSM), and between people with and without HIV.MethodsIn this cross-sectional observational study, we whole-genome sequenced N gonorrhoeae isolates from the archive of the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP).w Isolates that varied by five single nucleotide polymorphisms or fewer were grouped into clusters that represented sexual networks with N gonorrhoeae transmission. Clusters were described by gender, sexual risk group, and HIV status.FindingsWe sequenced 1277 N gonorrhoeae isolates with linked clinical and sociodemographic data that were collected in five clinics in England during 2013–16 (July 1 to Sept 30 in 2013–15; July 1 to Sept 9 in 2016). The isolates grouped into 213 clusters. 30 (14%) clusters contained isolates from heterosexual men and MSM but no women and three (1%) clusters contained isolates from only women and MSM. 146 (69%) clusters comprised solely people with negative or unknown HIV status and seven (3%) comprised only HIV-positive people. 60 (28%) clusters comprised MSM with positive and negative or unknown HIV status.InterpretationN gonorrhoeae molecular data can provide information indicating risk of HIV or other sexually transmitted infections for some individuals for whom such risk might not be known from clinical history. These findings have implications for sexual health care, including offering testing, prevention advice, and preventive treatment, such as HIV pre-exposure prophylaxis.FundingNational Institute for Health Research Health Protection Research Unit; Wellcome; Public Health England.

Rising HIV seroconversion rates & associated risks among employees of organization 'X': A case control study, Pakistan, 2017.

Background and Objectives:In 2004 Pakistan escalated from ‘low-prevalence’ to ‘concentrated’ phase of HIV epidemic. Despite global decline in HIV incidence since 1997, rate of HIV infections in Pakistan is persistently rising since 1990. Available literature focusses on key populations or localized outbreaks limited by short study duration and regional applicability of results. We studied HIV seroconversion trends over a period of 8 years in a geographically diverse population and evaluated associated risk factors.Methods:A desk review of HIV surveillance data from 2010 to 2017 was carried out at Armed Forces Institute of Pathology. A case was defined as any adult employed in organization ‘X’, initially screened for HIV but later seroconverted on ELISA and western blot. Case-control study was conducted on cases diagnosed in 2017. Age and sex matched controls were identified from same population sub-group. Structured telephonic interviews were conducted and statistical analysis done at 5% margin of error.Results:The annual HIV diagnosis rate remained relatively stable till 2015 (< 40 /100,000/yr) after which it rose sharply to 60/100,000/yr in 2016 .Upward trend continued in 2017 to reach 125/100,000/yr (>200% increase from baseline). Acquisition of HIV was significantly associated with commercial sex activities (OR=9; 95% CI: 1.25-395).Conclusion:HIV seroconversion rates among employees of organization X have increased significantly in the past two years. Unlike HIV outbreaks previously reported from Pakistan, sexual route seems to be the predominant mode of transmission. Focus is mandated on prevention of sexual transmission of HIV at national level as well for all vulnerable populations.

Sexual Behavior and Attitudes Toward Sex of Older Adults Living with HIV.

The number of older adults living with HIV (OALHIV) is increasing rapidly due to effective antiretroviral therapy. The current research describes sexual behavior, attitudes toward sex, and HIV transmission risk among OALHIV. Participants were HIV-infected persons aged 50years and older enrolled from community hospitals in Chiang Mai Province, Northern Thailand. Of the 328 participants, 57.6% were women, and the average age was 58.8years. The majority of participants (93.9%) had undetectable viral load. Most participants (77.1%) thought that it is ok/acceptable for PLHIV to have sex. About one-third of OALHIV participants were sexually active. Being male, younger, married, a previous smoker or a non-smoker, having a positive attitude toward sex, and not having a chronic health condition were independent predictors of having had sex in the last 12months. Risk of HIV sexual transmission was likely low due to consistent condom use, undetectable viral load, and low instances of extramarital sex.

Extracellular vesicles from symbiotic vaginal lactobacilli inhibit HIV-1 infection of human tissues

The vaginal microbiota, dominated by Lactobacillus spp., plays a key role in preventing HIV-1 transmission. Here, we investigate whether the anti-HIV effect of lactobacilli is mediated by extracellular vesicles (EVs) released by these bacteria. Human cervico-vaginal and tonsillar tissues ex vivo, and cell lines were infected with HIV-1 and treated with EVs released by lactobacilli isolated from vaginas of healthy women. EVs released by L. crispatus BC3 and L. gasseri BC12 protect tissues ex vivo and isolated cells from HIV-1 infection. This protection is associated with a decrease of viral attachment to target cells and viral entry due to diminished exposure of Env that mediates virus-cell interactions. Inhibition of HIV-1 infection is associated with the presence in EVs of several proteins and metabolites. Our findings demonstrate that the protective effect of Lactobacillus against HIV-1 is, in part, mediated by EVs released by these symbiotic bacteria. If confirmed in vivo, this finding may lead to new strategies to prevent male-to-female sexual HIV-1 transmission.

Interventions to improve the HIV continuum of care in China.

To describe HIV epidemic and interventions for improving HIV continuum of care in China. The reported HIV epidemic has been continuously increasing, partially due to the expansion of active HIV testing campaign. Public health intervention programs have been effective in containing HIV spread among former plasma donors and people who inject drugs (PWID), but more infections occur among heterosexual men and women and young men who have sex with men. Of 1.25 million Chinese people are living with HIV, one-third do not know their status. About two-thirds of diagnosed individuals have used antiretroviral therapy (ART) and two-thirds of those on ART have achieved viral suppression, but some risk groups such as PWID have lower rates. The national free ART program has reduced adult and pediatric mortality and reduced heterosexual transmission. China faces great challenges to reduce HIV sexual transmission, improve the HIV continuum of care, and close the gaps to the UNAIDS Three "90" Targets.

Alcohol use and sexual risk behaviors in the Armed Forces of the Democratic Republic of the Congo

BackgroundAlcohol misuse is an important contributor to sexual acquisition and transmission of HIV in military communities. This cross-sectional study quantified the prevalence of probable problematic alcohol use among male service members in the Armed Forces of the Democratic Republic of the Congo (FARDC), identified associated factors, and investigated associations of alcohol misuse with risky sexual behaviors.MethodsParticipants included 2549 active duty male soldiers ≥ 18 years old. Data were collected via computer-assisted personal-interview from October 2013–April 2014. The Alcohol Use Disorders Identification Test (AUDIT) was used to identify probable problematic alcohol use (AUDIT score ≥ 8) compared to no/low-risk alcohol use (AUDIT score ≤ 7). Bivariate logistic regressions were used to identify factors associated with probable problematic alcohol use. Several multivariable logistic regressions (adjusted for age, marital status, education level) were used to examine associations of probable problematic alcohol use with risky sexual behaviors. Tests were two sided; statistical significance was defined as p < 0.05.ResultsFifteen percent of men screened positive for probable problematic alcohol use. The odds of probable problematic alcohol use were elevated among men who were single and living with a partner (OR = 1.66; 95% CI = 1.24–2.21), ranked as a non-commissioned officer [NCO] (OR = 1.40; 95% CI = 1.10–1.77), and in the 30–39 and 40–49 age groups (OR 30–39 age group = 2.17; 95% CI = 1.56–3.02; OR 40–49 age group = 1.79; 95% CI = 1.26–2.55). Probable problematic alcohol use was associated with increased odds of having sex with a sex worker (SW), having multiple sexual partners, and participating in transactional sex (aOR sex with a SW = 2.36; 95% CI = 1.78–3.13; aOR multiple sexual partners = 2.08; 95% CI = 1.66–2.60; aOR transactional sex = 1.99; 95% CI = 1.59–2.50).ConclusionsResults emphasize the need to address alcohol use in the FARDC and integrate alcohol abuse education into HIV prevention programs among male service members. Alcohol abuse prevention efforts should target men who are 30–49 years of age, unmarried, and ranked as a NCO. Messages and interventions to reduce alcohol misuse in relation to risky sexual behaviors are needed.

Stimulant Use and Study Protocol Completion: Assessing the Ability of Men Who Have Sex with Men to Collect Dried Blood Spots for Laboratory Measurement of HIV Viral Load.

Stimulant use is associated with higher HIV viral load (VL) and sexual HIV transmission risk among men who have sex with men (MSM) living with HIV. There is little research on willingness of drug users living with HIV to fully participate in studies, especially those involving self-collection of biomarker data. This study presents findings from an at-home dried blood spot collection study measuring laboratory-quantified VL among U.S. HIV-positive MSM who reported high-risk sexual behavior and/or suboptimal antiretroviral therapy (ART) adherence to assess the association between drug-use behavior and (1) ability to complete a study protocol and (2) VL outcomes. Among recruited participants (n = 766), 35% reported stimulant drug use (amphetamines, cocaine, crack, crystal meth, ecstasy, or a combination of stimulant drugs), 39% reported using other drugs (heroin, marijuana, prescription opioids, and others), and 27% reported no drug use in the past 3 months. In all, 61% of enrolled participants completed the study protocol. Stimulant drug users were less likely (ARR 0.84; 95% CI 0.72-0.98) to complete the protocol than other drug users. Furthermore, other drug users were significantly less likely than non-drug users (ARR 0.52; 95% CI 0.28-0.97) to have an HIV VL result ≥ 1500 copies/mL. This study provides important estimates regarding the likelihood of participation in biomedical research activities among HIV-positive MSM with varying drug-use behaviors, showing that it is feasible to conduct such biomedical studies with drug-using MSM who report high-risk sexual behavior and struggle with their ART adherence.

Geographic distribution of risk (\u201cHotspots\u201d) for HIV, HCV, and drug overdose among persons who use drugs in New York City: the importance of local history

AimsTo identify geographic “hotspots” for potential transmission of HIV and HCV and for drug overdose among persons who use heroin and cocaine in New York City and to examine historical continuities in problem drug use hotspots in the city.MethodsA total of 2714 study participants were recruited among persons entering Beth Israel substance use treatment programs. A structured questionnaire was administered and blood samples for HIV and HCV testing were collected. Hotspots for potential virus transmission were defined as ZIP codes with 10+ participants, 2+ persons infected with the virus and engaging in transmission behavior, and 2+ persons not infected and engaging in acquisition behavior. ZIP codes with 3+ persons with previous overdoses were considered potential hotspots for future overdoses.ResultsParticipants resided in 166/178 (93%) of the ZIP codes in New York City. Injecting drug use was reported in 150/178 (84%) of the ZIP codes. No zip codes were identified for injecting-related HIV transmission, 5 zip codes were identified for sexual HIV transmission, 3 for HCV transmission, and 8 for drug overdose. Many of the ZIP code potential hotspots were in neighborhoods long associated with drug use: Lower Eastside and Harlem in Manhattan, the South Bronx, and Central Brooklyn.DiscussionHeroin and cocaine use requiring treatment were reported from almost all ZIP codes in New York City, indicating needs for widely dispersed harm reduction services. Identified hotspots should be targeted for reducing sexual transmission of HIV, transmission of HCV, and drug overdoses. Some of the hotspots have persisted as problem drug use areas for 40 to over 100 years. Monitoring of drug use patterns in historical hotspot neighborhoods may permit early identification of and response to emerging drug use-related health problems. Persistent historical hotspots for problem drug use present a complex problem for implementing harm reduction services that deserve additional research.

The anti-parasitic drug suramin potently inhibits formation of seminal amyloid fibrils and their interaction with HIV-1

Seminal amyloid fibrils are made up of naturally occurring peptide fragments and are key targets for the development of combination microbicides or antiviral drugs. Previously, we reported that the polysulfonic compound ADS-J1 is a potential candidate microbicide that not only inhibits HIV-1 entry, but also seminal fibrils. However, the carcinogenic azo moieties in ADS-J1 preclude its clinical application. Here, we screened several ADS-J1-like analogs and found that the antiparasitic drug suramin most potently inhibited seminal amyloid fibrils. Using various biochemical methods, including Congo red staining, CD analysis, transmission EM, viral infection assays, surface plasmon resonance imaging, and molecular dynamics simulations, we investigated suramin's inhibitory effects and its putative mechanism of action. We found that by forming a multivalent interaction, suramin binds to proteolytic peptides and mature fibrils, thereby inhibiting seminal fibril formation and blocking fibril-mediated enhancement of viral infection. Of note, suramin exhibited potent anti-HIV activities, and combining suramin with several antiretroviral drugs produced synergistic effects against HIV-1 in semen. Suramin also displayed a good safety profile for vaginal application. Moreover, suramin inhibited the semen-derived enhancer of viral infection (SEVI)/semen-mediated enhancement of HIV-1 transcytosis through genital epithelial cells and the subsequent infection of target cells. Collectively, suramin has great potential for further development as a combination microbicide to reduce the spread of the AIDS pandemic by targeting both viral and host factors involved in HIV-1 sexual transmission.