HIV Sexually Transmitted Infections Research Articles

PrEP Uptake and Discontinuation Among a U.S. National Sample of Transgender Men and Women.

Pre-exposure prophylaxis (PrEP) has revolutionized HIV prevention efforts by effectively preventing the sexual transmission of HIV infection. Few studies have examined PrEP uptake and discontinuation among transgender individuals who are underserved in HIV prevention efforts. An online U.S. nationwide survey screened 294 HIV-negative transgender people for participation in a larger cohort study. We analyzed associations between demographic characteristics and PrEP use and discontinuation. We conducted thematic analyses of open-ended responses to identify reasons for PrEP discontinuation. Fifty-one participants (17.4%) reported ever receiving a PrEP prescription. Transgender men reported higher PrEP use than transgender women (χ2 = 18.06; p < 0.0001). PrEP discontinuation was reported by 49.0% of individuals who reported PrEP use. Reasons for PrEP discontinuation were related to side effects, insurance coverage, relationship status, and access to providers. HIV prevention efforts to increase PrEP should include mechanisms for PrEP uptake and re-initiation among transgender individuals.

HIV prevalence and gender differences among new injection-drug-users in Tallinn, Estonia: A persisting problem in a stable high prevalence epidemic.

IntroductionNew injectors / younger drug users are an important population to target for intervention because they are often at especially high risk of HIV and HCV infection. We examined HIV prevalence and gender differences in HIV prevalence and risk behavior among new injection-drug-users in Tallinn, Estonia.MethodsRespondent driven sampling (RDS) interview surveys and HIV testing were conducted in Tallinn in 2009, 2011 and 2013. We classified “new injectors” as persons who reported their first injection as occurring within three years of the study interview. Recruiting trees of the three individual RDS studies were joined to form one RDS dataset and RDS estimates for prevalence and means were derived. Bootstrap tests were used to compare data from men and women, HIV infected and uninfected.ResultsAmong 110 new injectors (34 women and 76 men) the mean age was 24.5 (SD 7.5) years; 63% reported injecting mainly fentanyl, 34% injecting mainly amphetamine, 36% sharing syringes, 89% were sexually active, and, of these, 88% did not always use condoms in the last 6 months. HIV prevalence was 18% (95%CI 8–28%) (41% (95%CI 19–63%) among female and 7% (95%CI 2–12%) among male new injectors). Based on self-reports, 8.1% of all new injectors (and 22% of female new injectors) were HIV positive before starting to inject drugs. 40% of HIV infected reported receiving antiretroviral therapy. In multivariable analysis, gender (male: OR 0.12, 95% CI 0.03–0.45), main drug injected (fentanyl: OR 6.7, 95% CI 1.3–35.7) and syringe sharing (distributive: OR 0.11, 95% CI 0.02–0.55; and receptive: OR 3.7, 95% CI 1.0–13.5) were associated with the HIV seropositivity.ConclusionsNew injectors exhibit high-risk behavior and correspondingly high HIV prevalence. Sexual transmission of HIV infection, including before injection initiation, is likely to be a significant contributor to HIV risk among female new injectors. This highlights the need to identify and target new injectors and their partners with gender specific interventions in addition to interventions to reduce initiation into injecting and ensuring provision of ART to HIV positive new injectors.

72: HIV PREVALENCE AMONG FEMALE SEX WORKERS IN IRAN: A SYSTEMATIC REVIEW

Background and aims:Although injecting drug use is considered the main route of HIV transmission in Iran, the growing trend of sexual transmission of HIV infection has been much of a...

Knowledge Levels of Male Circumcision among Pregnant Women at a Referral Health Institution: A Pilot Study

Worldwide, 30% of all men, (665 million), are circumcised for various reasons including cultural, religious and medical reasons. This figure is too low, considering that it is projected that by the end of 2015 80% of all males should have been circumcised in order to reduce sexual transmission of HIV infection by 50% by 2025. Though prevalence of male circumcision is high in Jewish, Islamic and Muslim countries where it is about 98%, in some parts of the world, it is less than 5%. The purpose of this study was to assess the level of knowledge of medical benefits of male circumcision among pregnant women aged 18-35 years at Parirenyatwa Antenatal Clinic in Harare, Zimbabwe. The study was conducted with a convenience sample of 30 pregnant women. Data was collected from February to March 2013 using structured questionnaires. The health belief model was the guiding framework for the study. Permission to carry out the study was granted by the respective institutional review boards and all participants gave written consent. Data was analyzed using Microsoft Excel. Results indicated that 66.7% knew that male circumcision is a preventive method of HIV. Twenty five (83.3%) were aware that it was easier to be infected with HIV if he is not circumcised that when he is circumcised. Ten percent of the respondents demonstrated low knowledge of Voluntary Medical Male Circumcision while 53.3% had moderate knowledge and 36.7% had high levels of knowledge about VMMC. It follows from the study that women need to be actively involved in the VMMC programme.

Investments in sexually transmitted infection research, 1997-2013: a systematic analysis of funding awarded to UK institutions.

BackgroundWe report the first study that analyses public and philanthropic investments awarded to UK institutions for research related to sexually transmitted infections (STIs).MethodsWe systematically searched award data from the major funders for information on all infectious disease research funding awarded in 1997–2013. The STI–related projects were identified and categorised by pathogen, disease and type of science along the research pipeline from preclinical to translational research.FindingsWe identified 7393 infection–related awards with total investment of GBP 3.5 billion. Of these, 1238 awards (16.7%) covering funding of GBP 719.1 million (20.5%) were for STI research. HIV as an STI received GBP 465 million across 719 studies; non–HIV STIs received GBP 139 million across 378 studies. The Medical Research Council provided greatest investment (GBP 193 million for HIV, GBP 45 million for non–HIV STIs). Preclinical awards totalled GBP 233 million (37.1%), whilst translational research received GBP 286 million (39.7%). Substantial proportions of HIV investment addressed global health research (GBP 265 million), vaccinology (GBP 110 million) and therapeutics (GBP 202 million). For other STIs, investments focused on diagnostics (GBP 45 million) and global health (GBP 27 million). Human Papilloma Virus research received GBP 58 million and chlamydia GBP 24 million. Funding for non–HIV STIs has declined in the three most recent years of this data set.ConclusionsThe investment for HIV research awarded to UK institutions correlates with the high global burden, but other STIs are relatively neglected, including gonorrhoea and syphilis. Future STI funding should be better aligned with burden while addressing the emerging risk of antimicrobial resistance in Neisseria gonorrhoeae and outbreaks of other pathogens.

Having Multiple Sexual Partners among Iranian Intra-Venous Drug Users.

Background: Transmission of HIV from intra-venous drug users (IDUs) to the community occurs predominantly through high-risk sexual behaviors. Limited information exists regarding the high-risk sexual behaviors of IDUs in Iran.Aim: The aim of this study was to determine the prevalence and factors associated with having multiple sexual partners among Iranian IDUs.Methods: This is a national survey on drug-dependent adults. Participants were sampled from medical centers, prisons, and streets of capitals of 29 provinces in Iran between May 2007 and February 2008. We analyzed data of 1416 current IDUs. Socio-demographics and drug use characteristics were entered into a binary logistic regression model to determine predictors of having multiple sexual partners.Results: Having multiple sexual partners in the past or at the time of survey was reported by 56.4% of Iranian IDUs. Multivariate analysis showed that the likelihood of having multiple sexual partners in IDUs decreased by being married [odds ratio (OR), 0.38; P < 0.001] and increased by female gender (OR, 13.44; P = 0.02), having illegal income (OR, 1.72; P = 0.003), higher monthly family income (OR, 1.01; P = 0.003), pleasure, curiosity, and recreation as cause of first drug use (OR, 1.37; P = 0.04), ruins as usual place for injection (OR, 1.89; P = 0.001) and history of syringe sharing (OR, 1.50; P = 0.02).Conclusion: Having multiple sexual partners was reported by majority of Iranian IDUs, and this was linked to socio-demographics, initiation data, and other risk behaviors. This information should be considered in prevention efforts to reduce sexual transmission of HIV infection in Iran.

Epidemiologic patterns in HIV infection in Mureş county

Despite the important scientific progress regarding HIV pandemics registered during the last decade, more and more cases of HIV infection are diagnosed every year, as HIV testing practices vary across Europe. Purpose: to identify epidemiologic trends in newly diagnosed patients with HIV infection in the center of Romania. We performed a retrospective, cross-sectional study, over a 5-year period (January 2009 – December 2013), upon all new cases of HIV infection, diagnosed in Mures county. We analyzed demographic data, transmission patterns, level of CD4 T-lymphocytes and patients’ outcome. Over a 5 years-period, we have diagnosed 58 new cases of HIV infection, 63.79% male / 36.21% female. Average age was 27 years, median – 23 years, with extremes between 2 and 55 years. Most cases came from urban areas (65.38%). Transmission patterns included risk groups: men who have sex with men (MSM) – 4 patients, unknown multiple partners – 3 patients, HIV-infected sexual partner – 15 patients, screening at delivery – 4 patients, 1 case of mother-to-child transmission. The dominant pattern was heterosexual transmission – 27 patients. CD4 T-cells count registered an average level of 369 cells/μL, median 335 cells/μL, ranging from 2 to 1304 cells/μL. 23 (39.65%) patients were late presenters. We registered 3 deaths (5.17%). While previous epidemiologic data from our region suggested an unknown route of transmission in children born around the 1990’s, during the last years, the dominant epidemiologic pattern in HIV infection in Mures county was heterosexual transmission. An important category of newly diagnosed patients was represented by late presenters, with potential unfavorable evolution. We registered a concerning trend of sexual transmission of HIV infection in serodiscordant couples, despite medical education.

LANGUAGE, BELIEFS AND THE HIV-AIDS CAMPAIGN IN AFRICA

African governments accepted the reality of HIV-AIDS as a matter of convenience and not out of conviction. As a result, many of them failed to achieve the targets they set for HIV-AIDS prevention. This paper attributes this failure to the language and concepts used in introducing HIV-AIDS as a disease and in promoting safer sex practices such as abstinence, being faithful and condom use (ABC) as the core measures for the prevention of sexual transmission of HIV infection. The paper observes that the concepts of HIV-AIDS, abstinence, mutual fidelity (monogamy) and condom use originated from the west and did not fit into the cosmology, the consensus of meaning and normative behaviour within the African sociocultural and economic environment and therefore could not engender the desired sexual behavioural changes at the group and individual levels. The paper notes however, that there are linguistic elements in some African countries studied that negatively or positively reinforce the spread of HIV-AIDS and promote large family size. By identifying the linguistic elements in the culture that positively reinforce HIV-AIDS prevention messages and behaviours, we may succeed in assimilating the people’s traditional values in line with the demands of modernity. There is therefore need for semantic restructuring of HIV-AIDS campaign messages so that words, slogans and messages originate from the community and reflect the linguistic and sociocultural realities of the people. By using local language, local idioms, local media and local social networks, we may succeed in reducing the semantic noise in HIV-AIDS messages. Keywords: Language and Beliefs, Language use and HIV/AIDS Transmission in Africa.

Design challenges facing clinical trials of the effectiveness of new HIV-prevention technologies

Recent successes of antiretroviral pre-exposure prophylaxis (PrEP) in preventing HIV infection have raised questions whether further placebo controlled trials of new HIVprevention technologies are ethically justifiable. A trial with active agent(s) in the comparator group can be designed either as a superiority or non-inferiority trial. In a non-inferiority trial the hypothesis tested is that the intervention is not inferior to, by a predefined clinically relevant amount, or at least as effective as, the comparator. Noninferiority trials pose challenges in data interpretation. Firstly it is possible to show equivalence of two non-effective interventions. If the active comparator intervention is ineffective, the new intervention would be shown to be noninferior to this inactive intervention, while neither intervention is superior to placebo or no intervention. The second challenge is that any effect that dilutes the true efficacy of an intervention in a trial, such as non-adherence, loss to follow-up or protocol violations, makes it easier for the two interventions to be declared equivalent. Nondifferential low adherence is unlikely to lead to the conclusion that an inferior intervention is non-inferior. However, differential adherence between study arms, which is more likely in non-blinded trials, is likely to bias the results and lead to incorrect conclusions. Investigators conducting non-inferiority trials will have to pay special attention to supporting, measuring and maintaining high adherence. The goal in future noninferiority trials should be to maintain similar levels of high adherence in all study arms, but at a minimum to reduce the likelihood of differential adherence across study arms. 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins AIDS 2012, 26:000‐000

Randomized Clinical Trial of Brief Risk Reduction Counseling for Sexually Transmitted Infection Clinic Patients in Cape Town, South Africa

Objectives. We examined the effects of a brief counseling intervention designed to reduce HIV risk behaviors and sexually transmitted infections (STIs) among patients receiving STI services in Cape Town, South Africa. Methods. After randomization to either a 60-minute risk reduction counseling session or a 20-minute HIV–STI educational session, patients completed computerized sexual behavior assessments. More than 85% of the participants were retained at the 12-month follow-up. Results. There were 24% fewer incident STIs and significant reductions in unprotected vaginal and anal intercourse among participants who received risk reduction counseling relative to members of the control condition. Moderator analyses showed shorter lived outcomes for heavy alcohol drinkers than for lighter drinkers. The results were not moderated by gender. Conclusions. Brief single-session HIV prevention counseling delivered to STI clinic patients has the potential to reduce HIV infections. Counseling should be enhanced for heavier drinkers, and sustained outcomes will require relapse prevention techniques. Disseminating effective, brief, and feasible behavioral interventions to those at highest risk for HIV infection should remain a public health priority.

Perception of the risk of sexual transmission of HIV among Congolese and Japanese university students

Sub-Saharan Africa remains the region most heavily affected by HIV infection. This study aimed to evaluate the knowledge, attitudes, and practices of Congolese students of risk behaviors for sexual transmission of HIV in comparison with their Japanese counterparts. Of the 1,747 undergraduate students who participated in the survey, there were 1,326 respondents (752 Japanese, 574 Congolese) who voluntarily and fully filled out the auto-administered questionnaire. The proportion of Congolese respondents who do not always use condoms with an occasional sex partner was significantly higher, 57%, as compared with their Japanese counterparts (15%; p<0.001). Fewer than 40% (9.9-39.7%) of Congolese respondents had accurate knowledge about multiple sex partnership (MSP), men sex with men (MSM), precocious sex, and commercial sex work (CSW) being high-risk behaviors (p<0.001) for the sexual transmission of HIV infection. However, the proportion of Congolese tested or willing to get tested for HIV was significantly higher (97.2%) than that in the Japanese group (72.4%, p<0.001). In Congolese students, we observed an absence of adherence to preventive measures such as condom use with an occasional sex partner, and a greater proportion of students having inaccurate knowledge of major risk behaviors such as MSM, precocious sex, and MSP, compared with their Japanese counterparts. This study showed that, though sexual contact remains the main mode of HIV transmission in the region, Congolese students tend to have inaccurate knowledge of risk behaviors that expose people to the sexual transmission of HIV. This suggests that continuous education targeting those risk behaviors is of great importance to reduce the spread of the HIV epidemic.

Randomized Clinical Trial of Brief Risk Reduction Counseling for Sexually Transmitted Infection Clinic Patients in Cape Town, South Africa

We examined the effects of a brief counseling intervention designed to reduce HIV risk behaviors and sexually transmitted infections (STIs) among patients receiving STI services in Cape Town, South Africa. After randomization to either a 60-minute risk reduction counseling session or a 20-minute HIV-STI educational session, patients completed computerized sexual behavior assessments. More than 85% of the participants were retained at the 12-month follow-up. There were 24% fewer incident STIs and significant reductions in unprotected vaginal and anal intercourse among participants who received risk reduction counseling relative to members of the control condition. Moderator analyses showed shorter lived outcomes for heavy alcohol drinkers than for lighter drinkers. The results were not moderated by gender. Brief single-session HIV prevention counseling delivered to STI clinic patients has the potential to reduce HIV infections. Counseling should be enhanced for heavier drinkers, and sustained outcomes will require relapse prevention techniques. Disseminating effective, brief, and feasible behavioral interventions to those at highest risk for HIV infection should remain a public health priority.

P5-S6.12 Control of sexually transmitted infections (STI) in Guyana: plan to integrate into existing programmes

BackgroundOver the last decade, Guyana has developed and strengthened surveillance, prevention and care and treatment for HIV. These interventions have resulted in a decline in HIV prevalence in antenatal as...

Sexual behavior of students and risk perception

Knowledge on sexuality, contraception, abortion and sexually transmitted diseases, is a fundamental prerequisite for determination of proper attitudes and increase of risk awareness level. Aim of this survey is to examine some characteristics of students sexual behavior and differences in knowledge, sexual behavior and risk perception for sexual diseases acquisition. Cross-sectional study was carried out among the student population of the Medical College of Vocational Studies in Belgrade. Examined sample population consisted of 246 students. There was used a questionnaire taken over from the Project called 'State of Health and HealthCare Needs of Population in Serbia, and Its Use of HealthCare Protection Service' from the year 2000, designed by the WHO. It was filled out anonymously. For the data statistical processing, there were used methods of descriptive and explorative analysis as well as the cross-table methods with the application of Pearson χ2 test. Analysis was done in the SPSS 13.0 software package. Results are presented in tables. Our research findings indicate that the students are well-informed on sexual transmission of HIV infection, while some smaller ration of them is familiar with the vertical transmission of HIV infection. Consistent use of condoms was found in a half of male participants and 2/5 of female ones, while 1/5 of examinees of both sexes each never use condoms. Inconsistent condom use is the main behavioral pattern in the student population. If a safe sex is considered to be a sexual intercourse with a condom during each sexual relation, with one partner and without sexual relations with unknown persons, we come to a conclusion that such a sex is being done only by 1/3 of the examinees, as well as that 2/3 of them have a risk behavior according to their statements that they never (17,8%), or occasionally (43,5%) use a condom.

Potential for Sexual Transmission of HIV Infection From Male Injecting-Drug Users Who Have Sex With Men in Tehran, Iran

Iran faced an HIV epidemic among injecting-drug users (IDUs) and has responded to this threat. Meanwhile, there is growing concern over the possibility of bridging HIV infection from IDUs to other populations, including men who have sex with men (MSM). Cross-sectional biobehavioral surveys were conducted among 370 injecting-drug users recruited from drug treatment centers, a drop-in center, as well as streets in drug-populated areas in Tehran, Iran, between 2003 and 2004. Data from these surveys showed that about 12% of male, sexually experienced IDUs have had same-gender sex, and HIV prevalence is high (19%), but condom use during the last sexual encounter was low (20%). A multivariate analysis showed that IDUs who had sex with men (MSM IDUs), compared to other sexually experienced IDUs, are younger (AOR, 0.89; 95% CI, 0.81-0.98), more likely to have used a shared needle/syringe for drug injection (AOR, 4.29; 95% CI, 1.82-10.12), and have had more than 5 sexual partners in their lifetime (AOR, 2.71; 95% CI, 1.14-6.44). These results show that MSM IDUs exhibit more drug-related and sexual risk behaviors that may serve as a bridge for sexual transmission of HIV to other populations, including the broader MSM community, in Tehran. This report intends to encourage health authorities in Iran to take serious action to prevent sexual transmission of HIV from MSM IDUs to their sexual networks.

Three City Feasibility Study of a Body Empowerment and HIV Prevention Intervention Among Women with Drug Use Histories: Women FIT

New intervention models are needed for HIV prevention among drug-using women. The Women Fighting Infection Together (Women FIT) feasibility study enrolled 189 women in three U.S. cities (Providence, New York, Philadelphia) with drug-using histories, who also reported risky sexual behavior. Eligible women had participated previously in a yearlong study of HIV Counseling and Testing (HIV-CT) and limited case management. Two thirds of the sample were black, most were unemployed, and about two thirds reported prior or current crack use. Women were randomized into two groups. In one group, women participated in a manualized, four-session, peer-led, interactive group intervention that stressed body knowledge, woman-initiated HIV/sexually transmitted infection (HIV/STI) prevention, including a focus on women's health (reproductive health screening, sexual violence, self-breast examination, STI signs, symptoms), which aimed to increase comfort with and pride in their bodies. Control group women received HIV-CT enriched by female condom counseling. Outcomes included study retention, session attendance and ratings, changes in knowledge, and use of protection methods. The study successfully retained 95% of the participants for a 2-month follow-up. Positive assessments from participants and peer leaders exceeded preset thresholds for success. Pre-post changes in body knowledge (p < 0.0001) and protection methods knowledge (p < 0.01) was greater among the intervention women than the control women. The body empowerment model deserves further elaboration in interventions focusing on women at high risk of HIV/STI acquisition.

Role of acute and early HIV infection in the sexual transmission of HIV

Acute HIV infection (AHI), the earliest period after HIV acquisition, is only a few weeks in duration. In this brief period, the concentration of HIV in blood and genital secretions is extremely high, increasing the probability of HIV transmission. Although a substantial role of AHI in the sexual transmission of HIV is biologically plausible, the significance of AHI in the epidemiological spread of HIV remains uncertain. AHI is diagnosed by detecting viral RNA or antigen in the blood of persons who are HIV seronegative. Depending on the setting, persons with AHI represent between 1 and 10% of persons with newly diagnosed HIV infection. The high concentration of virus during AHI leads to increased infectiousness, possibly as much as 26 times greater than during chronic infection. In mathematical models, the estimated proportion of transmission attributed to AHI has varied considerably, depending on model structure, model parameters, and the population. Key determinants include the stage of the HIV epidemic and the sexual risk profile of the population. Despite its brief duration, AHI plays a disproportionate role in the sexual transmission of HIV infection. Detection of persons with AHI may provide an important opportunity for transmission prevention.

Microbicide delivery: formulation technologies and strategies

The aim of this article is to summarize the latest information on microbicide formulations for prevention of sexual transmission of HIV infection in women. Although early microbicide formulations were conventionally coitally dependent gel products, new technologies are being developed for vaginal delivery of anti-HIV agents. Intravaginal rings for delivery of microbicides, for example, are being developed and evaluated clinically. Safety and acceptability data are available for many microbicide gels and for one microbicide intravaginal ring. Other microbicide formulations in development for once daily or other vaginal administration strategies include films, tablets, and ovules. Various microbicide formulations for rectal administration are also in development. New microbicide formulations in development are addressing many of the issues with the original gels such as coital dependency, frequency of use, acceptability, compliance, cost, and adaptability to large-scale production. All of these dosage forms are promising options for safe, effective, and acceptable microbicide products.

Topical application of entry inhibitors as "virustats" to prevent sexual transmission of HIV infection.

With the continuing march of the AIDS epidemic and little hope for an effective vaccine in the near future, work to develop a topical strategy to prevent HIV infection is increasingly important. This stated, the track record of large scale "microbicide" trials has been disappointing with nonspecific inhibitors either failing to protect women from infection or even increasing HIV acquisition. Newer strategies that target directly the elements needed for viral entry into cells have shown promise in non-human primate models of HIV transmission and as these agents have not yet been broadly introduced in regions of highest HIV prevalence, they are particularly attractive for prophylaxis. We review here the agents that can block HIV cellular entry and that show promise as topical strategies or "virustats" to prevent mucosal transmission of HIV infection

HIV Antiretroviral Postexposure Prophylaxis: A Cautionary Note

Antiretroviral therapy can be used in 3 ways to prevent the sexual transmission of HIV infection: (1) to reduce an infected persons viral burden below a critical threshold; (2) as preexposure prophylaxis for people with persistent high-risk behavior(s); and (3) as postexposure prophylaxis (PEP) to be used after occupational needlesticks or sexual or other nonoccupational risks. The first 2 approaches are currently being tested in clinical trials to evaluate their efficacy. However PEP has already found its way into widespread clinical practice. Antiretroviral PEP initiated after occupational needlesticks has been used in an attempt to protect health care workers after exposure to HIV. On the basis of historical data Cardo et al. used a casecontrol design and reported that zidovudine appeared to reduce the risk of HIV infection by 81% from ~1 in 200 to 1 in 10000. But it has been impossible to design case-control or prospective studies to determine the efficacy of the nonoccupational use of PEP against sexual transmission when a partners HIV infection status is unknown and given the poor efficiency of the transmission of HIV infection. Data generated in studies of macaques suggest that therapy for HIV infection initiated within 72 h after genital tract exposure and continued for 28 days can prevent sexual acquisition of HIV infection in the majority of animals. (excerpt)