Suchergebnisse

As part of the baseline survey of a prospective study of the natural history of HIV-1 infection among intravenous (IV) drug users, 1,580 current and former IV drug users (IVDUs) were interviewed about their knowledge of AIDS, acquisition and prevention of HIV-1 infection, and risk behaviors. Using the National Center for Health Statistics's AIDS Knowledge and Attitudes Questionnaire, responses are compared to a cross-section of the U.S. population. The results show few differences between current knowledge of routes of transmission, general AIDS knowledge, unlikely sources of infection, and methods of prevention among IVDUs who are at high risk of acquiring HIV-1 and the general public, presumably at very low risk of infection. Analyses of HIV-1 and AIDS knowledge also demonstrated virtually no differences by HIV-1 antibody status or awareness of their serostatus at baseline, with the exception that those aware of their status were less likely to be hopeless in dealing with the problem. While few consistent differences were found between drug use behaviors and knowledge, IVDUs who reported having been in drug treatment were systematically better informed as to routes of transmission and prevention methods. However, those with a history of treatment were also more likely to see themselves at higher risk of acquiring HIV-1 than those who did not have this history. The data demonstrate that basic knowledge about HIV-1 has diffused to the IVDU community. Increasing treatment opportunities would seem to offer one avenue for assisting in behavior change in light of the HIV-1 epidemic these individuals face.

BackgroundHIV/AIDS in India disproportionately affects women, not by their own risks, but by those of their partners, generally their spouses. We address two marginalized populations at elevated risk of acquiring HIV: women who are married to men who also have sex with men (MSM) and wives of injection drug users (IDUs).MethodsWe used a combination of focus groups (qualitative) and structured surveys (quantitative) to identify the risks that high‐risk men pose to their low‐risk wives and/or sexual partners. Married MSM were identified using respondent‐driven recruitment in Tamil Nadu, India, and were interviewed by trainer assessors. A sample of wives of injection drug users in Chennai were recruited from men enrolled in a cohort study of the epidemiology of drug use among IDUs in Chennai, and completed a face‐to‐face survey. Focus groups were held with all groups of study participants, and the outcomes transcribed and analyzed for major themes on family, HIV and issues related to stigma, discrimination and disclosure.ResultsUsing mixed‐methods research, married MSM are shown to not disclose their sexual practices to their wives, whether due to internalized homophobia, fear of stigma and discrimination, personal embarrassment or changing sexual mores. Married MSM in India largely follow the prevailing norm of marriage to the opposite sex and having a child to satisfy social pressures. Male IDUs cannot hide their drug use as easily as married MSM, but they also avoid disclosure. The majority of their wives learn of their drug‐using behaviour only after they are married, making them generally helpless to protect themselves. Fear of poverty and negative influences on children were the major impacts associated with continuing drug use.ConclusionsWe propose a research and prevention agenda to address the HIV risks encountered by families of high‐risk men in the Indian and other low‐ and middle‐income country contexts.

Stated reasons for sharing needles and not intending to carry bleach for 413 injection drug users in the Stop AIDS for Everyone (SAFE) study in Baltimore, Maryland, were analyzed. Over two-thirds (69%) reported they knew individuals who had "gotten in trouble" by police for carrying needles. Of the injection drug users, 38% stated the main reason they shared needles without cleaning them first with bleach was a sense of time urgency, and 30% reported that clean needles were not available. The most common reason given by 24% of the participants for not intending to carry bleach was that they inject at home where bleach is available. Another frequently mentioned reason for not intending to carry bleach was wanting to stop using drugs. These results have implications for HIV prevention and suggest the importance of preventive interventions that emphasize drug users' planning where and when they will inject drugs. The findings also suggest that needle sharing may be in part an unintended consequence of Maryland's current drug paraphernalia laws.

Introduction: Age‐disparate sex has long been considered a factor that increases HIV risk for young women in South Africa. However, recent studies from specific regions in South Africa have found conflicting evidence. Few studies have assessed the association between age‐disparate partnerships (those involving an age gap of 5 years or more) and HIV risk at the national level. This study investigates the relationship between age‐disparate sex and HIV status among young women aged 15–24 in South Africa.Methods: Nationally representative weighted data from the 2002, 2005, 2008, and 2012 South African National HIV Surveys were analysed for young women aged 15–24 years using bivariate analyses and multiple logistic regressions.Results: After conducting multiple logistic regression analyses and controlling for confounders, young women with age‐disparate partners had greater odds of being HIV positive in every survey year: 2002 (aOR = 1.74, 95%CI: 0.81–3.76, p = 0.16); 2005 (aOR = 2.11, 95%CI: 1.22–3.66, p < 0.01); 2008 (aOR = 2.02, 95%CI: 1.24–3.29, p < 0.01); 2012 (aOR = 1.53, 95%CI: 0.92–2.54, p < 0.1). The odds of being HIV positive increased for each year increase in their male partner's age in 2002 (aOR = 1.10, 95%CI: 0.98–1.22, p = 0.11), 2005 (aOR = 1.10, 95%CI: 1.03–1.17, p < 0.01), 2008 (aOR = 1.08, 95%CI: 1.01–1.15, p < 0.05), and 2012 (aOR = 1.08, 95%CI: 1.01–1.16, p < 0.05). Findings were statistically significant (p < 0.1) for the years 2005, 2008, and 2012.Conclusions: Our findings suggest that age‐disparate sex continues to be a risk factor for young women aged 15–24 in South Africa at a national level. These results may reflect variation in HIV risk at the national level compared to the differing results from recent studies in a demographic surveillance system and trial contexts. In light of recent contradictory study results, further research is required on the relationship between age‐disparate sex and HIV for a more nuanced understanding of young women's HIV risk.

To identify risk factors for infection with the human immunodeficiency virus (HIV) and for progression to the acquired immunodeficiency syndrome (AIDS) among intravenous drug users, we established a cohort in Baltimore Maryland in 1988–1989. Intravenous drug users were recruited by extensive community outreach to undergo interview and confidential HIV testing in a special study site. During 13 months of recruitment, 2,921 intravenous drug users were enrolled of whome 24 percent were HIV seropositive; 90 percent returned to receive test results. Methodological issues for enhancing recruitment and retention of drug users are discussed.

This article presents a description and preliminary evidence on validity of self-report interview methods being used in a study of HIV-1 infection and AIDS among intravenous drug users (IVDUs). The study population includes 2,616 currently active IVDUs living in or near Baltimore City, Maryland (USA), many of them reporting no prior treatment for drug dependence, and many with no history of criminal arrest or incarceration. These IVDUs were recruited in 1988–89 by extensive community outreach efforts; most learned of the study by word-of-mouth. To study IV drug use and HIV-1 infection in relation to onset of AIDS, the subjects are being interviewed, examined, and tested at baseline (recruitment), and periodically thereafter. This report compares information from the self-report baseline interview with independently collected data on physical stigmata of drug injection, T-lymphocyte cell subsets, and HIV-1 serostatus. The evidence generally supports the validity of these self-report data on IV drug use, including data from a year-by-year history of sharing injection equipment, obtained by retrospection at baseline.

AbstractIntroductionThe COVID‐19 pandemic has threatened to diminish gains in HIV epidemic control and impacts are likely most profound among key populations in resource‐limited settings. We aimed to understand the pandemic's impact on HIV‐related service utilization among men who have sex with men (MSM) and people who inject drugs (PWID) across India.MethodsBeginning in 2013, we established integrated care centres (ICCs) which provide HIV preventive and treatment services to MSM and PWID across 15 Indian sites. We examined utilization patterns for an 18‐month period covering 2 months preceding the pandemic (January–February 2020) and over the first and second COVID‐19 waves in India (March 2020–June 2021). We assessed: (1) unique clients accessing any ICC service, (2) ICC services provided, (3) unique clients tested for HIV and (4) HIV diagnoses and test positivity. Among an established cohort of PWID/MSM living with HIV (PLHIV), we administered a survey on the pandemic's impact on HIV care and treatment (June–August 2020).ResultsOverall, 13,854 unique clients visited an ICC from January 2020 to June 2021. In January/February 2020, the average monthly number of clients was 3761. Compared to pre‐pandemic levels, the number of clients receiving services declined sharply in March 2020, dropping to 25% of pre‐pandemic levels in April/May 2020 (first wave), followed by a slow rebound until April/May 2021 (second wave), when there was a 57% decline. HIV testing followed a similar trajectory. HIV test positivity changed over time, declining in the first wave and reaching its nadir around July 2020 at ∼50% of pre‐pandemic levels. Positivity then increased steadily, eventually becoming higher than pre‐pandemic periods. The second wave was associated with a decline in positivity for MSM but was relatively unchanged for PWID. Among 1650 PLHIV surveyed, 52% of PWID and 45% of MSM reported the pandemic impacted their ability to see an HIV provider. MSM had barriers accessing sexually transmitted infection testing and partner HIV testing.ConclusionsThe COVID‐19 pandemic led to significant decreases in HIV‐related service utilization among key populations in India. This presents an opportunity for increased transmission and patients presenting with advanced disease among groups already disproportionately impacted by HIV.

IntroductionSuccessful global treatment as prevention (TasP) requires identifying HIV‐positive individuals at high risk for transmitting HIV, and having impact via potential infections averted. This study estimated the frequency and predictors of numbers of HIV transmissions and bacterial sexually transmitted infection (STI) acquisition among sexually active HIV‐positive individuals in care from three representative global settings.MethodsHIV‐positive individuals (n=749), including heterosexual men, heterosexual women and men who have sex with men (MSM) in HIV care, were recruited from Chiang Mai (Thailand), Rio De Janeiro (Brazil) and Lusaka (Zambia). Participants were assessed on HIV and STI sexual transmission risk variables, psychosocial characteristics and bacterial STIs at enrolment and quarterly for 12 months (covering 15 months). Estimated numbers of HIV transmissions per person were calculated using reported numbers of partners and sex acts together with estimates of HIV transmissibility, accounting for ART treatment and condom use.ResultsAn estimated 3.81 (standard error, (SE)=0.63) HIV transmissions occurred for every 100 participants over the 15 months, which decreased over time. The highest rate was 19.50 (SE=1.68) for every 100 MSM in Brazil. In a multivariable model, country×risk group interactions emerged: in Brazil, MSM had 2.85 (95% CI=1.45, 4.25, p<0.0001) more estimated transmissions than heterosexual men and 3.37 (95% CI=2.01, 4.74, p<0.0001) more than heterosexual women over the 15 months. For MSM and heterosexual women, the combined 12‐month STI incidence rate for the sample was 22.4% (95% CI=18.1%, 27.3%; incidence deemed negligible in heterosexual men). In the multivariable model, MSM had 12.3 times greater odds (95% CI=4.44, 33.98) of acquiring an STI than women, but this was not significant in Brazil. Higher alcohol use on the Alcohol Use Disorders Identification Test (OR=1.04, 95% CI=1.01, 1.08) was also significantly associated with increased STI incidence. In bivariate models for both HIV transmissions and STI incidence, higher depressive symptoms were significant predictors.ConclusionsThese data help to estimate the potential number of HIV infections transmitted and bacterial STIs acquired over time in patients established in care, a group typically considered at lower transmission risk, and found substantial numbers of estimated HIV transmissions. These findings provide an approach for evaluating the impact (in phase 2 studies) and potentially cost‐effectiveness of global TasP efforts.

BACKGROUND: We evaluated the effectiveness of integrated care centers (ICCs), which provided single-venue HIV testing, prevention, and treatment services for people who inject drugs (PWID) and men who have sex with men (MSM), in India. METHODS: We conducted baseline respondent-driven sampling (RDS) surveys in 27 sites across India, and selected 22 of these (12 PWID and 10 MSM) for a cluster randomised trial on the basis of high HIV prevalence and logistical considerations. We used stratified (PWID and MSM), restricted randomisation to allocate sites to either the ICC intervention or usual care (11 sites per arm). We implemented ICCs in 11 cities (6 PWID ICCs embedded within opioid agonist treatment centers and 5 MSM PWIDs embedded within locations of government-sponsored health services), with a single ICC per city in all but 1 city. After a 2-year intervention phase, we conducted evaluation RDS surveys of target population members 18 years or older at all sites. The primary outcome was self-reported HIV testing in the prior 12 months (recent testing) in the evaluation survey. We used a biometric identification system to estimate ICC exposure (visited an ICC at least once) among evaluation survey participants at intervention sites. This trial is registered with ClinicalTrials.gov (NCT01686750). FINDINGS: ICCs provided HIV testing for 14,689 unique clients during the intervention phase. In the evaluation phase (August 2016 to May 2017) we surveyed 11,721 PWID and 10,005 MSM participants using RDS. In the primary population-level analysis, recent HIV testing was 31% higher in ICC than usual care sites (adjusted prevalence ratio [aPR] 1·31, 95% confidence interval [CI] 0·95, 1·81, p=0·09). Among survey participants at intervention sites, ICC exposure was lower than expected (median exposure 40% at PWID sites and 24% at MSM sites). In intervention sites, survey participants who visited an ICC were 3·5-fold (95% CI 2·9, 4·1) more likely to report recent HIV testing than participants who had not. Post-hoc analyses ...