Burden of HIV among young transgender women: factors associated with HIV infection and HIV treatment engagement

Young transgender women (YTW) are disproportionately affected by HIV, however, little is known about the factors associated with HIV infection and treatment engagement. We examined correlates of HIV infection and the steps of the HIV treatment cascade, specifically, being aware of their HIV infection, linked to care, on ART, and adherent to ART. We analyzed the baseline data of Project LifeSkills, a randomized control trial of sexually active YTW recruited from Chicago, Illinois and Boston, Massachusetts. We conducted multivariable Poisson regressions to evaluate correlates of HIV infection and the steps of the HIV treatment cascade. Nearly a quarter (24.7%) of YTW were HIV-infected. Among HIV-infected YTW, 86.2% were aware of their HIV status, 72.3% were linked to care, 56.9% were on ART, and 46.2% were adherent to ART. Having avoided healthcare due to cost in the past 12 months and not having a primary care provider were associated with suboptimal engagement in HIV care. Our results suggest that improving linkage and retention in care by addressing financial barriers and improving access to primary care providers could significantly improve health outcomes of YTW as well as reduce forward transmission of HIV.     

Robotic Vaginal Natural Orifice Transluminal Endoscopic Hysterectomy for Benign Indications

Study ObjectiveThe Hominis surgical system is a novel robot-assisted system, designed specifically for robotic vaginal natural orifice transluminal endoscopic surgery (RvNOTES). We presented our experience of the first 30 RvNOTES hysterectomies assessing the feasibility and safety of this technology.DesignA two-center prospective study.SettingAcademic tertiary referral centers. The ethics committees approved the study in both centers.PatientsThirty women with benign indication for hysterectomy.InterventionRvNOTES hysterectomy performed by the Hominis surgical system.Measurements and Main ResultsThe primary outcome of the study was the rate of conversion to open or conventional laparoscopic approaches. Secondary outcomes included intra- and postoperative adverse events, operative time, estimated blood loss, length of hospital stay, and 6-week follow-up assessment. A total of 15 women were enrolled at each site. The median age was 59 years (range: 37–79) and the median body mass index was 25.4 kg/m² (range: 17.6–40.0). Twenty-four women (80%) had comorbidities. All the procedures were completed successfully without conversion to open abdominal, traditional vaginal, or conventional laparoscopic surgery. No intraoperative complications were observed. Median blood loss and procedure duration were 50 mL (range: 20–400) and 57 minutes (range: 24–88), respectively. Postoperative pain was minimal, with a median visual analog scale of 3 (range: 1–5) for the first 24 hours following surgery. The median hospital stay was 3 days (range: 2–8). According to the treating physicians’ evaluations, the vaginal cuff was fully healed in all patients at the 6-week postoperative follow-up visit.ConclusionsThis is the first publication of robot-assisted vaginal hysterectomy using the Hominis surgical system. The positive results of this study show this new technology to be a safe and effective tool for vaginal natural orifice transluminal endoscopic surgery, enabling surgeons to operate vaginally with the known advantages of robotic modality.     

Gender Expression,Violence, and Bullying Victimization: Findings From Probability Samples of High School Students in 4 US School Districts

BACKGROUND

Young people may experience school‐based violence and bullying victimization related to their gender expression, independent of sexual orientation identity. However, the associations between gender expression and bullying and violence have not been examined in racially and ethnically diverse population‐based samples of high school students.

METHODS

This study includes 5469 students (13–18 years) from the 2013 Youth Risk Behavior Surveys conducted in 4 urban school districts. Respondents were 51% Hispanic/Latino, 21% black/African American, 14% white. Generalized additive models were used to examine the functional form of relationships between self‐reported gender expression (range: 1 = Most gender conforming, 7 = Most gender nonconforming) and 5 indicators of violence and bullying victimization. We estimated predicted probabilities across gender expression by sex, adjusting for sexual orientation identity and potential confounders.

RESULTS

Statistically significant quadratic associations indicated that girls and boys at the most gender conforming and nonconforming ends of the scale had elevated probabilities of fighting and fighting‐related injury, compared to those in the middle of the scale (p < .05). There was a significant linear relationship between gender expression and bullying victimization; every unit increase in gender nonconformity was associated with 15% greater odds of experiencing bullying (p < .0001).

CONCLUSIONS

School‐based victimization is associated with conformity and nonconformity to gender norms. School violence prevention programs should include gender diversity education.

     

Use of the highly sensitive PCR method to detect the Herpes simplex virus type 1 genome and its expression in samples from Behçet disease patients

To study the involvement of the Herpes simplex virus type 1 (HSV-1) in patients with Beh?et's disease (BD), PCR was used to detect HSV-1 DNA and RNA (LAT, TK, gB) in peripheral blood leukocytes and oral smears from patients with BD. Out of 32 patients with BD and 30 healthy volunteers, HSV-1 specific DNA was not detected in any case. Using a highly sensitive competitive RT-PCR method, HSV-1 specific mRNA was not detected either in peripheral blood leukocytes from any of the patients or volunteers. In contrast, serum levels of IgG anti HSV-1 antibody were higher in patients with BD; however, there were 70% sero-positives among the control subjects. Even though it has been reported that the highly frequent presence of the HSV-1 genome in peripheral blood is a characteristic feature of BD, our results show that the HSV-1 genome and its expression are not present in peripheral blood in patients with BD. We could not find any evidence that the lesions associated with BD were caused by the direct lytic effects of HSV-1.