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Seth C Kalichman Chauncey Cherry Moira O Kalichman Christopher Washington Tamar Grebler Cindy Merely Brandi Welles Jennifer Pellowski Christopher Kegler 《Journal of the International AIDS Society》2015,18(1)
Introduction
Antiretroviral therapy (ART) improves the health of people living with HIV and has the potential to reduce HIV infectiousness, thereby preventing HIV transmission. However, the success of ART for HIV prevention hinges on sustained ART adherence and avoiding sexually transmitted infections (STI).Objectives
To determine the sexual behaviours and HIV transmission risks of individuals with suppressed and unsuppressed HIV replication (i.e., viral load).Methods
Assessed HIV sexual transmission risks among individuals with clinically determined suppressed and unsuppressed HIV. Participants were 760 men and 280 women living with HIV in Atlanta, GA, USA, who completed behavioural assessments, 28-daily prospective sexual behaviour diaries, one-month prospective unannounced pill counts for ART adherence, urine screening for illicit drug use and medical record chart abstraction for HIV viral load.Results
Individuals with unsuppressed HIV demonstrated a constellation of behavioural risks for transmitting HIV to uninfected sex partners that included symptoms of STI and substance use. In addition, 15% of participants with suppressed HIV had recent STI symptoms/diagnoses, indicating significant risks for sexual infectiousness despite their HIV suppression in blood plasma. Overall, 38% of participants were at risk for elevated sexual infectiousness and just as many engaged in unprotected sexual intercourse with non-HIV-infected partners.Conclusions
Implementation strategies for using HIV treatments as HIV prevention requires enhanced behavioural interventions that extend beyond ART to address substance use and sexual health that will otherwise undermine the potential preventive impact of early ART. 相似文献2.
Sayuri Sekimitsu Jacqueline DePasse Michelle Morrison Mary Mahy Brian Rice Kristen Earle Kate Daley Jim Larson Anna Carter Geoff P Garnett Charles B Holmes 《Journal of the International AIDS Society》2020,23(12)
IntroductionWhile there is a global consensus on monitoring Human Immunodeficiency Virus (HIV) treatment progress, there has been less attention to the degree of consistency of the measurement of HIV prevention programmes—and the global prevention response is not on‐track to achieve 2020 goals. In this paper, we assess the degree of variability in primary prevention indicators selected by national strategic plans (NSPs) and global stakeholder monitoring and evaluation (M&E) strategies.MethodsWe obtained the most recent NSPs from low and middle income Joint United Nations Programme on HIV/AIDS (UNAIDS) Fast‐Track countries, and M&E documents from The Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund), President’s Emergency Plan for AIDS Relief (PEPFAR), UNAIDS, the Global HIV Prevention Coalition and the World Health Organization (WHO). We extracted HIV primary prevention indicators from each document, standardized and aggregated them by age/ sex, categorized indicators by topic, and evaluated the frequency of matched indicators between countries and stakeholders. Data were collected between February and April of 2019.ResultsTwenty‐one NSPs and five global stakeholder documents were assessed; 736 primary prevention indicators were identified; 284 remained following standardization and aggregation. NSPs contained from 3 to 48 primary prevention indicators, with an average of 23; categories included: HIV education and outreach (17.6%), testing (17.3%) and condom use (16.2%). Of unique national indicators, only 34% was shared between two or more countries. Sixty‐nine per cent was applied in a single country only. 56% of NSP indicators did not appear in any global stakeholder document. Conversely, 42% of global indicators did not appear in any surveyed NSPs. Within global indicators, 63% was only measured by one global body, and no single indicator was measured by all five.ConclusionsThese analyses reveal a lack of consensus both between and within countries’ and global stakeholders'' measurement of HIV prevention. Though some variability is expected, these findings point to a need to refocus attention on achieving greater consensus on a global measurement framework for HIV prevention. 相似文献
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Benjamin R Bavinton Fengyi Jin Limin Mao Iryna Zablotska Garrett P Prestage Andrew E Grulich 《Journal of the International AIDS Society》2015,18(1)
Introduction
Studies in heterosexual HIV serodiscordant couples have provided critical evidence on the role of HIV treatments in reducing HIV transmission risk. However, there are limited data regarding the effect of treatment on HIV transmission in homosexual male couples. We examined features of male homosexual HIV serodiscordant relationships that may impact upon the design of HIV treatment and transmission studies.Methods
Data were from a prospective cohort study of HIV-negative homosexual men in Sydney, Australia. Men were followed up with six-monthly interviews and annual testing for HIV. Characteristics of men in HIV serodiscordant and seroconcordant relationships at baseline were compared, and a longitudinal analysis performed of rate of relationship break-up and of HIV incidence.Results
At baseline, 5.5% of participants (n=79) had an HIV-positive partner. Most (80.8%) of these relationships were non-monogamous, and 36.7% of men reported recent unprotected anal intercourse (UAI) with casual partners. The rate of relationship break-up was 29.5 per 100 person-years. Half of men in serodiscordant relationships (49.4%) reported recent UAI with their regular partners. HIV incidence was 2.2 per 100 person-years. It was substantially higher in relationships of less than one year''s duration (6.1 per 100 person-years) and in men who reported unprotected receptive anal intercourse with ejaculation with their regular partners (15.5 per 100 person-years).Conclusions
Levels of HIV transmission risk and incidence were high, particularly in early relationships. Rates of relationship break-up were high. These data suggest that studies of HIV treatments and transmission in homosexual serodiscordant couples should focus on early relationships so as not to underestimate risk, and sample sizes must allow for high rates of relationship break-up. 相似文献9.
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推广男性包皮环切,预防艾滋病,提高国民生殖健康水平 总被引:30,自引:10,他引:30
中国新感染HIV者中异性性传播的比例逐年快速上升,2007年已达44.7%。为了减少HIV通过异性传播,改善国民的生殖健康水平,本文介绍了国际上有关包皮环切能够预防HIV异性传播的流行病学研究证据,病毒经包皮感染的分子细胞生物学机理,以及在非洲取得的大规模随机对照的包皮环切预防艾滋病临床试验的最新研究成果。1997~2007年间,发表的4份调查报告表明,在中国不同地区15109名儿童和青少年中,包皮过长者和包茎的比例分别为43.90%和11.55%,但是包皮环切率只有2.66%。鉴于包皮环切是高效、简单和价廉的预防艾滋病的新措施,我们呼吁国家有关部门,如同推动其它预防艾滋病的多种措施一样,尽快制定推广包皮环切的实施计划,大力普及男性生殖健康的知识,把新生儿包皮环切、未成年人和成年人包皮环切列入医疗保险范围,尽早对HIV感染的高危成年男人以及妻子为HIV阳性而丈夫为阴性者实行免费包皮环切,开展有关包皮环切的流行病学和社会文化的科学研究,以及安全、简单和价廉的新技术研究。 相似文献
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Susannah M Allison Darrin Adams Kent C Klindera Tonia Poteat R Cameron Wolf 《Journal of the International AIDS Society》2014,17(1)
Globally, overall rates of HIV are on the decline; however, rates among gay men and other men who have sex with men (MSM) and transgender persons are increasing. Meanwhile, there has been exponential growth in access to communication technology over the last decade. More innovative prevention and care technology-based programmes are needed to help address the growing numbers of MSM and transgender persons living with HIV and those at risk for infection. To address this need, a meeting was hosted by the U.S. Agency for International Development (USAID) through the President''s Emergency Plan for AIDS Relief (PEPFAR) and co-sponsored by amfAR, The Foundation for AIDS Research and the National Institute of Mental Health (NIMH). The meeting brought together researchers, community implementers, advocates and federal partners to discuss the current landscape of technology-based interventions for MSM and transgender persons and to discuss key considerations. Presentations and discussions focused on the research gaps, facilitators and barriers to programme implementation and public–private partnerships. This article summarizes the meeting proceedings and outlines key considerations for future work in this area. 相似文献
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The HIV Modes of Transmission model: a systematic review of its findings and adherence to guidelines
Zara Shubber Sharmistha Mishra Juan F. Vesga Marie-Claude Boily 《Journal of the International AIDS Society》2014,17(1)