Knowledge, attitudes, and experience regarding HIV/AIDS among older adult inner-city Latinos

Although Latinos, now the largest minority group in the U.S., comprise 13% of the population, they represent 18% of all new HIV and AIDS cases. This disproportionate representation also appears among older adult Latinos. Semi-structured interviews with 45 inner-city Spanish speaking older adult Latinos provide new data regarding HIV/AIDS among this largely ignored but at risk population. Findings indicate that approximately two thirds of the sample ascribed to at least one myth regarding viral transmission (e.g., via mosquito bites; using public toilets) and less than half were aware of age and gender specific risk factors (e.g., increased mortality and side-effects from antiviral medication; greater risk of contracting HIV through intercourse among older women). Women were significantly less likely to have experience with condoms than men, and machismo, lack of perceived risk, and perceived ineffectiveness were identified as potential barriers to condom use. Recommendations are offered for the design of culturally sensitive, primary prevention programs for this older Latino population.     

Treatment and disease outcomes of migrants from low- and middle-income countries in the Australian HIV Observational Database cohort

People from culturally and linguistically diverse backgrounds, including low- and middle-income countries, account for a third of new HIV diagnoses in Australia and are a priority for HIV prevention and treatment programs. We describe the demographic and clinical characteristics of participants in the Australian HIV Observational Database (AHOD) and compare disease outcomes, progression to AIDS and treatment outcomes of those born in low- and middle-income countries, with those born in high-income countries and Australia. All participants enrolled in AHOD sites where country of birth is routinely collected were included in the study. Age, CD4 count, HIV viral load, antiretroviral therapy, hepatitis co-infection, all-cause mortality and AIDS illness were analysed. Of 2403 eligible participants, 77.3% were Australian born, 13.7% born in high-income countries and 9.0% born in middle- or low-income countries. Those born in Australia or high-income countries were more likely to be male (96%) than those from middle- or low-income countries (76%), p?p?p?p?=?.19.There was no difference in adjusted incidence risk ratios for all-cause mortality and AIDS incidence in all three groups, p?=?.39. These findings reflect successful outcomes of people born in low- and middle-income countries once engaged in HIV care.     

Men who have sex with men who are born abroad and diagnosed with HIV in England and Wales: an epidemiological perspective

Relatively little is known about the sexual health needs of men who have sex with men (MSM) born abroad who reside in the UK. We describe here the epidemiology of HIV among MSM born outside the UK and diagnosed with HIV in England and Wales. Reports of HIV diagnoses in England and Wales received at the Health Protection Agency Centre for Infections were analysed.Between 2000 and 2003, 6386 MSM were diagnosed with HIV in England and Wales. Country of birth was recorded for 3571 (56%). Of those with country of birth reported, 2598 (73%) were born in the UK and 973 (27%) abroad. Of those born abroad (973), 424 (44%) were born in Europe, 141 (15%) in Africa, 104 (11%) in South/Central America and the remainder in other regions. Where reported (949), 69% of MSM born abroad were White, 12% other/mixed, 9% Black Caribbean and 7% Black African. Probable country of infection was reported for 612 MSM born abroad: 52% were infected in the UK, 43% in their region of birth and 5% in another region. Men born abroad represent a significant proportion of HIV diagnoses among MSM in England and Wales. More than half probably acquired their HIV infection in the UK, strengthening the call for targeted HIV prevention and sexual health promotion among MSM who are not born in England and Wales.     

2011年辽宁省艾滋病哨点高危人群监测结果分析

目的了解辽宁省高危人群中艾滋病流行状况及相关行为信息,为制定艾滋病防治规划和开展有效干预提供科学依据。方法采用连续抽样调查的方法,对吸毒者、男男性行为者(Men who have sex with men,MSM)、暗娼、性病门诊男性就诊者进行问卷调查和血清学检测。结果 2011年共监测4类人群16 879人。吸毒者、MSM、暗娼、性病门诊男性就诊者的HIV阳性检出率分别是0.4%、4.3%、0和0.3%。吸毒者最近一年不安全商业性行为的比例为66.7%;MSM人群最近6个月肛交安全套坚持使用率为54.7%;暗娼最近一个月商业性行为坚持使用安全套的比例为62.9%。从2007-2011年辽宁省高危人群的HIV阳性检出率变化趋势来看,MSM人群HIV阳性检出率处于相对较高水平。结论 MSM人群HIV阳性率最高,提示该人群是艾滋病防控工作的重点。全省艾滋病疫情呈低流行态势,但诸多传播因素仍然存在,必须进行有效的行为干预。     

Factors related to delayed diagnosis of HIV infection in southeastern France. EVALVIH group

We aimed to identify risk factors associated with delayed diagnosis of HIV infection in a French region highly affected by AIDS. Data were collected in southeastern France through the HIV-surveillance system based upon anonymous declarations by laboratories and physicians prescribing HIV testing. From January 1996 to December 1997, 825 persons were diagnosed for the first time as HIV infected (female: 32%; >40 years: 28%); 46% had been infected through heterosexual intercourse, 26% through homosexual intercourse, and 19% through intravenous drug use. The semestrial (6 monthly) incidence rate decreased from 122.7 to 69.7 per million inhabitants (P<0.001). County of residence, age, sex, country of birth, and transmission category did not change significantly during the observation period. Twenty-seven per cent had a delayed diagnosis of HIV infection. This proportion did not differ significantly according to sex or country of birth, or during the observation period. However, after controlling for the other factors, delay was more frequent among injecting drug users (IDUs) (35%, P<10(-2)) than other transmission categories; it was also positively associated with age (47% above 50 years vs 13% under 30 years, P<10(-2)). This study highlights that, in spite of the current AIDS prevention policy and wide access to HIV screening, the proportion of delayed diagnosis of HIV infection remains high. Physicians should concern themselves with this public health issue, and campaigns should target people insufficiently aware, especially IDUs and older people. Further research is needed to understand better the causes of delayed diagnoses and of inequalities in access to HIV screening.     

HIV Seropositivity and Correlates of Infection Among Heterosexually Active Adults in High-Risk Areas in South Florida

The U.S. HIV/AIDS epidemic disproportionately impacts lower-income populations. We conducted a cross-sectional study of heterosexually active adults (N = 1076) in areas with high poverty and HIV/AIDS rates in South Florida in 2007. Using venue-based sampling, anonymous interviews and HIV tests were conducted at randomly selected venues (primarily retail businesses not associated with risk behaviors). The sample’s HIV infection rate was 7.1%. Half (52.2%) of the infections were previously undiagnosed. Our findings underscore the impact of social and environmental factors on HIV risk, as well as the need to increase and optimize HIV testing and other prevention services.     

天津市2008-2011年MSM人群HIV流行趋势分析

目的了解天津市2008-2011年男男性行为人群(MSM)艾滋病病毒(HIV)的流行趋势,为在该人群中开展相关控制措施提供依据。方法分析2008-2011年天津市监测中新发现的MSM中的HIV/艾滋病(AIDS)病例情况、MSM人群血清学监测的数据以及横断面调查数据。结果新发现HIV/AIDS病例中,MSM病例所占比例最高,2008-2011年病例报告显示的构成比及报告数量增长最快的传播途径是男男性传播。MSM病例中流动人口占53.3%,未婚占61.0%,高中及以上文化程度占69.6%,15～29岁占47.2%。无偿献血及自愿咨询和检测发现的阳性病例中,MSM所占的比例最高。血清学监测结果显示,天津市MSM人群HIV感染率维持在稳定水平。横断面调查结果显示,MSM近6个月发生同性性行为时每次都使用安全套构成的中位数为35.85%,近6个月中最近1次发生同性性行为时安全套使用率中位数为59.55%,近6个月与异性发生性行为比例的中位数为18.05%,梅毒检出的中位数为18.25%,HIV检出的中位数为6.25%。结论 MSM人群为天津市HIV/AIDS感染的主要人群,艾滋病流行趋势严重,危险行为普遍存在,急需采取有效措施控制HIV通过其传播及扩散。     

南宁市邕宁区2008--2011年艾滋病自愿咨询检测结果分析

目的分析邕宁区艾滋病自愿咨询检测（VCT）工作开展情况,以了解艾滋病疫情的现状、分布特点和流行趋势,为艾滋病的防控工作提供依据。方法对2008-2011年到南宁市邕宁区疾病预防控制中心VCT门诊求询者的资料和HIV抗体检测结果进行分析。结果2008-2011年共检测求询者1165人,均为异性性传播;共检出艾滋病病毒（HIV）抗体阳性252人,总阳性率为21．63％;各年的阳性率分别为：13．36％、18．62％、31．07％、37．75％;≥50岁人群阳性率高于〈50岁的。求询者中以20～39岁人群为主,男女比例为1．5：1;求询原因以性行为为主（占53．73％）,其次是静脉吸毒（占44．38％）。结论异性性传播为邕宁区艾滋病的主要传播途径,要加强艾滋病防治知识和VCT工作的宣传,加强对重点人群的干预,防止艾滋病疫情的进一步蔓延。     

Factors contributing to delayed diagnosis of HIV-infected women and their children in south Texas

Preliminary results from a previous study at a family human immunodeficiency virus (HIV) clinic in South Texas indicated that HIV-positive (HIV+) children from small communities were usually infected and often symptomatic at the time of referral. The current study evaluated rates of vertical transmission and factors that contributed to delayed diagnosis of HIV for 82 children born to HIV-infected women in South Texas. Children from smaller metropolitan statistical areas (MSAs) were infected more often (70.4% vs. 33.3%), identified later (average 9.7 vs. 3.2 months) and were less often known to be HIV+ at birth (51.4% vs. 64.4%), than those from the largest MSA. In addition, children whose mothers were infected sexually were infected more often (52.8% vs. 32.0%), tested later (average 7.6 vs. 1.6 months), and were less often known to be HIV+ at birth (46.8% vs. 85.2%), than those children whose mothers were injecting drug users (IDU). Children followed from birth were infected less often (34.3%) than those identified later (65.5%). In South Texas, children born to HIV+ mothers were at higher risk for missed or delayed diagnosis if they were from small MSAs and had mothers who were infected sexually. Early diagnosis of HIV+ women and children is increasingly important because of advances in treatment of HIV and prevention of vertical transmission of HIV.     

湖州市2011年艾滋病自愿咨询检测结果分析

目的了解湖州市接受艾滋病自愿咨询检测（VCT）服务人群的现状,为艾滋病防治措施的制定提供科学依据。方法对2011年在湖州市接受VCT服务的人员的人口学状况、求询原因、危险行为等进行统计学分析。结果3 778名求询者中,3 759人（99.5%）接受了HIV抗体检测,检出阳性9例,HIV检出率为0.24%。求询者男女性别比为0.8∶1;年龄主要集中在20～49岁,占90.3%;初中学历占38.6%。各类高危行为中,有性乱史者占58.8%。结论青壮年和性接触是湖州市艾滋病传播的高危人群及方式;加强艾滋病知识宣传和VCT服务、提高求询者阳性者转介率,是今后VCT工作的重点。     

HIV/AIDS in the Southern USA: A disproportionate epidemic

This research synthesis examined HIV/AIDS surveillance and health care financing data and reviewed relevant research literature to describe HIV epidemiology, outcomes, funding, and contributing factors to the HIV epidemic in the Southern USA with particular focus on a group of Southern states with similar demographic and disease characteristics and comparable HIV epidemics (Alabama, Georgia, Florida, Los Angeles, Mississippi, North Carolina, South Carolina, Tennessee, and Texas). These states are hereafter referred to as “targeted Southern states.” Eight of the 10 states with the highest HIV diagnosis rates in 2011 were in the Southern USA; six were targeted states. Forty-nine percent of HIV diagnoses were in the South in 2011, which contains only 37% of the US population. The targeted states region had the highest HIV diagnosis rate than any other US region in 2011. The South was also found to have the highest HIV-related mortality and morbidity rates in the USA. The high levels of poverty, HIV-related stigma, and STDs found in the South, particularly in the targeted Southern states, likely contribute to greater HIV incidence and mortality. The disproportionate impact of HIV in the South, particularly among targeted states, demonstrates a critical need to improve HIV prevention and care and address factors that contribute to HIV disease in this region.     

Knowledge,attitudes and perceptions of HIV/AIDS among traditional birth attendants and herbal practitioners in Lagos State,Nigeria

Recognising the widespread role of traditional birth attendants (TBAs) and herbal practitioners (HPs) in health care at community level in Nigeria, we set out to assess their knowledge, attitudes and practices in relation to HIV infection and prevention. Questionnaires were administered to a convenience sample of 189 participants in 20 local government areas of Lagos State. We found that knowledge of modes of transmission of HIV was less than adequate and included lack of knowledge of the existence of HIV/AIDS amongst some practitioners, claims for the ability to treat HIV/AIDS, failure to name major avenues of transmission and confusion of HIV/AIDS with other conditions. The use of measures to prevent infection of clients and themselves showed that normal standards of infection control are not adhered to. Considering that as many as 60% of children born in Nigeria are delivered by traditional birth attendants and that use of the services of herbal practitioners extends across the entire society in both rural and urban settings, this is seen as reason for concern. It is suggested that better incorporation of TBAs/HPs into the well-developed primary health care system offers not only a way of overcoming the risks of infection posed by traditional health practices but also offers an opportunity to extend the reach of voluntary counselling and testing and prevention of mother-to-child infection programmes. The research has shown the need for appropriate training of TBAs, to enable them to recognise the risk of HIV infection in their own practices and to encourage them to adopt universal precautions against spreading infection. We also recommend that they be more extensively integrated as primary health care workers in VCT and PMTCT programmes in Nigeria. We further suggest that referrals made between the traditional practitioners and professional health care providers can be an effective and successful element of HIV/AIDS prevention and control programmes.     

The Association Between HIV/AIDS During Pregnancy and Fetal Growth Parameters in Florida: A Population Based Study

In this population-based retrospective study, we sought to investigate the association between HIV/AIDS during pregnancy and adverse birth outcomes, including low birth weight (LBW), very low birth weight (VLBW), preterm birth (PTB), very preterm birth (VPTB), and small for gestational age (SGA), among women in Florida by sociodemographic variables. Using data from Florida's maternally linked birth cohort files, we examined singleton live births in the state during 1998 to 2007 (N = 1,698,107). The study population was categorized based on the maternal HIV/AIDS status. Poisson regression models were used to generate adjusted rate ratios (ARR) to estimate the association between HIV/AIDS status and fetal growth parameters. The main outcome measures were fetal growth parameters, including LBW, VLBW, PTB, VPTB, and SGA. As compared to HIV/AIDS-negative women, mothers with HIV/AIDS had elevated risks for LBW (ARR = 1.40; 95% CI = 1.30-1.50), VLBW (ARR = 1.25; 95% CI = 1.04-1.51), SGA (ARR = 1.26; 95% CI = 1.17-1.35), PTB (ARR = 1.23; 95% CI = 1.03-1.47), and VPTB (ARR = 1.27; 95% CI = 1.20-1.36). Risk estimates for LBW and SGA were highest among Hispanics mothers with HIV/AIDS, while white mothers with HIV/AIDS had the highest risk levels for VLBW and PTB, compared to their HIV/AIDS negative counterparts. Our findings show that women with HIV/AIDS have elevated risks for inhibited fetal growth and shortened gestation with important racial/ethnic variation. This is the first known population-based study that reveals racial/ethnic differences in HIV/AIDS-related fetal growth morbidity outcomes.     

Blind spots in the epidemiology of HIV in black Americans

In the USA, annual rates of new human immunodeficiency virus (HIV)/AIDS diagnoses are seven and 21 times higher in black men and women, respectively, than in whites. Epidemiological inquiry on this disparity has chiefly focused on contextual factors; such emphasis has eclipsed study of direct HIV vectors. The US Centers for Disease Control and Prevention recently announced its intention to curb HIV propagation in black communities, recommending culturally appropriate HIV/AIDS strategies. Contemplated societal interventions should be informed by data evaluating more direct (and under-assessed) HIV transmission vectors, specifically anal intercourse and unsuspected blood exposures. This recommendation involves tracing sexual and non-sexual contacts of recently infected persons and uninfected controls, coupled with DNA sequencing of HIV isolates. Public health authorities do not know the extent to which unmeasured yet plausible HIV transmission vectors can account for ethnic disparities. Appropriate prevention strategies depend critically on direct, rather than ecologic, evidence.     

HIV prevalence in pregnant women in an ethnically diverse population in the UK: 1998-2002

OBJECTIVE: To describe trends in the prevalence of HIV in an ethnically diverse population of pregnant women in the United Kingdom. METHODS: Data on parental country of birth from national birth registration records were linked to neonatal dried blood spot samples routinely collected for neonatal screening in the North Thames region between 1998 and 2002. Identifiers were subsequently irreversibly deleted prior to establishing maternal HIV status by testing the neonatal samples. RESULTS: A total of 491 213 dried blood spot samples were collected, and 490 879 (99.93%) were tested for HIV. Of these, 1029 were seropositive. There was an overall significant increasing trend (P-value = 0.001) between 1998 and 2002. Maternal region of birth was available for 89.8% of HIV-infected samples, and, among these, 80.5% of mothers were born in sub-Saharan Africa and 11.1% in the UK. The highest prevalences of HIV were in women born in sub-Saharan Africa (2.09%). If both parents were born in the UK, overall seroprevalence was 0.016%. CONCLUSION: HIV infection in pregnant women in the UK continues to occur predominantly in women born in sub-Saharan Africa with prevalence in this group increasing significantly. Although the absolute number of HIV-infected women rose in some other groups, there was no evidence for a statistically significant rise in HIV prevalence in women born outside sub-Saharan Africa. Over 93% of children at risk of vertical transmission of HIV had at least one parent born abroad. This paper underlines the value of data linkage in monitoring HIV prevalence in a diverse population.     

Associations of Acculturation and Country of Birth with Asthma and Wheezing in Mexican American Youths

Background: Mexican Americans have lower rates of asthma than other ethnic groups in the United States.    Objective: To examine the relationship between country of birth and acculturation with asthma and wheezing among Mexican American youths.    Methods: We used Chi-squared statistics and logistic regression analyses to determine the associations of country of birth and acculturation with asthma and wheezing among 1,770 Mexican Americans age 12-19 years who participated in the National Health and Nutrition Examination Survey 1999-2002.    Results. Mexican American adolescents born in the United States and those with high acculturation levels reported significantly higher prevalence rates of asthma, wheezing, and hay fever than their peers with low acculturation levels and born in Mexico. In multivariate analyses, youths with a high acculturation level had a higher risk of asthma than those with a low acculturation level independent of country of birth. Highly acculturated youths born in the US had a higher risk for wheezing compared with less acculturated US-born or Mexico-born participants after adjusting for confounding variables. In contrast, associations of asthma and wheezing with country of birth were not significant after controlling for acculturation. Conclusions. Our findings showed that both acculturation and country of birth were linked with the risk of asthma and wheezing, with acculturation having stronger effects than country of birth, among Mexican American youths. These findings may imply that factors modified by immigration and acculturation could influence the risk of asthma and wheezing. Identification of such factors could help in the design of asthma prevention programs.     

Associations of Acculturation and Country of Birth with Asthma and Wheezing in Mexican American Youths

Background: Mexican Americans have lower rates of asthma than other ethnic groups in the United States. Objective: To examine the relationship between country of birth and acculturation with asthma and wheezing among Mexican American youths. Methods: We used Chi-squared statistics and logistic regression analyses to determine the associations of country of birth and acculturation with asthma and wheezing among 1,770 Mexican Americans age 12–19 years who participated in the National Health and Nutrition Examination Survey 1999–2002. Results. Mexican American adolescents born in the United States and those with high acculturation levels reported significantly higher prevalence rates of asthma, wheezing, and hay fever than their peers with low acculturation levels and born in Mexico. In multivariate analyses, youths with a high acculturation level had a higher risk of asthma than those with a low acculturation level independent of country of birth. Highly acculturated youths born in the US had a higher risk for wheezing compared with less acculturated US-born or Mexico-born participants after adjusting for confounding variables. In contrast, associations of asthma and wheezing with country of birth were not significant after controlling for acculturation. Conclusions. Our findings showed that both acculturation and country of birth were linked with the risk of asthma and wheezing, with acculturation having stronger effects than country of birth, among Mexican American youths. These findings may imply that factors modified by immigration and acculturation could influence the risk of asthma and wheezing. Identification of such factors could help in the design of asthma prevention programs.     

Racial/ethnic disparities in delayed HIV diagnosis among men who have sex with men,Florida, 2000–2014

Only about 85% of men who have sex with men (MSM) with human immunodeficiency virus (HIV) have been tested for and diagnosed with HIV. Racial/ethnic disparities in HIV risk and HIV care outcomes exist within MSM. We examined racial/ethnic disparities in delayed HIV diagnosis among MSM. Males aged ≥13 reported to the Florida Enhanced HIV/AIDS Reporting System 2000–2014 with a reported HIV transmission mode of MSM were analyzed. We defined delayed HIV diagnosis as an AIDS diagnosis within three months of the HIV diagnosis. Multilevel logistic regressions were used to estimate adjusted odds ratios (aOR). Of 39,301 MSM, 27% were diagnosed late. After controlling for individual factors, neighborhood socioeconomic status, and rural–urban residence, non-Latino Black MSM had higher odds of delayed diagnosis compared with non-Latino White MSM (aOR 1.15, 95% confidence interval [CI] 1.08–1.23). Foreign birth compared with US birth was a risk factor for Black MSM (aOR 1.27, 95% CI 1.12–1.44), but a protective factor for White MSM (aOR 0.77, 95% CI 0.68–0.87). Rural residence was a risk for Black MSM (aOR 1.79, 95% CI 1.36–2.35) and Latino MSM (aOR 1.87, 95% CI 1.24–2.84), but not for White MSM (aOR 1.26, 95% CI 0.99–1.60). HIV testing barriers particularly affect non-Latino Black MSM. Social and/or structural barriers to testing in rural communities may be significantly contributing to delayed HIV diagnosis among minority MSM.     

AIDS病例报告中病例发现及时率的影响因素分析

目的了解影响艾滋病（AIDS）病例发现及时率的相关因素。方法通过对广东省某市2012年1月1日至2013年9月30日报告病例的分析,了解可能影响病例发现及时率的相关因素（不包括感染者本人的主观因素）。结果此间报告的489例艾滋病病毒（HIV）感染者和AIDS病人中,有37.6%（184/489）发现不及时。异性性传播的HIV感染者发现不及时的比例,显著高于其他途径感染者（χ^2=21.53,P〈0.01）;医院报告的病例及时率低于疾病预防控制中心、羁押场所及血站等其他单位[比值比（OR）=0.42,95%可信区间（CI）：0.28～0.64,P〈0.01]报告的病例;主动提供检测发现病例的及时率显著高于接受被动检测发现的病例（OR=3.17,95%CI：2.17～4.65,P〈0.01）。Logistic多因素分析发现,仅监测类型对病例发现及时率构成影响（OR=2.91,95%CI：1.67～5.04,P〈0.01）。结论积极为各种高危人群提供主动检测,是提高病例发现及时率的重要手段和方法,主动检测的重点人群应该以可能发生异性性传播的人群为主。     

黑龙江省1993～1999年艾滋病流行状况

目的总结黑龙江省1993～1999年艾滋病流行趋势和传播途径,为黑龙江省艾滋病防治策略提供科学依据.方法对1993～1999年黑龙江省艾滋病监测资料进行分析.结果从1993～1999年末黑龙江省共检出艾滋病病毒感染者47例,艾滋病病人2例(已死亡),47例中血液传播占85%,经性接触传播占13%.黑龙江省目前主要传播途径以血液传播为主.结论黑龙江省处在艾滋病流行的低感染阶段,当前防治重点是对高危人群监测和艾滋病预防知识宣传.同时应注意控制艾滋病性接触传播流行.