Factors influencing frontline health service providersʼ likelihood to recommend a future,preventive HIV vaccine to key populations in Karnataka,south India

The HIV epidemic in the south Indian state of Karnataka disproportionately burdens key populations of men who have sex with men and female sex workers. Despite having successfully reduced HIV incidence among certain key populations through the use of targeted intervention, Indiaʼs HIV epidemic remains one of its greatest public health issues. The best long-term strategy for managing the global HIV epidemic might involve a preventive vaccine; however, vaccine availability cannot guarantee its accessibility or acceptability. Vaccine recommendations from frontline health service providers have previously been identified as useful strategies to enhance vaccine uptake among target groups. This study used structured interviews to explore frontline health service providersʼ self-identified likelihood to recommend a future, preventive HIV vaccine to key populations in Karnataka. A modified social ecological model was then used to categorise factors that might prevent health service providers from recommending an HIV vaccine. Overall, 83% of health service providers reported that they would be very likely to recommend an HIV vaccine to men who have sex with men and female sex workers, while less than one-third of participants identified one or more barrier to vaccine recommendation. Intrapersonal, interpersonal, and structural/political factors were most commonly reported to act as potential barriers to future HIV vaccine recommendation among health service providers in Karnataka. This study adds to the limited body of literature focussing on future HIV vaccine acceptability in low- and middle-income countries and highlights some of the several complexities surrounding vaccine acceptability and uptake among key populations in Karnataka.     

The social constructions of sexuality: marital infidelity and sexually transmitted disease-HIV risk in a Mexican migrant community

OBJECTIVES: This article explores the social context of the migration-related HIV epidemic in western Mexico. METHODS: Data collection involved life histories and participant observation with migrant women in Atlanta and their sisters or sisters-in-law in Mexico. RESULTS: Both younger and older women acknowledged that migrant men's sexual behavior may expose them to HIV and other sexually transmitted diseases.Younger Mexican women in both communities expressed a marital ideal characterized by mutual intimacy, communication, joint decisionmaking, and sexual pleasure, but not by willingness to use condoms as an HIV prevention strategy. CONCLUSIONS: Migrant Mexican women's commitment to an illusion of fidelity will hinder HIV prevention initiatives targeted toward them. Furthermore, the changing meanings of marital sex may make it harder to convince young couples to use condoms as an HIV prevention strategy. If the chain of heterosexual marital HIV transmission is to be interrupted in this community, prevention programs must target men.     

HIV Sexual Risk Behaviors and Multilevel Determinants Among Male Labor Migrants from Tajikistan

The purpose of this study was to investigate HIV risk behaviors and their multilevel determinants in male labor migrants from Tajikistan to Moscow. In Russia and Central Asia, where AIDS rates are amongst the world’s highest, conditions in both sending and receiving countries pose serious challenges to HIV prevention. A survey of Tajik married male seasonal labor migrants in Moscow was completed by 200 workers from 4 bazaars and 200 workers from 18 construction sites as part of a mixed method study. The quantitative results indicated that male labor migrants were at risk for HIV due to higher sexual behaviors including sexual relations with sex workers (92 %), multiple partnering in the past month (86 %), unprotected sex with sex workers (33 %), and reduced frequency of condom use while drinking alcohol (57 %). Multivariate tests indicated the multilevel factors that increased HIV sexual risks including: pre-migration factors (e.g. used sex workers in Tajikistan); migrant work and lifestyle factors (e.g. greater number of times visited Moscow); migrant sexual and relational factors (e.g. regular partner in Moscow); and migrant health and mental health factors (e.g. increased frequency of alcohol use). Qualitative findings from longitudinal ethnographic interviews and observations of a subset of 40 purposively sampled Tajik male migrants demonstrated how these multilevel pre-migration and migration factors account for HIV risk and protective behaviors in context. These findings underscore the seriousness of HIV risk for labor migrants and call both for multilevel approaches to prevention and for further study.     

男性流动农民工艾滋病相关知识及行为调查

[目的]了解男性农民工的艾滋病知识及行为，探讨针对不同类型的流动务工人员开展性病艾滋病干预的切入点及干预方法。[方法]在昆明选择4家餐馆、3家建筑工地的流动农民工305人，进行问卷调查及个人访谈，主要调查内容是一般情况、艾滋病相关知识、危险性行为及原因、相关信息的获取途径。[结果]58．7％的调查对象处于性活跃年龄，平均流动时间为3．9年，寂寞、性观念的改变等导致高危性行为普遍，60．3％的调查对象回答“同行人中，配偶或女朋友不在身边的人在外找小姐”。蚊虫叮咬不传播，可以做抽血检测答对率均少于5％，对艾滋病相关信息需求强烈。[结论]对男性农民工的艾滋病干预工作显得尤为迫切，加强多部门的协调，有效开展全国农民工预防艾滋病宣传教育工程；不同层次的农民工艾滋病干预重点及方法不同。     

HIV-Risk Behavior Among the Male Migrant Factory Workers in a North Indian City

Background:Male migrants act as a bridge for transmitting infection from core risk groups to general population and hence this group becomes essential for the HIV control program. Migrant workers constitute a large proportion of workforce in India and HIV/AIDS epidemic in them would cause huge economic losses.Objectives:The aim of this study was to ascertain the HIV-risk behavior among male migrant factory workers.Results:A total of 755 male subjects completed the interview. About 21.5% had experienced non-spousal sexual intercourse in last one year. Nearly 60% did not use a condom at the last non-spousal sex. Factors associated with recent non-spousal sex were being unmarried, younger age at migration, recent migration to Haryana, greater number of places migrated and lesser total duration of migration and those associated with non-use of condom at the last non-spousal sex were older age, lower education, lesser number of places migrated and lower level of HIV/AIDS knowledge.Conclusion:Unprotected, recent non-spousal sex was common among male migrants, which could increase their HIV/AIDS vulnerability.     

HIV risks among women who are married to men who have sex with men in India: a qualitative investigation

In countries such as India, men who have same-sex partnerships may marry women due to cultural pressures regardless of their sexual desires and preferences. The wives of such men may be at risk for HIV but limited existing research addresses this issue. This qualitative study used in-depth interviews to investigate HIV-related risk among married men who have sex with men (n = 34) and women who were aware of their husband’s same-sex behaviour (n = 13) from six research sites in five states and a Union Territory in India: Delhi (Delhi), Visakhapatnam (Andhra Pradesh), Hyderabad (Telangana), Bengaluru (Karnataka), Chennai and Madurai (Tamil Nadu). Thematic analysis revealed that wives of men who have sex with men were at risk for HIV from their husbands’ sexual practices, which are often hidden to avoid the potential consequences of stigmatisation, as well as from gender-based inequities that make husbands the primary decision-makers about sex and condom use, even when wives are aware of their husband’s same-sex behaviour. Innovative interventions are needed to address HIV-related risk in couples where wives remain unaware of their husband’s same-sex behaviour, and for wives who are aware but remain within these marriages.     

南京市2008－2013年男男性行为人群早期梅毒及HIV感染率变化趋势分析

目的 了解南京市男男性行为人群早期梅毒、HIV感染流行水平及变化趋势,为估计疫情进展,调整、制订控制策略和干预措施提供依据.方法 对2008－2013年自愿接受艾滋病、梅毒咨询检测的男男性行为者进行梅毒和HIV感染的血清学监测,对梅毒血清学试验阳性者进行性病诊疗转介,以明确其临床诊断和分期.分析被调查人群人口学特征及早期梅毒、HIV感染和合并HIV感染的早期梅毒流行状况及其变化趋势.结果 2008－2013年各年度分别监测1 004、1 218、1 236、748、1 019和1 420名男男性行为者.各年度早期梅毒的感染率分别为2.19%、2.71%、2.43%、1.74%、3.04%和2.32%,趋势检验P> 0.05;HIV感染率分别为1.29%、2.63%、5.42%、8.82%、11.97%和10.42%,趋势检验P< 0.01;合并HIV感染的早期梅毒感染率从2008年的0.20%上升至2013年的1.06%,趋势检验P< 0.01;合并HIV感染的早期梅毒占早期梅毒的比例从2008年的9.09%上升至2013年的45.45%,趋势检验P< 0.01.结论 南京市男男性行为人群早期梅毒的流行趋于平稳,HIV感染状况上升趋势明显,合并HIV感染的早期梅毒的流行呈上升趋势,其占早期梅毒的比例也呈逐年增长的态势.在男男性行为人群中需要采取持续有效的干预措施以应对梅毒及HIV感染的流行.     

2011年龙陵县缅甸籍媳妇艾滋病知识知晓、行为、感染情况及影响因素调查

目的了解云南省龙陵县缅甸籍媳妇艾滋病知识知晓、行为及感染情况及其影响因素,为制定有针对性的防治措施提供依据。方法2011年1～2月,对龙陵县缅甸籍媳妇进行问卷调查,并进行HIV、梅毒抗体检测。结果合计调查缅甸籍媳妇845人,艾滋病相关知识知晓率为59．05％。90．77％的人最近一年内与配偶有性行为,最近1次与配偶发生性行为使用安全套的比例为5．87％,近1年坚持每次使用安全套的比例为1．04%;1年内有商业性伴的比例为0．59％,最近1次发生商业性行为均未使用安全套。检测845人,HIV感染率为0．70％,梅毒感染率为0．00o．40。对HIV感染率进行单因素分析,婚姻状况为影响因素,在婚、丧偶者HIV感染率较高。结论该人群的艾滋病知晓率较低,HIV和梅毒感染相对较低,但不安全性行为普遍存在。     

Married men and same sex activity: a field study on HIV risk among men who do not identify as gay or bisexual

Interviews that took place at several sites where anonymous sex is practiced suggest that some married men engage in same sex activity without regard for the risk to HIV infection they impose upon themselves and their spouses. Much of the sexual activity is considered to be high risk by Centers for Disease Control standards, and the men who engaged in these behaviors were knowledgeable of those standards. A random sample of 94 individuals were interviewed from a possible population of 198 (47.9%). Of the men interviewed, 15% identified themselves as married or engaged to be married to a woman. Only 2 married men informed their female sex partner (regular partner) of their clandestine activity. By comparison, 29 of the gay or bisexual men had informed their partners of their unprotected and anonymous sex seeking. It is suggested that perhaps the focus on high risk groups instead of on high risk behavior has given a false sense of security to men who do not identify as gay or bisexual.     

Men Who Report Recent Male and Female Sex Partners in Cape Town, South Africa: An Understudied and Underserved Population

The HIV/AIDS epidemic in South Africa has largely focused on the needs of heterosexual men and women. However, little is known about the sexual risk histories of men who have sex with both men and women (MSMW). Furthermore, we know very little about the psychosocial health needs or of the possibility of a syndemic (numerous interrelated epidemics) among MSMW. We surveyed 1,203 men attending drinking establishments in a township located in Cape Town, South Africa. We compared the behaviors and experiences of MSMW to men reporting only having sex with women (MSW). Twelve percent of the sample reported having sex with both men and women in the past 4 months. MSMW were twice as likely as MSW to report being HIV positive (10.5 vs. 4.6 %). MSW were more likely to be married than MSMW but reported similar numbers of female sex partners. MSMW were more likely to report a history of childhood sexual abuse, recent experienced and perpetrated physical and sexual partner violence, both receiving and giving sex for money, drugs, or shelter, and a recent STI. These factors were found to be interrelated among MSW but not MSMW. Although MSMW demonstrate considerable risk taking and report higher rates of HIV infection than MSW, their needs are largely unmet and underemphasized. Findings suggest the need to better understand factors contributing to sexual risk taking among MSMW. HIV prevention interventions should consider psychosocial health problems unique to MSMW residing in South African townships.     

Human immunodeficiency virus and migrant labor in South Africa

The authors investigate the impact of the migrant labor system on heterosexual relationships on South African mines and assess the implications for the future transmission of human immunodeficiency virus (HIV) infection. The migrant labor system has created a market for prostitution in mining towns and geographic networks of relationships within and between urban and rural communities. A section of the migrant workforce and a group of women dependent on prostitution for economic support appear especially vulnerable to contracting HIV infection since they are involved in multiple sexual encounters with different, changing partners, usually without condom protection. Furthermore, sexually transmitted disease morbidity is extensive in the general and mineworker populations. Historically, migration facilitated the transmission of sexually transmitted diseases and may act similarly for HIV. Problems of combating the HIV epidemic in South Africa are discussed.     

Dutiful daughters: HIV/AIDS,moral pragmatics,female citizenship and structural violence among Devadasis in northern Karnataka,India

Decades of research have documented how sex workers worldwide, particularly female sex workers (FSWs), shoulder a disproportionate burden of the HIV epidemic. In India, although a substantial progress has been made in controlling the epidemic, its prevalence among FSWs and the Devadasis (also called traditional sex workers) in northern Karnataka is still significantly high. On the other hand, much of the HIV prevention research has focused on their mapping and size estimation, typologies, bio-behavioural surveillance, condom use and other prevention technologies. In this article, drawing on critical theoretical perspectives, secondary historical sources and in-depth interviews, we unravel wider social, cultural and political economic complexities surrounding the lives of Devadasis, and specifically illuminate the moral pragmatics that shed light on their entry into sex trade and vulnerability to HIV. Findings from this research are extremely important since while much is known about Devadasis in social sciences and humanities, relatively little is known about the complexities of their lives within public health discourses related to HIV. Our work has direct implications for ongoing HIV prevention and health promotion efforts in the region and beyond.     

Cross-sectional study of sexual behaviour and knowledge about HIV among urban, rural, and minority residents in Viet Nam

OBJECTIVE: A cross-sectional survey was conducted in three districts of Quang Ninh province, Viet Nam, to find out what proportion of the people who lived there engaged in behaviour that put them at risk of becoming infected with HIV, and to measure their knowledge about HIV infection and AIDS. METHODS: The survey was conducted in a rural district, Yen Hung; a mountainous district inhabited primarily by ethnic minority groups, Binh Lieu; and an urban district, Ha Long. Participants aged 15-45 years were randomly selected from the general population to be interviewed. FINDINGS: A total of 630 people from 707 households were interviewed; 8% were not home despite repeated visits and 3% refused to participate. The prevalence of premarital intercourse ranged from 9% to 16% among married men and 4% to 7% among married women. Among single men the proportion who had ever had intercourse ranged from 6% to 16%. Fewer than 3% reported having ever had sex with a sex worker. The median number of extramarital sex partners was 1. Knowledge about HIV/AIDS was high in the urban and rural areas but low in the mountainous area. Being male and being 20-29 years old were associated with having multiple sex partners. CONCLUSION: The low prevalence of individuals reporting that they had had intercourse with sex workers and partners other than their spouse may explain the low rates of HIV infection among the heterosexual population; these rates are in contrast to the high rates of HIV infection found among injecting drug users. The association between having extramarital partners and being a younger man suggests that the tendency to have more sexual partners may increase in the future. If this happens, the potential for HIV to be spread through heterosexual sex will increase.     

HIV / AIDS among men who have sex with men in Pakistan

1200 South Asian men from India, Pakistan, and Bangladesh who lived in either South Asia or the UK participated in focus group discussions conducted by the Naz Foundation to gain insight into the sociocultural dimensions of sex between men in the region. Although participants noted the lack of accessibility to women as the main reason for such behavior, the overwhelming majority of these men who have sex with men were married. Those aged 14-16 years had an average of 2 sex partners per year, while those aged 17-20 had 5, those aged 21-35 had 42, and those aged 36-45 had 35. There are many anecdotal reports of young men in South Asia who have sex with men and/or women in exchange for money or other tangible goods. By early 1997, 1232 cases of HIV infection had been reported in Pakistan, of which 88.4% were in men. These data come from the National AIDS Program, and consist largely of cases reported from 4 provinces. While the mode of HIV transmission was not recorded in 41% of cases, male-male sex was the acknowledged mode of transmission among 3.2% of HIV-positive men. Male-male sex appears to exist among married men who have extramarital sex contacts, prisoners, seafarers, IV drug users, truck drivers, and male prostitutes. In Pakistan, men who have sex with men comprise a highly vulnerable group which needs to be targeted for HIV/AIDS awareness-raising interventions.     

Sex and sexuality in the Shenzhen tongzhi circle: HIV risk context and migrant men who have sex with men in China

The paper explores the HIV risk context of migrant men who have sex with men, or tongzhi, in Shenzhen, China. Findings from 42 qualitative interviews indicate that respondents are living within a complex risk environment, characterised by the realities of migration and a ‘weak ties’, virtual men who have sex with men community, which offers little emotional support but many opportunities for sexual engagement. Male sex work has proliferated in Shenzhen, with respondents informally participating in a type of buy-sell circuit. Respondents' portrayal of their environment and conflicts were underscored by three interacting elements: sexual freedom, migration and traditional Chinese values. The confluence of these factors, and how they may influence risk prioritisation in a multi-risk environment, is explored.     

The other side of the bridge: exploring the sexual relationships of men who have sex with men and their female partners in Mumbai,India

Behaviourally bisexual men have been identified as a ‘bridge’ population of HIV transmission to heterosexual women in India. Little is known about the sexual relationships that these men have with their female sex partners. The primary objective of this study was to explore the sexual practices and relationship dynamics between married and unmarried behaviourally bisexual men and their female sex partners in Mumbai, India. In 2009, semi-structured qualitative interviews were conducted with 32 men who reported sex with men and women. Participants discussed a variety of sexual practices and arrangements with female sex partners. Irrespective of marital status and sexual identity, many said that they had satisfying sexual experiences and feelings of affection for female sex partners. However, sexual incompatibility between married partners was also reported. Explanations of bisexual concurrency were discussed in terms of both sexual satisfaction and sexual preference. Self-perceived HIV risk related to same-sex sexual behaviour motivated many men to use condoms with female partners. Expectations of unprotected marital sex and perceptions of partner risk were barriers to condom use. HIV-prevention programmes for this population may benefit from tailored risk-reduction counselling that attends to the variations of these sexual and social relationship dynamics.     

育龄男女非婚性行为及避孕套使用情况调查

目的 了解我国育龄男女非婚性行为发生情况，为项目干预措施提供基础资料。方法 2005年11～12月采用分层、三阶段与规模成正比的容量比例抽样方法获得调查对象，采用统一调查问卷由统一培训的调查员入户进行面对面调查。结果 90％以上的育龄男女认为人应该只有1个性伴侣，其中约i／3认为多性伴增加性传播疾病和艾滋病的危险。20．2％的未婚男性有过性行为，其中47．8％在第1次性行为时没有使用任何避孕方法，42．2％使用了避孕套。8．7％的未婚女性有过性行为，30．4％在第1次性行为时没有采取避孕措施，43．5％使用了避孕套。1．6％的已婚男性、0．5％的已婚女性和25．6％有过性行为的未婚男性、4．3％有过性行为的未婚女性有过临时性伴侣，且相当比例在发生性行为时未使用避孕套。结论 虽然大多数认为应该只有1个性伴侣，但仍有一定比例非婚性行为的发生，并且在发生非婚性行为时避孕套的使用较少。在加强道德教育时，还应加大避孕套使用的宣传力度，保证安全性行为。     

Local understandings of, and responses to, HIV: rural-urban migrants in Tanzania

Migration is an important process of change for rural populations in developing countries. Migration is a primary cause of behaviour change-by their very act of migrating, migrants are different from those who do not migrate. The focus of the current study is male rural-urban migration in Tanzania and its interaction with sexual behaviour. The analysis presents results from a comparison with individual-level analyses of two populations, one (composed of recent rural-urban migrants) in an urban area and one made up of residents in a rural area. Detailed migration histories (n=96 rural-urban migrants) and in-depth interviews form the basis of the analysis. Three key research questions are addressed: How does the sexual behaviour of migrants differ from that of rural residents? How do HIV knowledge levels vary between rural-urban migrants and rural residents? What factors are associated with either intentions of behaviour change or reported behaviour? The results are counter-intuitive: rural-urban migrants-both married and unmarried-are not having sex in town. Despite limited understanding of the nature of HIV, the migrant population studied here regulates its behaviour in a way that reflects local understandings of the disease. This finding is important, not least because it challenges the view that HIV in sub-Saharan Africa is largely transmitted to rural areas by return migrants. Maasai rural-urban migrants in Tanzania-both married and unmarried-are not having sex in town. The policy and service provision implications of the results are explored.     

2008－2014年中国预防艾滋病经性传播干预措施落实情况分析

目的 分析我国自2008年艾滋病综合防治信息网络直报系统建立以来,艾滋病经性传播高危人群的干预措施落实情况。方法 收集2008－2014年MSM人群、暗娼人群和外来务工人员的干预数据和哨点监测数据,采用历史资料的描述性统计方法分析干预工作各项指标的变化趋势。结果 2008－2012年,MSM人群的月均干预人数和月均干预覆盖率分别从4.9万人和8.6%升至25.2万人和78.5%,暗娼人群月均干预人数和月均干预覆盖率分别从32.9万人和30.9%升至62.5万人和87.0%。2013－2014年两类人群上述指标有小幅回落。全国哨点监测数据显示:MSM人群和暗娼人群的行为学、知晓率指标逐年提高。外来务工人员的干预覆盖率从2008年的4.7%升至2014年的10.0%左右,哨点监测数据显示,男性流动人口的行为学、知晓率指标低于其他高危人群。结论 艾滋病经性传播高危人群的干预措施得到有效落实,干预工作取得一定成效,但新的疫情态势又为艾滋病干预工作提出新的挑战。