Disclosure of HIV among black African men and women attending a London HIV clinic

Little research has focused specifically on disclosure among HIV+ Black Africans living in the UK; however, the available evidence suggests that this population may be reluctant to disclose to significant others. Forty-five HIV+ Black African men and women were recruited from a London HIV clinic. Semi-structured interviews gathered information on: disclosure, social support, mental and physical health, medication adherence, acculturation and the perceived prevalence of stigma. Both qualitative and quantitative analyses were conducted. The majority of the participants had disclosed to one significant other and there was an inverse association between perceived stigma and disclosure. Disclosure could not be predicted by any of the respondent characteristics identified in the study; rather, disclosure decisions were reasoned, interpersonal in nature and many of the motivations were specific to the individual. There was little evidence to suggest that those who disclosed to more than one other gained additional benefits in physical or mental well-being. Clinicians seeking to assist members of this population to disclose need to assess the specific reasons for and barriers against disclosure for that individual.     

Pathophysiology of thrombocytopenia associated with HIV infection in homosexual men

Summary The pathophysiology of HIV associated immune thrombocytopenia (HIV-ITP) and its response to AZT was investigated. Using autologous ¹¹¹Indium-labelled platelets, platelet kinetic were analysed in two patient groups. Group 1 (untreated) was comprised of 13 patients with HIV-ITP. Group 2 (AZT) was comprised of 6 patients with a history of HIV-ITP prior to starting AZT. These patients were studied following a rise in their platelet count on AZT. Platelet survivals in both groups were shortened compared to controls, however there was no significant difference between the 2 groups. However platelet turnover rates were significantly depressed in Group 1 compared to Group 2 (P<0.05) and control values (P<0.05). The platelet count correlated with platelet turnover in Group 1 but not in AZT treated patients. Thus patients with HIV-ITP appear to have both shortened survivals and suppressed platelet production. The mechanism of the latter is unknown, but the increased turnover rate seen with AZT suggests it is a direct or indirect effect of the HIV virus.This work was supported by a grant from the National Health Research and Development Program of CanadaPresented at the International Workshop on ITP, August 26 and 27, 1988, Lucerne, Switzerland     

Lack of awareness of HIV post-exposure prophylaxis among HIV-infected and uninfected men attending an inner London clinic

An audit of HIV-infected and -uninfected men attending two clinics at an inner London treatment centre demonstrated an alarming lack of awareness of post-exposure prophylaxis following sexual exposure (PEPSE). This audit suggests that strategies for increasing awareness of PEPSE among 'at risk' men are urgently needed.     

The low rate of HIV infection in Japanese homosexual and bisexual men: an analysis of HIV seroprevalence and behavioural risk factors.

OBJECTIVE: To assess the seroprevalence of HIV-1 infection in homosexual and bisexual men in Nagoya City, Japan. DESIGN: A prospective study ongoing since April 1986. METHODS: Nine hundred and thirty-eight serum samples were collected from 531 participants in August 1990 in an anonymous, confidential testing programme. A self-administered questionnaire was completed and all participants anonymized by a code number. Interviews were conducted and HIV-antibody test results given by telephone, except for the positive test results, which were given in person and counselling offered. RESULTS: Two out of the 531 participants (0.38%) were found to be seropositive for HIV-1, although the seroprevalences of sexually transmitted diseases, including hepatitis B, syphilis, chlamydia infection and amoebiasis, were remarkably high. A small number of participants had had sexual contact with individuals from countries where HIV infection rates are high. No patient had had a recent episode of intravenous drug use. Numbers of male sexual partners were decreasing and unsafe sexual practices, such as anal intercourse without condom use, were also decreasing. CONCLUSIONS: The apparent low-risk behaviour of the men studied here (low levels of sexual contact with foreigners, absence of intravenous drug use, decreasing numbers of sexual partners and unsafe sexual practices) may explain the low prevalence of HIV infection.     

Lymphocyte subsets and urinary excretion of cytomegalovirus among homosexual men attending a clinic for sexually transmitted diseases

A significantly higher frequency of urinary excretion of human cytomegalovirus (HCMV) was noted in homosexual men (29 [18%] of 161) than in heterosexual men (3 [4%] of 77) attending a clinic for sexually transmitted diseases. However, differences were not significant when only persons with antibody to HCMV were compared (29 of 157 vs. 3 of 33). The homosexual men who excreted HCMV had a significantly lower mean ratio of T-helper (OKT4+) to T-suppressor (OKT8+) cells (1.13 +/- 0.09) than did the homosexuals who did not excrete HCMV (1.67 +/- 0.1) or than did the heterosexual men (2.28 +/- 0.2). The abnormal ratio resulted from both a decrease in the percentage of OKT4+ and an increase in percentage of OKT8+ lymphocytes. The urinary excretion of HCMV by asymptomatic individuals who exhibit serological evidence of previous infection by this virus may be an indicator of impaired immune competence.     

HIV incidence on the increase among homosexual men attending an Amsterdam sexually transmitted disease clinic: using a novel approach for detecting recent infections

OBJECTIVE: Dramatic increases have occurred in sexually transmitted diseases (STD) and in sexual risk behaviour among homosexual men in Amsterdam and internationally. We investigated whether these trends indicate a resurgence of the HIV epidemic. METHODS: HIV incidence was determined among homosexual attendees of an STD clinic in Amsterdam, who had participated in semi-annual anonymous unlinked cross-sectional HIV prevalence studies from 1991 to 2001. Stored HIV-seropositive samples were tested with a less-sensitive HIV assay and, if non-reactive, were further tested for the presence of antiretroviral drugs, indicative of the use of highly active antiretroviral therapy. Seropositive men who tested non-reactive on the less-sensitive assay and had not used antiretroviral drugs were classified as recently infected (< 170 days). Annual HIV incidence and its changes were examined. RESULTS: Among 3090 homosexual participants (median age 34 years), 454 were HIV infected, of whom 37 were recently infectioned. From 1991 to 2001 the overall incidence was 3.0 infections/100 person-years. Incidence increased over time (P = 0.02) and, strikingly, the increase was evident in older (> or = 34 years) men (P < 0.01), but not in the young. Of men recently infected, 84% (n = 31) were unaware of their infection and 70.3% (n = 26) had a concurrent STD. These 26 men reportedly had sex with a total of 315 men in the preceding 6 months. CONCLUSION: HIV incidence is increasing among homosexual attendees of an STD clinic. It is imperative to trace recently infected individuals, because they are highly infectious, and can thus play a key role in the spread of HIV.     

Slips, breaks and 'falls': condom errors and problems reported by men attending an STD clinic

The objective was to comprehensively assess the prevalence of condom-use errors and problems among male clients attending a public sexually transmitted disease (STD) clinic. Men (n = 278) attending an STD clinic completed an anonymous questionnaire. Seven errors and six problems were assessed. Summative scores were tested for associations with three key variables. Of 834 condom-protected events: 19% were associated with 'fit and feel' problems, 15% involved breakage, 14% involved lost erection, 9% were associated with lost erection while applying condoms, 8% involved slippage during withdrawal and 7% involved slippage during sex. A mean of 6.4 errors/problems were observed. None of these summative variables (total errors, total problems or total of errors and problems) were significantly associated with age, minority status or whether men indicated they had ever been taught how to use condoms. Multiple types of condom-use errors and problems may be highly prevalent among high-risk men attending public STD clinics.     

Determinants of gonorrhoea infection among STD clinic attenders in Trinidad--II: sexual behavioural factors.

Sexual behavioural factors associated with gonococcal infection among 991 STD clinic attenders in Trinidad, West Indies (WI) were determined by univariate and stepwise multiple logistic regression analysis. Casual sex (odds ratios [OR] 1.6) was the only predictor of gonorrhoea. Among males, significant associations were identified by univariate analysis between concurrent partnerships, > or =one sexual partner(s) in the past 6 months, and drug use prior to engaging in casual and/or oral sex. No significant associations were identified between gonorrhoea and sexual behaviour factors among females. This study is the first to describe sexual behaviours associated with gonococcal infection in Trinidad and to evaluate risk behaviours by gender.     

Increasing hepatitis A IgG prevalence rate in men who have sex with men attending a sexual health clinic in London: implications for immunization policy

The aims of this study were to audit an immunization policy to vaccinate men who have sex with men (MSM) attending a large London sexual health clinic, and to undertake an approximate cost analysis of different strategies, using the estimated prevalence rate of anti-hepatitis A virus (HAV) immunoglobulin G (IgG). A retrospective study of the seroprevalence of anti-HAV IgG among MSM was conducted for a 12-month period, involving 395 homosexual or bisexual men attending the genitourinary medicine clinic at St Mary's Hospital, London, for the first time. Overall seroprevalence of anti-HAV IgG in the 2004 population surveyed was 46.6% (140/300); 75.1% (300/395) were offered screening on their first visit and 49.9% (197/395) were offered vaccination. We concluded that anti-HAV IgG screening prior to vaccination of MSM in an area of relatively low prevalence of HAV is still the most cost-effective approach. The audit data also showed that in 2004 the British Association for Sexual Health and HIV targets for hepatitis A screening and vaccination were not reached. If a one-dose policy is seen to establish long-term immunity, then the cost of hepatitis A prevention will be drastically reduced.     

Incidence and presentation of early syphilis diagnosed in HIV-positive gay men attending a central London outpatients' department

We examined the incidence, presentation and sexual behaviour of gay men diagnosed with early syphilis at the Royal Free Hospital HIV department in 2002. A total of 1086 gay men attended and 31 were diagnosed with early syphilis (2.9/100 person years). Twenty-six (84%) of the men were symptomatic and 15 (48%) had documented negative serology within the previous six months. All of the men reported anal intercourse with a new partner in the previous three months. The results support offering regular serological screening to sexually active gay men attending our HIV outpatients' department.     

Incidence of Kaposi's sarcoma and HHV-8 seroprevalence among homosexual men with known dates of HIV seroconversion. Italian Seroconversion Study

OBJECTIVES: To evaluate temporal trends of Kaposi's sarcoma (KS) and of the KS-related human herpesvirus (HHV-8) among homosexual men who seroconverted for HIV between 1984 and 1997. METHODS: The study participants were 387 homosexual men. Changes over a period of time were assessed by estimating KS incidence rates per 1000 person-years for the periods 1984-1989, 1990-1992, 1993-1995, and 1996-1997. The proportional incidence of KS as the AIDS-defining disease for the same periods was also calculated. To evaluate a cohort effect of calendar period, Kaplan-Meier curves were used to estimate the risk of KS by period of HIV seroconversion [i.e. before 1990 (median year of seroconversion) versus later]. Relative hazards for the four periods were estimated using competitive-risks models. We also estimated HHV-8 seroprevalence over the study period. RESULTS: Forty-eight participants developed KS. Between 1984 and 1995, the incidence rate of KS per 1000 person-years increased from 3.9 to 32.8, whereas the proportional incidence decreased from 33.3 to 24.3%. The risk of developing KS after HIV seroconversion did not change when comparing the seroconversion periods (i.e. before 1990 versus later). HHV-8 seroprevalence also remained stable. The rates of KS and the relative hazards dramatically decreased after 1995. CONCLUSIONS: Although KS incidence rates increased up to 1995, the proportional incidence decreased, due to the higher increase in rates of other AIDS-defining diseases. The finding that the risk of developing KS after HIV seroconversion remained stable over time is consistent with the stable trend of HHV-8 seroprevalence. The dramatic decrease in KS incidence rates after 1995 coincides with combined antiretroviral therapy.     

在性病门诊开展咨询服务的近期效果及可行性初探

目的 探索在性病门诊开展咨询服务的可行性，为在性病门诊开展有效的咨询服务提供依据。方法 将到性病门诊就诊的符合研究对象的男性性病患者随机分成咨询组和对照组，咨询组给予平均20分钟的咨询，对照组不进行咨询。分别对两组进行基线调查和随访调查，比较两组的差异。结果 提供咨询使受教育水平不同的患者的性病艾滋病知识有了非常显著提高。咨询组的性伴侣通知率(42％)明显高于对照组(21％)。咨询促进了医患交流，加强了信息传递。结论 咨询对改善目前普通性病门诊诊疗服务有着积极的意义。