Increasing hepatitis A immunity in men who have sex with men in Sydney, 1996–2012

We examined the hepatitis A virus status of all MSM seen at a large sexual health clinic in inner Sydney between 1996 and 2012. Overall, the proportion of MSM susceptible to hepatitis A decreased from 68.1% in 1996 to 36.2% in 2012; most of this reduction was attributable to vaccination.     

Where have all the young men gone? Using sex ratios to measure fetal death rates

Fetal health is an important consideration in policy formation. Unfortunately, a complete census of fetal deaths, an important measure of overall fetal health, is infeasible, and available data are selectively observed. We consider this issue in the context of the Clean Air Act Amendments of 1970 (CAAA), one of the largest and most influential environmental regulations in the history of the United States. We discuss a model of potential bias in measuring observed fetal deaths, and present the sex ratio of live births as an alternative fetal health endpoint, taking advantage of the finding that males are more vulnerable to side effects of maternal stress in utero. We find the CAAA caused substantial improvements in fetal health, in addition to previously identified reductions in post-natal mortality.     

#86 Changes in hiv prevalence among emnt who have sex with men (Msm) Who attend public sexually transmitted disease clinics in the western region of the us (1989–1999)

PURPOSE: To compare the distribution and trends in HIV infection among MSM STD clinic attendees in four Western urban counties.METHODS: As part of CDC's national HIV seroprevalence surveys, unlinked HIV testing was performed on sera routinely collected for syphilis screening between 1989 and 1999 from public STD clinics in Denver, Los Angeles, San Francisco, and Seattle. HIV test results were linked to demographic and risk information abstracted from clinic records.RESULTS: Greater than 70% of MSM attendees were between the ages of 20 and 39. The majority in 3 of 4 counties was white. HIV prevalence over the study period ranged from 13% in Seattle to 30% in San Francisco. In all counties, prevalence was highest among blacks, lowest among Asian/Pacific Islanders, and similar between whites and Hispanics. The 30–39 year-old age group was most likely to be infected. After adjustment for age, race, and injection drug use, mean annual declines in HIV prevalence from 1989 to 1999 ranged from 2.1% (95% CL 1.6, 2.6) in Seattle to 2.8% (95% CL 2.6, 3.1) in San Francisco. All counties except San Francisco saw larger adjusted declines among whites and Hispanics than among blacks.CONCLUSION: Despite variations in the severity of the HIV epidemic across the Western region counties, relative differences in prevalence by race and age were similar. Moreover, all four counties saw temporal declines in HIV prevalence. Trends in HIV prevalence among the MSM STD clinic attendees may not, however, reflect population trends in HIV incidence or prevalence. This may be due to more HIV-positive MSM becoming aware of their status and seeking STD treatment in other settings, thus biasing downward the HIV prevalence observed in public STD clinics, compared with prevalence in the general population.     

Access to medical appointments by men with sexually transmitted diseases at a health unit in Fortaleza, Ceará, Brazil

Access to healthcare services is one of the important aspects of the Unified National Health System in Brazil, and the supply and management of such services is the responsibility of municipalities. This study focuses on difficulties faced by men with sexually transmitted diseases (STDs) in accessing appointments for treatment. This was a qualitative study of men treated at an STD clinic in Fortaleza, Ceará State, Brazil, in November 2003, using content analysis technique and interpretation of interviews, focusing on access as the category. Men with STDs encountered extensive difficulty in accessing medical appointments, even when they used different strategies for this purpose. Scheduling of services is incompatible with patients' available time. At the primary care level, the supply of appointments for STDs scarcely exists. More investment is needed in the Unified National Health System in order to improve access to appointments for men with STDs, and the supply of services should take the population's demand into account.     

An integrated model of care to counter high incidence of HIV and sexually transmitted diseases in men who have sex with men – initial analysis of service utilizers in Zurich

Background  

As other countries, Switzerland experiences a high or even rising incidence of HIV and sexually transmitted infections (STI) among men who have sex with men (MSM). An outpatient clinic for gay men (" Checkpoint ") was opened in 2006 in Zurich (Switzerland) in order to provide sexual health services. The clinic provides counselling, testing, medical treatment and follow-up at one location under an "open-door-policy" and with a high level of personal continuity. We describe first experiences with the new service and report the characteristics of the population that utilized it.     

Increasing breastfeeding rates in New York City, 1980–2000

Our objective was to determine temporal patterns of breastfeeding among women delivering infants in New York City (NYC) and compare national breastfeeding trends. All hospitals in NYC with obstetric units were contacted in May and June 2000 to provide information on the method of infant feeding during the mother’s admission for delivery. Feeding was categorized as “exclusive breastfeeding,” “breast and formula,” or “exclusive formula.” The first two categories were further grouped into “any breastfeeding” in the analysis. Hospitals were classified as “public” and “private,” and patients were classified by insurance type as “service” and “private.” Data between public and private hospitals and service and private patients were compared. Breastfeeding trends over time were compared by using previous iterations of the same survey. Of 16,932 newborns, representing approximately 80.0% of all reported live births in the city during the study period, 5,305 (31.3%) were exclusively breastfed, 6,189 (36.6%) were fed a combination of breast milk and formula, and the remaining 5,438 (32.1%) were exclusively formula-fed. Infants born in private hospitals were 1.6 times more likely to be exclusively breastfed compared with infants discharged from public hospitals (33% vs. 21%, respectively). Similarly, private patients were more likely than service patients to exclusively breastfeed their infants (39.6% vs. 22.9%, respectively) and to use a combination of breast and formula (i.e., any breastfeeding) (73.6% vs. 62.0%, respectively). From 1980 to 2000, the proportion of exclusive breastfeeding increased from 25.0% to 31.0%, the percentage of combined feeding increased from 8.0% to 37.0%, and the percentage of any breastfeeding increased from 33.0% to 68.0%. NYC has more than doubled the rate of breastfeeding since 1980. However, there is much progress to be made, and continued efforts are vital to maintain current gains in breastfeeding, improve the rates further, and prolong the duration of breastfeeding. at the time of the research.     

‘It's my inner strength’: spirituality,religion and HIV in the lives of young African American men who have sex with men

Young black men who have sex with men account for 48% of 13–29-year-old HIV-positive men who have sex with men in the USA. It is important to develop an effective HIV prevention approach that is grounded in the context of young men's lives. Towards this goal, we conducted 31 interviews with 18–30-year-old men who have sex with men in the San Francisco-Oakland Bay Area. This paper examines the roles of religion and spirituality in men who have sex with men's lives, which is central in the lives of many African Americans. Six prominent themes emerged: (1) childhood participation in formal religious institutions, (2) the continued importance of spirituality among men who have sex with men, (3) homophobia and stigmatisation in traditional black churches, (4) tension between being a man who has sex with men and being a Christian, (5) religion and spirituality's impact on men's sense of personal empowerment and coping abilities and (6) treatment of others and building compassion. Findings suggest that integrating spiritual practice into HIV prevention may help programmes be more culturally grounded, thereby attracting more men and resonating with their experiences and values. In addition, faith-based HIV/AIDS ministries that support HIV-positive men who have sex with men may be particularly helpful. Finally, targeting pastors and other church leaders through anti-stigma curricula is crucial.     

Bordetella pertussis infection in children with severe pneumonia,Philippines, 2012–2015

A case-comparison study was conducted based on an observational study of severe pneumonia among hospitalized children in the Philippines. The children, from 8 days to 13 years old and hospitalized with clinical diagnosis of severe or very severe pneumonia from August 2012 to February 2015, were recruited. Nasopharyngeal swabs were collected from 1152 cases and B. pertussis were detected from 34 cases by PCR. Pertussis-positive cases were more likely to have no fever, more than one week of coughing and breathing difficulty, decreased breathing sounds, and central cyanosis than pertussis- negative cases. The percentage of underweight was significantly higher in pertussis-positive cases than pertussis-negative cases. Pertussis-positive cases showed remarkably higher fatality rate than pertussis-negative cases. All of the fatal cases among pertussis-positive cases were less than 6 months old. More attention should be given to protect young infants from pertussis.     

Trends in human immunodeficiency virus diagnoses among men who have sex with men in North America,Western Europe,and Australia, 2000–2014

PurposeThe aim of the article was to investigate recent trends in human immunodeficiency virus (HIV) diagnosis rates among men who have sex with men (MSM) in high-income countries in North America, Western Europe, and Australia.MethodsData on annual rates of HIV diagnoses among MSM aged 15 to 65 years from 2000 to 2014 were collected from 13 high-income countries. Joinpoint regression software was used to empirically determine country-specific trend periods. Trends in HIV diagnosis rates and in the proportion of diagnoses occurring in young MSM aged 15 to 24 years were analyzed using Poisson regression and log-binomial regression, respectively.ResultsSix countries experienced an increasing trend from 2000 to 2007-08 followed by either a stable or declining trend through 2014. Five countries had recently increasing trends, and two countries had one stable trend from 2000 to 2014. All 13 countries experienced increases in the proportion of diagnoses occurring in young MSM.ConclusionsSince 2008, half of the 13 high-income countries examined experienced stable or decreasing trends. Still, some countries continue to experience increasing HIV trends, and young MSM are increasingly represented among new diagnoses. Efforts to support early sexual health promotion, reduce barriers to pre-exposure prophylaxis, and improve care engagement for young MSM are critical to addressing current HIV trends.     

Can a woman refuse sex if her husband has a sexually transmitted infection? Attitudes toward safer-sex negotiation among married women in Bangladesh

In developing countries, HIV, sexually transmitted infections (STIs) and unintended pregnancy take an enormous toll on women's reproductive health, yet preventive programmes are lacking as married women's risks are frequently underestimated. We examined predictors of married Bangladeshi women's attitudes towards safer-sex negotiation using data on 15,178 currently married women aged 15–49 from the 2011 Bangladesh Demographic Health Survey. Approximately 92% of women believed that a wife's refusal to have sex with her husband is justified if he has an STI. Multilevel logistic regression analysis revealed that the likelihood of a woman holding this belief increased with her autonomy, as measured by the ability to go to a health centre/hospital without another adult, participation in household decision making and rejection of wife beating (p < 0.001). Other significant predictors were knowledge/awareness of STIs (p < 0.05), living in Dhaka division (p < 0.001) and younger age (p < 0.01). Our findings suggest that sexual health education programmes may be more effective if they include strategies to address social norms and cultural practices that limit women's autonomy in society.     

HIV prevention using the operative group approach among men who have sex with men in São Paulo, Brazil

This study aimed to evaluate the operative group as a preventive approach among men who have sex with men that use two public health services in the city of S?o Paulo, Brazil. One hundred volunteers were randomly allocated to two groups (intervention and control, with 50 each). All participants answered questionnaires in two phases: before the intervention and six months after its conclusion. Effect was measured by comparing the groups for the following outcomes: median number of anal sex acts without condoms and responses from the participants to questions about HIV infection. 69 participants completed the study (34 in the prevention group and 35 in the control group). Analysis showed a decrease in the number of unprotected anal sex acts (p = 0.029) and an increase in the number of answers favoring prevention in the intervention group. The results indicate that the study group was responsive to a safer sex operative group intervention. Further research is necessary to evaluate the feasibility of this prevention approach as a public health strategy, including other social groups.     

Epidemic of Mumps among Vaccinated Persons,the Netherlands, 2009–2012

To analyze the epidemiology of a nationwide mumps epidemic in the Netherlands, we reviewed 1,557 notified mumps cases in persons who had disease onset during September 1, 2009–August 31, 2012. Seasonality peaked in spring and autumn. Most case-patients were males (59%), 18–25 years of age (67.9%), and vaccinated twice with measles-mumps-rubella vaccine (67.7%). Nearly half (46.6%) of cases occurred in university students or in persons with student contacts. Receipt of 2 doses of vaccine reduced the risk for orchitis, the most frequently reported complication (vaccine effectiveness [VE] 74%, 95% CI 57%–85%); complications overall (VE 76%, 95% CI 61%–86%); and hospitalization (VE 82%, 95% CI 53%–93%). Over time, the age distribution of case-patients changed, and proportionally more cases were reported from nonuniversity cities (p<0.001). Changes in age and geographic distribution over time may reflect increased immunity among students resulting from intense exposure to circulating mumps virus.     

Results from the National Legionella Outbreak Detection Program,the Netherlands, 2002–2012

In 2002, the National Legionella Outbreak Detection Program was implemented in the Netherlands to detect and eliminate potential sources of organisms that cause Legionnaires’ disease (LD). During 2002–2012, a total of 1,991 patients with LD were reported, and 1,484 source investigations were performed. Of those sources investigated, 24.7% were positive for Legionella spp. For 266 patients with LD, 105 cluster locations were identified. A genotype match was made between a strain detected in 41 patients and a strain from a source location. Despite the systematic approach used by the program, most sources of LD infections during 2002–2012 remained undiscovered. Explorative studies are needed to identify yet undiscovered reservoirs and transmission routes for Legionella bacteria, and improved laboratory techniques are needed to detect Legionella spp. in clinical samples with a high background of microbial flora (such as soil).     

Homosexuality,seropositivity, and family obligations: Perspectives of HIV‐infected men who have sex with men in China

The HIV epidemic has had major impact on men who have sex with men in China. Most current studies view male‐to‐male sex as a behavioural dimension or variable affecting HIV infection, paying little attention to the socio‐cultural meanings of homosexuality and their impacts on men's experiences with HIV/AIDS. This oversight has impeded understanding of the health practices of this population. Based on a qualitative study of experiences of Chinese people living with HIV/AIDS, this paper explores the complex processes in which men who have sex with men struggle and negotiate with their sexuality, family obligations, and this disease. To facilitate Chinese men who have sex with men in responding effectively to HIV and AIDS, researchers and practitioners should take into account a wide range of contextual factors including desired gender roles, family obligations, homophobia, and HIV‐related stigma that contribute to current constructions of ‘homosexuality’ in China.

Résumé

En Chine, l'épidémie de sida a eu un impact majeur sur les hommes qui ont des rapports sexuels avec des hommes. Actuellement, la plupart des recherches envisagent les rapports sexuels entre hommes comme une dimension ou une variable comportementale qui a des conséquences sur l'épidémie, en prêtant peu d'attention aux significations socio‐culturelles de l'homosexualité et à leur impact sur les expériences des hommes vivant avec le VIH/sida. Cette négligence entrave la compréhension des pratiques de santé dans cette population et l'élaboration d'interventions qui lui soient plus spécifiques. En se basant sur une étude qualitative des expériences des Chinois vivant avec le VIH/sida, cet article explore les processus complexes selon lesquels les hommes qui ont des rapports avec des hommes luttent et négocient avec leur sexualité, leurs obligations familiales et cette maladie. Pour aider les hommes qui ont des rapports avec des hommes à apporter des réponses efficaces au VIH/sida, les chercheurs et les praticiens devraient prendre en considération un large éventail de facteurs contextuels comprenant les rôles de genre désirés, les obligations familiales, l'homophobie et le stigma dÛ au VIH, qui contribuent aux constructions actuelles de «l'homosexualité» en Chine.

Resumen

La epidemia del sida ha tenido un fuerte impacto en los hombres que tienen relaciones homosexuales en China. En la mayoría de estudios actuales se consideran las relaciones homosexuales como una dimensión de conducta o variable que afecta a la infección del VIH. Se presta poca atención a los significados socioculturales de la homosexualidad y al impacto que tiene en las experiencias de los hombres afectados con el VIH/sida. Esta negligencia ha impedido conocer las practicas sanitarias en esta población y la posibilidad de desarrollar intervenciones más sensibles. A partir de un estudio cualitativo sobre las experiencias de chinos afectados con el VIH/sida, en este artículo se exploran los complejos procesos en que los hombres con relaciones heterosexuales negocian y luchan por su sexualidad, las obligaciones familiares y la enfermedad. Para ofrecer una respuesta eficaz al VIH y el sida a esta población con relaciones homosexuales, los investigadores y profesionales de la salud deberían tener en cuenta toda una serie de factores contextuales, por ejemplo los roles sexuales deseados, las obligaciones familiares, la homofobia y el estigma relacionado con el VIH que contribuyen a crear el concepto actual de la ‘homosexualidad’ en China.     

The role of patient–provider sexual health communication in understanding the uptake of HIV prevention services among Black men who have sex with men

We examined factors that may be associated with whether Black men who have sex with men a) disclose their sexual orientation to healthcare providers, and b) discuss their sexual health with healthcare providers to inform interventions to improve HIV prevention efforts and reduce HIV incidence rates among Black men who have sex with men. During 2011–2012, we conducted semi-structured individual in-depth interviews with Black men who have sex with men in New York City. Interviews were audio recorded. We examined transcribed responses for main themes using a qualitative exploratory approach followed by computer-assisted thematic analyses. Twenty-nine men participated. The median age was 25.3 years; 41% (n = 12) earned an annual income of < US$10,000; 72% (n = 21) had a college degree; 86% (n = 25) reported being single; 69% (n = 20) self-identified as gay or homosexual. We identified three main themes affecting whether the men discussed their sexual orientation and sexual health with healthcare providers: 1) comfort discussing sexual health needs; 2) health literacy; and 3) trust. Identifying strategies for improved comfort, health literacy and trust between Black men who have sex with men and healthcare providers may be an important strategy for increasing sexual health patient–provider communications, increasing opportunities for HIV prevention including testing and reducing HIV-related health disparities.