HIV prevalence and risk behaviours for HIV transmission in South Australian prisons

During the latter half of 1989, HIV prevalence in South Australian prisoners was 1.4%. The prevalence of HIV infection across the prison system did not change significantly during 1989 but there was clustering of HIV-infected prisoners in some prisons. Almost half the prisoners from all of the South Australian prisons agreed to participate in our studies, from which we estimate that about 42% of prisoners engage in risk behaviours at least once while incarcerated. Prisoners estimated that 36% of all prisoners inject drugs intravenously at some stage during their stay and that 12% engage in anal intercourse at least once. Interviews with former prisoners who had a history of intravenous drug use revealed that about half had injected themselves while in prison, 60% shared needles and most did not clean shared needles adequately. Most of these prisoners injected themselves once a month or less frequently. The conditions for spread of HIV within the prison system exist but at the current prevalence of infection, transmission can be expected to be infrequent. The opportunity exists now to improve and expand preventive measures.     

HIV risk behaviours among female prostitute drug injectors in Glasgow

This paper focuses upon HIV-related risk behaviours of 51 female drug injecting prostitutes, interviewed as part of a serial cross-sectional study of injecting drug users in Glasgow. Forty-five per cent injected with used needles and syringes in the 6 months prior to interview. Condom use in private sexual relations was low with only 9% of those with primary partners and 22% of those with casual partners reporting consistent use of condoms with these partners. In contrast, use of condoms for all commercial sexual encounters was almost universal. Prevalence of HIV was 2.2%. Despite this low prevalence, we conclude that the level of injecting-related and private sexual risk behaviours reported here requires the continuing monitoring of drug injecting prostitutes in Glasgow.     

HIV单阳家庭配偶间传播研究进展

目的综述HIV"单阳"家庭配偶间传播流行病学相关研究进展。方法查阅相关文献并进行综述分析。结果受各种因素影响,不同地区"单阳"家庭阴性配偶的HIV阳转率存在较大差异,23个国家的研究显示,"单阳"家庭中阴性配偶的阳转率从4.2/100人年～47.4/100人年不等;国内研究表明,中国"单阳"家庭阴性配偶的阳转率为1.2/100人年,其中,河南省(0.9/100人年)和云南省(1.7/100人年)的阴性配偶阳转率显著低于印度(6.5/100人年),发展中国家的阴性配偶阳转率显著高于发达国家;在"单阳"家庭中,影响HIV传播的生物因素主要包括性别、先证者的病程、病毒载量、性传播疾病(STD)状况等。结论与国外对"单阳"家庭的研究相比,国内研究对HIV合并感染的梅毒、淋病等STD检测较多,而对HSV-2的检测较少;男性包皮环切在许多国外文献中都被证明与HIV的传播有关,而国内对其研究较少;从研究数量上看,对HIV"单阳"家庭的相关研究多集中在非洲地区,相比于MSM人群,国内有关"单阳"家庭的研究较少,缺少随访时间长、样本量大的队列研究;作为HIV经性传播的重要途径之一,"单阳"家庭配偶间传播的影响因素应当得到进一步的研究。     

Sero-silence and sero-sharing: managing HIV in serodiscordant heterosexual relationships

Research shows that couples with differing HIV status can face a number of social, sexual and relationship challenges. Communication is often emphasised as the key to couples' ability to cope with these challenges. Silence by implication becomes positioned as inherently negative, even dysfunctional. The privileging of communication as proper therapeutic adjustment to illness forecloses consideration of the complexities of managing HIV as a serodiscordant couple, let alone any enabling aspects of silence. Drawing on qualitative research interviews with HIV-serodiscordant couples in Australia, this article examines the usefulness of this polarisation between communication and silence and explores alternative ways of understanding silence that might offer useful tools for HIV health workers and researchers.     

Predictors of sexual transmission risk behaviors among HIV-positive young men

Reduction in the incidence of high-risk sexual behaviors among HIV-positive men is a priority. We examined the roles of proximal substance use and delinquency-related variables, and more distal demographic and psychosocial variables as predictors of serious high-risk sexual behaviors among 248 HIV-positive young males, aged 15-24 years. In a mediated latent variable model, demographics (ethnicity, sexual orientation and poverty) and background psychosocial factors (coping style, peer norms, emotional distress, self-esteem and social support) predicted recent problem behaviors (delinquency, common drug use and hard drug use), which in turn predicted recent high-risk sexual behaviors. Hard drug use and delinquency were found to predict sexual risk behaviors directly, as did lower self-esteem, white ethnicity and being gay/bisexual. Negative peer norms strongly influenced delinquency and substance use and positive coping predicted less delinquency. In turn, less positive coping and negative peer norms exerted indirect effects on sexual transmission risk behavior through delinquency and hard drug use. Results suggest targeting hard drug use, delinquency, maladaptive peer norms, dysfunctional styles of escaping stress and self-esteem in the design of intervention programs for HIV-positive individuals.     

2012年河南省驻马店市HIV单阳家庭阴性配偶阳转情况及其影响因素分析

目的了解2012年河南省驻马店市艾滋病病毒（HIV）单阳家庭中,HIV阴性配偶的阳转情况及其影响因素。方法2012年7—12月,对河南省驻马店市单阳家庭进行横断面调查,收集HIV单阳家庭的基本信息、配偶间性行为信息、原阳者的治疗信息、CD4＋T淋巴细胞计数等,并对阴性配偶进行采血检测其HIV抗体阳转情况。结果共随访单阳家庭3850户,阴性配偶3850人,其中HIV抗体阳转17人,2012年驻马店市单阳家庭阴性配偶的HIV阳转率为0．44％。按原阳者性别分层,分别得到原阳者为男性的女性配偶阳转的危险因素为：近一年夫妻性生活不坚持使用安全套[比值比（OR）=31．176,95％可信区间（CI）：6．617-146．884,P〈0．0001]。原阳者为女性的男性配偶阳转的危险因素为：近一年夫妻性生活不坚持使用安全套（OR=37．859,95％CI：10．058～142．504,P〈0．0001）,近一年夫妻性生活频次〉2次／月（OR=5．875,95％CI：1．200～28．771,P=0．0289）,最近一次CD4＋T淋巴细胞计数≤350个／μL（OR=5．983,95％CI：1．213～29．503,P=0．0280）。综合来看,家庭内配偶间HIV传播的影响因素为：近一年夫妻性生活不坚持使用安全套（OR=32．557,95％CI：11．772-90．042,P〈0．0001）,近一年夫妻性生活频次〉2次／月（OR=5．630,95％CI：1．775-17．854,P=0．0033）,最近一次CD4＋T淋巴细胞计数≤350个／μL（OR=4．895,95％CI：1．536-15．606,P=0．0073）。结论驻马店市HIV单阳家庭阴性配偶阳转率较低,仍需要加强安全套的宣传以及CD4＋T淋巴细胞计数和病毒载量的检测工作。     

Sexual risk behaviors and acceptability of HIV pre-exposure prophylaxis among HIV-negative gay and bisexual men in serodiscordant relationships: a mixed methods study

The objective of this mixed methods study was to examine current sexual risk behaviors, acceptability and potential adoption of pre-exposure prophylaxis (PrEP) for HIV prevention, and sexual behavior intentions with PrEP adoption among HIV-negative gay and bisexual men (GBM) in HIV serodiscordant relationships. A multiracial/ethnic sample of 25 HIV-negative GBM in serodiscordant relationships completed a qualitative interview and a brief interviewer-administered survey. A modified grounded theory approach was used to identify key themes relating to acceptability and future adoption of PrEP. Participants reported engaging in sexual risk behaviors that place them at risk for HIV infection. Participants also reported a high level of acceptability for PrEP and willingness to adopt PrEP for HIV prevention. Qualitative themes explaining future PrEP adoption included: (1) the opportunity to engage in sex using a noncondom HIV prevention method, (2) protection from HIV infection, and (3) less anxiety when engaging in sex with an HIV-positive partner. Associated with the future adoption of PrEP, a majority (64%) of participants indicated the likelihood for an increase in sexual risk behaviors and a majority (60%) of participants also indicated the likelihood for a decrease or abandonment of condom use, both of which are in contrast to the findings from the large iPrEx study. These findings suggest that the use of PrEP by HIV-negative GBM in serodiscordant relationships carries with it the potential for risk compensation. The findings suggest that PrEP only be offered as part of a comprehensive HIV prevention strategy that includes ongoing risk reduction counseling in the delivery of PrEP to help moderate risk compensation.     

The impact of community-based groups to help persons reduce HIV infection risk behaviours

In addition to widescale AIDS education campaigns, interventions are also needed which can directly assist in the development of skills to reduce HIV infection. Cognitive-behavioural and skills training approaches have long been used to help individuals learn to change other behaviour patterns related to health and can be applied to AIDS. Several approaches (self-management skills training, assertiveness training, and problem-solving) are discussed in relation to HIV risk reduction counselling. Examples and outcome data from prior risk reduction groups for gay men are summarised. Involvement in multiple-session group intervention can produce rapid and clinically meaningful changes in high-risk behaviour patterns. Issues pertinent to the field implementation of such interventions are discussed.     

HIV risk behaviours among gay men who use anabolic steroids

Aims. To examine the injecting and sexual risk behaviours of gay men in London who use anabolic steroids or other fitness-enhancing substances (referred to as AS). Design. Cross-sectional survey using self-administered questionnaire. Setting. Five gyms in central London. Participants. 1004 gay men using the gyms during September-October 1997. Measurements. Proportion of men who report (i) injecting AS, (ii) sharing needles and (iii) HIV status-unknown unprotected anal intercourse (UAI). Findings. Of 1004 men, 136 (13.5%) were current users of AS (range across the five gyms, 2.7-21.2%, p < 0.001), and 81 (8.1%) injected AS (range 0.4-17.5%, p < 0.001). None said they shared a needle with other users and more than 90% said they always used disposable units from sealed packets. Among current AS users, 20.9% (28/136) reported status-unknown UAI compared with 12.9% (107/827) of never-users (p = 0.02), a differential which remained significant after adjusting for confounding factors (adjusted odds ratio = 1.75, 95% CI 1.05, 2.91 , p = 0.03). Conclusions. While nearly one in 10 gay men in this study injected anabolic steroids or other fitness-enhancing substances, none reported sharing needles. Steroid users were, however, more likely to report status-unknown UAI than other men, a differential that remained after adjusting for confounding factors. Since any change in injecting practice could dramatically increase the risk of HIV transmission in this population, behavioural surveillance to monitor risk behaviours among gay men using anabolic steroids is recommended, as are targeted HIV prevention programmes.     

Correlates of suicidal ideation among HIV-positive persons

OBJECTIVES: The present investigation sought to determine the extent to which demographic characteristics, illness-related burdens, alcohol and other substance use, and psychosocial factors are independently associated with suicidal ideation in HIV-positive individuals. DESIGN: HIV-positive individuals in four US cities (San Francisco, Los Angeles, Milwaukee, and New York City) were screened between July 2000 and January 2002 for recruitment into a randomized behavioral prevention trial. Utilizing data from this screening visit, rates and correlates of suicidal ideation were examined in a diverse sample of 2909 HIV-positive individuals. METHODS: Using binary logistic regression study sites, demographic characteristics, illness-related burdens, alcohol and substance use, and psychosocial factors were entered as predictors of suicidal ideation. This cross-sectional model thus examined the independent effects of each factor. RESULTS: Approximately one-fifth (19%) of participants reported thoughts of suicide in the past week. We observed that participants who were not heterosexual, rated HIV-related symptoms and medication side effects as more severe, reported regular marijuana use, and described elevated affective symptoms of depression were those who were more likely to report suicidal ideation. Conversely, participants who identified as Hispanic/Latino, individuals in a primary romantic relationship, and those who reported greater self-efficacy for coping were less likely to report suicidal ideation. CONCLUSION: Suicidal ideation among HIV-positive individuals is relatively common and is associated with multiple factors. These independent correlates may assist with identifying HIV-positive individuals who are at increased risk of suicidal ideation so that they may be assessed regularly and referred for psychological treatment when appropriate.     

Prevalence of HIV infection and risk behaviours among Montreal street youth

We aim to estimate HIV prevalence and associated risk factors among street youth in Montreal, Canada. We conducted a one-year cross-sectional anonymous study in 1995. We recruited youth aged 13-25 years meeting specific criteria for itinerancy through the 20 major Montreal street youth agencies. Participation included a structured interview and provision of an oral specimen for HIV testing. Among the 909 subjects studied, 99.3% had been sexually active, 25.9% had exchanged sex for money, gifts, drugs, a place to sleep, or other things; 31.8% reported anal sex; and 36.4% reported having ever injected drugs. Overall, HIV prevalence was 1.9% (1.1% in girls and 2.2% in boys). Multivariate logistic regression showed that being over 20 years of age (adjusted odds ratio (AOR) 7.09), having injected drugs (AOR 4.48), having engaged in prostitution (AOR 3.32), and being born outside Canada (AOR 4.41) were all independently associated with HIV infection.     

Social context of HIV risk behaviours among male-to-female transgenders of colour

To explore the social context of drug use and sexual behaviours that put male-to-female (MTF) transgenders at risk for HIV, focus groups were conducted consisting of African American, Latina and Asian and Pacific Islander MTF transgenders (N = 48) who reside or work in San Francisco, California. Participants were likely to report having unprotected sex with primary partners to signify love and emotional connection, as well as to receive gender validation from their partners. In contrast, viewing sex work with customers as a business encouraged intentious to use condoms. Safer sex intentions with customers were frequently undermined by urgent financial needs, which stemmed from transphobia, employment discrimination and costly procedures associated with gender transition. Participants reported using drugs as a way to cope with or escape life stresses associated with relationships, sex work, transphobia and financial hardship. Interventions with at-risk MTF transgenders should address the interpersonal and social context of unsafe sex and drug use, particularly the unique roles of relationship issues with male partners, stigma, discrimination and community norms regarding sex work and drug use.     

Condom use and perceived risk of HIV transmission among sexually active HIV-positive men who have sex with men.

This study examined the association between HIV transmission risk perception and the sexual risk behaviors of HIV-positive men who have sex with men. Respondents rated the degree of risk of transmitting HIV through insertive anal intercourse and insertive oral sex. We examined (a) the perceived level of HIV transmission risk assigned to each sexual behavior and (b) the association between perceived risk for HIV transmission and condom use during insertive anal intercourse and insertive oral sex. We found for behaviors that have achieved less risk consensus that as transmission risk perception increases, so too does the likelihood of condom use. This study highlights the need for more research in understanding how perceived health risk to others influences protective behaviors.     

Gendered socioeconomic conditions and HIV risk behaviours among young people in South Africa

Recent evidence suggests that the burden of new HIV infections in sub-Saharan Africa is concentrated among young people, especially females. Even in a country such as South Africa where knowledge among young people of how to protect oneself from infection is rather high, such information may not always be usable in daily situations of economic and social disadvantage that characterise many of their lives. Despite this possibility, there are surprisingly few definitive studies that examine the effects of socioeconomic status on HIV risk and prevention behaviours among youth in South Africa.

Using household survey data collected in 2001, this study investigates how socioeconomic disadvantage has influenced the sexual behaviour and experiences of 4 000 young women and men aged 14–24 years in KwaZulu-Natal province — an area characterised by high HIV prevalence and high rates of poverty and inequality. Socioeconomic disadvantage, measured here as low relative household wealth, is found to be associated with a variety of unsafe sexual behaviours and experiences, particularly for females. Among young women low wealth is associated with earlier sexual debut, having had multiple sexual partners in the year before the survey, and lower chances of condom use at last sex. It is also associated with increased chances that first female sexual experience is non-consensual and with higher odds of females having traded sex and having experienced physically forced sex. For females and males, low wealth reduces the chances of discussing safe-sex practices with the most recent sexual partner. Without sufficient attention, during the design and placement of HIV prevention programmes, to the gendered economic and social conditions in which individuals live — conditions that can make people more or less vulnerable to behaviours and experiences that may lead to infection — the potential effectiveness of the global response to HIV/AIDS is sacrificed.     

Past year and prior incarceration and HIV transmission risk among HIV-positive men who have sex with men in the US*

Three quarters of new HIV infections in the US are among men who have sex with men (MSM). In other populations, incarceration is a social determinant of elevations in viral load and HIV-related substance use and sex risk behavior. There has been limited research on incarceration and these HIV transmission risk determinants in HIV-positive MSM. We used the Veterans Aging Cohort Study (VACS) 2011-2012 follow-up survey to measure associations between past year and prior (more than one year ago) incarceration and HIV viral load and substance use and sex risk behavior among HIV-positive MSM (N?=?532). Approximately 40% had ever been incarcerated, including 9% in the past year. In analyses adjusting for sociodemographic factors, past year and prior incarceration were strongly associated with detectable viral load (HIV-1 RNA >500 copies/mL) (past year adjusted odds ratio (AOR): 3.50 95% confidence interval (CI): 1.59, 7.71; prior AOR: 2.48 95% CI: 1.44, 4.29) and past 12 month injection drug use (AORs?>?6), multiple sex partnerships (AORs?>?1.8), and condomless sex in the context of substance use (AORs?>?3). Past year incarceration also was strongly associated with alcohol and non-injection drug use (AOR > 2.5). Less than one in five HIV-positive MSM recently released from incarceration took advantage of a jail/prison re-entry health care program available to veterans. We need to reach HIV-positive MSM leaving jails and prisons to improve linkage to care and clinical outcomes and reduce transmission risk upon release.     

Sexual risk behaviors among heterosexual HIV serodiscordant couples in the era of post-exposure prevention and viral suppressive therapy

OBJECTIVES: To describe awareness and use of antiretroviral treatments, viral load monitoring, and post-exposure prevention; to assess changing concerns about HIV transmission; and to examine the effect of these advances on sexual behavior in HIV-serodiscordant heterosexual couples. METHODS: Cross-sectional analysis of a baseline sample of 104 couples (n = 208 individuals) from the California Partners Study II, an intervention trial for HIV-serodiscordant couples in California. Questions on sexual practices, viral load testing, HIV treatment, post-exposure prevention, and their effect on sexual behaviors, risk taking and transmission concerns were measured at intake. RESULTS: Over two-thirds of couple members surveyed reported unprotected sex with their partner in the past 6 months. Among seropositive respondents, 37% were taking protease inhibitor therapy, 92% had undergone viral load testing, and of those, 40% said it had ben undetectable at their most recent test. Most respondents, regardless of serostatus, said that viral load testing and awareness of post-exposure prevention had no effect on their condom use. In addition, perceiving that their partner had an undetectable viral load was associated with having protected sex among seronegative subjects (P < 0.05). Seropositive respondent taking protease inhibitors were 2.4 times less likely to report unprotected sex compared with those not taking protease inhibitors (P = 0.05). However, up to 33% of seropositive and 40% of seronegative respondents acknowledged decreased transmission concerns in the light of the new HIV treatments. In comparison with their seropositive partners, seronegative individuals were more likely to acknowledge increased risk taking and decreased HIV transmission concerns (P < 0.05). CONCLUSIONS: New medical advances were not associated with unprotected sex in HIV-serodiscordant couples. However, new treatment options may decrease concerns about HIV transmission, particularly among seronegative partners. Providers should discuss the effect of antiretroviral treatments on sexual transmission risk with their patients. The inclusion of seronegative partners in counseling interventions may decrease risk taking in serodiscordant couples.