HIV Risk Among Patients Attending Sexually Transmitted Disease Clinics in China

HIV and other sexually transmitted diseases (STDs) are spreading rapidly in China. However, little is known about HIV risk among STD patients. In October–November 1997, we recruited a consecutive sample of 1,371 STD clinic patients from 16 different provinces and municipalities across the country and examined their sexual practices and condom use. We found that the median age for sexual initiation was 22 years for men and 21 years for women, and only a small proportion of men (12%) and women (15%) had used a condom during this first sexual intercourse. Eighty-one percent of men and 53% of women had two or more sexual partners in the past year. During the same period, 78% of men and 44% of women had both steady and nonsteady partners; of those with both types of partners, only 1% of men and 7% of women always used a condom with these partners. Multiple sexual partnerships in the past year were more common among men, older men (over 35 years), and those who had initiated sex at an earlier age. More frequent condom use was associated with being younger, having nonsteady partners, and having used a condom during a first sexual encounter. Our findings underline a need for patient education and condom promotion among STD clinic patients as a part of efforts to prevent the spread of HIV in China.     

Changes in HIV risk behaviour in clients of syringe-exchange schemes in England and Scotland

The impact of syringe-exchange schemes on the behaviour of injecting drug users was investigated through self-reported behaviour change. Fifteen syringe-exchange schemes in England and Scotland participated in a government-sponsored pilot programme from April 1987. Clients were provided with sterile injecting equipment and condoms, and with knowledge of HIV risks. One hundred and forty-two injecting drug users who first attended between April 1987 and March 1988 participated in a prospective interview-based survey with questions at two points in time. Measurements were self-reported attitudinal, knowledge and behavioural changes relevant to HIV infection and transmission. Many clients maintained or adopted low-risk behaviours: 79% sustained or adopted low or lower levels of syringe sharing. Trends identified include decreases in syringe-sharing, from 34 to 27%; using others' syringes (risk of infection) from 25 to 19%; passing on syringes (risk of transmission) from 30 to 25%. Many clients reported changes in sexual behaviour; those with sexual partners decreased from 77 to 69% and those with two or more sexual partners from 26 to 21%. However, non-use of condoms increased from 62 to 79%. Comparison groups of non-attenders showed higher levels of risk behaviour (59-62% sharing syringes, 86-88% with sexual partners). Overall, changes in HIV risk behaviour show small but encouraging trends and support arguments that injectors can be helped to change their behaviour, which could be of cumulative importance in reducing the spread of HIV.     

Dyspepsia in England and Scotland

A validated postal questionnaire has been used to establish the prevalence of dyspeptic symptoms in five geographical locations from the south coast of England to the north of Scotland. The six month period prevalence of dyspepsia in the 7428 respondents to the questionnaire is 41% and equal between the sexes, with similar prevalence rates in the centres studied. There is considerable overlap between upper abdominal symptoms and symptoms of heartburn; 56% of patients with dyspepsia experience both groups of symptoms. Symptom frequency falls progressively with age in men and women, but the proportion of people seeking medical advice for dyspepsia rises with age. One quarter of the dyspeptic patients studied have consulted a general practitioner about their symptoms. This study suggests that the prevalence of dyspepsia in the community has changed little over the last 30 years, despite evidence that the frequency of peptic ulcer disease is falling. Symptom prevalence is unrelated to social class, but this factor is associated with consultation behaviour, the consultation rate rising from 17% in social class 1 to 29% in social class 4. The use of investigations--barium meal and endoscopy--is similarly related to social class; the lowest rate for ulcer diagnosis (4.7%) is found in social class 1 and the highest (17.1%) in social class 5.     

Rubella in England, Scotland and Wales

Rubella vaccine was offered to schoolgirls in the United Kingdom (UK) from 1970, with antenatal testing and postpartum vaccination for susceptible women introduced during the 1970s. Mass vaccination with MMR of children aged 12-15 months was introduced in 1988; schoolgirl vaccination was discontinued in 1996 and replaced by a second dose of MMR for pre-school children; postpartum vaccination of susceptible women identified through antenatal testing continues. Rubella was made a notifiable disease in 1988, and is monitored through clinical and laboratory reports; data are available on rubella associated terminations and congenital rubella syndrome(CRS) births, rubella susceptibility in population subgroups, and vaccine uptake. Reported cases of CRS declined from about 50 a year 1971-75 to just over 20 a year 1986-90, and rubella associated terminations from an average of 750 to 50 a year. About 40 infants with CRS have been reported since 1991; about a third of their mothers were infected abroad, most in their country of origin (imported infections), a third were born abroad but acquired infection in the UK, and a third were UK-born. Women living in the UK who were born abroad have much higher rubella susceptibility rates than UK-born women. Although there is currently very little rubella infection circulating, uptake of MMR has dropped by over 10% since 1995. If rubella starts to circulate again, immigrant women will be at increased risk of acquiring infection in pregnancy.     

Psychosocial Risk Factors for HIV Transmission in Female Drug Abusers

The authors studied the influences of domains of psychosocial risk factors on needle-sharing with familiar people and with strangers in a cohort of female injecting drug users (IDUs). Subjects were 119 female IDUs, 46% of whom were HIV+. Subjects were given individually administered questionnaire interviews. Using Pearson correlation coefficients and multiple hierarchical regression analyses, the authors found that personality, family, and peer attributes related to needle-sharing in women were similar to those found in men, with certain exceptions. The role of the family, particularly the Significant Other, was more important and proximal in its effect on needle-sharing behavior in women than in men. There was a main effect as well as a mediating effect of family in women, buffering risk factors leading to needle-sharing.     

Factors Associated with Condom Use Among HIV Clients in Stable Relationships with Partners at Varying Risk for HIV in Uganda

In Africa, HIV infections occur mostly in stable relationships, yet little is known about the determinants of condom use in this context. We examined condom use among 272 coupled HIV clients in Uganda who had just screened for ART eligibility; 128 had an HIV-positive partner, 47 HIV-negative, and 97 a partner with unknown HIV status. Sixty-six percent reported unprotected sex with their partner over the past 6 months (57–70% across the three subgroups). Multiple variables among socioeconomic characteristics, physical health, social support, and psychosocial adjustment were correlated with condom use in bivariate analysis, but in multivariate analysis, condom use self-efficacy was the only predictor of condom use in the total sample and subgroups; church attendance and physical functioning were also predictors among unknown status couples. This analysis reveals high rates of unprotected sex among coupled HIV clients, regardless of partner’s HIV status, and suggests multiple targets for prevention.     

A seroepidemiological survey of toxoplasmosis in Scotland and England

The Sabin-Feldman dye test was used to detect the presence of Toxoplasma antibodies in two groups of blood donors in central Scotland, one group from a rural area and one from an urban area, and in patients attending a medical outpatients clinic and females attending an antenatal clinic serving a mixed urban and rural area in the midlands of England. Results obtained from these four groups showed that 7.6, 7.8, 35.7 and 14.9% respectively had antibody titres of 1: greater than or equal to 10. A group of travelling people, defined in the Local Government and Planning (Scotland) Act, 1982, as '...persons of nomadic habit of life, whatever their race or origin...', from Scotland were also surveyed and 28% of this group had antibodies of 1: greater than or equal to 10. Individuals in this latter group were reported to have minimal contact with cats because of their lifestyles. The prevalences of the travelling people were analysed by age group and showed no correlation with age, but other groups did show an increasing prevalence with age. The significance of these results is discussed.     

HIV Transmission Risk among HIV Seroconcordant and Serodiscordant Couples: Dyadic Processes of Partner Selection

Selecting sex partners of the same HIV status or serosorting is a sexual risk reduction strategy used by many men who have sex with men. However, the effectiveness of serosorting for protection against HIV is potentially limited. We sought to examine how men perceive the protective benefits of factors related to serosorting including beliefs about engaging in serosorting, sexual communication, and perceptions of risk for HIV. Participants were 94 HIV negative seroconcordant (same HIV status) couples, 20 HIV serodiscordant (discrepant HIV status) couples, and 13 HIV positive seroconcordant (same HIV status) couples recruited from a large gay pride festival in the southeastern US. To account for nonindependence found in the couple-level data, we used multilevel modeling which includes dyad in the analysis. Findings demonstrated that participants in seroconcordant relationships were more likely to believe that serosorting reduces concerns for condom use. HIV negative participants in seroconcordant relationships viewed themselves at relatively low risk for HIV transmission even though monogamy within relationships and HIV testing were infrequent. Dyadic analyses demonstrated that partners have a substantial effect on an individual’s beliefs and number of unprotected sex partners. We conclude that relationship partners are an important source of influence and, thus, intervening with partners is necessary to reduce HIV transmission risks.     

Positive and Negative Self-Conscious Emotion and Transmission Risk Following HIV Diagnosis

While negative emotions are associated with risk behaviors and risk avoidance among people with HIV, emerging evidence indicates that negative self-conscious emotions, those evoked by self-reflection or self-evaluation (e.g., shame, guilt, and embarrassment), may differentially influence health-risk behaviors by producing avoidance or, conversely, pro-social behaviors. Positive emotions are associated with beneficial health behaviors, and may account for inconsistent findings related to negative self-conscious emotions. Using multinomial logistic regression, we tested whether positive emotion moderated the relationships between negative emotion and negative self-conscious emotions and level of condomless sex risk: (1) seroconcordant; (2) serodiscordant with undetectable viral load; and (3) serodiscordant with detectable viral load [potentially amplified transmission (PAT)] among people recently diagnosed with HIV (n = 276). While positive emotion did not moderate the relationship between negative emotion and condomless sex, it did moderate the relationship between negative self-conscious emotion and PAT (AOR = 0.60; 95% CI 0.41, 0.87); high negative self-conscious and high positive emotion were associated with lower PAT risk. Acknowledgment of both positive and negative self-conscious emotion may reduce transmission risk behavior among people with HIV.     

Community Legal Systems: Targeting PrEP and HIV Education to Decrease Risk of HIV Transmission

The southern U.S. has both high HIV and incarceration rates in comparison to its population. As in the rest of the country, HIV prevention is based on education, behavior change, and biomedical efforts, such as pre-exposure prophylaxis (PrEP). This study examined the implementation of an educational intervention and supportive services to obtain PrEP in a population of individuals (N?=?218) involved in an Adult Drug Court (ADC) or on probation or parole (P-P). Nearly all ADC and P-P participants self-reported risk behaviors linked to HIV acquisition. Results supported the acceptance and usefulness of the intervention as rated by participants. Participants showed increased knowledge of HIV risks and testing post-education. In multivariate analysis, predictors of interest in using PrEP included low stigma beliefs, specifically their level of prejudice views, high depressive symptoms, and white race. The intervention shows promise. Given the high risk documented for ADC and P-P individuals, HIV prevention is a critical component for increased protective behaviors.

     

Behavioral Surveillance Study: Sexual Risk Taking Behaviour in UK HIV Outpatient Attendees

This study aimed to determine demographic, behavioural and self-report disease/treatment variables among HIV-infected individuals (n = 666) that predict unprotected intercourse with a partner of unknown/discordant status. Sexual risk behaviour was reported by 12.8%. In multivariable analysis, risk was more likely to be reported by gay men compared to women or heterosexual men, and for those with higher psychological symptom burden. Psychological symptoms should be assessed and managed in the HIV outpatient setting to ensure integrated care that enhances prevention.     

Predicting HIV Transmission Risk among HIV-Infected Patients Seen in Clinical Settings

We assessed risk of transmission among 4,016 HIV-infected patients in primary care, including men who have sex with men (MSM, n = 2,109), women (n = 1,104) and men who had sex with women (MSW, n = 803) in clinics in 15 cities across the U.S. A transmission risk act, assessed by computer assisted interviews, was defined as unprotected vaginal or anal sex with a partner who was HIV-uninfected or of unknown HIV status. MSM were more than twice as likely to report transmission risk acts than MSW (Odds Ratio [OR] = 2.35; 95% Confidence Interval [CI] = 1.84, 3.00; P ≤ .001). Women were also more likely to report transmission risk acts than MSW (OR = 1.56; 95% CI = 1.19, 2.05; P ≤ .001). Stimulant use was associated with transmission risk in all three groups (P ≤ .05). MSM were more likely to use methamphetamines (8% versus 2% and 3% respectively), while MSW (17%) and women (12%, compared to 11% for MSM) were more likely to use cocaine. Clinical settings offer opportunities for preventing HIV transmission, particularly if interventions are tailored to sub-populations of HIV-infected patients.     

Bipolar Disorder is Associated with HIV Transmission Risk Behavior Among Patients in Treatment for HIV

This study examined HIV transmission risk behavior among 63 patients with bipolar disorder (BD), major depressive disorder, and no mood disorder; half had substance use disorders (SUDs). Patients with BD were more likely than others to report unprotected intercourse with HIV-negative partners and?<95?% adherence to antiretroviral medications. In multivariate models, BD and SUD were independent predictors of both risk behaviors. Participants with poorer medication adherence were more likely to have detectable HIV viral loads and unprotected intercourse with HIV-negative partners. Patients with BD deserve careful evaluation and HIV prevention services to reduce HIV transmission risk behaviors.     

HIV/STD Risk and Sexual Strategies Among Women Family Planning Clients in New York: Project FIO

This report describes among 360 family planning clients in an HIV epicenter, women's HIV/STD risk characteristics, the barriers and facilitators of condom use within the context of relationships, and the use of alternative strategies for protection. Women attending the clinic were recruited for an HIV/STD preventive intervention and interviewed at baseline. At least 1 risk factor was reported by 77%, including a diagnosis of an STD within the last year for 30%. Recent STD diagnosis was associated with having a risky partner, but not with number of current partners. Women reporting consistent condom use had higher quality of couple communication, stronger intentions to prevent pregnancy, more positive reactions to condoms themselves and from their partners. Alternative risk reduction strategies, including using a barrier method other than condoms, refusing sex, engaging in nonpenetrative sex, leaving a relationship due to STD concerns, or undergoing mutual HIV testing had been used by 39% of women in the past 3 months.