Migrants' risky sexual behaviours in India and at home in far western Nepal

OBJECTIVE: To examine Nepali migrants' vulnerability to HIV/sexually transmitted infections (STIs) and their possible role in causing the epidemic in far western Nepal. METHODS: From August to October 2000, we conducted six focus group discussions among 53 returned migrants from India, mainly from Mumbai. Data were analysed by interpretative thematic analysis. RESULTS: Migrants commonly had multiple sexual encounters, changed partners, and used condoms infrequently both in India and at home. Several factors influenced them to practice high-risk sexual behaviours. In India, these included peer norms and pressures, cheaper sex, lack of family restraint, drinking alcohol, and low perceived vulnerability to HIV/STIs. In Nepal, these factors included the migrants' new status, frequent local festivals, and low perceived vulnerability to HIV/STIs. Participants displayed substantial deficits in their knowledge of HIV/STIs. CONCLUSIONS: This study revealed Nepali migrants' high-risk sexual behaviours both abroad and at home. Understanding these realities will assist in the development of culturally appropriate HIV/STI interventions necessary to halt the spread of HIV/STIs in Nepal.     

Retention and effectiveness of HIV/AIDS training of traditional healers in far western Nepal

OBJECTIVE: To evaluate HIV/AIDS training for traditional healers (THs) in far western Nepal. METHODS: We collected data using a structured questionnaire and assessed THs' knowledge of HIV transmission, misconceptions and preventive measures immediately prior to the initial training conducted from June to December 1999, and then 9-12 months after the training in 2000. We also conducted six focus group discussions (FGD) and assessed THs' performances after the training. We interviewed 12 key informants about their perceptions towards the trained THs. RESULTS: THs significantly improved their knowledge of HIV transmission, misconceptions and preventive measures after the training. The FGD and key informant interview results showed that the trained THs provided culturally acceptable HIV/AIDS education to the local people, distributed condoms and played a role in reducing the HIV/AIDS-related stigma. CONCLUSIONS: THs have a potential to work as key players in HIV/AIDS programmes in Nepal.     

A systematic review of current knowledge of HIV epidemiology and of sexual behaviour in Nepal

OBJECTIVE: To systematically review information on HIV epidemiology and on sexual behaviour in Nepal with a view to identifying gaps in current knowledge. METHODS: Systematic review covering electronic databases, web-based information, personal contact with experts and hand searching of key journals. RESULTS: HIV-1 seroprevalence has been rising rapidly in association with high-risk behaviours, with current levels of 40% amongst the nation's injecting drug users and approaching 20% amongst Kathmandu's female commercial sex workers (FCSWs). HIV seroprevalence remains low in the general population (0.29% of 15-49 year olds). There are significant methodological limitations in many of the seroprevalence studies identified, and these estimates need to be treated with caution. There are extensive migration patterns both within the country and internationally which provide the potential for considerable sexual networking. However, studies of sexual behaviour have focused on FCSWs and the extent of sexual networks within the general population is largely unknown. CONCLUSIONS: Whilst some of the ingredients are present for an explosive HIV epidemic in Nepal, crucial knowledge on sexual behaviour in the general population is missing. Research on sexual networking is urgently required to guide HIV control in Nepal. There is also a need for further good-quality epidemiological studies of HIV seroprevalence.     

天津市性服务男孩的HIV和梅毒感染状况分析

目的了解天津市性服务男孩（MoneyBoy,MB）的艾滋病病毒（HIV）和梅毒感染状况及相关因素,为在该人群中开展有效的性病艾滋病防治提供依据。方法用横断面调查的方法,对来自两家同志会所及一家同志浴池的MB,进行匿名问卷调查和HIV及梅毒检测。结果89名MB年龄最小16岁,最大29岁,平均20．6岁;29．2％自认为是同性恋,18．0％异性恋,51．7％双性恋。HIV阳性率为6．7％,快速血浆反应素环状卡片试验（RPR）阳性率为20．2％;来自同志浴池的MB其HIV和RPR阳性率明显高于来自同志会所的MB（P〈0．001）;同性性倾向MB的RPR阳性率高于非同性性倾向MB（P〈0．05）。结论MB流动性强,同性和异性性行为活跃,艾滋病和梅毒感染率高,是艾滋病和性病防治工作中应重点关注的人群,特别是同志浴池中的MB应格外引起重视。     

Development and initial validation of a brief screener for focused HIV prevention efforts

Objectives

The public health response to the spread of HIV relies on behavioural changes, especially reductions in sexual and drug‐use‐related transmission risk behaviours (TRBs). While understanding the factors that dispose people towards risky behaviours is important scientifically, it can be difficult to distil the many predictors of sexual risk behaviours into a useful clinical tool for focused prevention efforts. Our goal was to evaluate the extent to which known predictors of sexual TRBs (self‐efficacy, treatment optimism, engagement with medical care, awareness of risky behaviours, substance use, and relevant behavioural and socio‐demographic characteristics) combined with additional attitude‐related assessments to identify those who had engaged in recent sexual TRBs and may therefore be at risk of additional TRBs.

Methods

In this study, we analysed data on beliefs and behaviours related to sex, substance use, HIV prevention and other relevant factors for 280 patients at a publicly funded HIV/AIDS clinic in Seattle. All participants completed a baseline audio computer‐assisted self interview (ACASI) as part of a larger trial focused on reducing TRBs.

Results

Our multivariate model yielded three screening questions that could prove effective in identifying HIV‐positive patients in need of focused prevention resources.

Conclusions

The resulting screener holds promise as a brief and easily deployed tool that can be used by providers regardless of access to ACASI technology. Additional validation is needed and longitudinal evaluation is currently in progress.

     

Clinical importance of HIV and depressive symptoms among veterans with HIV infection

OBJECTIVE: To compare the clinical importance (association with illness severity and survival) of depressive and HIV symptoms among veterans with HIV infection. DESIGN: Cross-sectional study; survival analysis. SETTING: Infectious Disease Clinics at 3 VA Medical Centers. PARTICIPANTS: HIV-infected patients (N = 881) and their health care providers from June 1999 through July 2000. MEASUREMENTS AND MAIN RESULTS: Depressive symptoms were assessed using the 10-item Centers for Epidemiologic Studies Depression Scale (CES-D). Patient baseline survey included an HIV Symptom Index measuring the frequency and bother of 20 common symptoms. Providers were surveyed on patients' illness severity, and survival data were obtained from VA death records. Of 881 patients, 46% had significant depressive symptoms (CES-D >/=10). Increasing depression symptom severity was associated with increasing HIV symptom frequency (P <.001) and bother (P <.001). Multiple regression results revealed that having moderate or severe depressive symptoms was not associated with provider-reported illness severity or survival. However, HIV symptoms were significantly associated with provider-reported illness severity (P <.01) and survival (P =.05), after adjusting for moderate and severe depressive symptoms, CD4 cell count/mm3, viral load, age, race, and antiretroviral use. CONCLUSIONS: Depression, while common in this sample, was not associated with illness severity or mortality after adjusting for HIV symptoms. HIV symptoms are associated with severity of illness and survival regardless of patients' severity of depressive symptoms. This suggests that equal medical consideration should be given to HIV symptoms presented by HIV-infected patients regardless of their depression status, rather than automatically attributing medical complaints to depression.     

HIV/AIDS合并梅毒患者临床特征及长期抗病毒治疗研究

[摘要]　目的　探讨HIV/AIDS合并梅毒患者临床特征及长期抗反转录病毒治疗（anti-retroviral therapy, ART）的病毒学、免疫学效果以及梅毒复发和/或再感染情况。方法?收集2017年1月1日—2019年12月31日在首都医科大学附属北京佑安医院进行初始ART的HIV/AIDS患者的基本信息和实验室检测数据,分析患者的临床特征及其ART后病毒学、免疫学效果以及梅毒复发及再感染情况。结果?共纳入728例HIV合并梅毒感染者,其中99.6%为男性,97.7%为同性性传播感染者,ART时间中位数为950（691,1217） d,从诊断到开始ART的中位时间为15.5（8.0,41.0） d,诊断至开始ART时间≥180 d以上的患者占14.7%（107/728）。经过治疗,患者CD4+ T淋巴细胞计数增加了242（130,369）个/μl,99.3%（723/728）的患者HIV载量控制在400拷贝ml以内。经足量、规律驱梅治疗6～12个月后,梅毒复发和/或再感染率为18.4%（134/728）。结论?HIV/AIDS合并梅毒患者经长期ART后病毒学、免疫学效果良好,梅毒的复发和/或再感染率较高,梅毒足量规则治疗的同时,加强性健康宣教和定期随访复查至关重要。     

Some aspects of the natural history of HIV infection

Studying factors influencing the length of the incubation period of HIV/AIDS is important to our understanding of the natural history of the disease and for the decision when to start with anti-retroviral therapy. In a multicentre study among HIV-positive homosexual men with a known date of seroconversion, we found that the median survival time after HIV infection was 12.1 years. Age is an important determinant of the survival: the older the shorter the incubation period and survival. Gender does not seem to play a role, but women appear to have higher CD4 counts than men at seroconversion, AIDS and death. HIV-positive drug users often die before they 'reach' AIDS often from HIV-related causes e.g. bacterial infections. In a multicentre study we found that such pre-AIDS mortality is now also found among homosexual men and haemophiliacs but at a much lower level. Most studies show that HIV subtype does not influence the incubation period. On the other hand genetic factors do play an important role.     

Ecological correlates of multiple sexual partnerships among adolescents and young adults in urban Cape Town: a cumulative risk factor approach

Studies in South Africa have reported unsafe levels of risky sexual behvaiours among adolescents and young adults, with the country reporting the highest burden of HIV/AIDS globally, as well as a high rate of teenage pregnancy. While determinants of risky sexual behaviours have been investigated for factors occurring at the individual and household levels, not fully explored in the literature is the effect of community level factors. Furthermore, it is unclear whether risk factors occurring within the ecology of adolescents and young adults act cumulatively to influence their sexual practices. This article aims to address this knowledge gap using a case study of the Cape Area Panel Study of adolescents and young adults in urban Cape Town, South Africa. The ecological framework was adopted to guide the selection of risk factors at the individual, household, and community levels. Multivariate linear discriminant function analyses were used to select significant risk factors for multiple sexual partnerships and used to produce risk indices for the respondents. The cumulative risk approach was applied to test whether significant risk factors acted cumulatively. Findings point to the importance of ecological factors in influencing outcomes of multiple sexual partnerships among respondents and further demonstrate that ecological risk factors may act cumulatively. These findings are important for South Africa that is grappling with teenage pregnancy and disproportionate HIV epidemic among the youth.     

湖南省吸毒人群中HIV感染及其危险因素调查

目的 了解湖南省吸毒人群HIV感染及其相关危险因素,为制定预防吸毒传播HIV提供依据。方法 采用血清流行病学和问卷方法,对湖南四地戒毒所809名吸毒者进行调查。结果 检出HIV感染者23例,HIV感染与共用注射器、每日吸毒的频率、职业、共用注射器对象不固定、经济状况和艾滋病知识缺乏有一定关系。结论 在吸毒人群中应加强健康知识教育和行为干预。     

HIV感染献血者并发感染HBV、HCV及梅毒调查分析

目的:了解曲靖市无偿献血人群中艾滋病病毒(HIV)感染者并发感染乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)和梅毒的状况。方法:应用酶联免疫吸附试验(ELISA),对HIV感染献血者检测HBsAg、抗-HCV、抗-TP。结果:133例HIV感染献血者中,HBV感染率为1.5%,HCV感染率为10.5%,梅毒感染率为7.5%。结论:曲靖市HIV感染的献血者中,并发HCV和梅毒感染率高,而并发HBV感染率较低。     

2007-2010年锦江区艾滋病流行病学特征分析

目的 了解分析成都市锦江区艾滋病感染者/艾滋病患者(HIV/AIDS)流行病学特点,为制定艾滋病预防控制措施提供依据.方法 对2007-2010年锦江区HIV/AIDS资料进行描述性统计分析.结果 2007-2010年报告现住址为锦江区的HIV/AIDS共计221例,其中AIDS 32例,分别为1例、5例、9例、17例;性接触传播为主(186人,占84.16％);锦江区16个街道辖区均有分布;男性202 (91.40％)例,女性19 (8.60％)例;同性恋人群分别为4例、15例、39例、44例;20～45岁年龄组为主(191例,占86.43％);职业以家政、家务及待业和商业服务为主(均为15.84％),其次为工人(8.14％),不详及其他占较高比例(36.65％),干部职员(5.43)、学生(4.98％)、餐饮业人员(2.71％)、离退人员(2.71％)、教师(2.26％)、公共场所人员(2.26％),涉及多种职业群体.结论 2007-2010年锦江区HIV/AIDS人数上升明显,性传播为主要传播途径,同性恋人群感染人数快速上升,人群感染面广.提示今后防控重点应放在青壮年男性人群、同性恋人群,应进一步加强监测、宣传、干预等综合性防治工作.     

1045例MSM HIV感染状况及影响因素

目的了解男男性行为人群（MSM）的高危行为特征、艾滋病病毒（HIV）感染状况及影响因素。方法采取＂滚雪球＂法进行横断面调查,对选定的贵阳市和遵义市MSM开展面对面问卷调查,内容包括社会人口学特征、艾滋病知识和高危行为并采集血样检测HIV抗体。结果进行χ2检验和Logistic回归分析。结果共招募MSM 1 045人,平均年龄25.6岁,以贵州省的未婚男性为主,文化程度较高。艾滋病知识知晓率为89.7%（936/1 045）。HIV感染率达18.5%（193/1 045）。近6个月与男性发生肛交的占81.2%（829/1 021）,有14.0%（146/1 044）的MSM与女性发生过性行为。多因素回归分析结果提示,HIV的感染与年龄[≥41岁组,比值比（OR）=3.99]、民族（OR=1.91）、文化程度（大专以上文化组,OR=0.48）和近1年有性病相关症状（OR=1.97）等因素有关联。结论调查现场所在城市的MSM人群艾滋病（AIDS）处于高流行水平,该人群普遍存在无保护的多性伴行为,面对该人群艾滋病流行的严峻形势,急需实施具有针对性的预防服务和干预措施。     

北京市报告的HIV/AIDS病人的梅毒感染情况及相关因素分析

目的了解北京市报告的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)的梅毒感染情况,分析HIV/AIDS病人感染梅毒的相关因素。方法对北京市2011年4月至2013年3月报告的HIV/AIDS病人的血液样本,采用快速血浆反应素环状卡片试验(RPR)及梅毒螺旋体明胶颗粒凝集实验(TPPA)检测梅毒螺旋体形成检测数据库,同时结合这一时期的"艾滋病综合防治数据信息管理系统"的病例报告数据进行统计分析。结果 2011年4月至2013年3月,北京市共报告HIV/AIDS病人3806例,经性传播占94.0%(3579例);梅毒阳性者450例,梅毒感染率11.8%。报告的HIV/AIDS病人,有1911例在HIV抗体检测确证阳性前3个月内发生过性行为,其中发生无保护性行为的比例为66.6%(1272例);报告的HIV/AIDS病人的不同特征对应的梅毒感染率水平为:男性高于女性,汉族高于其他民族,年龄40岁以上者高于年轻者,男男同性性行为途径高于其他传播途径,婚姻状态为未婚、离异或丧偶者高于已婚及不详者,文化程度为初中、高中或中专者高于其他文化程度者,既往曾患性病者高于未患性病及不详者,报告单位为传染病医院者高于其他报告机构,样本来源为性病门诊者高于其他样本来源者。结论应根据HIV/AIDS病人感染梅毒的主要特征开展梅毒筛查及规范治疗,降低感染梅毒对HIV传播的促进作用。     

梅毒合并艾滋病的临床表现及治疗与预防

随着社会的发展,梅毒合并艾滋病的发病率逐渐上升,同时感染艾滋病病毒（HIV）会影响密螺旋体感染的诊断、自然病史、治疗及预后。该文针对梅毒合并HIV感染的临床表现、诊断、预防、治疗、疗效判定、预防复发、治疗失败的应对措施,以及妊娠梅毒对之进行了综述。     

Estimating risk factors for HIV infection among women in Mozambique using population-based survey data

The use of population-based survey data together with sound statistical methods can enhance better estimation of HIV risk factors and explain variations across subgroups of the population. The distribution and determinants of HIV infection in populations must be taken into consideration. We analysed data from the HIV Prevalence and Behaviour Survey in Mozambique aiming to find risk factors associated with HIV infection among Mozambican women. The paper provides a complex survey logistic regression model to explain the variation in HIV seropositivity using demographic, socio-economic and behavioural factors. Results show that women aged 25–29 years, living in female-headed households, living in richer households and those widowed, divorced or not living with a partner have higher odds of being HIV-positive. Findings from our study provide a unique and integrated perspective on risk factors for being HIV-positive among Mozambican women and could support the implementation of programmes aiming to reduce HIV infection in Mozambique.     

长沙市男男性行为者HIV和梅毒感染现状及影响因素分析

目的 了解长沙地区男男性行为者(MSM)艾滋病病毒(HIV)和梅毒感染状况及其影响因素.方法 2018年10月至2019年6月期间,委托非政府组织(NGOs)应用滚雪球的方法招募MSM,开展问卷调查和HIV及梅毒检测.采用多因素Logistic回归模型分析HIV和梅毒感染的影响因素.结果 共招募1 220名MSM,其中...