Mumbai disease in far western Nepal: HIV infection and syphilis among male migrant-returnees and non-migrants

OBJECTIVE: To measure the seroprevalence of human immunodeficiency virus (HIV) infection and syphilis, and to assess the behavioural risk factors for these infections among migrant-returnees and non-migrants in far western Nepal. METHODS: In April 2001, we recruited 97 male migrant-returnees and 40 non-migrants from five rural villages in Doti district where migration to Mumbai is common. For data collection, we conducted a serological examination for HIV and syphilis, and a perception and behaviour survey on HIV and other sexually transmitted infections. RESULTS: We found that 11 of 137 men (8%) were positive for HIV infection and 30 men (22%) for syphilis. The respondents, especially the migrant-returnees from Mumbai, were engaging in risky behaviours such as pre- or extramarital sex, and sex with multiple partners, including sex workers. CONCLUSIONS: This study revealed high HIV and syphilis prevalence among the male migrant-returnees and non-migrants in far western Nepal where migration to Mumbai is common. The prevalent behaviours, particularly among the migrant-returnees, imply urgent needs of the behavioural modification programme in this area to prevent the spread of HIV infection to general population.     

AIDS-related knowledge and sexual behaviour among married and previously married persons in rural central Mozambique

HIV prevalence in central Mozambique is the highest in the country with high urban rates impacting on the rural areas. To identify potential factors influencing the spread of HIV in three sparsely populated districts in southern Sofala province, 847 married and previously married persons were surveyed for their knowledge, practices and beliefs regarding HIV/AIDS and STIs. 21.9% and 6.5% of males and females, respectively, were engaged in casual sexual partnerships in the past year. Being male, married, educated, and having genital discharge and ulcers in the last year were significantly associated with risky sexual activity. Risky behaviour was significantly associated with being Catholic or Protestant when compared with those from Zionist churches. Knowledge of ABC prevention strategies and condom usage was significantly associated with being male, married, having an STI in the past year, and being educated, particularly at the secondary level (Grade 8+). Attitudes and behaviour were influenced by cultural and religious involvement, as well as sex and marital status. It is imperative that prevention strategies take into account the cultural, economic and religious conditions present in rural African settings to create HIV prevention programmes that are culturally relevant and acceptable to the participants.     

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.     

Interventions to prevent substance use and risky sexual behaviour in young people: a systematic review

Aims To identify and assess the effectiveness of experimental studies of interventions that report on multiple risk behaviour outcomes in young people. Methods A systematic review was performed to identify experimental studies of interventions to reduce risk behaviour in adolescents or young adults and that reported on both any substance (alcohol, tobacco and illicit drug) use and sexual risk behaviour outcomes. Two authors reviewed studies independently identified through a comprehensive search strategy and assessed the quality of included studies. The report was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Results From 1129 papers, 18 experimental studies met our inclusion criteria, 13 of which were assigned a strong or moderate quality rating. The substantial heterogeneity between studies precluded the pooling of results to give summary estimates. Intervention effects were mixed, with most programmes having a significant effect on some outcomes, but not others. The most promising interventions addressed multiple domains (individual and peer, family, school and community) of risk and protective factors for risk behaviour. Programmes that addressed just one domain were generally less effective in preventing multiple risk behaviour. Conclusions There is some, albeit limited, evidence that programmes to reduce multiple risk behaviours in school children can be effective, the most promising programmes being those that address multiple domains of influence on risk behaviour. Intervening in the mid‐childhood school years may have an impact on later risk behaviour, but further research is needed to determine the effectiveness of this approach.     

HIV testing is associated with increased knowledge and reductions in sexual risk behaviours among men in Cape Town,South Africa

HIV testing benefits those who test positive, allowing them to receive treatment, but the benefits for those who test negative remain controversial. We evaluated the impact of testing on HIV knowledge and sexual risk among men in South Africa. Men were recruited from townships outside Cape Town and completed a survey that assessed testing history, knowledge, and sexual behaviours. Among the 820 participants, 516 (63%) reported being tested (82% tested negative, 6% tested positive, and 12% unknown). Compared to those who had never been tested for HIV, men who tested for HIV were more knowledgeable about HIV transmission, but did not differ on sexual risk behaviour. Knowledge moderated the effect of testing on sexual risk such that men reported fewer sexual partners (incidence rate ratio (IRR) = 0.91, 95% CI = 0.84, 0.98) and fewer unprotected anal sex events (IRR = 0.81, 95% CI = 0.66, 1.00) if they had been tested for HIV and were knowledgeable about HIV transmission. For men testing HIV-negative, knowledge predicted fewer sexual risk behaviours. Previous HIV testing is associated with enhanced knowledge, which moderates sexual risk behaviour among South African men living in Cape Town. Results suggest that HIV testing may increase knowledge and lead to reductions in sexual risk even when results are negative.     

Health care provider and self-assessment of health status and sexual behaviour in HIV-seropositive young men with haemophilia

We hypothesized that persons with HIV who perceive themselves as having waning health status may participate in fewer sexual behaviours than HIV-infected persons without HIV-related health problems. The object-ives of this study were to compare health care provider responses with participant responses for health status and for sexual activity and to examine the relationship of HIV-related health status to the sexual behaviour of HIV-seropositive adolescents and young men with haemophilia. A detailed questionnaire designed by researchers from 11 participating US haemophilia treatment sites and CDC personnel was administered to 306 HIV-seropositive young men with haemophilia aged 12–25 years. A health care provider from the haemophilia treatment centre also completed a questionnaire on each respondent. Self-assessment of HIV-related health status was similar to provider assessment of health status. Providers accurat-ely assessed participant sexual activity (overall Kappa = 0.62). Participation in vaginal intercourse and condom use was independent of health status. Following extensive educational efforts, most HIV-seropositive adolescents and young men with haemophilia are aware of the relationship between their HIV seropositivity and health status. Waning health status does not reduce participation in penetrative sexual behaviours or increase use of condoms. HIV prevention efforts should continue for this population.     

Correlates of sedentary behaviour in Asian adults: A systematic review

The objective of this study is to systematically review the evidence on correlates of sedentary behaviour (SB) among Asian adults. We searched for studies that examined individual, environmental, and political/cultural correlates of total and domain‐specific SB (transport, occupation, leisure, and screen time) in Asian adults published from 2000 onwards in nine scientific databases. Two reviewers independently screened identified references. Following quality assessment of included studies, we performed narrative synthesis that considered differences based on SB measurements, regions, and population characteristics (PROSPERO: CRD42018095268). We identified 13 249 papers of which we included 49, from four regions and 12 countries. Researchers conducted cross‐sectional analyses and most relied on SB self‐report for SB measurement. Of the 118 correlates studied, the following associations were consistent: higher age, living in an urban area (East Asia), and lower mental health with higher total SB; higher education with higher total and occupational SB; higher income with higher leisure‐time SB; higher transit density with higher total SB in older East Asians; and being an unmarried women with higher SB in the Middle East. We encourage more research in non‐high‐income countries across regions, further exploration of important but neglected correlates using longitudinal designs and qualitative research, and the use of objective instruments to collect SB data.     

Reproductive and sexual health knowledge,experiences, and milestones in young adults with life-long HIV

ABSTRACT

Reproductive and sexual health outcomes of adults with perinatal human immunodeficiency virus (PHIV) have not been well-characterized. This prospective cross-sectional study of 35 adult persons living with HIV (PLWH) from early life and 20 matched HIV-negative controls assessed quality of life, depressive symptoms, HIV transmission knowledge, and sexual/reproductive behaviors through self-report questionnaires. PLWH scored significantly worse than controls on depressive symptoms (p?=?0.04) and two of six quality of life domains (p?=?0.03, p?=?0.0002). In contrast, PLWH scored significantly higher on transmission knowledge in the context of family planning (p?=?0.002). PLWH were more likely to learn about sex from healthcare providers (p?=?0.002) and were more confident in their sexual/reproductive health knowledge (p?<?0.05). Both groups reported inconsistent condom use, but PLWH were more likely to have planned pregnancies (p?=?0.005) and to share pregnancy planning with their partners (p?<?0.05). Despite the challenges of living with a chronic stigmatized condition, adults with PHIV were knowledgeable about HIV transmission and family planning and demonstrated sexual practices and reproductive outcomes similar to age-matched controls. However, sub-optimal rates of viral suppression, inconsistent condom use, and the psychosocial impact of living with HIV continue to require the attention of healthcare provides for young adults with PHIV.     

Interplay between economic empowerment and sexual behaviour and practices of migrant workers within the context of HIV and AIDS in the Lesotho textile industry

Abstract

Economic empowerment brings with it a wide range of consequences, both positive and negative. The objective of this paper was to examine the relationship between economic empowerment and the sexual behaviour and practices of migrant workers within the context of HIV and AIDS in the Lesotho textile industry. Data for this paper were extracted from the findings of a larger study which had been conducted concerning HIV and AIDS in the textile industry in Lesotho. Using in-depth interviews, data were collected from 40 participants who were purposively selected from five factories which had been chosen randomly. Empowerment theory was used as a lens to provide meanings for the experiences of the participants. The findings show that the participants were empowered only in certain respects in terms of Kabeer's empowerment model of ‘power to’ and ‘power within’, on one hand, and in terms of Malhotra's comprehensive empowerment framework at the household level, on the other, as being employed in the industry enabled them to participate in the economy. Employment in the sector provided the participants with the means to be able to acquire basic needs and the ability to participate in household decision-making: for the female participants, the ability to make independent sexual decisions was also enhanced. These improvements were greeted enthusiastically, particularly by the female participants, given their previously disadvantaged status as a result of coming from rural patriarchal villages with gender-defined hegemonic notions of respectability. The findings also indicate that environmental factors and others, such as meagre salaries, encouraged some of the female workers to engage in transactional sex, while some of the male participants tended to increase their sexual relationships as a result of acquiring employment and income from the industry. It is the contention of the authors of this study that true empowerment requires both vital resources and individual and collective participation, particularly for the women, who are more vulnerable than men. Finally, we conclude that the opportunities provided by economic empowerment have given the participants a new social meaning for their situation and an awareness about their place in power relations.     

Male condom use,multiple sexual partners and HIV: a prospective case-control study in Kinshasa (DRC)

In the Democratic Republic of Congo no previous studies have assessed the factors associated with different patterns of condom use and with multiple sexual partners, and the association between condom use simultaneously taking into account multiple sexual partnerships, and HIV infection. We carried out a prospective case–control study. From December 2010 until June 2012, 1630 participants aged 15–49 getting HIV Voluntary Counseling and Testing in a hospital in Kinshasa were selected. Cases were new HIV diagnosis and controls were HIV-negative participants detected along the study period. We recruited 274 cases and 1340 controls that were interviewed about HIV-related knowledge, attitudes and behaviours. Among cases there was a high prevalence of multiple lifetime and concurrent sexual partnerships (89.8% and 20.4%, respectively) and most cases never used condoms with only 1.5% using them consistently. Condom use and multiple partnerships were associated with male, single and high-educated participants. An association was found between multiple lifetime partners and ‘any condom use’ (OR?=?2.99; 95%CI: 2.14–4.19) but not with consistent use. Both having two or more multiple concurrent sexual partners or not using condoms were variables similarly and highly associated to HIV risk. The association found between having two or more concurrent sexual partners and HIV was slightly higher (OR?=?3.58, 95%CI:2.31–5.56) than the association found between never condom use and HIV (OR?=?3.38, 95%CI:1.15–9.93). We found a high prevalence of multiple lifetime sexual partners and an extremely high prevalence of inconsistent condom use, both strongly associated with HIV seropositivity. Local programmes would benefit from comprehensive interventions targeting all behavioural and sociocultural determinants.     

The global epidemiology of HIV/AIDS

The HIV pandemic continues to evolve, in both magnitude and diversity. In this paper, we briefly review the global epidemiology of HIV/AIDS, reflecting on the differences by region, and the challenges posed by the evolving epidemics in terms of prevention and surveillance. Despite the reduction in numbers of new AIDS cases in the US and Western Europe due to advances in treatment, a constant number of new HIV infections persists every year, with evidence that in some settings high-risk behaviour has increased, indicating failure in primary prevention. However, the vast majority of new infections still occur in developing countries. The two giants, India and China, are set to determine Asia's ultimate contribution to the pandemic, but currently it is Africa that remains in the eye of the storm, with rapidly increasing epidemics in many countries in the south and east of the continent impacting on all levels of society.     

Qualitative evaluation of selected social factors that impact sexual risk-taking behaviour among African students in Kwazulu-Natal,South Africa

Background: The incidence of HIV and AIDS continues to be a source of great concern within universities in South Africa. Furthermore, university students constitute an important community in the intervention against the HIV/AIDS epidemic. Students in the age group of 15–24 years are at a greater risk of HIV infection than any other group in the country; yet, little is known about why they continue to engage in risky sexual practices. Objectives: This study was designed to explore the sexual behaviour of students in a metropolitan Durban University of Technology in KwaZulu-Natal to understand the social factors underlying their risk of HIV infection. Methods: This is a qualitative study that used cluster sampling where the population was stratified by campus and faculty. The study population was selected using a standard randomization technique. This was a part of a multi-phased research project aimed at providing a sero-prevalence baseline and an analysis of risk-taking behaviour at a Durban University of Technology in the eThekwini Metropolitan Municipality area. Results: The study highlights peer pressure among students as an influence in promoting high-risk sexual behaviour. Within this context, the findings revealed that university students lack the ability to negotiate risk-aware decisions especially regarding sexual relationships. Conclusion: This study draws attention to the perspectives of African university students regarding their risk-taking sexual practices and selected factors which influence such behaviour. The findings are not exhaustive in exploring contextual antecedents that shape students’ sexual practices. However, they provide an important basis in understanding key factors which expose students to HIV infections. The study provides insights into opportunities for further studies as well as preventative implications.     

No difference in HIV incidence and sexual behaviour between out-migrants and residents in rural Manicaland, Zimbabwe

OBJECTIVES: Migration is associated with HIV infection, but the relationship has been mostly assessed in cross-sectional studies. In a prospective study, we investigated whether out-migrants are a selection of high-risk individuals and whether rural-to-urban migration results in risky sexual behaviour for HIV incidence. METHODS: A population cohort was enrolled in a stratified household census in four different community types in Manicaland, east Zimbabwe, between July 1998 and February 2000, and followed-up after 3 years. Out-migrants to the national capital (Harare), the provincial capital (Mutare) and other study areas were followed-up. A structured questionnaire was administered and an HIV test was conducted at each interview. HIV prevalence and sexual risk behaviour at baseline, and HIV incidence and sexual behaviour during follow-up were compared for out-migrants and residents. RESULTS: At baseline, future migrants were significantly younger, better educated and more likely to be single than residents. For males, migration was highest from subsistence farming areas and roadside trading centres and lowest from estates. After adjusting for age, education, marital status and location, there were no differences in HIV prevalence and sexual risk behaviour between future migrants and residents at baseline, for either sex. No significant differences in HIV incidence or sexual behaviour during follow-up were detected between rural-to-urban out-migrants and residents. CONCLUSIONS: Out-migrants from rural Zimbabwe did not have higher levels of HIV infection or sexual risk behaviour than residents either before or after they moved. These findings may be related to the mature stage of the HIV epidemic and the social and living conditions of migrants in Zimbabwean cities.     

北京市农村流动人口的HIV/STD高危性行为和知识分析

目的调查北京市流动人口中存在的感染艾滋病病毒/性传播疾病(HIV/STD)的高危性行为和他们所掌握的艾滋病知识状况。方法在北京市流动人口集中的行业中,用按比例抽样的方法抽取了2222名流动人员,采取问卷调查了解他们拥有的性伙伴数量、参与商业性性行为、安全套使用等高危性行为的情况和艾滋病知识掌握的状况。结果对被调查者中报告有性行为的900人进行了统计分析,结果发现67.4%的人有婚前性行为,31.0%的人有多个性伙伴,9.4%的人参与了商业性性行为,而只有39.0%的人使用过安全套。对全体被调查者的艾滋病知识分析发现,他们的艾滋病知识掌握的相对比较多,熟悉艾滋病传播的三大途径,但对不传播途径没有多大把握。结论加强对流动人口感染HIV/STD的危险和使用安全套的干预。     

HIV-1阳性配偶/固定性伴的分子流行病学研究进展

在HIV-1的传播中,异性性传播逐渐成为主要的传播途径。配偶/固定性伴间的HIV-1传播越来越受研究者的关注。本综述阐述了国内外HIV-1阳性配偶/固定性伴人群的HIV-1感染情况以及亚型流行特征,同时总结了现有针对该人群的干预措施,为HIV-1防控策略的制定提供一定的参考。     

Descriptive systematic review of sub-Saharan African studies on the association between alcohol use and HIV infection

The purpose of this review was to identify and assess studies that have quantified the association between alcohol consumption and HIV infection in sub-Saharan Africa. PubMed, CAB Abstracts and article references were searched to identify studies published in English between 2000 and 2008 that reported relative measures of the association between alcohol use and HIV prevalence and/or seroconversion rates. Twenty-one eligible studies were described in detail and information on study characteristics extracted. All of the identified studies were conducted either in east or southern Africa, and varied substantially regarding study population and alcohol use definitions. Overall, users of alcohol and especially problem drinkers were more likely to be HIV seropositive (HIV+) than non-users, frequency or quantity of alcohol use was positively associated with HIV prevalence, and the association varied by gender. The use of alcohol in sexual contexts was significantly associated with an increased risk of HIV acquisition and prevalence. The findings of this review of sub-Saharan African research strongly support an association between alcohol consumption and HIV infection. Although a causal relationship could not be established with certainty from the mainly cross-sectional studies, the negative consequences of such an association have profound implications for the burden of disease in this region. To confirm causality, future research should use prospective study designs, use clearly defined standardised measures of alcohol use (and problematic drinking) and an ‘event-specific’ approach to examine the situational links between alcohol use and HIV acquisition.     

Tuberculosis epidemiology in the Asia–Pacific region

Abstract:   The Asia–Pacific region accounts for about 20% of the global burden of tuberculosis (TB). However, there are a wide variety of TB problems between countries and areas. This variety could be described in three dimensions: (i) historical trends of the TB epidemics, closely related to the advent of industrialization or urbanization; (ii) success in modern TB control in the early days; and (iii) expansion of the directly observed therapy, short course (DOTS) strategy during the past 20 years. Moreover, these dimensions have been subject to the 'health infrastructure' based on such social goods as people's education, economic standards, and social security or stability. The Asia–Pacific Region offers very good examples to illustrate the roles of these factors in leading to such a variety of TB problems as seen today. Thus, this region was the first to achieve the global target of DOTS by the end of 2005, that is to detect 70% of patients and to treat them with DOTS, and to successfully cure 85% of those detected.
However, we should remember that we are currently challenged by TB combined with HIV infection and AIDS; TB with drug-resistance, especially multidrug-resistant (MDR) or extensively drug resistant (XDR) forms; TB in people with special risk factors, for example diabetes and senility; and other medical and socioeconomic problems. At the same time, we have to be careful about the premature loss of people's interest in TB, due to illusion or unfounded optimism, especially among medical professionals and the government.     

Gender differences in university students' HIV/AIDS-related knowledge and sexual behaviours in Malawi: a pilot study

A cross-sectional study was conducted among first-year university students in Malawi to determine distributions of HIV/AIDS related knowledge, and sexual behaviours. A total of 314 (199 male and 115 female) students were eligible to participate, and of these 221 (70.4%) participated in the survey. Generally, levels of HIV/AIDS-related knowledge were similar between sexes. Overall, 68.9% of students of both sexes felt that they knew enough about HIV/AIDS. Altogether, 83.3% of students reported that they knew where to access HIV testing on campus, but only 19.0% reported that they knew their HIV status. Some 60.3% of students who had never been tested intended to have an HIV test. A history of having ever been tested was not associated with sex. Most (68.4%) students felt that they were not at risk of acquiring HIV infection. Overall, 66.8% of students knew where to get a condom on campus, and 38.7% stated that they knew exactly how to use it. About half (52.6%) of the students used a condom at last vaginal sexual intercourse. Having multiple sex partners in the last 12 months was reported by 40.4% of students.