Mortality rates and causes of death in a cohort of HIV-infected and uninfected women, 1993–1999

HIV/AIDS-associated and non-HIV/AIDS-associated death rates and causes of death between 1993 and 1999 were examined in 885 HIV-infected women and 425 uninfected women of the HIV Epidemiology Research Study cohort. Causes of death were determined by review of death certificates and the National Death Index. Adjusted bazard ratios were calculated for mortality risk factors. In the 885 HIV-infected women and 425 uninfected women, 234 deaths and 8 deaths, respectively, occurred by December 31, 1999. All-cause death rates in the HIV-infected women were unchanged between the pre-HAART (1993–1996) and HAART eras (1997–1999) —5.1 versus 5.4 deaths per 100 person-years (py). AIDS as a cause of death decreased from 58% of all deaths in 1996 to 19% in 1999, while HAART use increased to 42% by the end of 1999. In spite of the modest proportion ever using HAART, HIV-related mortality rates did decline, particularly in women with CD4+cell counts less than 200/mm³. Drug-related factors were prominent: for the 129 non-AIDS-defining deaths, hepatitis C positivity (relative bazard [RH] 2.6, P<0.001) and injection drug use (RH 1.7, P=0.02) were strong predictors of mortality, but were not significant in the Cox model for 105 AIDS-defining deaths (RH 0.9, P>30 and RH 0.7, P>.30, respectively. The regression analysis findings, along with the high percentage of non-AIDS deaths attributable to illicit drug use, suggest that high levels of drug use in this population offset improvements in mortality from declining numbers of deaths due to AIDS. Supported by cooperative agreements No. U64/CCU106795, U64/CCU206798, U64/CCU306802, and U64/CCU506831 with the Centers for Disease Control and Prevention including supplementary support from the National Institute on Drug Abuse. Centers for Disease Control and Prevention, Division of HIV     

同性交友方式对男男性行为人群高危性行为及感染HIV的相关影响

目的 了解同性交友方式对MSM的高危性行为及HIV感染的相关影响。方法 采用横断面调查方法,2018年4-11月在宁波市采用滚雪球的非概率抽样法招募MSM,收集其人口学特征、交友方式、同性社交软件使用、高危性行为发生情况等相关信息,研究对象均需进行HIV抗体检测。分类资料采用χ²检验,采用多因素logistic回归分析MSM的HIV感染相关因素。结果 共调查MSM 735人,同性社交软件交友者、QQ或微信交友者和场所交友者分别为447人（60.8%）、237人（32.3%）和51人（6.9%）。同性社交软件交友者最近6个月性行为次数≥ 1次/周和发生多性伴的分别有75人（16.8%）和187人（41.8%）;最近1次和最近6个月发生无保护肛交行为的分别有54人（12.1%）和234人（52.3%）;HIV感染率为12.1%（54/447）。感染时间<2年的HIV/AIDS中,同性社交软件使用时间<2年的比例为68.6%（24/35）。多因素logistic回归分析结果显示,与QQ或微信交友者比较,同性社交软件交友者更易感染HIV（OR=3.03,95% CI：1.30~7.07）。结论 宁波市MSM中,同性社交软件交友者比例较高,存在较高危险性行为和HIV感染风险。应针对同性社交软件交友者加强监测和干预。     

艾滋病疫情估计与预测方法研究进展

近年来,由于艾滋病监测系统的不断完善以及监测资料来源的多样性,艾滋病疫情估计与预测方法已成为了解艾滋病流行状况及预测发展趋势的重要工具,为此国内外学者采用了多种方法对艾滋病疫情进行了估计与预测。本研究对目前常用艾滋病疫情估计与预测方法的基本原理、适用条件、应用、优点及局限性进行综述,为疫情估计方法的选择与应用提供参考。     

Foreign-Born Hispanic Women's Health Patterns in Allostatic Load Converge to U.S.-Born Hispanic Women at a Slower Tempo Compared With Men

ObjectivesWe investigated the patterns of foreign-born Hispanic health convergence to U.S.-born Hispanics using an allostatic load index, a subjective biological risk health profile, and we explored whether the health convergence patterns differ by sex.MethodsThe analytic sample consisted of 3,347 Hispanics from the pooled 2005–2010 National Health and Nutrition Examination Survey. We used negative binomial regression models to investigate the association between duration in the United States and the allostatic load index, while controlling for potential covariates.ResultsForeign-born Hispanics who had lived in the United States for 0–9 years and 10–19 years had lower levels of allostatic load than U.S.-born Hispanics; however, those who had lived in the United States for 20 or more years had a level of allostatic load similar to their U.S.-born counterparts. The pattern of immigrant health convergence shows a clear sex difference. In the sex-stratified models, we found that foreign-born Hispanic men converged to the level of allostatic load of U.S.-born Hispanic men after having lived in the United States for approximately 10 years. The health convergence pattern qualitatively differed for foreign-born Hispanic women, who remained healthier than U.S.-born Hispanic women regardless of duration in the United States.ConclusionsForeign-born Hispanics are healthier than their U.S.-born counterparts, providing support for the healthy migrant hypothesis. This relatively better health of foreign-born Hispanics disappears with a longer duration in the United States, providing support for the health convergence hypothesis, but is most noticeable for men. Foreign-born Hispanic women converge to U.S.-born Hispanic women's health status at a slower tempo, compared with foreign-born Hispanic men.     

Perceptions of politicization and HPV vaccine policy support

BackgroundSince its FDA approval in 2006, the Human papillomavirus (HPV) vaccine has been politically-charged, given its association with sexual health among young women and its history of controversial, and largely unsuccessful, legislative mandates. The extent to which perceived politicization is related to public support for the vaccine’s use, however, is not clear. We sought to examine the relationship between public perceptions of politicization of the HPV vaccine and public support for HPV vaccine policies.MethodsWe fielded a survey from May-June 2016 using a nationally representative sample of U.S. adults (18–59 years). Among respondents aware of the HPV vaccine (n = 290), we predict support for HPV vaccine policies based on respondents’ perceptions of three characteristics of the vaccine’s portrayal in public discourse: degree of controversy, certainty of the scientific evidence supporting the vaccine’s use, and frequency with which the vaccine appears in political discussion.ResultsRespondents who perceived greater certainty about the scientific evidence for the HPV vaccine were more supportive of HPV vaccine policies (p < 0.0001) than respondents who perceived the scientific evidence to be uncertain, after adjusting for respondents’ characteristics, including demographics and partisanship.ConclusionsPublic perceptions of the HPV vaccine’s politicization, particularly the portrayal of scientific evidence, are associated with receptivity to legislative mandates.Policy implicationsHow the certainty of a body of evidence gets communicated to the public may influence the policy process for a critical cancer prevention intervention.     

Randomized Trial of the Effects of Housing Assistance on the Health and Risk Behaviors of Homeless and Unstably Housed People Living with HIV

Homelessness affects HIV risk and health, but little is known about the longitudinal effects of rental assistance on the housing status and health of homeless and unstably housed people living with HIV/AIDS. Homeless/unstably housed people living with HIV/AIDS (N = 630) were randomly assigned to immediate Housing Opportunities for People with AIDS (HOPWA) rental assistance or customary care. Self-reported data, CD4, and HIV viral load were collected at baseline, 6, 12, and 18 months. Results showed that housing status improved in both groups, with greater improvement occurring in the treatment group. At 18 months, 51% of the comparison group had their own housing, limiting statistical power. Intent-to-treat analyses demonstrated significant reductions in medical care utilization and improvements in self-reported physical and mental health; significant differential change benefiting the treatment group was observed for depression and perceived stress. Significant differences between homeless and stably housed participants were found in as-treated analyses for health care utilization, mental health, and physical health. HOPWA rental assistance improves housing status and, in some cases, health outcomes of homeless and unstably housed people living with HIV/AIDS.     

Prevalence of HIV Infection and Prior HIV Testing among Young Men Who have Sex with Men. The Baltimore Young Men’s Survey

Data are presented from the Baltimore Young Men’s Survey, a cross-sectional, venue-based sample survey of risks associated with HIV and report of a prior HIV test, conducted between 1996 and 2000, and enrolling 843 young men who have sex with men (MSM) aged 15–29 years. HIV prevalence was 12.1% overall and racial disparities in HIV prevalence were pronounced (range, 2.9% among non-Hispanic whites to 27.1% among non-Hispanic blacks). Risks independently associated with being HIV-positive were: being between 26 and 29 years of age, being non-Hispanic black or of other/mixed race, having had 20 or more lifetime male sex partners, having been diagnosed with a sexually transmitted disease (STD), and not being currently enrolled in school. The majority of participants (78.9%) reported a prior HIV test. In multivariate analysis, being older, having had five or more lifetime male sex partners, having had anal intercourse with males, reporting an STD diagnosis, and reporting recent unprotected anal sex were associated with report of a prior HIV test. Prevention efforts must address high HIV prevalence among young non-Hispanic black MSM and must make testing and effective counseling for young MSM readily available.     

The characteristics and risk factors for HIV infection among Beijing drug users in different settings

Background

Treatment for drug addiction in China can take place in mandatory detoxification centers (MDC), voluntary detoxification centers (VDC), or at outreach programs located in the community. To date little is known about HIV prevalence or associated risk factors among the current and past drug users (DU) in each setting.

Methods

Cross-sectional surveys were conducted at three different settings in Beijing, China; 795 subjects were enrolled at MDC, 824 at VDC, and 520 within the community. Subjects who provided informed consent took part in face-to-face interviews and provided blood samples for HIV and syphilis testing.

Results

Significant differences were found across enrollment sites in terms of demographic, drug use and sexual behavior characteristics. Overall HIV sero-prevalence was 2.9%, and was particularly high in MDC (5.2% versus 1.0% in VDC and 2.3% among community drug users). Adjusted odds ratios (OR) for HIV infection were 50.5 (95% CI: 19.07-133.85) for being of Yi ethnicity, 29.4 (95% CI: 15.10-57.24) for Uyghur ethnicity, 3.4 (95% CI: 1.57-7.52) for injection drug users who did not share equipment, and 18.8 (95% CI: 8.31-42.75) among injection drug users who shared injection equipment.

Conclusions

The vast differences among DU in various enrollment sites in terms of demographic characteristics, socioeconomic status, and HIV related risk profiles underscore the importance of familiarity with population characteristics and drug user environment to better inform targeted prevention programs. Prevention programs targeting DU in Chinese settings must also consider differences in ethnicities, culture, and residential status.     

Epidemiology and risk factors for human papillomavirus infection in a diverse sample of low-income young women

BackgroundTwo HPV vaccines prevent infection with HPV-16 and HPV-18, high-risk (cancer-associated) HPV types which together cause approximately 70% of cervical cancers; one vaccine also prevents HPV-6 and HPV-11, which together cause approximately 90% of anogenital warts. Defining type-specific HPV epidemiology in sexually experienced women will help estimate the potential clinical benefits of vaccinating this population.ObjectivesTo examine HPV epidemiology in a diverse sample of sexually experienced women, and to determine factors associated with high-risk HPV and vaccine-type HPV (HPV-6, HPV-11, HPV-16 and HPV-18).Study designCross-sectional study of 13–26-year-old women (N = 409) who completed a questionnaire and provided a cervicovaginal swab. Swabs were genotyped for HPV using PCR amplification. Logistic regression models were used to determine whether participant characteristics, knowledge, and behaviors were associated with high-risk and vaccine-type HPV.ResultsMost women (68.4%) were positive for ≥1 HPV type, 59.5% were positive for ≥1 high-risk type, 33.1% were positive for ≥1 vaccine-type HPV, and 3.5% were positive for both HPV-16 and HPV-18: none was positive for all four vaccine types. In adjusted logistic regression models, Black race (OR 2.03, 95% CI 1.21–3.41) and lifetime number of male sexual partners (OR 4.79, 95% CI 2.04–11.23 for ≥10 partner vs. ≤1 partner) were independently associated with high-risk HPV infection.ConclusionsHPV prevalence was very high in this sample of sexually active young women, but <5% were positive for both HPV-16 and HPV-18, suggesting that vaccination could be beneficial for many individual women who are sexually experienced.