Nonsupportive Peer Norms and Incarceration as HIV Risk Correlates for Young Black Men who have Sex with Men

Black men who have sex with men (BMSM) are at considerable risk for HIV infection. A convenience sample of BMSM (n = 252) attending nightclubs in three North Carolina cities was surveyed to investigate factors associated with unprotected anal intercourse (UAI). About 45% reported UAI in the past 2 months. BMSM who strongly agreed that their male friends used condoms for anal sex were significantly less likely to report any UAI. Recently incarcerated men were significantly more likely to report unprotected insertive anal sex. In secondary analyses, men who reported experiencing discrimination based on their race and nongay identified men reported more favorable peer norms for condom use. Men who reported that their family disapproved of their being gay were more likely to have been incarcerated in the past 2 months. HIV prevention for BMSM must promote supportive peer norms for condom use and address incarceration, racial discrimination, and family disapproval.     

Regional differences in HIV prevalence among drug users in China: potential for future spread of HIV?

Background  

Drug use and in particular injecting drug use has been at the forefront of the explosive spread of HIV in general populations in many countries in Asia. There is concern that also in China increased HIV incidence in drug users might spark off a generalized epidemic in the wider population. Close monitoring of HIV incidence and risk factors in drug users is therefore important to be able to target interventions effectively. Second generation surveillance was launched to assess HIV prevalence and risk behaviours jointly with the purpose of describing trends and predicting future developments. To assess whether these goals were fulfilled among drug users in China we provide an analysis of risk factors for HIV infection and of regional differences in HIV prevalence.     

2015－2019年我国新报告50岁及以上异性传播艾滋病感染者/患者性别比分析

  目的   了解我国2015—2019年新报告≥50岁异性传播艾滋病感染者/患者（HIV/AIDS）的性别比特征。  方法   通过艾滋病综合防治信息系统收集我国2015—2019年新诊断发现、诊断年龄≥50岁且经异性传播感染的HIV/AIDS,分析不同诊断年龄、感染方式的男女性别比差异。  结果   2015—2019年我国新报告≥50岁异性传播HIV/AIDS由2015年29 765例增至2019年60 591例,其中经配偶/固定性伴感染占比由2015年12.7%减少至2019年10.6%,商业性伴及非商业临时性伴构成比维持在较高水平,均值分别为46.0%、39.5%。 随诊断年龄增加,报告病例性别比由50～59岁组1.8增加至60～69岁组2.5、≥70岁组6.8。 分不同感染方式,经商业性伴感染病例和经非商业临时性伴感染者的性别比分别由50～59岁组的10.4和1.1增至≥70岁组的58.7（Z=38.31,P<0.001）和3.4（Z=51.49,P<0.001）,经配偶/固定性伴感染的性别比稳定于0.2～0.4。  结论   我国报告≥50岁异性传播HIV/AIDS中不同诊断年龄、感染方式的性别比存在差异。 需扩大高风险人群检测、治疗及综合行为干预工作,结合分子流行病学探索≥50岁人群HIV传播链,提高病例发现效率。     

福建省吸毒人群中HIV感染情况及其危险因素分析

目的分析和探讨福建省吸毒人群中艾滋病病毒(HIV)流行情况及其相关危险行为。方法在福州市、泉州市和厦门市设立吸毒者艾滋病监测哨点,通过社区药物维持治疗门诊和强制戒毒所招募监测对象,收集吸毒者血清学和行为学相关信息。结果福州市、泉州市和厦门市吸毒人群中估计HIV感染率和95%可信区间(CI)分别为0.5%(95%CI:0.087～1.995)、0.5%(95%CI:0.087～1.995)和0(95%CI:0.022～1.143)。吸毒者艾滋病防治知识知晓率为80.3%,而且随着文化程度的提高,其知识知晓率也在不断增加。Logistic回归分析表明,与外省籍吸毒者相比,福建籍吸毒者曾经共用注射器吸毒的比值比(OR)是0.543(95%CI:0.327～0.900);与社区吸毒者相比,强制戒毒所中吸毒者曾经共用注射器吸毒的OR值是6.181(95%CI:3.611～10.582)。结论福建省吸毒人群中存在一些HIV蔓延扩散的危险因素,必须密切关注吸毒人群中相关危险行为的动态变化情况,采取积极有效的干预措施。     

Reaching Men Who Have Sex with Men: A Comparison of Respondent-Driven Sampling and Time-Location Sampling in Guatemala City

We present a comparison of respondent-driven sampling (RDS) and time-location sampling (TLS) for behavioral surveillance studies among men who have sex with men (MSM). In 2010, we conducted two simultaneous studies using TLS (N = 609) and RDS (N = 507) in Guatemala city. Differences in characteristics of the population reached based on weighted estimates as well as the time and cost of recruitment are presented. RDS MSM were marginally more likely to self-report as heterosexual, less likely to disclose sexual orientation to family members and more likely to report sex with women than TLS MSM. Although RDS MSM were less likely than TLS MSM to report ≥2 non-commercial male partners, they were more likely to report selling sex in the past 12 months. The cost per participant was $89 and $121 for RDS and TLS, respectively. Our results suggest that RDS reached a more hidden sub-population of non-gay-identifying MSM than TLS and had a lower implementation cost.     

A Review of the Cost-Effectiveness of Interventions to Prevent Sexual Transmission of HIV in the United States

Because resources to fund HIV prevention are limited, public health decision makers—such as health departments and HIV prevention community planning groups—need to know which prevention strategies are the most cost-effective. In the past several years, a number of studies have appeared in the literature that assess the cost-effectiveness of interventions to prevent the sexual transmission of HIV in the United States. Here, we comprehensively review 16 such studies and then outline an agenda for further research to advance the cost-effectiveness literature and to make the findings of these studies more useful for public health decision makers. The research summarized here provides compelling evidence that interventions to prevent sexual transmission of HIV can be highly cost-effective. Small-group, community-level, and outreach-based sexual risk reduction interventions, in particular, appear to be very efficient strategies for preventing the spread of HIV in moderate- to high-risk populations.     

The Effects of HIV Stigma on Health, Disclosure of HIV Status, and Risk Behavior of Homeless and Unstably Housed Persons Living with HIV

HIV-related stigma negatively affects the lives of persons living with HIV/AIDS (PLWHA). Homeless/unstably housed PLWHA experience myriad challenges and may be particularly vulnerable to the effects of HIV-related stigma. Homeless/unstably housed PLWHA from 3 U.S. cities (N = 637) completed computer-assisted interviews that measured demographics, self-assessed physical and mental health, medical utilization, adherence, HIV disclosure, and risk behaviors. Internal and perceived external HIV stigma were assessed and combined for a total stigma score. Higher levels of stigma were experienced by women, homeless participants, those with a high school education or less, and those more recently diagnosed with HIV. Stigma was strongly associated with poorer self-assessed physical and mental health, and perceived external stigma was associated with recent non-adherence to HIV treatment. Perceived external stigma was associated with decreased HIV disclosure to social network members, and internal stigma was associated with drug use and non-disclosure to sex partners. Interventions are needed to reduce HIV-related stigma and its effects on the health of homeless/unstably housed PLWHA.     

Site factors may be more important than participant factors in explaining HIV test acceptance in the prevention of mother-to-child HIV transmission programme in Kenya, 2005

Objective  To determine the role of participant factors on the acceptance of a Prevention-of-Mother-to-Child (PMTCT) HIV test programme in a situation with an opt-out testing strategy.
Methods  We analysed antenatal clinic (ANC) HIV sentinel surveillance data. All 43 sites in the 2005 round of Kenya's ANC surveillance offered opt-out PMTCT services and recorded if women were offered PMTCT HIV testing and whether they accepted or refused. Logistic regression was used to determine the role of participant-level factors on PMTCT acceptance.
Results  During the period of sentinel surveillance, 13 026 women attended ANC and testing was offered to 12 030 women. Of those offered testing, 9690 (80.5%) accepted, with a large variation in the percent of acceptors by site. Age, residence and educational status were significant determinants of PMTCT acceptance. However, after adjusting for site none of the participant-level factors were significant determinants of PMTCT acceptance.
Conclusions  Participant level factors were not significant determinants of PMTCT HIV test acceptance after adjusting for sites. PMTCT programmes should collect and evaluate the role of site-level (provider and testing service) factors on PMTCT acceptance. Improvement of site-level factors could improve PMTCT uptake.     

Structural-level factors affecting implementation of the methadone maintenance therapy program in China

This study identifies structural-level factors influencing methadone maintenance therapy (MMT) program implementation in China. Twenty-eight service providers and 560 randomly selected clients from 28 MMT clinics in the study area underwent face-to-face interviews. Number of clients, retention rate, coverage, and structural-level factors were collected from a survey of service providers. Individual-level factors and self-reported illicit drug use information were obtained from clients. Urine specimens were collected from the client participants to test for heroin use. Clinics affiliated with the local Centers for Disease Control and Prevention (CDC) had more clients, higher retention rates, and broader coverage than those not affiliated with the CDC. Longer operating hours, incentive for compliant clients, and comprehensive services were positively associated with client recruitment and coverage. Comprehensive services and incentives for compliant clients were negatively associated with concurrent illicit drug use. Comprehensive services should be incorporated into the MMT program. Extended operating hours and incentives for compliant clients should be implemented.