Global epidemiology of HIV infection in men who have sex with men

Epidemics of HIV in men who have sex with men (MSM) continue to expand in most countries. We sought to understand the epidemiological drivers of the global epidemic in MSM and why it continues unabated. We did a comprehensive review of available data for HIV prevalence, incidence, risk factors, and the molecular epidemiology of HIV in MSM from 2007 to 2011, and modelled the dynamics of HIV transmission with an agent-based simulation. Our findings show that the high probability of transmission per act through receptive anal intercourse has a central role in explaining the disproportionate disease burden in MSM. HIV can be transmitted through large MSM networks at great speed. Molecular epidemiological data show substantial clustering of HIV infections in MSM networks, and higher rates of dual-variant and multiple-variant HIV infection in MSM than in heterosexual people in the same populations. Prevention strategies that lower biological transmission and acquisition risks, such as approaches based on antiretrovirals, offer promise for controlling the expanding epidemic in MSM, but their potential effectiveness is limited by structural factors that contribute to low health-seeking behaviours in populations of MSM in many parts of the world.     

NIMH Project Accept (HPTN 043) HIV/AIDS Community Mobilization (CM) to Promote Mobile HIV Voluntary Counseling and Testing (MVCT) in Rural Communities in Northern Thailand: Modifications by Experience

Project Accept is a RCT designed to test the efficacy of community mobilization (CM), mobile voluntary counseling and testing (MVCT), and post-test support services (PTSS) in reducing HIV incidence in three African countries and Thailand. The intervention started in rural areas, northern Thailand in January 2006. CM initially included door-to-door visits during the daytime, small group discussions and joining organized meetings and followed by MVCT. In February 2007, CM strategy using HIV/AIDS "edutainment" (education and entertainment) during evening hours was introduced. After edutainment was initiated, the number of participants increased substantially. VCT uptake increased from 18 to 28 persons/day on average (t test; t = 7.87 P < 0.0001). Edutainment especially motivated younger people, as the median age of VCT clients decreased from 38 to 35 years old (median test; z = 6.74, P < 0.0001). Providing free MVCT in community settings along with edutainment during evening hours increased VCT uptake and was particularly attractive to younger adults.     

Health diplomacy and Adapting global health interventions to local needs: findings from project accept (HPTN 043), a community-based intervention to reduce HIV incidence in populations at risk in Sub-Saharan Africa and Thailand

ABSTRACT: BACKGROUND: Study-based HIV prevention interventions, especially those that are conducted on an international or multi-site basis, frequently require site-specific adaptations in order to (1) respond to socio-cultural differences in risk determinants, (2) to make interventions more relevant to target population needs, and (3) in recognition of 'public health diplomacy' issues. We report on the adaptations development, approval and implementation process and describe adaptations from the Project Accept voluntary counseling and testing, community mobilization and post-test support services intervention. METHODS: We reviewed all relevant documentation collected during the study intervention period (e.g. monthly progress reports; bi-annual steering committee presentations) and conducted a series of semi-structured interviews with project directors and between 12 and 23 field staff at each study site in South Africa, Zimbabwe, Thailand and Tanzania during 2009. Respondents were asked to describe (1) the adaptations development and approval process and (2) the most successful site-specific adaptations in terms of facilitating intervention implementation. RESULTS: Across sites, proposed adaptations were identified by field staff and submitted to project directors for review, on a formally planned basis. The cross-site intervention sub-committee then ensured fidelity to the study protocol before approving. Successfully-implemented adaptations included: intervention delivery adaptations (e.g. development of tailored counseling messages for immigrant labour groups in South Africa); environmental and infrastructural adaptations (e.g. use of local community centers as VCT venues in Zimbabwe); religious adaptations (e.g. dividing clients by gender in Muslim areas of Tanzania); economic adaptations (e.g. co-provision of income generating skills classes in Zimbabwe); epidemiological adaptations (e.g. provision of 'youth-friendly' services in South Africa, Zimbabwe and Tanzania), and social adaptations (e.g. modification of terminology to local dialects in Thailand; adjustment of service delivery schedules to suit seasonal and daily work schedules across sites). CONCLUSIONS: Adaptation selection, development and approval during multi-site HIV intervention research studies should be a planned process that maintains fidelity to the study protocol. The successful implementation of appropriate site-specific adaptations may have important implications for intervention implementation, from both a service uptake and a 'public health diplomacy' perspective.     

Sensitivity of Turbutester and Accuhaler tester in asthmatic children and adolescents

Background:  Dry powder inhalers (DPI) are alternative devices for delivering medication for treatment of asthma. The amount of drug delivery to the lungs is directly influenced by peak inspiratory flow rate (PIFR). A minimum PIFR of −30 L/min is needed for the Turbuhaler and Accuhaler.
Methods:  In order to evaluate the sensitivity of the Turbutester and Accuhaler tester in detecting the minimum and optimum PIFR for the Turbuhaler and Accuhaler in asthmatic children, PIFR was measured using the In-Check Dial through the internal resistance of the Turbuhaler and Accuhaler and compared according to the child's ability to make a whistle sound via both testers.
Results:  A total of 259 asthmatic children were studied: 20 pre-school children, aged 5–6 years; 174 school-age children, aged 7–12 years; and 65 adolescents, aged 13–18 years. The sensitivity of the Turbutester and Accuhaler tester to detect optimum PIFR were 98.40% and 97.2%, respectively. In the comparison among age groups, the sensitivity of the Accuhaler tester to detect optimum or minimum PIFR for the Accuhaler was 95%, 97.7% and 95.4%, respectively. The sensitivity of the Turbutester to detect optimum PIFR for the Turbuhaler was 94.4%, 98.8% and 98.5%, respectively. The sensitivity of the Turbutester to detect minimum PIFR for the Turbuhaler was 94.7%, 100% and 100%, respectively. There were no significant differences in percentage of having optimum or minimum PIFR among asthma severity and current device usage in all age groups.
Conclusions:  Most children aged at least 5 years could generate enough PIFR to use dry powder inhaler devices. Both the Turbutester and Accuhaler tester were found to have high sensitivity in detecting optimum and minimum required PIFR.     

Assessing HIV/AIDS Stigma and Discrimination in Developing Countries

HIV/AIDS-related stigma and discrimination are barriers to HIV prevention effectiveness, voluntary counseling and testing uptake, and accessing care in many international settings. Most published stigma scales are not comprehensive and have been primarily tested in developed countries. We sought to draw on existing literature to develop a scale with strong psychometric properties that could easily be used in developing countries. From 82 compiled questions, we tested a 50-item scale which yielded 3 dimensions with 22 items in pilot testing in rural northern Thailand (n = 200) and urban and peri-urban Zimbabwe (n = 221). The three factors (shame, blame and social isolation; perceived discrimination; equity) had high internal consistency reliability and good divergent validity in both research settings. Systematic and significant differences in stigmatizing attitudes were found across countries, with few differences by age or sex noted within sites. This short, comprehensive and standardized measure can be easily incorporated into questionnaires in international research settings.     

Influence of Cement Replacement with Fly Ash and Ground Sand with Different Fineness on Alkali-Silica Reaction of Mortar

The alkali-silica reaction (ASR) is an important consideration in ensuring the long-term durability of concrete materials, especially for those containing reactive aggregates. Although fly ash (FA) has proven to be useful in preventing ASR expansion, the filler effect and the effect of FA fineness on ASR expansion are not well defined in the present literature. Hence, this study aimed to examine the effects of the filler and fineness of FA on ASR mortar expansion. FAs with two different finenesses were used to substitute ordinary Portland cement (OPC) at 20% by weight of binder. River sand (RS) with the same fineness as the FA was also used to replace OPC at the same rate as FA. The replacement of OPC with RS (an inert material) was carried out to observe the filler effect of FA on ASR. The results showed that FA and RS provided lower ASR expansions compared with the control mortar. Fine and coarse fly ashes in this study had almost the same effectiveness in mitigating the ASR expansion of the mortars. For the filler effect, smaller particles of RS had more influence on the ASR reduction than RS with coarser particles. A significant mitigation of the ASR expansion was obtained by decreasing the OPC content in the mortar mixture through its partial substitution with FA and RS.     

Keep Talking About It: HIV/AIDS-Related Communication and Prior HIV Testing in Tanzania, Zimbabwe, South Africa, and Thailand

Informal, interpersonal communication within a community about HIV and AIDS, or lack of such communication, may influence community members’ uptake of voluntary counseling and testing. Drawing from Noelle-Neumann’s spiral of silence theory, this study examined the association between communication about HIV/AIDS and prior HIV testing in communities in Tanzania, Zimbabwe, South Africa, and Thailand. Participants (N = 14,818) in 48 communities across five sites throughout the four countries completed a behavioral survey assessing communication, prior voluntary counseling and testing (VCT) uptake, social norms, stigma, and sexual risk. Site-specific logistic regression models demonstrated that frequent conversations about HIV were significantly associated with prior HIV testing at every site. Odds ratios for each site ranged from 1.885 to 3.085, indicating a roughly doubled or tripled chance of past VCT uptake. Results indicate that verbal communication may be an important mechanism for increasing health behaviors and inclusion in future interventions should be considered.