Recruitment of Caribbean female commercial sex workers at high risk of HIV infection / Captación de mujeres profesionales del sexo con alto riesgo de infección por VIH en el Caribe

OBJECTIVE: To evaluate novel eligibility criteria and outreach methods to identify and recruit women at high risk of HIV-1 infection in the Caribbean. METHODS: A prospective cohort study was conducted in 2009-2012 among 799 female commercial sex workers in the Dominican Republic, Haiti, and Puerto Rico. Minimum eligibility criteria included exchange of sex for goods, services, or money in the previous 6 months and unprotected vaginal or anal sex with a man during the same period. Sites used local epidemiology to develop more stringent eligibility criteria and recruitment strategies. Participants were asked questions about HIV/AIDS and their level of concern about participating in an HIV vaccine trial. Logistic regression modeling was used to assess predictors of prevalent HIV infection and willingness to participate in a future HIV vaccine study. RESULTS: HIV prevalence at screening was 4.6%. Crack cocaine use [odds ratio (OR) = 4.2, 95% confidence interval (CI) (1.8-9.0)] was associated with and having sex with clients in a hotel or motel [OR = 0.5, CI (0.3-1.0)] was inversely associated with HIV infection. A total of 88.9% of enrolled women were definitely or probably willing to participate in a future HIV vaccine trial. CONCLUSIONS: This study indicated that local eligibility criteria and recruitment methods can be developed to identify and recruit commercial sex workers with higher HIV prevalence than the general population who express willingness to join an HIV vaccine trial.

OBJETIVO: Evaluar nuevos criterios de selección y métodos extrainstitucionales encaminados a detectar y captar a las mujeres con alto riesgo de contraer la infección por virus de la inmunodeficiencia humana (VIH) en el Caribe. MÉTODOS: Del 2009 al 2012, se llevó a cabo un estudio prospectivo de cohortes de 799 mujeres profesionales del sexo en la República Dominicana, Haití y Puerto Rico. Los requisitos mínimos de selección fueron el intercambio de relaciones sexuales por bienes, servicios o dinero en los últimos 6 meses y las relaciones sexuales vaginales o anales sin protección con un hombre durante el mismo período. En cada centro se aplicaron criterios de selección y estrategias de captación más restrictivos, en función de las características epidemiológicas locales. Se formularon a las participantes preguntas acerca de la infección por el VIH/sida y su motivación para participar en un estudio clínico sobre la vacuna contra el VIH. Se usó un modelo de regresión logística con el fin de analizar los factores pronósticos de prevalencia de infección por el VIH y la voluntad de participar en un estudio futuro sobre la vacuna contra el virus. RESULTADOS: La prevalencia de infección por el VIH en el momento del tamizaje fue 4,6%. El consumo de crack se asoció con la infección por el VIH (razón de posibilidades [OR]: 4,2; intervalo de confianza [IC] de 95%: 1,8-9,0) y la práctica de relaciones sexuales con clientes en un hotel o un motel se asoció inversamente con esta infección (OR: 0,5; IC 95%: 0,3-1,0). El 88,9% de las mujeres inscritas manifestó una disposición decidida o probable de participar en un estudio futuro sobre la vacuna contra el VIH. CONCLUSIONES: Los resultados del estudio indican que es posible formular criterios de selección e introducir métodos de captación locales con el propósito de detectar y captar a las mujeres profesionales del sexo, que presentan una prevalencia de infección por el VIH mayor que la población general y manifiestan una buena disposición de participar en un ensayo clínico sobre la vacuna contra el VIH.

Mother-to-Child HIV-1 transmission: state of the art and implications for public policy

During the past five years there have been significant advances in the knowledge of the factors that affect mother-to-infant HIV-1 transmission. Diverse interventions have been designed and proven effective in reducing the risk of such transmission. In reviewing the pivotal literature in such respect implications for public policy are also analyzed. Because of the constant evolution of the interventions, the public policies also need constant revisions. The impact of viral load assessment during pregnancy and its relationship to transmission risks is discussed, as well as the effectiveness of elective Caesarean delivery. The latter has both positive and negative aspects which merit consideration. Newer approaches, such as highly active anti retroviral therapies (HAART), which have shown to decrease the AIDS mortality, have also shown zero transmission in small cohorts. Shorter and cheaper interventions are also somewhat effective and are good alternatives to resource poor countries.

La mujer ante el VIH/SIDA: barreras y nuevos desafíos / Women and HIV/AIDS: barriers and new challenges

Women have been placed at a vulnerable situation regarding the HIV epidemic. Recent advances in antiretroviral therapies have placed in evidence the gender disparities and the new challenges to overcome them. The mortality of AIDS has decreased dramatically in the United States and Puerto Rico as a consequence of new combination therapies. Still, women constitute the fastest growing group of AIDS cases. There are gender differences in access to treatment and care, economic income and social and personal power. Among women's barriers to care are the lack of knowledge about AIDS in women by health providers, the family responsibilities and the burden and fear of disclosure. The authors suggest the need for empowerment as strategy for attaining better health and improving the quality of life in women living with HIV.

Redefining empowerment and sexual negotiation for women living with HIV

The HIV/AIDS epidemic has presented many challenges to both: researchers and care providers. In addition, the concepts and models of human behavior needed a re-examination in response to this pandemic. We are redefining both empowerment and sexual negotiation for women living with HIV. Empowerment is defined as a process of awareness throughout which women recognize their capacity to achieve individual and social changes. This process involves a mental and spiritual awareness that will enable them to focus on their physical, psychological and social aspects. For women living with HIV, this is also a strategy for survival. For women living with HIV, sexual negotiation is a straightforward issue: it is either safer sex or nothing. Safer sexual practices then are a consequence or by-product of the process of empowerment. To facilitate this process our approach is directed to the individual, in an attempt to reach the inner power source that all human beings share.

Recomendaciones para el manejo de mujeres con infección VIH / Guidelines fot the management of women with HIV infection

During the second decade of AIDS the spread of this disease has encompassed most areas of the world. In Puerto Rico the epidemic has been different than in the mainland USA. Our initial cases were mostly associated to intravenous drug use and subsequently heterosexual transmission. Sexual transmission of HIV is the principal cause of AIDS for women in Puerto Rico. AIDS is also the principal cause of death in young women in Puerto Rico (ages 25-40). Therefore the counselling to women has to include the universality of the risk. Data from seroprevalence studies show a high prenatal seroprevalence (1 per cent ) in the San Juan Metropolitan Health Region. In view of the high prenatal seroprevalence, universal offering of HIV counselling and testing is recommended. Gynecologic evaluation is essential in the follow-up of women with HIV infection and should include frequent evaluations to determine the frequent occurrence of premalignant lesions in the cervix that may be associated to immunosuppression