Estado de vacunación en pacientes con riesgo de enfermedades invasoras por bacterias capsuladas en un hospital pediátrico de Buenos Aires / Vaccination status in patients at risk for invasive disease with encapsulated bacteria at a children's hospital in the City of Buenos Aires

Introducción. El Ministerio de Salud contempla vacunas específicas para personas con riesgo elevado de infecciones invasoras por bacterias capsuladas (BC). En la actualidad se desconoce el cumplimiento del programa. El objetivo fue evaluar el estado de vacunación para BC en ≤ 18 años con factores de riesgo. Población y métodos. Estudio observacional, analítico, mediante encuesta a padres de ≤ 18 años con VIH, asplenia y/o déficit de complemento que concurrieron al vacunatorio de un hospital pediátrico de octubre de 2020 a septiembre de 2021. Se recabaron datos sociodemográficos y clínicos. Se evaluó el estado de vacunación para BC: neumococo, meningococo y Haemophilus influenzae b (Hib), calendario regular y antigripal. Se administró la escala de reticencia a la vacunación (ERV): rango 10-50. Se analizó la asociación entre las variables estudiadas y la vacunación para BC mediante regresión logística (OR, IC95%). Se utilizó la base datos REDCap® y STATA vs14®. Resultados. Participaron 104 sujetos, media 9,9 años (DE 4,4). Asplenia: 91,3 %, VIH: 7,6 % y déficit de complemento: 0,9 %. Nivel socioeconómico: pobreza relativa: 38,4 %, seguido por clase media: 37,5 %. Estado de vacunación completa para meningococo: 45 %, neumococo: 42 %, Hib: 97 %. El 77,9 % tenía al día el calendario regular y el 61,5 %, el antigripal. Media ERV: 41,9 (DE 3,2). No se encontraron asociaciones significativas entre las variables y el estado de vacunación para BC. Conclusiones. Un elevado porcentaje no tenía vacunación completa para BC, tampoco el calendario regular y antigripal. La confianza en la vacunación de los cuidadores fue elevada.

Introduction. The Ministry of Health has established specific vaccines for people at high risk for invasive infections with encapsulated bacteria (EB). There is currently no information about compliance with the vaccination schedule. Our objective was to assess EB vaccination status in subjects ≤ 18 years with risk factors. Population and methods. Observational, analytical study with a survey to parents of subjects aged ≤ 18 years with HIV, asplenia and/or complement deficiency attending a vaccination center at a children's hospital between October 2020 and September 2021. Sociodemographic and clinical data were collected. Their vaccination status for the EB pneumococcus, meningococcus, and Haemophilus influenzae type b (Hib), their regular vaccination and flu vaccination schedules were assessed. The vaccine hesitancy scale (VHS) was administered: range 10­50. The association between the study variables and EB vaccination was analyzed using logistic regression (OR, 95% CI). The REDCap® database and the STATA® v.14 software were used. Results. A total of 104 subjects participated; mean age: 9.9 years (SD: 4.4). Asplenia: 91.3%, HIV: 7.6%, and complement deficiency: 0.9%. Socioeconomic level: relative poverty: 38.4%, followed by middle class: 37.5%. Complete vaccination status: meningococcal vaccine 45%, pneumococcal vaccine: 42%, Hib: 97%. The regular vaccination and flu vaccination schedules were up-to-date in 77.9% and 61.5% of cases, respectively. Mean VHS score: 41.9 (SD: 3.2). No significant associations were observed between variables and EB vaccination status. Conclusions. A high percentage of subjects had not completed neither their EB vaccination nor their regular or their flu vaccination schedules. Caregivers' confidence in vaccines was high.

Clinical-epidemiological characterization of women who received post-exposure HIV prophylaxis in a public hospital in Porto Alegre, Rio Grande do Sul / Caracterização clínico-epidemiológica de mulheres que receberam a profilaxia pós-exposição ao HIV em um hospital público de Porto Alegre, Rio Grande do Sul

Introduction: Prevention strategies are key to combating the epidemic of infections such as HIV and syphilis. The epidemiological scenario of Porto Alegre/RS for these infections shows the need for greater efforts in the area of prevention, seeking to characterize both the population that uses these strategies and the services involved in the care of exposed people. Objective: This study aimed to characterize the clinical and epidemiological profile of patients who received post-exposure prophylaxis (PEP) to HIV treated in a public hospital in Porto Alegre/RS. Methods: This is a retrospective, research, descriptive study based on the Clinical Protocol and Therapeutic Guidelines for PEP, updated in 2018 by the Ministry of Health. Prophylaxis request forms and medical records of patients treated were analyzed. Results: The population consisted of 87 women who received PEP from January to September 2019. There was a predominance of women aged between 20 and 29 years old (55.2%). The most frequent sexual exposure was consensual (69.0%) followed by sexual assault (31.0%). Porto Alegre was the place of residence of most patients (73.6%). The most frequently used therapeutic regimen was the combination of atazanavir, ritonavir, and tenofovir plus lamivudine. On the first visit, 8.0% of the patients showed reactive results for the treponemal syphilis test. Only 23.0% and 14.9% of patients returned for anti-HIV tests in the first and third months after exposure, respectively, and the results were non-reactive. Only 19 patients (21.8%) attended the consultations between 0 and 28 days after PEP. Conclusion: It was identified that a considerable percentage of women already had reactive serology for syphilis, most women did not return for follow-up within 28 and 90 days after the first consultation, more than half of the women were aged between 20 and 29 years old, and the most frequent sexual exposure was consensual. In this sense, efforts are needed, such as adequate counseling, adoption of interventions such as sending messages by cell phone, telephone calls, and preparation of educational materials, seeking to improve adherence to treatment and follow-up in the service, which is important given the scenario of epidemiology in Porto Alegre.Keywords: HIV. Sexually transmitted diseases. Post-exposure prophylaxis. Disease prevention

Introdução: Estratégias de prevenção são fundamentais para o combate à epidemia de infecções como o vírus da imunodeficiência humana (HIV) e sífilis. O cenário epidemiológico de Porto Alegre/RS para essas infecções mostra a necessidade de maiores esforços na área de prevenção, buscando caracterizar tanto a população que utiliza essas estratégias quanto os serviços envolvidos no atendimento das pessoas expostas. Objetivo: Caracterizar o perfil clínico-epidemiológico das pacientes que receberam a profilaxia pós-exposição (PEP) ao HIV atendidas em um hospital público de Porto Alegre/RS. Métodos: Trata-se de um estudo retrospectivo, documental, descritivo e baseado no Protocolo Clínico e Diretrizes Terapêuticas para PEP, atualizado em 2021 pelo Ministério da Saúde. Foram analisados os formulários de solicitação da profilaxia e prontuários das pacientes atendidas. Resultados: A população foi composta de 87 mulheres que receberam a PEP no período de janeiro a setembro de 2019. Predominaram mulheres com idades entre 20 e 29 anos (55,2%). A exposição sexual mais frequente foi a consentida (69,0%), seguida pela violência sexual (31,0%). Porto Alegre foi o local de residência da maioria das pacientes (73,6%). O esquema terapêutico utilizado com maior frequência foi a combinação com atazanavir, ritonavir e tenofovir associado à lamivudina. No primeiro atendimento, 8,0% das pacientes demonstraram resultados reagentes para o teste treponêmico de sífilis. Retornaram para a realização dos testes anti-HIV no primeiro e terceiro mês após a exposição apenas 23,0 e 14,9% das pacientes, respectivamente, e os resultados foram não reagentes. Apenas 19 delas (21,8%) compareceram às consultas entre zero e 28 dias posteriores à PEP. Conclusão: Foi identificado que um percentual considerável de mulheres já apresentava sorologia reagente para sífilis, a maioria das mulheres não retornou para o seguimento no período de 28 e 90 dias após o primeiro atendimento, mais da metade delas tinha idade entre 20 e 29 anos e a exposição sexual mais frequente foi a consentida. Nesse sentido, são necessários esforços como aconselhamento adequado, adoção de intervenções como o envio de mensagens pelo celular, ligações telefônicas e elaboração de materiais educativos, buscando a melhoria da adesão ao tratamento e do acompanhamento no serviço, o que é importante diante do cenário epidemiológico de Porto Alegre.Palavras-chave: HIV. Infecções sexualmente transmissíveis. Profilaxia pós-exposição. Prevenção

Knowledge on post-exposure prophylaxis, sexual behavior, and vulnerabilities to HIV and other STIs among young adults in Brazil

Introduction: Post-exposure prophylaxis (PEP) is the use of antiretroviral drugs (ARVs) to reduce the risk of human immunodeficiency virus (HIV) infection after potential risk exposure. ARV-based interventions are recommended as part of combination HIV prevention, especially for key populations. Objective: The aim of this study was to measure knowledge about PEP among university students. Methods: A cross-sectional study was conducted on university students from the Health, Education, Exact, and Human Sciences Departments of the State University of Bahia, Brazil. Sociodemographic data, information on sexual behavior, and knowledge of PEP were collected through a standardized self-applied questionnaire. Results: We analyzed 1580 questionnaires, of which 66.7% (1024/1536) were from females, with a mean age of 23.9 (±6.5) years, and 35.4% (448/1264) reported irregular use of condoms and regular use was not associated with being students from the health area (p=0.44, OR 0.90, 95%CI 0.69­1.17). Regarding PEP, 28.5% (449/1578) had known about it and their knowledge was statistically associated with men who have sex with men (MSM) (p<0.01, OR 3.92, 95%CI 2.45­6.28). It was noted that 94.0% (1485/1579) did not know the time limit for starting PEP, 95.1% (1500/1578) did not know the duration of prophylaxis, and 91.1% (1437/1577) did not know where to get PEP. Finally, 0.4% (7/1578) referred to previous use and 96.6% (1488/1540) would not change their sexual behavior after knowing about PEP. Conclusion: PEP is a prevention strategy available for decades and is safe, effective, and cost-effective. However, it is underutilized and a lack of knowledge on PEP is one of the main obstacles to access. Among university students, there is a limited knowledge about PEP acting as a barrier in preventing new infections, which shows the need for interventions based on sexual-health education, stimulating the reduction of risk behaviors and disseminating information about combination prevention.

Introdução: A Profilaxia Pós-Exposição (PEP) é o uso de medicamentos antirretrovirais (ARVs) para reduzir o risco de infecção pelo vírus da imunodeficiência humana (HIV) após uma potencial exposição. Intervenções baseadas em ARV são recomendadas como parte da prevenção combinada do HIV, especialmente para populações-chave. Objetivo: O objetivo deste estudo foi medir o conhecimento sobre PEP entre estudantes universitários. Métodos: Estudo transversal realizado entre universitários dos Departamentos de Saúde, Educação, Ciências Exatas e Humanas da Universidade do Estado da Bahia, Brasil. Dados sociodemográficos, informações sobre comportamento sexual e conhecimento sobre PEP foram coletados por meio de um questionário autoaplicável padronizado. Resultados: Foram analisados 1.580 questionários, 66,7% (1024/1536) do sexo feminino, idade média de 23,9 (±6,5) anos, 35,4% (448/1264) relatam uso irregular de preservativo, e o uso regular não foi associado ao fato de ser estudante da área da saúde (p=0,44, OR 0,90, IC95% 0,69-1,17). Em relação à PEP, 28,5% (449/1578) já tinham ouvido falar, e seu conhecimento foi estatisticamente associado a homens que fazem sexo com homens (HSH) (p<0,01, OR 3,92, IC95% 2,45­6,28). Destaca-se que 94,0% (1485/1579) não sabiam o tempo limite para iniciar o PEP, 95,1% (1500/1578) não sabiam o tempo de duração da profilaxia e 91,1% (1437/1577) não sabiam onde conseguir o PEP. Por fim, 0,4% (7/1578) referiu uso anterior e 96,6% (1488/1540) não mudaria seu comportamento sexual após saber da PEP. Conclusão: A PEP é uma estratégia de prevenção disponível há décadas, segura, eficaz e de baixo custo, porém, é subutilizada e seu desconhecimento é um dos principais obstáculos ao acesso. Há um conhecimento limitado sobre PEP entre universitários, destacando-se como uma barreira na prevenção de novas infecções, o que evidencia a necessidade de intervenções baseadas na educação em saúde sexual, estimulando a redução de comportamentos de risco e disseminando informações sobre prevenção combinada.

Fatores associados à exposição ao HIV em usuários de álcool / Factors associated with HIV exposure in alcohol users

Introdução: A prevalência de HIV é maior em Porto Alegre comparada ao restante do país. O abuso de álcool afeta o juízo crítico, sendo associado a comportamentos de risco que podem levar à contaminação pelo HIV. Objetiva-se analisar fatores associados à exposição ao HIV em alcoolistas com práticas sexuais de risco comparando com aqueles que se previnem.Métodos: Estudo transversal com 126 homens alcoolistas (HIV negativo), divididos em 2 grupos: Exposto Sexual (n = 42) e Pouco Exposto Sexual (n = 84), considerando uso de preservativo e número de parceiros sexuais.Resultados: A maioria dos sujeitos do grupo Exposto Sexual era solteiro, sem ocupação laboral, com histórico de moradia de rua e de relação com profissional do sexo, apresentavam maior preocupação com infecção por HIV (p < 0,05).Conclusão: Sugere-se o desenvolvimento e monitoramento de intervenções preventivas específicas, considerando as características do abuso de álcool e seu papel na transmissão do HIV.

Introduction: The HIV prevalence is higher in Porto Alegre compared to other capitals in Brazil. Alcohol abuse affects critical judgment, being associated with risky behaviors that can lead to HIV infection. Aim:To analyze factors associated with exposure to HIV in alcohol users, comparing those with risky sexual practices and those who use prevention methods.Methods: Cross-sectional study with 126 male alcohol users (HIV negative), divided into 2 groups: Sexually Exposed (n = 42) and Less Sexually Exposed (n = 84), considering condom use and number of sexual partners.Results: Most subjects in the Sexually Exposed group were single, without a job, with a history of homelessness and a relationship with a sexual worker, and were more concerned about HIV infection (p < 0.05).Conclusion: The development and monitoring of specific preventive interventions is suggested, considering the characteristics of alcohol abuse and its role in HIV transmission.

Estimate the population size of transgender women based on the capture-recapture method in Tianjin / 中华流行病学杂志

Objective: To investigate the population size of transgender women (TGW) in Tianjin and analyze the characteristics of their sexual behaviors to provide a basis for AIDS prevention and control. Methods: To estimate the population size of TGW in Tianjin using the capture-recapture method. At the same time, an anonymous questionnaire was collected to conduct a multi-factor logistic analysis of the TGW population's sexual behavior. Results: A total of 213 TGW were investigated. Tianjin's estimated TGW population size was 599 (95%CI: 407-792). Multivariate logistic analysis of the use of condoms consistently showed that compared with TGW without regular sex partners, those with regular sex partners had a lower proportion of consistent condom use (aOR=0.44, 95%CI: 0.23-0.82) and had received HIV tests in the last year were more likely to adhere to condom use than those who had not been tested (aOR=2.73, 95%CI: 1.06-6.99). Conclusion: It is necessary to strengthen HIV mobilization testing among the TGW population and their regular sexual partners to improve condom use.

Status and associated factors of pre-exposure prophylaxis use among men who have sex with men in 24 cities in China / 中华流行病学杂志

Objective: To understand the cognition and medication use of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in China and its associated factors. Method: From August 25 to September 5, 2021, 2 447 MSM were recruited in 24 cities to complete the online questionnaire through a male social interaction platform, Blued 7.5 software. The survey contents included demographic information of the respondents, PrEP awareness and usage, and risk behaviors. Descriptive analysis and multi-level logistic regression were performed for data analysis. SPSS 24.0 and SAS 9.4 software were used for statistical analysis. Results: Among the 2 447 respondents of MSM, 1 712 (69.96%) had heard of PrEP, 437 (17.86%) ever used PrEP, 274 (11.20%) were on PrEP, and 163 (6.66%) had discontinued PrEP; among the 437 cases (whoever used PrEP), more than 61.88% (388/627) adopted emtricitabine/tenofovir disoproxil fumarate regimen, and most of them adopted on-demand regimen. The average PrEP dosage reported in the past year is 1.12 tabletsper person per week. PrEP purchase was primarily via an online channel, and the most concerned factor was the PrEP effectiveness on HIV prevention. The most common reasons for discontinuing PrEP, reported by 163 cases, were the lack of HIV risk perception, the use of a condom to prevent HIV, and the economic burden of PrEP use. The logistic regression analysis showed that PrEP use among MSM in 24 cities was statistically associated with age, monthly income, ever having unprotected anal sex in the past year, used sexual drugs and sexually transmitted disease (STD) diagnosis in the past year. Compared with MSM aged 18-24, the proportion of MSM was relatively lower among those aged 25-44, who discontinued the PrEP (aOR=0.54,95%CI:0.34-0.87) or never used PrEP (aOR=0.62,95%CI:0.44-0.87). The proportion of unprotected anal sex among MSM currently on PrEP use was higher than those who have stopped PrEP and never used PrEP (all P<0.05). Those MSM group, with monthly income higher than 5 000 Yuan, used sexual drugs and STD diagnosis in the past year were more likely to have a higher rate for PrEP usage (all P<0.05). Conclusions: Currently, pre-exposure prophylaxis in the MSM group is primarily obtained via the online channel and adopted in an on-demand mode. Although the PrEP users have reached a certain proportion, it is still necessary to strengthen health education on the PrEP effects and side effects of MSM and to improve the awareness and use rate, especially for young MSM group, which can be combined with the advantages of the internet targeting its needs and use barriers.

Progress in research on HIV cluster detection and response / 中华流行病学杂志

HIV cluster detection and response (CDR) is a critical strategy to end the HIV epidemic by offering information to identify prevention and care services gaps. The risk metrics for HIV clusters can be classified into three groups: growth-based metrics, characteristic-based metrics, and phylogeny-based metrics. When identifying HIV risk clusters, the public health response can reach people in the affected networks, including people with undiagnosed HIV, people with diagnosed HIV who might not be accessing HIV care or other services, and people without HIV who would benefit from prevention services. To provide references for HIV precise prevention in China, we summarized the risk metrics and the intervention measures for CDR.

Association between response to repeated negative HIV testing and risk sexual behaviors in men who have sex with men in Chengdu / 中华流行病学杂志

Objective: To investigate the association between the response to repeated negative HIV testing and the risk sexual behaviors in men who have sex with men (MSM) in Chengdu. Methods: A total of 610 MSM were recruited by convenience sampling method through Chengdu Tongle Health Consultation Service Centre from March to May 2022. Data were collected from the MSM through questionnaire survey, including the demographic characteristics, sexual behaviors in the past 6 months, the response to rerpeated negative HIV testing. Univariate and multivariate logistic regression models were conducted to analyze the association between the response to repeated negative HIV testing and risk sexual behavior. Results: A total of 579 (94.9%) participants participated in the questionnaire survey and 354 (61.1%) subjects were included in the study.For the negative HIV testing, some MSM believed that they had taken effective protection measures (17.03±2.20), some believed that they were lucky (7.50±1.87) and some believed that they were at low risk (8.87±3.62). Multivariate logistic regression model showed that protected sexual behavior was negatively associated with group sex (aOR=0.80, 95%CI: 0.67-0.95), lucky was positively associated with casual sex (aOR=1.20, 95%CI: 1.06-1.35), inconsistent condom use (aOR=1.21, 95%CI: 1.06-1.37), group sex (aOR=1.26, 95%CI: 1.00-1.60), and multiple sexual partners (aOR=1.24, 95%CI: 1.09-1.42) and low risk perception was positively associated with multiple sexual partners only (aOR=1.08, 95%CI: 1.01-1.15). Conclusions: There were high levels of recognition of protected sexual behavior and lucky dimensions in response to repeated negative HIV testing and well risk perception in MSM in Chengdu. In HIV testing and counseling services, intervention and risk warning should be strengthened in MSM who believed that they are lucky to improve their awareness of safe sex and reduce the negative effects of fluke mind.

Tajectories of the self-efficacy of HIV testing among MSM based on latent class growth model / 中华预防医学杂志

Objective: To analyze the trajectories of HIV testing self-efficacy among men who have sex with men (MSM) based on latent class growth model. Methods: From August 2019 to May 2021, 404 MSM were recruited in Shandong Province and subjected to a 1-year follow-up study with individual intervention (pushing intervention pictures and videos in WeChat and follow-up questionnaires) and community intervention (forwarding to friends and sharing and discussing HIV testing-related information in WeChat groups). The level of HIV testing self-efficacy among MSM was measured. The long-term trend of HIV testing self-efficacy was analyzed using the latent class growth model (LCGM), and the influencing factors of the trend were analyzed. Results: A total of 404 MSM were (28.25±8.95) years old, with the oldest being 58 and the youngest being 18. The scores of HIV testing self-efficacy M(Q1, Q3) at baseline and 4 follow-ups were 18.00 (17.00, 21.00), 19.00 (18.00, 22.00), 19.00 (18.00, 22.00), 19.00 (18.00, 22.00) and 19.00 (18.00, 22.00). The results of the freely estimated two-category LCGM model showed that the trend of HIV testing self-efficacy among MSM could be divided into two classes, "intervention response group" [255(63.1%)] and "intervention non-response group" [149(36.9%)]. The former had a higher level of HIV testing self-efficacy which tended to increase at first and then decrease over time, while the latter had a lower and more stable level. The results of the multifactorial logistic regression analysis showed that the OR values of MSM in business or service and jobless or unemployed were 0.261 (95%CI: 0.108-0.633) and 0.186 (95%CI: 0.057-0.610), respectively, using the students as the reference group. Conclusion: There is a group heterogeneity in the trend of HIV testing self-efficacy in the intervention conditions among MSM, and occupation may be an influencing factor.

Acceso al diagnóstico rápido de VIH/sífilis en contextos de encierro: relato de experiencia en una unidad penal de la provincia de Buenos Aires en el año 2021 / Access to rapid diagnosis of HIV/syphilis in confinement contexts: an experience report in a penal unit in the province of Buenos Aires in the year 2021

En Argentina se estima que 140 mil personas viven con VIH y de ellas el 17% no conocen su diagnóstico (Ministerio de Salud, 2021). La Dirección de Sida y Enfermedades de Transmisión Sexual (DSyETS) del Ministerio de Salud de la Nación realizó un estudio que mostró una prevalencia global de VIH de 2,68% en unidades del servicio penitenciario federal (DSyETS; 2017). Por ello nuestro objetivo fue favorecer el acceso al testeo y a la prevención de estas enfermedades en personas privadas de su libertad en una unidad penal de la provincia de Buenos Aires en el marco de la pandemia. Relato de experiencia: en diciembre del 2021 se ofreció el testeo voluntario, gratuito y confidencial para VIH y sífilis y accedieron 38 personas. Participaron de la actividad docentes, estudiantes del Departamento de Ciencias de la Salud de la Universidad Nacional del Sur y referentes del programa de VIH-ITS y HV de la Región Sanitaria I del ministerio de salud de la provincia de Buenos Aires. Conclusiones: Esta experiencia mostró la importancia de construcción de redes para la articulación de prácticas que favorezcan el acceso a un diagnóstico temprano y tratamiento oportuno para VIH y sífilis a las personas viviendo en contexto de encierro (AU)

In Argentina, it is estimated that 140 thousand people live with HIV and 17% of them do not know their diagnosis (Ministry of Health, 2021). The Directorate of AIDS and Sexually Transmitted Diseases (DSyETS) of the Ministry of Health of the Nation carried out a study that showed a global prevalence of HIV of 2.68% in units of the federal prison service (DSyETS; 2017). For this reason, our objective was to promote access to testing and the prevention of these diseases in people deprived of their liberty in a penal unit in the province of Buenos Aires in the context of the pandemic. Experience report: in December 2021, voluntary, free and confidential testing for HIV and syphilis was offered and 38 people agreed. Teachers, students from the Department of Health Sciences of the National University of the South and referents of the HIV-STI and HV program of the Sanitary Region I of the Ministry of Health of the province of Buenos Aires participated in the activity. Conclusions: This experience showed the importance of building networks for the articulation of practices that favor access to early diagnosis and timely treatment for HIV and syphilis for people living in a confinement context (AU)

Comportamiento sexual de pacientes con infección por VIH según grupos de edad / Sexual behavior among patients with HIV according to age groups

Nuestro objetivo fue determinar la prevalencia y conductas de riesgo por grupos de edad entre pacientes con infección por VIH. Se realizó un estudio observacional analítico transversal de pacientes que acuden al servicio de Enfermedades Infecciosas a recibir tratamiento antirretroviral. Resultados: De 117 personas que ingresaron al estudio, se observó que el grupo etario de los jóvenes varones con infección por VIH señalaron una orientación homosexual (HSH) en 64,5% y una mayor tasa de haber sufrido abuso sexual (29%) respecto al resto. En adultos el uso de métodos anticonceptivos es 71,4% y superior al resto de grupos de edad, la concurrencia a lugares de riesgo (visita a trabajadoras sexuales de la calle) se encuentra mayoritariamente en el rango de 45 a 90 años. El rol homosexual activo de los hombres con VIH representa 66,7%. Los hallazgos enfatizan la necesidad de realizar más estudios que profundicen el tema del abuso sexual en adolescentes y adultos jóvenes, debido a la alta prevalencia encontrada en este estudio(AU)

Our objective was to determine the prevalence and risk behaviors by age groups in patients with HIV infection. A cross-sectional analytical observational study of patients attending the Infectious Diseases service to receive antiretroviral treatment was carried out.Results: Out of 117 people who entered the study, it was observed that the age group of young men with HIV infection indicated a homosexual orientation (MSM) 64.5%; and a higher rate of having suffered sexual abuse (29%) in comparison to the others. In adults, the use of contraceptive methods is 71.4%, and higher than the rest of the age groups, attendance at places of risk (visits to street sex workers) is mostly in the range of 45 to 90 years. The active homosexual role of men with HIV represents 66.7%. The findings emphasize the need for more studies that delve into the issue of sexual abuse in adolescents and young adults, due to the high prevalence found in this study(AU)

Consideraciones en población transgénero respecto a la infección por VIH, terapia antiretroviral, profilaxis preexposición (PreP) e interacción con tratamiento de reafirmación de género / Considerations in the transgender population regarding HIV infection, antiretroviral therapy, pre-exposure prophylaxis (PreP) and interaction with gender reaffirmation treatment

Resumen La infección por VIH es una epidemia global (prevalencia de 0,8%). En Latinoamérica, Chile, Brasil y Uruguay son los países con mayores índices. Entre las más afectadas están la población transgénero (OR 48,8 respecto a la población general). Múltiples factores bio-psico-sociales explican estas cifras. Bajo uso del preservativo, la idea de reafirmación de género, el temor a ser reemplazadas(os) por personas cisgéneros, presencia de comercio sexual, entre otros, influyen en las mayores tasas de infección. Se han implementado medidas de prevención del VIH, pero pocas dirigidas en específico a personas transgénero. La profilaxis preexposición (PreP) parece ser una nueva alternativa de prevención en este grupo, y la integración de las unidades de apoyo en la reafirmación de género con las unidades que entregan PreP, podrían aumentar su adherencia y cobertura. En las personas transgénero con infección por VIH existe baja adherencia a terapia antirretroviral (TARV), en parte por priorización del tratamiento hormonal y miedo a que la TARV altere su proceso de hormonización. Los pocos datos existentes muestran que la hormonización no se afecta con la mayoría de la TARV, pero algunos tratamientos hormonales podrían disminuir las concentraciones plasmáticas y tisulares de ciertos antirretrovirales. Faltan estudios que evalúen la interacción entre antirretrovirales y tratamiento hormonal de reafirmación de género.

Abstract HIV infection is a global epidemic, with a prevalence of 0.8%. In Latin America, Chile, Brazil and Uruguay are the countries with the highest rates. The transgender population is the most affected (OR of 48.8 compared to the general population). Multiple bio-psycho-social factors explain these issues. The low use of condoms for pressure from the partner, the idea of reaffirmation of gender, the fear to be replaced by a cisgender person, the presence of commercial sex, among others, influence the highest rates of infection. HIV prevention measures have been implemented, but few specifically targeted at transgender people. Pre-exposure prophylaxis (PreP) seems to be a new prevention alternative in this group, and the integration of support units in gender reaffirmation with units that deliver PreP could increase their adherence and coverage. In HIV (+) transgender people there is low adherence to antiretroviral therapy (ART), in part due to the prioritization of hormonal treatment and the fear that ART will alter their hormonalization process. The few data that exist show that hormonalization is not affected by ART, but that some hormonal treatments could lower the levels of certain antiretrovirals. More studies must be done to evaluate the interaction between antiretrovirals and gender affirming hormone therapy.

Experiencias y percepciones sobre sexualidad, riesgo y campañas de prevención de ITS/VIH por estudiantes universitarios. Diseñando una intervención digital / Experiences and perceptions on sexuality, risk and STI/HIV prevention campaigns by university students. Designing a digital intervention

Resumen Damos cuenta de la fase cualitativa de una investigación que busca diseñar una intervención digital de prevención de ITS/VIH y promoción de salud sexual en jóvenes universitarios. A partir de grupos focales se abordó la experiencia y percepción que universitarios tienen sobre sexualidad, riesgo y campañas de prevención. Se realizan entrevistas semiestructuradas a informantes claves. Los resultados muestran que la educación sexual es escasa, reducida a lo biológico, cargada de prejuicios y sesgos de género, limitando el manejo de información por la población estudiantil. Se evidencian estrategias vacilantes de prevención, no logrando motivar ni ofrecer oportunidades para la toma de decisiones conscientes y autónomas en salud sexual. Las campañas de ITS/VIH se evaluaron poco inclusivas, lejanas y basadas en el miedo. Las intervenciones en salud sexual han fallado en sopesar aspectos experienciales de la sexualidad juvenil, basándose en modelos de comportamiento ideal y estereotipado, desechando narrativas en primera persona y su rica complejidad. Es imperativo innovar en la prevención de ITS/VIH, formulando intervenciones basadas en un diseño integrador, multidisciplinar y situado, que valore la teoría y la experiencia de las poblaciones objetivo.

Abstract This study reports on the qualitative phase of a study that seeks to design a digital intervention for the prevention of STI / HIV and promotion of sexual health in university students. The experience and perception that university students have about sexuality, risk and prevention campaigns are addressed through focus groups. Semi-structured interviews are conducted with key informants. The results reveal that sexual education is limited and restricted to the biological aspect, as well as loaded with prejudices and gender biases, which narrows the information provided to the student population. Wavering prevention strategies that fail to motivate students or offer them opportunities for making informed and independent decisions about their sexual health are apparent. The STI / HIV campaigns assessed are distant, fear-based and not inclusive. Interventions in sexual health do not weigh experiential aspects of youth sexuality, as they are based on models of ideal and stereotyped behavior, discarding first-person narratives and their rich complexity. It is imperative to innovate in the prevention of STI/HIV, formulating interventions based on an integrative, multidisciplinary and contextualized design that values the theory and experience of the target populations.

Factors influencing HIV testing and counselling services among men who have sex with men in Western China: a cross-sectional study based on Andersen's Behavioral Model

BACKGROUND@#Men who have sex with men (MSM), as a marginal population, has been largely ignored by health service projects. We assessed the utilization of HIV testing and counselling services and its influencing factors based on Andersen's Behavioral Model, so as to provide a theoretical basis for future infectious disease prevention and control strategies and health services policy formulation for these population.@*METHOD@#This was a cross-sectional study. A sample survey was conducted in Western China, and an anonymous self-administered questionnaire survey was conducted among MSM. Based on Andersen's Behavioral Model, the questionnaire divided the influencing factors into predisposing factor, enabling factor and need factor. Multivariate logistic regression analysis was used to explore the factors influencing the utilization of HIV testing and counselling.@*RESULTS@#There were 3184 valid questionnaires. In the survey of HIV health services, 82.85% MSM had HIV testing and 64.98% MSM had HIV counselling, respectively. Among the predisposing factor, age 25 years old and over was a facilitator of HIV testing and counselling, and ethnicity was a factor associated with HIV testing. Among the enabling factor, MSM living in urban were more likely to have access to testing and counselling services, and income was also linked to HIV testing. Among the need factor, a high level of HIV knowledge could promote testing and counselling, and a history of sexually transmitted diseases (STD) was a facilitator of testing.@*CONCLUSIONS@#HIV testing is widespread in Western China and higher than counselling service. MSM with high-risk characteristics should be identified as a priority in the future public health services.

Effects of unsafe sexual behavior and sexual orientation on previous HIV testing and HIV testing willingness among college students in Harbin / 中华流行病学杂志

Objective: To analyze the effects of unsafe sexual behavior and sexual orientation on previous HIV testing and HIV testing willingness among college students in Harbin, to provide a theoretical basis for promoting and promoting HIV testing among them. Methods: A cross-sectional survey design was used to place the automatic vending machine of HIV urine test kit in 9 universities in Harbin from December 2017 to January 2018. The questionnaire star was used to design and recruit college students to carry out an anonymous online survey. The estimated sample size was 6 659. A multivariate logistic regression model was used to analyze the effects of unsafe sexual behavior and sexual orientation on previous HIV testing and HIV testing willingness among college students. WPS 2016 was used to sort out the database, and SPSS 21.0 software was used for statistical analysis. Results: A total of 60 849 valid questionnaires were collected. 19.1% (11 189/58 605) of college students reported having sex. College students who used condoms correctly every time, occasionally or never during sex in the past six months 58.5% (6 206/10 603), 25.2%(2 669/10 603)and 16.3% (1 728/10 603), respectively. Heterosexuality, homosexuality and bisexuality accounted for 94.1% (54 393/57 823), 2.4% (1 369/57 823) and 3.5% (2 061/57 823), respectively. The HIV testing willingness of college students was 73.3% (44 572/60 849). The proportion of previous HIV testing was 10.3% (951/9 241). Results of the multivariate logistic analysis showed that compared with the college students who used condoms correctly whenever they had sex in the past six months, there was no significant difference in the proportion of previous HIV testing among college students who sometimes/occasionally used or never used condoms (OR=0.94,95%CI:0.69-1.29; OR=1.11,95%CI:0.73-1.67), but their willingness to HIV testing was lower (OR=0.79, 95%CI:0.71-0.89; OR=0.48, 95%CI:0.42-0.55); Compared with heterosexual college students, homosexual or bisexual college students have a higher proportion of previous HIV testing (OR=2.62, 95%CI:1.62-4.24; OR=2.04, 95%CI:1.25-3.32), but have lower HIV testing willingness (OR=0.76, 95%CI: 0.62-0.93; OR=0.64, 95%CI: 0.53-0.77). Conclusions: Unsafe sexual behavior existed among college students in Harbin, and college students with weak awareness of HIV prevention also have weak awareness of testing. Behavioral intervention should be strengthened and HIV testing promoted. Compared with heterosexuals, homosexual or bisexual college students had a higher proportion of previous HIV testing, but their willingness to test was lower. The HIV detection mode with better concealment, accuracy, and convenience should be promoted on the college's campus.

Progress on application of spatial epidemiology in HIV/AIDS control and prevention / 中华流行病学杂志

Spatial epidemiology focuses on the use of geographic information systems and spatial analysis to study spatial distribution and change tendency of diseases and explore the health status of specific populations. In recent years, spatial epidemiology has been applied in the field of HIV/AIDS prevention and control. This review summarizes the progress in the application of spatial epidemiology in the analysis of spatiotemporal distribution, non-monitoring area data estimation, influencing factors of AIDS and health resource allocation and utilization to provide reference for its application in the prevention and control of AIDS in the future.

Meta analysis on acceptance rate of HIV pre-exposure prophylaxis among men who have sex with men in China / 中华预防医学杂志

Objective: To systematically evaluate the acceptance of pre-exposure prophylaxis (PrEP)among men who have sex with men (MSM) in China, so as to provide reference for the promotion of preventive drug use before human immunodeficiency virus exposure in China. Methods: By searching the databases of China national knowledge infrastructure, VIP database, Wanfan knowledge service platform, PubMed, Web of Science, Embase and The Cochrane Library with key words of "men who have sex with men" "pre-exposure prophylaxis" "PrEP" and "MSM". The literature on the willingness of Chinese MSM population to accept PrEP was systematically collected, and the data of the literature meeting the inclusion criteria were extracted for Meta analysis. Results: A total of 12 articles were selected in this study, including 6 articles in English and 6 in Chinese. The score of bias risk assessment of eligible articles was 14-18, which was more than 70% of the total score. The total number of samples was 11 269. The overall acceptance rate of PrEP was 0.77(95%CI:0.71-0.82). In subgroup analysis, the acceptance rates of different nationalities, marriage, household registration, age, education background, income, sexual orientation, sexual behavior and awareness of PrEP were statistically significant. Conclusion: In general, the acceptance rate of PrEP in MSM population is higher, but the awareness rate is low. There are differences in the acceptance rate among different groups.

Condom stigma among men who have sex with men population: Concept synthesis / 中南大学学报(医学版)

OBJECTIVES@#The epidemic of acquired immune deficiency syndrome (AIDS) among men who have sex with men (MSM) is severe in China. And MSM has now become a key population for the infection and transmission of AIDS. At present, the bottleneck of AIDS prevention and control among MSM population is low rate of continuous condom use and high incidence of unsafe sexual behavior. Inductive summarization of the literature revealed that the most critical reason for low rate of continuous condom use among the MSM population was condom-related stigma. Although many studies mentioned condom-related stigma among MSM populations, there has been no any definition of MSM-related condom stigma and no measurement for it. Therefore, the paper aims to explore barriers to condom use among MSM, then construct the conceptual and operational definition of "MSM-related condom stigma" through Meta synthesis and concept synthesis, and provide a new perspective for AIDS prevention and control among MSM.@*METHODS@#Based on evidence-based method, "PICoS" framework and Meta-synthesis was used to include the literatures. Then, we used synthesized qualitative evidence from included studies to construct the concept and operational definition of MSM-related condom stigma by the means of thematic analysis and concept synthesis.@*RESULTS@#According to the results of the concept synthesis, MSM-related condom stigma refers to any taboos or misbeliefs about condom use or feeling ashamed or embarrassed to talk about using condoms which perceived by individuals at the individual, interpersonal, and social levels.It was demonstrated through 4 sub-themes at operational level: a symbol of distrust, a symbol of HIV/sexual transmitted infections (STIs) prevention, a symbol of an embarrassing topic, and a symbol of violating the traditional cognition of sexual intercourse. According to the Social-ecological Model (SEM), a symbol of distrust refers to that the MSM population believes that not using condoms represents mutual trust between sexual partners, while using condoms is difficult to express intimacy, trust and loyalty between sexual partners. A symbol of HIV/STIs prevention at the interpersonal level refers to that the MSM population believes that condom use is a "symbol" for the prevention or infection of AIDS; on the one hand, if someone proposes to use condoms, he may be considered infected with HIV or have unsafe sex experiences, thus, making it difficult to propose condom use; on the other hand, if they believe that sexual partners are "AIDS free" (often a wrong perception, such as sexual partners may have the risk of AIDS infection although they do not have AIDS), it is considered that condom use is completely unnecessary. The environmental level includes a symbol of an embarrassing topic and a symbol of violating the traditional cognition of sexual intercourse. A symbol of an embarrassing topic refers to the MSM population feels shame about topics related to sexual behavior and is embarrassed to carry/buy/propose condom use or be ashamed to engage in conversations about whether to use condoms during sexual behavior. And a symbol of violating the traditional cognition of sexual intercourse: The MSM population have limitations in their perception of "sex" or "sexual behavior" and believe that real sex (behavior) is unobstructed contact between the bodies and exchange between all body fluids.@*CONCLUSIONS@#The concept of MSM-related condom stigma is proposed for the first time, and its operational definition is given. The concept includes 3 levels and 4 dimensions. It is helpful to understand MSM people's attitude and cognition towards condoms, and adds indicators with cultural sensitivity and behavioral sensitivity to the behavioral intervention for AIDS in the future.