Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 238
Filter
1.
Cien Saude Colet ; 26(5): 1853-1862, 2021 May.
Article in Portuguese, English | MEDLINE | ID: covidwho-20238966

ABSTRACT

This essay reflects on sexual practices and prevention in the contexts of the AIDS and COVID-19 pandemics. It analyses data collected between July and October 2020 through participant observation, as part of an ethnographic research project on HIV vulnerability and prevention among men who have sex with men in the Metropolitan Region of Recife, state of Pernambuco (PE), Brazil. The results point to the relevance of physical appearance and the affective bond between partners in engendering emotions that mediate coping with the risk of infection during both pandemics. It indicates the need to incorporate those communicational dimensions into informational materials to make them more effective.


Este ensaio reflete sobre práticas sexuais e prevenção nos contextos das pandemias de AIDS e da COVID-19. Analisa dados coletados entre julho e outubro de 2020, por meio de observação participante, no âmbito de uma pesquisa etnográfica sobre vulnerabilidade e prevenção ao HIV entre homens que fazem sexo com homens da Região Metropolitana do Recife. Os resultados apontam para a relevância da aparência corporal e da vinculação afetiva entre os parceiros no engendramento de emoções que medeiam a lida com risco de infecção em ambas as pandemias. Sinaliza para a necessidade de incorporar essas dimensões comunicacionais em materiais informativos, de modo a torná-los mais eficazes.


Subject(s)
Acquired Immunodeficiency Syndrome , COVID-19 , HIV Infections , Sexual and Gender Minorities , Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/prevention & control , Brazil/epidemiology , HIV Infections/epidemiology , HIV Infections/prevention & control , Homosexuality, Male , Humans , Male , Pandemics/prevention & control , SARS-CoV-2 , Sexual Behavior , Sexual Partners , Sexuality
2.
PLoS One ; 18(6): e0287061, 2023.
Article in English | MEDLINE | ID: covidwho-20238333

ABSTRACT

During the pandemic, the capacity of medical resources focused on testing, diagnosing and treating COVID-19 has severely limited public access to health care. In particular, HIV screening, for which homosexual males in Korea received free and anonymous testing at public health centers, was completely halted. This study investigated behavioral predictors related to the HIV screening needs of Korean male homosexuals during the pandemic. Data were collected by conducting a web survey targeting members of the largest homosexual portal site in Korea with support from the National Research Foundation of Korea (n = 1,005). The key independent variables are COVID-19-related characteristics and sexual risk behavior. The moderating variable is health information search behavior, and the dependent variable is the need for HIV screening. For a statistical analysis, a hierarchical multiple logistic regression analysis was conducted while controlling for potential confounding variables. According to the results of this study, the need for HIV screening was 0.928 times lower for older people (p<0.05, 95% CI = 0.966-0.998). However, if the respondent had a primary partner, the need for HIV screening was 1.459 times higher (p<0.01, 95% CI = 1.071-1.989). In addition, the need for screening was 1.773 times higher for those who preferred anal intercourse (p<0.01, 95% CI = 1.261-2.494) and 2.034 times higher (p<0.01, 95% CI = 1.337-3.095) if there was a history of being diagnosed with an STD. Finally, health information-seeking behavior was marginally significant. This study revealed that male Korean homosexuals who were young, preferred anal sex with a primary partner, and who had a history of a sexually transmitted disease had a high need for HIV screening at public health centers. They are more likely to be susceptible to HIV infection because they are usually consistent with gay men, characterized by risky behavior. Therefore, an intervention strategy that provides health information using a communication campaign is needed.


Subject(s)
COVID-19 , HIV Infections , Sexual and Gender Minorities , Male , Humans , Aged , Pandemics , Homosexuality, Male , Information Seeking Behavior , Republic of Korea
3.
BMC Public Health ; 23(1): 716, 2023 04 20.
Article in English | MEDLINE | ID: covidwho-20236491

ABSTRACT

INTRODUCTION: Antiretroviral medication coverage remains sub-optimal in much of the United States, particularly the Sothern region, and Non-Hispanic Black or African American persons (NHB) continue to be disproportionately impacted by the HIV epidemic. The "Ending the HIV Epidemic in the U.S." (EHE) initiative seeks to reduce HIV incidence nationally by focusing resources towards the most highly impacted localities and populations. This study evaluates the impact of hypothetical improvements in ART and PrEP coverage to estimate the levels of coverage needed to achieve EHE goals in the South. METHODS: We developed a stochastic, agent-based network model of 500,000 individuals to simulate the HIV epidemic and hypothetical improvements in ART and PrEP coverage. RESULTS: New infections declined by 78.6% at 90%/40% ART/PrEP and 94.3% at 100%/50% ART/PrEP. Declines in annual incidence rates surpassed 75% by 2025 with 90%/40% ART/PrEP and 90% by 2030 with 100%/50% ART/PrEP coverage. Increased ART coverage among NHB MSM was associated with a linear decline in incidence among all MSM. Declines in incidence among Hispanic/Latino and White/Other MSM were similar regardless of which MSM race group increased their ART coverage, while the benefit to NHB MSM was greatest when their own ART coverage increased. The incidence rate among NHB women declined by over a third when either NHB heterosexual men or NHB MSM increased their ART use respectively. Increased use of PrEP was associated with a decline in incidence for the groups using PrEP. MSM experienced the largest absolute declines in incidence with increasing PrEP coverage, followed by NHB women. CONCLUSIONS: Our analysis indicates that it is possible to reach EHE goals. The largest reductions in HIV incidence can be achieved by increasing ART coverage among MSM and all race groups benefit regardless of differences in ART initiation by race. Improving ART coverage to > 90% should be prioritized with a particular emphasis on reaching NHB MSM. Such a focus will reduce the largest number of incident cases, reduce racial HIV incidence disparities among both MSM and women, and reduce racial health disparities among persons with HIV. NHB women should also be prioritized for PrEP outreach.


Subject(s)
Anti-HIV Agents , Disease Eradication , HIV Infections , Health Status Disparities , Pre-Exposure Prophylaxis , Female , Humans , Male , Anti-HIV Agents/therapeutic use , Goals , HIV Infections/drug therapy , HIV Infections/epidemiology , HIV Infections/prevention & control , Homosexuality, Male/statistics & numerical data , Incidence , Pre-Exposure Prophylaxis/methods , Pre-Exposure Prophylaxis/statistics & numerical data , Sexual and Gender Minorities/statistics & numerical data , United States/epidemiology , Disease Eradication/methods , Disease Eradication/statistics & numerical data
4.
J Med Virol ; 95(5): e28763, 2023 05.
Article in English | MEDLINE | ID: covidwho-20234552

ABSTRACT

People are expected to have been previously vaccinated with a Vaccinia-based vaccine, as until 1980 smallpox vaccination was a standard protocol in China. It is unclear whether people with smallpox vaccine still have antibody against vaccinia virus (VACV) and cross-antibody against monkeypox virus (MPXV). Herein, we assessed the binding antibodies with antigen of VACV-A33 and MPXV-A35 in the general population and HIV-1 infected patients. Firstly, we detected VACV antibody with A33 protein to evaluate the efficiency of smallpox vaccination. The result show that 29% (23 of 79) of hospital staff (age ≥ 42 years) and 63% (60 of 95) of HIV-positive patients (age ≥ 42 years) from Guangzhou Eighth People's Hospital were able to bind A33. However, among the subjects below 42 years of age, 1.5% (3/198) of the hospital volunteer samples and 1% (1/104) of the samples from HIV patients were positive for antibodies against A33 antigen. Then, we assessed the specific cross-reactive antibodies against MPXV A35 protein. 24% (19 of 79) hospital staff (age〉 = 42 years) and 44% (42 of 95) of HIV-positive patients (age〉 = 42 years) were positive. 98% (194/198) of the hospital staff and 99% (103/104) of the HIV patients had no A35-binding antibodies. Further, we found significant sex differences for the reactivity to A35 antigen were observed in HIV population, but no significant sex differences in hospital staff. Further, we analyzed the positivity rate of anti-A35 antibody of men who have sex with men (MSM) and non-MSM in HIV patients (age〉 = 42years). We found that 47% of no-MSM population and 40% of MSM population were positive for A35 antigen, with no significant difference. Lastly, we found only 59 samples were positive for anti-A33 IgG and anti-A35 IgG in all participants. Together, we demonstrated A33 and A35 antigens binding antibodies were detected in HIV patients and general population who were older than 42 years, and cohort studies only provided data of serological detection to support early response to monkeypox outbreak.


Subject(s)
HIV Infections , HIV-1 , Monkeypox , Sexual and Gender Minorities , Smallpox Vaccine , Smallpox , Adult , Female , Humans , Male , Antigens, Viral , Homosexuality, Male , Immunoglobulin G , Monkeypox/epidemiology , Monkeypox virus , Vaccinia virus , Viral Proteins
5.
Int J Environ Res Public Health ; 20(11)2023 May 28.
Article in English | MEDLINE | ID: covidwho-20233100

ABSTRACT

When the COVID-19 pandemic emerged in early 2020, not only did it abruptly impede the progress that was being made toward achieving global targets to end the HIV pandemic, but it also created significant impacts on the physical and mental health of middle-aged and older men who have sex with men living with HIV. Utilizing a qualitative, community-based participatory research approach, we conducted semi-structured, one-on-one interviews with 16 ethnoracially diverse, middle-aged and older men who have sex with men living with HIV residing in Southern Nevada, to examine the different ways the COVID-19 pandemic directly impacted their physical and mental health, and explore how they eventually coped and thrived during the peak of the crisis. Using thematic analysis to analyze our interview data, we identified three prominent themes: (1) challenges to obtaining credible health information, (2) the physical and mental health impacts of the COVID-19-pandemic-imposed social isolation, and (3) digital technologies and online connections for medical and social purposes. In this article, we extensively discuss these themes, the current discourse on these themes in academic literature, and how the perspectives, input, and lived experiences of our participants during the peak of the COVID-19 pandemic could be critical to addressing issues they had already been experiencing prior to the emergence of the pandemic in 2020, and just as importantly, helping us best prepare in stark anticipation of the next potentially devastating pandemic.


Subject(s)
COVID-19 , HIV Infections , Sexual and Gender Minorities , Male , Middle Aged , Humans , Aged , Pandemics , Homosexuality, Male , COVID-19/epidemiology , Adaptation, Psychological , HIV Infections/epidemiology
6.
Lancet Microbe ; 4(2): e102-e112, 2023 02.
Article in English | MEDLINE | ID: covidwho-20233032

ABSTRACT

BACKGROUND: HIV-1 infections initiated by multiple founder variants are characterised by a higher viral load and a worse clinical prognosis than those initiated with single founder variants, yet little is known about the routes of exposure through which transmission of multiple founder variants is most probable. Here we used individual patient data to calculate the probability of multiple founders stratified by route of HIV exposure and study methodology. METHODS: We conducted a systematic review and meta-analysis of studies that estimated founder variant multiplicity in HIV-1 infection, searching MEDLINE, Embase, and Global Health databases for papers published between Jan 1, 1990, and Sept 14, 2020. Eligible studies must have reported original estimates of founder variant multiplicity in people with acute or early HIV-1 infections, have clearly detailed the methods used, and reported the route of exposure. Studies were excluded if they reported data concerning people living with HIV-1 who had known or suspected superinfection, who were documented as having received pre-exposure prophylaxis, or if the transmitting partner was known to be receiving antiretroviral treatment. Individual patient data were collated from all studies, with authors contacted if these data were not publicly available. We applied logistic meta-regression to these data to estimate the probability that an HIV infection is initiated by multiple founder variants. We calculated a pooled estimate using a random effects model, subsequently stratifying this estimate across exposure routes in a univariable analysis. We then extended our model to adjust for different study methods in a multivariable analysis, recalculating estimates across the exposure routes. This study is registered with PROSPERO, CRD42020202672. FINDINGS: We included 70 publications in our analysis, comprising 1657 individual patients. Our pooled estimate of the probability that an infection is initiated by multiple founder variants was 0·25 (95% CI 0·21-0·29), with moderate heterogeneity (Q=132·3, p<0·0001, I2=64·2%). Our multivariable analysis uncovered differences in the probability of multiple variant infection by exposure route. Relative to a baseline of male-to-female transmission, the predicted probability for female-to-male multiple variant transmission was significantly lower at 0·13 (95% CI 0·08-0·20), and the probabilities were significantly higher for transmissions in people who inject drugs (0·37 [0·24-0·53]) and men who have sex with men (0·30 [0·33-0·40]). There was no significant difference in the probability of multiple variant transmission between male-to-female transmission (0·21 [0·14-0·31]), post-partum transmission (0·18 [0·03-0·57]), pre-partum transmission (0·17 [0·08-0·33]), and intra-partum transmission (0·27 [0·14-0·45]). INTERPRETATION: We identified that transmissions in people who inject drugs and men who have sex with men are significantly more likely to result in an infection initiated by multiple founder variants, and female-to-male infections are significantly less probable. Quantifying how the routes of HIV infection affect the transmission of multiple variants allows us to better understand how the evolution and epidemiology of HIV-1 determine clinical outcomes. FUNDING: Medical Research Council Precision Medicine Doctoral Training Programme and a European Research Council Starting Grant.


Subject(s)
Anti-HIV Agents , HIV Infections , HIV Seropositivity , HIV-1 , Sexual and Gender Minorities , Humans , Male , Female , HIV Infections/epidemiology , HIV Infections/drug therapy , HIV-1/genetics , Homosexuality, Male , Anti-HIV Agents/therapeutic use , HIV Seropositivity/epidemiology , HIV Seropositivity/drug therapy
7.
BMC Public Health ; 23(1): 1025, 2023 05 30.
Article in English | MEDLINE | ID: covidwho-20235605

ABSTRACT

BACKGROUND: This study investigated the associations between COVID-19 related stigma and post-traumatic stress symptoms (PTSS); and the associations between PTSS and COVID-19 related stigma, HIV status, COVID-19 status and key HIV population status. METHODS: This was a secondary analysis of data of 12,355 study participants generated through an online survey that recruited adults from 152 countries between July and December 2020. The dependent variables were COVID-19-related stigma and PTSS. The independent variables were HIV status (positive/negative), transaction sex (yes/no), use of psychoactive drugs (yes/no), and vulnerability status (transaction sex workers, people who use psychoactive drugs, living with HIV, and COVID-19 status). The confounding variables were age, sex at birth (male/female), level of education, sexual minority individuals (yes/no) and country income level. Multivariable logistic regression analyses were conducted to determine associations between the dependent and independent variables after adjusting for confounders. RESULTS: There were 835 (6.8%) participants who experienced COVID-19 related stigma during the pandemic and 3,824 (31.0%) participants reported PTSS. Respondents who were living with HIV (AOR: 1.979; 95%CI: 1.522-2.573), tested positive for COVID-19 (AOR: 3.369; 95%CI: 2.692-4.217), engaged in transactional sex (AOR: 1.428; 95%CI: 1.060-1.922) and used psychoactive drugs (AOR: 1.364; 95%CI: 1.053-1.767) had significantly higher odds of experiencing COVID-19 related stigma. Individuals with vulnerability status (AOR:4.610; 95%CI: 1.590-13.368) and who experienced COVID-19 related stigma (AOR: 2.218; 95%CI: 1.920-2.561) had significantly higher odds of PTSS. CONCLUSION: Individuals with vulnerability status may be at increased risk for COVID-19 related stigma. Key and vulnerable populations who were living with HIV and who experienced stigma may be at a higher risk of experiencing PTSS. Populations at risk for PTSS should be routinely screened and provided adequate support when they contract COVID-19 to reduce the risk for poor mental health during COVID-19 outbreaks and during future health crisis with similar magnitude as the COVID-19 pandemic.


Subject(s)
COVID-19 , HIV Infections , Stress Disorders, Post-Traumatic , Adult , Infant, Newborn , Humans , Male , Female , Homosexuality, Male , Pandemics , Stress Disorders, Post-Traumatic/epidemiology , COVID-19/epidemiology , HIV Infections/epidemiology , HIV Infections/psychology , Perception
8.
Cien Saude Colet ; 27(7): 2703-2715, 2022 Jul.
Article in Portuguese | MEDLINE | ID: covidwho-20238967

ABSTRACT

The text addresses the sociability circuits of 'men who have sex with men' in the Metropolitan Region of Recife during the first year of the COVID-19 pandemic. In March 2020, with the arrival of the epidemic in Brazil, a first movement was characterized by the shift of interactions to the online dimension. From June onwards, after stricter social distancing, offline sexual interactions, social interactions at friends' houses, the return to bars and sociability on the street were resumed in that order, in the wake of what was happening in the broader society. In the mismatch between the negationist speech of the President of the Republic and the role of the state government in implementing measures of social distancing; in the contradictions generated by the leniency regarding crowding in public transport on the way to and from work and the attempts to contain the crowds seeking leisure activities, a 'new normal' emerged and was marked by negativism, omnipotence and fatalism. Between September 2020 and February 2021, what were most evident were parties, ostensive circulation of people and the lack of mask use, boosting the numbers of the infected and the dead, in the normalization of an unprecedented health crisis in Brazil.


O texto aborda os circuitos de sociabilidade de homens que fazem sexo com homens, na Região Metropolitana do Recife durante o primeiro ano da pandemia de COVID-19. Em março de 2020, com a chegada da doença ao Brasil, um primeiro movimento foi caracterizado pelo deslocamento das interações para a dimensão on-line. A partir de junho, após distanciamento social mais rigoroso, as interações sexuais offline, a social na casa de amigos, a volta aos bares e a sociabilidade na rua foram sendo, nessa ordem, retomadas na esteira do que acontecia na sociedade abrangente. No descompasso entre o discurso negacionista do presidente da República e o protagonismo do governo estadual em implantar as medidas de distanciamento social, nas contradições geradas pela leniência em relação à aglomeração no transporte público na ida para o trabalho e nas tentativas de contenção das aglomerações de lazer, produziu-se um novo normal caracterizado pelo negacionismo, a onipotência e o fatalismo. Entre setembro de 2020 e fevereiro de 2021, o que mais se viu foram festas, circulação ostensiva das pessoas e ausência do uso de máscara, impulsionando os números de infectados e de mortos, na normalização de uma crise sanitária sem precedentes no Brasil.


Subject(s)
COVID-19 , Sexual and Gender Minorities , Brazil/epidemiology , Homosexuality, Male , Humans , Male , Pandemics
9.
PLoS One ; 18(4): e0284056, 2023.
Article in English | MEDLINE | ID: covidwho-2327771

ABSTRACT

This study identified subgroups of sexual behaviors associated with increased STI/HIV risk among those eligible for but not using pre-exposure prophylaxis (PrEP) in order to improve PrEP uptake and prioritization in the context of restricted capacity. We used data from sexual health centers (SHCs) in the Netherlands, including all visits of eligible but non-PrEP using men who have sex with men (MSM), men who have sex with men and women (MSMW) and transgender persons between July 2019 (start of the Dutch national PrEP pilot (NPP)) and June 2021. Using latent class analysis (LCA), we identified classes of sexual behaviors (number of partners, chemsex, group sex and sex work) and explored whether these classes were associated with STI diagnosis and sociodemographics. Across 45,582 visits of 14,588 eligible non-PrEP using individuals, the best fitting LCA model contained three classes of sexual behaviors. Classes were distinguished by seldomly reported sexual behaviors (class 1; 53.5%, n = 24,383), the highest proportions of ≥6 partners and group sex (class 2; 29.8%, n = 13,596), and the highest proportions of chemsex and sex work (class 3; 16.7% of visits, n = 7,603). Visits in classes 2 and 3 (vs. class 1) were significantly more often with individuals who were diagnosed with an STI, older (≥36 vs. ≤35 years), MSMW (vs. MSM), and visiting an urban (vs. non-urban) SHC; while these visits were significantly less often with individuals from an STI/HIV endemic area. The percentage of visits at which an STI was diagnosed was 17.07% (n = 4,163) in class 1, 19.53% (n = 2,655) in class 2 and 25.25% (n = 1,920) in class 3. The highest risk of STI, and thereby HIV, was in those engaging in specific subgroups of sexual behavior characterized by frequently reporting multiple partners, group sex, sex work or chemsex. PrEP uptake should be encouraged and prioritized for these individuals.


Subject(s)
HIV Infections , Pre-Exposure Prophylaxis , Sexual and Gender Minorities , Male , Humans , Female , Homosexuality, Male , HIV Infections/epidemiology , HIV Infections/prevention & control , Netherlands/epidemiology , Sexual Behavior
10.
Front Immunol ; 14: 1174223, 2023.
Article in English | MEDLINE | ID: covidwho-2327003

ABSTRACT

Monkeypox virus (MPXV) cases have increased dramatically worldwide since May 2022. The Atlanta Center for Disease Control and Prevention (Atlanta CDC) had reported a total of 85,922 cases as of February 20th, 2023. During the COVID-19 pandemic, MPXV has emerged as a potential public threat. MPXV transmission and prevalence must be closely monitored. In this comprehensive review, we explained the basic characteristics and transmission routes of MPXV, individuals susceptible to it, as well as highlight the impact of the behavior of men who have sex with men (MSM) and airline traveling on recent outbreaks of MPXV. We also describe the clinical implications, the prevention of MPXV, and clinical measures of viral detection.


Subject(s)
COVID-19 , Monkeypox , Sexual and Gender Minorities , Male , Humans , Monkeypox virus , Monkeypox/epidemiology , Homosexuality, Male , Pandemics , COVID-19/epidemiology
11.
BMC Health Serv Res ; 23(1): 494, 2023 May 16.
Article in English | MEDLINE | ID: covidwho-2324349

ABSTRACT

BACKGROUND: Mental health and substance use disorders disproportionately affect people with HIV (PWH), and may have been exacerbated during COVID-19. The Promoting Access to Care Engagement (PACE) trial was designed to assess the effectiveness of electronic screening for mental health and substance use in HIV primary care and enrolled PWH from October 2018 to July 2020. Our objective here was to compare screening rates and results for PWH before (October 2018 - February 2020) and early in the COVID-19 pandemic (March-July 2020). METHODS: Adult (≥ 18 years) PWH from 3 large HIV primary care clinics in a US-based integrated healthcare system were offered electronic screening online or via in-clinic tablet computer every 6 months. Screening completion and results (for depression, suicidal ideation, anxiety, and substance use) were analyzed using logistic regression with generalized estimating equations to estimate prevalence ratios (PR) before and after the start of the regional COVID-19 shelter-in-place orders on March 17, 2020. Models adjusted for demographics (age, sex, race/ethnicity), HIV risk factors (men who have sex with men, injection drug use, heterosexual, other), medical center, and modality of screening completion (online or tablet). We conducted qualitative interviews with providers participating in the intervention to evaluate how the pandemic impacted patient care. RESULTS: Of 8,954 eligible visits, 3,904 completed screenings (420 during COVID, 3,484 pre-COVID), with lower overall completion rates during COVID (38% vs. 44%). Patients completing screening during COVID were more likely to be White (63% vs. 55%), male (94% vs. 90%), and MSM (80% vs., 75%). Adjusted PRs comparing COVID and pre-COVID (reference) were 0.70 (95% CI), 0.92 (95% CI), and 0.54 (95% CI) for tobacco use, any substance use, and suicidal ideation, respectively. No significant differences were found by era for depression, anxiety, alcohol, or cannabis use. These results were in contrast to provider-reported impressions of increases in substance use and mental health symptoms. CONCLUSION: Findings suggest PWH had modest declines in screening rates early in the COVID-19 pandemic which may have been affected by the shift to telemedicine. There was no evidence that mental health problems and substance use increased for PWH in primary care. TRIAL REGISTRATION: NCT03217058 (First registration date: 7/13/2017); https://clinicaltrials.gov/ct2/show/NCT03217058.


Subject(s)
COVID-19 , HIV Infections , Sexual and Gender Minorities , Substance-Related Disorders , Adult , Humans , Male , COVID-19/diagnosis , COVID-19/epidemiology , HIV Infections/complications , HIV Infections/diagnosis , HIV Infections/epidemiology , Homosexuality, Male , Mental Health , Pandemics , Primary Health Care , Substance-Related Disorders/diagnosis , Substance-Related Disorders/epidemiology
12.
BMJ Open ; 13(5): e070693, 2023 05 17.
Article in English | MEDLINE | ID: covidwho-2323455

ABSTRACT

PURPOSE: In order to enable long-term follow-up of the natural course of HIV infection in the central nervous system, a longitudinal cohort study with repeated cerebrospinal fluid (CSF) analyses at intervals over time was initiated in 1985. When antiretrovirals against HIV were introduced in the late 1980s, short-term and long-term effects of various antiretroviral treatment (ART) regimens were added to the study. PARTICIPANTS: All adult people living with HIV (PLWH) who were diagnosed at or referred to the Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden were asked to participate in the Gothenburg HIV CSF Study Cohort. PLWH with neurological symptoms or other clinical symptoms of HIV, as well as those with no symptoms of HIV infection, were included. Most participants were asymptomatic, which distinguishes this cohort from most other international HIV CSF studies. In addition, HIV-negative controls were recruited. These included people on HIV pre-exposure prophylaxis who served as lifestyle-matched controls to HIV-infected men who have sex with men. Since lumbar puncture (LP) is an invasive procedure, some PLHW only consented to participate in one examination. Furthermore, at the beginning of the study, several participants were lost to follow-up having died from AIDS. Of 662 PLWH where an initial LP was done, 415 agreed to continue with follow-up. Among the 415, 56 only gave permission to be followed with LP for less than 1 year, mainly to analyse the short-term effect of ART. The remaining 359 PLWH were followed up with repeated LP for periods ranging from >1 to 30 years. This group was defined as the 'longitudinal cohort'. So far, on 7 April 2022, 2650 LP and samplings of paired CSF/blood had been performed, providing a unique biobank. FINDINGS TO DATE: A general finding during the 37-year study period was that HIV infection in the central nervous system, as mirrored by CSF findings, appears early in the infectious course of the disease and progresses slowly in the vast majority of untreated PLWH. Combination ART has been highly effective in reducing CSF viral counts, inflammation and markers of neural damage. Minor CSF signs of long-term sequels or residual inflammatory activity and CSF escape (viral CSF blips) have been observed during follow-up. The future course of these changes and their clinical impact require further studies. FUTURE PLANS: PLWH today have a life expectancy close to that of non-infected people. Therefore, our cohort provides a unique opportunity to study the long-term effects of HIV infection in the central nervous system and the impact of ART and is an ongoing study.


Subject(s)
HIV Infections , Sexual and Gender Minorities , Adult , Male , Humans , HIV Infections/drug therapy , HIV Infections/complications , Longitudinal Studies , Homosexuality, Male , Central Nervous System , Anti-Retroviral Agents/therapeutic use
13.
J Med Virol ; 95(5): e28781, 2023 05.
Article in English | MEDLINE | ID: covidwho-2326185

ABSTRACT

To identify the frequency of late presentation and late presentation with advanced disease, and associated factors in people living with HIV (PLHIV). Data from PLHIV diagnosed between 2008 and 2021 were retrospectively analyzed. Time of diagnosis (categorized based on key events affecting HIV care continuum e.g., national strategies, HIV guidelines, COVID-19 pandemic) and characteristics of late presenters (LP: CD4 ≤350 cells/mm³ or an AIDS defining event) and late presenters with advanced disease (LPAD: CD4 <200 cells/mm³) were describe. Associations between dependent (LP, LPAD) and independent variables were assessed using univariate/multivariate regression tests and presented as odds ratios (95% confidential interval). Of 1585 individuals (93.7% men), 42.5% were LPs and 19.3% were LPADs. Most common route of transmission was sex between men (54.3%). Non-LPs were younger (30 vs. 34 and 36 years; p < 0.001) and included more men who have sex with men (60.3% vs. 46.3% and 39.5%; p < 0.001). Factors associated with being LP and LPAD were age >30 years, heterosexual/unknown route of transmission (vs. sex between men), diagnosis in 2008-2013 or 2020-2021, (vs. 2014-2019). With reference to Turkish subjects, migrants from Africa had higher odds of being LPAD. LP is still an important health issue in HIV care. Heterosexuality, older age (>30 years), migration from Africa, and the COVID-19 pandemic are associated with delays in HIV presentation in Turkey. These factors need to be considered when developing and implementing policies to enable earlier diagnosis and treatment of PLHIV to achieve UNAIDS 95-95-95 targets.


Subject(s)
COVID-19 , HIV Infections , Sexual and Gender Minorities , Male , Humans , Adult , Female , HIV Infections/epidemiology , HIV Infections/diagnosis , Risk Factors , Homosexuality, Male , Turkey/epidemiology , Retrospective Studies , Pandemics , CD4 Lymphocyte Count , Delayed Diagnosis , Age Factors , COVID-19/diagnosis , COVID-19/epidemiology
14.
BMC Infect Dis ; 23(1): 252, 2023 Apr 20.
Article in English | MEDLINE | ID: covidwho-2325849

ABSTRACT

BACKGROUND: The World Health Organization recommends changing the first-line antimicrobial treatment for gonorrhoea when ≥ 5% of Neisseria gonorrhoeae cases fail treatment or are resistant. Susceptibility to ceftriaxone, the last remaining treatment option has been decreasing in many countries. We used antimicrobial resistance surveillance data and developed mathematical models to project the time to reach the 5% threshold for resistance to first-line antimicrobials used for N. gonorrhoeae. METHODS: We used data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England and Wales from 2000-2018 about minimum inhibitory concentrations (MIC) for ciprofloxacin, azithromycin, cefixime and ceftriaxone and antimicrobial treatment in two groups, heterosexual men and women (HMW) and men who have sex with men (MSM). We developed two susceptible-infected-susceptible models to fit these data and produce projections of the proportion of resistance until 2030. The single-step model represents the situation in which a single mutation results in antimicrobial resistance. In the multi-step model, the sequential accumulation of resistance mutations is reflected by changes in the MIC distribution. RESULTS: The single-step model described resistance to ciprofloxacin well. Both single-step and multi-step models could describe azithromycin and cefixime resistance, with projected resistance levels higher with the multi-step than the single step model. For ceftriaxone, with very few observed cases of full resistance, the multi-step model was needed to describe long-term dynamics of resistance. Extrapolating from the observed upward drift in MIC values, the multi-step model projected ≥ 5% resistance to ceftriaxone could be reached by 2030, based on treatment pressure alone. Ceftriaxone resistance was projected to rise to 13.2% (95% credible interval [CrI]: 0.7-44.8%) among HMW and 19.6% (95%CrI: 2.6-54.4%) among MSM by 2030. CONCLUSIONS: New first-line antimicrobials for gonorrhoea treatment are needed. In the meantime, public health authorities should strengthen surveillance for AMR in N. gonorrhoeae and implement strategies for continued antimicrobial stewardship. Our models show the utility of long-term representative surveillance of gonococcal antimicrobial susceptibility data and can be adapted for use in, and for comparison with, other countries.


Subject(s)
Gonorrhea , Sexual and Gender Minorities , Male , Humans , Female , Neisseria gonorrhoeae/genetics , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Gonorrhea/drug therapy , Gonorrhea/epidemiology , Cefixime/pharmacology , Cefixime/therapeutic use , Ceftriaxone/pharmacology , Ceftriaxone/therapeutic use , Azithromycin/pharmacology , Azithromycin/therapeutic use , Homosexuality, Male , Drug Resistance, Bacterial , Ciprofloxacin/pharmacology , Ciprofloxacin/therapeutic use , Microbial Sensitivity Tests
15.
BMC Public Health ; 23(1): 829, 2023 05 05.
Article in English | MEDLINE | ID: covidwho-2317796

ABSTRACT

BACKGROUND: Men and gender-diverse people who have sex with men are disproportionately affected by health conditions associated with increased risk of severe illness due to COVID-19 infection. METHODS: An online cross-sectional survey of men and gender-diverse people who have sex with men in the UK recruited via social networking and dating applications from 22 November-12 December 2021. Eligible participants included self-identifying men, transgender women, or gender-diverse individuals assigned male at birth (AMAB), aged ≥ 16, who were UK residents, and self-reported having had sex with an individual AMAB in the last year. We calculated self-reported COVID-19 test-positivity, proportion reporting long COVID, and COVID-19 vaccination uptake anytime from pandemic start to survey completion (November/December 2021). Logistic regression was used to assess sociodemographic, clinical, and behavioural characteristics associated with SARS-CoV-2 (COVID-19) test positivity and complete vaccination (≥ 2 vaccine doses). RESULTS: Among 1,039 participants (88.1% white, median age 41 years [interquartile range: 31-51]), 18.6% (95% CI: 16.3%-21.1%) reported COVID-19 test positivity, 8.3% (95% CI: 6.7%-10.1%) long COVID, and 94.5% (95% CI: 93.3%-96.1%) complete COVID-19 vaccination through late 2021. In multivariable models, COVID-19 test positivity was associated with UK country of residence (aOR: 2.22 [95% CI: 1.26-3.92], England vs outside England) and employment (aOR: 1.55 [95% CI: 1.01-2.38], current employment vs not employed). Complete COVID-19 vaccination was associated with age (aOR: 1.04 [95% CI: 1.01-1.06], per increasing year), gender (aOR: 0.26 [95% CI: 0.09-0.72], gender minority vs cisgender), education (aOR: 2.11 [95% CI: 1.12-3.98], degree-level or higher vs below degree-level), employment (aOR: 2.07 [95% CI: 1.08-3.94], current employment vs not employed), relationship status (aOR: 0.50 [95% CI: 0.25-1.00], single vs in a relationship), COVID-19 infection history (aOR: 0.47 [95% CI: 0.25-0.88], test positivity or self-perceived infection vs no history), known HPV vaccination (aOR: 3.32 [95% CI: 1.43-7.75]), and low self-worth (aOR: 0.29 [95% CI: 0.15-0.54]). CONCLUSIONS: In this community sample, COVID-19 vaccine uptake was high overall, though lower among younger age-groups, gender minorities, and those with poorer well-being. Efforts are needed to limit COVID-19 related exacerbation of health inequalities in groups who already experience a greater burden of poor health relative to other men who have sex with men.


Subject(s)
COVID-19 , Sexual and Gender Minorities , Infant, Newborn , Male , Humans , Female , Adult , Homosexuality, Male , Cross-Sectional Studies , COVID-19 Vaccines , Post-Acute COVID-19 Syndrome , COVID-19/epidemiology , COVID-19/prevention & control , SARS-CoV-2 , England , Vaccination
16.
J Med Internet Res ; 25: e43841, 2023 06 06.
Article in English | MEDLINE | ID: covidwho-2314273

ABSTRACT

BACKGROUND: Shortly after the worst of the COVID-19 pandemic, an outbreak of mpox introduced another critical public health emergency. Like the COVID-19 pandemic, the mpox outbreak was characterized by a rising prevalence of public health misinformation on social media, through which many US adults receive and engage with news. Digital misinformation continues to challenge the efforts of public health officials in providing accurate and timely information to the public. We examine the evolving topic distributions of social media narratives during the mpox outbreak to map the tension between rapidly diffusing misinformation and public health communication. OBJECTIVE: This study aims to observe topical themes occurring in a large-scale collection of tweets about mpox using deep learning. METHODS: We leveraged a data set comprised of all mpox-related tweets that were posted between May 7, 2022, and July 23, 2022. We then applied Sentence Bidirectional Encoder Representations From Transformers (S-BERT) to the content of each tweet to generate a representation of its content in high-dimensional vector space, where semantically similar tweets will be located closely together. We projected the set of tweet embeddings to a 2D map by applying principal component analysis and Uniform Manifold Approximation Projection (UMAP). Finally, we group these data points into 7 topical clusters using k-means clustering and analyze each cluster to determine its dominant topics. We analyze the prevalence of each cluster over time to evaluate longitudinal thematic changes. RESULTS: Our deep-learning pipeline revealed 7 distinct clusters of content: (1) cynicism, (2) exasperation, (3) COVID-19, (4) men who have sex with men, (5) case reports, (6) vaccination, and (7) World Health Organization (WHO). Clusters that largely communicated erroneous or irrelevant information began earlier and grew faster, reaching a wider audience than later communications by official instances and health officials. CONCLUSIONS: Within a few weeks of the first reported mpox cases, an avalanche of mostly false, misleading, irrelevant, or damaging information started to circulate on social media. Official institutions, including the WHO, acted promptly, providing case reports and accurate information within weeks, but were overshadowed by rapidly spreading social media chatter. Our results point to the need for real-time monitoring of social media content to optimize responses to public health emergencies.


Subject(s)
COVID-19 , Deep Learning , Health Communication , Monkeypox , Social Media , Adult , Humans , Male , COVID-19/epidemiology , Disease Outbreaks , Homosexuality, Male , Pandemics , Public Health , Sexual and Gender Minorities
17.
Cad Saude Publica ; 39Suppl 1(Suppl 1): e00154021, 2023.
Article in English | MEDLINE | ID: covidwho-2309715

ABSTRACT

Adolescent men who have sex with men (AMSM) are at a heightened vulnerability for human immunodeficiency virus (HIV). This study aimed to estimate the prevalence of HIV and associated individual, social, and programmatic factors among AMSM in Salvador, Bahia State, Brazil. This is a cross-sectional study which analyzed baseline data from the PrEP1519 cohort in Salvador. Descriptive, bivariate, and multivariate analyses were conducted using the dimensions of vulnerability to HIV as hierarchical levels of analysis. Logistic regression models were used to estimate the odds ratios (OR) of the association between predictor variables and HIV infection. The prevalence of HIV infection among the 288 AMSM recruited to the project was 5.9% (95%CI: 3.7-9.3). Adjusted analysis showed a statistically significant association between self-identifying as a sex worker (OR = 3.74, 95%CI: 1.03-13.60) and HIV infection. Other associations with borderline statistical significance were the use of application programs to find sexual partners (OR = 3.30, 95%CI: 0.98-11.04), low schooling level (OR = 3.59, 95%CI: 0.96-13.41), failing to be hired or being dismissed from a job because of sexual orientation (OR = 2.88, 95%CI: 0.89-9.28), and not using health services as a usual source of care (OR = 3.14, 95%CI: 0.97-10.17). We found a high HIV prevalence among AMSM in Salvador. Furthermore, our study found that individual, social, and programmatic factors were associated with HIV infection among these AMSM. We recommend intensifying HIV combined-prevention activities for AMSM.


Subject(s)
HIV Infections , Sexual and Gender Minorities , Humans , Male , Adolescent , Female , HIV Infections/epidemiology , HIV Infections/prevention & control , HIV , Homosexuality, Male , Brazil/epidemiology , Prevalence , Cross-Sectional Studies , Sexual Behavior , Risk Factors
18.
Sex Health ; 20(2): 99-104, 2023 04.
Article in English | MEDLINE | ID: covidwho-2293643

ABSTRACT

Recent studies have provided evidence for the effectiveness of using doxycycline (Doxy-PEP) to prevent bacterial sexually transmissible infections (STI), namely chlamydia, gonorrhoea, and syphilis, among gay, bisexual, and other men who have sex with men who have experienced multiple STIs. However, there remain several unanswered questions around potential adverse outcomes from Doxy-PEP, including the possibility of inducing antimicrobial resistance in STIs and other organisms, and the possibility of disrupting the microbiome of people who choose to use Doxy-PEP. This interim position statement from the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine aims to outline the current evidence for Doxy-PEP, and to highlight potential adverse outcomes, to enable clinicians to conduct evidence-based conversations with patients in Australia and Aotearoa New Zealand who intend to use Doxy-PEP.


Subject(s)
HIV Infections , Hepatitis, Viral, Human , Sexual Health , Sexual and Gender Minorities , Sexually Transmitted Diseases , Male , Humans , Doxycycline/therapeutic use , Homosexuality, Male , HIV Infections/prevention & control , Post-Exposure Prophylaxis , New Zealand , Sexually Transmitted Diseases/prevention & control
19.
Sex Transm Dis ; 50(5): 304-309, 2023 05 01.
Article in English | MEDLINE | ID: covidwho-2303267

ABSTRACT

BACKGROUND: With the potential impact of the COVID-19 pandemic on HIV preexposure prophylaxis (PrEP) care management, we assessed the number of PrEP users and sexually transmitted infection (STI) testing-eligible PrEP users, STI testing rates, and prevalence between prepandemic (January 1, 2018-March 31, 2020) and early-pandemic (April 1, 2020-September 30, 2020) periods. METHODS: In this retrospective cohort study, a PrEP user for a given quarter is defined as either a previous PrEP user or a PrEP initiator who has at least 1-day coverage of tenofovir/emtricitabine in the given quarter. The STI testing-eligible PrEP users for a given quarter were defined as those persons whose runout date (previous dispense date + days of tenofovir/emtricitabine supply) was in the given quarter. RESULTS: The quarterly number of PrEP users increased from the first quarter of 2018 to the first quarter of 2020 and then decreased in the second and third quarter of 2020. Among STI testing-eligible PrEP users who had ≤14 days between runout and next refill date, gonorrhea and chlamydia screening testing rates were 95.1% for prepandemic and 93.4% for early pandemic ( P = 0.1011). Among all STI testing-eligible PrEP users who were tested for gonorrhea and chlamydia, gonorrhea prevalence was 6.7% for prepandemic and 5.7% for early pandemic ( P = 0.3096), and chlamydia prevalence was 7.0% for prepandemic and 5.8% for early pandemic ( P = 0.2158). CONCLUSIONS: Although the early COVID-19 pandemic resulted in lower numbers of PrEP users and PrEP initiators, individuals who remained continuous users of PrEP maintained extremely high rates of bacterial STI screening. With high STI prevalence among PrEP users, assessments of PrEP care management are continuously needed.


Subject(s)
COVID-19 , Gonorrhea , HIV Infections , Pre-Exposure Prophylaxis , Sexually Transmitted Diseases , Male , Humans , Gonorrhea/diagnosis , Gonorrhea/epidemiology , Gonorrhea/drug therapy , Pandemics/prevention & control , HIV Infections/diagnosis , HIV Infections/epidemiology , HIV Infections/prevention & control , Retrospective Studies , Homosexuality, Male , COVID-19/epidemiology , COVID-19/prevention & control , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/prevention & control , Tenofovir/therapeutic use , Emtricitabine , Pre-Exposure Prophylaxis/methods
20.
Sex Health ; 20(2): 105-117, 2023 04.
Article in English | MEDLINE | ID: covidwho-2303035

ABSTRACT

BACKGROUND: Young men who have sex with men (MSM) are a key population at high risk of sexually transmitted infections (STIs). We conducted a respondent-driven sampling (RDS) bio-behavioural survey to estimate the prevalence of five curable STIs: chlamydia, gonorrhoea, syphilis, trichomoniasis and Mycoplasma genitalium infection, and associated risk factors among tertiary student MSM (TSMSM) in Nairobi, Kenya. METHODS: Between February and March 2021, we recruited 248 TSMSM aged ≥18years who self-reported engaging in anal and/or oral sex with another man in the past year. Samples collected included urine, anorectal and oropharyngeal swabs for pooled Chlamydia trachomatis , Mycoplasma genitalium , Neisseria gonorrhoeae and Trichomonas vaginalis testing using multiplex nucleic acid amplification tests, and venous blood for serological Treponema pallidum screening and confirmation of current infection. Participants self-completed a behavioural survey on a REDCap digital platform. Data analysis was done using RDS-Analyst (v0.72) and Stata (v15). Differences in proportions were examined using the chi-squared (χ 2 ) test, and unweighted multivariate logistic regression was used to assess factors associated with STI prevalence. RESULTS: RDS-adjusted prevalence rates of at least one of the five STIs, chlamydia, gonorrhoea, Mycoplasma genitalium infection, trichomoniasis and latent syphilis were 58.8%, 51.0%, 11.3%, 6.0%, 1.5% and 0.7%, respectively. Factors independently associated with STI prevalence were inconsistent condom use (adjusted odds ratio (AOR)=1.89, 95% confidence interval (CI): 1.03-3.47, P =0.038) and the last sex partner being a regular partner (AOR=2.35, 95% CI: 1.12-4.92, P =0.023). CONCLUSION: STI prevalence among TSMSM in Nairobi, Kenya, is disturbingly high, demonstrating urgent need for tailored testing, treatment and prevention interventions for this population.


Subject(s)
Chlamydia Infections , Gonorrhea , Mycoplasma Infections , Mycoplasma genitalium , Sexual and Gender Minorities , Sexually Transmitted Diseases , Syphilis , Trichomonas Infections , Male , Humans , Homosexuality, Male , Gonorrhea/epidemiology , Gonorrhea/diagnosis , Syphilis/epidemiology , Prevalence , Kenya/epidemiology , Mycoplasma Infections/epidemiology , Mycoplasma Infections/diagnosis , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/diagnosis , Risk Factors , Neisseria gonorrhoeae , Surveys and Questionnaires , Trichomonas Infections/epidemiology , Chlamydia Infections/epidemiology , Chlamydia Infections/diagnosis
SELECTION OF CITATIONS
SEARCH DETAIL