[Sexually transmitted infections in a cohort of female sex workers in Palermo]. / Infezioni sessualmente trasmesse osservate in una coorte di prostitute straniere a Palermo.

AIM: To evaluate the prevalence of sexually transmitted infections (HIV, HBV, HCV, Treponema pallidum) in a cohort of foreign female sex workers observed in Palermo from 1999 to 2008. MATERIALS AND METHODS: Authors conducted a prospective observational study on 239 foreign female sex workers aged between 18 and 36 years old. The nation of origin was Nigeria, Romania, Ucraina, Bulgaria. RESULTS: Overall, the diagnosis of IST was placed in 17 women, 7.1% of the population under study. In 14 cases we observed a single infection: HIV in 5 cases; syphilis and HBV in 4 cases; HCV in only one case. In the remaining three women were diagnosed a co-infection with HIV and HBV, HIV and HCV, HIV and syphilis LUE. In our study, a statistically significant correlation (p<0.0001) was observed between the non-constant condom use and a higher frequency of HIV, HCV and syphilis infection. This correlation was not statistically significant in the women with HBV infection. CONCLUSIONS: The results of this study show a higher morbidity of this specific population, and, consequently, the need to start as soon as possible specific programs of intervention which can ensure the health of these women. Language and cultural barriers, as well as immigration concern among all vulnerable populations, form barriers to healthcare access.

[Infectious diseases and health in the migrant people: experience from Lampedusa 2011]. / Salute e malattie infettive nella popolazione migrante: l'esperienza della "Coorte di Lampedusa 2011"

Migration is one of the possible points of contact between the rich world and the poor world. This paper analyzes and quantifies the presence of infectious diseases in a cohort of about 25,000 immigrants from Africa who landed in Lampedusa in 2011. The main clinical presentations of a cohort of migrants in Lampedusa were observed consecutively in 2011 during landing and then within the reception centers. In over 75% of the cases observed, the population was healthy. In 23% of cases diseases were observed in relation to the migration route, especially the precarious conditions of the crossing of the Channel of Sicily. Infectious diseases or female genital pathologies were observed in less than 2% of the population. The experience of Lampedusa in 2011 confirmed the Healthy Migrant theory, a population predominantly represented by young people who are at risk of becoming ill during the difficult migration or in the host country due to poor living conditions. Taking care of such people is an act of civilization and ensures the health of this population and of the whole community.

Sexual behaviour reported by a sample of Italian MSM before and after HIV diagnosis.

In 2006 we conducted a cross-sectional study involving hospital clinical centres in five Italian cities to compare the sexual behaviour of HIV-positive MSM (men who have sex with men) before and after the diagnosis of HIV infection. Each centre was asked to enrol 30 HIV-positive persons aged ≥ 18 years. The questionnaire was administered to 143 MSM on average 9 years after HIV diagnosis. After diagnosis there was a decrease in the number of sexual partners: the percentage of persons who reported having had more than 2 partners decreased from 95.8% before diagnosis to 76.2% after diagnosis. After diagnosis, there was a significant decrease in the percentage of persons who had never (or not always) used a condom with their stable partner for anal sex from 69.2% before diagnosis to 26.6% after diagnosis and for oral-genital sex from 74.8% before diagnosis to 51.7% after diagnosis. Though at-risk behaviour seems to decrease after diagnosis, seropositive MSM continue to engage in at-risk practices: one fourth of them did not use a condom during sexually transmitted infections (STI) episodes, 12.5% of the participants had had sex for money, and 8.4% had paid for sex. The study shows that our sample of Italian HIV-positive MSM, though aware of being infected, engage in sexual behaviours that could sustain transmission of HIV and other STIs. The results could constitute the first step in implementing national prevention programs for persons living with HIV.

HIV infection among illegal migrants, Italy, 2004-2007.

To determine HIV prevalence and place of exposure for illegal migrants in Italy, we tested 3,003 illegal adult migrants for HIV; 29 (0.97%) were HIV positive. Antibody avidity index results (indicators of time of infection) were available for 27 of those persons and showed that 6 (22.2%) presumably acquired their infection after migration.

Changes in at-risk behavior for HIV infection among HIV-positive persons in Italy.

Many HIV-positive persons reportedly continue to engage in at-risk behavior. We compared the sexual and drug-using practices of HIV-positive persons before and after the diagnosis of HIV infection to determine whether their behavior had changed. To this end, in 2006, we conducted a cross-sectional study involving clinical centers in five Italian cities. Each center was asked to enroll 100 persons aged 18 years or older who had a diagnosis of HIV infection that dated back at least 2 years. Data were collected with a specifically designed questionnaire, administered during a structured interview. The McNemar chi2 test was used to compare the data before and after the diagnosis. A total of 497 persons participated (65.5% males; median age of 40 years; age range, 34-45 years). The most common exposure categories were: heterosexual contact (43.4%), homosexual contact (27.2%), and injecting drug use (20.6%). Although the percentage of drug users significantly decreased after diagnosis, 32.4% of injectors continued to use drugs, and approximately half of them exchanged syringes. Regarding sexual behavior, after diagnosis there was a significant decrease in the number of sexual partners and in stable relationships and an increase in condom use, both for persons with stable partners and those with occasional partners, although the percentage varied according to the specific sexual practice. These results indicate that though at-risk behavior seems to decrease after the diagnosis of HIV infection, seropositive persons continue to engage in at-risk practices, indicating the need for interventions specifically geared toward HIV-positive persons.