High-risk behaviours in men from Bogotá, Colombia and the spread of HIV.

Our objective was to identify sexual behaviours related to risk of HIV infection. A cluster survey of sexually experienced men from diverse sociodemographic settings in Bogotá, Colombia was carried out using a standardized self-administered questionnaire. A high response rate (96%) resulted in the enrollment of 553 men. Most participants 129/442 reported having intercourse with women and 51/111 reported having sex with other men. Most respondents (90%) engaged in high-risk sexual practices; only 2% knew their HIV-1 serostatus. Consistent condom use was reported by 20% of those who practised anal sex, and was even lower (5%) among men who had sex with women during menses. Heterosexuals exhibited a higher degree of risky sexual patterns than homosexual/bisexuals (P=0.01). In conclusion, high-risk sexual practices are prevalent among men in Bogotá, particularly heterosexuals, attesting to the urgent need for effective and specific interventions to prevent HIV transmission.

Human herpesvirus 8 can be transmitted through blood in drug addicts.

Human Herpes virus type-8 (HHV-8) seroprevalence was studied in a population of HIV positive intravenous drug users (IVDUs) from Argentina. Analysis of this population also indirectly made it possible to study HHV-8 blood transmission, because these individuals frequently engage in needle sharing behavior and are capable of acquiring a broad array of blood borne pathogens, including Hepatitis B/C virus. The seroprevalence of HHV-8 in IVDUs was compared to a group of non-IVDUs and HIV negative individuals. Of the 223 individuals tested, 13.45% were HHV-8 positive, 16.99% in the IVDUs group, and 5.71% in the non-IVDUs. Among HIV positive IVDUs, 25/144 (17.36%) were also HHV-8 seropositive. The seropositivity rate of HHV-8 in HIV negative IVDUs was 11.1%. In contrast, HHV-8 seroprevalence in HIV negative heterosexual individuals without drug usage behavior was even lower (5.71%). The rate of HHV-8 infection in HIV positive IVDUs was three times as high compared to the non IVDU HIV negative individuals, suggesting that IVDU is a risk for HHV-8 infection. Furthermore, it was found that IVDUs showed a very high rate of Hepatitis B/C (52.77%), which also correlate with HHV-8 infection in this population (23.68%). All Hepatitis B/C positive individuals were also HIV positive. Our data confirm other studies showing that individuals who share needles are at risk for acquiring Hepatitis B/C and HIV infections. In addition, our results suggest that they are also at risk to acquiring HHV-8 infection by the same route.

Human herpesvirus 8 can be transmitted through blood in drug addicts.

Human Herpes virus type-8 (HHV-8) seroprevalence was studied in a population of HIV positive intravenous drug users (IVDUs) from Argentina. Analysis of this population also indirectly made it possible to study HHV-8 blood transmission, because these individuals frequently engage in needle sharing behavior and are capable of acquiring a broad array of blood borne pathogens, including Hepatitis B/C virus. The seroprevalence of HHV-8 in IVDUs was compared to a group of non-IVDUs and HIV negative individuals. Of the 223 individuals tested, 13.45

were HHV-8 positive, 16.99

in the IVDUs group, and 5.71

in the non-IVDUs. Among HIV positive IVDUs, 25/144 (17.36

) were also HHV-8 seropositive. The seropositivity rate of HHV-8 in HIV negative IVDUs was 11.1

. In contrast, HHV-8 seroprevalence in HIV negative heterosexual individuals without drug usage behavior was even lower (5.71

). The rate of HHV-8 infection in HIV positive IVDUs was three times as high compared to the non IVDU HIV negative individuals, suggesting that IVDU is a risk for HHV-8 infection. Furthermore, it was found that IVDUs showed a very high rate of Hepatitis B/C (52.77

), which also correlate with HHV-8 infection in this population (23.68

). All Hepatitis B/C positive individuals were also HIV positive. Our data confirm other studies showing that individuals who share needles are at risk for acquiring Hepatitis B/C and HIV infections. In addition, our results suggest that they are also at risk to acquiring HHV-8 infection by the same route.

Risky behaviour in Jamaican adolescent patients attending a sexually transmitted disease clinic

The prevalence of sexually transmitted diseases (STD) and risky behaviour patterns were studied in 165 adolescents attending a STD clinic in Jamaica. A standardised structured questionnaire, clinical algorithms for STD and serological tests for HIV and syphilitic infection were applied. High prevalences of risky behaviour including young age at onset of sexual activity, especially in boys, (mean age 12.5 +/- 2.5 years); unprotected sexual intercourse (only 4 used condoms consistently); multiple sexual partners (mean 3.8 +/- 2.4 and 1.8 +/- 1.2 for boys and girls, respectively) were found. Marijuana, used by 60 of the boys, was an independent risk factor for dysuria (adjusted Odds Ratio (OR), 2.0; 95 CI, 1.6-3.4). Repeated episodes of STD (33), coinfection with HIV (1.2), syphilis (1.2) and teenage pregnancy (13) were prominent findings. Educational strategies which promote behaviour intervention at an early age, frequent and consistent use of condoms, abstinence or delayed onset of sexual activity are essential to reducing the HIV/AIDS and STD risk in adolescents in Jamaica.

Risky behaviour in Jamaican adolescent patients attending a sexually transmitted disease clinic

The prevalence of sexually transmitted diseases (STD) and risky behaviour patterns were studied in 165 adolescents attending a STD clinic in Jamaica. A standardised structured questionnaire, clinical algorithms for STD and serological tests for HIV and syphilitic infection were applied. High prevalences of risky behaviour including young age at onset of sexual activity, especially in boys, (mean age 12.5 ñ 2.5 years); unprotected sexual intercourse (only 4 percent used condoms consistently); multiple sexual partners (mean 3.8 ñ 2.4 and 1.8 ñ 1.2 for boys and girls, respectively were found. Marijuana, used by 60 percent of the boys, was an independent risk factor for dysuria (adjusted Odds Ratio (OR), 2.0; 95 prcent CI, 1.6 - 3.4). Repeated episodes of STD (33 percent), coinfection with HIV (1.2 percent), syphilis (1.2 percent) and teenage pregnancy (13 percent) were prominent findings. Educational strategies which promote behaviour intervention at an early age, frequent and consistent use of condoms, abstinence or delayed onset of sexual activity are essential to reducing the HIV/AIDS and STD risk in adolescents in Jamaica.(Au)

HIV-related high risk sexual behaviors and practices among women in Bogotá, Colombia.

Determinants associated with high-risk sexual behaviors were investigated in 1,133 sexually active women in Bogotá, Colombia. A self-administered questionnaire was completed by two groups of women: 721 representing the general population (GP), and 412 commercial sex workers (CSWs). High-risk sexual behaviors for HIV/AIDS were evident in both groups. Nevertheless, consistent condom use was reported by only 6% of the GP group, as compared to 67% of the CSWs. Failure to recognize high-risk routes for HIV infection was indicated in 69% of the GP women for anal sex, and by the majority of both groups for intercourse during menses (56% GP women and 54% CSWs). Multivariate analysis revealed that education level, actual age, and age of first sex experience were significant predictors of high-risk sexual practices. The necessity for educational programs regarding high-risk sexual practices and risk of HIV/ AIDS is evident for HIV/AIDS prevention.

Differences in HIV-risk behaviours among recidivists and persons with their first episode of an STD in Guyana

OBJECTIVE: To ascertain differences in HIV-risk behaviour patterns between recidivists and persons having their first episode of an STD. DESIGN AND METHODS: A cross-sectional survey was conducted among 300 consecutive persons who complained of a new STD. RESULTS: 164/300 (55 percent) persons were recidivists while 136 (45 percent) were persons with their first STD episode. Recidivists were more likely to be males odds ratio (OR=1.89; 95 percent CI: 1.16-3.09) and Afro-Guyanese (OR=3.8; 95 percent CI: 1.96-5.50). As compared to recidivists, persons with their first STD episode were more likely to be younger, <20 years old, (23.4 percent vs. 8.8 percent; p=0.009). No significant differences were found between recidivists and first-timers with respect to educational attainment and marital status. As compared to the first-timers, recidivists were significantly less likely to report condom use (OR=0.56; 95 percent CI: 0.31-0.99) and two times more likely to report having had sex for money (OR=2.22; 95 percent CI: 1.23-5.32). No significant differences were found between recidivists and first-timers with respect to mean age of first sexual intercourse and mean number of partners during the past 12 months. Recidivists were more likely to report alcohol use (76.2 percent vs. 58. percent; p=0.003) and use of marijuana (23.2 percent vs. 16.3 percent; p=0.176). CONCLUSIONS: Recidivists were more likely to engage in high-risk sexual behaviour patterns, indicating that they should be targeted by HIV-prevention programmes that focus on the reduction of high-risk sexual practices.(Au)

Symptomatic and asymptomatic chlamydial non-gonococcal urethritis in Jamaica: the potential for HIV transmission.

To determine the contribution of Chlamydia trachomatis to non-gonococcal urethritis (NGU) in men attending sexually transmitted disease (STD) clinics in Jamaica we studied men with NGU (n=339), and control groups including asymptomatic men who were STD contacts (n=61), asymptomatic men who were not STD contacts (n=32) and men with gonococcal urethritis (GU) (n=61). Urethral specimens were examined for C. trachomatis and Neisseria gonorrhoeae. Serological tests for syphilis (STS) and HIV-1 infection were also performed. C. trachomatis accounted for 63% of cases of NGU but high prevalences were also found in asymptomatic STD contacts (59%), asymptomatic STD non-contacts (78%) and men with GU (48%). The prevalence of C. trachomatis in men with GU differed significantly from that in men with NGU and asymptomatic STD non-contacts (P<0.05). C. trachomatis infection in men with NGU was associated with multiple sex partners (71% vs 58%; chi2=4.78; odds ratio (OR)=1.76; P<0.05) and previous history of gonococcal infection (83% vs 42%; chi2=59.8; OR=6.8; P<0.0001). Concomitant infection with HIV-1 occurred in 5.2% of cases of NGU and 50% and 90%, respectively, of the HIV-positive men had chlamydia or reactive STS. As a cost effective strategy in the control of STD and HIV we recommend presumptive treatment for C. trachomatis in men seeking STD treatment in Jamaica.

Symptomatic and asymptomatic chlamydial non-gonococcal urethritis in Jamaica: the potential for HIV transmission

To determine the contribution of Chlamydia trachomatis to non-gonococcal urethritis (NGU) in men attending sexually transmitted (STD) clinics in Jamaica, we studied men with NGU (n=339), and control groups including asymptomatic men who were STD contacts (n=61), asymptomatic men who were not STD contacts (n=32) and men with gonococcal urethritis (GU) (n=61). Urethral specimens were examined for C. trachomatis and Neisseria gonorrhoeae. Serological tests for syphillis (STS) and HIV-1 infection were also performed. C. trachomatis accounted for 63 percent of cases of NGU but high prevalence of C. trachomatis in men with GU differed significantly from that in men with NGU and asymptomatic STD non-contacts (P<0.05). C. trachomatis infection in men with NGU was associated with multiple sex partners (71 percent vs 58 percent; x2=4.78; odds ratio OR=1.76; P<0.05) and previous history of gonococcal infection (83 percent vs 42 percent; x2=59.8; OR=6.8; P<0.0001). Concomitant infection with HIV-1 occured in 5.2 percent of cases of NGU and 50 percent and 90 percent, respectively, of the HIV-positive men had chlamydia or reactive STS. As a cost effective strategy in the control of STD and HIV we recommend presumptive treatment for C. trachomatis in men seeking STD treatment in Jamaica.(Au)

Risky behaviour in Jamaican adolescent patients attending a sexually transmitted disease clinic.

The prevalence of sexually transmitted diseases (STD) and risky behaviour patterns were studied in 165 adolescents attending a STD clinic in Jamaica. A standardised structured questionnaire, clinical algorithms for STD and serological tests for HIV and syphilitic infection were applied. High prevalences of risky behaviour including young age at onset of sexual activity, especially in boys, (mean age 12.5 +/- 2.5 years); unprotected sexual intercourse (only 4% used condoms consistently); multiple sexual partners (mean 3.8 +/- 2.4 and 1.8 +/- 1.2 for boys and girls, respectively) were found. Marijuana, used by 60% of the boys, was an independent risk factor for dysuria (adjusted Odds Ratio (OR), 2.0; 95% CI, 1.6-3.4). Repeated episodes of STD (33%), coinfection with HIV (1.2%), syphilis (1.2%) and teenage pregnancy (13%) were prominent findings. Educational strategies which promote behaviour intervention at an early age, frequent and consistent use of condoms, abstinence or delayed onset of sexual activity are essential to reducing the HIV/AIDS and STD risk in adolescents in Jamaica.

Drug use and syphilis. Co-factors for HIV transmission among commercial sex workers in Guyana.

A cross-sectional survey was conducted among 124 street- and brothel-based female commercial sex workers (CSWs) in Georgetown in January and February 1997 to determine the seroprevalence of human immunodeficiency virus (HIV) infection and describe the sexual practices and drug use patterns. Their median age was 30 years (range 17 to 52 years). 119 (88%) reported regular alcohol consumption while looking for clients, 27 (22%) said they smoked cocaine and 51 (42%) reported use of marijuana. Street-based CSWs were significantly more likely to report marijuana use (p = 0.033). 72% reported that they never used condoms with regular sex partners and 35% reported that they never used condoms with clients. Brothel-based women were significantly more likely to report consistent condom use with their clients (p = 0.05). 46% (54/118) tested HIV positive and 28% (33/118) had a positive serological test for syphilis. Factors that were significantly associated with HIV infection included a positive serological test for syphilis (OR = 7.56; 95% CI = 2.7-21.97; p < 0.01) and a history of having received treatment for syphilis (OR = 2.93; 95% CI = 1.12-7.8). Weak associations were also found between HIV infection and a history of cocaine use (OR = 2.57; 95% CI = 0.95-7.11; p = 0.039); having more than four clients per night (OR = 5.14; 95% CI = 1.65-16.74; p = 0.04); and a history of receiving treatment for salpingitis (OR = 2.31; 95% CI = .93-5.75; p = 0.0035). No statistically significant association was found between HIV infection and marijuana use nor any sociodemographic variables (age, place of work, and duration of sex work). There is an urgent need for a community based behavioural intervention programme targetting this high risk population.

Total immunoglobulin E levels and dengue infection on San Andrés Island, Colombia.

An evaluation of total immunoglobulin E (IgE) and dengue serostatus in 168 subjects from San Andrés Island, Colombia, revealed altered levels of IgE in 89% of the population. IgE levels were higher in patients with a history of dengue or with a current secondary or current primary infection than in subjects with no exposure (P = 0. 01). Dengue infection accounted for 23% of the variation in IgE levels.

Drug use and syphilis. Co-factors for HIV transmission among commercial sex workers in Guyana

A cross-sectional survey was conducted among 124 street- and brothel-based female commercial sex workers (CSWs) in Georgetown in January and February 1997 to determine the seroprevalence of human immunodeficiency virus (HIV) infection and describe the sexual practices and drug use patterns. Their median age was 30 years (range 17 to 52 years). 119 (88) reported regular alcohol consumption while looking for clients, 27 (22) said they smoked cocaine and 51 (42) reported use of marijuana. Street-based CSWs were significantly more likely to report marijuana use (p = 0.033). 72reported that they never used condoms with regular sex partners and 35reported that they never used condoms with clients. Brothel-based women were significantly more likely to report consistent condom use with their clients (p = 0.05). 46(54/118) tested HIV positive and 28(33/118) had a positive serological test for syphilis. Factors that were significantly associated with HIV infection included a positive serological test for syphilis (OR = 7.56; 95CI = 2.7-21.97; p < 0.01) and a history of having received treatment for syphilis (OR = 2.93; 95CI = 1.12-7.8). Weak associations were also found between HIV infection and a history of cocaine use (OR = 2.57; 95CI = 0.95-7.11; p = 0.039); having more than four clients per night (OR = 5.14; 95CI = 1.65-16.74; p = 0.04); and a history of receiving treatment for salpingitis (OR = 2.31; 95CI = .93-5.75; p = 0.0035). No statistically significant association was found between HIV infection and marijuana use nor any sociodemographic variables (age, place of work, and duration of sex work). There is an urgent need for a community based behavioural intervention programme targetting this high risk population.

Drug use and syphilis: co-factors for HIV transmission among commercial sex workers in Guyana

A cross-sectional survey was conducted among 124 street-and brothel-based female commercial sex workers (CSWs) in Georgetown in January and February 1997 to determine the seroprevalence of human immunodeficiency virus (HIV) infection and describe the sexual practices and drug use patterns. Their median age was 30 years (range 17 to 52 years). 119 (88 percent) reported regular alcohol consumption while looking for clients, 27 (22 percent) said they smoked cocaine and 51 (42 percent) reported use of marijuana. Street-based CSWs were significantly more likely to report marijuana use (p = 0.033). 72 percent reported that they never used condoms with regular sex partners and 35 percent reported that they never used condoms with clients. Brothel-based women were significantly more likely to report consistent condom use with their clients (p = 0.05). 46 percent (54/118) tested HIV positive and 28 percent (33/118) had a positive serological test for syphilis. Factors that were significantly associated with HIV infection included a positive serological test for syphilis (OR = 7.56; 95 percent CI = 2.7-21.97; p < 0.01) and a history of having received treatment for syphilis (OR = 2.93; 95 percent CI = 1.12-7.8). Weak associations were also found between HIV infection and a history of cocaine use (OR = 2.57; 95 percent CI = 0.95-7.11; p = 0.039); having more than four clients per night (OR = 5.14; 95 percent CI = 1.65-16.74; p = 0.04; and a history of receiving treatment for salpingitis (OR = 2.31; 95 percent CI = 0.93-5.75; p = 0.0035). No statistically significant association was found between HIV infection and marijuana use nor any sociodemographic variables (age, place of work, and duration of sex work). There is an urgent need for a community based behavioural intervention programme targetting this high risk population (AU)

Evaluation of the MRL diagnostics dengue fever virus IgM capture ELISA and the PanBio Rapid Immunochromatographic Test for diagnosis of dengue fever in Jamaica

We evaluated two new commercial dengue diagnostic tests, the MRL Diagnostics Dengue Fever Virus IgM Capture ELISA and the PanBio Rapid Immunochromatographic Test, on serum samples collected during a dengue epidemic in Jamaica. The MRL ELISA method correctly identified 96 percent (78 of 80) of the samples as dengue positive, while the PanBio test identified 100 percent (80 of 80). Both tests were 100 percent (20 samples of 20) specific.(Au)

Evaluation of the MRL diagnostics dengue fever virus IgM capture ELISA and the PanBio Rapid Immunochromatographic Test for diagnosis of dengue fever in Jamaica.

We evaluated two new commercial dengue diagnostic tests, the MRL Diagnostics Dengue Fever Virus IgM Capture ELISA and the PanBio Rapid Immunochromatographic Test, on serum samples collected during a dengue epidemic in Jamaica. The MRL ELISA method correctly identified 98% (78 of 80) of the samples as dengue positive, while the PanBio test identified 100% (80 of 80). Both tests were 100% (20 samples of 20) specific.

Intestinal parasites in human immunodeficiency virus infected patients

Treatment of concurrent opportunistic and non-opportunistic infections is a priority in improving quality of life in HIV infected patients in developing countries. The objective of the study was to determine the prevalence of opportunistic intestinal parasites in persons with and without HIV infection in Honduras. It was based on study of 52 HIV-positive and 48 HIV-negative persons at the Social Security Hospital in San Pedro Sula. Data sheets recording age, sex, stool parasitology, HIV serology and clinical state of HIV infection were completed for each study participant. Cryptosporidium parvum and Strongyloides stercoralis, which are intracellular or live in the mucosa, were found exclusively in persons infected with HIV. In contrast, the prevalence of the extracellular parasites Giardia lamblia, Ascaris lumbricoides and Trichuris trichiura was significantly higher in persons who were HIV-negative. It appears that infection with HIV may selectively deter the establishment of some intestinal parasites. This may be due to HIV induced enteropathy which does not favor the establishment of extracellular parasites. However, intracellular and mucosal dwelling organisms may benefit from pathological changes and reduced local immune responses which are induced by the virus which, in turn, lead to higher prevalence among HIV-infected individuals. We further postulate that the switch from a Th-1 to a predominantly Th-2 response as HIV infection progresses to AIDS may lead to an environment which is unsuitable for parasite survival (AU)

Epidemiology of giardiasis and cryptosporidiosis in Jamaica.

We report the findings of a cross-sectional epidemiologic study of Giardia lamblia and Cryptosporidum infections in Jamaica. Three hundred twenty eight stool samples from patients less than one to 81 years of age were examined using formalin-ether concentration for G. lamblia, Zeihl-Neelsen staining for Cryptosporidium, and the Prospect rapid enzyme immunoassay (EIA; Alexon, Sunnyvale, CA) for parasite diagnosis. The Prospect Giardia rapid assay detected 17 cases of G. lamblia infection compared with six by formalin-ether concentration. However, the Prospect Cryptosporidum EIA did not increase the rate of detection of Cryptosporidum when compared with Zeihl-Neelsen staining. Cryptosporidum infections were most frequently diagnosed in children less than five years old and prevalence decreased with age. In contrast, the prevalence of giardiasis increased as children became older. There were no associations between the infections and stool consistency, clinical manifestations, or sex of the individuals. The contribution of the parasites to childhood morbidity will depend on accurate laboratory diagnosis.