High HIV prevalence among men who have sex with men in Jamaica is associated with social vulnerability and other sexually transmitted infections.

BACKGROUND: Human immunodeficiency virus (HIV) prevalence among men who have sex with men (MSM) is thought to be high in Jamaica. The objective of this study was to estimate HIV prevalence and identify risk factors in order to improve prevention approaches. METHODS: With the help of influential MSM, an experienced research nurse approached MSM in four parishes to participate in a cross-sectional survey in 2007. Men who have sex with men were interviewed and blood taken for HIV and syphilis tests, and urine taken for gonorrhoea, chlamydia and trichomonas testing using transcription-mediated amplification assays. A structured questionnaire was administered by the nurse. RESULTS: One third (65 of 201; 32%, 95% Confidence Interval (CI) 25.2, 47.9) of MSM were HIV positive. Prevalence of other sexually transmitted infections (STI) was: chlamydia 11%, syphilis 6%, gonorrhoea 3.5% and trichomonas 0%. One third (34%) of MSM identified themselves as being homosexual, 64% as bisexual and 1.5% as heterosexual. HIV positive MSM were significantly more likely to have ever been told by a doctor that they had an STI (48% vs 27%, OR 2.48 CI 1.21, 5.04, p = 0.01) and to be the receptive sexual partner at last sex (41% vs 23%, OR 2.41 CI 1.21, 4.71, p = 0.008). Men who have sex with men who were of low socio-economic status, ever homeless and victims of physical violence were twice as likely to be HIV positive. The majority (60%) of HIV positive MSM had not disclosed their status to their partner and over 50% were not comfortable disclosing their status to anyone. CONCLUSIONS: The high HIV prevalence among MSM is an important factor driving the HIV epidemic in Jamaica. More effective ways need to be found to reduce the high prevalence of HIV among MSM including measures to reduce their social vulnerability, combat stigma and discrimination and empower them to practice safe sex.

High HIV prevalence among men who have sex with men in Jamaica is associated with social vulnerability and other sexually transmitted infections / La alta prevalencia del VIH entre hombres que tienen relaciones sexuales con hombres en Jamaica se halla asociada con vulnerabilidad social e infecciones de transmisión sexual

BACKGROUND: Human immunodeficiency virus (HIV) prevalence among men who have sex with men (MSM) is thought to be high in Jamaica. The objective of this study was to estimate HIV prevalence and identify risk factors in order to improve prevention approaches. METHODS: With the help of influential MSM, an experienced research nurse approached MSM in four parishes to participate in a cross-sectional survey in 2007. Men who have sex with men were interviewed and blood taken for HIV and syphilis tests, and urine taken for gonorrhoea, chlamydia and trichomonas testing using transcription-mediated amplification assays. A structured questionnaire was administered by the nurse. RESULTS: One third (65 of 201; 32%, 95% Confidence Interval (CI) 25.2, 47.9) of MSM were HIV positive. Prevalence of other sexually transmitted infections (STI) was: chlamydia 11%, syphilis 6%, gonorrhoea 3.5% and trichomonas 0%. One third (34%) of MSM identified themselves as being homosexual, 64% as bisexual and 1.5% as heterosexual. HIV positive MSM were significantly more likely to have ever been told by a doctor that they had an STI (48% vs 27%, OR 2.48 CI 1.21, 5.04, p = 0.01) and to be the receptive sexual partner at last sex (41% vs 23%, OR 2.41 CI 1.21, 4.71, p = 0.008). Men who have sex with men who were of low socio-economic status, ever homeless and victims of physical violence were twice as likely to be HIV positive. The majority (60%) of HIV positive MSM had not disclosed their status to their partner and over 50% were not comfortable disclosing their status to anyone. CONCLUSIONS: The high HIV prevalence among MSM is an important factor driving the HIV epidemic in Jamaica. More effective ways need to be found to reduce the high prevalence of HIV among MSM including measures to reduce their social vulnerability, combat stigma and discrimination and empower them to practice safe sex.

ANTECEDENTES: Se piensa que la prevalencia del virus de inmunodeficiencia humana (VIH) entre hombres que tienen sexo con hombres (HSH) es alta en Jamaica. El objetivo de este estudio fue estimar la prevalencia del VIH e identificar los factores de riesgo a fin de mejorar las estrategias de prevención. MÉTODOS: Con la ayuda de HSH influyentes, una enfermera investigadora experimentada abordó a HSH en cuatro distritos, recabando su participación en una encuesta transversal en 2007. Se entrevistó a hombres que tienen sexo con hombres, y se tomaron muestras de sangre para realizar pruebas de VIH. Asimismo se tomaron muestras de orina para hacer pruebas de gonorrea, clamidia y trichomonas, usando ensayos de amplificación mediada por transcripción. Un cuestionario estructurado fue aplicado por la enfermera. RESULTADOS: Un tercio (65 de 201; 32%, 95% intervalo de confianza (IC) 25.2, 47.9) de los HSH fueron VIH positivos. La prevalencia de otras infecciones de transmisión sexual (ITS) fue como sigue: clamidia 11%, sífilis 6%, gonorrea 3.5%, y trichomonas 0%. Un tercio (34%) de los HSH se identificaron como homosexuales, 64% como bisexuales, y un 1.5% como heterosexuales. Los HSH que resultaron VIH positivos presentaron una probabilidad significativamente mayor de haber recibido un diagnóstico de ITS por parte de un médico (48% vs 27%, OR 2.48 IC 1.21, 5.04, p = 0,01), y de haber sido la pareja sexual receptora en el último intercambio sexual (41% frente a 23%, OR 2.41 IC 1.21, 4.71, p = 0.008). Los hombres que tuvieron sexo con hombres tenían un bajo nivel socio-económico, y alguna vez estuvieron sin hogar, fueron víctimas de violencia física, y tenían una probabilidad dos veces más alta de ser VIH positivos. La mayoría (60%) de los MSM VIH positivos no habían revelado su condición a sus parejas, y más del 50% no se sentían cómodos revelando su estatus a otras personas. CONCLUSIONES: La alta prevalencia de VIH entre HSH es un factor importante en el desarrollo de la epidemia de VIH en Jamaica. Se necesita hallar formas más eficaces de reducir la alta prevalencia de VIH entre los HSH, incluidas las medidas para reducir su vulnerabilidad social, combatir el estigma y la discriminación, y capacitarles para practicar sexo seguro.

Alicyclobacillus acidoterrestris in pasteurized exotic Brazilian fruit juices: isolation, genotypic characterization and heat resistance.

In this study, the population of Alicyclobacillus spp. was estimated in pasteurized exotic Brazilian fruit juices using the most probable number (MPN) technique followed by biochemical tests. Pasteurized passion fruit (n = 57) and pineapple (n = 50) juices were taken directly from Brazilian manufacturers. While Alicyclobacillus spp. was isolated from passion fruit juice, the microorganism was not found in any pineapple juice samples. A higher incidence of Alicyclobacillus was observed in samples taken in June and July (dry months in Brazil) in comparison to the other months (March, April, May and August), and the highest Alicyclobacillus counts were recovered from these samples(>23 MNP/100 mL). Sixteen (n = 16) Alicyclobacillus strains were typed using the randomly amplified polymorphic DNA method (RAPD-PCR). RAPD-PCR revealed great genetic similarity between the passion fruit juice strains and Alicyclobacillus acidoterrestris DSM 2498. The heat resistance of three isolates was determined, and the mean D(95°) (1.7 min) and z (7.6 °C) values in the passion fruit juice were not significantly different (p > 0.05) from those obtained for the DSM 2498 strain (D(95°) = 1.5 min and z = 7.1 °C). This is the first report on the isolation of A. acidoterrestris from exotic fruit juices such as passion fruit juice. It is worth pointing out the importance of applying good agricultural practices in the field and applying controls for the fruit selection and washing steps, as well as controlling the time/temperature conditions for pasteurization so as to reduce the incidence and chances of A. acidoterrestris spoilage in these juices.

Managing HIV. Part 7: Professional issues. 7.4 HIV and complementary medicine.

Many people with HIV use complementary or alternative therapies, often without the knowledge of their doctors. To encourage open communication with their patients, doctors need to be aware of what complementary therapies are available and willing to discuss their use. They are then in a better position to defend their patients against exploitation or unsafe treatment.

Managing HIV. Part 2. Phases of disease. 2.3 HIV and intermediate immune deficiency.

Intermediate immune deficiency is defined by a CD4 cell count between 500/microL and 200/microL. This phase is one of increasing therapeutic intervention, mostly for minor infections of skin and mucous membranes and mostly manageable within general practice. Most people with HIV begin antiretroviral therapy during this phase. Regular monitoring of CD4 cell count is essential for making appropriate therapeutic decisions and for determining prognosis.

Managing HIV. Part 1: Principles. 1.2 Strategies of care in managing HIV.

Apply the science, use a team approach, help patients to promote their own health, ensure access to support and accept a public health role. These are the practical lessons of our experience in HIV medicine.