[High-risk sex behavior and HIV prevalence among gay and bisexual men in the community of Madrid]. / Conductas sexuales de riesgo y prevalencia de infección por VIH en hombres con prácticas homosexuales y bisexuales en la Comunidad de Madrid.

BACKGROUND: To analyze high-risk sexual behavior as regards HIV, the use of preventive measures and the patient-reported prevalence of HIV infections among males belonging to one of the leading homosexual associations in the Region of Madrid. METHODS: Cross-sectional study conducted in 1997-1998 by way of mailed anonymous questionnaires. An analysis is made of the sociodemographic characteristics, how often condoms are used for different types of sexual intercourse with regular or casual partners, patient-reported prevalence of HIV and other related aspects. RESULTS: 157 questionnaires were returned by gay/bisexual males. These subjects averaged 32 years of age, 85% having a high school or college education, over the past 3 months, 56% had had intercourse with more than one man; 70.6% practiced insertive anal intercourse with a regular partner and 57.4% with casual partners, solely 32.5% and 61.1% of whom always used a condom. 69.7% had receptive anal intercourse with a regular partner and 39.4% with casual partners, 35.5% and 78.4% of whom respectively always used a condom. 86.6% had oral-genital intercourse, less than 10% having always used a condom. 137 were aware of their serological condition, and 15.2% were HIV positive. 10% had had some STD at some point during the previous year. CONCLUSIONS: A major percentage of those surveyed were involved in high-risk practices (several partners and unprotected high-risk sexual intercourse) which, in conjunction with the major prevalence of infection, can be said to be the same as a major seroconversion rate.

Pulmonary and extrapulmonary tuberculosis at AIDS diagnosis in Spain: epidemiological differences and implications for control.

OBJECTIVE: To ascertain the differential factors associated with pulmonary versus extrapulmonary tuberculosis (TB) at AIDS diagnosis in Spain. DESIGN: Analysis of AIDS surveillance data. METHODS: Data about AIDS patients, aged 12 years and over, diagnosed in 1995 were taken from the Spanish AIDS Register. The respective proportions of cases presenting with pulmonary and extrapulmonary TB at AIDS diagnosis were analysed by gender, age, HIV transmission category, prison record, province, country of origin and CD4+ lymphocyte count. A multivariate analysis was carried out using logistic regression analysis. RESULTS: Of 6161 AIDS cases analysed, 20.1% presented with pulmonary TB and 20.4% with extrapulmonary TB. Overall, TB showed association with men, age under 30 years, injecting drug users (IDU), cases of heterosexual HIV transmission, and concurrent or past stay in prison. Frequency of TB proved no different among foreign-born patients. Pulmonary and extrapulmonary TB showed a similar distribution for most of the variables. Current prison inmates registered a high risk of pulmonary TB [adjusted odds ratio (OR), 4.2; 99% confidence interval (CI), 3.1-5.8] compared with patients without prison record, and ex-prison inmates registered an intermediate risk (OR, 2.3; 99% CI, 1.8-3.0). Among patients with TB at AIDS diagnosis, pulmonary TB was associated with subjects currently in prison (OR, 2.1; 99% CI, 1.5-3.0) and injecting drug use (OR, 1.5; 99% CI, 1.0-2.4). Pulmonary TB presented with higher CD4+ lymphocyte counts than extrapulmonary TB (P < 0.001). CONCLUSIONS: The results suggest the importance that recent transmission of TB may be having among young adults, IDU and prison inmates in particular, and calls for a review of control strategies.

Impact of human immunodeficiency virus infection on mortality among young men and women in Spain.

BACKGROUND: This paper describes the impact of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) mortality among young adults in Spain with specific reference to other causes of death. METHODS: Based on death registration data for the period 1980-1993, HIV/AIDS was compared against all other causes of death by gender, using specific rates in the 25-44 age group and standardized rates for potential years of life lost (PYLL). RESULTS: In 1993, HIV/AIDS was the leading cause of death among men aged 25-44 years (21.8% of all deaths) and the second leading cause of death among women (14.9%), exceeded only by cancer. Since 1982, the trend in the overall standardized mortality rate for men in the 25-44 age group has been reversed, showing a progressive increase. Similarly, since 1984 there has been a halt in the decline in female mortality. For both sexes, maintenance of these trends in mortality was largely ascribable to the effect of HIV/AIDS deaths which registered a marked rise, a rise far sharper than that witnessed for variations in all other causes studied. In 1993, the adjusted PYLL rate for HIV/AIDS for ages 1-70 rose to 615 per 100,000 population in men and 156 in women. These values accounted for 9.2% and 5.8% of PYLL for all causes, thereby ranking HIV/AIDS behind motor vehicle accidents as the second leading cause of premature death in men, and behind motor vehicle accidents and breast cancer as the third leading cause in women. For both sexes, the rise in the PYLL rate for HIV/AIDS from 1992 to 1993 proved far greater than that for all other causes of death. CONCLUSION: In Spain, HIV/AIDS has become the leading cause of death among young adults and is counteracting improvements in mortality due to other causes. It should therefore be regarded as a priority public health problem.