The HIV epidemic in Haiti: is disability a factor?

People with disabilities (PWD) are thought to be low risk for HIV because of social norms regarding disability and sex. However, qualitative studies indicate they are at risk and are not being reached by HIV programs. The Demographic and Health Survey (DHS) conducted in Haiti in 2016 included HIV biomarker data and disability status. Crude and adjusted odds ratios were calculated using a disability severity indicator as the independent variable and HIV infection as the dependent variable. Covariates were selected based on theory and previous studies. Individuals reporting milder disabilities had a higher odds of HIV infection in the crude model (OR:1.65; CI: 1.16-2.34) and those adjusted for demographics (OR:1.73; CI:1.19-2.51) and sexual activity (OR:1.60; CI:1.06-2.42). Those with moderate and more severe disabilities have the same odds of HIV infection as the general population. PWD are HIV-positive and at risk of HIV infection. Based on this, it is essential that HIV education, testing, and treatment programs are inclusive of PWD. Accessible HIV education materials need to be created. HIV testing programs should involve PWD in planning and implementation. Providers of HIV care must be trained regarding the needs of PWD for reproductive healthcare.

Low socioeconomic status is associated with self-reported HIV positive status among young MSM in Brazil and Peru.

BACKGROUND: Despite efforts to stop HIV epidemic in Latin America, new HIV cases continue to increase in the region especially among young MSM (YMSM). This study aims to assess if sociodemographic characteristics are associated with self-reported HIV positive status among YMSM from three Latin American countries. METHODS: Cross-sectional web-based survey advertised on dating apps (Grindr and Hornet) and Facebook in Brazil, Mexico and Peru. For this analysis, we included YMSM aged 18-24 years who self-reported their HIV status. We used multivariable logistic regression models for each country separately to verify if sociodemographic characteristics (race, education and income) were associated with HIV self-reported status after adjusting for behavior characteristics (sexual attraction and steady partner). RESULTS: Among 43,687 MSM who initiated the questionnaire, 27,318 (62.5%) reported their HIV status; 7001 (25.6%) of whom were YMSM. Most YMSM (83.4%) reported an HIV test in the past year, and 15.7% reported an HIV positive status in Peru, 8.4% in Mexico and 7.7% in Brazil. In adjusted models, low-income was associated with higher odds of self-reported HIV positive status in Brazil (aOR = 1.33, 95%CI: 1.01-1.75) and Peru (aOR = 1.56, 95%CI: 1.02-2.40), but not in Mexico. Lower education was associated with higher odds of self-reported HIV positive status only in Brazil (aOR = 1.35, 95%CI: 1.05-1.75). CONCLUSIONS: In this large, cross-country study, self-reported HIV positive status among YMSM was high. Lower socioeconomic status was associated with higher odds of self-reported HIV positive status in Brazil and Peru. There is an urgent need for HIV prevention interventions targeting YMSM, and efforts to address low-income YMSM are especially needed in Peru and Brazil.

The Prevalence of HIV Among Men Who Have Sex With Men (MSM) and Young MSM in Latin America and the Caribbean: A Systematic Review.

Young men who have sex with men (YMSM) under 25 years old are among the few populations with increasing numbers of new HIV infections in parts of the world where HIV incidence is declining overall. In this systematic review, we synthesize the literature on HIV prevalence among MSM in Latin America and the Caribbean focusing on YMSM. Results were stratified according to study population sampling method used (probability and non-probability based). Forty-seven studies from 17 countries were published in the last 10 years. Among studies using probability-based sampling method (N = 21), HIV prevalence among MSM ranged from 1.2 to 32.6%. HIV prevalence tended to increase over time in studies sampling at different time points. HIV prevalence among YMSM exceeded 5.0% in more than a half of studies (51%; N = 22/43). Our review corroborates the high and potentially rising incidence of HIV among YMSM and characterizes the region's greatest challenge to ending the epidemic.

RESUMEN: Los hombres jóvenes que tienen sexo con hombres (JHSH) menores de 25 años se encuentran entre las pocas poblaciones con un aumento en las nuevas infecciones por VIH en regiones del mundo donde la incidencia del VIH está disminuyendo en general. En esta revisión sistemática, resumimos la literatura sobre la prevalencia del VIH entre HSH en América Latina y el Caribe, con un enfoque en JHSH. Los resultados se estratificaron por método de muestreo de la población de estudio (probabilístico y no probabilístico). Nuestra investigación encontró 47 estudios de 17 países publicados en los últimos 10 años. Entre los estudios que utilizaron muestreo probabilístico (N = 21), la prevalencia del VIH entre HSH osciló entre 1.2% y 32.6%. La prevalencia del VIH aumentó con el tiempo en ciudades que repitieron el método de muestreo. La prevalencia del VIH entre JHSH superó el 5.0% en más de la mitad de los estudios (51%; N = 22/43). Nuestro análisis corrobora la alta y potencialmente creciente incidencia de VIH entre JHSH y caracteriza el mayor desafío de la región para poner fin a la epidemia.

Prevalence and Risk Factors for HIV Infection in a Population of Homosexual, Bisexual, and Other Men Who Have Sex with Men in the Metropolitan Region of Chile: A Re-emerging Health Problem.

According to the most recent UNAIDS report, the number of new HIV infections has increased by 34% since 2010 in Chile, representing the largest increase in the Americas. The objective of this study was to identify factors associated with HIV prevalence among men who have sex with men (MSM) in the metropolitan region (MR) of Santiago, Chile. Cross-sectional study of MSM living in the MR, recruited using respondent-driven sampling (RDS). Participants were tested using Human Immunodeficiency virus rapid test, and reactive cases were confirmed withELISA. Participants were interviewed using a questionnaire adapted for the Chilean population. Descriptive and logistic regression analyses were then performed. All applicable ethical norms were followed in the execution of this study. The total sample consisted of 375 individuals. HIV prevalence among MSM was 17.6% overall. Among the HIV-negative men, most (71.5%) had not been tested for sexually-transmitted diseases (STIs) other than HIV in the past 12 months, and 24.1% had never been tested for HIV. Participants who had been tested for an STI other than HIV in the past 12 months had a 3.56-fold greater OR for HIV-positive status than those who had not. Conversely, having had an HIV test in the past 12 months was a protective factor against positive HIV status (OR = 0.09). The high prevalence of HIV among MSM suggests a re-emergence of the disease in Chile, and cases are specifically concentrated among young MSM. Access to sexual health care and STI testing in Chile is insufficient. Targeted prevention efforts are urgently needed as part of the Chilean national strategy to combat the spread of HIV, including community-based testing programs.

HIV Prevalence and Risk Behaviors in Male to Female (MTF) Transgender Persons in Tijuana, Mexico.

Compared to HIV research on men who have sex with men, less is known about the risks and vulnerabilities for HIV among Male to Female (MTF) transgender persons, particularly in different geographic regions like Mexico. In Tijuana, Mexico, a border city experiencing a dynamic HIV epidemic, no precedent data exists on the MTF transgender population. Our aims were to estimate HIV prevalence and examine the behaviors and characteristics of the population. We conducted a cross-sectional study of 100 MTF transgender persons recruited through time location sampling in 2012. Participants underwent interviewer-administered (paper and pen) surveys and rapid tests for HIV. Descriptive univariate analyses were conducted on various factors, including sociodemographics, substance use, accessing social services (requested vs. received), stigma, and sex behaviors. A total of 22% tested positive for HIV, a prevalence higher than other key populations at risk for HIV in Tijuana.

Knowledge, attitudes and practices on HIV/AIDS and prevalence of HIV in the general population of Sucre, Bolivia

Background: To analyse knowledge, attitudes and sexual practices on HIV/AIDS, and estimate HIV prevalence among residents of Sucre (Bolivia).Methodology: Population-based survey of residents aged 15-49 randomly selected during 2008/2009. Blood samples were collected on Whatman-filter paper and tested with enzyme-linked immunosorbent assay. Knowledge on HIV/AIDS, sexual risk practices and discriminatory attitudes against people living with HIV/AIDS (PLWHA) were modelled with multiple logistic regression.Results: Of 1499 subjects, 59% were women. All subjects were HIV-negative. Inadequate knowledge of HIV/AIDS transmission and prevention was observed in 67% and risk factors varied by gender (interaction p-value < 0.05). Discriminatory attitudes were displayed by 85% subjects; associated factors were: rural residence, low educational level and low income. Unsafe sex was reported by 10%; risk factors varied by residence area (interaction p-value < 0.05). In urban areas, risk factors were male sex, younger age and being in common-law union.Conclusions: Prevalence of HIV infection is very low and unsafe sex is relatively uncommon. Inadequate knowledge on HIV/AIDS and discriminatory attitudes towards PLWHA are extremely high and are associated to gender, ethnic and economic inequalities.

Knowledge, attitudes and practices on HIV/AIDS and prevalence of HIV in the general population of Sucre, Bolivia.

BACKGROUND: To analyse knowledge, attitudes and sexual practices on HIV/AIDS, and estimate HIV prevalence among residents of Sucre (Bolivia). METHODOLOGY: Population-based survey of residents aged 15-49 randomly selected during 2008/2009. Blood samples were collected on Whatman-filter paper and tested with enzyme-linked immunosorbent assay. Knowledge on HIV/AIDS, sexual risk practices and discriminatory attitudes against people living with HIV/AIDS (PLWHA) were modelled with multiple logistic regression. RESULTS: Of 1499 subjects, 59% were women. All subjects were HIV-negative. Inadequate knowledge of HIV/AIDS transmission and prevention was observed in 67% and risk factors varied by gender (interaction p-value<0.05). Discriminatory attitudes were displayed by 85% subjects; associated factors were: rural residence, low educational level and low income. Unsafe sex was reported by 10%; risk factors varied by residence area (interaction p-value<0.05). In urban areas, risk factors were male sex, younger age and being in common-law union. CONCLUSIONS: Prevalence of HIV infection is very low and unsafe sex is relatively uncommon. Inadequate knowledge on HIV/AIDS and discriminatory attitudes towards PLWHA are extremely high and are associated to gender, ethnic and economic inequalities.

Prevalence and correlates of HIV among men who have sex with men in Tijuana, Mexico.

INTRODUCTION: Men who have sex with men (MSM) in developing countries such as Mexico have received relatively little research attention. In Tijuana, Mexico, a border city experiencing a dynamic HIV epidemic, data on MSM are over a decade old. Our aims were to estimate the prevalence and examine correlates of HIV infection among MSM in this city. METHODS: We conducted a cross-sectional study of 191 MSM recruited through respondent-driven sampling (RDS) in 2012. Biological males over the age of 18 who resided in Tijuana and reported sex with a male in the past year were included. Participants underwent interviewer-administered surveys and rapid tests for HIV and syphilis with confirmation. RESULTS: A total of 33 MSM tested positive for HIV, yielding an RDS-adjusted estimated 20% prevalence. Of those who tested positive, 89% were previously unaware of their HIV status. An estimated 36% (95% CI: 26.4-46.5) had been tested for HIV in the past year, and 30% (95% CI: 19.0-40.0) were estimated to have ever used methamphetamine. Independent correlates of being infected with HIV were methamphetamine use (odds ratio [OR] = 2.24, p = 0.045, 95% CI: 1.02, 4.92) and active syphilis infection (OR = 4.33, p = 0.01, 95% CI: 1.42, 13.19). CONCLUSIONS: Our data indicate that MSM are a key sub-population in Tijuana at higher risk for HIV. Tijuana would also appear to have the highest proportion among upper-middle-income countries of HIV-positive MSM who are unknowingly infected. More HIV prevention research on MSM is urgently needed in Tijuana.

Prevalência de HIV e sífilis em parturientes atendidas em uma maternidade de referência na cidade de Marabá-Pará. / Prevalence of HIV and syphilis in parturients attended in a reference maternity in Marabá, Pará

Objetivo: conhecer a prevalência da infecção pelo HIV e pelo Treponema pallidum em parturientes atendidas em uma maternidade de referência do SUS. Método: estudo transversal, descritivo com dados coletados do cartão pré-natal e dos prontuários de 480 parturientes envolvidas no estudo. Para o diagnóstico de sífilis e de infecção pelo HIV foi considerado a realização de 2 testes na gravidez e um no parto. Resultados: as prevalências de infecção pelo HIV e de sífilis na amostra estudada foram de 0,4% e 1,9% respectivamente; houve predomínio da faixa etária de 20 a 29 anos nas mulheres com VDRL reagente no parto. A maioria das parturientes frequentou o pré-natal; destas, 48,5% iniciou no primeiro trimestre; 67,6% com o primeiro teste de HIV e 76,3% com o primeiro VDRL e entre as que tiveram 6 ou mais consultas a cobertura do segundo teste foi 37,6% para VDRL e 12,4% para HIV. Ressalte-se que 107 (23,7%) e 146 (32,4%) parturientes respectivamente, só tiveram a oportunidade de fazer o VDRL e a sorologia para HIV no mo-mento do parto. Conclusão: a prevalência de HIV e sífilis em parturientes é elevada e está na dependência da qualidade da assistência pré-natal.

Objective: To know the prevalence of HIV and Treponema pallidum infections among parturients attended at SUS Maternity reference. Method: Cross-sectional and descriptive study. Data was collected from pre-natal cards and from medical records of 480 parturients attended in a Maternity reference, in Marabá, Pará, Brasil. Diagnosis of syphilis and HIV were based on two tests performed during pregnancy and one test performed in labor. Results: Prevalence of HIV infection and syphilis were respectively 0.4% and 1.9%. Predominance of reagent VDRL during labor was observed among 20-29 years old women. The majority attended prenatal care, 48.5% in the first trimester of pregnancy. Among those women 67.6% performed the first HIV test and 37.6% the first VDRL test. Among those who had six or more prenatal visits the coverage of second test was 37.6% for VDRL and 12.4% for HIV. It is worth to note that 23.7% (107/480) and 32.4% (146/480) of pregnant women performed VDRL and HIV serology only at delivery. Conclusion: High prevalence of HIV and syphilis were observed in pregnant attended in a reference maternity of Marabá, Pará, Brazil, and it was associated with quality of prenatal care.