Sexual Behaviors of US Women at Risk of HIV Acquisition: A Longitudinal Analysis of Findings from HPTN 064

ObjectivesTo study the implementation, effects and costs of Break the Chains, a community-based HIV prevention campaign for men who have sex with men (MSM) in Switzerland, from March to May 2015, which aimed to reduce early HIV transmission by promoting the campaign message to adopt short-term risk reduction followed by HIV testing.DesignNon-randomised evaluation and cost analysis.SettingGay venues in 11 of 26 cantons in Switzerland and national online media campaign.ParticipantsMSM in online surveys (precampaign n=834, postcampaign n=688) or attending HIV testing centres (n=885); campaign managers (n=9); and campaign staff (n=38) or further intermediaries (n=80) in an online survey.Primary and secondary outcome measuresThe primary outcome measure was the proportion of MSM at risk of HIV acquisition or transmission who adhered to the campaign message. Secondary outcomes were postcampaign test uptake, knowledge about HIV primary infection and sense of belonging to the gay community.ResultsCampaign staff estimated that they contacted 17 145 MSM in 11 cantons. Among 688 respondents to the postcampaign survey, 311 (45.2%) were categorised as MSM at risk. Of 402/688 (58.5%) MSM who had heard about Break the Chains 2015, MSM categorised as being at risk were less likely to report adherence to the campaign message than MSM not at risk (adjusted OR 0.24; 95% CI 0.14 to 0.42). Twenty per cent of MSM with a defined risk of HIV acquisition or transmission who adopted risk reduction declared having done so because of the campaign. Costs for one MSM at risk to adhere to the campaign message were estimated at USD purchasing power parity 36–55. The number of HIV tests in the month after the campaign was twice the monthly average.ConclusionBreak the Chains increased HIV testing, implying that community-based campaigns are useful HIV prevention strategies for MSM. Additional interventions are needed to reach MSM at the highest risk of infection more effectively.

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Acceptability of blood-based HIV self-testing among adolescents aged 15–19 years at risk of HIV acquisition in Bangkok

International Journal of STD & AIDS ◽

10.1177/09564624211003742 ◽

2021 ◽

pp. 095646242110037

Author(s):

Pongpak Phongphiew ◽

Wipaporn N Songtaweesin ◽

Nantika Paiboon ◽

Panyaphon Phiphatkhunarnon ◽

Patchareeyawan Srimuan ◽

...

Keyword(s):

At Risk ◽

Point Of Care ◽

Cross Sectional Study ◽

Hiv Treatment ◽

Cross Sectional ◽

Sex With Men ◽

Finger Stick ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition ◽

Antibody Tests

Introduction: Young men who have sex with men (YMSM) and young transgender women (YTGW) in Thailand are at high HIV risk. HIV self-tests (HIVSTs) are rapidly administrable and prompt linkage to HIV treatment or prevention services. This study assesses the acceptability and feasibility of blood-based HIVST use in adolescents. Methods: A cross-sectional study was conducted among YMSM and YTGW aged 15–19 years with HIV acquisition risk. Participants completed questionnaires on the HIVST and then administered INSTI® independently, an HIVST immunoassay detecting gp41 and gp36 antibodies from finger-stick blood. Confirmatory HIV antibody tests were performed. Results: Between July and September 2020, 90 adolescents were enrolled. Mean (SD) age was 17.6 (1.1) years. Half ( N = 45) were YMSM. Forty-six (51%) were first-time HIV testers, and 32 (36%) had “ever used” HIV pre-exposure prophylaxis (PrEP). Two (2.2%, 95% CI: 0.0–5.3) tested positive, 21 (23.4%) invalid, and 67 (74.4%) negative. Invalidity causes included 17 (81%) insufficient blood, 3 (14%) buffer spillage, and 1 (5%) procedural missteps; all had negative HIV antibody tests. HIV self-test acceptability was 87.8% (95% CI: 81.0–94.5). Most (79%) preferred HIVST performance in hospital rather than at home. Conclusions: HIVSTs are acceptable in HIV at-risk adolescents. Blood-based HIVSTs should be positioned as rapid point-of-care tests with real-time linkage to HIV services.

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Differentiated Prevention And Care To Reduce The Risk of HIV Acquisition And Transmission Among Female Sex Workers In Zimbabwe: Study Protocol For The ‘AMETHIST’ Cluster Randomised Trial

10.21203/rs.3.rs-475222/v1 ◽

2021 ◽

Author(s):

Frances Cowan ◽

Fortunate Machingura ◽

Sungai T Chabata ◽

Sanni Ali ◽

Joanna Busza ◽

...

Keyword(s):

At Risk ◽

Hiv Prevention ◽

Sex Workers ◽

Female Sex Workers ◽

Sub Saharan Africa ◽

Total N ◽

Female Sex ◽

Prevention And Treatment ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition

Abstract Background: Female sex workers (FSW) in sub-Saharan Africa are disproportionately affected by HIV and are critical to engage in both HIV prevention and care. Here we describe our approach to evaluation of the AMETHIST intervention for FSW, adapted to the African context and set in Zimbabwe where there is a nationally-scaled programme for sex workers (Sisters). We hypothesise this intervention will raise uptake and adherence to prevention and treatment among FSW resulting in a reduction in their risk of HIV acquisition/transmission.Methods: The AMETHIST intervention (Adapted Microplanning to Eliminate Transmission of HIV in Sex Transactions) aims to provide risk differentiated prevention and care to FSW through microplanning and self help groups. Twenty two towns with the Sisters programme were randomised using restricted randomisation to either the Sisters programme or the Sister programme plus AMETHIST. The primary outcome is composite and is defined as the proportion of HIV positive FSW at risk of HIV transmission combined with the proportion of HIV negative FSW at risk of HIV acquisition. The outcome will be assessed after two years of intervention delivery in a respondent-driven sampling survey (total n=4400; n=200 FSW recruited at each site). Primary analysis will use the ‘RDS-2’ method to estimate cluster summaries and will adapt Hayes and Moulton’s ‘2-step’ method to adjust effect estimates for individual-level confounders and further adjust for cluster baseline prevalence. An in-depth process evaluation guided by our project trajectory will be undertaken.Discussion: Innovative pragmatic trials are needed to generate evidence on effectiveness of combination interventions in HIV prevention and treatment in different contexts. We describe the design and analysis of such a study.Trial Registration: The trial was registered at Pan African Clinical Trials Registry (PACTR202007818077777) on 2 July 2020.

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Southern African guidelines on the safe use of pre-exposure prophylaxis in persons at risk of acquiring HIV-1 infection

Southern African Journal of HIV Medicine ◽

10.4102/sajhivmed.v17i1.455 ◽

2016 ◽

Vol 17 (1) ◽

Cited By ~ 32

Author(s):

Linda-Gail Bekker ◽

Kevin Rebe ◽

Francois Venter ◽

Gary Maartens ◽

Michelle Moorhouse ◽

...

Keyword(s):

At Risk ◽

Treatment Guidelines ◽

World Health ◽

Combination Prevention ◽

Transgender Persons ◽

Sex With Men ◽

Health Organization ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition ◽

Exposure Prophylaxis

The Southern African HIV Clinicians Society published its first set of oral pre-exposure prophylaxis (PrEP) guidelines in June 2012 for men who have sex with men (MSM) who are at risk of HIV infection. With the flurry of data that has been generated in PrEP clinical research since the first guideline, it became evident that there was a need to revise and expand the PrEP guidelines with new evidence of safety and efficacy of PrEP in several populations, including MSM, transgender persons, heterosexual men and women, HIV-serodiscordant couples and people who inject drugs. This need is particularly relevant following the World Health Organization (WHO) Consolidated Treatment Guidelines released in September 2015. These guidelines advise that PrEP is a highly effective, safe, biomedical option for HIV prevention that can be incorporated with other combination prevention strategies in Southern Africa, given the high prevalence of HIV in the region. PrEP should be tailored to populations at highest risk of HIV acquisition, whilst further data from studies in the region accrue to guide optimal deployment to realise the greatest impact regionally. PrEP may be used intermittently during periods of perceived HIV acquisition risk, rather than continually and lifelong, as is the case with antiretroviral treatment. Recognition and accurate measurement of potential risk in individuals and populations also warrants discussion, but are not extensively covered in these guidelines.

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Dynamic Perceived HIV Risk and Sexual Behaviors Among Young Women Enrolled in a PrEP Trial in Kenya: A Qualitative Study

Frontiers in Reproductive Health ◽

10.3389/frph.2021.637869 ◽

2021 ◽

Vol 3 ◽

Author(s):

Kenneth Ngure ◽

Nicholas Thuo ◽

Vallery Ogello ◽

Catherine Kiptinness ◽

Kevin Kamolloh ◽

...

Keyword(s):

Risk Perception ◽

High Risk ◽

Hiv Prevention ◽

Qualitative Study ◽

Young Women ◽

Hiv Risk ◽

Sexual Behaviors ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition ◽

Over Time

Background: In Kenya and elsewhere in sub-Saharan Africa, young women are disproportionately affected by the HIV epidemic compared to young men. The extent to which young women's self-perceptions about risk of HIV acquisition influence their sexual behaviors and use of HIV prevention methods remains unclear. We therefore conducted a qualitative study to explore these issues among young women enrolled in a pre-exposure prophylaxis (PrEP) trial.Methods: From January 2017 to January 2020, we conducted serial semi-structured in-depth interviews 50 purposively selected young women (18–24 years old) who were participating in the MPYA (Monitoring PrEP for Young Adult women) study—a randomized controlled trial in Thika and Kisumu, Kenya, assessing the impact of SMS reminders on PrEP adherence. Interviews were conducted at three time points (~1 week, 3, and 12 months after initiating PrEP). We used an inductive, content analytic approach to identify key themes related to risk perceptions, sexual behavior, and use of HIV prevention tools.Results: Around the time of enrollment, most of the 50 women interviewed reported being at high risk of HIV because of their own sexual behaviors, such as inconsistent condom use, multiple sexual partners, and transactional sex. Additionally, high risk perception was based on the behavior of their partners, such as refusing to use condoms and being unsure of their partner's HIV status. Young women's perceived risk of HIV acquisition was a key motivator for PrEP initiation and continuation. During PrEP use, participants reported feeling protected and at less risk compared to peers who were not taking PrEP. Some reported no longer using condoms because they were confident that PrEP provided enough protection. Over time, many young women reported reducing risky sexual behaviors because of the regular counseling and HIV testing they received as part of their PrEP services. This lowered risk perception was in most cases accompanied by discontinuation of PrEP.Conclusions: HIV risk perception among young women in Kenya was dynamic and influenced their use of PrEP and condoms over time, suggesting an often-deliberate approach to HIV prevention and sexual health.

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An Event-Specific Analysis of Condom Breakage Among African American Men at Risk of HIV Acquisition

Sexually Transmitted Diseases ◽

10.1097/olq.0b013e3181585bf5 ◽

2008 ◽

Vol 35 (2) ◽

pp. 174-177 ◽

Cited By ~ 23

Author(s):

Richard Crosby ◽

Ralph J. DiClemente ◽

William L. Yarber ◽

Gregory Snow ◽

Adewale Troutman

Keyword(s):

At Risk ◽

African American ◽

African American Men ◽

Specific Analysis ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition ◽

Condom Breakage

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Contraceptive Preference Among Women at Risk of HIV Acquisition in a Preparatory Screening Study for a Phase III Microbicide Trial in South Western Uganda

AIDS and Behavior ◽

10.1007/s10461-018-2177-3 ◽

2018 ◽

Vol 22 (S1) ◽

pp. 131-138 ◽

Cited By ~ 2

Author(s):

Sylvia Kusemererwa ◽

Andrew Abaasa ◽

Martin Onyango ◽

Annalene M. Nel ◽

Michelle Isaacs ◽

...

Keyword(s):

At Risk ◽

Phase Iii ◽

Microbicide Trial ◽

Screening Study ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition ◽

Western Uganda

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Refining self-reported condom use among young men at risk of HIV acquisition

Sexual Health ◽

10.1071/sh07039 ◽

2007 ◽

Vol 4 (3) ◽

pp. 211 ◽

Cited By ~ 4

Author(s):

Richard Crosby ◽

Ralph J. DiClemente ◽

William L. Yarber ◽

Gregory Snow ◽

Adewale Troutman

Keyword(s):

At Risk ◽

African American ◽

Condom Use ◽

African American Men ◽

Descriptive Study ◽

Consistent Condom ◽

Consistent Condom Use ◽

Late Application ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition

This descriptive study evaluated the validity of self-reported condom use among young African American men. Thirty percent (n = 79) of the men reported consistent condom use. After accounting for late application and/or early removal of condoms, slippage, and breakage, 26 men remained classified as consistent users. Among the 79 men initially classified as consistent condom users, 695 sexual episodes were reported as ‘condom-protected;’ however, after correcting for user error, 29.6% of the sexual episodes were actually not protected. Studies assessing self-reported condom use among young African American men should assess user errors as well as frequency of condom use.

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Vaginal practices among women at risk for HIV acquisition in Soweto, South Africa

Southern African Journal of HIV Medicine ◽

10.4102/sajhivmed.v20i1.866 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Erica Lazarus ◽

Kennedy Otwombe ◽

Janan Dietrich ◽

Michele P. Andrasik ◽

Cecilia A. Morgan ◽

...

Keyword(s):

South Africa ◽

At Risk ◽

Estimating Equation ◽

Consistent Condom ◽

Hiv Acquisition ◽

Vaginal Practices ◽

Multiple Sexual Partnerships ◽

Risk Of Hiv Acquisition ◽

A Prospective Study ◽

Over Time

Background: Vaginal practices (VP) may adversely affect normal vaginal flora and mucosal integrity, and increase acquisition risk of HIV and other genital tract infections.Objective: The aim of this study was to describe self-reported VP, changes in the reported number of VP over time and factors associated with VP in a cohort of young Sowetan women enrolled in the HVTN 915 observational study.Method: We longitudinally assessed self-reported VP in 50 young women at risk of HIV acquisition aged 18–25 years in a prospective study over 3 months in Soweto, South Africa. Interviewer-administered HIV behavioural risk questionnaires were completed. No intervention to reduce VP was specified per protocol, but clinicians provided education at their discretion. The generalised estimating equation with inverse probability weights assessed VP over time.Results: The mean age at screening was 22 years; women reported multiple sexual partnerships with a mean of one main and 2 casual partners in the last 30 days. Consistent condom use was 2% (n = 1), 25% (n = 12) and 43% (n = 3) with main, casual and new partners, respectively. Commonly reported VP included washing the vagina with water (44%) and using fingers (48%). VP decreased significantly over time (p < 0.001). Women who used condoms inconsistently or whose last sex was with a casual partner were 3 times more likely to report VP (p = 0.001).Conclusion: Despite the high incidence of HIV in our setting, VP are still common and are associated with other behavioural risks for HIV. Further study is needed to assess whether clinician education may reduce VP and therefore should be included in HIV risk reduction counselling.

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Factors influencing perception of risk of HIV acquisition among male heterosexual STD clinic attenders

Irish Journal of Psychological Medicine ◽

10.1017/s0790966700016608 ◽

1990 ◽

Vol 7 (2) ◽

pp. 94-101 ◽

Cited By ~ 3

Author(s):

Ian T. Bownes ◽

Ethna C. O'Gorman ◽

Wallace W. Dinsmore

Keyword(s):

At Risk ◽

Sexual Dysfunction ◽

Perceived Risk ◽

Behavioural Change ◽

Psychiatric Morbidity ◽

Motivation To Change ◽

Perception Of Risk ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition ◽

Male Heterosexual

AbstractA variety of demographic, psychosocial, intrapersonal and behavioural factors have been shown to influence behavioural change in response to AIDS education. The study investigated perceived risk of HIV acquisition amongst 50 male heterosexual STD clinic attenders and its relationship to knowledge regarding the nature and prevention of transmission of HIV, current sexual practices, relationship difficulties, sexual dysfunction, alcohol abuse and psychiatric morbidity.The sample demonstrated a good general knowledge about AIDS but there was little evidence of the practice of ‘safer sex’. The overall incidence of psychiatric morbidity was 38%, of problem drinking 52%, of sexual dysfunction 32% and marital/relationship dysfunction 42%. Only 22% felt that their life-style put them at risk of HIV acquisition. It was felt that a narrow emphasis on information in AIDS prevention programmes ignores the powerful effect other factors may have on an individual's motivation to change his behaviour. Evaluation of the cognitions of this at risk group with particular reference to the role of cognitive distortions in perception of risk could provide a means of enhancing the efficacy of future health education campaigns.

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