scholarly journals Ongoing HIV transmission following a large outbreak among people with long term injecting drug use in Athens, Greece (2014-2020)

2021 ◽  
Author(s):  
Sotirios Roussos ◽  
Dimitrios Paraskevis ◽  
Mina Psichogiou ◽  
Evangelia Georgia Kostaki ◽  
Eleni Flountzi ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Hiv Prevalence ◽  
Treatment Programs ◽  
Hiv Incidence ◽  
C Programs ◽  
Socioeconomic Characteristics ◽  
Phylogenetic Cluster ◽  
Prevention And Treatment ◽  
Hiv Seroconversion ◽  
Large Outbreak

Background The HIV outbreak among People Who Inject Drugs (PWID) in Athens, Greece in 2011-2013 was the largest recent epidemic in Europe and North America. We aim to provide updated estimates of HIV prevalence and incidence. Methods Two community-based HIV/hepatitis C programs on active PWID were implemented in 2012-2013 (ARISTOTLE, N=3,320) and 2018-2020 (ARISTOTLE HCV-HIV, N=1,635) through consecutive respondent-driven sampling recruitment rounds. PWID were uniquely identified across rounds/programs. We evaluated trends in HIV prevalence, socioeconomic characteristics, and injection practices in PWID participating in both periods and estimated HIV incidence in a cohort of seronegative PWID. Molecular sequencing and phylogenetic analysis were performed in HIV seroconverters. Results HIV prevalence (95% CI) increased from 14.2% (11.7%-17.1%) in 2012-2013 to 22.0% (19.0%-25.3%) in 2018-2020 (p<0.001). There was a deterioration of socioeconomic characteristics such as homelessness (from 16.2% to 25.6%, p<0.001), a shift in the use of cocaine (from 16.6% to 28.1%, p<0.001), reduced access to free syringes (past 12 months: 51.8% and 45.1%, p=0.005) and to HIV testing (past 12 months: 50.9% and 49.4%). HIV incidence (95% CI) in 2014-2015, 2016-2017 and 2018-February 2020 was 2.10 (1.41-3.14), 2.04 (1.34-3.10) and 1.52 (0.84-2.75) new cases/100 person-years, respectively. Younger age, lower educational level, larger injection network and daily injecting were risk factors for HIV seroconversion. Almost 9% of HIV seroconversions occurred within a newly expanding phylogenetic cluster. Conclusion The ongoing HIV transmission among PWID in Athens provides empirical evidence that the current levels of prevention and treatment are inadequate to control the epidemic, leading to expansion of the pool of infected PWID and a rise in HIV prevalence. Re-evaluation of prevention and treatment programs is urgently needed.

scholarly journals HIV incidence and associated risk factors in female spouses of men who inject drugs in Pakistan

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Jenny Iversen ◽  
Salman ul H Qureshi ◽  
Malika Zafar ◽  
Machteld Busz ◽  
Lisa Maher
Keyword(s):  
Hiv Transmission ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hiv Prevalence ◽  
Hiv Incidence ◽  
Hiv Education ◽  
Number Of Children ◽  
Cox Proportional Hazards Models ◽  
Incident Infection ◽  
Female Spouses

Abstract Introduction Female sexual partners of men who inject drugs (MWID) living with HIV are at risk of HIV transmission. HIV prevalence estimates among non-drug using female sex partners of MWID are scarce, with no studies documenting HIV incidence. We investigated HIV prevalence and incidence among female spouses of MWID registered at Nai Zindagi Trust (NZT), Pakistan, between 2012 and 2019. Methods NZT registration and service provision data for female spouses who participated in HIV testing and counselling calculated HIV prevalence and incidence using the person years (PY) method. Cox proportional hazards models identified factors associated with incident infection. Results Overall HIV prevalence among female spouses of MWID was 8.5%. Among 3478 HIV-negative female spouses, 109 incident infections were observed, yielding an incidence rate of 1.5/100PY (95% CI 1.2–1.8). Independent predictors of incident infection were registration in Punjab province (AHR 1.73 95% CI 1.13–2.68, p = 0.012) and 1–5 years of education (AHR 1.89 95% CI 1.22–2.93, p = 0.004). Knowledge of HIV at registration was protective against infection (AHR 0.51, 95% CI 0.26–0.99, p = 0.047), along with a MWID spouse who had initiated antiretroviral therapy (ART) (AHR 0.25, 95% CI 0.16–0.38, p < 0.001), while incident infection was inversely associated with number of children (≥ 5 children AHR 0.44 95% CI 0.22–0.88, p = 0.022). Conclusions Additional efforts are needed to reduce HIV transmission among female spouses of MWID, including targeted provision of HIV education and access to HIV screening. Interventions that target MWID are also required, including evidence-based drug treatment and access to ART, including support to maximize adherence. Finally, consideration should be given to making HIV pre-exposure prophylaxis available to female spouses at high risk of HIV transmission, particularly young women and those whose husbands are not receiving, or have difficulty adhering to, ART.

scholarly journals Association of HIV prevalence and concurrency of sexual partnerships in South Africa’s language groups: An ecological analysis

2013 ◽  
Vol 14 (1) ◽  
pp. 25-28 ◽  
Author(s):  
Chris Kenyon
Keyword(s):  
Sexual Partner ◽  
Hiv Transmission ◽  
Hiv Prevalence ◽  
Hiv Incidence ◽  
Ecological Analysis ◽  
Sexual Partnerships ◽  
Multiple Sexual Partners ◽  
Language Groups ◽  
High Prevalence ◽  
Partner Concurrency

Background. There is considerable variation in HIV prevalence between different language groups in South Africa (SA). Sexual partner concurrency has been linked to the spread of HIV, but its effect on differential HIV transmission within SA’s language groups has not been investigated quantitatively. Objective. This ecological analysis was intended to explore the degree to which the variation in HIV prevalence according to language group can be explained by differential concurrency rates. Method. Linear regression was used to assess the association between each language group’s HIV prevalence and four risk factors: the prevalence of concurrency, multiple sexual partners in the preceding year, circumcision, and condom utilisation. Results. In multivariate analysis, only the point prevalence of concurrency remained associated with HIV prevalence. Conclusion. There is evidence of a high prevalence of point concurrency in sexual partnerships in SA’s most HIV-affected language groups. Together with evidence that relatively small decreases in concurrency can lead to large declines in HIV incidence, this provides impetus for interventions to promote having only one sexual partner at a time. S Afr J HIV Med 2013;14(1):25-28. DOI:10.7196/SAJHIVMED.884

scholarly journals Resilient Aging: Psychological Well-Being and Social Well-Being as Targets for the Promotion of Healthy Aging

2021 ◽  
Vol 7 ◽  
pp. 233372142110029
Author(s):  
Eric S. Kim ◽  
Rifky Tkatch ◽  
David Martin ◽  
Stephanie MacLeod ◽  
Lewis Sandy ◽  
...  
Keyword(s):  
Healthy Aging ◽  
Population Aging ◽  
Well Being ◽  
The United States ◽  
Treatment Programs ◽  
Response Effort ◽  
Psychological Well Being ◽  
Social Trends ◽  
Functional Quality ◽  
Prevention And Treatment

Population aging is one of the most important social trends of the 21st century and in the United States, the number of people aged ≥65 is projected to increase by nearly 50% in the next 15 years. Most biomedical and public health efforts have focused on reducing harmful risk factors when targeting chronic disease—an approach that has contributed greatly to prevention and treatment programs. However, evidence suggests that the number of years lost to disability is increasing and historic gains we have made in life expectancy are eroding, and even reversing in some groups. As our society ages and grapples with these issues, expanding the focus to include resilience, as well as psychosocial assets in our prevention and treatment programs might help inform the multidisciplinary response effort we need. Here we synthesize research evaluating associations between different dimensions of psychological well-being (e.g., purpose in life, optimism, life satisfaction) and social well-being (e.g., structural, functional, quality) with chronic conditions. We also evaluate evidence around three biopsychosocial pathways hypothesized to underlie these associations. These factors are meaningful, measurable, and potentially modifiable; thus, further pursuing this line of inquiry might unveil innovative paths to enhancing the health of our rapidly aging society.

Confound it: latent lessons from the Mwanza trial of STD treatment to reduce HIV transmission

2003 ◽  
Vol 14 (3) ◽  
pp. 179-184 ◽  
Author(s):  
David Gisselquist ◽  
John J Potterat
Keyword(s):  
Sexually Transmitted Disease ◽  
Hiv Transmission ◽  
Additional Data ◽  
Transmitted Disease ◽  
Published Data ◽  
Hiv Incidence ◽  
Syndromic Management ◽  
Sexually Transmitted ◽  
Safe Injection ◽  
Injection Safety

In 1995, an international team reported that improved syndromic management of sexually transmitted disease (STD) in Mwanza, Tanzania, had reduced HIV incidence by 38% in intervention compared to control communities. However, the team has not addressed confound: project interventions might have reduced HIV transmission during health care through provision of syringes and benzathine (replacing short acting) penicillin and through interactions with a coeval safe injection initiative. Mwanza's success in lowering HIV incidence is a puzzle, since it was achieved with only minor reductions in observed STD prevalence. Despite incomplete analyses, reports from Mwanza have encouraged expansion of STD treatment. However, should success be attributed to injection safety rather than to decreased STD prevalence — an hypothesis that fits published data — expanded STD treatment without attention to injection safety could, ironically, increase rather than decrease HIV incidence. To control for confound, additional data and analyses from the Mwanza study are warranted.

scholarly journals High HIV prevalence and associated factors in a remote community in the Rwenzori region of Western Uganda

2010 ◽  
Vol 2 (2) ◽  
pp. 13 ◽  
Author(s):  
John Rubaihayo ◽  
Akib Surat ◽  
Mughusu Ezekiel ◽  
Abaasa Andrew
Keyword(s):  
Hiv Transmission ◽  
Risk Behaviour ◽  
Population Based ◽  
Cross Sectional Study ◽  
Sexual Partners ◽  
Hiv Prevalence ◽  
Community Perceptions ◽  
Cross Sectional ◽  
Multiple Sexual Partners ◽  
Western Uganda

In Uganda, previous studies have shown a tremendous decline in HIV prevalence over the past two decades due to changes in sexual behavior with a greater awareness of the risks involved. However, studies in Fort-Portal municipality, a rural town in Western Uganda, continued to show a persistent high HIV prevalence despite the various interventions in place. We conducted a study to establish the current magnitude of HIV prevalence and the factors associated with HIV prevalence in this community. This cross-sectional study was conducted between July and November 2008. Participants were residents of Fort-Portal municipality aged 15-49 years. A population-based HIV sero-survey and a clinical review of prevention of mother to child HIV transmission (PMTCT) and voluntary counseling and HIV Testing (VCT) records were used to collect quantitative data. An inteviewer administered structured questionnaire was used to collect qualitative data on social deographics, risk behaviour and community perceptions. Focus group discussions (FGDs) and in-depth interviews provided supplementary data on community perceptions. Logistic regression was used in the analysis. The overall HIV prevalence in the general population was 16.1% [95% CI; 12.5-20.6]. Prevalence was lower among women (14.5%; 95% CI; 10.0-19.7) but not significantly different from that among men (18.7%; 95% CI; 12.5-26.3) (c2=0.76, P=0.38). Having more than 2 sexual partners increased the odds of HIV by almost 2.5 times. None or low education and age over 35 years were independently associated with HIV prevalence (P<0.05). Most participants attributed the high HIV prevalence to promiscuity/multiple sexual partners (32.5%), followed by prostitution (13.6%), alcoholism (10.1%), carelessness (10.1%), poverty (9.7%), ignorance (9.5%)), rape (4.7%), drug abuse (3.6%) and others (malice/malevolence, laziness, etc.) (6.2%). Although there was a slight decline compared to previous reports, the results from this study confirm that HIV prevalence is still high in this community. In order to prevent new infections, the factors mentioned above need to be addressed, and we recommend that education aimed at changing individual behavior should be intensified in this community.

scholarly journals 1701. Added Benefits of Pre-exposure Prophylaxis Use on HIV Incidence with Minimal Changes in Efficiency in the Context of High Treatment Engagement among Men Who Have Sex with Men

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S833-S833
Author(s):  
Alyson L Singleton ◽  
Brandon D Marshall ◽  
Xiao Zang ◽  
Amy S Nunn ◽  
William C Goedel
Keyword(s):  
African American ◽  
Hiv Infection ◽  
Hiv Transmission ◽  
Treatment Engagement ◽  
Hiv Incidence ◽  
Black African ◽  
African American Msm ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
High Treatment

Abstract Background Although there is ongoing debate over the need for substantial increases in PrEP use when antiretroviral treatment confers the dual benefits of reducing HIV-related morbidity and mortality and the risk of HIV transmission, no studies to date have quantified the potential added benefits of PrEP use in settings with high treatment engagement across variable sub-epidemics in the United States. Methods We used a previously published agent-based network model to simulate HIV transmission in a dynamic network of 17,440 Black/African American and White MSM in Atlanta, Georgia from 2015 to 2024 to understand how the magnitude of reductions in HIV incidence attributable to varying levels of PrEP use (0–90%) changes in potential futures where high levels of treatment engagement (i.e. the UNAIDS ‘90-90-90’ goals and eventual ‘95-95-95’ goals) are achieved and maintained, as compared to current levels of treatment engagement in Atlanta (Figure 1). Model inputs related to HIV treatment engagement among Black/African American and White men who have sex with men in Atlanta. A comparison of current levels of treatment engagement (Panel A) to treatment engagement at ‘90-90-90’ (Panel B) and ‘95-95-95’ goals (Panel C). Results Even at achievement and maintenance of ‘90-90-90’ goals, 75% PrEP coverage reduced incidence rates by an additional 67.9% and 74.2% to 1.53 (SI: 1.39, 1.70) and 0.355 (SI: 0.316, 0.391) per 100 person-years for Black/African American and White MSM, respectively (Figure 2), compared to the same scenario with no PrEP use. Additionally, an increase from 15% PrEP coverage to 75% under ‘90-90-90’ goals only increased person-years of PrEP use per HIV infection averted, a measure of efficiency of PrEP, by 8.1% and 10.5% to 26.7 (SI: 25.6, 28.0) and 73.3 (SI: 70.6, 75.7) among Black/African American MSM and White MSM, respectively (Figure 3). Overall (Panel A) and race-stratified (Panel B and Panel C) marginal changes in HIV incidence over ten years among Black/African American and White men who have sex with men in Atlanta across scenarios of varied levels of treatment engagement among agents living with HIV infection and levels of pre-exposure prophylaxis use among HIV-uninfected agents. Note: All changes are calculated within each set of treatment scenarios relative to a scenario where no agents use pre-exposure prophylaxis. Person-years of pre-exposure prophylaxis use per HIV infection averted among Black/African American (Panel A) and White (Panel B) men who have sex with men in Atlanta across scenarios of varied levels of treatment engagement among agents living with HIV infection and levels of pre-exposure prophylaxis use among HIV-uninfected agents. Note: The number of HIV infections averted is calculated within each set of treatment scenarios relative to a scenario where no agents use pre-exposure prophylaxis. Conclusion Even in the context of high treatment engagement, substantial expansion of PrEP use still contributes to meaningful decreases in HIV incidence among MSM with minimal changes in person-years of PrEP use per HIV infection averted, particularly for Black/African American MSM. Disclosures All Authors: No reported disclosures

HIV Prevalence Trends and Disparities by Gender and Urban-rural Residence Among Adolescents in Sub-saharan Africa

2020 ◽  
Author(s):  
Reka Maulide Cane ◽  
Dessalegn Melesse ◽  
Nkomba Kayeyi ◽  
Abubakar Manu ◽  
Yohannes Dibaba Wado ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Hiv Transmission ◽  
Hiv Prevalence ◽  
Sub Saharan Africa ◽  
Annual Rate ◽  
Lower Prevalence ◽  
Average Annual Rate ◽  
African Countries ◽  
Urban Rural ◽  
Sub Saharan

Abstract Background In sub-Saharan Africa HIV transmission is a major challenge in adolescents, especially among girls and those living in urban settings. Major international efforts have aimed at reducing sexual transmission. This analysis aims to assess the trends in HIV prevalence by gender in adolescents, as well as urban-rural disparities. Methods HIV prevalence data were obtained for 30 countries with a national survey since 2010 and for 23 countries with one survey circa 2005 and a recent survey circa 2015. Countries were grouped into 2% or higher and lower than 2% HIV prevalence among girls 15–19 years in the first survey. Country medians and average annual rates of changes were used to summarize the trends. Data on HIV incidence at ages 15–24 and prevalence at 5–9 and 10–14 years were reviewed from 11 recent national surveys. Trends in urban-rural disparities in HIV prevalence and selected indicators of sexual and HIV testing behaviours were assessed for females and males 15–24 years, using the same surveys. Results HIV prevalence among girls 15–19 years declined in the higher HIV prevalence group from 5.7–2.6% during 2005–2015, corresponding with an average annual rate of reduction of 6.5% per year. Among boys, the median HIV prevalence declined from 2.1–1.2% in the higher prevalence group. Smaller changes were observed in the lower prevalence country group where median HIV prevalence among girls decreased from 0.7–0.4% (average annual rate of reduction 5.9%). Girl – boy differences at 10–14 years were small with a country median HIV of 1.0% and 1.3%, respectively. Urban females and males 15–24 had at least 1.5 times higher HIV prevalence than their rural counterparts, and all experienced similar declines during 2005–2015. Condom use and HIV testing increased among adolescents in both higher and lower prevalence countries, but indicators of sexual activity showed little change over time. Conclusions HIV prevalence declined in almost all countries during the last decade, in both urban and rural settings, for both sexes. The urban-rural gap persisted and HIV transmission to girls, but not boys, is still a major challenge in eastern and southern African countries.

scholarly journals Prevention of Perinatal HIV Transmission in an Area of High HIV Prevalence in the United States

2021 ◽  
Vol 228 ◽  
pp. 101-109
Author(s):  
Wei Li A. Koay ◽  
Jiaqi Zhang ◽  
Krishna V. Manepalli ◽  
Caleb J. Griffith ◽  
Amanda D. Castel ◽  
...  
Keyword(s):  
United States ◽  
Hiv Transmission ◽  
The United States ◽  
Hiv Prevalence ◽  
Perinatal Hiv
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