Comparing men who have sex with men and inject drugs and people who inject drugs who are men and have sex with men in San Francisco: Implications for HIV and hepatitis C virus prevention

ABSTRACTBackgroundMen who have sex with men (MSM) and people who inject drugs (PWID) carry a disproportionate burden of HIV and hepatitis C virus (HCV) infections. We compared the demographic and risk profiles of MSM who inject drugs (MSM-IDU, i.e., men reached through affiliation with MSM) and PWID who are men and have sex with men (PWID-MSM, i.e., men reached through affiliation with PWID).MethodsWe used data from the most recent waves of the National HIV Behavioural Surveillance among MSM (2017) and PWID (2018) in San Francisco. Participants were recruited through venue-based (MSM) and peer-referral (PWID) sampling and completed standardised questionnaires. We compared the characteristics of MSM-IDU and PWID-MSM using bivariate tests.ResultsOf 504 participants completing the MSM survey, 6.2% reported past-year injection drug use (MSM-IDU). Among 311 male participants completing the PWID survey, 19.0% reported past-year sex with a male (PWID-MSM). Relative to MSM-IDU, more PWID-MSM were older, identified as bisexual, had lower income, a history of incarceration and were homeless. MSM-IDU had more male sexual partners (median: 10 vs 3) and fewer injected daily (29.0% vs 64.4%) than PWID-MSM. While more PWID-MSM sought sterile equipment from a syringe program (86.4% vs 35.5%), fewer reported using PrEP (15.0% vs 42.9%).ConclusionThe sociodemographic, risk behaviour, and prevention access profiles of MSM-IDU and PWID-MSM in San Francisco suggest that they represent distinct populations who may require tailored HIV and HCV prevention strategies. MSM- and PWID-focused prevention programs should provide combined sexual health and harm reduction messages and services.

Monitoring populations at increased risk for SARS-CoV-2 infection in the community

Background: The COVID-19 pandemic is rapidly evolving, with emerging variants and fluctuating control policies. Real-time population screening and identification of groups in whom positivity is highest could help monitor spread and inform public health messaging and strategy. Methods: To develop a real-time screening process, we included results from nose and throat swabs and questionnaires taken 19 July 2020-17 July 2021 in the UK's national COVID-19 Infection Survey. Fortnightly, associations between SARS-CoV-2 positivity and 60 demographic and behavioural characteristics were estimated using logistic regression models adjusted for potential confounders, considering multiple testing, collinearity, and reverse causality. Findings: Of 4,091,537 RT-PCR results from 482,677 individuals, 29,903 (0.73%) were positive. As positivity rose September-November 2020, rates were independently higher in younger ages, and those living in Northern England, major urban conurbations, more deprived areas, and larger households. Rates were also higher in those returning from abroad, and working in healthcare or outside of home. When positivity peaked December 2020-January 2021 (Alpha), high positivity shifted to southern geographical regions. With national vaccine roll-out from December 2020, positivity reduced in vaccinated individuals. Associations attenuated as rates decreased between February-May 2021. Rising positivity rates in June-July 2021 (Delta) were independently higher in younger, male, and unvaccinated groups. Few factors were consistently associated with positivity. 25/45 (56%) confirmed associations would have been detected later using 28-day rather than 14-day periods. Interpretation: Population-level demographic and behavioural surveillance can be a valuable tool in identifying the varying characteristics driving current SARS-CoV-2 positivity, allowing monitoring to inform public health policy. Funding: Department of Health and Social Care (UK), Welsh Government, Department of Health (on behalf of the Northern Ireland Government), Scottish Government, National Institutes of Health Research.

The medical evaluation of the internationally adopted child

Children who have been internationally adopted often have complex health issues and unique challenges. 1 The paediatric office provides a medical home by offering continuity of care, links to community support, and appropriate evaluation and treatment. During the pre-adoption evaluation, biographical and medical information provided by the child’s country of origin is reviewed. Additionally, soon after the child’s adoption, a complete medical history and physical examination should be completed. Although laboratory work may have been performed previously, studies should be repeated to ensure reliability. Developmental assessment and review of vaccinations should be completed as well. Anticipatory guidance should be provided regarding medical concerns, effects of institutionalisation and the possibility of attachment issues. Follow-up care ensures optimal medical, developmental and behavioural surveillance in this patient population.

Geographical Disparities in HIV Seroprevalence Among Men Who Have Sex with Men and People Who Inject Drugs in Nigeria: Exploratory Spatial Data Analysis

Background The assessment of geographical heterogeneity of HIV among men who have sex with men (MSM) and people who inject drugs (PWID) can usefully inform targeted HIV prevention and care strategies. Objective We aimed to measure HIV seroprevalence and identify hotspots of HIV infection among MSM and PWID in Nigeria. Methods We included all MSM and PWID accessing HIV testing services across 7 prioritized states (Lagos, Nasarawa, Akwa Ibom, Cross Rivers, Rivers, Benue, and the Federal Capital Territory) in 3 geographic regions (North Central, South South, and South West) between October 1, 2016, and September 30, 2017. We extracted data from national testing registers, georeferenced all HIV test results aggregated at the local government area level, and calculated HIV seroprevalence. We calculated and compared HIV seroprevalence from our study to the 2014 integrated biological and behavioural surveillance survey and used global spatial autocorrelation and hotspot analysis to highlight patterns of HIV infection and identify areas of significant clustering of HIV cases. Results MSM and PWID had HIV seroprevalence rates of 12.14% (3209/26,423) and 11.88% (1126/9474), respectively. Global spatial autocorrelation Moran I statistics revealed a clustered distribution of HIV infection among MSM and PWID with a <5% and <1% likelihood that this clustered pattern could be due to chance, respectively. Significant clusters of HIV infection (Getis-Ord-Gi* statistics) confined to the North Central and South South regions were identified among MSM and PWID. Compared to the 2014 integrated biological and behavioural surveillance survey, our results suggest an increased HIV seroprevalence among PWID and a substantial decrease among MSM. Conclusions This study identified geographical areas to prioritize for control of HIV infection among MSM and PWID, thus demonstrating that geographical information system technology is a useful tool to inform public health planning for interventions targeting epidemic control of HIV infection.

Access to HIV-prevention in female sex workers in Ukraine between 2009 and 2017: Coverage, barriers and facilitators

The provision of comprehensive prevention services is vital for reducing the high burden of HIV amongst Ukrainian female sex workers (FSWs). To identify barriers and facilitators that influence access to HIV prevention amongst this population between 2009 and 2017, we developed a literature-informed conceptual framework and conducted a document analysis to identify the components of the Ukrainian prevention package (PP). Using the Integrated Bio Behavioural Surveillance Surveys, we then conducted descriptive analyses to explore PP coverage from 2009 to 2017 and the influence of factors, identified by our conceptual framework. After increasing over four years, a drop in PP coverage was observed from 2013 onwards. Being a client of a non-governmental organisation, street and highway solicitation, non-condom use, and knowledge of HIV may influence access to HIV prevention in the Ukrainian context. Future interventions should consider barriers and facilitators to HIV prevention and the multiple structural levels on which they operate.

Transactional sex and HIV infection among commercial farm workers in South Africa

Background: High prevalence of HIV infection has been reported among commercial farm workers in South Africa, but studies of the role of transactional sex in this epidemic is limited. Objective: This study seeks to examine the association between transactional sex and HIV infection among commercial farm workers in South Africa. Methods: This is a cross-sectional secondary data analysis of the Integrated Biological and Behavioural Surveillance Survey by the International Organization of Migration among farm workers in Mpumalanga and Limpopo Provinces, South Africa in 2010. The study included 2,758 sexually active farm workers. The outcome variable was HIV infection while the main explanatory variable was engagement in transactional sex. Other explanatory variables were sex, age, marital status, number of sex partners, food security, recent history of sexually transmitted infection, condom use at last sex with non-regular partner, history of sexual violence and migration status. Bivariate and multivariable logistic regression analyses were done to obtain unadjusted and adjusted odds ratios of the association between transactional sex and HIV infection. Results: Engagement in transactional sex was common (19%) but not significantly associated with HIV infection (OR 1.1; CI 0.57-2.44). Female sex (1.93; 1.60-2.32), age 25 to 44 years, recent STI (OR 1.37; CI 1.18-1.58) and sexual violence (OR 1.39; CI 1.19-1.63) were significant risk factors for HIV infection. Conclusion: Risky sexual behaviours were common among the farmworker population. HIV prevention interventions should include behavioural change communication and improved access to healthcare for STI and HIV treatment.

Trend of Human Immunodeficiency Virus (HIV) or Acquired Immunodeficiency Syndrome (AIDS) and Care For People Living with HIV and AIDS in Benue State, North Central, Nigeria

This article reveals trend of HIV/AIDS in Benue State, north central, Nigeria. The method adopted was a descriptive analysis of the HIV epidemiology in Nigeria using Benue State as a case study. This review article was through the report of periodic epidemiological surveys of Antenatal Clinic (ANC) sentinel surveys, National HIV and AIDS and Reproductive Health Surveys (NARHS), Nigeria Demographic Health Surveys (NDHS), Integrated Biological and Behavioural Surveillance Surveys (IBBSS), National Agency for the Control of AIDS (NACA), United Nations Agency for AIDS (UNAIDS) and Benue State Agency for the Control of AIDS (BenSACA). This study reveals that, out of the current 1.9 million people representing 1.4% (15-49 years) living with HIV in Nigeria, Benue State accounts for 188,482 representing 4.9%. Thus, Benue State is now second as against the previous reports which have consistently placed Benue State as the state with highest prevalence of HIV/AIDS in Nigeria since the beginning of the pandemic in the country. The new prevalence estimates by states, however, still categorize Benue state and six other states with high prevalence of 2.0% and above. The national prevalence among females is significantly higher at an estimated 1.9% than the male prevalence estimated at 0.9%. In conclusion, the effort of peer educator trainers, awareness of HIV/AIDS on radio and television programs and efforts of other stake holders who are working towards ending the AIDS epidemic have been the secret behind the compliance of Benue people towards spreading news of AIDS not the virus. However, much still need to be done to consolidate on this success.