sodium-ethylxanthate and HIV-Infections

Key populations, including sex workers, are at high risk of HIV acquisition and transmission. Men who pay for sex can contribute to HIV transmission through sexual relationships with both sex workers and their other partners. To characterize the population of men who pay for sex in sub-Saharan Africa (SSA), we analyzed population size, HIV prevalence, and use of HIV prevention and treatment.. We performed random-effects meta-analyses of population-based surveys conducted in SSA from 2000 to 2020 with information on paid sex by men. We extracted population size, lifetime number of sexual partners, condom use, HIV prevalence, HIV testing, antiretroviral (ARV) use, and viral load suppression (VLS) among sexually active men. We pooled by regions and time periods, and assessed time trends using meta-regressions. We included 87 surveys, totaling over 368,000 male respondents (15-54 years old), from 35 countries representing 95% of men in SSA. Eight percent (95% CI 6%-10%; number of surveys [Ns] = 87) of sexually active men reported ever paying for sex. Condom use at last paid sex increased over time and was 68% (95% CI 64%-71%; Ns = 61) in surveys conducted from 2010 onwards. Men who paid for sex had higher HIV prevalence (prevalence ratio [PR] = 1.50; 95% CI 1.31-1.72; Ns = 52) and were more likely to have ever tested for HIV (PR = 1.14; 95% CI 1.06-1.24; Ns = 81) than men who had not paid for sex. Men living with HIV who paid for sex had similar levels of lifetime HIV testing (PR = 0.96; 95% CI 0.88-1.05; Ns = 18), ARV use (PR = 1.01; 95% CI 0.86-1.18; Ns = 8), and VLS (PR = 1.00; 95% CI 0.86-1.17; Ns = 9) as those living with HIV who did not pay for sex. Study limitations include a reliance on self-report of sensitive behaviors and the small number of surveys with information on ARV use and VLS.. Paying for sex is prevalent, and men who ever paid for sex were 50% more likely to be living with HIV compared to other men in these 35 countries. Further prevention efforts are needed for this vulnerable population, including improved access to HIV testing and condom use initiatives. Men who pay for sex should be recognized as a priority population for HIV prevention.

Topics: Africa South of the Sahara; HIV Infections; Humans; Male; Men; Population Density; Prevalence; Sex

Sexual transmission of HIV-1 consists of processes that exert either positive or negative selection pressure on the virus. The sum of these selection pressures lead to the transmission of only one specific HIV-1 strain, termed the transmitted founder virus. Different dendritic cell subsets are abundantly present at mucosal sites and, interestingly, these DC subsets exert opposite pressure on viral selection during sexual transmission. In this review we describe receptors and cellular compartments in DCs that are involved in HIV-1 communication leading to either viral restriction by the host or further dissemination to establish a long-lived reservoir. We discuss the current understanding of host antiretroviral restriction factors against HIV-1 and specifically against the HIV-1 transmitted founder virus. We will also discuss potential clinical implications for exploiting these intrinsic restriction factors in developing novel therapeutic targets. A better understanding of these processes might help in developing strategies against HIV-1 infections by targeting dendritic cells.

Topics: Dendritic Cells; Disease Transmission, Infectious; HIV Infections; HIV-1; Host-Pathogen Interactions; Humans; Sex

Despite reports of unusual clinical presentations and therapeutic responses among HIV-infected patients with syphilis, syphilis has not been regarded as a serious opportunistic infection that predictably progresses among most HIV-coinfected patients.. To define and describe differences in the presentation and response to treatment of early syphilis among HIV-infected and HIV-uninfected patients, to describe any differences by gender, and to determine if clinical presentation of central nervous system involvement predicted serologic failure.. A prospective, multicenter, randomized, controlled trial of enhanced versus standard therapy to compare the benefit of enhanced therapy, the clinical importance of central nervous system involvement, and the clinical manifestations of early syphilis infection among HIV-infected and HIV-uninfected patients.. The median number of ulcers was significantly greater among HIV-infected and HIV-uninfected patients, as was the percent of HIV-infected patients with multiple ulcers. Among patients diagnosed with secondary syphilis, a higher percentage of HIV-infected patients presented with genital ulcers [13/53 (25%)] than did HIV-uninfected patients [27/200 (14%)]. No differences between HIV-infected and HIV-uninfected patients were detected for other secondary syphilis manifestations. Although women presented more frequently with secondary syphilis than did men, no other gender differences in clinical manifestations were noted. Neurologic complaints were reported most frequently among patients with secondary syphilis [103/248 patients (42%)] compared with patients with primary syphilis [32/136 (24%)] and early latent syphilis [48/ 142, (34%)] (P < 0.05), but no differences in neurologic complaints were apparent by HIV status or CSF abnormalities. No neurologic complaints were significantly associated with serologic treatment failures at 6 months.. Overall, HIV infection had a small effect on the clinical manifestations of primary and secondary syphilis. Compared with HIV-uninfected patients, HIV-infected patients with primary syphilis tended to present more frequently with multiple ulcers, and HIV-infected patients with secondary syphilis presented with concomitant genitals ulcers more frequently.

Topics: Adult; Female; HIV Infections; Humans; Male; Neurosyphilis; Prospective Studies; Randomized Controlled Trials as Topic; Severity of Illness Index; Sex; Syphilis; Syphilis Serodiagnosis; United States

With the influx of rural migrants into urban areas, the spread of HIV has increased significantly in Shaanxi Province (China). Migrant workers are at high risk of HIV infection due to social conditions and hardships (isolation, separation, marginalization, barriers to services, etc.).. We explored the efficacy of a HIV/AIDS prevention and control program for rural migrants in Shaanxi Province, administered at both rural and urban sites.. Guidance concerning HIV/AIDS prevention was given to the experimental group (266 migrants) for 1 year by the center of disease control, community health agencies and family planning department. The intervention was conducted according to the HIV/AIDS Prevention Management Manual for Rural Migrants. A control group of migrants only received general population intervention. The impact of the intervention was evaluated by administering HIV/AIDS knowledge, attitudes and sexual behavior (KAB) questionnaires after 6 and 12 months.. In the experimental group; 6 months of intervention achieved improvements in HIV/AIDS related knowledge. After 12 months; HIV/AIDS-related knowledge reached near maximal scores. Attitude and most behaviors scores were significantly improved. Moreover; the experimental group showed significant differences in HIV-AIDS knowledge; attitude and most behavior compared with the control group.. The systematic long-term cross-site HIV/AIDS prevention in both rural and urban areas is a highly effective method to improve HIV/AIDS KAB among rural migrants.

Topics: Adult; Asian People; Behavior; China; Female; Health Education; Health Knowledge, Attitudes, Practice; HIV Infections; Humans; Male; Middle Aged; Program Evaluation; Rural Population; Sex; Transients and Migrants

Substantial falls in the mortality of people living with HIV (PLWH) have been observed since the introduction of antiretroviral therapy (ART) in sub-Saharan Africa. However, access and uptake of ART have been variable in many countries. We report the excess deaths observed in PLWH before and after the introduction of ART. We use data from five longitudinal studies in Malawi, South Africa, Tanzania, and Uganda, members of the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA).. Individual data from five demographic surveillance sites that conduct HIV testing were used to estimate mortality attributable to HIV, calculated as the difference between the mortality rates in PLWH and HIV-negative people. Excess deaths in PLWH were standardized for age and sex differences and summarized over periods before and after ART became generally available. An exponential regression model was used to explore differences in the impact of ART over the different sites.. 127,585 adults across the five sites contributed a total of 487,242 person years. Before the introduction of ART, HIV-attributable mortality ranged from 45 to 88 deaths per 1,000 person years. Following ART availability, this reduced to 14-46 deaths per 1,000 person years. Exponential regression modeling showed a reduction of more than 50% (HR =0.43, 95% CI: 0.32-0.58), compared to the period before ART was available, in mortality at ages 15-54 across all five sites.. Excess mortality in adults living with HIV has reduced by over 50% in five communities in sub-Saharan Africa since the advent of ART. However, mortality rates in adults living with HIV are still 10 times higher than in HIV-negative people, indicating that substantial improvements can be made to reduce mortality further. This analysis shows differences in the impact across the sites, and contrasts with developed countries where mortality among PLWH on ART can be similar to that of the general population. Further research is urgently needed to establish why the different impacts on mortality were observed and how the care and treatment programmes in these countries can be more effective in reducing mortality further.

Topics: Adolescent; Adult; Age Factors; Anti-HIV Agents; Female; HIV Infections; Humans; Longitudinal Studies; Malawi; Male; Middle Aged; Population Surveillance; Proportional Hazards Models; Sex; South Africa; Tanzania; Uganda; Young Adult

The evolutionary and demographic history of the circular recombinant form CRF02_AG in a selected retrospective group of HIV-1 infected men who have sex with men (MSM) resident in Central Italy was investigated.. A total of 55 HIV-1 subtype CRF02_AG pol sequences were analyzed using Bayesian methods and a relaxed molecular clock to reconstruct their dated phylogeny and estimate population dynamics.. Dated phylogeny indicated that the HIV-1 CRF02_AG strains currently circulating in Central Italy originated in the early 90's. Bayesian phylogenetic analysis revealed the existence of a main HIV-1 CRF02_AG clade, introduced in the area of Rome before 2000 and subsequently differentiated in two different subclades with a different date of introduction (2000 versus 2005). All the sequences within clusters were interspersed, indicating that the MSM analyzed form a close and restricted network where the individuals, also moving within different clinical centers, attend the same places to meet and exchange sex.. It was suggested that the HIV-1 CRF02_AG epidemic entered central Italy in the early 1990s, with a similar trend observed in western Europe.

Topics: Bayes Theorem; Female; HIV Infections; HIV-1; Homosexuality, Male; Humans; Italy; Male; Molecular Epidemiology; Phylogeny; Retrospective Studies; Sex

The study explores the meanings of sex among migrant coal miners in Vietnam and identifies contextual factors influencing engagement in unsafe sexual practices. Findings reveal that sex carries a number of social meanings in the lives of migrant miners: sex is relaxation and reward for their risk and hard work; access to sex is an incentive for miners to continue working in the mine; sex strengthens identity and social networks; sex helps miners to affirm manhood, group membership and masculinity; and sex workers are confidants with whom they can share their problems. Facing accidents at work on a daily basis, miners are less inclined to worry about the long-term risks of HIV infection. In addition, being excluded from access to relevant information, miners feel distant from HIV infection. Findings suggest that interventions on sexual behaviour and practices should be sensitive to the concepts of risk and meanings of sex among migrant groups such as coal miners.

Topics: Attitude; Coal Mining; Cross-Cultural Comparison; Developing Countries; Gender Identity; HIV Infections; Humans; Male; Motivation; Sex; Sex Work; Sexual Behavior; Sexually Transmitted Diseases; Social Identification; Social Values; Transients and Migrants; Unsafe Sex; Vietnam

Pharmacokinetic differences, contributing to drug-related side effects, between men and women have been reported for HIV protease inhibitors. As only limited and inconclusive data on ritonavir-boosted atazanavir are available, we evaluated the respective steady-state pharmacokinetics in 48 male and 26 female HIV-1-infected adults receiving atazanavir/ritonavir 300/100 mg once-daily as part of their antiretroviral therapy.. Pharmacokinetic profiles (24 h) of atazanavir/ritonavir were assessed and measured by HPLC/tandem mass spectrometry. Geometric mean (GM; ANOVA) of minimum and maximum plasma drug concentrations (C(min) and C(max)), area under the concentration-time curve (AUC) and total clearance (CL(total)) were compared between the sexes and correlated to demographic (age, gender and ethnicity), physiological (weight and body mass index) and clinical (CD4+ cell count, HIV-RNA, co-medication and hepatitis serology) co-factors.. The GM of the atazanavir AUC, C(max) and C(min) of men versus women were 32 643 versus 36 232 ng.h/mL [GM ratio (GMR) = 1.11, P = 0.435], 2802 versus 3211 ng/mL (GMR = 1.15, P = 0.305) and 398 versus 470 ng/mL (GMR = 1.18, P = 0.406), respectively. Although weight (80.6 versus 63.9 kg, P = 0.001) and body weight-adjusted atazanavir dose (3.84 versus 4.60 mg/kg, P = 0.013) were different between the sexes, no significant correlation to atazanavir pharmacokinetics was observed. A linear regression analysis detected significant correlations of atazanavir C(min) with ritonavir AUC (P < 0.001) and the co-administration of methadone oral solution (P = 0.032), and inverse correlations with the time since the first HIV infection diagnosis (P = 0.003) and the number of previous antiretroviral treatments (P = 0.022).. Atazanavir/ritonavir steady-state pharmacokinetics was comparable in men and women, despite gender-related significant differences in atazanavir dose/body weight. The administration of atazanavir/ritonavir is pharmacokinetically safe; 95% of all trough samples were above the recommended plasma concentration of 150 ng/mL.

Topics: Adult; Area Under Curve; Atazanavir Sulfate; Chromatography, High Pressure Liquid; Female; HIV Infections; HIV Protease Inhibitors; Humans; Male; Metabolic Clearance Rate; Middle Aged; Oligopeptides; Outpatients; Plasma; Pyridines; Ritonavir; Sex; Tandem Mass Spectrometry

Bathhouses and sex clubs were identified as primary venues for HIV transmission during the original HIV epidemic. Because HIV incidence is increasing in some high-risk groups, their potential role in HIV transmission is being examined again. We present an extension of the Bernoulli process model of HIV transmission to incorporate subpopulations with different behaviors in sex acts, condom use, and choice of partners in a single period of time. With this model, we study the role that bathhouses and sex clubs play in HIV transmission using data from the 1997 Urban Men's Health Study. If sexual activity remains the same, we find that bathhouse closures would likely lead to a small increase in HIV transmission in the period examined by this study, although this impact is less than that which would be achieved through a 1% change in current condom use rates. If, conversely, bathhouse closure leads to a reduction of the sexual activity that was in the bathhouse by at least 2%, HIV transmission would be lowered.

Topics: Female; HIV Infections; Humans; Male; Models, Biological; Sex; Sexual Behavior; Sexually Transmitted Diseases

This study tested whether having racially and gender-matched counsellors for HIV Post-test counselling were preferred. In the NIDA-funded EachOneTeachOne study, 115 African American respondents (19-68) were asked would they rather talk to someone of the same sex and race. Forty-three percent of the counsellor-respondent pairs were race concordant, and 58% were gender concordant. Chi-square statistics examined effects of gender, race and match. Out of those who desired a gender-match, 89% were men compared to 11% of women. Only 9% of African-Americans reported that they would feel more comfortable talking to an African-American counsellor. The sample size dropped due to non-response of the matching reference questions. Among the 39 race-counsellor concordant respondents (n=98), 23% expressed a preference for a race matched counsellor while no one with a race discordant counsellor expressed such a preference. Among the 56 respondents with a gender concordant counsellor (n=102), 27% said they would prefer a gender matched counsellor in the future; only 7% of those with a gender discordant counsellor expressed such as preference. Previously matched respondents were more likely to desire matched counsellors, but the majority still did not. Assumptions that race and gender matching are imperative are not supported by these findings.

Topics: Adult; Aged; Black or African American; Counseling; Female; HIV Infections; Humans; Male; Middle Aged; Patient Satisfaction; Professional-Patient Relations; Racial Groups; Sex

We examined the relationship between sex and the risk of intrauterine, intrapartum and postnatal HIV transmission among 4495 infants born to HIV-infected mothers in Harare, Zimbabwe. Intrauterine transmission was 8.6%, and consistent with other studies was higher among girl than boy infants (AOR 1.53; 95% CI 1.23-1.91). Unlike previous studies, we observed no independent effect of infant sex on intrapartum or breastfeeding-associated HIV transmission. Sex-specific postnatal prevention strategies are not warranted in this population.

Topics: Adult; Breast Feeding; Female; HIV Infections; HIV-1; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Male; Pregnancy; Pregnancy Complications, Infectious; Puerperal Infection; Risk Factors; Sex; Zimbabwe

Topics: Africa South of the Sahara; Disease Outbreaks; Female; Global Health; HIV Infections; Humans; Risk Factors; Sex; Women's Health

Topics: Cervix Uteri; Female; HIV Infections; HIV-1; Humans; Ovulation; Sex; Vagina; Virus Shedding

Topics: Congresses as Topic; Family Planning Services; Global Health; Health Policy; HIV Infections; Humans; International Cooperation; Internationality; Male; Power, Psychological; Reproduction; Sex; Women's Health; Women's Rights

Women are the fastest growing group in the USA to become infected with HIV. Also, the mode of transmission is changing with heterosexual behaviour being the predominant source. As these changes occur, HIV infection becomes more common in women who have not typically been considered at high risk. This paper describes an intervention designed to decrease unsafe sexual encounters and to focus on a highly meaningful concern in the lives of these women: relationships with men. The sessions encouraged making decisions, choice, partner selection, sexual rights, refusal of any unwanted sex, female controlled methods and other elements of empowerment. An eight-session and a four-session curriculum were created to assess dose factors as well.

Topics: Adolescent; Adult; Female; Health Education; Health Knowledge, Attitudes, Practice; Heterosexuality; HIV Infections; Humans; Incidence; Risk Factors; Safe Sex; Sex; Sex Education; United States; Women's Health

The development and validation process of the Video Rating Scale of Conflict Management and Sexual Negotiation (EAVI) is presented. This instrument was developed as a response to the growing incidence of HIV/AIDS infection among heterosexual women and recognizes the need to evaluate prevention efforts that focus on the development of sexual negotiation skills. EAVI was used to evaluate taped simulations of couples negotiating safer sex. Content validity and reliability analysis were performed. Overall, the scale has a content validity score of .90 and a reliability of 75%. The validity and reliability of specific subscales was low thus suggesting a need for revision. Suggestions are provided for improving the measure and examples of its actual usefulness in academic and community settings are presented.

Topics: Acquired Immunodeficiency Syndrome; Adult; Conflict, Psychological; Female; HIV Infections; Humans; Negotiating; Puerto Rico; Reproducibility of Results; Sex; Video Recording

Topics: Female; HIV Infections; Humans; Interpersonal Relations; Male; Sex

Topics: HIV Infections; Humans; Risk; Sex

Topics: Female; Germany; HIV Infections; Humans; Male; Sex

The issues worldwide that deserve attention pertain to international migration, the education of women, family planning, missing female children, and prevention and control of AIDS cases. Migration outside country borders has been increasing due to economic and social disparities, and uncounted and unrecognized refugees are fleeing environmental disasters. The educational status of women has increased over the past 30 years. For example, female illiteracy has declined among women aged 20-24 years from 19% to 8% in Latin America, from 38% to 12% in eastern and western Asia, and from 80% to 49% in Africa. These improvements are significant, but the problem remains, where, for instance in Africa, there is still extensive illiteracy (75% of females aged under 25 years). A 1993 Population Action International Report states that low female educational levels and weak family planning and health programs are related to large family size and high child death rates. During the 1980s family planning was linked with ecological concerns. Progress has been made in the increase in contraceptive users in developing countries from 14% to 53% during 1965-70. Fertility has declined from 6.1 children per woman in the 1950s to 3.7. Kenya is a good example of a country with high fertility that reduced fertility through its emphasis on family planning. Obstacles to increased prevalence of contraception still remain. In Mexico more than 50% of public birth control services are provided to women in secret due to fear of their husband's abuse. Population pressure can result in the loss of girl children through higher mortality, better nutrition, neglect, or gender preference in the early fetal stages. The challenge of AIDS will be in caring for the sick and adjusting to social changes due to the expected increases in orphaned children.

Topics: Acquired Immunodeficiency Syndrome; Asia; Asia, Eastern; Bangladesh; Behavior; China; Demography; Developing Countries; Disease; Economics; Educational Status; Emigration and Immigration; Evaluation Studies as Topic; Family Characteristics; Family Planning Services; Family Relations; Health Planning; HIV Infections; India; Nuclear Family; Population; Population Dynamics; Psychology; Sex; Social Class; Social Values; Socioeconomic Factors; Virus Diseases

To study incidence and risk factors of heterosexually transmitted HIV infection, we followed a cohort of 343 seronegative women, stable, monogamous partners of infected men whose only risk of acquiring HIV was sexual exposure to the infected partner. Nineteen seroconversions occurred in 529.6 person years (py) of observation, yielding an incidence rate of 3.6 per 100 py. The incidence rate was 7.2 per 100 py among women who did not always use or never used condoms and 1.1 among those who always used them [relative risk (RR) 6.6, 95% confidence interval (CI) 1.9-21.9]. Anal sex was associated with a risk increase in only those women not always using condoms (RR 1.4, 95% CI 0.4-4.8). No seroconversions were observed among 22 women using oral contraceptives. One of the women using intrauterine devices seroconverted. In couples who did not always use condoms, seroconversions occurred more frequently in partners of men with symptomatic diseases, with a low CD4+ cell number (< 400 per mm3) or with a detectable p24 antigen. In couples not always using condoms and where the man had a low CD4+ cell count, the joint presence of blood viral antigens and AIDS symptoms conditioned a fivefold increased risk of seroconversion of the woman (RR 5.4, CI 1.4-20.3). At multivariate analysis, women with longer relationships (> or = 1 year) showed a lower risk of seroconversion (RR 0.3, CI 0.1-0.8), and those partners of men positive for p24 antigen in serum had an increased risk of seroconversion (RR = 4.0, CI 0.1-0.8).

Topics: CD4-Positive T-Lymphocytes; Condoms; Female; HIV Infections; HIV Seropositivity; Humans; Intrauterine Devices; Leukocyte Count; Male; Multivariate Analysis; Risk Factors; Sex; Vaginitis

We compared three groups of injecting drug users in a large cross-sectional study on HIV/AIDS and risk behaviors in Sydney, Australia, to determine what differences existed between those who had never been in treatment (n = 458), had previously been in treatment (n = 387), and were currently in treatment (n = 367). Drug use for those currently in treatment was assessed during the last typical using month before treatment. Those previously and currently in treatment were similar in terms of drug use patterns and HIV risk-related injecting behaviors. Those never in treatment were younger, had a lower level of HIV risk-related injecting behaviors, and reported lower drug use and less involvement in the drug subculture. There was little difference between the three groups on HIV risk-related sexual behaviors. These data suggest that those never in treatment are less dysfunctional and possibly less involved in drug-using careers, whereas there appears to be a close relationship between being previously and currently in treatment.

Topics: Adult; Australia; Cross-Sectional Studies; Female; HIV Infections; HIV Seropositivity; Humans; Male; Parity; Risk Factors; Sex; Socioeconomic Factors; Substance Abuse, Intravenous

Until recently, the only sustained AIDS activity in India has been alarmist media attention complemented by occasional messages calling for comfort and dignity. Public perception of the AIDS epidemic in India has been effectively shaped by mass media. Press reports have, however, bolstered awareness of the problem among literate elements of urban populations. In the absence of sustained guidance in the campaign against AIDS, responsibility has fallen to voluntary health activists who have become catalysts for community awareness and participation. This voluntary initiative, in effect, seems to be the only immediate avenue for constructive public action, and signals the gradual development of an AIDS network in India. Proceedings from a seminar in Ahmedabad are discussed, and include plans for an information and education program targeting sex workers, health and communication programs for 150 commercial blood donors and their agents, surveillance and awareness programs for safer blood and blood products, and dialogue with the business community and trade unions. Despite the lack of coordination among volunteers and activists, every major city in India now has an AIDS group. A controversial bill on AIDS has ben circulating through government ministries and committees since mid-1989, a national AIDS committee exists with the Secretary of Health as its director, and a 3-year medium-term national plan exists for the reduction of AIDS and HIV infection and morbidity. UNICEF programs target mothers and children for AIDS awareness, and blood testing facilities are expected to be expanded. The article considers the present chaos effectively productive in forcing the Indian population to face up to previously taboo issued of sexuality, sex education, and sexually transmitted disease.

Topics: Acquired Immunodeficiency Syndrome; Administrative Personnel; Asia; Attitude; Behavior; Child Welfare; Clinical Laboratory Techniques; Communication; Community Participation; Culture; Demography; Developing Countries; Diagnosis; Disease; Economics; Government; Health; Health Planning; Health Services Needs and Demand; Hematologic Tests; HIV Infections; Homosexuality; India; Infections; International Agencies; Legislation as Topic; Mass Media; Maternal Welfare; Morbidity; Organization and Administration; Organizations; Philosophy; Politics; Population; Population Characteristics; Psychology; Public Opinion; Public Policy; Research; Sex; Sexual Behavior; Sexually Transmitted Diseases; Social Planning; Social Values; United Nations; Urban Population; Virus Diseases; Volunteers; World Health Organization