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1.  Acceptability of Global Positioning System technology to survey injecting drug users’ movements and social interactions: a pilot study from San Francisco, USA 
Despite potential applications for improving health services using GPS technology, little is known about ethical concerns, acceptability, and logistical barriers for their use, particularly among marginalized groups.
We garnered the insights of people who inject drug (PWID) in San Francisco on these topics.
PWID were enrolled through street-outreach (n=20) and an ongoing study (n=4) for 4 focus group discussions. Participants also completed a self-administered questionnaire on demographic characteristics and their numbers and types of interactions with other PWID.
Median age was 30.5 years, majorities were male (83.3%) and white (68.2%). Most interacted with other PWID for eating meals and purchasing drugs over the last week; fewer reported interactions such as sexual contact, drug treatment, or work. Participants identified several concerns about carrying GPS devices, including what authorities might do with the data, that other PWID and dealers may suspect them as informants, and adherence to carrying and use. Most felt concerns were surmountable with detailed informed consent on the purpose of the study and practical ways to carry, charge, and hide devices.
PWID felt data collection on their movements and social interactions with other PWID using GPS can be acceptable with addressing specific concerns. The technology is now in hand to greatly expand the ability to monitor health conditions with respect to the environment and improve the location of prevention, care, and treatment facilities to serve hard to reach, mobile, and hidden populations.
PMCID: PMC4511082  PMID: 24990173
GPS Technology; Data Collection; Acceptability; People Who Inject Drugs
2.  Factors Determining Survival and Retention among HIV-Infected Children and Adolescents in a Community Home-Based Care and a Facility-Based Family-Centred Approach in Kampala, Uganda: A Cohort Study 
ISRN AIDS  2014;2014:852489.
We describe factors determining retention and survival among HIV-infected children and adolescents engaged in two health care delivery models in Kampala, Uganda: one is a community home-based care (CHBC) and the other is a facility-based family-centred approach (FBFCA). This retrospective cohort study reviewed records from children aged from 0 to 18 years engaged in the two models from 2003 to 2010 focussing on retention/loss to follow-up, mortality, use of antiretroviral therapy (ART), and clinical characteristics. Kaplan Meier survival curves with log rank tests were used to describe and compare retention and survival. Overall, 1,623 children were included, 90.0% (1460/1623) from the CHBC. Children completed an average of 4.2 years of follow-up (maximum 7.7 years). Median age was 53 (IQR: 11–109) months at enrolment. In the CHBC, retention differed significantly between patients on ART and those not (log-rank test, adjusted, P < 0.001). Comparing ART patients in both models, there was no significant difference in long-term survival (log-rank test, P = 0.308, adjusted, P = 0.489), while retention was higher in the CHBC: 94.8% versus 84.7% in the FBFCA (log-rank test, P < 0.001, adjusted P = 0.006). Irrespective of model of care, children receiving ART had better retention in care and survival.
PMCID: PMC4003865  PMID: 25006529
3.  HIV test-seeking blood donors in a large blood bank in São Paulo, Brazil 
Transfusion  2010;50(8):1806-1814.
Persons with HIV risk behaviors are excluded from donation to reduce the risk of transfusion-transmitted infection. Persons donating in order to be tested for HIV may therefore deny risk behaviors.
A random sample of donors completed a survey on motivations, knowledge, and attitudes on the screening process. Donors were considered test seekers if they agreed with two statements: “I think that blood donation is a good, fast, and anonymous way to get my blood tested” and “I donate to get my test results”. This study was conducted from June to November 2006 at the largest blood bank in São Paulo, Brazil.
Of 3,061 participants, 208 (7%) were test seekers. They tended to be male and lower educational level. They were more likely to have incorrect knowledge about blood safety (e.g., not knowing that a unit can test antibody negative and still transmit infection, 50% vs. 42%, p=0.02), express dissatisfaction with screening questions (e.g., feeling important questions were not asked, 14% vs. 5%, p<0.01), and concur that donors do not answer questions truthfully (e.g., donors have more sexual partners than they admit, 29% vs. 18%, p<0.01). Test seekers were more likely to believe it is alright to donate blood to get tested for HIV (41% vs. 10%, p<0.01).
Test-seeking motivation, coupled with low knowledge of window period risk, is counter to improving blood safety and to donor prevention needs. Donor education needs to be improved along with availability of appropriate HIV counseling and testing.
PMCID: PMC2981410  PMID: 20456699
4.  Increases in sexually transmitted infections and sexual risk behaviour without a concurrent increase in HIV incidence among men who have sex with men in San Francisco: a suggestion of HIV serosorting? 
Sexually Transmitted Infections  2006;82(6):461-466.
Sexually transmitted infections (STI) and unprotected anal intercourse (UAI) have been increasing among men who have sex with men (MSM) in San Francisco. However, HIV incidence has stabilised.
To describe recent trends in sexual risk behaviour, STI, and HIV incidence among MSM in San Francisco and to assess whether increases in HIV serosorting (that is, selective unprotected sex with partners of the same HIV status) may contribute to preventing further expansion of the epidemic.
The study applies an ecological approach and follows the principles of second generation HIV surveillance. Temporal trends in biological and behavioural measures among MSM were assessed using multiple pre‐existing data sources: STI case reporting, prevention outreach programmatic data, and voluntary HIV counselling and testing data.
Reported STI cases among MSM rose from 1998 through 2004, although the rate of increase slowed between 2002 and 2004. Rectal gonorrhoea cases increased from 157 to 389 while early syphilis increased from nine to 492. UAI increased overall from 1998 to 2004 (p<0.001) in community based surveys; however, UAI with partners of unknown HIV serostatus decreased overall (p<0.001) among HIV negative MSM, and among HIV positive MSM it declined from 30.7% in 2001 to a low of 21.0% in 2004 (p<0.001). Any UAI, receptive UAI, and insertive UAI with a known HIV positive partner decreased overall from 1998 to 2004 (p<0.001) among MSM seeking anonymous HIV testing and at the STI clinic testing programme. HIV incidence using the serological testing algorithm for recent HIV seroconversion (STARHS) peaked in 1999 at 4.1% at the anonymous testing sites and 4.8% at the STI clinic voluntary testing programme, with rates levelling off through 2004.
HIV incidence among MSM appears to have stabilised at a plateau following several years of resurgence. Increases in the selection of sexual partners of concordant HIV serostatus may be contributing to the stabilisation of the epidemic. However, current incidence rates of STI and HIV remain high. Moreover, a strategy of risk reduction by HIV serosorting can be severely limited by imperfect knowledge of one's own and one's partners' serostatus.
PMCID: PMC2563862  PMID: 17151031
men who have sex with men; sexual risk behaviour; sexually transmitted infections; HIV
5.  Health indicators among low income women who report a history of sex work: the population based Northern California Young Women's Survey 
Sexually Transmitted Infections  2005;81(5):428-433.
Objectives: We examined differences in demographic characteristics, HIV related risk behaviour, prevalence of sexually transmitted infections (STI), and HIV and other health concerns among women with and without a history of sex work.
Methods: A secondary analysis of a population based, cross sectional survey of young, low income women in northern California.
Results: Of the 2543 women interviewed, 8.9% reported a history of sex work. These women reported more lifetime male sexual partners, were more likely to use drugs before sex, and were more likely to have a history of having sex with partners at high risk for HIV (that is, men who have sex with men, inject drugs, or were known to be HIV positive). They were significantly more likely to have positive serology for syphilis, herpes simplex virus type 2 (HSV-2), and hepatitis C regardless of their personal injecting drug use history; however, they were no more likely to have HIV, chlamydia, gonorrhoea, hepatitis A or hepatitis B infection compared to women without a history of sex work. Women with a history of sex work were significantly more likely to have a history of sexual coercion and tobacco use.
Conclusions: These data measure the population prevalence of sex work among low income women and associated STI. Women with a history of sex work have health concerns beyond STI and HIV treatment and prevention.
PMCID: PMC1745033  PMID: 16199746
6.  Improved data, methods and tools for the 2007 HIV and AIDS estimates and projections 
Sexually Transmitted Infections  2008;84(Suppl_1):i1-i4.
PMCID: PMC2569833  PMID: 18647859

Results 1-6 (6)