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1.  Incidence of Sexually Transmitted Infections in HIV-Infected and HIV-Uninfected Adolescents in the United States 
Summary
Little is known about the incidence of bacterial sexually transmitted infections (STIs) among HIV-infected vs. HIV-uninfected adolescents. This secondary analysis of a national, multisite study included adolescents aged 12–18 years who were behaviorally HIV-infected (n=346) or HIV-uninfected but at-risk (n=182). Incidence rates of bacterial STIs (gonorrhea, chlamydia [CT], and trichomonas [TV; females]) were calculated using Poisson modeling. Factors associated with incident STIs were explored using Cox proportional hazards modeling. HIV-infected vs. HIV-uninfected women had higher TV incidence (1.3 vs. 0.6/100 person-months; p=0.002). HIV-uninfected vs. HIV-infected women had higher CT incidence (1.6 vs. 1.1/100 person-months; p=0.04). Among women, demographic, behavioral, and HIV-related factors were associated with incident STIs. Among men, there were no differences in incident STIs. In this first analysis comparing STI incidence between HIV-infected and HIV-uninfected adolescents, bacterial STI incidence among women significantly differed by HIV status, and factors associated with incident STIs varied by STI and HIV status.
doi:10.1177/0956462412472425
PMCID: PMC4327832  PMID: 23467290
Adolescent; HIV; STI; Incidence
2.  Herpes simplex virus type 2 seroprevalence and incidence in acute and chronic HIV-1 infection 
Summary
Herpes simplex virus type 2 (HSV-2) HIV co-infection is common and associated with increased risk of HIV transmission. HSV-2 seroprevalence was assessed on stored samples from baseline and one year follow-up from 81 patients identified with acute HIV infection and 81 age-matched chronically infected men. HSV-2 seroprevalence at baseline was lower for those with acute rather than chronic HIV-infection, 51.9 versus 71.6% (P = 0.01); relative risk 0.72 (95% confidence interval [CI] 0.57–0.92). Since HSV-2 seroprevalence is lower in those newly HIV-infected, the diagnosis of early HIV infection may allow for counselling to reduce subsequent HSV-2 acquisition.
doi:10.1258/ijsa.2011.010551
PMCID: PMC4313875  PMID: 21742810
herpes simplex virus type 2; HSV-2; seroprevalence; acute HIV infection; chronic HIV infection
3.  Factors Associated with High Transmission Risk and Detectable Plasma HIV RNA in HIV-infected MSM on ART 
International journal of STD & AIDS  2014;25(10):734-741.
HIV transmission risk is increased during ART use if individuals are not virologically suppressed and engage in high risk transmission behavior. Baseline data of HIV-infected MSM with recent history of risky behavior on ART for ≥3 months (n=139) was evaluated to assess predictors of detectable viremia and HIV transmission risk taking behavior. 24 subjects had VL>75 c/mL and 12 had VL>1000 c/mL. In multivariable regression analyses, subjects with VL>75 c/mL were more likely to be Black (OR 4.48, p=0.007), have lower CD4 cells (OR 0.727, p=0.005) and have used methamphetamines in the last month (OR 6.64, p=0.019). Subjects with VL>1000 c/mL were more likely to have lower CD4 cells (OR 0.494, p=0.004), report <90% adherence (OR 7.94; p=0.046) and have used methamphetamines in the last month (OR 10.01, p=0.034). Subjects with VL>75c/mL with the greatest transmission risk behavior (n=14) were more likely to be Black (OR 8.00, p=0.006), have lower CD4 cells (OR 0.657, p=0.009) and have used methamphetamines in the last month (OR 5.20, p=0.042). High risk HIV transmission behavior with viremia occurred in 10% of the cohort. Future efforts to reduce HIV transmission among MSM on ART will require combined interventions that target risk-taking behaviors and substance use.
doi:10.1177/0956462413518500
PMCID: PMC4303352  PMID: 24452730
4.  Social-structural indices and between-nation differences in HIV prevalence 
Research emphasises the role that social structures play in shaping national HIV prevalence. This study examined how social, economic, and political contexts that may represent the confluence of individual capabilities and environmental affordances or constraints are associated with national HIV prevalence. Based on social-ecological perspectives, we examined social-structural dimensions in relation to national HIV prevalence. The study identified six publicly available nation-level social, political, and economic indices and examined their associations with national 2009 HIV prevalence across 225 nations. National indices, (a) education expenditures, (b) unemployment rate, (c) homicide rate, (d) freedom of religion, and (e) women’s social rights, altogether explained 43% of the variability in national HIV prevalence. Education expenditures, homicide rate, and freedom of religion were significant predictors of national HIV prevalence in the multivariate analysis. The present study identified nation-level factors that capture social, economic, and political contexts to explain between-nation differences in HIV prevalence. Findings extend current literature on the social-structural foundation of HIV-risk and the relationship between human rights and health. National safeguards that afford individuals the power to promote general quality of life and protection from structural violence may be most important to lowering overall rates of HIV transmission.
doi:10.1177/0956462414529264
PMCID: PMC4183719  PMID: 24700198
National HIV prevalence; national indices; social and structural factors; power; human rights
5.  Sexual risk and HIV prevention behaviors among African American and Latino MSM social networking users 
International journal of STD & AIDS  2013;24(8):10.1177/0956462413478875.
This study explores the feasibility of recruiting minority men who have sex with men (MSM) Facebook users for HIV prevention studies, and notes demographic and sexual risk behaviors. Facebook-registered MSM (N=118) were recruited using online and offline methods. Participants validated Facebook-user status through using a Facebook Connect (computer science) application. Participants were primarily Latino (60.2%) and African-American (28.0%), with 33.1% using social media to find sex partners. Black MSM social networking users reported engaging in a lower frequency (Coeff = −.48, p < .05) of unprotected receptive anal intercourse (URAI) compared to Latino MSM. Results suggest that minority social media-users can be recruited for HIV studies and that sexual risk behavioral differences exist among minority social networking users. Findings highlight the importance of incorporating technologies into population-focused HIV interventions.
doi:10.1177/0956462413478875
PMCID: PMC3855428  PMID: 23970575
HIV prevention; social networking; at-risk populations; MSM
6.  Comparison of two interferon-gamma release assays (QuantiFERON-TB Gold In-Tube and T-SPOT.TB) in testing for latent tuberculosis infection among HIV-infected adults 
International Journal of STD & AIDS  2013;24(10):775-779.
There is currently no ‘gold standard’ for diagnosis of latent tuberculosis infection (LTBI), and both the tuberculin skin test and interferon-gamma release assays (IGRAs) are used for diagnosis; the latter have a higher sensitivity than tuberculin skin tests for diagnosis of LTBI in HIV-infected individuals with lower CD4 counts. No evidence base exists for selection of IGRA methodology to identify LTBI among human immunodeficiency virus-infected patients in the UK. We prospectively evaluated two commercially available IGRA methods (QuantiFERON-TB Gold In Tube [QFG] and T-SPOT.TB) for testing LTBI among HIV-infected patients potentially nosocomially exposed to an HIV-infected patient with ‘smear-positive’ pulmonary tuberculosis. Among the exposed patients median CD4 count was 550 cells/µL; 105 (90%) of 117 were receiving antiretroviral therapy, of who 104 (99%) had an undetectable plasma HIV load. IGRAs were positive in 12 patients (10.3%); QFG positive in 11 (9.4%) and T-SPOT.TB positive in six (5.1%); both IGRAs were positive in five patients (4.3%). There was one indeterminate QFG and one borderline T-SPOT.TB result. Concordance between the two IGRAs was moderate (κ = 0.56, 95% confidence interval = 0.27–0.85). IGRAs were positive in only 4 (29%) of 14 patients with previous culture-proven tuberculosis. No patient developed tuberculosis during 20 months of follow-up.
doi:10.1177/0956462413486459
PMCID: PMC4107858  PMID: 23970606
Interferon-gamma release assays; latent tuberculosis infection; HIV; screening; tuberculin skin test; AIDS; IGRA; Mycobacterium tuberculosis
8.  Treatment of High-Grade Anal Dysplasia in High Risk Patients: Outcome at an Urban Community Health Center 
SUMMARY
Human immunodeficiency (HIV)-infected patients and men who have sex with men (MSM) have a higher rate of high-grade anal intraepithelial neoplasia (HGAIN), a likely precursor to anal cancer. This retrospective study describes the outcome of treating MSM with incident biopsy-proven HGAIN in an urban community health setting with access to outpatient ablation or operative treatment. The main outcome was freedom from HGAIN at follow-up. 153 met inclusion criteria; 86 (56%) were HIV-infected. Eighty (52%) received outpatient ablation, 49(61%) had a follow-up within 9 months. Among those, 26 (53%) were free of high-grade disease, 19 (39%) had high-grade disease; and 4 (8%) had unknown grading. In a logistic regression model, a lower extent of anal disease (1 quadrant vs. 2,3, or 4 quadrants) was significantly associated with a lower probability of high-grade disease (p-value 0.04.) HGAIN could be managed in a community health setting; however, systems are needed to ensure follow-up care.
doi:10.1177/0956462412472298
PMCID: PMC3890353  PMID: 23535356
HIV/AIDS; HPV; Treatment; Homosexual
9.  Biomarker evaluation of self-reported condom use among women in HIV-discordant couples 
Summary
Self-reported condom use is a commonly collected statistic, yet its use in research studies may be inaccurate. We evaluated this statistic among women in HIV-discordant couples enrolled in a clinical trial in Nairobi, Kenya. Vaginal swabs were acquired from 125 women and tested for prostate-specific antigen (PSA), a biomarker for semen exposure, using an enzyme-linked immunosorbent assay. Ten (10%) of 98 women who reported 100% use of condoms in the previous month tested PSA positive. In a bivariate logistic regression analysis, among women who reported 100% condom use in the previous month, those with ≤8 years of school had significantly higher odds of testing PSA-positive (odds ratio [OR] = 8.39, 95% confidence interval [CI] 1.02–69.13) than women with more schooling. Our estimate may be conservative, as the ability to detect PSA may be limited to 24–48 hours after exposure. Less educated women may be a target group for counselling regarding reporting sexual behaviour in clinical trials.
doi:10.1177/0956462412473892
PMCID: PMC4006961  PMID: 23970768
HIV; AIDS; transmission; prevention; condom use; self-reported; semen exposure; biomarker; prostate-specific antigen; PSA; women; discordant couples; sexual behaviour
10.  Herpes Simplex Virus Type 2 Infection among Commercial Sex Workers in Kunming, Yunnan Province, China 
International journal of STD & AIDS  2008;19(10):694-697.
Summary
A cross-sectional prevalence survey was conducted to determine the sociodemographic correlates of HSV-2 infection among commercial sex workers (CSWs) in Kunming, Yunnan Province of China. HSV-2 prevalence was 33.0%, HIV infection was 2.4%, and HCV infections was 6.8%. Subjects who were positive for HSV-2 had a significantly higher prevalence of HIV infection (5.5% vs. 0.9%, p=0.002; OR: 6.4, p=0.006) and HCV infection (18.7% vs. 2.4%, p<0.001; OR: 7.6, p<0.001) compared to HSV-2 negative individuals. Risk factors that increased the odds of HSV-2 infection were HIV infection, HCV infection, being female, and having a steady sex partner within the last six months (p≤0.01). In a multivariate analysis, female sex workers (OR: 6.6, p<0.001), HCV infection (OR: 5.9, p<0.001), and having a sex partner within the last 6 months (OR: 2.2, p<0.05) had greater odds of being infected with HSV-2. A strong relationship was found between HSV-2, HIV, and HCV infections.
doi:10.1258/ijsa.2008.008072
PMCID: PMC3991299  PMID: 18824623
commercial sex workers (CSWs); herpes simplex virus type 2 (HSV-2); human immunodeficiency virus (HIV); hepatitis C virus (HCV); China
11.  Condom Use Behaviors and Correlates of Use in the Botswana Defence Force 
International journal of STD & AIDS  2013;24(11):883-892.
Preventing HIV infection is a priority for militaries. HIV prevention research is needed to monitor existing programs, identify areas for modification, and develop new interventions. Correct and consistent condom use is highly effective against HIV. However, use among soldiers is lower than ideal. This study describes condom use behaviors and examines correlates of use in the Botswana Defence Force (BDF). Analyses were based on 211 male personnel, aged 18–30, who completed a cross-sectional survey that collected baseline data for an intervention study. Results showed that 51% of participants reported always using condoms, 35% used condoms most times, and 14% used condoms occasionally/never. Condom use varied by partner type and was typically higher with casual partners in comparison to regular partners. After adjustment for age and marital status, factors associated with lower condom use included excessive alcohol use, perception that using condoms reduce sexual pleasure, and having a trusted partner. However, higher levels of HIV knowledge and reports of being circumcised were protective against lower condom use. HIV interventions aimed at increasing condom use in the BDF should address condom perceptions, alcohol abuse, and issues of trust. Innovative ways to increase condom use in this population should also be explored.
doi:10.1177/0956462413486889
PMCID: PMC3989099  PMID: 23970609
HIV/AIDS; military populations; sexual behaviors; condom use
12.  The longitudinal association of venue stability with consistent condom use among female sex workers in two Mexico–USA border cities 
Summary
We examined the relationship between venue stability and consistent condom use (CCU) among female sex workers who inject drugs (FSW-IDUs; n = 584) and were enrolled in a behavioural intervention in two Mexico–USA border cities. Using a generalized estimating equation approach stratified by client type and city, we found venue stability affected CCU. In Tijuana, operating primarily indoors was significantly associated with a four-fold increase in the odds of CCU among regular clients (odds ratio [OR]: 3.77, 95% confidence interval [CI]: 1.44, 9.89), and a seven-fold increase among casual clients (OR: 7.18, 95% CI: 2.32, 22.21), relative to FSW-IDUs spending equal time between indoor and outdoor sex work venues. In Ciudad Juarez, the trajectory of CCU increased over time and was highest among those operating primarily indoors. Results from this analysis highlight the importance of considering local mobility, including venue type and venue stability, as these characteristics jointly influence HIV risk behaviours.
doi:10.1177/0956462412473890
PMCID: PMC3987857  PMID: 23970766
HIV; AIDS; sexually transmitted infections; sexual risk behaviours; prevention; injection drug use; venue stability; mobility; condom use; female sex workers; longitudinal analysis; Mexico
13.  The HVTN503/Phambili HIV vaccine trial: a comparison of younger and older participants 
By comparing younger to older participants enrolled in a HIV vaccine efficacy trial, we aimed to gain insights into the inclusion of adolescents in future trials. This was a sub-analysis of a multisite HIV vaccine randomized clinical trial in South Africa, conducted January-September, 2007. Motivations for trial enrollment, social harms, adverse events, and loss to follow-up were compared between younger (18-20 years old) and older participants (21-35 years old). Both younger (n=238) and older participants (n=563) were equally likely to report enrolling for altruistic reasons. Younger females were less likely than older participants to join for trial reimbursement (p=0.005), while younger males were more likely to enroll because the vaccine may provide protection from HIV-acquisition (p<0.001). There were no significant differences in the number of social harms reported. Compared to males over 20 years-old, 18-20-year-old females were less likely to experience adverse events (OR=0.1, CI 0.01-0.80) and no more likely to be lost to follow up (OR=0.7, CI 0.39-1.25), while 18-20-year-old males were no more likely to experience adverse events (OR=1.3, CI 0.58-2.83) or loss to follow-up (OR=0.8, CI 0.51-1.41). Our data support the inclusion of younger participants who are at risk for HIV in future HIV vaccine efficacy trials.
doi:10.1177/0956462413506892
PMCID: PMC3968181  PMID: 24104693
HIV; vaccine trials; clinical trials; youth; South Africa
14.  Expanding sexually transmitted infection screening among women and men engaging in transactional sex: the feasibility of field-based self-collection 
Summary
Routine screening is a key component of sexually transmitted infection (STI) prevention and control; however, traditional programmes often fail to effectively reach men and women in hidden communities. To reduce prevalence, we must understand the programmatic features that would encourage utilization of services among asymptomatic individuals. Using incentivized snowball sampling, 44 women and men recently engaging in transactional sex were recruited (24 women, 20 men); median age 37 years. Respondents were offered the opportunity to collect genital, oropharyngeal and rectal samples for STI testing and completed a face-to-face interview about their experience with self-obtained sampling. Interviews were analysed using qualitative methods. Participants were unaware of potential risk for STI, but found self-sampling in non-clinical settings to be acceptable and preferable to clinic-based testing. All participants collected genital specimens; 96% and 4% collected oropharyngeal and rectal specimens, respectively. The burden of disease in this population was high: 38% tested positive for at least one STI. We detected multiple concomitant infections. Incorporating field collection of self-obtained samples into STI control programmes may increase utilization among high-risk populations unlikely to access clinic-based services. High infection rates indicate that individuals engaging in transactional sex would benefit from, and be responsive to, community-based self-sampling for STI screening.
doi:10.1177/0956462412472791
PMCID: PMC3970701  PMID: 23970665
sexually transmitted infections; diagnosis; sex workers; field collection; self-administered sampling; preferences; STI screening; transactional sex
15.  Clinical and social determinants of diarrhoeal disease in a rural HIV/AIDS clinic, South Africa: a case-control study 
Summary
Diarrhoeal diseases are a common cause of morbidity and are associated with mortality in HIV-infected populations. Little is known about the contribution of clinical and socio-environmental factors to the risk of diarrhoea in these populations in rural sub-Saharan Africa. We conducted a case-control study of people attending a rural HIV clinic with an episode of diarrhoea in Bushbuckridge, South Africa. Cases were defined as HIV-positive adults with symptoms of diarrhoea before or after initiation of antiretroviral therapy (ART). Controls without diarrhoea were randomly selected from clinic attendees. Structured questionnaires and case-file reviews were undertaken to describe clinical and socioenvironmental risk factors. We recruited 103 cases of diarrhoea from 121 patients meeting case definitions. Cases were more likely to be women (P = 0.013), aged over 45 years (P = 0.002), divorced or separated (P = 0.006), have limited formal education (P = 0.003), have inadequate access to sanitation facilities (P = 0.045), have water access limited to less than three days per week (P = 0.032) and not yet initiated on ART (P < 0.001). In multivariate analysis, diarrhoea remained associated with female gender (adjusted odds ratio [aOR]: 2.02, 95% CI 1.10–3.73), older age (aOR: 6.31, 95% CI 1.50–26.50), limited access to water (aOR: 2.66, 95% CI 1.32–5.35) and pre-ART status (aOR: 5.87, 95% CI 3.05–11.27). Clinical and socio-environmental factors are associated with occurrence of diarrhoeal disease among rural HIV patients in South Africa. Further intervention research is urgently needed, combining community- and clinic-based approaches, to improve access to water, sanitation and ART for rural areas with high HIV prevalence, along with structural interventions to address gender inequities.
doi:10.1258/ijsa.2011.011285
PMCID: PMC3966081  PMID: 22648889
HIV/AIDS; antiretroviral therapy; diarrhoea; risk factors; environment; women; water; sanitation; rural; South Africa
16.  DEPRESSION AND SEXUAL RISKBEHAVIOR AMONG CLIENTS ABOUT TO START HIV ANTIRETROVIRAL THERAPY IN UGANDA 
Objective
We investigated depression in relationship to sexual risk behavior with primary partners among HIVclients in Uganda.
Methods
Baseline data were analyzed from a cohort of clients starting ART. The Patient Health Questionnaire (PHQ-9) was used to classify depressive severity (none, minor and major depression) and symptom type (cognitive and somatic). Condom use was assessed over the past 6 months and during the last episode of sexual intercourse.
Results
386 participants had a primary sex partner, with whom 41.6% always used condoms during sex over the past 6 months, and 62.4% during last sex. Use of a condom during last sex was associated with having no depression and lower PHQ-9 total and cognitive and somatic subscale scores in bivariate analyses; most of these relationships were marginally significant for sex over the past 6 months. Controlling for demographics, HIV disclosure and partner HIV status, only minor depression was associated with unprotected sex.
Conclusion
Depressive symptoms, even if not a clinical disorder, warrant early detection and treatment for promoting HIV prevention among HIV-affected couples.
doi:10.1177/0956462413495186
PMCID: PMC3841244  PMID: 23970636
depression; HIV; Uganda; sexual risk behavior; condom use
17.  Anal Human Papillomavirus Infection in a Street Based Sample of Drug Using HIV-Positive Men 
HIV facilitates an increase in human papillomavirus (HPV) associated conditions. HIV-positive men living in a substance use context in Los Angeles were recruited using Respondent Driven Sampling, completed a questionnaire and had biological samples including an anal HPV swab taken. 316 evaluable men were enrolled in the study. The prevalence of all HPV, high-risk (HR) infection, and multiple type infection was highest for men who have sex with men (MSM) (93.9%, 64.6%, 29.7% respectively). When all HPV and HR-HPV prevalence in all men was stratified by age, the youngest group had 100% and 68.2% prevalence respectively with similarly high rates maintained up to 49 years. The individual’s use of alcohol, marijuana, cocaine, methamphetamine or heroin was not significantly associated with anal HPV isolation. In this marginalized population, high anal HPV and HR-HPV prevalence rates over a wide age range may increase the individual’s risk for anal dysplasia and anal cancer.
doi:10.1258/ijsa.2011.011169
PMCID: PMC3899933  PMID: 22581874
human papillomavirus (HPV); substance use; anal; HIV; men who have sex with men (MSM)
18.  Factors associated with condom use negotiation by female sex workers in Bangladesh 
International journal of STD & AIDS  2013;24(10):813-821.
Summary
Negotiation for condom use by female sex workers (FSWs) with their male clients can enhance condom use. A cross-sectional study was conducted among 1395 FSWs; 439 from two brothels, 442 from 30 hotels, and 514 from streets of two cities in Bangladesh to determine the predictors of condom use negotiation. Consistent condom use rates in the seven days prior to interview were reported to be 16.2%, 21.7%, and 4.5% among the brothel, hotel, and street based FSWs respectively. Overall, 28.1% of FSWs negotiated for condom use with their clients. Participation in behaviour change communication (BCC) programmes (AOR, 1.5; 95% CI, 1.2.–2.0), and self-perceived risk of HIV infection (AOR, 1.8 95% CI, 1.6–2.1) were positive predictors for condom negotiation. Compared to the hotel based FSWs, street (AOR, 0.6; 95% CI, 0.4–0.9), and brothel based FSWs (AOR, 0.7; 95% CI, 0.5–0.9) were less likely to negotiate for condom use. FSWs in Bangladesh are at high risk for STI/HIV infection because of low overall negotiation for condom use. Participation in BCC programmes had positive effect on condom negotiation by FSWs, and should be strengthened in commercial sex venues.
doi:10.1177/0956462413486452
PMCID: PMC3897248  PMID: 23970599
Condom use negotiation; Female sex workers; Bangladesh
19.  A qualitative assessment of perspectives on the inclusion of adolescents in HIV vaccine trials in South Africa 
International journal of STD & AIDS  2010;21(3):10.1258/ijsa.2009.008484.
Summary
Adolescents are at high risk for HIV acquisition, and thus need to be included in HIV vaccine trials. In preparation for inclusion of adolescents in HIV vaccine trials in an urban community in Cape Town with a high antenatal HIV prevalence, the study assessed the attitudes towards the inclusion of adolescents in HIV vaccine trials. A total of 18 focus group discussions were conducted using a semistructured interview guide. The participants (n = 200) were adolescents, young adults, parents and other key informants. Participants from all groups welcomed the inclusion of adolescents in HIV vaccine trials due to their high-risk status. There were, however, concerns about sexual disinhibition, fear of side-effects, fear of HIV testing and disclosure of HIV status, mistrust of nurses and clinics. The study highlighted a number of ethical and social issues that need to be addressed before the trials.
doi:10.1258/ijsa.2009.008484
PMCID: PMC3878910  PMID: 20215620
HIV vaccine trials; adolescents; community consultation; South Africa
20.  Stimulating an immune response? Oral sex is associated with less endometritis 
International journal of STD & AIDS  2012;23(11):775-780.
Introduction
Adaptive immunity requires antigenic priming of the lymphatic system. As lymphatic tissue is abundant in the oropharynx, oral sex could lead to effective immune stimulation and prevent pelvic inflammatory disease (PID).
Objective
To determine whether oral sex could be a protective factor for PID.
Method
The relationship between self-reported oral sex and endometritis was analysed among 619 women with clinically suspected PID who participated in the PID Evaluation and Clinical Health (PEACH) study.
Results
Nearly one quarter of participants reported oral sex in the past 4 weeks. These women also reported a higher number of sexual partners, a new partner within the past 4 weeks, and a higher frequency of sexual intercourse (all p< 0.03). They were more likely to smoke (p<0.0001) and use alcohol (p<0.004) and recreational drugs (p<0.02). Participants reporting oral sex were significantly less likely to be black or to have a positive test for Neisseria gonorrhoeae (7.8% vs 21.6%, p= 0.001).
Women who disclosed oral sex were significantly less likely to have endometritis after adjusting for race, number of partners, recent new partner, smoking, alcohol use, and drug use (adjusted OR 0.5 (0.3 – 0.8)).
Conclusion
This is the first paper showing a negative association between oral sex and endometritis. This may be mediated by a protective immune response in the genital tract following priming in the pharynx. This hypothesis needs to be tested in further studies.
doi:10.1258/ijsa.2012.011407
PMCID: PMC3639487  PMID: 23155096
21.  HIV Prevalence and Sexual Behaviour at Older Ages in Rural Malawi 
Summary
Research on HIV infection and sexual behaviour in sub-Saharan Africa typically focuses on individuals aged 15-49 under the assumption that both become less relevant for older individuals. We test this assumption using data from rural Malawi to compare sexual behaviour and HIV infection for individuals aged 15-49 with individuals aged 50-64 and 65+. Although general declines with age were observed, levels of sexual activity and HIV remained considerable: 26.7% and 73.8% of women and men aged 65+ reported having sex in the last year; men's average number of sexual partners remained above 1; and HIV prevalence is significantly higher for men aged 50-64 (8.9%) than men aged 15-49 (4.1%). We conclude that older populations are relevant to studies of sexual behaviour and HIV risk. Their importance is likely to increase as access to ARVs in Africa increases. We recommend inclusion of adults over 49 in African HIV/AIDS research and prevention efforts.
doi:10.1258/ijsa.2011.011340
PMCID: PMC3788708  PMID: 22844003
22.  Prevalence and Associations with Hepatitis B and Hepatitis C infection Amongst HIV-infected Adults in South Africa 
International journal of STD & AIDS  2012;23(10):e10-e13.
We assessed prevalence and factors associated with hepatitis B in a cross-section of HIV-infected primary care and anti-natal clinic patients in South Africa and evaluated a rapid hepatitis B surface antigen (HBsAg) assay. We enrolled 998 patients; 88% were women, median age was 29 years, and median CD4 count was 354 cells/mm3. HBsAg ELISA, anti-hepatitis B core (HBc) antibodies, and hepatitis C virus antibody were positive among 4.2%, 37%, and 0.1% of subjects, respectively. Univariate and multivariate associations were assessed using logistic regression. Anti-HBc antibodies were associated with alcohol use, traditional medicines, and higher CD4. HBsAg positivity was associated with lower CD4. Compared to the HBsAg ELISA, a rapid HBsAg test had a sensitivity of 75.0% and specificity of 99.6%. In conclusion, we identified a moderate prevalence of both HBsAg and anti-HBc. Importantly, we found subjects with HBsAg positivity had lower CD4 counts.
doi:10.1258/ijsa.2009.009340
PMCID: PMC3724418  PMID: 23104758
HIV/AIDS; HBV; HBsAg; HCV; rapid test; Africa
23.  Trends of HIV-1, HIV-2 and dual infection in women attending outpatient clinics in Senegal, 1990–2009 
International journal of STD & AIDS  2012;23(10):710-716.
Summary
We assessed trends in the relative prevalences of HIV-1, HIV-2 and dual HIV-1/HIV-2 infection in 10,321 women attending outpatient clinics in Senegal between 1990 and 2009. The relative prevalence of HIV-1 (defined as the proportion of seropositive subjects having HIV-1) rose sharply from 38% in 1990 until 1993 (P < 0.001), whereupon it continued to rise, but at a slower rate, reaching 72% of HIV infections in 2009. As compared with HIV-1, the relative prevalence of HIV-2 decreased sharply from 54% in 1990 until 1993 (P < 0.001) and continued to decrease at a slower rate through 2009. The relative prevalence of dual infection, as compared with HIV-1, was stable from 1990 to 1993, but decreased slightly thereafter (P < 0.001). These study findings indicate that during the early 1990s, the relative prevalence of HIV-1 increased markedly, while the relative prevalence of HIV-2 decreased and the relative prevalence of dual infection remained stable in Senegal. From 1993 to 2009, the relative prevalence of HIV-1 increased at a slower rate, while the relative prevalences of HIV-2 and dual infection decreased. These results confirm trends in HIV prevalence observed in other West African populations and provide a critical update on HIV transmission risk among women in Senegal.
doi:10.1258/ijsa.2012.011219
PMCID: PMC3726192  PMID: 23104745
HIV; epidemiology; HIV-1; HIV-2; trends; seroprevalence; Africa; Senegal; dual infection
24.  Mycoplasma genitalium infection among HIV-positive women: prevalence, risk factors and association with vaginal shedding 
Summary:
This study examined the prevalence and factors associated with Mycoplasma genitalium (MG) infection among HIV-positive women and the association between MG and vaginal HIV-1 RNA shedding. HIV-positive women attending an outpatient clinic in New Orleans, Louisiana, USA, from 2002 to 2005 were examined for a battery of sexually transmitted infections (STIs) and underwent a behavioural survey. A selected subset had a measurement of vaginal shedding analysed. Of the 324 HIV-positive women, 32 (9.9%) were infected with MG. HIV-positive women with MG were more likely to be co-infected with Neisseria gonorrhoeae and Chlamydia trachomatis and to have had ≥1 male sexual partners in the last month. In the subset (n = 164), no differences were found in the presence of detectable vaginal HIV-1 RNA between women infected and not infected with MG (30.8% versus 34.8% shedding; P = 0.69). While MG was a common co-STI in this sample of HIV-positive women, it was not associated with vaginal HIV shedding.
doi:10.1258/ijsa.2010.010320
PMCID: PMC3778661  PMID: 21464453
Mycoplasma genitalium; HIV-infected women; vaginal shedding
25.  Characteristics and predictors of women who obtain rescreening for sexually transmitted infections using the www.iwantthekit.org screening program 
Professional organizations recommend rescreening chlamydia-infected women. The iwantthekit Internet-screening program offered rescreening opportunities by using iwantthekit. Mailed, home-collected vaginal swabs were tested for chlamydia, gonorrhea, and trichomonas by nucleic acid amplification tests. Demographics and risk behaviors of repeat users were determined from questionnaires. Predictors of repeat users were measured in a matched case–control study. Of 1747 women, 304 (17%), who used iwantthekit, indicated they had used the kit previously. Mean age was 24.7 ± 5.7 year and 69% were African American. Repeat iwantthekit users were more likely to be ≥20 years (OR = 2.10); were more likely to have been treated for a sexually transmitted infection (OR = 2.32); less likely to drink alcohol before sex (OR = 0.63); and to never use condoms (OR = 0.43). Of repeaters, 84.2% had a negative prior test and 15.8% had a positive. At current test, 13.2% were infected. Previous trichomonas was associated with current trichomonas (p < 0.05). The iwantthekit may offer rescreening opportunities for previously infected women.
doi:10.1177/0956462413483252
PMCID: PMC3777605  PMID: 23970594
Chlamydia (Chlamydia trachomatis); sexually transmitted infection; gonorrhea; Neisseria gonorrhoeae; epidemiology; screening; sexual behavior; trichomonas

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