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Li Y, Yan LL, Ronsmans C, Wen H, Xu J, Wang D, Yang M. Excess mortality among patients with severe mental disorders and effects of community-based mental healthcare: A community-based prospective study in Sichuan, China - RETRACTION. BJPsych Open 2024; 10:e64. [PMID: 38497104 PMCID: PMC10951854 DOI: 10.1192/bjo.2024.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
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2
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Caoimhe C, Spate J, Day S. Improving awareness and uptake of pre-exposure HIV prophylaxis amongst service users accessing Sexual Health London, a regional online postal sexually transmitted infection testing health service. Int J STD AIDS 2024:9564624241231630. [PMID: 38300848 DOI: 10.1177/09564624241231630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND The UK pledged commitment to the global strategy of zero new HIV infections and HIV-related deaths by 2030. PrEP was commissioned in England in 2020 and is fundamental to achieving these targets, yet awareness and uptake are suboptimal in certain populations. METHOD Sexual Health London (SHL) incorporated questions on its e-triage questionnaire estimating need for PrEP amongst online service users. Two types of signposting messaging were shown to users directing them to more detailed online content: PrEP-discussion (potential need) and PrEP-eligible (assumed need). The effectiveness of this signposting was evaluated by reviewing demographics and triage responses in returning users. RESULTS 426,149 SHL users requested STI screening between 1.7.21-31.10.22. 16% (69,867/426,149) and 32.2% (137,489/426,149) of individuals received PrEP-eligible and PrEP-discussion signposting. The PrEP-eligible cohort were: 41.0% gay/bisexual or other men who have sex with men (GBMSM), 16.3% heterosexual males, 33.1% heterosexual females, and 60.6% were of white ethnicity. The PrEP-discussion cohort were: 9.3% GBMSM, 34.3%% heterosexual males, 45.5% heterosexual females and 63.7% of white ethnicity. 50.4% (35,190/69,867) and 41.3% (56,808/137,489) of the PrEP-eligible and PrEP discussion cohorts ordered a subsequent SHL STI testing kit, during which 10.0% (3510/35,190) and 5.9% (3364/56,808) reported taking PrEP. Of those who denied taking PrEP, 59% (18,702/31,680) and 61.0% (32,559/53,444) triggered PrEP signposting again. 95.4% of PrEP starters were GBMSM (6562/6874) and 1.4% (97/6874) heterosexual males/females. CONCLUSION The e-service demonstrated feasibility in estimating PrEP need and signposting service users. Up to 16% of returning users subsequently commenced PrEP. This highlights significant missed opportunities for the remaining online users, who continue to report HIV acquisition risk(s). Further efforts regionally/nationally to optimise uptake of PrEP, particularly among under-represented groups are warranted.
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Affiliation(s)
- Curran Caoimhe
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK
| | | | - Sara Day
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK
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Ubrihien A, Lewis DA, Rambaldini B, Kirwan M, Gwynne K. Clinicians' perspectives on why young Aboriginal people are not testing for sexually transmissible infections in Western Sydney. Int J STD AIDS 2023; 34:803-808. [PMID: 37277965 DOI: 10.1177/09564624231179766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Incidence of sexually transmissible infections (STI) amongst young Aboriginal people in Australia are significantly higher compared to the wider population. Low levels of engagement with public sexual health services also exacerbates health inequity. This study sought to understand the access barriers facing Aboriginal People with local Sexual Health services from the perspective of local clinicians within Western Sydney. METHODS Six clinicians (six registered nurses, two medical practitioners) and two social workers, working in a Sexual Health service, were interviewed using a semi-structure questionnaire. Interviews were audio recorded and transcribed verbatim. Interview texts were analysed using NVIVO 12 and a thematic analysis undertaken. RESULTS Thematic analysis revealed three broad themes: personal, practical, and programmatic. Clinicians believed the involvement of Aboriginal people in service delivery would contribute to greater inclusion and more culturally competent services. Clinicians also considered that young Aboriginal people were unaware of the risks of untreated STIs, and that greater STI-related education regarding risk and prevention may reduce STI incidence and improve participation in services. Clinicians believed that culturally-competent STI education would be more effective if co-designed with the local Aboriginal community. Clinicians identified that Aboriginal young people were concerned about their privacy when accessing services, and that barriers could be reduced by greater community engagement in service delivery design and quality improvement initiatives. CONCLUSION The three themes identified in this study provide guidance for service providers about approaches that may enhance the access, participation, and cultural safety sexual health services for Aboriginal clients.
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Affiliation(s)
- Ashley Ubrihien
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Sydney, NSW, Australia
- Westmead Clinical School and Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia
| | - Boe Rambaldini
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Morwenna Kirwan
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Kylie Gwynne
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research and Education, Macquarie University, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
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Ab Hakimee NI, Atan A, Sutantri S, Lee SP. Health Information-Seeking Behaviour on High-Risk Behaviour among Adolescents. Malays J Med Sci 2023; 30:181-191. [PMID: 37928781 PMCID: PMC10624441 DOI: 10.21315/mjms2023.30.5.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 12/23/2022] [Indexed: 11/07/2023] Open
Abstract
Background The unique nature of adolescence makes youths highly susceptible to high-risk behaviours. Thus, prevention and health promotion are imperative for this influential age. Despite various approaches towards health promotion, knowledge related to adolescent health is still low among Malaysian adolescents. This study aims to investigate adolescent health information-seeking behaviours related to high-risk behaviours. Methods A cross-sectional study was conducted among 370 adolescents aged 10 years old-19 years old throughout Malaysia. The questionnaire used was adapted from a previous study and the pilot study resulted in Cronbach's alpha of 0.85. IBM SPSS Statistics version 25.0 software was used for data analysis at two statistical levels: descriptive and inferential (Mann-Whitney U test). Result The most important health information needs related to high-risk behaviour according to the adolescents were 'violence' (3.72 score out of 5), 'sexual activity-related disease' (3.64 score out of 5) and 'physical activity and effect of lack in physical activity' (3.61 score out of 5). 'Physician' (4.01 score out of 5) and 'the internet' (3.95 score out of 5) were the most important sources for obtaining health information related to high-risk behaviours. The main criterion for the quality of health information was the 'validity and reliability of the information' (4.55 score out of 5). The findings indicate that adolescents have a positive attitude towards health information-seeking behaviour, although slight differences between boys and girls are exhibited. The most common barrier to health information seeking experienced by adolescents is 'difficulty in determining the quality of information found'. Conclusion Adolescents tend to use professional and informal sources, have good criteria in the selection of information and have a considerably high interest in seeking health information related to high-risk behaviour.
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Affiliation(s)
| | - Ashikin Atan
- Department of Professional Nursing Studies, Kulliyyah of Nursing, International Islamic University Malaysia, Pahang, Malaysia
| | - Sutantri Sutantri
- School of Nursing, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Siew Pien Lee
- Department of Special Care Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Pahang, Malaysia
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Regan T, Gette J, McAfee N, Parker J. Substance use disparities by age, race, sex, and sexual orientation among persons living with HIV in the Southern U.S. Int J STD AIDS 2023:9564624231162150. [PMID: 36919911 DOI: 10.1177/09564624231162150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Alcohol and drug use is overrepresented among individuals living with Human Immunodeficiency Virus (HIV) and is associated with poor health outcomes. Determining the extent to which substance use differs between demographic profiles of people living with HIV (PLWH) would determine at-risk groups that would benefit from intervention. METHODS Cross-sectional screening data (N = 1307, Mage = 42.7 years, 66% male, 86% African American, 39% sexual minority) was examined from an HIV clinic in the southern U.S. largely treating underserved and low-income patients. Age, gender, race/ethnicity, sexual orientation, and their interactions were entered as predictors of substance use and related impairment in a series of zero-inflated negative binomial regressions. RESULTS African Americans reported more drug use (p = 0.004) and drug-related negative consequences (p = 0.003). Notably, alcohol-related negative consequences of African American heterosexuals were much higher at younger ages, compared to sexual minorities (regardless of race) and White heterosexuals of all age groups (p = 0.04). CONCLUSIONS Among PLWH in the U.S. South, African Americans may be uniquely at-risk with for problems related to drug-related functional impairment. Specifically, young heterosexual African Americans are at high risk for alcohol-related impairment. Implications are discussed.
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Affiliation(s)
- Timothy Regan
- Department of Mental Health, RinggoldID:25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jordan Gette
- Center of Alcohol and Substance Use Studies, RinggoldID:242612Rutgers University, Piscataway, NJ, USA
| | - Nicholas McAfee
- Department of Psychiatry and Human Behavior, RinggoldID:12276University of Mississippi Medical Center, Jackson, MI, USA
| | - Jefferson Parker
- Department of Psychiatry and Human Behavior, RinggoldID:12276University of Mississippi Medical Center, Jackson, MI, USA
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Kawi NH, Sihotang EP, Nisa T, Hui B, Causer LM, Januraga PP, Ronoatmodjo S. Incidence and risk factors for syphilis infection among men who have sex with men: A cohort study from an urban sexual health clinic in Jakarta, Indonesia. Int J STD AIDS 2022; 33:1065-1072. [PMID: 36067281 DOI: 10.1177/09564624221125079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Syphilis infection remains a significant health issue among marginalised populations in Indonesia, in particular among men who have sex with men (MSM), in whom there are limited studies from Indonesia exploring risk factors associated with STI acquisition.Our study aimed to identify risk factors of syphilis infection among MSM attending large sexual health clinic in Jakarta. Methods: We conducted a retrospective cohort analysis using patient records (MSM aged 18 years or older) period Jan 2018-Dec 2019. We used Cox regression to identify risk factors associated with syphilis incidence. Results: Study population were 2912 MSM tested for syphilis, 473 (16.2%) were diagnosed with syphilis on their first visit; early syphilis (415; 14%) and latent syphilis (58, 2%). Among the cohort of 2439 MSM who tested negative at baseline, 40 MSM were identified with a new positive syphilis result during 2 years follow up. Risk factors remaining significantly associated with syphilis incidence included having STI symptom at 1st visit (aHR, 2.8; 95% CI, 1.38-5.65), and HIV-infection (aHR 4.53; 95% CI 2.24 - 9.17).Syphilis incidence rate was 8.19 (95% CI 6.01-11.16) per 100 PYFU. Conclusions: Syphilis infection at baseline and incidence was high among MSM attending this large clinic in Jakarta. Integrated and accessible syphilis prevention and detection coupled with HIV services are needed, with a special focus on high-risk individuals.
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Affiliation(s)
- Nurhayati H Kawi
- Public Health, 206718University of Indonesia, Depok (Kota), Indonesia.,Globalindo Clinic, Jakarta Selatan, Indonesia
| | | | - Tiara Nisa
- Globalindo Clinic, Jakarta Selatan, Indonesia
| | - Ben Hui
- UNSW Sydney, 2786Kirby Institute, Sydney, Australia
| | | | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, 95340Udayana University, Denpasar, Indonesia
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Pechtel P, Harris J, Karl A, Clunies-Ross C, Bower S, Moberly NJ, Pizzagalli DA, Watkins ER. Emerging ecophenotype: reward anticipation is linked to high-risk behaviours after sexual abuse. Soc Cogn Affect Neurosci 2022; 17:1035-1043. [PMID: 35438797 PMCID: PMC9629466 DOI: 10.1093/scan/nsac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/28/2022] [Accepted: 04/19/2022] [Indexed: 01/12/2023] Open
Abstract
Adolescents frequently engage in high-risk behaviours (HRB) following childhood sexual abuse (CSA). Aberrant reward processes are implicated in HRB, and their underlying fronto-striatal networks are vulnerable to neurodevelopmental changes during adversity representing a promising candidate for understanding links between CSA and HRB. We examined whether fronto-striatal responses during reward anticipation and feedback (i) are altered in depressed adolescents with CSA compared to depressed, non-abused peers and (ii) moderate the relationship between CSA and HRB irrespective of depression. Forty-eight female adolescents {14 with CSA and depression [CSA + major depressive disorder (MDD)]; 17 with MDD but no CSA (MDD); 17 healthy, non-abused controls} completed a monetary reward task during functional magnetic resonance imaging. No differences in fronto-striatal response to reward emerged between CSA + MDD and MDD. Critically, high left nucleus accumbens activation during reward anticipation was associated with greater HRB in CSA + MDD compared to MDD and controls. Low left putamen activation during reward feedback was associated with the absence of HRB in CSA + MDD compared to MDD. Striatal reward responses appear to play a key role in HRB for adolescents with CSA irrespective of depression, providing initial support for a CSA ecophenotype. Such information is pivotal to identify at-risk youth and prevent HRB in adolescents after CSA.
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Affiliation(s)
- Pia Pechtel
- Correspondence should be addressed to Pia Pechtel, Department of Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Perry Road, Exeter EX4 4QQ, UK. E-mail:
| | - Jennifer Harris
- Department of Psychology, College of Life and Environmental Sciences (CLES), University of Exeter, Exeter EX4 4QG, UK
| | - Anke Karl
- Department of Psychology, College of Life and Environmental Sciences (CLES), University of Exeter, Exeter EX4 4QG, UK
| | - Caroline Clunies-Ross
- Child and Adolescent Mental Health Services, Children and Family Health Devon, Exeter EX2 4NU, UK
| | - Susie Bower
- Child and Adolescent Mental Health Services, Children and Family Health Devon, Exeter EX2 4NU, UK
| | - Nicholas J Moberly
- Department of Psychology, College of Life and Environmental Sciences (CLES), University of Exeter, Exeter EX4 4QG, UK
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont MA 02478, USA,Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA,McLean Imaging Center, McLean Hospital, Belmont, MA 02478 USA
| | - Edward R Watkins
- Department of Psychology, College of Life and Environmental Sciences (CLES), University of Exeter, Exeter EX4 4QG, UK
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Mashaphu S, Wyatt GE, Zhang M, Liu H. Condom use consistency among South African HIV serodiscordant couples following an HIV risk-reduction intervention. Int J STD AIDS 2022; 33:479-484. [PMID: 35315305 DOI: 10.1177/09564624221076617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Although there are several ways to transmit HIV, condomless sex remains the primary mode in sub-Saharan Africa, including South Africa, with KwaZulu-Natal Province being one of the epicentres of HIV infection. This study explored the use of condoms in serodiscordant couples who were exposed to an HIV-risk reduction intervention that aimed to improve condom use and reduce the spread of HIV.Methods: A Total of 30 couples completed a paper-based questionnaire on their demographics and general health at baseline and 3 months, plus a semi-structured questionnaire with four domains. An analysis of HIV knowledge, condom use, condom use attitudes and protection perceptions about how other serodiscordant couples behave was conducted following a 12-week HIV risk reduction intervention. Participants were randomised 2:1 into intervention and control groups.Results: Condom use increased from 55% at baseline to 73.7% (p = .0047) at 3 months for the intervention group and condom use in the last 7 days increased from 53% to 86% (p = .0117). For the control group, condom use remained low at the 3 months follow up period (p = .625). HIV knowledge improved significantly from baseline to 3 months for the intervention group (p < .0001), as well as the control group (p = .0005). Negative HIV condom use attitude scores in both groups decreased significantly from baseline to 3 months; intervention group (p = .0059) and control group (p = .0007).Conclusion: HIV knowledge and condom use improved significantly, while negative condom use attitudes and HIV protection perceptions decreased significantly following exposure to a risk-reduction intervention, suggesting that HIV preventive interventions should focus on partnership interventions.
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Affiliation(s)
- Sibongile Mashaphu
- Department of Psychiatry, 56394University of KwaZulu-Natal, Durban, South Africa
| | - Gail E Wyatt
- 145230UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Muyu Zhang
- 145230UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Honghu Liu
- Division of Public Health and Community Dentistry, 8783University of California Los Angeles, Los Angeles, CA, USA
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Burmann SN, Oellig F, Gräser Y, Michalowitz AL, Paschos A, Kreuter A. Sexually acquired pubogenital dermatophytosis induced by Trichophyton quinckeanum. Int J STD AIDS 2022; 33:508-510. [PMID: 35282716 DOI: 10.1177/09564624211068782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tinea corporis is a common superficial dermatophytosis mostly located at the trunk and extremities. In contrast, tinea of the anogenital region is rare and predominantly occurs in tropical countries. In recent years, a distinctive variant of pubogenital tinea (PT) characterized by deep tissue infiltration and systemic symptoms has been reported, and transmission via sexual contacts has been hypothezised. In the majority of cases, a new genotype of Trichophyton mentagrophytes classified as T. mentagrophytes VII was detected as the causative pathogen. We report a case of PT caused by T. quinckeanum that experienced a strong inflammatory reaction following initiation of successful antifungal treatment with itraconazole.
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Affiliation(s)
- Sven-Niklas Burmann
- Department of Dermatology, Venereology, and Allergology, HELIOS St Elisabeth, Hospital Oberhausen, University Witten-Herdecke, Germany
| | - Frank Oellig
- Pathology Rhein-Ruhr, Mülheim an der Ruhr, Germany
| | - Yvonne Gräser
- National Reference Laboratory for Dermatophytes, Institute for Microbiology and Infection Immunology, 14903Charité-University Medicine Berlin, Germany
| | - Alena-Lioba Michalowitz
- Department of Dermatology, Venereology, and Allergology, HELIOS St Elisabeth, Hospital Oberhausen, University Witten-Herdecke, Germany
| | - Alexandros Paschos
- Department of Dermatology, Venereology, and Allergology, HELIOS St Elisabeth, Hospital Oberhausen, University Witten-Herdecke, Germany
| | - Alexander Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St Elisabeth, Hospital Oberhausen, University Witten-Herdecke, Germany
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Li Y, Yan LL, Ronsmans C, Wen H, Xu J, Wang D, Yang M. Excess mortality among patients with severe mental disorders and effects of community-based mental healthcare: a community-based prospective study in Sichuan, China. BJPsych Open 2021; 7:e84. [PMID: 33883057 PMCID: PMC8086393 DOI: 10.1192/bjo.2021.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND High-quality primary care reduces premature mortality in the general population, but evidence for psychiatric patients in China is scarce. AIMS To confirm excess mortality in patients with severe mental illness (SMI), and to examine the impact of community-based mental healthcare and other risk factors on their mortality. METHOD We included 93 655 patients in 2012 and 100 706 in 2013 from the national mental health surveillance system in Sichuan, China to calculate the standardised mortality ratio (SMR). A total of 112 576 patients were followed up from 2009 to 2014 for model analyses. We used growth models to quantify the patterns of change for community management measures, high-risk behaviour, disease stability and medication adherence of patients over time, and then used multilevel proportional hazard models to examine the association between change patterns of management measures and mortality. RESULTS The SMR was 6.44 (95% CI 4.94-8.26) in 2012 and 7.57 (95% CI 5.98-9.44) in 2013 among patients with SMI aged 15-34 years, and diminished with age. Unfavourable baseline socioeconomic status increased the hazard of death by 38-50%. Positive changes in high-risk behaviour, disease stability and medication adherence had a 54% (95% CI 47-60%), 69% (95% CI 63-73%) and 20% (4-33%) reduction in hazard of death, respectively, versus in those where these were unchanged. CONCLUSIONS High excess mortality was confirmed among younger patients with SMI in Sichuan, China. Our findings on the relationships between community management and socioeconomic factors and mortality can inform community-based mental healthcare policies to reduce excess mortality among patients with SMI.
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Affiliation(s)
- Yaxi Li
- West China School of Public Health, Sichuan University, China; Global Heath Research Center, Duke Kunshan University, China
| | - Lijing L Yan
- Global Heath Research Center, Duke Kunshan University, China; School of Global Health and Development, Peking University, China; The George Institute for Global Health at Peking University Health Science Center, China; and Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, USA
| | - Carine Ronsmans
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - Hong Wen
- The Third Hospital of Mianyang, China
| | - Jiajun Xu
- West China Hospital, Sichuan University, China
| | - Dan Wang
- The Third Hospital of Mianyang, China
| | - Min Yang
- West China School of Public Health, Sichuan University, China; and Faculty of Health, Art and Design, Swinburne University of Technology, Australia
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Gedela K, Wirawan DN, Wignall FS, Luis H, Merati TP, Sukmaningrum E, Irwanto I. Getting Indonesia's HIV epidemic to zero? One size does not fit all. Int J STD AIDS 2020; 32:290-299. [PMID: 33226314 DOI: 10.1177/0956462420966838] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Indonesia has one of the fastest growing HIV epidemics in the world. AIDS related deaths in Indonesia have not fallen and have increased significantly since 2010. HIV infection rates remain high and rising in key affected populations. We provide an on the ground, evidence-based perspective of the challenges Indonesia faces. We discuss what is required to adopt tailored public health approaches that address context specific challenges, confront structural barriers and the heterogeneity of the current evolving HIV epidemic.
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Affiliation(s)
- Keerti Gedela
- Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Dewa Nyoman Wirawan
- Faculty of Medicine, Udayana University, Denpasar, Indonesia.,Yayasan Kerti Praja, Denpasar, Indonesia
| | | | | | - Tuti Parwati Merati
- Faculty of Medicine, Udayana University, Denpasar, Indonesia.,Department of Infectious Diseases, Sanglah General Hospital, Denpasar, Indonesia
| | - Evi Sukmaningrum
- AIDS Research Centre and Department of Psychology, Atma Jaya Catholic University, Jakarta, Indonesia
| | - Irwanto Irwanto
- AIDS Research Centre and Department of Psychology, Atma Jaya Catholic University, Jakarta, Indonesia
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12
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Gill A, Ranasinghe A, Sumathipala A, Fernando KA. Prevalence of mental health conditions amongst people living with human immunodeficiency virus in one of the most deprived localities in England. Int J STD AIDS 2020; 31:619-626. [PMID: 32370682 DOI: 10.1177/0956462420904299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mental health conditions (MHCs) are often unrecognised which can result in detrimental physical health outcomes and poor quality of life. This can be compounded by the impact of deprivation. People living with human immunodeficiency virus (PLWH) are more likely to be affected by MHCs which if untreated, may result in both clinical and psychosocial adversities. To ascertain the prevalence of and factors associated with MHCs in the human immunodeficiency virus cohort of Stoke-on-Trent, which is the 13th most deprived locality in England, we conducted a cross-sectional service evaluation using electronic records of 302 PLWH attending the service between October 2018 and January 2019. The prevalence of MHCs amongst PLWH was 33.4% (101/302). Depression was the most prevalent MHC affecting 17.2% (52/302). Those of white ethnicity were at higher risk (odds ratio [OR] = 3.14; p < 0.01) of MHCs compared to black Asian and minority ethnic groups. Women were at higher risk of having an MHC (OR = 3.15; p < 0.01), and recreational drug use was also a significant factor (OR = 16.18; p = 0.01) associated with MHCs. There is sub-optimal access and heterogeneity in the modes of referral to mental health support services. Commissioning constraints will further detrimentally affect our ability to provide support in an already deprived area, thus widening health inequalities affecting the most vulnerable.
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Affiliation(s)
- A Gill
- Cobridge Community Health Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Awip Ranasinghe
- Faculty of Medicine & Health Sciences, School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | - A Sumathipala
- Faculty of Medicine & Health Sciences, School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | - K A Fernando
- Cobridge Community Health Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
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13
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Ng RX, Guadamuz TE, Akbar M, Kamarulzaman A, Lim SH. Association of co-occurring psychosocial health conditions and HIV infection among MSM in Malaysia: Implication of a syndemic effect. Int J STD AIDS 2020; 31:568-578. [PMID: 32299293 DOI: 10.1177/0956462420913444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Malaysia, the HIV epidemic is concentrated in a highly stigmatized population, men who have sex with men (MSM). The relationship of multiple psychosocial health conditions and HIV risks have not been investigated. This study aims to assess the association of multiple psychosocial factors with risky sexual behaviour and HIV infection among MSM. Data on demographic characteristics, psychosocial health conditions, condomless anal intercourse (CAI), HIV testing and HIV status were collected via an anonymous online survey. Multivariable logistic regression model was used to determine whether psychosocial health conditions among MSM have a syndemic association with HIV status. Between July 2017 and February 2018, 622 MSM completed the online survey. Overall, 54.3% of participants reported engaging in CAI in the past three months and 46.0% were found to have two or more psychosocial health conditions. Increasing numbers of psychosocial health conditions (1, 2, 3, 4 or more) were significantly associated with HIV infection compared to those without psychosocial health condition (odds ratio [OR] 3.39, 95% confidence interval [CI]: 1.41–8.14; OR 3.51, 95% CI: 1.43–8.61; OR 4.22, 95% CI: 1.68–10.96, and OR 7.58, 95% CI: 2.44–23.55, respectively). Comprehensive HIV prevention programs addressing mental health and substance use are needed for MSM in Malaysia.
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Affiliation(s)
- Rong Xiang Ng
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Thomas E Guadamuz
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Bangkok, Thailand
| | - Mohd Akbar
- Faculty of Medicine, Centre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Faculty of Medicine, Centre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia
| | - Sin How Lim
- Faculty of Medicine, Centre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia.,Faculty of Medicine, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
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14
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Raffe S, Pollard A, Vera JH, Soni S, Peralta C, Rodriguez L, Dean G, Llewellyn CD. HIV self-tests for men who have sex with men, accessed via a digital vending machine: a qualitative study of acceptability. Int J STD AIDS 2020; 31:420-425. [PMID: 32188345 DOI: 10.1177/0956462419890726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As the number of people living with undiagnosed HIV infection in the UK declines, innovative ways to access those least engaged with services are needed. This study explores the attitudes of men who have sex with men (MSM) towards using HIV self-testing (HIVST) kits distributed via a vending machine in a sauna (a licenced sex-on-premise venue). Twenty-three MSM attending the sauna were recruited to take part in semi-structured qualitative interviews. The participants were overwhelmingly positive about the HIVST vending machine. They identified convenience and flexibility as major benefits to testing in this way. The sauna was felt to be an appropriate location for the intervention. Limitations identified included the potential to reduce screening for other sexually transmitted infections and the inappropriate use of HIVST kits as a tool for risk-assessment prior to condomless sex, with a poor understanding of the window period. The implications of receiving a positive result without immediate access to support were also a concern. HIVST vending machines are an acceptable, innovative way to encourage HIV testing. Providers need to ensure this intervention is supported by adequate information regarding the limitations of the test and how to access comprehensive services to avoid any unintended negative effects.
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Affiliation(s)
- S Raffe
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - A Pollard
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - J H Vera
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - S Soni
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - C Peralta
- Department of Design and Architecture, University of Brighton, Brighton, UK
| | | | - G Dean
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,Martin Fisher Foundation, Brighton, UK
| | - C D Llewellyn
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
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15
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Sorsdahl K, Morojele NK, Parry CD, Kekwaletswe CT, Kitleli N, Malan M, Shuper PA, Myers B. 'What will it take': addressing alcohol use among people living with HIV in South Africa. Int J STD AIDS 2019; 30:1049-1054. [PMID: 31451075 DOI: 10.1177/0956462419862899] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Given that hazardous and harmful alcohol use has been identified as a significant barrier to adherence to antiretroviral therapy (ART) in South Africa, alcohol reduction interventions delivered within HIV treatment services are being investigated. Prior to designing and implementing an alcohol-focused screening and brief intervention (SBI), we explored patients’ perceptions of alcohol as a barrier to HIV treatment, the acceptability of providing SBIs for alcohol use within the context of HIV services and identifying potential barriers to patient uptake of this SBI. Four focus groups were conducted with 23 participants recruited from three HIV treatment sites in Tshwane, South Africa. Specific themes that emerged included: (1) barriers to ART adherence, (2) available services to address problematic alcohol use and (3) barriers and facilitators to delivering a brief intervention to address alcohol use within HIV care. Although all participants in the present study unanimously agreed that there was a great need for SBIs to address alcohol use among people living with HIV and AIDS, our study identified several areas that should be considered prior to implementing such a programme.
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Affiliation(s)
- K Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - N K Morojele
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa.,School of Public Health, University of the Witwatersrand, Witwatersrand, South Africa
| | - C D Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa.,Department of Psychiatry, Stellenbosch University, Tygerberg, South Africa
| | - C T Kekwaletswe
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - N Kitleli
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - M Malan
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - P A Shuper
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - B Myers
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa.,Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
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16
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Misra G, Sahu D, Reddy US, Nair S. Correlates of HIV prevalence among female sex workers in four north and east Indian states: findings of a national bio-behavioural survey. Int J STD AIDS 2018; 30:120-130. [PMID: 30236041 DOI: 10.1177/0956462418799018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The socio-demographic, sex work characteristics and the factors affecting HIV prevalence among female sex workers (FSWs) are not well known in low prevalence states showing rising trends within the HIV epidemic. This paper studies these attributes among FSWs in three north (Punjab, Rajasthan and Uttar Pradesh) and one east Indian states (Jharkhand). Integrated Biological and Behavioural Surveillance (IBBS) data, collected from 4491 FSWs in the study states, were analysed, with HIV status as the dependent variable and several socio-demographic, sex work, knowledge and agency characteristics as independent variables. Multivariate analysis found a number of factors such as age above 25 years (adjusted odds ratio [AOR] 5.0, 95% confidence interval [CI] 1.4-18.1), client solicitation in rented rooms (AOR 2.8, 95% CI 1.2-6.4) and the use of mobile phones for client solicitation (AOR 5.1, 95% CI 1.6-16.0) to be significantly associated with HIV risk. The study found low levels of HIV programme services uptake and HIV/AIDS knowledge among FSWs in the study states. There is an urgent need to focus on these risk factors for improving the effectiveness of the ongoing HIV prevention efforts and attaining the 'Sustainable Development Goals' goal of 'Ending the AIDS epidemic' by 2030.
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Affiliation(s)
- Gunjika Misra
- 1 School of Medicine and Para-Medical Health Sciences, Guru Gobind Singh Indraprastha University, New Delhi, India
| | - Damodar Sahu
- 2 ICMR-National Institute of Medical Statistics, Indian Council of Medical Research (ICMR), New Delhi, India
| | - Umenthala S Reddy
- 2 ICMR-National Institute of Medical Statistics, Indian Council of Medical Research (ICMR), New Delhi, India
| | - Saritha Nair
- 2 ICMR-National Institute of Medical Statistics, Indian Council of Medical Research (ICMR), New Delhi, India
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17
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Dolan G, Chauhan M, Foster K, Basta M, Bushby S, White C, Verlander NQ, Gorton R. Factors associated with repeat diagnosis of syphilis in genitourinary medicine (GUM) clinic attendees in the North East of England, 2002-2014. Int J STD AIDS 2018; 29:790-799. [PMID: 29482448 DOI: 10.1177/0956462418757554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This study aimed to identify factors associated with repeat syphilis infection in North East England, in order to inform local prevention and control opportunities. We undertook a case-case study comparing individuals diagnosed with single or multiple episodes of syphilis infection within genitourinary medicine (GUM) clinics in NE England (12 clinics serving a population of 2.5 million). Study cases were verified as having had true re-infection by a GUM clinician (using serological and/or clinical parameters) and control cases (3 per case) frequency matched to cases by age and year of presentation. The odds of exposure to sexual behavioural and clinical factors were compared for cases and control cases using stepwise multivariable logistic regression. We included 66 cases and 235 control cases. The majority of cases (62/66) and control cases (165/235) were men who had sex with men (MSM). Data were missing for 0-64% of cases across different variables. Following multivariable analysis HIV seropositivity (OR 23.3, 95% CI 4.32-125.9), failure to attend follow-up (OR 4.63, 95% CI 1.11-19.31), stage of infection and deprivation were associated with re-infection ( p < 0.001). In this study, HIV seropositivity and failure to attend follow-up were associated with re-infection with syphilis. Actions targeted at these groups may help to reduce ongoing transmission.
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Affiliation(s)
- G Dolan
- 1 EPIET Associate Programme, Public Health England, UK FETP, Newcastle-upon-Tyne, UK.,2 Public Health England, North East Centre, Newcastle-upon-Tyne, UK
| | - M Chauhan
- 3 Genitourinary Medicine, Newcastle Hospitals, NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - K Foster
- 2 Public Health England, North East Centre, Newcastle-upon-Tyne, UK
| | - M Basta
- 4 Sexual Health and HIV, South Tyneside Foundation Trust, South Shields, UK
| | - S Bushby
- 5 Genitourinary Medicine, City Hospitals Sunderland, Sunderland, UK
| | - C White
- 6 Genitourinary Medicine and Sexual Health, University Hospital of North Durham, Durham, UK
| | - N Q Verlander
- 7 National Infection Service, Statistics, Modelling and Economics Department, Public Health England, London, UK
| | - R Gorton
- 8 National Infections Service, Public Health England, Newcastle-upon-Tyne, UK
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18
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Timol F, Vawda MY, Bhana A, Moolman B, Makoae M, Swartz S. Addressing adolescents' risk and protective factors related to risky behaviours: Findings from a school-based peer-education evaluation in the Western Cape. SAHARA J 2017; 13:197-207. [PMID: 27892820 PMCID: PMC5349190 DOI: 10.1080/17290376.2016.1241188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Peer-education programmes aim to bring about attitudinal and behavioural changes in their target audience. In the South African educational context, peer education is a favoured approach in dealing with issues such as HIV and AIDS, sexual decision-making and substance misuse. Given the reliance on peer-education programmes in the educational system, it is important to establish how well they are working. This study aims to assess the effect of an extensive, structured, time-limited, curriculum-based, peer-led educational programme on first-year high school learners in public schools in the Western Cape Province of South Africa. METHOD The curriculum called 'Listen Up' addresses issues such as supporting peers, sexual decision-making, healthy relationships, HIV risk, alcohol misuse and unwanted pregnancy in seven structured sessions. The programme targeted adolescents in Grade 8 growing up in what are considered to be risky environments in public schools in the Western Cape during 2012 and 2013. The intervention was evaluated based on 10 scales sourced from published literature related to the outcome indicators of future orientation, sensation-seeking, self-efficacy in sexual relations, HIV transmission knowledge, HIV prevention knowledge, HIV attitudes, sexual attitudes, decision-making, healthy relationships and social support. Descriptive statistics were used to analyse demographic and community characteristics and analyses of variance were used to detect differences between groups. The surveys were administered to a total of 7709 learners across three waves of the study in 27 peer intervention schools and eight control schools. RESULTS Immediately post intervention, statistically significant differences were noted for the intervention schools when compared to their baseline levels on measures of future orientation, self-efficacy in sexual relations, knowledge regarding HIV transmission, knowledge regarding HIV prevention and knowledge in terms of healthy relationships. Comparing baseline values with results collected between five and seven months post intervention, statistically significant results were noted for self-efficacy in sexual relations and knowledge regarding HIV transmission. CONCLUSION The findings of this study suggest that peer-education can improve adolescents' self-efficacy in sexual relations as well as knowledge regarding the transmission of HIV and therefore can contribute to the prevention of HIV transmission among adolescents.
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Affiliation(s)
- Furzana Timol
- a MA, is a Researcher in the Human and Social Development Unit, Human Sciences Research Council , Pretoria , South Africa
| | - Mohammed Yacoob Vawda
- b MA, is a Lecturer in the School of Built Environment and Development Studies, University of KwaZulu-Natal , Durban , South Africa
| | - Arvin Bhana
- c PhD, is a Chief Specialist Scientist in the Health Systems Research Unit, South African Medical Research Council , Durban , South Africa.,d PhD, is an Honorary Associate Professor in the School of Applied Human Sciences, University of KwaZulu-Natal , Durban , South Africa
| | - Benita Moolman
- e PhD, is a Senior Research Specialist in the Human and Social Development Unit, Human Sciences Research Council , Pretoria , South Africa
| | - Mokhantso Makoae
- f PhD, is an African Research Fellow in the Human and Social Development Unit, Human Sciences Research Council , Pretoria , South Africa
| | - Sharlene Swartz
- g PhD, is a Research Director in the Human and Social Development Unit, Human Sciences Research Council , Pretoria , South Africa.,h PhD, is an Adjunct Associate Professor in the Department of Sociology , University of Cape Town , Capetown , South Africa
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19
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Boman J, Lindqvist H, Forsberg L, Janlert U, Granåsen G, Nylander E. Brief manual-based single-session Motivational Interviewing for reducing high-risk sexual behaviour in women - an evaluation. Int J STD AIDS 2017; 29:396-403. [PMID: 28920542 DOI: 10.1177/0956462417729308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to develop and evaluate brief Motivational Interviewing (MI) to facilitate behaviour change in women at high risk of contracting sexually transmitted infections (STIs). One hundred and seventy-three women (mean age 24.7) at high risk of contracting STIs were randomized to a brief risk-reducing MI counselling intervention (n = 74) or assigned to the control group (n = 99). MI skill was assessed using the Motivational Interviewing Treatment Integrity (MITI) Coding System. Seventeen of 74 (23%) women tested for Chlamydia trachomatis (CT) in the MI intervention group and 22 of 99 (22%) in the control group had a genital CT infection 0-24 months before baseline. All additional CT testing was monitored up to 24 months for all 173 women in the study. None of the 49 CT-retested women in the MI group was CT infected, as compared to 3 of 72 (4%) women in the control group. A generalized estimating equations model with sexual high-risk behaviour measured at baseline and at six-month follow-up produced an adjusted estimated odds ratio of 0.38 (95% confidence interval = 0.158, 0.909), indicating efficacy. Brief manual-based single-session MI counselling seems to be effective in reducing high-risk sexual behaviour in women at high risk of acquiring STIs.
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Affiliation(s)
- Jens Boman
- 1 Department of Public Health and Clinical Medicine, Dermatology and Venereology, Umeå University, Umeå, Sweden
| | - Helena Lindqvist
- 2 Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Urban Janlert
- 4 Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Gabriel Granåsen
- 4 Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Elisabet Nylander
- 1 Department of Public Health and Clinical Medicine, Dermatology and Venereology, Umeå University, Umeå, Sweden
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20
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Tomkins A, Ahmad S, Cannon L, Higgins SP, Kliner M, Kolyva A, Ward C, Vivancos R. Prevalence of recreational drug use reported by men who have sex with men attending sexual health clinics in Manchester, UK. Int J STD AIDS 2017; 29:350-356. [PMID: 28835196 DOI: 10.1177/0956462417725638] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recreational drug use (RDU) has been reported to be disproportionately higher in men who have sex with men (MSM) when compared to their heterosexual counterparts. To identify RDU, links to risky sexual practices and infections for MSM attending three sexual health clinics across Manchester, United Kingdom, a retrospective case note review was conducted using a random powered sample of service users attending three sites during 2014. Three hundred and fifty-seven case notes were reviewed across three sites. Eighteen per cent of service users reported any type of RDU. Use of at least one of the three drugs associated with chemsex (crystal methamphetamine, mephedrone, gamma hydroxybutyrate/gamma butyrolactone) was reported by 3.6%. A statistically significant difference was identified between non-drug users and any-drug users reporting: group sex (odds ratio [OR] 5.88, p = 0.013), condomless receptive anal intercourse (CRAI) (OR 2.77, p = 0.003) and condomless oral intercourse (OR 2.52, p = 0.016). A statistically significant difference was identified between chemsex-related drug user and non-drug user groups reporting: group sex (OR 13.05, p = 0.023), CRAI (OR 3.69, p = 0.029) and condomless insertive anal intercourse (OR 1.27, p = 0.039). There was also a statistically higher incidence of gonorrhoea infection in chemsex-related drug use compared with those not using drugs (p = 0.002, OR 6.88). This study identifies that substance use is common in MSM attending sexual health clinics in Manchester. High-risk sexual practices and certain sexually transmitted infections are more common in MSM reporting RDU.
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Affiliation(s)
- A Tomkins
- 1 Pennine Acute Hospitals NHS Trust and Public Health England/BASHH Fellowship, Manchester, UK
| | - S Ahmad
- 2 5295 University Hospital of South Manchester , Manchester, UK
| | - L Cannon
- 2 5295 University Hospital of South Manchester , Manchester, UK
| | - S P Higgins
- 3 Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - M Kliner
- 4 436306 Public Health England North West , Manchester, UK
| | - A Kolyva
- 3 Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - C Ward
- 5 5293 Central Manchester University Hospitals NHS Foundation Trust , Manchester, UK
| | - R Vivancos
- 6 National Infection Service, 436306 Public Health England , London, UK.,7 University of Liverpool, Liverpool, UK
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21
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Wanyama JN, Nabaggala MS, Wandera B, Kiragga AN, Castelnuovo B, Mambule IK, Nakajubi J, Kambugu AD, Paton NI, Wanyenze RK, Colebunders R, Easterbrook P. Significant rates of risky sexual behaviours among HIV-infected patients failing first-line ART: A sub-study of the Europe-Africa Research Network for the Evaluation of Second-line Therapy trial. Int J STD AIDS 2017; 29:287-297. [PMID: 28814161 DOI: 10.1177/0956462417724707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There are limited data on the prevalence of risky sexual behaviours in individuals failing first-line antiretroviral therapy (ART) and changes in sexual behaviour after switch to second-line ART. We undertook a sexual behaviour sub-study of Ugandan adults enrolled in the Europe-Africa Research Network for the Evaluation of Second-line Therapy trial. A standardized questionnaire was used to collect sexual behaviour data and, in particular, risky sexual behaviours (defined as additional sexual partners to main sexual partner, inconsistent use of condoms, non-disclosure to sexual partners, and exchange of money for sex). Of the 79 participants enrolled in the sub-study, 62% were female, median age (IQR) was 37 (32-42) years, median CD4 cell count (IQR) was 79 (50-153) cells/µl, and median HIV viral load log was 4.9 copies/ml (IQR: 4.5-5.3) at enrolment. The majority were in long-term stable relationships; 69.6% had a main sexual partner and 87.3% of these had been sexually active in the preceding six months. At enrolment, around 20% reported other sexual partners, but this was higher among men than women (36% versus 6.7 %, p < 0.001). In 50% there was inconsistent condom use with their main sexual partner and a similar proportion with other sexual partners, both at baseline and follow-up. Forty-three per cent of participants had not disclosed their HIV status to their main sexual partner (73% with other sexual partners) at enrolment, which was similar in men and women. Overall, there was no significant change in these sexual behaviours over the 96 weeks following switch to second-line ART, but rate of non-disclosure of HIV status declined significantly (43.6% versus 19.6%, p <0.05). Among persons failing first-line ART, risky sexual behaviours were prevalent, which has implications for potential onward transmission of drug-resistant virus. There is need to intensify sexual risk reduction counselling and promotion of partner testing and disclosure, especially at diagnosis of treatment failure and following switch to second- or third-line ART.
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Affiliation(s)
- Jane N Wanyama
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Maria S Nabaggala
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Bonnie Wandera
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Agnes N Kiragga
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Barbara Castelnuovo
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ivan K Mambule
- 2 Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Josephine Nakajubi
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew D Kambugu
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Nicholas I Paton
- 3 Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rhoda K Wanyenze
- 4 School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Colebunders
- 5 Institute of Tropical Medicine, Antwerp, Belgium.,6 Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Philippa Easterbrook
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
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22
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Abstract
Sexual health policy remains focussed on younger adults. However, rates of sexually transmitted infections (STIs) in older people continue to increase. We explored the sexual healthcare needs of women aged 40 and over attending an integrated sexual health clinic in South London. We conducted a retrospective case note review and found that almost 20% of these women had STIs. These included genital herpes, trichomoniasis, genital warts, chlamydia and gonorrhoea. Less than a quarter of women reported use of condoms during most recent sexual contact, indicating sexual risk-taking behaviour. 38% of women attended for contraception. The sexual health needs of older people can only continue to increase, given our rapidly ageing population. Age-specific health promotion strategies are needed.
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Affiliation(s)
- Patrice Grech
- Department of GUM/HIV, King's College Hospital NHS Foundation Trust, London, UK
| | - Rebecca Marchant
- Department of GUM/HIV, King's College Hospital NHS Foundation Trust, London, UK
| | - Mannampallil Samuel
- Department of GUM/HIV, King's College Hospital NHS Foundation Trust, London, UK
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23
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Ottaway Z, Finnerty F, Amlani A, Pinto-Sander N, Szanyi J, Richardson D. Men who have sex with men diagnosed with a sexually transmitted infection are significantly more likely to engage in sexualised drug use. Int J STD AIDS 2016; 28:91-93. [PMID: 27542697 DOI: 10.1177/0956462416666753] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The sexualised use of recreational drugs (Mephedrone, GBL/GHB, Crystal Meth) generally known as 'chemsex' in men who have sex with men (MSM) is thought to be associated with sexually transmitted infection (STI) acquisition; however there is little data showing a direct relationship. We reviewed 130 randomly selected cases of MSM with an STI attending our STI service and 130 controls (MSM attending the STI service who did not have an STI) between 5 May 2015 and 2 November 2015. Reported condomless anal sex was significantly higher in cases 90/121 (74%) compared with controls 65/122 (53%); ( χ2 = 11.71, p < 0.005, OR 2.54). Recreational drug use in the cases 38/122 (31%) was significantly greater than in controls 20/125 (16%); ( χ2 = 7.88, p < 0.005, OR 2.37). This demonstrates a link between STI acquisition and recreational drug use in MSM. Harm reduction initiatives identifying and addressing party drug use can help to improve the sexual health of MSM, including reducing risk-taking behaviours.
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Affiliation(s)
- Z Ottaway
- 1 Maidstone and Tunbridge Wells NHS Trust, Maidstone Hospital, UK
| | | | - Aliza Amlani
- 2 Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Joshua Szanyi
- 2 Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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24
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Melendez-Torres GJ, Hickson F, Reid D, Weatherburn P, Bonell C. Findings from within-subjects comparisons of drug use and sexual risk behaviour in men who have sex with men in England. Int J STD AIDS 2016; 28:250-258. [PMID: 27013616 DOI: 10.1177/0956462416642125] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Epidemiological evidence for the encounter-level association between sexualised drug use and unprotected anal intercourse in men who have sex with men is unclear and has not examined men who have sex with men in England. To estimate this association, we compared dyadic sexual encounters within respondents. We used encounter-level data from a longitudinal online survey of men who have sex with men living in England and multilevel models to test univariate and multivariate associations between any respondent or partner drug use, specific respondent drug use, additional situational characteristics and unprotected anal intercourse. Based on 6742 encounters from 2142 men who have sex with men, respondent drug use and respondent use of certain specific drugs were associated with increased unprotected anal intercourse odds. In univariate models, partner drug use was associated with increased unprotected anal intercourse odds, but in multivariate models, only non-specific knowledge of partner drug use was associated with the same. Encounters with non-regular-and-steady partners or that were not HIV-seroconcordant were associated with decreased unprotected anal intercourse odds. This is the first within-subjects comparison of drug use and unprotected anal intercourse conducted on a sample from England, and the largest of its kind. Findings are consistent with other studies, though associations between drug use and unprotected anal intercourse are shaped by social contexts that may change over time.
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Affiliation(s)
- G J Melendez-Torres
- 1 Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ford Hickson
- 2 Sigma Research, London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - David Reid
- 2 Sigma Research, London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Peter Weatherburn
- 2 Sigma Research, London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Chris Bonell
- 3 Department of Social Science, UCL Institute of Education, University College London, London, UK
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25
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Martin F, Lee J, Thomson E, Tarrant N, Hale A, Lacey CJ. Two cases of possible transmitted drug-resistant HIV: likely HIV superinfection and unmasking of pre-existing resistance. Int J STD AIDS 2016; 27:66-9. [PMID: 25663247 PMCID: PMC4674743 DOI: 10.1177/0956462415571671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 01/05/2015] [Indexed: 11/17/2022]
Abstract
In the UK, patients undergo HIV viral load and genotype testing before they are prescribed antiretroviral therapy. The genotype test guides clinicians in prescribing antiretroviral therapy with maximum efficacy against the patient's specific viral strain. HIV viral load escape under antiretroviral drug therapy, to which the virus was thought to be genotypically susceptible, is commonly observed in patients with poor adherence. We observed early viral escapes in two-newly diagnosed patients, during antiretroviral treatment, with different sequences compared to their original viral resistance test and who reported excellent adherence to and tolerance of their therapy. HIV superinfection with a new viral strain was identified in a patient with multiple risk factors and co-infections with sexually transmitted infections. The second patient was a case of the emergence of primary resistant virus under drug pressure. Both suppressed their virus promptly after treatment switch.
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Affiliation(s)
- Fabiola Martin
- Centre for Immunology and Infection, Department of Biology, University of York, York, UK
| | - John Lee
- Genitourinary Department, Josephine Butler Centre King Street Health Centre, Wakefield, UK
| | - Emma Thomson
- Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Nick Tarrant
- Genitourinary Department, York Teaching Hospital, York, UK
| | - Antony Hale
- Department of Virology, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Charles J Lacey
- Centre for Immunology and Infection, Department of Biology, University of York, York, UK
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26
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Valverde EE, DiNenno EA, Schulden JD, Oster A, Painter T. Sexually transmitted infection diagnoses among Hispanic immigrant and migrant men who have sex with men in the United States. Int J STD AIDS 2015; 27:1162-1169. [PMID: 26464501 DOI: 10.1177/0956462415610679] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/11/2015] [Indexed: 11/15/2022]
Abstract
Hispanic immigrant/migrant men who have sex with men (MSM) should be at higher risk for sexually transmitted infections/human immunodeficiency virus (STIs/HIV) given individual-level factors associated with the migration process that have been theorised to increase susceptibility to STIs/HIV among migrant populations. However, relatively little is known if these individual level factors are actually associated with the STI prevalence among this population. During 2005-2007, 2576 men and women foreign-born Hispanics were surveyed at three community-based organisations offering services to immigrant/migrant communities in the US. We analysed demographic characteristics, sexual risk behaviours, migration patterns, and factors associated with STI diagnoses (syphilis, chlamydia, and gonorrhoea) in the past 12 months among Hispanic immigrant/migrant MSM. Of 1482 Hispanic immigrant/migrant men surveyed who reported having sex in the past 12 months, 353 (24%) reported sex with a man, and of these, 302 answered questions regarding whether or not they had been diagnosed with a bacterial STI in the past year. Of these 302 men, 25% reported being married; 42% self-identified as being heterosexual and 20% as bisexual. Twenty-nine (9.6%) men reported that they had received an STI diagnosis in the past year. In the multivariate logistic regression model, men who reported receiving money or goods for sex had increased odds of a self-reported STI diagnosis. The prevalence of bacterial STIs among Hispanic immigrant/migrant MSM is lower than the prevalence of bacterial STIs among other MSM in the United States. Nevertheless, receiving money or goods for sex was significantly associated with a self-reported STI diagnosis among Hispanic immigrant/migrant MSM. It is important to understand factors contributing to participation in exchange sex among this population. HIV/STI prevention interventions tailored to non-gay identifying MSM are important for Hispanic immigrant/migrant MSM.
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Affiliation(s)
- Eduardo E Valverde
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth A DiNenno
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeffrey D Schulden
- National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH) Neuroscience Center, Bethesda, MD, USA
| | - Alexandra Oster
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas Painter
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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27
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Pattanasin S, Wimonsate W, Chonwattana W, Tongtoyai J, Chaikummao S, Sriporn A, Sukwicha W, Mock PA, Holtz TH. Loss to follow-up and bias assessment among a cohort of Thai men who have sex with men in Bangkok, Thailand. Int J STD AIDS 2015; 27:196-206. [PMID: 25792548 DOI: 10.1177/0956462415578954] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 03/03/2015] [Indexed: 11/17/2022]
Abstract
Minimising loss to follow-up is essential to obtain unbiased results. This study aimed to assess factors associated with loss to follow-up and effects on biasing exposure-outcome associations in a cohort of men who have sex with men in Bangkok. We enrolled sexually-active Thai men who have sex with men, at least 18 years old, in a study with four-monthly follow-up visits. At each visit, men answered HIV risk behaviour questions using audio computer-assisted self-interview. Logistic regression was used to evaluate factors associated with loss to follow-up and bias between exposures and prevalent HIV infection were estimated using adjusted relative odds ratios. From 2006 to 2010, we enrolled 1744 men who have sex with men; as of April, 2014, 1256 (72%) had completed at least the month-36 visit; loss to follow-up was 9.6%. Factors independently associated with loss to follow-up were age (18-21 years), education (primary level or less, secondary or vocational education), living outside Bangkok and vicinity, sexual orientation (bisexual, heterosexual), previous HIV testing, HIV infection, and behaviour in the past 4 months (recreational drug use, reporting group sex). An effect of loss to follow-up on factors of prevalent HIV infection was found by sexual orientation (transgender) and unprotected anal intercourse (receptive/insertive). These findings highlight the need to strengthen post-HIV test counselling. Directed counselling for HIV care should be given to young men who have sex with men and recreational drug users.
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Affiliation(s)
- Sarika Pattanasin
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Wipas Wimonsate
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Wannee Chonwattana
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Jaray Tongtoyai
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Supaporn Chaikummao
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Anuwat Sriporn
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Wichuda Sukwicha
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Philip A Mock
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Timothy H Holtz
- Thailand Ministry of Public Health - US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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28
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Bennett A, Wainwright E, Lord E, Oduru M, Chen F, Desmond N, Sherrard J, Duncan S. The impact of the 2011 UK post-exposure prophylaxis for HIV following sexual exposure guidelines: a regional retrospective audit. Int J STD AIDS 2014; 26:746-8. [PMID: 25332226 DOI: 10.1177/0956462414556329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/23/2014] [Indexed: 11/16/2022]
Abstract
A re-audit of prescribing of post-exposure prophylaxis for HIV following sexual exposure in the Thames Valley demonstrated that an updated proforma has led to significant improvements in clinician-led outcomes, but had no impact on completion or follow-up rates.
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Affiliation(s)
- A Bennett
- The Garden Clinic, Upton Hospital, Slough, Berkshire, UK
| | - E Wainwright
- The Churchill Hospital, Old Road, Headington, Oxford, UK
| | - E Lord
- The Churchill Hospital, Old Road, Headington, Oxford, UK
| | - M Oduru
- The Florey Unit, Royal Berkshire Hospital, Reading, UK
| | - F Chen
- The Florey Unit, Royal Berkshire Hospital, Reading, UK
| | - N Desmond
- The Garden Clinic, Upton Hospital, Slough, Berkshire, UK
| | - J Sherrard
- The Churchill Hospital, Old Road, Headington, Oxford, UK
| | - S Duncan
- Darlington Memorial Hospital, Hundens Lane, Darlington, UK
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29
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van der Sluis WB, Bouman MB, Gijs L, van Bodegraven AA. Gonorrhoea of the sigmoid neovagina in a male-to-female transgender. Int J STD AIDS 2014; 26:595-8. [PMID: 25060698 DOI: 10.1177/0956462414544725] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 06/30/2014] [Indexed: 11/17/2022]
Abstract
A 33-year-old male-to-female transgender consulted our outpatient clinic with perneovaginal bleeding during and following coitus. Four years before, she underwent a total laparoscopic sigmoid neovaginoplasty. Physical, histological and endoscopic examination revealed neither focus of active bleeding nor signs of active inflammation. A polymerase chain reaction test performed on a neovaginal swab showed gonococcal infection. Treatment consisted of 500 mg intramuscular ceftriaxone. Three weeks later, our patient reported resolution of symptoms, consistent with eradication of the infection demonstrated by a follow-up neovaginal swab polymerase chain reaction. To our knowledge, this is the first case report of gonococcal infection of the sigmoid neovagina.
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Affiliation(s)
- Wouter B van der Sluis
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Luk Gijs
- Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
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30
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Shah NS, Kim E, de Maria Hernández Ayala F, Guardado Escobar ME, Nieto AI, Kim AA, Paz-Bailey G. Performance and comparison of self-reported STI symptoms among high-risk populations - MSM, sex workers, persons living with HIV/AIDS - in El Salvador. Int J STD AIDS 2014; 25:984-91. [PMID: 24616119 DOI: 10.1177/0956462414526860] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Resource-limited countries have limited laboratory capability and rely on syndromic management to diagnose sexually transmitted infections (STIs). We aimed to estimate the sensitivity, specificity and positive predictive value (PPV) of STI syndromic management when used as a screening method within a study setting. Men who have sex with men (MSM), female sex workers (FSWs) and people living with HIV/AIDS (PLWHA) participated in a behavioural surveillance study. Data were obtained on demographics, sexual behaviours, STI history and service utilisation. Biological specimens were tested for genital inflammatory infections (Neisseria gonorrhoeae [GC], Chlamydia trachomatis [CT], Mycoplasma genitalium [MG], Trichomonas vaginalis [TV]) and genital ulcerative infection (syphilis and Herpes simplex virus-2). There was a high prevalence of Herpes simplex virus-2 (MSM 48.1%, FSW 82.0% and PLWHA 84.4%). Most participants reported no ulcerative symptoms and the majority of men reported no inflammatory symptoms. Sensitivity and PPV were poor for inflammatory infections among PLWHA and MSM. Sensitivity in FSWs for inflammatory infections was 75%. For ulcerative infections, sensitivity was poor, but specificity and PPV were high. Reliance on self-reported symptoms may not be an effective screening strategy for these populations. STI prevention studies should focus on symptom recognition and consider routine screening and referral for high-risk populations.
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Affiliation(s)
- Neha S Shah
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Evelyn Kim
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Andrea A Kim
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gabriela Paz-Bailey
- Training Programs in Epidemiology and Public Health Interventions Network, Atlanta, GA, USA Universidad de Valle de Guatemala, Guatemala City, Guatemala
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31
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Mishra KK, Reddy S, Khairkar P. Genital self-mutilation in a suicide attempt: a rare sequela of a hypochondriacal delusion of infection with HIV. Int J STD AIDS 2013; 25:312-4. [PMID: 24021211 DOI: 10.1177/0956462413501647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Genital self-mutilation is mostly seen among psychotic, affective and gender identity disorder(s). We present here a rare case report of such genital self-mutilation in a person with a hypochondriacal delusion of infection with HIV precipitated by erroneous and anxiety-provoking miscommunication during HIV testing. Such cases remind us of the need for systematic and appropriate pre-test and post-test HIV counseling, to help prevent such outcomes.
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Affiliation(s)
- Kshirod K Mishra
- Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Maharashtra, India
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32
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Patel RR, Patel S, Clarke E, Khan AW, Doshi B, Radcliffe KW. Guidance and practice on frequency of HIV and sexually transmitted infection testing in men who have sex with men - what is the European situation? Int J STD AIDS 2013; 25:213-8. [PMID: 24216033 DOI: 10.1177/0956462413497700] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Men who have sex with men (MSM) are at particular risk for HIV/sexually transmitted infections (STI). To investigate the European guidance used for MSM STI and HIV screening, risk level profiling and how this translated to practice, we conducted a questionnaire survey of leading physicians in the European branch of the International Union against Sexually Transmitted Infections (IUSTI). We identified that most European countries have limited guidance on screening intervals for MSM. Where risk profiling is advised, it is often left to clinicians to weight different behaviours and decide on screening frequency. Our results suggest that European MSM STI and HIV testing guidelines be developed with clear and specific recommendations around screening intervals and risk profiling. These guidelines will be particularly helpful due to rapidly evolving models of sexual healthcare, and the emergence of new providers who may benefit from guidelines that require less interpretation.
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33
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de Coul ELMO, Warning TD, Koedijk FDH. Sexual behaviour and sexually transmitted infections in sexually transmitted infection clinic attendees in the Netherlands, 2007-2011. Int J STD AIDS 2013; 25:40-51. [PMID: 23970630 DOI: 10.1177/0956462413491736] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
High annual figures of sexually transmitted infections (STIs) are diagnosed in the Netherlands despite significant efforts to control them. Herein, we analyse trends and determinants of STI diagnoses, co-infections, and sexual risks among visitors of 26 STI clinics between 2007 and 2011. We recorded increased positivity rates of STIs (chlamydia, syphilis, gonorrhoea, and/or HIV) in women and heterosexual men up to 12.6% and 13.4%, respectively, in 2011, while rates in men having sex with men (MSM) were stable but high (18.8%) through the documented years. Younger age, origin from Surinam/Antilles, history of previous STI, multiple partners, or a previous notification are the identified risk factors for an STI in this population. Known HIV-infected men (MSM and heterosexuals) were at highest risk for co-infections (relative rate heterosexual men: 15.6; MSM: 11.6). STI positivity rates remained high (MSM) or increased over time (women and heterosexual men), a fact that highlights the importance of continuing STI prevention. Most importantly, the very high STI co-infection rates among HIV-positive men requires intensified STI reduction strategies to put an end to the vicious circle of re-infection and spread of HIV and other STIs.
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Affiliation(s)
- E L M Op de Coul
- Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
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34
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Baker A, Fleury C, Clarke E, Foley E, Samraj S, Rowen D, Patel R. Increasing screening frequency in men who have sex with men: impact of guidance on risk profiling on workload and earlier diagnosis of sexually transmitted infection and HIV. Int J STD AIDS 2013; 24:613-7. [PMID: 23970570 DOI: 10.1177/0956462413477552] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Increasing screening frequency in men who have sex with men (MSM) engaging in high-risk behaviours can reduce prevalence of sexually transmitted infections (STIs). This evaluation investigated the impact of applying stricter screening guidelines for MSM on service workload and earlier STI diagnoses. A validated risk assessment tool (RAT) was distributed to MSM attending a level 3 sexual health service over three months. Australian screening guidelines were applied to the data to identify MSM requiring more frequent screening and data projected to the larger MSM population. The RAT identified a 2-5-fold increase in the number of STI and HIV screenings required based on six- and three-monthly screening intervals, respectively, in the MSM cohort. When screening intervals are reduced from three-monthly to six-monthly there is a potential loss of 66.7% of earlier HIV diagnoses. The use of RATs will increase workload in sexual health services, but potentially diagnose a large proportion of disease earlier.
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Affiliation(s)
- A Baker
- School of Medicine, University of Southampton
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35
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Abstract
Genitourinary medicine (GUM) departments need to be resource efficient to manage the increasing numbers of patients seeking to access services. At the Edinburgh GUM department, we wished to develop a new No-Talk Testing (NTT) clinic for asymptomatic, low-risk patients attending for routine sexually transmitted infection (STI) screening. We undertook a questionnaire feasibility study to determine patient acceptability and ability to self-screen for this service. A total of 267 respondents completed questionnaires regarding acceptability of a future NTT service; 227 agreed to comparison of their self-screen with clinician risk-assessment. Overall, patient acceptability for a future NTT service was high, with an average of 7.8/10 awarded for opinion. Seventy-three percent of patients agreed they would consider utilizing such a service in the future. Sixty-one percent of respondents suggested at least one benefit to a future NTT service; principally, prospects for increased speed, efficiency, capacity and reduced waiting times. Comparing STI risk self-assessment with clinician assessment, discrepancies were identified for 37% of individuals. However, a majority (70%) of the discrepancies identified were due to a risk being noted in the self-screen alone, and missed from clinician notes. In summary, the study demonstrated NTT as acceptable and feasible. Based on these results, we have now successfully introduced such a service within our department.
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Affiliation(s)
- I Fernando
- Chalmers Sexual Health Centre, NHS Lothian, 2A Chalmers Street, Edinburgh EH3 9ES, UK.
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