scispace - formally typeset
Search or ask a question

Showing papers in "International Journal of Std & Aids in 2014"


Journal ArticleDOI
TL;DR: Cervical cancer screening should be integrated into HIV treatment programmes and incidence and progression rates increased with lower CD4 counts, and the effect of antiretroviral therapy on the natural history of cervical neoplasia remains unclear.
Abstract: Global data on cervical lesion incidence and progression in HIV-positive women are essential for understanding the natural history of cervical neoplasia and informing screening policy. A systematic review was performed summarizing the incidence and progression of cervical lesions in HIV-positive women. Of 5882 HIV-positive women from 15 studies, incidence ranged from 4.9 to 21.1 cases per 100 woman-years for any cervical lesion and 0.4 to 8.8 cases per 100 woman-years for high-grade cervical lesions. HIV-positive women showed a median three-fold higher incidence of cervical lesions compared to HIV-negative women. Of 1099 HIV-positive women from 11 studies, progression from low- to high-grade lesions ranged from 1.2 to 26.2 cases per 100 woman-years. Both incidence and progression rates increased with lower CD4 counts. The effect of antiretroviral therapy on the natural history of cervical neoplasia remains unclear. HIV-positive women have higher incidence and progression of cervical neoplasia. Cervical cancer screening should be integrated into HIV treatment programmes.

139 citations


Journal ArticleDOI
TL;DR: There was modest evidence of a dose-response relationship between time on the road and HIV risk, and targeted HIV interventions for long-distance truck drivers are needed.
Abstract: We estimated the prevalence of HIV and assessed correlates of HIV infection in long-distance truck drivers in South Africa. Between October 2003 and July 2004, 1900 long-distance truck drivers aged ≥18 years consented to interview and for testing for HIV. Participants were selected from a 10% stratified random sample of registered truck depots. A proximate-determinants framework was used to assess the hierarchical relationship between risk factors and HIV infection using logistic regression. HIV prevalence was 26% (95% confidence interval 24% to 28%). In multivariate analyses, HIV infection was associated with spending 2-4 weeks on the road (adjusted odds ratio 1.4; 95% confidence interval 1.1 to 1.9). There was modest evidence of a dose-response relationship between time on the road and HIV risk. Mobility increased risk by creating conditions for unsafe sex and reducing access to health services. Targeted HIV interventions for long-distance truck drivers are needed.

74 citations


Journal ArticleDOI
TL;DR: The 2014 European Guideline on HIV Testing provides advice on testing for HIV infection in individuals aged 16 years and older who present to sexually transmitted infection, genito-urinary or dermato-venereology clinics across Europe.
Abstract: Testing for HIV is one of the cornerstones in the fight against HIV spread. The 2014 European Guideline on HIV Testing provides advice on testing for HIV infection in individuals aged 16 years and older who present to sexually transmitted infection, genito-urinary or dermato-venereology clinics across Europe. It may also be applied in other clinical settings where HIV testing is required, particularly in primary care settings. The aim of the guideline is to provide practical guidance to clinicians and laboratories that within these settings undertake HIV testing, and to indicate standards for best practice.

67 citations


Journal ArticleDOI
TL;DR: The association of M. genitalium with non-specific urethritis is now well established, but the evidence supporting its role in both male and female infertility remains inconclusive and the recommended treatment is azithromycin as a single 1 gm dose.
Abstract: Mycoplasma genitalium (M. genitalium)was first isolated from the urethral swabs of two symptomatic men with urethritis in 1980. Published prevalence rates vary greatly between populations studied. A number of urogenital conditions have been ascribed toM. genitalium, which is recognised to cause a sexually transmitted infection. The association of M. genitalium with non-specific urethritis is now well established, but the evidence supporting its role in both male and female infertility remains inconclusive. Laboratory methods are challenging and there is a lack of test standardisation. The recommended treatment of the infection is azithromycin as a single 1 gm dose. However, in recent years macrolide resistance has been observed. More studies are required to establish the clinical importance of M. genitaliumin urogenital conditions, particularly infertility, and to establish the role for screening and treatment in high-risk populations.

66 citations


Journal ArticleDOI
TL;DR: This guideline offers recommendations on the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of TV, covering the management of the initial presentation, as well as how to prevent transmission and future infection.
Abstract: The main objective is to assist practitioners in managing men and women diagnosed with Trichomonas vaginalis (TV) infection. This guideline offers recommendations on the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of TV, covering the management of the initial presentation, as well as how to prevent transmission and future infection.

62 citations


Journal ArticleDOI
TL;DR: Exclusion of anorectal infections is generally indicated as part of standard screening for sexually transmitted infections (STIs).
Abstract: Proctitis is defined as an inflammatory syndrome of the distal 10-12 cm of the anal canal, also called the rectum. Infectious proctitis can be sexually transmitted via genital-anal mucosal contact, but some also via mutual masturbation.N. gonorrhoeae,C. trachomatis(including lymphogranuloma venereum), Herpes Simplex Virus andT. pallidumare the most common sexually transmitted anorectal pathogens. Shigellosis can be transferred via oral-anal contact and may lead to proctocolitis or enteritis. Although most studies on these infections have concentrated on men who have sex with men (MSM), a significant proportion of women have anal intercourse and therefore may also be at risk. A presumptive clinical diagnosis of proctitis can be made when there are symptoms and signs, and a definitive diagnosis when the results of laboratory tests are available. The symptoms of proctitis include anorectal itching, pain, cramps (tenesmus) and discharge in and around the anal canal. Asymptomatic proctitis occurs frequently and can only be detected by laboratory tests. The majority of rectal chlamydia and gonococcal infections are asymptomatic. Therefore when there is a history of receptive anal contact, exclusion of anorectal infections is generally indicated as part of standard screening for sexually transmitted infections (STIs). Condom use does not guarantee protection from bacterial and protozoan STIs, which are often spread without penile penetration.

55 citations


Journal ArticleDOI
TL;DR: It is shown that many young people are not comfortable with accessing sexual health information through these channels, and further research is needed to determine how to best take advantage of these novel opportunities for health promotion.
Abstract: Social media are growing in popularity and will play a key role in future sexual health promotion initiatives. We asked 620 survey participants aged 16 to 29 years about their time spent using social media and their comfort in receiving information about sexual health via different channels. Median hours per day spent using social network sites was two; 36% spent more than 2 hours per day using social network sites. In multivariable logistic regression, being aged less than 20 years and living in a major city (compared to rural/regional Australia) were associated with use of social media more than 2 hours per day. Most participants reported being comfortable or very comfortable accessing sexual health information from websites (85%), followed by a doctor (81%), school (73%), and the mainstream media (67%). Fewer reported being comfortable getting information from social media; Facebook (52%), apps (51%), SMS (44%), and Twitter (36%). Several health promotion programmes via social media have demonstrated efficacy; however, we have shown that many young people are not comfortable with accessing sexual health information through these channels. Further research is needed to determine how to best take advantage of these novel opportunities for health promotion.

53 citations


Journal ArticleDOI
TL;DR: This guideline is an update of a previous version published in 2006 by adding an expanded section on integrated STI/ contraception services and a new section on outreach services and the sections on electronic patient records and the use of technology in sexual history taking.
Abstract: This guideline is an update of a previous version published in 2006. In this new version, we have reflected changes in the way sexual health services are now provided by adding an expanded section on integrated STI/ contraception services and a new section on outreach services. We have also expanded the sections on electronic patient records and the use of technology in sexual history taking. The other sections have been updated to reflect new evidence and practice.

50 citations


Journal ArticleDOI
TL;DR: Urgent education and risk reduction programmes are needed in this population of female sex workers in Iran as they are at greater risk for HIV infection and sexually transmitted infections.
Abstract: As a concentrated epidemic, human immunodeficiency virus (HIV) is spreading rapidly in one or more groups in Iran, but in the general population its prevalence is relatively low. Female sex workers (FSWs) and their partners are at greater risk for HIV infection. To determine the prevalence of HIV and sexually transmitted infections (STIs) including gonorrhoea, Chlamydia, herpes simplex type 2 and syphilis among FSWs. We conducted a cross-sectional study of 278 FSWs in Shiraz, by using respondent-driven sampling, from June to March 2010. The recruitment chain started with 14 seeds, and FSWs were tested for HIV, syphilis, herpes simplex type 2, gonorrhoea and Chlamydia. HIV prevalence was 4.7% (13/278); the most prevalent STI was herpes simplex type 2, 9.7% (27/278), followed by Chlamydia 9% (25/278), gonorrhoea 1.4% (4/278) and syphilis (0/278). The FSWs reported drug use (69.9%) of which 16.4% had history of injecting drug use. Unprotected sex in the past month was reported by 24.4% of FSWs. Urgent education and risk reduction programmes are needed in this population.

47 citations


Journal ArticleDOI
TL;DR: The study corroborates the feasibility of kidney transplantation in HIV-positive patients and suggests that the optimal immune suppression strategy in this population remains to be refined.
Abstract: HIV-positive patients are at increased risk of end-stage kidney disease. Kidney transplantation is an established treatment modality for end-stage kidney disease in the general population. Recent data have confirmed the feasibility of kidney transplantation in HIV-positive patients, and kidney transplantation is increasingly offered to end-stage kidney disease patients with well-controlled HIV infection. We report clinical outcomes in a national cohort study of kidney trans- plantation in HIV-positive patients. In all, 35 HIV-positive KT recipients who had undergone KT up to December 2010 (66% male, 74% black ethnicity) were identified; the median CD4 cell count was 366, all had undetectable HIV RNA levels at kidney transplantation, and 44% received a kidney from a live donor. Patient survival at 1 and 3 years was 91.3%, and graft survival 91.3% and 84.7%, respectively. At one-year post-kidney transplantation, the cumulative incidence of acute rejection was 48%, and the median (IQR) eGFR 64 (46, 78) mL/min/1.73m 2 . Although HIV viraemia and HIV disease progression were uncommon, renal complications were relatively frequent. Our study corroborates the feasibility of kidney transplantation in HIV-positive patients. The high rates of acute rejection suggest that the optimal immune suppression strategy in this population remains to be refined.

47 citations


Journal ArticleDOI
TL;DR: Schistosomiasis may have been an independent cause of HIV incidence in the RCTs of STI treatment for HIV prevention and may have obscured the findings of these trials.
Abstract: Treatment of sexually transmitted infections (STIs) has been hypothesised to decrease HIV transmission. Although observational studies show an association between STIs and HIV, only one prospective randomised controlled trial (RCT) has confirmed this. Female genital schistosomiasis can cause genital lesions, accompanied by bloody discharge, ulcers or malodorous discharge. Genital schistosomiasis is common, starts before puberty and symptoms can be mistaken for STIs. Three observational studies have found an association between schistosomiasis and HIV. Genital lesions that develop in childhood are chronic. This paper sought to explore the possible effects of schistosomiasis on the RCTs of STI treatment for HIV prevention.In the study sites, schistosomiasis was a likely cause of genital lesions. The studies recruited women that may have had genital schistosomal lesions established in childhood. Schistosomiasis endemic areas with different prevalence levels may have influenced HIV incidence in intervention a...

Journal ArticleDOI
TL;DR: The leucocyte counts in first-void urine (FVU) were determined as an objective measure of inflammatory response to ureaplasma in the hosts by automated quantitative urine particle analysis and positive correlations were observed between copies of the 16S rRNA genes of U. urealyticum.
Abstract: Ureaplasma urealyticum could be a pathogen of non-gonococcal urethritis (NGU) in men. However, ureaplasma is often detected in men without NGU, and the proportion of cases possibly attributable to this pathogen is still undefined. We attempted to determine the bacterial loads of U. urealyticum significantly associated with NGU. The 16S rRNA genes of U. urealyticum were quantified by a real-time polymerase chain reaction-based assay in first-void urine (FVU) from 26 asymptomatic and 25 symptomatic men positive for U. urealyticum. The leucocyte counts in first-void urine (FVU) were determined as an objective measure of inflammatory response to ureaplasma in the hosts by automated quantitative urine particle analysis. Positive correlations were observed between copies of the 16S rRNA genes of U. urealyticum per ml and the leucocyte counts per µl in FVU (r = 0.49, p = 0.0003). Loads of ≥10(4) copies of the 16S rRNA gene of U. urealyticum/ml, corresponding to ≥5 × 10(3) cells of U. urealyticum/ml in FVU, were significantly associated with the presence of urethritis symptoms (p < 0.0001) and with higher leukocyte counts in FVU (p < 0.0001). The bacterial load of U. urealyticum, possibly of ≥5 × 10(3) cells of U. urealyticum/ml in FVU, could be significantly associated with the development of symptomatic NGU.

Journal ArticleDOI
TL;DR: Mobile unit (MU) HIV testing reached large numbers of at-risk (MSM/TW) populations engaged in unsafe sexual behaviours, making MU outreach a worthy complement to FC testing.
Abstract: Mobile unit (MU) HIV testing is an alternative method of providing healthcare access. We compared demographic and behavioural characteristics, HIV testing history and HIV prevalence between participants seeking testing at a MU vs. fixed clinic (FC) in Lima, Peru. Our analysis included men and transgender women (TW) in Lima aged ≥ 18 years old seeking HIV testing at their first visit to a community-based MU or FC from October 2007 to November 2009. HIV testing history, HIV serostatus and behavioural characteristics were analysed. A large percentage of MU attendees self-identified as transgender (13%) or heterosexual (41%). MU attendees were more likely to engage in transactional sex (24% MU vs. 10% FC, p < 0.001), use alcohol/drugs during their last sexual encounter (24% MU vs. 20% FC, p < 0.01) and/or be a first-time HIV tester (48% MU vs. 41% FC, p < 0.001). MU HIV prevalence was 9% overall and 5% among first-time testers (49% in TW and 11% in men who have sex with men [MSM] first-time testers). MU testing reached large numbers of at-risk (MSM/TW) populations engaged in unsafe sexual behaviours, making MU outreach a worthy complement to FC testing. Investigation into whether MU attendees would otherwise access HIV testing is warranted to determine the impact of MU testing.

Journal ArticleDOI
TL;DR: It is suggested that syndromic management of STIs is not a sufficient tool for STI diagnosis in this setting; development and improvement of STI diagnostic capabilities through laboratory confirmation is needed in resource-limited settings.
Abstract: SummaryWhile laboratory aetiological diagnosis is considered the gold standard for diagnosis and management of sexually transmitted infections (STIs), syndromic management has been presented as a simplified and affordable approach for STI management in limited resource settings. STI signs and symptoms were collected using staff-administered computer-assisted personal interview and audio computer-assisted self-interview. Participants underwent a medical examination and laboratory testing for common STIs. The performance of syndromic management was assessed on the agreement between interviewing methods as well as accurate diagnosis. We screened 846 participants, of whom 88 (10.4%) received syndromic STI diagnosis while 272 (32.2%) received an aetiological diagnosis. Agreement between syndromic and aetiological diagnoses was very poor (overall kappa = 0.09). The most prevalent STI was herpes simplex virus type 2 and the percentage of persons with any STI was higher among women (48.6%) than men (15.6%, p < 0....

Journal ArticleDOI
TL;DR: RCt infection in women may be more prevalent than previously thought and whether RCt infections are clinically significant or whether they may act as a reservoir for re-infection requires further study.
Abstract: The aim of this study was to observe the proportion of concurrent rectal Chlamydia (RCt) infection in women who have cervical Chlamydia (CCt) and to observe whether there was any correlation with receptive anal intercourse (RAI). Untreated CCt-positive women were invited to take part. Women chose either to have a physician-collected or self-taken rectal swab. Treatment was then commenced. 17 samples were physician-collected and 80 were self-collected. 75/97 (77.3%, 95% Confidence Interval [95%CI] 69.0–85.7%) were RCt positive. 25/97 (25.8%, 95%CI 17.1–34.5%) reported RAI. There was no difference in the positivity rate whether RAI was reported (80%) or not (76%) (P = 0.71); or whether swabs were physician-collected (65%) or self-taken (80%) (P = 0.17). Only one of those with RCt reported rectal symptoms. One woman had concurrent gonococcal infection. 34/97 (35%) had a history of past sexually transmitted infections. Verified contact attendance was 0.52 and 72% of verified contacts were Chlamydia positive. ...

Journal ArticleDOI
TL;DR: Female sex workers in the Gambia have a higher prevalence of HIV compared to the general Gambian population, and service providers should consider non-paying partners of female sex workers, improve knowledge and availability of condoms and lubricant, and address safety and mental health needs.
Abstract: To determine HIV prevalence among female sex workers in the Gambia and HIV risk factors, we accrued participants (n = 251) through peer-referral and venue-based recruitment. Blood samples were screened for HIV and participants were administered a questionnaire. Bivariate and multivariate logistic regression identified factors associated with HIV status. Forty respondents (15.9%) were HIV-positive: 20 (8.0%) were infected with HIV-1 only, 10 (4.0%) with HIV-2 only, and 10 (4.0%) with both HIV-1 and HIV-2; 12.5% (n = 5/40) knew their status. Condom usage at last sex was 97.1% (n = 170/175) with new clients and 44.2% (n = 53/120) with non-paying partners. Having a non-paying partner, living with relatives or friends, having felt scared to walk in public, selling sex in multiple locations, and recent depressive symptoms were positively associated with HIV under multivariate regression. Female sex workers have a higher prevalence of HIV compared to the general Gambian population. Interventions should be rights...

Journal ArticleDOI
TL;DR: It is suggested that cART improved the quality of life of AIDS patients for a limited time, so further research for longer periods is needed to confirm this outcome.
Abstract: The aim of this paper was to review cohort studies that analyze changes in the quality of life of people living with HIV/AIDS. We searched the PubMed and EmBase databases from inception to December 2012 for primary cohort studies of the quality of life of people living with HIV/AIDS after combination antiretroviral therapy (cART). Two independent reviewers screened and selected published studies of quality of life that had been followed up for more than 12 weeks after the beginning of cART. Data from the papers were analyzed to identify common characteristics of the effects of cART on the quality of life of HIV/AIDS patients. Eight cohort studies were found: only four were assessed as high quality and four were assessed as moderate quality. None of the studies described patient selection. Six studies followed the patients for one year or more, and the other studies for less than 6 months. Seven studies reported quality of life had been improved after initiation of cART, and one study reported no change. Previous research suggested that cART improved the quality of life of AIDS patients for a limited time, so further research for longer periods is needed to confirm this outcome.

Journal ArticleDOI
TL;DR: This guideline was produced by the European region of the International Union against sexually transmitted infections and refers to ascending infections in the female genital tract unrelated to delivery and surgery and does not include actinomyces-related infection.
Abstract: This guideline was produced by the European region of the International Union against sexually transmitted infections (IUSTI) and refers to ascending infections in the female genital tract unrelated to delivery and surgery and does not include actinomyces-related infection.

Journal ArticleDOI
TL;DR: STI positivity rates remained high (MSM) or increased over time (women and heterosexual men), a fact that highlights the importance of continuing STI prevention, and the very high STI co-infection rates among HIV-positive men requires intensified STI reduction strategies.
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.

Journal ArticleDOI
TL;DR: It is suggested that routine text reminders increase clinic attendance rates by reminding patients to attend and prompting them to cancel if they cannot come.
Abstract: 'Did not attend' and cancellation rates were compared for two 12-month periods before (2009) and after (2012/2013) the introduction of routine short message service text reminders being sent to patients who have pre-booked appointments. After the introduction of short message service text appointment reminders, the overall 'did not attend' rates fell by 4% from 28% to 24% (p < 0.005) and by 10% from 28% to 18% (p < 0.05) for male sexual health appointments. There was no significant change in the HIV clinic 'did not attend' rates. In the same periods, the cancellation rates increased 4% overall (from 62% to 66%) and by 17% (from 55% to 72%) for female sexual health clinics (p < 0.005). These results suggest that routine text reminders increase clinic attendance rates by reminding patients to attend and prompting them to cancel if they cannot come.

Journal ArticleDOI
TL;DR: Duration of infection greater than 13 years was significantly associated with osteoporosis and duration of cART was associated in univariate but not multivariate analyses, and strategies to prevent osteoporeosis and fractures in HIV will require attention to viral and lifestyle factors and not just cART.
Abstract: Rates of osteoporosis and fracture may be increased in HIV but there are few UK data. Our aim was to examine the prevalence of and risk factors for osteoporosis and fractures among a homogeneous cohort of well-characterized HIV-infected men. In total, 168 men were recruited, median age 45 years, 37 combination antiretroviral therapy (cART) naive, 46 with 10 years). All participants provided information on bone health and underwent DEXA scanning. Osteopenia was found in 58% of subjects and osteoporosis in 12%; 14% reported fractures since HIV diagnosis. Number of fractures since HIV diagnosis was significantly increased among those with osteoporosis (OR 3.5, 95% CI 1.2–10.4, p = 0.018). Duration of infection greater than 13 years was significantly associated with osteoporosis. Duration of cART was associated in univariate but not multivariate analyses. Strategies to prevent osteoporosis and fractures in HIV will require attention to viral and ...

Journal ArticleDOI
TL;DR: Depressive symptoms, even if not a clinical disorder, warrant early detection and treatment for promoting HIV prevention among HIV-affected couples.
Abstract: We investigated depression in relationship to sexual risk behaviour with primary partners among HIV-positive clients in Uganda. Baseline data were analyzed from a cohort of clients starting antiretroviral therapy. 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 six months and during the last episode of sexual intercourse. A total of 386 participants had a primary sex partner with whom 41.6% always used condoms during sex over the past six 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 intercourse over the past six months. Controlling for demographics HIV disclosure and partner HIV status only minor depression was associated with unprotected sex. Depressive symptoms even if not a clinical disorder warrant early detection and treatment for promoting HIV prevention among HIV-affected couples.

Journal ArticleDOI
TL;DR: Deeper exploration of the relationship between shared methamphetamine injection and sexual risk among Iranian methamphetamine injectors would benefit HIV/sexually transmitted infection prevention efforts and existing psychosocial interventions for methamphetamine-injecting population may need to be adapted to better meet the risks of shared methamphetamine injections.
Abstract: Shared methamphetamine injection is an emerging route of drug use among Iranian methamphetamine injectors It is a primary vector for blood-borne infections The aim of the current study is to determine the prevalence and correlates of shared methamphetamine injection in a sample of Iranian methamphetamine injecting treatment seekers in the south of Tehran We surveyed male and female methamphetamine injectors at three drop-in centres and 18 drug-use community treatment programmes Participants reported socio-demographic characteristics, drug use, high-risk behaviours, current status of viral infections and service use for drug treatment Bivariate and multivariate logistic regression models were used to test associations between participants' characteristics and shared methamphetamine injection Overall, 209 clients were recruited; 909% were male; 526% reported current methamphetamine injection without any shared injection behaviour and 474% reported current shared methamphetamine injection Shared methamphetamine injection was found to be primarily associated with living with sex partners (AOR 125, 95% CI 113-198), reporting ≥3 years of dependence on methamphetamine injection (AOR 161, 95% CI 127-212), injection with pre-filled syringes in the past 12 months (AOR 196, 95% CI 147-242), homosexual sex without condom use in the past 12 months (AOR 185, 95% CI 121-225), the paucity of NA group participation in the past 12 months (AOR 067, 95% CI 041-099), the paucity of attending psychotherapeutic sessions in the past 12 months (AOR 044, 95% CI 028-096) and positive hepatitis C status (AOR 198, 95% CI 167-283) Deeper exploration of the relationship between shared methamphetamine injection and sexual risk among Iranian methamphetamine injectors would benefit HIV/sexually transmitted infection prevention efforts In addition, existing psychosocial interventions for methamphetamine-injecting population may need to be adapted to better meet the risks of shared methamphetamine injectors

Journal ArticleDOI
TL;DR: Alcohol and sexual risk reduction, strengthening of needle–syringe exchange, reducing injecting duration and clinical management of HIV, HCV and HIV/HCV co-infection appear as four core programme needs.
Abstract: SummaryIn this study 1155 injection drug users (IDUs) receiving targeted intervention in five cities of Punjab were surveyed; three cities (Amritsar, Taran-Taran, Batala) were in districts sharing ...

Journal ArticleDOI
TL;DR: It is identified that most European countries have limited guidance on screening intervals for MSM and HIV testing, and it is often left to clinicians to weight different behaviours and decide on screening frequency.
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.

Journal ArticleDOI
TL;DR: Primary prophylaxis with itraconazole among immunocompromised patients seems warranted and disseminated histoplasmosis is the most common febrile opportunistic infection in western French Guiana.
Abstract: In Western French Guiana there was a dramatic increase in HIV-prevalence between 1990 and 2000. The present study describes the causes of fever among HIV patients hospitalized in the medical ward of the only hospital in the western part of French Guiana. A retrospective descriptive study was conducted between January 1st 2008 and June 30th 2010 in the department of medicine of Saint Laurent du Maroni Hospital. The main characteristics of 67 patients having presented with fever in the first 48 hours of hospitalization were described. Among patients with CD4<200/mm3 the main febrile opportunistic infection was disseminated histoplasmosis (41.1%). Among patients with CD4 counts <50/mm3 and fever without focal points 85.7% had disseminated histoplasmosis. Three patients died and all had disseminated histoplasmosis. Disseminated histoplasmosis is the most common febrile opportunistic infection in western French Guiana. Primary prophylaxis with itraconazole among immunocompromised patients seems warranted.

Journal ArticleDOI
TL;DR: In women, sexual and clinical factors influenced the impact of genital warts on well-being, whereas in men no such factors were found.
Abstract: To assess gender-specific impact of genital warts on health-related quality of life (HRQoL), and to explore to what extent sexual characteristics and clinical symptoms influenced the impact on emotional and sexual well-being of both sexes We conducted a survey of sexual and clinical characteristics from persons diagnosed with genital warts at STI clinics HRQoL was measured using two measurement tools: 1) the generic EQ-5D; and 2) the genital warts-specific CECA-10 including an emotional well-being and a sexual activity dimension The EQ-5D scores were compared with scores of the general population Descriptive analyses were used to explore characteristics associated with HRQoL scores stratified for gender The HRQoL-measurement tools showed that genital warts have especially an emotional impact The impact of genital warts on HRQoL was greater for women than for men In addition, the CECA-10 showed that in women the impact of genital warts on sexual activity was influenced by age, relationship status and number of warts No related factors were seen in men Genital warts have a greater impact on women than on men In women, sexual and clinical factors influenced the impact of genital warts on well-being, whereas in men no such factors were found

Journal ArticleDOI
TL;DR: In Singapore, the prevalence of HPV infection was 9.31% and was related to penetrative sexual intercourse, multiple sexual partners and low educational level and the distribution of HPV subtypes in healthy women varies between different countries within Asia.
Abstract: This study reports the prevalence and risk factors of human papillomavirus (HPV) infection in healthy women in Singapore. Demography, education, sexual and reproductive history and cigarette smoking habits were obtained from a cross-sectional population of healthy women and girls aged above 12 years of age. Cervical or vaginal cytology samples were investigated for 37 known anogenital HPV subtypes using the linear array PCR method. Chi square statistics were used to test for associations of individual epidemiological factors with HPV infection. Independent risk factors were identified with binomial logistic regression analysis. Of 891 subjects, the prevalence of HPV infection was 9.31% (83/891 women) for any-type HPV and 5.05% (46/891 women) for the high-risk HPV (hrHPV). Of 30 HPV subtypes detected, the most prevalent genotypes in descending order of frequency were subtypes 51, 16, 52, 58 and 66 for hrHPV and subtypes 62, 61, 84, 72 and 53 for the low-risk HPV. This frequency distribution of HPV subtypes was different from reports from other countries within Asia. Forty-six virgins studied tested negative for HPV infection. Significant independent risk factors for any-type HPV infection were multiple sexual partners (adjusted OR 1.4) and low (≤6 years) educational level (adjusted OR 4.0). The distribution of HPV subtypes in healthy women varies between different countries within Asia. In Singapore, the prevalence of HPV infection was 9.31% and was related to penetrative sexual intercourse, multiple sexual partners and low educational level.

Journal ArticleDOI
TL;DR: Post-exposure prophylaxis after sexual exposure (PEPSE) awareness was audited in an HIV-positive cohort and MSM, younger patients, and those diagnosed after 2006 were significantly more likely to be PEPSE aware.
Abstract: Post-exposure prophylaxis after sexual exposure (PEPSE) awareness was audited in an HIV-positive cohort. A total of 403 out of 828 (48.7%) patients were PEPSE aware. Patients diagnosed post-2006 were more PEPSE aware; 57.2% vs. 44.2% (p = 0.0004). Men who have sex with men (MSM) were more PEPSE aware; 65.8% vs. 39.1% in heterosexuals (p 35 years (p 400 copies/mL), awareness was 64.1%. Overall, PEPSE awareness was unexpectedly low. MSM, younger patients, and those diagnosed after 2006 were significantly more likely to be PEPSE aware. More than one in three patients with detectable viraemia were PEPSE unaware.

Journal ArticleDOI
TL;DR: The need for surveillance and possible need for screening for Chlamydia trachomatis, which often progresses asymptomatically is drawn, since this pathogen has recently been implicated as a risk factor for HIV infection.
Abstract: This study describes the prevalence of infection by Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis in a female population in Amazonas, Brazil. We collected cervical samples from 361 women examined at 10 primary care health services in the city of Coari, Amazonas, Brazil. The women were interviewed about socio-economic data, clinical history and sexual behaviour. Pelvic examinations were performed and cervical specimens were collected for detection of pathogens by PCR. The prevalence of infection was: 12.7% for Trichomonas vaginalis, 6.4% for Chlamydia trachomatis and 1.4% for Neisseria gonorrhoeae. There were no statistically significant associations between infections by any of the pathogens nor by any pathogen alone with any clinical variable, socio-demographic data or sexual behaviour. This study draws attention to the need for surveillance and possible need for screening for Chlamydia trachomatis, which often progresses asymptomatically. For the significant prevalence found, attention should also be given to asymptomatic infection by Trichomonas vaginalis, since this pathogen has recently been implicated as a risk factor for HIV infection.