HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention
TLDR
It was demonstrated that it would require unreasonably low numbers of AI HIV exposures per partnership to reconcile the summary per-act and per-partner estimates, suggesting considerable variability in AI infectiousness between and within partnerships over time.Abstract:
Background The human immunodeficiency virus (HIV) infectiousness of anal intercourse (AI) has not been systematically reviewed, despite its role driving HIV epidemics among men who have sex with men (MSM) and its potential contribution to heterosexual spread. We assessed the per-act and per-partner HIV transmission risk from AI exposure for heterosexuals and MSM and its implications for HIV prevention.
Methods Systematic review and meta-analysis of the literature on HIV-1 infectiousness through AI was conducted. PubMed was searched to September 2008. A binomial model explored the individual risk of HIV infection with and without highly active antiretroviral therapy (HAART).
Results A total of 62 643 titles were searched; four publications reporting per-act and 12 reporting per-partner transmission estimates were included. Overall, random effects model summary estimates were 1.4% [95% confidence interval (CI) 0.2–2.5)] and 40.4% (95% CI 6.0–74.9) for per-act and per-partner unprotected receptive AI (URAI), respectively. There was no significant difference between per-act risks of URAI for heterosexuals and MSM. Per-partner unprotected insertive AI (UIAI) and combined URAI–UIAI risk were 21.7% (95% CI 0.2–43.3) and 39.9% (95% CI 22.5–57.4), respectively, with no available per-act estimates. Per-partner combined URAI–UIAI summary estimates, which adjusted for additional exposures other than AI with a ‘main’ partner [7.9% (95% CI 1.2–14.5)], were lower than crude (unadjusted) estimates [48.1% (95% CI 35.3–60.8)]. Our modelling demonstrated that it would require unreasonably low numbers of AI HIV exposures per partnership to reconcile the summary per-act and per-partner estimates, suggesting considerable variability in AI infectiousness between and within partnerships over time. AI may substantially increase HIV transmission risk even if the infected partner is receiving HAART; however, predictions are highly sensitive to infectiousness assumptions based on viral load.
Conclusions Unprotected AI is a high-risk practice for HIV transmission, probably with substantial variation in infectiousness. The significant heterogeneity between infectiousness estimates means that pooled AI HIV transmission probabilities should be used with caution. Recent reported rises in AI among heterosexuals suggest a greater understanding of the role AI plays in heterosexual sex lives may be increasingly important for HIV prevention.read more
Citations
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Antiretrovirals for HIV prevention: when should they be recommended?
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A scoping review on health education programs for improving Men's engagement with health services in low- and middle- income countries
TL;DR: Two main themes emerged from thematic content analysis of included studies: mode of health delivery (the process of enabling men and boys to become involved in health services as patients/clients) and health benefits to men (to achieve better health outcomes).
Dissertation
Dynamics of simultaneous epidemics on complex graphs
TL;DR: The subject of this thesis is the study of a system of multiple simultaneously spreading diseases, or strains of diseases, in a structured host population, modelled using the well-studied SEIR compartmental model, and introduces recombination and competition by replacement into the model.
Dissertation
HIV Risk among Men Who Have Sex with Men in a Large Chinese City
TL;DR: The HIV testing rate among MSM in Chongqing is still low, though MSM prevalence is high compared to other Chinese cities, and MSM preferring receptive anal sex are less likely to get testing and perceive having lower HIV risk.
A Comparison of Men Who Have Sex with Men, People Who Inject Drugs and High-Risk Heterosexuals' Risk for HIV
H. F. Raymond,San Francisco +1 more
TL;DR: HRH had a greater number of high-risk behaviors compared to MSM and PWID but had the lowest HIV prevalence, and focusing on risk behavior alone to label populations without considering the background HIV prevalence in communities may obscure which populations truly merit the label “high-risk” for HIV infection.
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