HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention
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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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Barriers to Condom Use among High Risk Men Who Have Sex with Men in Uganda: A Qualitative Study
Geofrey Musinguzi,Hilde Bastiaens,Joseph K. B. Matovu,Fred Nuwaha,Geoffrey Mujisha,Juliet Kiguli,Jim Arinaitwe,Jean-Pierre Van Geertruyden,Rhoda K. Wanyenze +8 more
TL;DR: Six major barriers to condom use were identified: Difficulties with using condoms, access challenges, lack of knowledge and misinformation about condom use, partner and relationship related issues, financial incentives and socio-economic vulnerability, and alcohol consumption.
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The HIV Epidemic: High-Income Countries
TL;DR: The HIV epidemic in higher-income nations is driven by receptive anal intercourse, injection drug use through needle/syringe sharing, and, less efficiently, vaginal intercourse, and alcohol and noninjecting drug use increase sexual HIV vulnerability.
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The relationship between pornography use and sexual behaviours among at-risk HIV-negative men who have sex with men
TL;DR: This exploratory study sheds light on the associations between viewing pornography and sexual risk taking for HIV infection and future studies in this area should focus on understanding how the content of pornography; in particular, the viewing of unprotected and protected sex acts, may affectSexual risk taking behaviour.
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A Cross Sectional Analysis of Gonococcal and Chlamydial Infections among Men-Who-Have-Sex-with-Men in Cape Town, South Africa.
Kevin Rebe,David A. Lewis,Landon Myer,Glenn de Swardt,Helen Struthers,Monika Kamkuemah,James McIntyre +6 more
TL;DR: Asymptomatic STI was common and would not have been detected using a syndromic management approach and supports dual NG/CT molecular screening for MSM, which, in the case of confirmed NG infections, may trigger further culture-based investigations to determine gonococcal antimicrobial susceptibility in the current era of multi-drug resistant gonorrhoea.
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Perceived Versus Calculated HIV Risk: Implications for Pre-exposure Prophylaxis Uptake in a Randomized Trial of Men Who Have Sex With Men.
Jill Blumenthal,Sonia Jain,Evan Mulvihill,Shelly Sun,Marvin Hanashiro,Eric Ellorin,Sara Graber,Richard Haubrich,Sheldon R. Morris +8 more
TL;DR: Blumenthal et al. as mentioned in this paper conducted a randomized controlled trial of men who have sex with men to determine whether an objective risk score affects future pre-exposure prophylaxis (PrEP) uptake.
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