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Monitoring prevalence of advanced human immunodeficiency virus (HIV) disease (i.e., CD4+ T-cell count <200 cells/µL) among persons starting antiretroviral therapy (ART) is important to understand ART program outcomes, inform HIV prevention strategy, and forecast need for adjunctive therapies.*,†,§ To assess trends in prevalence of advanced disease at ART initiation in 10 high-burden countries during 2004-2015, records of 694,138 ART enrollees aged ≥15 years from 797 ART facilities were analyzed. Availability of national electronic medical record systems allowed up-to-date evaluation of trends in Haiti (2004-2015), Mozambique (2004-2014), and Namibia (2004-2012), where prevalence of advanced disease at ART initiation declined from 75% to 34% (p<0.001), 73% to 37% (p<0.001), and 80% to 41% (p<0.001), respectively. Significant declines in prevalence of advanced disease during 2004-2011 were observed in Nigeria, Swaziland, Uganda, Vietnam, and Zimbabwe. The encouraging declines in prevalence of advanced disease at ART enrollment are likely due to scale-up of testing and treatment services and ART-eligibility guidelines encouraging earlier ART initiation. However, in 2015, approximately a third of new ART patients still initiated ART with advanced HIV disease. To reduce prevalence of advanced disease at ART initiation, adoption of World Health Organization (WHO)-recommended "treat-all" guidelines and strategies to facilitate earlier HIV testing and treatment are needed to reduce HIV-related mortality and HIV incidence.

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Worldwide, military personnel have been recognized as a population at elevated risk for sexually transmitted infections (STIs) and HIV; however, it is not well understood how the military occupation itself is implicated in the production of sexual risk behavior. Using qualitative and quantitative data collected from the Belize Defense Force (BDF), we employed a grounded theoretical framework and the Bourdieusian concept of the field and habitus to clarify how the military occupation is implicated in structuring aspects of sexual risk behaviors among personnel. We focus results on in-depth qualitative interviews conducted with 15 male-identified BDF personnel. We identify and describe how two field elements, namely operational tempo and ongoing exposure to occupational hazards, are occupationally specific field elements implicated in the production of sexual risk behavior through the mediating matrix of the military class habitus. Our findings demonstrate a conceptual clarity regarding the institutional field and habitus through which military personnel make sense of and act on the risk of bodily harm with regard to their own sexual behaviors. We conclude by outlining our theoretical concept so that it can be directly applied in public health efforts in order to leverage military occupational field elements for the purpose of HIV and STI prevention.

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Worldwide, military personnel have been recognized as a population at elevated risk for sexually transmitted infections and HIV. However, few evidence based behavioral interventions for the prevention of HIV and STIs have been rigorously evaluated in military personnel. We adapted the Popular Opinion Leaders (POL) intervention and piloted the adapted program with the Barbados Defence Force at one military base in Barbados. Popular Opinion Leaders were selected and trained to focus conversations on condom use. Behavioral questionnaires were administered using audio computer-assisted self interview at baseline (n = 256) and 6-month follow-up (n = 303). Mid-point focus groups were conducted with a sample of 15 POLs at a 3 month mid-point assessment. Quantitative data showed moderate increases in condom use at 6-months, and significant uptake of condom use during oral-genital contact in female personnel. A subgroup analysis suggests that this change was partially mediated by post-intervention changes in injunctive norms surrounding condom use in women. Focus groups revealed that POLs were heavily focusing on condom demonstrations, condom provision within social networks, speaking with coworkers about pleasure associated with condom use, and that the most common venues for conversations included those where alcohol was consumed. During the intervention, POLs dispersed from the intervention site as a result of normal personnel movement across bases, resulting in our having to use a pre and post intervention design across the population. It is likely that larger effect sizes would be observed in efforts that account for the natural dispersion of personnel across bases.

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Condom use during last sexual contact is a survey measure that may be used to inform monitoring and evaluation indicators of recent condom use in populations at risk for HIV infection and other sexually transmitted infections, such as the uniformed services. The authors tested for differences in condom use measures that were fielded within separate Biological and Behavioral Surveillance Surveys conducted in the armed forces of two separate nations: the Dominican Republic and Belize. Both surveys included measures of condom use during last sexual contact with specified partners and both surveys included the Risk Behavior Assessment (RBA), which measures specific sexual acts and condom use frequency during a specified time period. In both samples, more than 40% of respondents who reported condom use during last sexual contact with a regular partner also reported engaging in unprotected sex when screened with the RBA. Furthermore, more than 60% of respondents who reported condom use during last sexual encounter with a commercial sex worker also reported engaging in unprotected sex when screened with the RBA. The results carry implications for monitoring and evaluation indicators of large-scale HIV prevention programs. The authors recommend that, when feasible, more in-depth instruments such as the RBA be considered to measure recent condom use in populations of uniformed services personnel.

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OBJECTIVES: To determine whether self-reported sexual behavior and mental health varied by interviewer gender in a population of male military personnel. METHODS: Eight male and six female data collectors verbally administered structured interviews to 474 male Dominican military personnel stationed at border crossing zones in the Dominican Republic. Measurements included sexual behaviors and mental health. RESULTS: Respondents were less likely to report oral and vaginal sex to male interviewers, and were more likely to report sexual coercion and alcohol abuse to male interviewers. Respondents were more likely to report depression and post-traumatic stress disorder to female interviewers. CONCLUSION: Interviewer gender influenced the prevalence of sexual behaviors and mental health, which carries implications for future research in military personnel.

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CONTEXT: A survey was conducted of sexually active male military personnel stationed along major border-crossing zones between the Dominican Republic (DR) and Haiti, taking an applied scientific approach, to better inform prevention programming with military personnel in the region. DESIGN AND METHOD: A subsample of 470 sexually active male military personnel was drawn from a stratified systematic sample of military personnel stationed along the three largest border-crossing zones on the western border of the Dominican Republic. Using a verbally administered questionnaire, an examination of how foci of current HIV prevention programming with military personnel correlated with key sexual risk behavioral outcomes was conducted. RESULTS: Mental health factors such as probable alcohol abuse and posttraumatic stress disorder showed consistent associations with sexual risk behaviors. Participants showed a relatively high level of HIV/AIDS-related knowledge, a moderate level of negative attitudes toward condoms, and a moderate level of stigma toward people living with HIV/AIDS. Psychosocial factors, which are typically preventive in nature, were not associated with decreased sexual risk behaviors. CONCLUSION: Gaps were identified in HIV prevention programming that need to be addressed in this population of sexually active male military personnel. Although knowledge, attitudes, and psychosocial factors are important foci of HIV prevention programming, they were not associated with sexual risk behaviors, particularly after controlling for mental health factors. The authors suggest that prevalent psychiatric disorders in military personnel, such as posttraumatic stress disorder, should be factored in to the development of HIV prevention programs for military personnel.

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OBJECTIVE: To estimate the prevalence of sexual risk behaviors among military personnel stationed along major border-crossing zones between the Dominican Republic and Haiti. METHODS: From November 2008 to January 2009, behavioral surveys were administered to 498 active duty military personnel stationed along the three largest border-crossing zones on the western border of the Dominican Republic. Participants were selected using systematic random sampling and asked about their sexual behavior over the past 12 months, alcohol use, and mental health. RESULTS: Forty-one percent reported having casual sex during the past 12 months, 37 percent of men had a history of having sex with a commercial sex worker (19 percent during the past 12 months), and 7 percent of men reported a history of having sex with a transmigrating Haitian (6 percent during the past 12 months). Among sexually non-monogamous respondents (51 percent), inconsistent condom use exceeded 60 percent for those engaging in anal, vaginal, or oral sex. Fifteen percent reported using sexual coercion during the past 12 months. CONCLUSIONS. Sexual risk behaviors were prevalent among military personnel stationed along border-crossing zones between the Dominican Republic and Haiti. Prevention programs targeted at military personnel in this region should incorporate sexual coercion and mental health as key elements of their HIV prevention programs.

OBJETIVO. Calcular la prevalencia del comportamiento sexual riesgoso del personal militar que sirve en las principales zonas de paso fronterizo entre la República Dominicana y Haití. MÉTODOS. De noviembre del 2008 a enero del 2009, se aplicaron encuestas sobre comportamiento a 498 miembros del personal militar que estaba en servicio activo en las tres zonas principales de paso fronterizo de la frontera occidental de la República Dominicana. Se seleccionó una muestra aleatoria y sistemática de participantes, a los que se les formularon preguntas sobre su comportamiento sexual de los últimos 12 meses, el consumo de bebidas alcohólicas y la salud mental. RESULTADOS: De todos los entrevistados, 41 por ciento revelaron que habían mantenido relaciones sexuales casuales en los últimos 12 meses, 37 por ciento de los hombres alguna vez habían mantenido relaciones sexuales con un profesional del sexo (19 por ciento en los últimos 12 meses) y 7 por ciento de los hombres informaron que habían tenido relaciones sexuales con personas de Haití que cruzaron la frontera (6 por ciento en los últimos 12 meses). De los entrevistados no monógamos (51 por ciento), más de 60 por ciento de los que mantuvieran relaciones por vía anal, vaginal u oral no fueron constantes en el uso de preservativos. Refirieron el uso de coacción sexual en los últimos 12 meses 15 por ciento de los entrevistados. CONCLUSIONES: †El comportamiento sexual riesgoso es prevalente entre los miembros del personal militar que sirve en las zonas de paso fronterizo entre República Dominicana y Haití. Los programas de prevención contra la transmisión del VIH destinados al personal militar de esta región deben incorporar como temas esenciales la coacción sexual y la salud mental.

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OBJECTIVE: To estimate the prevalence of sexual risk behaviors among military personnel stationed along major border-crossing zones between the Dominican Republic and Haiti. METHODS: From November 2008 to January 2009, behavioral surveys were administered to 498 active duty military personnel stationed along the three largest border-crossing zones on the western border of the Dominican Republic. Participants were selected using systematic random sampling and asked about their sexual behavior over the past 12 months, alcohol use, and mental health. RESULTS: Forty-one percent reported having casual sex during the past 12 months, 37% of men had a history of having sex with a commercial sex worker (19% during the past 12 months), and 7% of men reported a history of having sex with a transmigrating Haitian (6% during the past 12 months). Among sexually non-monogamous respondents (51%), inconsistent condom use exceeded 60% for those engaging in anal, vaginal, or oral sex. Fifteen percent reported using sexual coercion during the past 12 months. CONCLUSIONS: Sexual risk behaviors were prevalent among military personnel stationed along border-crossing zones between the Dominican Republic and Haiti. Prevention programs targeted at military personnel in this region should incorporate sexual coercion and mental health as key elements of their HIV prevention programs.

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OBJECTIVES: To utilize radiosensitivity testing to improve early diagnosis of patients with ataxia-telangiectasia (A-T). STUDY DESIGN: We established normal ranges for the colony survival assay (CSA) by testing cells from 104 patients with typical A-T, 29 phenotypic normal patients, and 19 A-T heterozygotes. We also analyzed 61 samples from patients suspected of having A-T and 25 patients with related disorders to compare the CSA with other criteria in the diagnosis of A-T. RESULTS: When cells were irradiated with 1.0 Gy, the mean survival fraction (microSF +/- 1 SD) for patients with A-T was 13.1% +/- 7.2% compared with 50.1% +/- 13.5% for healthy control patients. These data served to define a diagnostic range for the CSA (ie, <21%), a normal range (>36%), and a nondiagnostic intermediate range of 21% to 36%. The mutations of patients with A-T with intermediate radiosensitivity tended to cluster around the functional domains of the ATM gene. CONCLUSIONS: The CSA is a useful adjunctive test for confirming an early clinical diagnosis of A-T. However, CSA is also abnormal in other chromosomal instability and immunodeficiency disorders.

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