RESUMO
Background Urban centres in Vietnam have high rates of HIV infection, especially among men who have sex with men (MSM). A subgroup of MSM, young male sex workers (YMSW), are at especially high risk due to concurrent sex with multiple male and female partners, low levels of knowledge regarding HIV and sexually transmissible infection (STI) transmission, and limited engagement with health services, including STI and HIV screening and treatment. METHODS: A targeted intervention (SHEATH) derived from Harm Reduction and Sexual Health Promotion intervention technology was implemented in an out-of-treatment population of YMSW in Hanoi and Ho Chi Minh City (n=919). RESULTS: YMSW reported high levels of satisfaction with each of the seven core modules within the intervention and for the intervention as a whole. The intervention conferred significant benefit in relation to improved knowledge of STI and HIV transmission (P<0.001). Although only 36% of participants had seen a healthcare provider in the past year, following the intervention 81% intended to see one in the next 6 months. Similarly, although 71% of participants did not disclose that they were MSM the last time they visited a healthcare provider, following the intervention 71% intended to do so at their next visit. High rates of STIs (>10%) and HIV (9.5%) were also found. CONCLUSION: The data show that the SHEATH intervention can be implemented in this population and setting, is met with high rates of acceptability, and positively impacts STI and HIV knowledge and multiple health services outcomes (including knowledge of HIV status and disposition towards habituation of HIV screening).
Assuntos
Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Profissionais do Sexo , Comportamento Sexual , Adolescente , Infecções por HIV/transmissão , Humanos , Masculino , Parceiros Sexuais , Infecções Sexualmente Transmissíveis , Vietnã , Adulto JovemRESUMO
OBJECTIVE: The aim of this manuscript is to describe the prevalence, genotypic distribution of penile HPV infection and the behavioral risk factors associated with penile HPV infection (any HPV type, high-oncogenic-risk [HR] types, low-oncogenic-risk [LR] types, and of multiple HPV types) in a group of sexually active males who went to an STI clinic in San Juan, Puerto Rico. METHODS: After providing informed consent, the participants, underwent a detailed behavioral interview and a clinical examination. Frequency distributions and descriptive statistics were used to characterize the study samples. Prevalence estimates and 95% confidence intervals (CI) were calculated for any type of HPV, HR types, LR types, or multiple types. Logistic regression analyses was performed to determine factors associated with each of the HPV types. RESULTS: Two hundred and six participants were enrolled in this study. The mean age of the participants was 37.8±13.1 years. Close to 80% of the sample were infected with at least one HPV type; 73.5% were infected with one or more LR-HPV types; 32.4%, with one or more HR-HPV types; and 46.0%, with multiple HPV types. The most prevalent HR types were HPV-35, -31, and -16; the most prevalent LR types were HPV 6/11, and -84. After adjusting for age, having a high number of lifetime female sexual partners was highly associated with having multiple types of HPV infection (estimated OR=2.86; 95% CI=1.41, 5.80). CONCLUSION: HPV infection is common among sexually active males frequenting this STI clinic. HPV types not covered by the current quadrivalent HPV vaccine were identified. Multiple HPV types in the penis are significantly related to the lifetime number of female sexual partners. The high prevalence of HPV at this particular STI clinic evidences that males need to be targeted in primary care settings if the available vaccine is to be effectively promoted. In addition, opportunities for secondary prevention of HPV in STI settings are recommended, because of the burden of anal and penile cancer documented in the island.
Assuntos
Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Doenças do Pênis/virologia , Comportamento Sexual/estatística & dados numéricos , Adulto , Feminino , Genótipo , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infecções por Papillomavirus/virologia , Doenças do Pênis/epidemiologia , Prevalência , Porto Rico/epidemiologia , Fatores de Risco , Parceiros Sexuais , Adulto JovemRESUMO
UNLABELLED: Background This paper examines sexual practices, partner concurrency and sexually transmissible infections (STI)/HIV infection among male sex workers (MSWs) in Vietnam. METHODS: Six hundred and fifty-four MSWs, aged 16-35 years, were recruited in Hanoi, Nha Trang and Ho Chi Minh City between 2009 and 2011. Survey measures included demographic characteristics, drug use, types of sexual partners and sexual practices. Subjects were screened for STIs, including HIV. RESULTS: MSWs in Ho Chi Minh City (33%) were more likely than those from the other two sites to be current users of one or more types of illegal drugs (P<0.001). MSWs with both male and female elective partners (compared with other partnership types) were more likely to have anal sex with male client partners (P<0.001), elective male partners (P=0.045) and elective female partners (P=0.025). At last sex with a male client partner, only 30% used a condom during anal intercourse. At last sex with an elective female partner, only 31% used a condom during vaginal sex and only 3% during anal sex. Although rates of HIV are low (4%), other STIs are high, including chlamydia (17%), gonorrhoea (29%) and human papillomavirus (33%). Most (57.3%) have never been tested for HIV and only 17% have ever disclosed to a healthcare provider that they have sex with men. CONCLUSIONS: Complex patterns of sexual concurrency, coupled with high rates of STIs, signal the urgent need for health services interventions among MSWs, both to improve individual health outcomes and to reduce secondary STI/HIV transmission among sexual partner networks.
RESUMO
Puerto Rico (PR) has a large and rapidly growing population of people living with HIV. However, relatively little behavioral or clinical research has been done in this population. As treatment for HIV increasingly moves into a chronic condition model, it is becoming increasingly important to understand the needs of this population so critical social and behavioral interventions can be developed, thus enabling the individual and community-level benefits of antiretroviral (ARV) treatment to be fully realized. To date, however, there has been very little research on the mental health needs of people living with HIV in PR, a fact that constrains intervention development and implementation. This paper describes data from a public sexually transmitted infection (STI) and HIV clinic study in the San Juan metropolitan area between April 2010 and December 2012 (n = 1185), roughly a third (36%) of whom are living with HIV. Descriptive statistics, chi-square, t-tests, and binary logistic regressions were used to assess associations between HIV status and a history of suicide attempt. The overall prevalence of a history of suicide attempt was 20.4%. No statistically significant relationship was found between a history of suicide attempt and being HIV positive, although people with HIV infection did evidence a higher prevalence of attempts than HIV-negative subjects (23.4% vs. 19.0%). Factors associated with having a history of suicide attempt within the overall sample included gender, current employment status, a lifetime history of drug use, and a lifetime history of sex work. Similar patterns were seen in the HIV-positive subsample. There was a nonsignificant trend toward increased risk for a post-diagnosis suicide attempt. These findings suggest that additional research on mental health risks among populations at risk for HIV in PR is needed.
Assuntos
Infecções por HIV/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Adulto , Demografia , Feminino , Soropositividade para HIV/psicologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Porto Rico/epidemiologia , Fatores de Risco , Fatores Socioeconômicos , Adulto JovemRESUMO
OBJECTIVE: This report describes the HIV-related health care practices and associated support service needs of a sample of HIV-positive incarcerated men in Puerto Rico. METHODS: Data are derived from a random sample of HIV-positive incarcerated men (n = 37) in Puerto Rico who completed a brief survey. Analysis included descriptive statistics to examine lifetime prevalence of substance use, selected health care practices, receipt of services, and hepatitis C virus (HCV) infection. RESULTS: Most men (97.3%) reported history of alcohol or drug use, prior incarceration, and drug use as the main risk factors for HIV infection (73.0%). In all, 83.8% of the men reported having had their first HIV screening test in a correctional facility, 55.6% reported intermittent HIV therapy, and most (83.8%) had also been diagnosed with HCV. CONCLUSIONS: Correctional facilities can be important settings for engaging high-risk populations in health care, capturing and enrolling unidentified HIV/HCV infections for clinical care, and engaging in substance abuse treatment. In order for these public health outcomes to be achieved, it is important to consider strategies to optimize care inside prison and in the community.
Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Prisioneiros/estatística & dados numéricos , Adulto , Estudos de Coortes , Infecções por HIV/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Porto RicoRESUMO
PURPOSE: Recent studies in Puerto Rico have reported an increasing incidence of anal cancer in Puerto Rican men. The objective of this study was to determine the prevalence, genotype distribution and risk factors associated with anal HPV infection among men attending an STI clinic in Puerto Rico. METHODS: We conducted a cross-sectional study among 205 men 18 years and older. A comprehensive survey was administered that included a demographic and a behavioral assessment. Separate logistic regression models were performed to determine factors associated with any, high-risk (HR), and multiple anal HPV infection. RESULTS: The mean age of the study sample was 38.0±13.5 years. The most common HR types were 58, 51 and 31. Overall, HR anal HPV infection was found in 53.5% of the participants. Multiple HPV types in the anal canal were found in 47.6% of the sample. A third (29.8%) of participants reported being men who had sex with men (MSM). MSM had a significantly higher prevalence of any, HR and multiple HPV infection (p-value<0.05). Separate multivariate logistic regression analyses showed that being MSM was associated with any (ORâ=â4.5; [95%CI: 1.9-10.7]), HR (ORâ=â3.4; [95%CI: 1.1-10.3) and multiple anal HPV infection (ORâ=â3.6; [95%CI: 1.5-9.1). HIV was marginally associated with multiple anal HPV infection in multivariate analysis (ORâ=â3.3; 95%CIâ=â1.0-11.0). CONCLUSIONS: Anal HPV is common among sexually active men attending this STI clinic, with higher likelihood of anal HPV infection among MSM.
Assuntos
Canal Anal/virologia , Infecções por Papillomavirus/epidemiologia , Infecções Sexualmente Transmissíveis/epidemiologia , Adulto , Alphapapillomavirus/classificação , Alphapapillomavirus/genética , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Papillomavirus/transmissão , Infecções por Papillomavirus/virologia , Prevalência , Porto Rico/epidemiologia , Fatores de Risco , Comportamento Sexual , Infecções Sexualmente Transmissíveis/transmissão , Infecções Sexualmente Transmissíveis/virologia , Adulto JovemRESUMO
OBJECTIVE: Puerto Rico has one of the fastest growing HIV epidemics in the United States and--consistent with patterns observed in the Caribbean region as a whole--data on new infections shows the increased influence of sexual transmission in the local epidemic. Historically, both epidemiology and prevention activities have focused primarily on the islands' large heroin injector population. Although the available surveillance data indicate high rates of STIs and HIV among men who have sex with men (MSM), there has been little social and behavioral research among MSM and hence little empirical information to inform intervention development and planning. METHODS: Given the absence of data on MSM and their importance in the emerging epidemic on the island, this paper describes a sample of MSM patients in an STI/HIV treatment center in the San Juan metropolitan area between October 2009 and June 2011 (n = 120). Assessment of sexual risk includes measures of onset of oral, vaginal, and anal sex, as well as current sexual practices and partner characteristics. Self-reported history of STI diagnoses and current HIV status are described. RESULTS: Overall, MSM evidenced relatively large numbers of multiple, concurrent sexual partners, substantial age-discordance among partners, and limited condom use. Relative to HIV-negative MSM, HIV-positive MSM have had more cumulative male sexual partners in anal intercourse (p = 0.005). HIV-negative MSM were more likely to have had sex without a condom at last receptive anal intercourse (p = 0.012) as well as at last insertive anal sex intercourse (p = 0.001). CONCLUSION: Priorities for advancing HIV interventions for MSM are delineated, including the need for targeted sexual health interventions, mental health services, and improved strategies for engaging and retaining MSM in health services.
Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Promoção da Saúde/métodos , Homossexualidade Masculina , Adolescente , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico/epidemiologia , Fatores de Risco , Adulto JovemRESUMO
INTRODUCTION: Circumcision among adult men has been widely promoted as a strategy to reduce human immunodeficiency virus (HIV) transmission risk. However, much of the available data derive from studies conducted in Africa, and there is as yet little research in the Caribbean region where sexual transmission is also a primary contributor to rapidly escalating HIV incidence. AIM: In an effort to fill the void of data from the Caribbean, the objective of this article is to compare history of sexually transmitted infections (STI) and HIV diagnosis in relation to circumcision status in a clinic-based sample of men in Puerto Rico. METHODS: Data derive from an ongoing epidemiological study being conducted in a large STI/HIV prevention and treatment center in San Juan in which 660 men were randomly selected from the clinic's waiting room. MAIN OUTCOME MEASURES: We assessed the association between circumcision status and self-reported history of STI/HIV infection using logistic regressions to explore whether circumcision conferred protective benefit. RESULTS: Almost a third (32.4%) of the men were circumcised (CM). Compared with uncircumcised (UC) men, CM have accumulated larger numbers of STI in their lifetime (CM = 73.4% vs. UC = 65.7%; P = 0.048), have higher rates of previous diagnosis of warts (CM = 18.8% vs. UC = 12.2%; P = 0.024), and were more likely to have HIV infection (CM = 43.0% vs. UC = 33.9%; P = 0.023). Results indicate that being CM predicted the likelihood of HIV infection (P value = 0.027). CONCLUSIONS: These analyses represent the first assessment of the association between circumcision and STI/HIV among men in the Caribbean. While preliminary, the data indicate that in and of itself, circumcision did not confer significant protective benefit against STI/HIV infection. Findings suggest the need to apply caution in the use of circumcision as an HIV prevention strategy, particularly in settings where more effective combinations of interventions have yet to be fully implemented.
Assuntos
Circuncisão Masculina , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Hispânico ou Latino , Infecções Sexualmente Transmissíveis/prevenção & controle , Infecções Sexualmente Transmissíveis/transmissão , Sexo sem Proteção , Adulto , Inquéritos Epidemiológicos , Humanos , Masculino , Porto RicoRESUMO
Puerto Rico has one of the highest incidence rates of HIV in the U.S. Concurrent with increases in sexually transmitted infections (STI), an increasing share of the new infections in PR are associated with sexual transmission. Much of the available research on sexual risk in PR derives from STI/HIV surveillance data. There is limited social and epidemiological research on sexual risk in PR, particularly in hidden and often hard-to-reach populations at high risk. Despite the absence of substantial resources that most epidemiological studies require, a research collaboration was initiated in 2007 between researchers in the School of Public Health at the University of Puerto Rico and the Centro Latinoamericano de Enfermedades de Transmisión Sexual (CLETS), one of the largest publicly funded centers for STI/HIV screening and treatment in the San Juan metropolitan area. Structured as a case study in the development of community-based research collaborations, this paper describes the early history and development of the project, including formative research, recruitment and training of students, and evolution in the study design that contributed to the current configuration of the ongoing "Core" study. Preliminary data are presented, highlighting data from a number of subpopulations that may contribute to our understanding of the role of behavioral risk in the STI/HIV epidemics in PR. More generally, the paper may guide the development of similar collaboration elsewhere in the Caribbean where HIV risk is increasing but where resources for research in high risk settings and groups are scarce.
Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Pesquisa Biomédica , Humanos , Fatores de RiscoRESUMO
OBJECTIVE: Puerto Rico has high HIV prevalence and incidence rates, including a large prison population living with HIV. While HIV treatment is available within the prisons, there are no linkages to care or treatment preparedness interventions following release. METHODS: In an effort to assess the risk of treatment discontinuity in this group, we examined data from an ongoing epidemiological study in the largest, publicly funded HIV/sexually transmitted infection (STI) treatment center in the San Juan area. RESULTS: Among the newly enrolled, HIV-positive patients with a history of incarceration, there was an average 4-year gap in reengagement in treatment. Drug and sexual risk behaviors were prevalent, as was evidence of significant immune impairment (including high viral load and low CD4 count). CONCLUSIONS: Treatment discontinuity may contribute to poor health outcomes in this group and also fuel new infections. There is an urgent need for interventions to retain HIV-positive inmates in community HIV care following release.
Assuntos
Infecções por HIV , Infecções Sexualmente Transmissíveis , Infecções por HIV/epidemiologia , Humanos , Porto Rico , Assunção de Riscos , Comportamento Sexual , Infecções Sexualmente Transmissíveis/epidemiologiaRESUMO
This paper examines changes in the interval between first heroin smoking and onset of injection in a large, out-treatment sample of male heroin users in Hanoi, Vietnam (n = 1,115). Mean age at initiation of heroin use (smoking) was 18.4 and mean age of onset of heroin injection was 20.9 years. Full multivariate analysis indicates that the interval between first heroin use (smoking) and first heroin injection has been significantly attenuated among more recent heroin initiates (P = 0.0043), suggesting that heroin users in Vietnam may be at increased risk for exposure to HIV relatively soon after onset of heroin use, highlighting the need for behavioral interventions that target heroin smokers. Critical intervention goals include delaying the onset of injection and improved education about safer drug sharing and drug injection practices.
Assuntos
Infecções por HIV/prevenção & controle , Redução do Dano , Dependência de Heroína/complicações , Heroína/administração & dosagem , Abuso de Substâncias por Via Intravenosa/complicações , Administração por Inalação , Adolescente , Adulto , Idade de Início , Estudos Transversais , Progressão da Doença , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Heroína/efeitos adversos , Dependência de Heroína/epidemiologia , Humanos , Injeções Intravenosas , Masculino , Fumar/efeitos adversos , Fumar/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Fatores de Tempo , Vietnã/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Surveillance studies have noted intravenous injection of promethazine hydrochloride (PHC) among populations that use heroin in south and southeast Asia. However, little is known about onset and initiation of PHC use and its relationship to habitual heroin use. METHODS: As part of a longitudinal study of heroin initiation, a sample of 179 new heroin users, aged 15-27 years, were interviewed between October 2005 and December 2006 in Hanoi, Vietnam. Cox proportional hazard regression analysis was used to characterize age at promethazine initiation and its association with relevant covariates. RESULTS: 76% reported lifetime use of PHC. Mean age of PHC initiation was 21.3 years, on average 6 months following onset of heroin injection. In multivariate analysis, lifetime use of diazepam [HR = 1.69 (1.17, 2.44); p-value = .01] and injecting heroin for more than 1.58 years [HR = 1.46 (1.04, 2.06); p-value = .03] were associated with PHC initiation. CONCLUSION: Intravenous injection of PHC is a relatively common practice among young injection heroin users in Hanoi, Vietnam who use it on a situational basis to substitute for heroin (when heroin is not available or when heroin is too costly) or to augment the effects of an inadequate heroin dosing (delaying onset of heroin withdraw). Existing drug prevention strategies in Vietnam are focused primarily on heroin and most new heroin users initiate PHC use without prior knowledge of its high risk for serious vein damage. Future research is needed on the PHC use among heroin users, including long-term medical consequences of PHC exposure.
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Dependência de Heroína/psicologia , Prometazina/administração & dosagem , Automedicação/psicologia , Abuso de Substâncias por Via Intravenosa/psicologia , Adolescente , Adulto , Fatores Etários , Humanos , Masculino , Fatores de Risco , Automedicação/estatística & dados numéricos , Fatores de Tempo , VietnãRESUMO
The present study describes complex drug and sexual risk in a group of male sex workers (n = 79) who were recruited in the context of a larger study of young heroin users in Hanoi, Vietnam (n = 1270). Male sex workers were significantly more likely than male non-sex workers to be migrants (P < 0.001) and to have unstable housing (P < 0.001), to have lifetime exposure to marijuana (P < 0.001), 3,4 methylenedioxymethamphetamine (MDMA, ecstasy) (P < 0.01), amphetamines (P < 0.05), cocaine (P < 0.01) and morphine (P < 0.001). Male sex workers are more likely to currently use MDMA (P < 0.05), amphetamines (P < 0.001), morphine (P < 0.05) and to 'smoke' as their most frequent mode of heroin administration (P < 0.01). Male sex workers are more likely to have both male and female concurrent sex partners (P < 0.001), to have a history of sexual victimisation (P < 0.001), to have had more than three different sex partners in the past 30 days (P < 0.001), and to have had partners who injected drugs before sex (P < 0.001) or who used drugs during sex (P < 0.01). In their last sexual encounter with a client partner, approximately one-third (31.1%) reported having had receptive anal sex. In nearly three-quarters of these exchanges (71.4%), no condom was used. Similarly, in their last sexual encounter with a client partner, 42.2% reported having had insertive anal sex and in nearly half (47.4%) of these encounters no condom was used. Consistent with recent data from elsewhere in the region, there is an urgent need for additional research on male sex work in South-east Asia in order to properly situate behavioural interventions for male sex workers in this region.