Sexual Risk, Nitrite Inhalant Use, and Lack of Circumcision Associated With HIV Seroconversion in Men Who Have Sex With Men in the United States
Men who have sex with men (MSM) continue to account for the largest number of new HIV infections in the United States, but limited data exist on independent risk factors for infection beyond the early 1990s. The HIV Network for Prevention Trials Vaccine Preparedness Study enrolled 3257 MSM in 6 US cities from 1995 to 1997. HIV seroincidence was 1.55 per 100 person-years (95% confidence interval: 1.23-1.95) over 18 months of follow-up. On multi-variable analysis using time-dependent covariates, independent risk factors for HIV seroconversion were increased number of reported HIV-negative male sex partners (adjusted odds ratio (AOR) = 1.14 per partner, population attributable risk (PAR) = 28%), nitrite inhalant use (AOR = 2.2, PAR = 28%), unprotected receptive anal sex with an HIV unknown serostatus partner (AOR = 2.7, PAR = 15%) or HIV-positive partner (AOR = 3.4, PAR = 12%), protected receptive anal sex with an HIV-positive partner (AOR = 2.2, PAR = 11%), lack of circumcision (AOR = 2.0, PAR = 10%), and receptive oral sex to ejaculation with an HIV-positive partner (AOR = 3.8, PAR = 7%). Having a large number of male sex partners, nitrite inhalant use, and engaging in receptive anal sex explained the majority of infections in this cohort and should be targeted in prevention strategies for MSM.
Available from: Xiaoxu Han
- "PYs) and the United States (1.55–2.10/100 PYs).5,6,7 "
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ABSTRACT: Men who have sex with men (MSM) have accounted for an alarmingly increasing proportion of nationally reported human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) cases recently. While the latest HIV epidemic among this population was not well understood, the underlying reasons for the rapid increase of the HIV epidemic were even more rarely evaluated. This study reviewed all published articles and national surveillance data in recent years to analyze the new HIV epidemic among MSM in China, and this study finally concluded that a culture of risky sexual behaviors, low adoption of HIV testing and a high prevalence of syphilis infection were the major risk factors that predominantly facilitate homosexual HIV transmission. Both HIV infection and homosexuality remain highly stigmatized in China, which further exacerbates attempts at HIV prevention and control. A great deal of work still needs to be done for the national policy makers, programming, research and clinical sectors to help curb the HIV epidemic among Chinese MSM.
Available from: Zhenxing Chu
- "The HIV incidence among Kunming MSM is moderately high: it is higher than the HIV incidence among Beijing MSM population (2.6/100 PY
, while lower than the HIV incidence among Shenyang MSM (5.4/100 PY)
 and Nanjing MSM (5.1/100 PY)
. And it is comparable with the HIV incidence among MSM in the Netherlands
, and the United States
[20,21]. Although at present heterosexual acts is still the dominant transmission route among recently reported HIV/AIDS cases, the proportion of MSM involved cases has increased rapidly. "
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Yunnan has the largest number of reported HIV/AIDS cases among all Chinese provinces, the reported prevalence of HIV among Yunnan men who have sex with men (MSM) passed 10%, while HIV incidence epidemic and molecular characteristics of new infected Yunnan MSM were not evaluated before.
An 18 months prospective followed up with a frequency of 3 month per visit were conducted among HIV seronegative MSM in Kunming cityduring 2009–2011. Interviewer-administrated questionnaires were carried out. Blood specimens were obtained to test for syphilis and HIV, in which HIV were evaluated by standard HIV enzyme immunoassay (EIA) and HIV nucleic acid amplification testing (NAAT). Near full-length regions of the HIV-1 were evaluated for subtyping, primary drug resistance mutations.
During the follow-up 70.1% of the recruited 378 MSM retained in the cohort. Eleven MSM seroconverted to HIV and fifteen MSM seroconverted to syphilis. The HIV incidence and syphilis incidence was 3.5 (95% CI 1.8-6.2) cases /100 person year(PY) and 5.3 (95% CI 3.0-8.7) cases/100 PY, respectively. Multivariate analysis showed that baseline syphilis infection (aHR, 17.7), occupation (students vs. others [aHR, 5.7], retirees vs. others [aHR, 4.1]), bleeding experience after receptive anal intercourse (aHR,7.6), and minority ethnic(vs. Han) [aHR, 5.7] were independent risk factors for HIV seroconversion(each P<0.05). Among the 7/11 successfully amplified near full-length sequences, 71.4% (5/7) were CRF01_AE, and 28.6% (2/7) were CRF07_BC. Two HIV transmission pairs were detected among seroconverted minority ethnic MSM.
HIV incidence was moderately high among Yunnan MSM. Yunnan province need to strengthen both HIV and syphilis screening among MSM population. Some subpopulations of MSM, such as students, retirees and minority ethnic groups require more HIV epidemic surveillance and strengthened behavior interventions. HIV subtypes and primary drug resistance should be continually monitored to track cross-group transmission of HIV strains.
Available from: Ethan K Gough
- "In contrast, inter-rater agreement on abstracted data was high once the information was found (median intra-class coefficient of 1.0 for same six key variables). Of the 36 studies, 10 reported an incidence from more than one geographic location [34,64,69-71,75,77,78,81,82]. Four studies reported one or more incidence estimates for continuously incarcerated inmates [34,35,60,83], four for inmates released and reincarcerated [34,36,61,62], 23 for IVDU [34,63-76,84-91], and six for MSM [77-82]. "
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ABSTRACT: High Human Immunodeficiency Virus (HIV) prevalence and high risk behaviors have been well documented within United States (US) correctional systems. However, uncertainty remains regarding the extent to which placing people in prison or jail increases their risk of HIV infection, and regarding which inmate populations experience an increased incidence of HIV. Describing these dynamics more clearly is essential to understanding how inmates and former detainees may be a source for further spread of HIV to the general US population.
The authors conducted a systematic review and meta-analysis of studies describing HIV incidence in US correctional facility residents and, for comparison, in high risk groups for HIV infection, such as non-incarcerated intravenous drug users (IVDU) and men who have sex with men (MSM) in the US. HIV incidence rates were further compared with Hepatitis B and Hepatitis C Virus rates in these same populations.
Thirty-six predominantly prospective cohort studies were included. Across all infection outcomes, continuously incarcerated inmates and treatment recruited IVDU showed the lowest incidence, while MSM and street recruited IVDU showed the highest. HIV incidence was highest among inmates released and re-incarcerated. Possible sources of heterogeneity identified among HIV studies were risk population and race.
Although important literature gaps were found, current evidence suggests that policies and interventions for HIV prevention in correctional populations should prioritize curtailing risk of infection during the post-release period. Future research should evaluate HIV incidence rates in inmate populations, accounting for proportion of high risk sub-groups.
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