bluuebunny/crossref_metadata_2025_split huggingface dataset:
O11.2 Sexual Behaviour of Heterosexual Men and Women Receiving Antiretroviral Pre-Exposure Prophylaxis For HIV Prevention: Post-Unblinding Analysis of the Partners PrEP Study
Authors: Mugwanya K K , Donnell D , Celum C , Mugo N , Thomas K K , Ngure K , Ndase P , Katabira E , Baeten J M 
Published: July 2013

BackgroundLimited data are available to assess the potential for increased sexual risk-taking by persons using antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention. In July 2011, the Partners PrEP Study, a randomised trial of daily oral tenofovir and emtricitabine/tenofovir PrEP among HIV-uninfected members of African heterosexual HIV serodiscordant couples, demonstrated efficacy of PrEP for HIV prevention and use of placebo was discontinued in the trial. Follow-up of study participants on active PrEP through December 2012 provided an opportunity to evaluate risk behaviour on PrEP after efficacy was announced.MethodsAmong participants assigned to active PrEP pre-unblinding who continued follow-up after the placebo arm was stopped, we used zero-inflated negative binomial regression with robust standard errors and adjusted for baseline sexual behaviour, age, gender, and secular changes to compare the frequency of unprotected sex up to 12 months before versus after knowledge of PrEP efficacy.ResultsWe analysed 54,876 person-months (33,254 pre- versus 21,622 post-unblinding) from 3024 HIV-uninfected subjects (64% male). On average, the observed frequency of unprotected sex with the HIV-infected study partner was 58 per 100 person-months pre-unblinding versus 53 per 100 person-months post-unblinding, reflecting no immediate change or change in trend over time following unblinding (p = 0.734 and 0.264, respectively). The annual average total number of unprotected sex post-unblinding was 6 acts versus 5 that would have been expected in the counterfactual situation had unblinding not occurred. There was no significant increase in diagnoses of incident sexually transmitted infections or pregnancy post- versus pre-unblinding (p > 0.05).ConclusionThe transition from a blinded, placebo-controlled trial to all participants aware they were receiving active PrEP in the Partners PrEP Study provided a “natural experiment” to evaluate behavioural risk compensation. PrEP, provided as part of a comprehensive prevention package, may not result in substantial changes in risk-taking sexual behaviour in HIV serodiscordant couples.
O11.3 Using HCV Incidence Trends to Disentangle the Likely Impact of HIV Anti-Retroviral Treatment on Decreasing HIV Incidence Amongst Injecting Drug Users: A Modelling Analysis
Authors: Chiyaka C , Martin N , Hickman M , Vickerman P 
Published: July 2013

BackgroundTwo epidemiological studies (Vancouver/Baltimore) have used ecological correlations between community measures of HIV viral load (CVL) and HIV incidence to postulate that scaled-up HIV anti-retroviral treatment (ART) has decreased HIV transmission amongst injecting drug users (IDUs). However, for both studies HCV incidence decreased concurrently with observed decreases in HIV incidence suggesting that reductions in injecting risks may also have played a role. We use modelling to estimate the likely importance of ART in producing the observed reductions in HIV incidence in Vancouver from 1997 to 2007.MethodsA joint HIV and HCV transmission model, calibrated to the Vancouver IDU HIV epidemic (60% chronic HCV prevalence and 20% HIV prevalence) explored what combinations of ART recruitment and decreases in injecting risk could produce the observed relative reductions in HIV (> 66%) and HCV (> 50%) incidence for Vancouver. For each, the relative importance of ART was assessed. Sensitivity analyses considered the implications of behavioural uncertainty.ResultsModel projections suggest modest reductions in injecting risk (∼30%) result in large reductions in HIV (∼70%) and HCV (∼45%) incidence over 10 years, whereas ART scale-up (10% per year) only reduces HIV incidence (∼40%). If we assume that HIV and HCV incidence decreased by 83% and 50% in Vancouver, respectively, then projections suggest 31–45% of the HIV impact was possibly due to ART. However, the combined intervention’s impact is less than the sum of its parts, with the estimated HIV incidence decrease only reducing by < 15% with no ART. For smaller assumed reductions in HIV incidence and/or larger decreases in HCV incidence then projections suggest a smaller contribution due to ART.ConclusionsOur analysis suggests ART may not have been too important for producing observed HIV incidence declines in Vancouver, and highlights the importance of considering HCV incidence trends in similar analyses.
O11.5 Risks For Sexually Transmitted Infections (STIs), HIV, and Pregnancy Among Women Working in Entertainment Establishments in Cambodia
Authors: Killam W P , Mun P , Mutuc J D , Chann N , Chan S , Shiraishi R W , Warren D , Vun M C 
Published: July 2013

BackgroundSince the 1990s, Cambodia successfully reduced HIV and STI prevalence among female sex workers. In 2008, brothels were outlawed, and non-brothel Entertainment Establishments (EEs) increased. Some women working in EEs exchange sex for gifts or money. We examined associations between behavioural risks and STIs, HIV and pregnancy among Cambodian Female Entertainment Workers (FEWs).MethodsIn 2011, a stratified multi-stage cluster survey of 2,564 FEWs was conducted in karaoke establishments, beer halls, and former brothels. Participants consented to private interviews, blood collection, and self-administered vaginal swabs for gonorrhoea and chlamydia. Analyses were weighted and controlled for the complex design of the survey. Logistic regression models were used to examine potential risk factors of STIs, HIV and pregnancy.ResultsTransactional sex in the last year was reported by 41.1% of FEWs. Chlamydia (18.9%), gonorrhoea (5.3%), and active syphilis (0.4%) were associated with younger age (p < 0.0001). HIV (2.6%) and pregnancies (n = 1194) were more likely among older women (p < 0.0001). Heavy drinking was associated with gonorrhoea (odds ratio [OR] = 2.5, 95% CI 1.1–5.4), while drug use was associated with any STI (p = 0.0062) and HIV (p = 0.0005). Always using condoms varied by partner type (clients [74.0%], boyfriends [31.2%], and husbands [9.8%]) and was negatively associated with pregnancy only. Working in a former brothel (OR = 2.5, 95% CI 1.4–4.6) and having > 7 vs. ≤ 7 clients per week (OR = 3.8, 95% CI 1.8–7.7) was associated with HIV. Among FEWs, 36.8% had clients plus a husband and/or boyfriend. Those with both a boyfriend and client had the highest odds of any STI (OR = 3.8, 95% CI 2.2–6.7).ConclusionCambodian FEWs are a heterogeneous group with varying risk behaviours. STIs and HIV appear to be concentrated in distinct subpopulations, but sexual partner relationships contribute to the complex transmission dynamics. Defining those most at risk will help focus national prevention and case-finding programmes.
O11.6 Migration and HIV Risk in Rakai Youth, 2000–2010
Authors: Edelstein Z R , Schulyer A C , Helleringer S , Wei Y , Sekasanvu J , Nalugoda F , Gray R H , Wawer M J , Serwadda D , Santelli J S 
Published: July 2013

BackgroundMigration is common among youth in Africa and is connected to life transitions. Migration has also long been associated with increased risk of being HIV-infected. Although this association has been observed in multiple studies, the temporal order between infection and migration is often unclear. This investigation uses unique cohort data from Rakai, Uganda to test whether recent in-migration places youth at a higher risk of HIV acquisition.MethodsWe used data from the Rakai Community Cohort Study, 1999–2011. Respondents included were aged 15–24, sexually experienced and initially HIV negative (n = 9365). Migration and HIV status were assessed at each annual survey round. Poisson regression with robust standard errors was used to estimate age-adjusted incidence rate ratios (aIRR) of HIV acquisition among in-migrants versus non-migrants, by geographic origin and reason for migration. Additional adjustment for characteristics assessed at follow-up was explored.ResultsIn young men, HIV incidence in recent in-migrants (14.3 per 1000 person-years (py)) was 2 times greater than non-migrants (6.6 per 1000 py) (aIRR = 2.04; 95% confidence interval (CI): 1.07–3.92). In young women, incidence among in-migrants (12.6 per 1000 py) was similar to non-migrants (11.5 per 1000 py) (aIRR = 1.07; CI: 0.74–1.55). Associations were not affected by geographic origin. Men who had migrated for marriage were at particularly high risk (141 per 1000 py) compared to non-migrants (aIRR = 17.16; CI: 3.15–93.35). However, this was uncommon (< 1% of py) and only in men aged > 19. Women who had migrated for work were at increased risk (30.3 per 1000 py) compared to non-migrants (aIRR = 2.59; CI: 1.41–4.76). IRRs were relatively unchanged with adjustment for marital status, number of partners in last 12 months or sexual concurrency.ConclusionRecent in-migration is associated with increased HIV risk in young Ugandan men. Among young women, the increase in HIV risk may be specific to migration for work.
O12.1 Using Social Determinants to PredictNeisseria GonorrhoeaeInfection Risk at the Census Tract-Level: Findings from the STD Surveillance Network (SSuN), United States
Authors: Stenger M , Samuel M , Weinstock H 
Published: July 2013

BackgroundAssociations between social factors and health outcomes have been established for many diseases, including gonorrhoea. Inequalities in gonorrhoea are particularly pronounced; the incidence for non-Hispanic Blacks is 17 times the incidence for non-Hispanic Whites. A gap exists in the literature on how social determinants for this population can be used to target STD interventions.MethodsHealth departments from 10 diverse states geocoded female gonorrhoea case reports from 2009–2011 to the census tract. We calculated three-year gonorrhoea incidence rates among females for 11,832 tracts in the study area. Tract-level social determinants were obtained from the American Community Survey. Female rates were used to preclude confounding by the unknown proportion of men-who-have-sex-with-men among male cases. Tracts were stratified as above or below the county-level mean proportion of non-Hispanic Black residents to minimise interactions between race and other factors, and subsequent analyses were limited to the stratum with a higher proportion of blacks (N = 4,345). Using hierarchical models and logistic regression, associations between female gonorrhoea incidence, household income, education and housing characteristics were examined. Factors found to be associated with gonorrhoea incidence were used to construct tract-level gonorrhoea risk indices.ResultsThe mean tract-level female incidence rate was 194/100,000 (range, 0–2,836) in this stratum. Gonorrhea incidence was correlated with: proportion of households with annual income below $20,000 (β = 0.7089, P < 0.0001), housing vacancy rate (β = 0.5519, p < 0.0001) and proportion of population with less than high school education (β = 0.3206, p < 0.0001). Risk indices based on these factors correctly predicted 77.3% of tracts with incidence in the highest quartile in this stratum while excluding 58.9% of tracts with lowest incidence.ConclusionsArea-based social factors provide more specific criteria than race alone and may be useful for better targeting disease prevention activities to areas at highest risk for gonorrhoea incidence, especially where street-level address information on reported cases is unavailable.
O12.2 Church Attendance in Men Who Have Sex with Men Diagnosed with HIV is Associated with Later Presentation
Authors: Wagoner N J Van , Mugavero M , Westfall A , Hollimon J , Slater L , Burkholder G , Raper J , Hook E W 
Published: July 2013

BackgroundTensions between religion/religious beliefs and personal behaviours may impact HIV-related health seeking for persons at risk for HIV. We evaluated the relationship between self-reported church attendance and sexual partner characteristics on CD4+ T lymphocyte count (CD4 count) and history of HIV screening among persons presenting for the first time to establish HIV care.MethodsThis was a secondary analysis of prospectively collected data at a University HIV Clinic in the U.S between April 2008 and June 2012. Socio-demographic and behavioural information, including church attendance, is collected and linked to laboratory data. Using logistic regression, we assessed for a 2-way interaction between church attendance and sexual behaviour on CD4 count at entry into care and on history of prior HIV testing in univariate and multivariable models.ResultsOf 508 participants, current church attendance was reported by 56%. There was a significant interaction between church attendance and sexual behaviour (p = 0.02) with CD4 count at the time of entry into care. MSM who reported church attendance were significantly more likely to present with a CD4 count < 200 cells/mm3(p = 0.013) than MSM who did not. No difference in CD4 count was observed for MSW or WSM when evaluated by report of church attendance. There was a significant interaction between church attendance and sexual behaviour (p = 0.012) on history of previous HIV testing. WSM who attended church were more likely to report previous HIV testing (p = 0.01). MSM who attended church were less likely to report previous HIV testing (unadj p = 0.041) but this difference did not maintain significance in adjusted models.DiscussionThese findings frame a potentially important interaction between church attendance and sexual behaviour on timing of HIV diagnosis and presentation into care with important implications for individual health outcomes and secondary HIV prevention.
O12.3 Evaluation of a Community-Based HIV Preventive Intervention For Female Sex Workers in Rural Areas of Karnataka State, South India
Authors: Washington R G , Nath A , Jawalkar P , Isac S , Moses S 
Published: July 2013

BackgroundTo examine changes in behavioural outcomes among rural female sex workers (FSWs) involved in a community-based HIV preventive intervention in south India.Methods14,284 rural FSWs from 1,253 villages that were selected through a process of rapid rural mapping were reached by community workers (called link workers) and FSW peer educators over a period of three years between 2009 and 2012. A community-based model for delivering outreach, medical and referral services was developed and employed. Socio-demographic profiles of the FSWs and programme outputs were captured using an individualised computerised management information system (CMIS). Changes in behaviour were assessed in an anonymised fashion using two rounds of polling booth surveys (PBS) conducted in 2009 and 2012.Results91% of FSWs were above the age of 25, and 85% had been involved in sex work for two or more years. During the three-year period, 95% of the mapped FSWs were reached at least once, 80.3% received condoms as per need, and 71% received health services for sexually transmitted infections. In 2012, 45% reported having been tested for HIV infection, at least once in the previous six months. The two rounds of PBS showed significant differences in behavioural outcomes. Condom use increased from 60% to 72%, and condom breakage reduced from 30. 2% to 8.4%. Utilization of HIV counselling and testing services increased from 64% to 92.4%, and the proportion of FSWs testing HIV positive declined from 2.3% to 0.17%.ConclusionsThis community-based model for delivering HIV prevention programmes and services among widely dispersed female sex workers in rural areas was effective. Community-based health workers provided the vital link between marginalised communities in need of services and the formal health system. This model for rural outreach and HIV care could also be applied to many other health problems.
O12.4 Design and Feasibility of Yo Puedo, a Combined Conditional Cash Transfer and Life Skills Sexual Health Intervention For Adolescents in San Francisco, California: Results of a Randomised Study
Authors: Minnis A M , Dommelen-Gonzalez E van , Luecke E , Cheng H , Dow W , Bautista-Arredondo S , Padian N S 
Published: July 2013

BackgroundInnovative interventions to prevent persistently high rates of STIs and pregnancy among Latino youth in the U.S. are needed. We developedYo Puedo(“I can”), a sexual health intervention that combines conditional cash transfers (CCTs) and life skills, for youth in a high-risk, urban neighbourhood.MethodsYo Puedotargeted small social networks of youth aged 16 to 21 (both in-school and out-of-school). CCTs were tied to completion of educational goals and use of reproductive health clinical services. We conducted feasibility research through randomization of networks toYo Puedoor an observational control arm.Results72 social networks comprised of 162 youth enrolled inYo Puedo, with 92% follow-up over six months. At baseline, participants had a mean age of 17 years and one-third were foreign-born. 80% of males and 65% of females had ever had sex (p = 0.06), with males reporting a higher mean lifetime number of partners (5.8 vs. 3.1, p < 0.01). Half (58.2%) of participants had gang-affiliated close friends. Nearly all (94%) participants reported not wanting to become pregnant or get someone pregnant, yet one-third of sexually active youth reported unprotected sex in the past six months. Social networks clustered significantly (intraclass correlations ranged from 0.31–0.92) across sociodemographic and risk profile characteristics; analyses were adjusted for network clustering. 72% of youth randomised to the intervention participated: 53% received at least one CCT payment; 66% came to at least one life skills group. The median amount earned was $30 (range $0-$200). There was little evidence that cash payments financed illicit or high-risk behaviour. A higher proportion of youth who participated, compared to those who did not, had been to a reproductive health clinic at follow-up (p < 0.01).ConclusionsYo Puedoshowed promise as a sexual health intervention for high-risk, urban youth. Targeting youth’s social networks may yield sustained effects over time.
O12.5 Traditional Explanatory Models of Disease and Messaging Around HIV and STI Risk and Prevention: Findings from an Exploratory Study with Traditional Health Practitioners in South Africa
Authors: Pascoe S J S , Moolla A , Tabane R , Mbele-Khama S , Dlamini N , Darkoh E 
Published: July 2013

BackgroundResearch has shown that traditional medicine and Traditional Health Practitioners (THPs) represent the first line of healthcare for the majority in sub-Saharan Africa (SSA). In this context, understanding traditional beliefs is critical, if we are to design effective health messages and improve health outcomes. The aim of this study was to identify and understand how traditional knowledge and beliefs influence explanatory models of disease and patient actions to avoid risk of HIV and STI infection.MethodsAn exploratory qualitative study involving THPs and their patients was conducted in 2011 at five sites in provinces Gauteng and KwaZulu-Natal. THPs (n = 54) were recruited through local forums and patients (n = 48) recruited by their THP. Diviners, herbalists, traditional birth attendants and traditional surgeons were all represented. Data were analysed using NVivo 9.ResultsTHPs provide a holistic ‘catch all’ service that would involve multiple providers within the allopathic sector. Whilst participants acknowledged allopathic risk factors and modes of transmission, beliefs around aetiology were generally located in the spiritual dimension with infection often blamed on lack of respect for/non-adherence to traditional practises resulting in ‘pollution’ and ‘dirt in the blood’. THPs demonstrated a willingness to refer patients to clinics for diagnosis and treatment, recognised benefits of circumcision, and encouraged patients on ARVs to continue treatment. However, protective and preventive properties of traditional medicines were frequently highlighted.ConclusionIt was clear from this study that for many in South Africa traditional beliefs are often held alongside an acknowledgement of some aspects of germ theory. Given the pervasive traditional belief-based explanatory model of disease, health messaging and interactions that do not acknowledge this are likely to fail. It is critical that the allopathic/western system understands these core beliefs of patients accessing their services so as to optimise health messages, treatments, behaviours and clinical outcomes in SSA.
O12.6 Understanding Experiences and Impact of Domestic Violence and Abuse in Gay and Bisexual Men Attending a Sexual Health Service in the UK
Authors: Bacchus L J , Buller A , Sethi C , White J 
Published: July 2013

BackgroundDomestic violence in men who have sex with men (MSM) is common and associated with adverse health consequences. This study aims to (i) explore the nature and impact of domestic abuse in gay and bisexual men attending a UK sexual health clinic and (ii) explore men’s views on routine enquiry for domestic abuse by health practitioners.MethodsA self-completion survey was implemented in the waiting rooms of sexual health clinics at a UK hospital. Men aged 18 and over, attending alone, who could read and write English were invited to participate in a male patient survey on relationships and health. The 2-part survey examined potentially abusive behaviours and health outcome including: anxiety and depression; alcohol and drug abuse; use of services; and views on routine enquiry within a health context.Results1,135 men completed a survey, of which 523 (46.0%) identified themselves as either gay or bisexual, 501 (95.8%) answered all questions relating to domestic violence in Part 1 of the survey. 145 (28.9%) men reported experiencing at least one abusive behaviour from a current or former partner; 81 (16.2%) men reported carrying out at least one abusive behaviour towards a current or former partner; 55 (11.0%) men reported both experiencing and perpetrating at least one abusive behaviour towards a partner. The majority of men supported the idea of health practitioners asking about domestic abuse during consultations.ConclusionThis study provides a greater understanding of domestic abuse in gay and bisexual men by including questions on impact as well as severity. The survey also examines the impact of these behaviours on men’s health and the role of sexual health practitioners in responding to gay and bisexual men affected by domestic abuse.