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- Abdurahman, Samir, 1965-, et al.
(författare)
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Pattern of microbial translocation in patients living with HIV-1 from Vietnam, Ethiopia and Sweden
- 2014
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Ingår i: Journal of the International AIDS Society. - 1758-2652. ; 17, s. 18841-
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The role of microbial translocation (MT) in HIV patients living with HIV from low- and middle-income countries (LMICs) is not fully known. The aim of this study is to investigate and compare the patterns of MT in patients from Vietnam, Ethiopia and Sweden.METHODS: Cross-sectional samples were obtained from treatment-naïve patients living with HIV-1 and healthy controls from Vietnam (n=83; n=46), Ethiopia (n=9492; n=50) and Sweden (n=51; n=19). Longitudinal samples were obtained from a subset of the Vietnamese (n=24) in whom antiretroviral therapy (ART) and tuberculostatics were given. Plasma lipopolysaccharide (LPS), sCD14 and anti-flagellin IgG were determined by the endpoint chromogenic Limulus Amebocyte Assay and enzyme-linked immunosorbent assay.RESULTS: All three biomarkers were significantly increased in patients living with HIV-1 from all countries as compared to controls. No differences were found between males and females. Vietnamese and Ethiopian patients had significantly higher levels of anti-flagellin IgG and LPS, as compared to Swedes. ART reduced these levels for the Vietnamese. Vietnamese patients given tuberculostatics at initiation of ART had significantly lower levels of anti-flagellin IgG and higher sCD14. The biomarkers were lower in Vietnamese who did not develop opportunistic infection.CONCLUSIONS: Higher MT is common in patients living with HIV compared to healthy individuals, and in patients from LMICs compared to patients from a high-income country. Treatment with tuberculostatics decreased MT while higher levels of MT are associated with a poorer clinical outcome.
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- Berg, R.C., et al.
(författare)
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Structural determinants in MSM HIV preventionenvironmental and structural factors predict internalised homonegativity in men who have sex with men (MSM) : findings from the European MSM internet survey (EMIS) in 38 countries
- 2012
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Ingår i: Journal of the International AIDS Society. - : JIAS. - 1758-2652. ; 15:S3, s. 158-158
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Varying patterns of policy and cultural disadvantage among sexual minorities have recently been pointed to as implicated in their poorer health outcomes, relative to the heterosexual majority. We examined the precursors of internalised homonegativity (IH) within a macro-meso-micro framework, using various data sources, to help disentangle the complex influences perpetuating homonegative internalisations among European MSM. Methods: EMIS is a collaborative study across 38 countries which during summer 2010 recruited over 180,000 MSM via Internet sites. The survey included a culturally stable form of the IH scale and various beliefs and behavioural variables. Additionally, to broaden the view of macro and meso environment at the level of individual men with respect to IH, we combined country-level data from the World Economic Forum, LGB status list, and European Values Survey. Results: The analyses included 38 countries and 144,177 MSM with a valid IH score, which varied across Europe, with the highest scores found in Southeast Europe. In multivariate analyses, at the societal structure of rule-systems, higher IH was predicted by the absence of legal rights (b.37 to .42). At the meso-level, IH was predicted by cultural values regarding homosexuality (b.16). At the individual level, greater homonegative internalisation was found among those men who perceived they could not access PEP and HIV and STI testing in their country (b.21 to .22). Higher IH, in turn, was associated with not testing for HIV and STIs (b.70 to .57). Conclusion: As possibly the first multi-level study, EMIS shows that a homonegative structural and social climate appears to have pervasive effects on MSM’s evaluation of the self, and greater IH in turn affected men’s levels of HIV precautionary behaviours. In addition to the human rights aspect, the EMIS results suggest that improved affirmative policy environments will have positive health impacts on MSM populations.
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- Fearon, Elizabeth, et al.
(författare)
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Associations between friendship characteristics and HIV and HSV-2 status amongst young South African women in HPTN-068
- 2017
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Ingår i: Journal of the International AIDS Society. - : John Wiley & Sons. - 1758-2652. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Prevalence of HIV among young women in South Africa remains extremely high. Adolescent peer groups have been found to be an important influence on a range of health behaviours. The characteristics of young women's friendships might influence their sexual health and HIV risk via connections to sexual partners, norms around sexual initiation and condom use, or provision of social support. We investigated associations between young women's friendships and their Herpes Simplex Virus Type 2 (HSV-2) and HIV infection status in rural South Africa. Methods: Our study is a cross-sectional, egocentric network analysis. In 2011 to 2012, we tested 13- to 20-year-old young women for HIV and HSV-2, and collected descriptions of five friendships for each. We generated summary measures describing friend socio-demographic characteristics and the number of friends perceived to have had sex. We used logistic regression to analyse associations between friend characteristics and participant HIV and HSV-2 infection, excluding likely perinatal HIV infections. Results: There were 2326 participants included in the study sample, among whom HIV and HSV-2 prevalence were 3.3% and 4.6% respectively. Adjusted for participant and friend socio-demographic characteristics, each additional friend at least one year older than the participant was associated with raised odds of HIV (odds ratio (OR)=1.37, 95% CI 1.03 to 1.82) and HSV-2 (adjusted OR=1.41, 95% CI 1.18 to 1.69). Each additional friend perceived to have ever had sex also raised the odds of HIV (OR=1.29, 95% CI 1.03 to 1.63) and HSV-2 (OR=1.18, 95% CI 1.03 to 1.35). Discussion: We found good evidence that a greater number of older friends and friends perceived to have had sex were associated with increased risk for HSV-2 and HIV infection among young women. Conclusions: The characteristics of young women's friendships could contribute to their risk of HIV infection. The extent to which policies or programmes influence age-mixing and young women's normative environments should be considered.
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- Kagaayi, Joseph, et al.
(författare)
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Uptake and retention on HIV pre-exposure prophylaxis among key and priority populations in South-Central Uganda
- 2020
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Ingår i: Journal of the International AIDS Society. - : Wiley. - 1758-2652. ; 23:8
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionPre‐exposure prophylaxis (PrEP) programmes have been initiated in sub‐Saharan Africa to prevent HIV acquisition in key populations at increased risk. However, data on PrEP uptake and retention in high‐risk African communities are limited. We evaluated PrEP uptake and retention in HIV hyperendemic fishing villages and trading centres in south‐central Uganda between April 2018 and March 2019.MethodsPrEP eligibility was assessed using a national risk screening tool. Programme data were used to evaluate uptake and retention over 12 months. Multivariable modified Poisson regression estimated adjusted prevalence ratios (aPR) and 95% Confidence intervals (CIs) of uptake associated with covariates. We used Kaplan–Meier analysis to estimate retention and multivariable Cox regression to estimate adjusted relative hazards (aRH) and 95% CIs of discontinuation associated with covariates.Results and discussionOf the 2985 HIV‐negative individuals screened; 2750 (92.1 %) were eligible; of whom 2,536 (92.2%) accepted PrEP. Male (aPR = 0.91, 95% CI = 0.85 to 0.97) and female (aPR = 0.85, 95% CI = 0.77 to 0.94) fisher folk were less likely to accept compared to HIV‐discordant couples. Median retention was 45.4 days for both men and women, whereas retention was higher among women (log rank, p < 0.001) overall. PrEP discontinuation was higher among female sex workers (aRH = 1.42, 95% CI = 1.09 to 1.83) and female fisher folk (aRH = 1.99, 95% CI = 1.46 to 2.72), compared to women in discordant couples. Male fisher folk (aRH = 1.37, 95% CI = 1.07 to 1.76) and male truck drivers (aRH = 1.49, 95% CI = 1.14 to 1.94) were more likely to discontinue compared to men in discordant couples. Women 30 to 34 years tended to have lower discontinuation rates compared to adolescents 15 to 19 years (RH = 0.78 [95% CI = 0.63 to 0.96]).ConclusionsPrEP uptake was high, but retention was very low especially among those at the highest risk of HIV: fisher folk, sex workers and truck drivers and adolescent girls. Research on reasons for PrEP discontinuation could help optimize retention.
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- Kilburn, Kelly N., et al.
(författare)
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Conditional cash transfers and the reduction in partner violence for young women : an investigation of causal pathways using evidence from a randomized experiment in South Africa (HPTN 068)
- 2018
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Ingår i: Journal of the International AIDS Society. - : JOHN WILEY & SONS LTD. - 1758-2652. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionEvidence has shown that the experience of violence by a partner has important influences on women's risk of HIV acquisition. Using a randomized experiment in northeast South Africa, we found that a conditional cash transfer (CCT) targeted to poor girls in high school reduced the risk of physical intimate partner violence (IPV) in the past 12months by 34%. The purpose of this analysis is to understand the pathways through which the CCT affects IPV. MethodsHPTN 068 was a phase 3, randomized controlled trial in rural Mpumalanga province, South Africa. Eligible young women (aged 13-20) and their parents or guardians were randomly assigned (1:1) to either receive a monthly cash transfer conditional on monthly high school attendance or no cash transfer. Between 2011 and 2015, participants (N=2,448) were interviewed at baseline, then at annual follow-up visits at 12, 24 and 36months. The total effect of the CCT on IPV was estimated using a GEE log-binomial regression model. We then estimated controlled direct effects to examine mediation of direct effects through intermediate pathways. Mediators include sexual partnership measures, the sexual relationship power scale, and household consumption measures. ResultsWe found evidence that the CCT works in part through delaying sexual debut or reducing the number of sexual partners. The intervention interacts with these mediators leading to larger reductions in IPV risk compared to the total effect of the CCT on any physical IPV [RR 0.66, CI(95%):0.59-0.74]. The largest reductions are seen when we estimate the controlled direct effect under no sexual debut [RR 0.57, CI(95%):0.48-0.65] or under no sexual partner in the last 12months [RR 0.53, CI(95%):0.46-0.60]. ConclusionsResults indicate that a CCT for high school girls has protective effects on their experience of IPV and that the effect is due in part to girls choosing not to engage in sexual partnerships, thereby reducing the opportunity for IPV. As a lower exposure to IPV and safer sexual behaviours also protect against HIV acquisition, this study adds to the growing body of evidence on how cash transfers may reduce young women's HIV risk.
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- Lippman, Sheri A., et al.
(författare)
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Communities can mobilize to test : findings from a community randomized trial of a theory-based community mobilization intervention in South Africa
- 2015
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Ingår i: Journal of the International AIDS Society. - : John Wiley & Sons. - 1758-2652. ; 18:S4, s. 94-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: While community mobilization (CM) is a powerful toolto increase and sustain demand for HIV testing services, few rigoroustrials of CM interventions have been conducted. We implementeda theory-driven CM intervention in order to improve HIV outcomesin 22 communities participating in a community randomized trial(CRT) in a rural area of Mpumalanga Province, South Africa. Themobilization activities were designed to improve community collaboration to address HIV and inequitable gender norms.Methods: Cross-sectional surveys were conducted with 5055residents ages 1835 in each village prior to (n=1181; 2012) andfollowing (n=1174; 2014) two years of intensive intervention activities in half of the villages. Intervention activities mapped onto sixdomains of CM: 1) shared concern around HIV, 2) community consciousness, 3) organizational structures, 4) leadership, 5) communitycohesion and 6) collective action. Validated domain measures wereincluded in the surveys and mean community CM scores werecomputed and used to predict HIV testing in the past year for eachdomain and for total CM scores. We used GEE logistic regressionanalysis to assess the effect of village level CM domain scores onindividual-level testing outcomes and included interaction terms toassess intervention effects at follow-up.Results: The overall CM score as well as three of six CM domains,including consciousness, concerns, collective action, were significantlyassociated with HIV testing following the intervention and interactedwith intervention assignment. For example, for every standard deviation increase in community consciousness, the odds of HIV testingincreased for intervention village participants (OR: 1.36, p=<0.01)but not for control village participants. Similar findings for total CMscore (OR: 1.51), shared concerns (OR: 1.62) and collective action (OR:1.45) indicate that the intervention successfully improved HIV testing.Leadership, presence of organizations and community cohesion werenot significantly associated with HIV testing at end line.Conclusions: To our knowledge this is the first CRT assessing atheory-based CM intervention including quantitative measures ofCM domains over time. While not all of the six domains were associated with HIV testing uptake, we found clear evidence that communities can be mobilized and that CM measures are associated withimproved engagement in HIV testing.
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- Lippman, Sheri A., et al.
(författare)
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Village community mobilization is associated with reduced HIV incidence in young South African women participating in the HPTN 068 study cohort
- 2018
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Ingår i: Journal of the International AIDS Society. - : John Wiley & Sons. - 1758-2652. ; 21:S7
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Adolescent girls and young women (AGYW) in South Africa bear a disproportionate burden of HIV. Community mobilization (CM), defined as community members taking collective action to achieve a common goal related to health, equity and rights, has been associated with increased HIV testing and condom use and has been called a ‘critical enabler’ for addressing the HIV epidemic. However, limited research has examined whether CM is associated with HIV incidence among AGYW.Methods: We examine the association of CM with incident HIV among AGYW (ages 13 to 21) enrolled in the HPTN 068 cohort in the Agincourt Health and socio‐Demographic Surveillance System, South Africa. This analysis includes 2292 participants residing in 26 villages where cross‐sectional, population‐based surveys were conducted to measure CM among 18‐ to 35‐year‐old residents in 2012 and 2014. HPTN 068 participants completed up to five annual visits that included an HIV test (2011 to 2016). Household‐level data were collected from AGYW parents/guardians and census data is updated annually. Mean village‐level CM scores were created using a validated community mobilization measure with seven components (social cohesion, social control, critical consciousness, shared concerns, organizations and networks, leadership and collective action). We used pooled generalized estimating equation regression with a Poisson distribution to estimate risk ratios (RR) for the association of village‐level CM score and CM components with incident HIV infection, accounting for village‐level clustering and adjusting for key covariates.Results: There were 194 incident infections over the follow‐up period. For every additional standard deviation of village‐level CM there was 12% lower HIV incidence (RR: 0.88, 95% CI: 0.79, 0.98) after adjusting for individual, household and community characteristics. CM components associated with lower HIV incidence included critical consciousness (RR: 0.88; CI: 0.79, 0.97) and leadership (RR: 0.87; CI: 0.79, 0.95); while not statistically significant, social cohesion (RR: 0.91; CI: 0.81, 1.01), shared concerns (RR: 0.90; CI: 0.81, 1.00), and organizations and networks (RR: 0.91; CI: 0.79, 1.03) may also play a protective role.Conclusions: These results suggest that having strong community social resources will reduce AGYW's risk of HIV acquisition. Work to mobilize communities, focusing on building social cohesion, shared concerns, critical consciousness, and effective and accountable leadership, can fortify prevention programming for AGYW.
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