Hepatitis E Virus Genotype 3 in Colombia: Survey in Patients with Clinical Diagnosis of Viral Hepatitis

Background

Hepatitis E virus is a major cause of outbreaks as well as sporadic hepatitis cases worldwide. The epidemiology of this enterically transmitted infection differs between developing and developed countries. The aims of this study were to describe HEV infection in Colombian patients and to characterize the genotype.

Methods

A prospective study was carried out on 40 patients aged over 15 with a clinical diagnosis of viral hepatitis, recruited from five primary health units in the city of Medellin, Colombia. Fecal samples obtained from the 40 consecutives cases were analyzed for HEV RNA using nested reverse transcription PCR for both ORF1 and ORF2-3. The amplicons were sequenced for phylogenetic analyses.

Results

Nine (22.5%) cases of HEV infection were identified in the study population. Three HEV strains obtained from patients were classified as genotype 3. No significant association was found between cases of Hepatitis E and the variables water drinking source, garbage collection system and contact with pigs.

Conclusions

This is the first prospective study of hepatitis E in Colombian patients. The circulation of the genotype 3 in this population is predictable considering the reports of the region and the identification of this genotype from pigs in the state of Antioquia, of which Medellin is the capital. Further studies are necessary to establish whether zoonotic transmission of HEV is important in Colombia.

Below:  Analysis of variables and HEV infection of patients with a clinical diagnosis of viral hepatitis in the city of Medellin

Full article at:   http://goo.gl/CuJJMP

By:  

Julio Rendon, Maria Cristina Hoyos, Diana di Filippo, Fabian Cortes-Mancera, Carolina Mantilla, Maria Mercedes Velasquez, Maria Elsy Sepulveda, Juan Carlos Restrepo, Gonzalo Correa, Maria-Cristina Navas

Grupo de Gastrohepatologia. Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia

Fabian Cortes-Mancera

Grupo de Investigación e Innovación Biomédica GI2B, Facultad de Ciencias Exactas y Aplicadas, Instituto Tecnologico Metropolitano, Medellin, Colombia

Maria Elsy Sepulveda, Juan Carlos Restrepo, Sergio Jaramillo

Hospital Pablo Tobon Uribe, Medellin, Colombia

Maria Patricia Arbelaez

Grupo de Epidemiología. Facultad Nacional de Salud Publica, Universidad de Antioquia, Medellín, Colombia

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Gender Affirmation and Body Modification among Transgender Persons in Bogotá, Colombia

This paper examined structural, social, and personal characteristics that shape the processes of gender affirmation and body modification among transgender persons (assigned male at birth) in Bogotá, Colombia. Qualitative data from life-history interviews (N=14) and a focus group (N=11) explored research questions concerning the ways in which the internal psychological and external contextual processes influence individuals' decisions and behaviors concerning hormonal treatment, injections, or surgery. Research questions concerning practices and consequences of treatment performed without medical supervision were addressed through qualitative data, as well as quantitative data from 58 transgender participants. Findings indicated variation in ways participants conceptualized gender (e.g., binary or fluid), but an increased feminine presentation was a strong personal desire expressed by many and often encouraged by romantic partners and transgender friends. Transgender individuals within participants' social networks were frequently instrumental not only in providing information about hormones and contouring injections, but also in carrying out procedures—sometimes with negative consequences. Body modification procedures occurred primarily outside the health care system, due to limited access to or awareness of medical care, societal stigma, social norms within the transgender community, and personal decision-making. Public health approaches to protect the health of transgender persons undergoing body modification were suggested.

…Colombian government policies aimed at increasing health care coverage for the general population have been instituted; however, discrepancies in care remain substantial (Comisión de Regulacion en Salud, 2012), and administrative, economic, and bureaucratic barriers to care are common (Abadia & Oviedo, 2009). Our findings suggest that in Colombia, such barriers lead to body modification procedures outside the medical system, as has been found elsewhere (e.g. Clements-Nolle et al., 2001; Garofalo et al., 2006; Rotondi et al., 2013; Sanchez et al., 2009; Xavier et al., 2007). Only two participants in the life history interviews had received medical feminization treatment, and they had specific characteristics (medical condition or status as internally displaced) that enabled them to receive care.

Personal and social factors shaped the motivation to engage in a body modification. The desire for change was often driven by the emotional distress arising from the discrepancy between sex at birth and self-perceived gender. Consistent with previous research (Morgan & Stevens, 2012; Sevelius, 2013), findings from this study highlight the importance for transgender women in Bogotá of being affirmed in their gender identity by themselves and by others. It has been suggested that in addition to reducing emotional distress, gender affirmation procedures also result in stigma reduction by allowing transgender persons to “pass” in the general population (Sevelius, 2013). However, “passing” may not be the goal for many transgender persons.

Results of this study also indicated that social peers—be their partners or other transgender persons—constituted an important source of encouragement and acceptance. In contrast, stigma associated with gender non-conformity and rejection from family were common social challenges to gender affirmation.

Although transgender peers often encouraged body modification, the consequences of their influence were not always as positive as their intentions. Consistent with previous findings (Pitts et al., 2009; Winter & Doussantousse, 2009), results suggested that other transgender persons were often misinformed, and therefore they conveyed inaccurate information about hormone use or injections. In addition, they frequently were actively involved in the process of injecting substances in the breasts or buttocks for each other, and their mutual lack of knowledge concerning possible short- and long-term negative effects contributed to increased risk of health complications, as did the use of non-medical-grade fillers. It was also alarming that some participants were unaware of the need for medical supervision of hormone treatment or injections. Thus, in addition to barriers to medical access, lack of knowledge served to increase the potential for health problems…

Full article at:  http://goo.gl/xUp3bl

By:  Rodrigo A. Aguayo-Romero, Carol A. Reisen, Maria Cecilia Zea, Fernanda T. Bianchi, and Paul J. Poppen

Department of Psychology, The George Washington University, Washington, DC

Address correspondence to Rodrigo A. Aguayo-Romero, Psychology Department, The George Washington University, 2125 G Street NW, Washington, DC 20052. Email: ude.uwg.liamwg@oyaugar

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Heroin Use and Injection Risk Behaviors in Colombia: Implications for HIV/AIDS Prevention

BACKGROUND:

Heroin production in Colombia has increased dramatically in recent decades, and some studies point to an increase in local heroin use since the mid-1990s. Despite this rapid increase, little is known about the effects of these activities on heroin injection within Colombia. One of the biggest concerns surrounding heroin injection is the potential spread of HIV through drug user networks.

OBJECTIVES:

This article examines injection risk behaviors among heroin injectors in the Colombian cities of Medellín and Pereira to explore the implications for possible increased HIV transmission within this group.

METHODS:

A cross-sectional study used respondent-driving sampling to recruit a sample of 540 people who inject drugs (PWID) over 18 years of age (Medellín: n = 242, Pereira: n = 298). Structured interviews with each participant were conducted using the World Health Organization Drug Injection Study Phase II Survey. An HIV test was also administered.

RESULTS:

Information regarding the socio-demographics, injection drug use, HIV risk and transmission behaviors, injection risk management, and HIV knowledge and prevalence of participants are reported. The study identified many young, newly initiated injectors who engage in risky injection practices. The study also found that HIV prevalence is fairly low among participants (2.7%). 

CONCLUSIONS: 

Findings indicate a potential risk for the spread of HIV among PWID in Colombia given their widespread sharing practices, high rate of new injector initiation, and unsafe syringe cleaning practices. Colombia has a possibly time-limited opportunity to prevent an HIV epidemic by implementing harm reduction interventions among young, newly initiated PWID.

Purchase full article at:   http://goo.gl/VLZeg4

By:  Mateu-Gelabert P1, Harris S2, Berbesi D3, Cardona ÁM3, Vélez LP3, Motta IE4, Jessell L1, Guarino H1, Friedman SR1.

• 1 National Development and Research Institutes , New York , New York , USA.
• 2 University of Central Florida , Orlando , Florida , USA.
• 3 Universidad CES , Medellín , Colombia.
• 4 University of the Andes , Bogotá , Colombia.
• Subst Use Misuse. 2016 Jan 22:1-11 

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Chlamydia trachomatis Frequency in a Cohort of HPV-Infected Colombian Women

BACKGROUND:

Chlamydia trachomatis (C. trachomatis), an obligate intracellular bacterium, is the commonest infectious bacterial agent of sexual transmission throughout the world. It has been shown that the presence of this bacteria in the cervix represents a risk regarding HPV persistence and, thereafter, in developing cervical cancer (CC). Prevalence rates may vary from 2% to 17% in asymptomatic females, depending on the population being analysed. This study reports the identification of C. trachomatis in a cohort of 219 HPV-infected Colombian females.

METHODS:

C. trachomatis infection frequency was determined during each of the study's follow-up visits; it was detected by amplifying the cryptic plasmid sequence by polymerase chain reaction (PCR) using two sets of primers: KL5/KL6 and KL1/KL2. Infection was defined as a positive PCR result using either set of primers at any time during the study. Cox proportional risk models were used for evaluating the association between the appearance of infection and a group of independent variables.

RESULTS:

Base line C. trachomatis infection frequency was 28% (n = 61). Most females infected by C. trachomatis were infected by multiple types of HPV (77.42%), greater prevalence occurring in females infected with HPV-16 (19.18%), followed by HPV-58 (17.81%). It was observed that females having had the most sexual partners (HR = 6.44: 1.59-26.05 95%CI) or infection with multiple types of HPV (HR = 2.85: 1.22-6.63 95%CI) had the greatest risk of developing C. trachomatis.

CONCLUSIONS:

The study provides data regarding the epidemiology of C. trachomatis /HPV coinfection in different population groups of Colombian females and contributes towards understanding the natural history of C. trachomatis infection.

Below:  Percentage of females infected by C. trachomatis per visit

Below:  The probability of the risk of the women in this cohort acquiring C. trachomatis infection as time elapsed

Below:  The time taken to clear Chlamydia trachomatis infection in the cohort of females initially infected by HPV and C. trachomatis

Full article at:   http://goo.gl/lnNktJ

By:  Quinónez-Calvache EM1,2, Ríos-Chaparro DI3, Ramírez JD3, Soto-De León SC1,4, Camargo M1,4, Del Río-Ospina L1,5, Sánchez R1,5, Patarroyo ME1,5,Patarroyo MA1,4.

• 1Molecular Biology and Immunology Department, Fundación Instituto de Inmunología de Colombia (FIDIC), Bogotá, Colombia.
• 2Biotechnology Institute, Faculty of Sciences, Universidad Nacional de Colombia, Bogotá, Colombia.
• 3Grupo de Investigaciones Microbiológicas-UR (GIMUR), Faculty of Natural and Mathematical Sciences, Universidad del Rosario, Bogotá, Colombia.
• 4School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia.
• 5School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.
• PLoS One. 2016 Jan 25;11(1):e0147504. doi: 10.1371/journal.pone.0147504. eCollection 2016. 

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Hepatitis C and HIV in Injecting Drug Users in Armenia, Colombia

 A constant and progressive increase in the availability of heroin in Colombia in recent decades and the intravenous use  of this drug have established the need to prevent a possible epidemic of HIV and hepatitis C. 

This research determined the sero-prevalence of hepatitis C and HIV according to sociodemographic characteristics and risk behaviors in people who inject drugs in Armenia, Colombia. 

This is a cross-sectional study on 265 users captured through respondent-driven sampling after informed consent. 

• Sero-prevalence of hepatitis C was 22.3%; 
• for HIV infection, it was 2.6 %; 
• 67.5% reported injecting for more than two years, 
• 35 % shared needles and syringes, and 
• 12.4 % had used a condom during their last sexual intercourse. 

Users who did not purchase syringes in drugstores in the last six months are 2.7 times more likely to contract hepatitis C; daily injection frequency was higher in HIV- positive cases [OR 2.87; 95% CI 0.55 to 15.9] but nonsignificant. One fourth of respondents are infected with HIV or hepatitis C, either as a single infection or co-infection. 

This study identified risk practices such as sharing needles and low condom use in the last six months, worldwide documented and discussed risk factors. This research is a first step in the search for strategies to prevent the spread of HIV infection and hepatitis C in networks of injecting drug users.

Full PDF article [in English] at: http://goo.gl/HN0798

Full PDF article [in Spanish] at: http://goo.gl/RFnaJd

By:   Berbesi-Fernández D¹, Segura-Cardona Á, Montoya-Vélez L, Castaño-Perez GA.

¹Universidad CES. dberbesi@ces.edu.co.

  

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To Kill and Tell? State Power, Criminal Competition, and Drug Violence

Violence is commonly viewed as an inherent attribute of the drug trade. Yet, there is dramatic variation in drug violence within countries afflicted by drug trafficking. T

his article advances a novel framework that explains how the interaction between two critical variables, the cohesion of the state security apparatus, and the competition in the illegal market determines traffickers’ incentives to employ violence. 

The analysis introduces a generally overlooked dimension of violence, its visibility. Visibility refers to whether traffickers publicly expose their use of violence or claim responsibility for their attacks. 

Drawing on fieldwork in five cities in Colombia and Mexico (Cali, Medellin, Ciudad Juárez, Culiacán, and Tijuana), 175 interviews, and a new data set on drug violence, I argue that violence becomes visible and frequent when trafficking organizations compete and the state security apparatus is fragmented. 

By contrast, violence becomes less visible and less frequent when the criminal market is monopolized and the state security apparatus is cohesive.

Purchase full article at:   http://goo.gl/ooBLH9

By:  Angelica Duran-Martinez1⇑

1. ¹Department of Political Science, University of Massachusetts–Lowell, Lowell, MA, USA

1. Angelica Duran-Martinez, Department of Political Science, University of Massachusetts–Lowell, Lowell, MA, USA. Email: angelica_duranmartinez@uml.edu

 

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Suicidal Ideation & Associated Factors in Inmates of a Prison of Antioquia, Colombia

INTRODUCTION:

Suicidal behavior shows high numbers in prison population; hence, the following research was developed, which aimed to identify the sociodemographic, family, personal and imprisonment factors that are associated with suicidal ideation in inmates of a prison of Antioquia, Colombia.

MATERIAL AND METHODS:

A cross descriptive study was carried out. It was applied the Suicide Orientation Inventory Test ISO-30, as well as a survey, in order to investigate sociodemographic, family and imprisonment aspects of a group of 154 inmates. Univariate and bivariate analysis were applied to the collected data by using Excel and OpenEpi programs.

RESULTS:

14.9% had high suicidal ideation. By analyzing the distribution of high suicidal ideation in the variables studied, it was found that the highest rates occurred in those who had previous attempts, 61.1%; a history of domestic violence, 50.0%; no schooling, 33.3%; those with a family history of suicide, 28.6%; and those without a definite sentence 22.9%. A significant association was found between the ideation and having committed previous suicide attempts (P<.01; rp=7.4), belonging to households with domestic violence (P=.03; rp=4.0), being single (P=.04; rp=2.2) and being under 30 years old (P=.04; rp=2.1).

CONCLUSIONS:

The high suicidal rates are much greater than those found in the general population; it is therefore recommended to the professionals of the institution to address the risk factors found here, in order to develop prevention and intervention programs.

Purchase full article at:  http://goo.gl/YZ0oUF

By:  Jaramillo Gutiérrez MR1, Silva Vallejo C1, Rojas Arango BP2, Medina-Pérez ÓA1.

• 1Escuela de Ciencias Sociales, Artes y Humanidades, Universidad Nacional Abierta y a Distancia (UNAD), Medellín, Colombia.
• 2Escuela de Ciencias Sociales, Artes y Humanidades, Universidad Nacional Abierta y a Distancia (UNAD), Medellín, Colombia. Electronic address: bibiana.rojas@unad.edu.co. 

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Prevalence of Marijuana Use among University Students in Bolivia, Colombia, Ecuador, and Peru

Young adults 18 to 25 years old show the highest prevalence of marijuana use in Latin America. This study analyzes the changes in prevalence of marijuana use among university students in the Andean Community (Bolivia, Colombia, Ecuador, and Peru) from two studies carried out in 2009 and in 2012. 

Data were collected through representative two-stage samples of universities and students in the Andean Community. An online survey was administered using a standardized questionnaire. Prevalence was calculated for lifetime, past year, and past month. Marijuana was the most widely used illicit substance consumed among university students, in 2009 and in 2012. 

Past month prevalence among university students in 2009 in Colombia was 5.27%, in Peru 1.00%, in Ecuador 1.68%, and in Bolivia 0.76%. Past month prevalence in 2012 in Colombia was 7.14%, in Ecuador 3.67%, in Peru 1.62%, and in Bolivia 1.45% in 2012. Among university students in the Andean Community, past month prevalence increased among both males and females between 2009 and 2012 in most countries. 

Marijuana continues to be the most commonly used illicit drug in Latin American countries. Increases in prevalence among young adults could have important implications for national drug policy.

Below:  Past year incidence of marijuana use in Andean Countries, by country

Full article at:  http://goo.gl/C3Q4wJ

By: Hynes M1, Demarco M2, Araneda JC3, Cumsille F4.

• 1Inter-American Observatory on Drugs, Inter-American Drug Abuse Control Commission (CICAD), Organization of American States (OAS), 1889 F Street NW, Washington, DC 20006, USA. mhynes@oas.org.
• 2Inter-American Observatory on Drugs, Inter-American Drug Abuse Control Commission (CICAD), Organization of American States (OAS), 1889 F Street NW, Washington, DC 20006, USA. mdemarco@oas.org.
• 3Global SMART Programme (Latin America), United Nations Office on Drugs and Crime, 1889 F Street NW, Washington, DC 20006, USA. jaraneda@oas.org.
• 4Inter-American Observatory on Drugs, Inter-American Drug Abuse Control Commission (CICAD), Organization of American States (OAS), 1889 F Street NW, Washington, DC 20006, USA. fcumsille@oas.org. 

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Gender Differences in the Interpretation of Experiences of Patients with Tuberculosis in Medellín, Colombia

This study sought to determine gender differences in the interpretation of tuberculosis (TB) in a group of patients from the city of Medellín.

This was a qualitative study, with the grounded theory method. Twelve semistructured interviews were applied to patients from both genders who were cured of TB. The sample was selected through convenience and for analysis the information was categorized through the Atlas Ti tool.

Regarding the symptoms, the most reported is cough, but men manifest expectoration more frequently. Men overstated the symptoms, while women tend to minimize them. Women report mental impairment and emotional-type manifestations produced by the disease. Men and women expressed ignorance about the disease upon diagnosis. Both manifested fear of infection, work incapacity, loss of employment, rejection by others, and death. Also highlighted is the importance of family support and of the healthcare personnel. Women expressed shame in that others knew of their disease and mentioned greater intolerance with taking the medications.

The gender role constructed culturally constitutes the central axis that explains how men and women interpret TB and can be modified by educational and accompaniment processes. Family support plays an important role in the healing process. Although common aspects exist, delving into the gender differences against the interpretation of TB may permit a different approach of the disease and better control of it.

Full article at:  http://goo.gl/E83ahd

By: Villa Vélez L1, Arbeláez Montoya MP2.

• 1Universidad de Antioquia, Medellín, Colombia.
• 2Universidad de Antioquia, Medellín, Colombia, patricia.arbelaez@udea.edu.co. 

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Sex Work among Men Who Have Sex with Men & Transgender Women in Bogotá

This qualitative study examined sex work among internally displaced male and transgender female sex workers in Bogotá, Colombia. Internal displacement has occurred in Colombia as a result of decades of conflict among armed groups and has created large-scale migration from rural to urban areas. Informed by the polymorphous model of sex work, which posits that contextual conditions shape the experience of sex work, we examined three main research questions. The first dealt with how internal displacement was related to the initiation of sex work; the second concerned the effect of agency on sex worker satisfaction; and the third examined how sex work in this context was related to HIV and other risks. Life history interviews were conducted with a 26 displaced individuals who had done sex work: 14 were men who have sex with men (MSM) and 12 were transgender women (natal males). Findings revealed that many participants began doing sex work in the period immediately after displacement, because of a lack of money, housing, and social support. HIV risk was greater during this time due to limited knowledge of HIV and inexperience negotiating safer sex with clients. Other findings indicated that sex workers who exerted more control and choice in the circumstances of their work reported greater satisfaction. In addition, we found that although many sex workers insisted on condom use with clients, several noted that they would sometimes have unprotected sex for additional money. Specific characteristics affecting the experience of sex work among the transgender women were also discussed...

I went to beauty salons [looking for a hairdresser job]… They wanted to see my diploma, and I don’t have one. I know my trade, but I don’t have a diploma… On the other hand, the prostitution business was better…I made enough that I could live two or three days. With this, one can pay rent, utilities, and this helps you with the clothes that you need....

Another participant (Julio, 37 years old) had been beaten by a member of a paramilitary group in his hometown and, as a result, had a physical disability. After his displacement to Bogotá, he engaged in sex work as a way to survive between odd jobs. He implied that sex work was very common for those in similar circumstances:

So, they invite you into a bathroom. What for? So that you can show them what you have between your legs. You turn your back [present your buttocks] knowing that you need 2,000 pesos [approximately US$1]. This happens to us—to young boys who have an illness and live on the streets… what I have done, my friends have done as well. We sell ourselves...

Full article at: http://goo.gl/0J5yAY

By: Fernanda T. Bianchi,1 Carol A. Reisen,2 Maria Cecilia Zea,2 Salvador Vidal-Ortiz,3 Felisa A. Gonzales,2 Fabián Betancourt,4 Marcela Aguilar,4 and Paul J. Poppen2

¹Global Women’s Institute, 714 21st Street NW 2nd Floor, The George Washington University, Washington, DC 20052

²Department of Psychology, The George Washington University, Washington, DC

³Department of Sociology, American University, Washington, DC

⁴Profamilia, Bogotá, Colombia

Email: ude.uwg@ihcnaibf

   

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HIV Prevalence & Awareness of Positive Serostatus among Men Who Have Sex with Men & Transgender Women in Bogotá, Colombia

We estimated HIV prevalence among men who have sex with men (MSM) and transgender women in Bogotá, Colombia, and explored differences between HIV-positive individuals who are aware and unaware of their serostatus.

In this cross-sectional 2011 study, we used respondent-driven sampling (RDS) to recruit 1000 MSM and transgender women, who completed a computerized questionnaire and received an HIV test.

The RDS-adjusted prevalence was 12.1%, comparable to a previous RDS-derived estimate. Among HIV-positive participants, 39.7% were aware of their serostatus and 60.3% were unaware before this study. HIV-positive-unaware individuals were more likely to report inadequate insurance coverage, exchange sex (i.e., sexual intercourse in exchange for money, goods, or services), and substance use than other participants. HIV-positive-aware participants were least likely to have had condomless anal intercourse in the previous 3 months. Regardless of awareness, HIV-positive participants reported more violence and forced relocation experiences than HIV-negative participants.

There is an urgent need to increase HIV detection among MSM and transgender women in Bogotá. HIV-positive-unaware group characteristics suggest an important role for structural, social, and individual interventions.

Below:  HIV status of recruited participants by serostatus of the recruiter in respondent-driven sampling of men who have sex with men and transgender women: Bogotá, Colombia, 2011

Below: Recruitment chains for the 4 seeds in respondent-driven sampling of men who have sex with men and transgender women: Bogotá, Colombia, 2011

Full article at:  http://ht.ly/SOsSV 

By: Zea MC1, Reisen CA1, del Río-González AM1, Bianchi FT1, Ramirez-Valles J1, Poppen PJ1.

• 1Maria Cecilia Zea, Carol A. Reisen, Ana María del Río-González, Fernanda T. Biachi, and Paul J. Poppen are with George Washington University, Washington, DC. Jesus Ramirez-Valles is with the University of Illinois, Chicago. 

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