HIV Disclosure and Transmission Risks to Sex Partners among HIV-Positive Men

Disclosure of HIV-positive status to sex partners is critical to protecting uninfected partners. In addition, people living with HIV often risk criminal prosecution when they do not inform sex partners of their HIV status. 

The current study examined factors associated with nondisclosure of HIV status by men living with HIV in Atlanta, GA (92% African African, mean age = 43.8), who engage in condomless sex with uninfected sex partners. 

Sexually active HIV-positive men (N = 538) completed daily electronic sexual behavior assessments over the course of 28 days and completed computerized interviews, drug testing, medication adherence assessments, and HIV viral load retrieved from medical records. 

Results showed that 

• 30% men had engaged in condomless vaginal or anal intercourse with an HIV-uninfected or unknown HIV status sex partner to whom they had not disclosed their HIV status. 
• Men who engaged in nondisclosed condomless sex were 
• less adherent to their HIV treatment, 
• more likely to have unsuppressed HIV, 
• demonstrated poorer disclosure self-efficacy, 
• enacted fewer risk reduction communication skills, and 
• held more beliefs that people with HIV are less infectious when treated with antiretroviral therapy. 

We conclude that undisclosed HIV status is common and related to condomless sex with uninfected partners. Men who engage in nondisclosed condomless sex may also be more infectious given their nonadherence and viral load. 

Interventions are needed in HIV treatment as prevention contexts that attend to disclosure laws and enhance disclosure self-efficacy, improve risk reduction communication skills, and increase understanding of HIV infectiousness.

Purchase full article at: http://goo.gl/JF8GBM

By:  Kalichman SC1, Kalichman MO1, Cherry C1, Grebler T1.

• 1Department of Psychology, University of Connecticut , Storrs, Connecticut.
• AIDS Patient Care STDS. 2016 May;30(5):221-8. doi: 10.1089/apc.2015.0333. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health 

Correlates of Recent HIV Testing among Substance-Using Men Who Have Sex with Men

Men who have sex with men are disproportionately impacted by HIV and substance use is a key driver of HIV risk and transmission among this population. 

We conducted a cross-sectional survey of 3242 HIV-negative substance-using men who have sex with men aged 18 + in the San Francisco Bay Area from March 2009 to May 2012. Demographic characteristics and sexual risk and substance use behaviors in the last six months were collected using structured telephone questionnaires. 

We used multivariable logistic regression to identify independent demographic and behavioral predictors of recent HIV testing. In all, 65% reported having an HIV test in the last six months. 

In multivariable analysis, increasing age and drinking alcohol (<1 drink/day: 0.65, 0.46-0.92; 2-3 drinks/day: 0.64, 0.45-0.91; 4 + drinks/day: 0.52, 0.35-0.78) were negatively associated with recent HIV testing. Having two or more condomless anal intercourse partners (2.17, 1.69-2.79) was positively associated with having a recent HIV test, whereas condomless anal intercourse with serodiscordant partners was not significantly associated with testing. 

Older men who have sex with men and those who drink alcohol may benefit from specific targeting in efforts to expand HIV testing. Inherently riskier discordant serostatus of partners is not as significant a motivator of HIV testing as condomless anal intercourse in general.

Purchase full article at:   http://goo.gl/1A4z1Q

By:  Rowe C1, Matheson T2, Das M3, DeMicco E3, Herbst JH4, Coffin PO2, Santos GM2.

• 1San Francisco Department of Public Health, USA chris.rowe@sfdph.org.
• 2San Francisco Department of Public Health, USA.
• 3University of California, San Francisco, USA.
• 4Centers for Disease Prevention and Control, Atlanta, USA. 
• Int J STD AIDS. 2016 Mar 21. pii: 0956462416640964

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Analysis of Related Factors for HIV Transmission among 263 Pairs of Male Spouses with Positive HIV Antibodies in Zhejiang Province

OBJECTIVE:

To identify the status and risk factors of transmission in couples which males was HIV-positive in Zhejiang province.

METHODS:

A cross-sectional study was conducted among HIV-serodiscordant couple (male positive) and HIV-seroconcordant couple (male first infected). A self-designed questionnaire was complimented containing basic information, the awareness of infection and HIV-testing, sexual relationship power, self-efficacy of condom use, sex. The univariated and multivariate logistic regression methods were used to analyze the influence factors.

RESULTS:

A total of 263 couples were enrolled in this study, including 210 HIV HIV-serodiscordant couples and 53 HIV-seroconcordant couples. 

• HIV-positive males aged 30-50 accounted for 57.8% 
• and females under junior high school accounted for 79.1%
• HIV/AIDS accounted for 41.1% 

The proportion of man who were diagnosed as HIV, MSM and ever heard HIV were 61.9% (130 cases), 38.3% (80 cases) and 81.9% (172 cases), which were higher than that in HIV positive 47.2% (25 cases), 7.5% (4 cases), 64.2% (34 cases); χ(2)=3.80, 18.33, 7.86;P=0.051, 0.001, 0.005. 

The results revealed that AIDS patients had high risk to infect their spouse than HIV patients. Male patients who had ever heard " HIV" before were less likely pass virus to their wives than those who had never heard " HIV". Compared with heterosexuality man, homosexuality man' wives had high risk to get virus from their husbands. Female infected with STIs was the independent factors for HIV infection.

CONCLUSION:

Among the couples of male HIV-positive in Zhejiang Province, the risk of spouses infected with HIV virus has relationship with male disease progression, sexual orientation and awareness of AIDS knowledge. For females who infected with sexual diseases in last 6 months might be infected by their spouses.

Purchase full article [Article in Chinese] at:   http://goo.gl/96WcsJ

By:  Chen L1, Pan XH, Yang JZ, Xu Y, Wang H, Zhou X, Jiang TT, Ma QQ.

• 1Department of HIV/AIDS and STDs Control and Prevention, Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou 310051, China. 
• Zhonghua Yu Fang Yi Xue Za Zhi. 2016 Feb 6;50(2):158-62. doi: 10.3760/cma.j.issn.0253-9624.2016.02.011.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Dual Contraceptive Method Use in HIV-Serodiscordant Kenyan Couples

BACKGROUND:

World Health Organization (WHO) guidelines recommend dual contraceptive method use with condoms and another contraceptive to reduce both incidence of HIV/sexually transmitted infection transmission and unintended pregnancies. This qualitative study assessed the barriers to and motivations for dual contraceptive use in Kenyan HIV-serodiscordant couples.

METHODS:

HIV-serodiscordant couples in Nairobi, Kenya, were recruited from two longitudinal cohorts. Qualitative semistructured interviews were conducted using a semistructured questionnaire. Twelve male and 12 female members of serodiscordant couples and 10 women with incident pregnancies during the cohort studies were included.

RESULTS:

Few couples reported using dual contraceptive methods, with men reporting more condom use than women. No HIV-seropositive men or HIV-seronegative women reported using non-condom contraception. Men and women agreed that men play a dominant role in decisions to use both condoms and contraception in HIV-serodiscordant couples. Participants reported that perceptions of side effects, male partner preference, and reproductive desire were critical factors in contraceptive decisions. Both men and women saw dual contraceptive method use as redundant and a sign of possible unfaithfulness. Many participants actively desired pregnancy, but few were able to accurately define monthly fertility windows.

CONCLUSIONS:

Dual contraceptive method use was low in these HIV-serodiscordant couples, with some couples finding it unnecessary while using condoms, and others being more focused on conceiving a child. Biomedical HIV prevention, including male circumcision, pre-exposure prophylaxis or antiretroviral therapy to reduce HIV transmission, may be more acceptable strategies to promote safer sexual relations among HIV-serodiscordant couples and safer conception when desired.

Purchase full article at:   http://goo.gl/FGvu92

By:  Roxby AC1, Ben-Youssef L2, Marx G3, Kinoti F4, Bosire R4, Guthrie B5, Mackelprang R6, Kiarie J7, John-Stewart G8, Farquhar C9.

• 1Assistant Professor, Departments of Medicine and Global Health, University of Washington, WA, USA.
• 2Resident Physician, Department of Emergency Medicine, Alameda County Medical Center, Highland Hospital, Oakland, CA, USA, and University of Washington School of Medicine, WA, USA Infectious Disease Fellow, Department of Medicine, University of Colorado, Aurora, CO, USA.
• 3Physician, Kenya Medical Research Institute, Nairobi, Kenya.
• 4Senior Clinical Research Scientist, Kenya Medical Research Institute, Nairobi, Kenya.
• 5Assistant Professor, Departments of Medicine and Global Health, University of Washington, WA, USA Assistant Professor, Departments of Epidemiology and Global Health, University of Washington, Seattle WA, USA.
• 6Assistant Professor, Departments of Epidemiology and Global Health, University of Washington, Seattle WA, USA.
• 7Acting Instructor, Department of Global Health, University of Washington, Seattle, WA, USA Professor, Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya and Department of Obstetrics and Gynaecology, Kenyatta National Hospital, Nairobi, Kenya.
• 8Assistant Professor, Departments of Medicine and Global Health, University of Washington, WA, USA Assistant Professor, Departments of Epidemiology and Global Health, University of Washington, Seattle WA, USA Professor, Departments of Medicine, Global Health, Pediatrics, and Epidemiology, University of Washington, Seattle, WA, USA Professor, Departments of Medicine, Epidemiology, Global Health, University of Washington, Seattle, WA, USA.
• 9Assistant Professor, Departments of Medicine and Global Health, University of Washington, WA, USA Assistant Professor, Departments of Epidemiology and Global Health, University of Washington, Seattle WA, USA Professor, Departments of Medicine, Epidemiology, Global Health, University of Washington, Seattle, WA, USA. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Characterizing HIV Epidemiology in Stable Couples in Cambodia, the Dominican Republic, Haiti, and India

Using a set of statistical methods and HIV mathematical models applied on nationally representative Demographic and Health Survey data, we characterized HIV serodiscordancy patterns and HIV transmission dynamics in stable couples (SCs) in four countries: Cambodia, the Dominican Republic, Haiti, and India. The majority of SCs affected by HIV were serodiscordant, and about a third of HIV-infected persons had uninfected partners. 

Overall, nearly two-thirds of HIV infections occurred in individuals in SCs, but only about half of these infections were due to transmissions within serodiscordant couples. The majority of HIV incidence in the population occurred through extra-partner encounters in SCs. 

There is similarity in HIV epidemiology in SCs between these countries and countries in sub-Saharan Africa, despite the difference in scale of epidemics. It appears that HIV epidemiology in SCs may share similar patterns globally, possibly because it is a natural 'spillover' effect of HIV dynamics in high-risk populations.

Below:  Patterns of HIV serodiscordancy in India, Cambodia, the Dominican Republic, and Haiti compared to those in low and high HIV prevalence countries in sub-Saharan Africa. Countries are shown in order of increasing HIV prevalence

Below:  HIV incidence and its sources in stable couples. (a) Fraction of new HIV infections in stable HIV serodiscordant couples that are due to sources external vs. internal to the couple. Estimates are shown for HIV incidence arising in stable HIV serodiscordant couples due to sources external to the couple. (b–h) The mean country-specific contributions to HIV incidence in the population stratified by couples' serostatus and source of HIV infection. Results are displayed for India, Cambodia, the Dominican Republic, and Haiti, compared to those in low and high HIV prevalence countries in sub-Saharan African. Countries are shown in order of increasing HIV prevalence.

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

By:  Chemaitelly H1, Abu-Raddad LJ1.

• 1Infectious Disease Epidemiology Group,Weill Cornell Medical College - Qatar,Cornell University,Qatar Foundation - Education City,Doha,Qatar. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

I Knew I Would Be Safer. Experiences of Kenyan HIV Serodiscordant Couples Soon After Pre-Exposure Prophylaxis (PrEP) Initiation

Pre-exposure prophylaxis (PrEP) for HIV-uninfected persons is highly efficacious for HIV prevention. Understanding how people at risk for HIV will use PrEP is important to inform PrEP scale-up and implementation. 

We used qualitative methods to gather insights into couples' early experiences with PrEP use within the Partners Demonstration Project, an open-label implementation study evaluating integrated delivery of PrEP and antiretroviral therapy (ART). PrEP is offered to HIV uninfected partners until the HIV-infected partner initiates and sustains ART use (i.e., PrEP as a "bridge" to ART initiation and viral suppression). 

From August 2013 to March 2014 we conducted 20 in-depth dyadic interviews (n = 40) with heterosexual HIV serodiscordant couples participating at the Thika, Kenya study site, exploring how couples make decisions about using PrEP for HIV prevention. We developed and applied deductive and inductive codes to identify key themes related to experiences of PrEP initiation and use of time-limited PrEP. 

Couples reported that PrEP offered them an additional strategy to reduce the risk of HIV transmission, meet their fertility desires, and cope with HIV serodiscordance. Remaining HIV negative at follow-up visits reinforced couples' decisions and motivated continued adherence to PrEP. In addition, confidence in their provider's advice and client-friendly services were critical to their decisions to initiate and continue use of PrEP. 

Strategies for wide-scale PrEP delivery for HIV serodiscordant couples in low resource settings may include building capacity of health providers to counsel on PrEP adoption while addressing couples' concerns and barriers to adoption and continued use.

Purchase full article at:   http://goo.gl/PRh12B

By:  Ngure K1,2, Heffron R2,3, Curran K2, Vusha S4, Ngutu M4, Mugo N2,4, Celum C2,3,5, Baeten JM2,3,5.

• 1 School of Public Health, Jomo Kenyatta University of Agriculture and Technology , Kenya .
• 2 Department of Global Health, University of Washington , Seattle, Washington.
• 3 Department of Epidemiology, University of Washington , Seattle, Washington.
• 4 Center for Clinical Research, Kenya Medical Research Institute , Kenya .
• 5 Department of Medicine, University of Washington , Seattle, Washington. 
• AIDS Patient Care STDS. 2016 Feb;30(2):78-83. doi: 10.1089/apc.2015.0259.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Absence of Transmission from HIV-Infected Individuals with HAART to Their Heterosexual Serodiscordant Partners

BACKGROUND:

Further studies are needed to evaluate the level of effectiveness and durability of HAART to reduce the risk of HIV sexual transmission in serodiscordant couples having unprotected sexual practices.

METHODS:

A cross-sectional study was conducted with prospective cohort of heterosexual HIV serodiscordant couples where the only risk factor for HIV transmission to the uninfected partner (sexual partner) was the sexual relationship with the infected partner (index case). HIV prevalence in sexual partners at enrolment and seroconversions in follow-up were compared by antiretroviral treatment in the index partner, HIV plasma viral load in index cases and sexual risk exposures in sexual partners. In each visit, an evaluation of the risks for HIV transmission, preventive counselling and screening for genitourinary infections in the sexual partner was performed, as well as the determination of the immunological and virological situation and antiretroviral treatment in the index case.

RESULTS:

At enrolment no HIV infection was detected in 202 couples where the index case was taking HAART. HIV prevalence in sexual partners was 9.6% in 491 couples where the index case was not taking antiretroviral treatment (p<0.001). During follow-up there was no HIV seroconversion among 199 partners whose index case was taking HAART, accruing 7600 risky sexual exposures and 85 natural pregnancies. Among 359 couples whose index case was not under antiretroviral treatment, over 13,000 risky sexual exposures and 5 HIV seroconversions of sexual partners were recorded. The percentage of seroconversion among couples having risky sexual intercourse was 2.5 (95% confidence interval [CI]: 1.1-5.6) when the index case did not undergo antiretroviral treatment and zero (95% CI: 0-3.2) when the index case received HAART.

CONCLUSIONS:

The risk of sexual transmission of HIV from individuals with HAART to their heterosexual partners can become extremely low.

Purchase full article at:   http://goo.gl/vzhCY7

By:  Del Romero J1, Río I2, Castilla J3, Baza B4, Paredes V5, Vera M4, Rodríguez C4.

• 1Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain. Electronic address: jromero@salud.madrid.org.
• 2CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
• 3Instituto de Salud Pública de Navarra, Pamplona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
• 4Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.
• 5Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Image from:  https://goo.gl/1erOaO

Pre-Exposure Prophylaxis (PrEP) for Safer Conception among Serodifferent Couples: Findings from Healthcare Providers Serving Patients with HIV in Seven US Cities

Pre-exposure prophylaxis (PrEP) can reduce the risk of HIV transmission among serodifferent couples trying to conceive, yet provider knowledge, attitudes, and experience utilizing PrEP for this purpose are largely unexamined. 

Trained interviewers conducted phone interviews with healthcare providers treating patients with HIV in seven cities (Atlanta, Baltimore, Houston, Kansas City, Newark, Philadelphia, and San Francisco, N = 85 total). 

Quantitative and qualitative data were analyzed to describe experience, concerns, and perceived barriers to prescribing PrEP for safer conception. Providers (67.1% female, 43 mean years of age, 70.4% white, 10 mean years treating HIV+ patients, 56% in academic vs. community facilities, 62.2% MD) discussed both benefits and concerns of PrEP for safer conception among serodifferent couples. 

Only 18.8% of providers reported experience prescribing PrEP, 74.2% were willing to prescribe it under ideal circumstances, and 7.0% were not comfortable prescribing PrEP. Benefits included added protection and a greater sense of control for the HIV-negative partner. Concerns were categorized as clinical, system-level, cost, or behavioral. 

Significant differences in provider characteristics existed across sites, but experience with PrEP for safer conception did not, p = 0.14. Despite limited experience, most providers were open to recommending PrEP for safer conception as long as patients understood the range of concerns and could make informed decisions. 

Strategies to identify and link serodifferent couples to PrEP services and clinical guidance specific to PrEP for safer conception are needed.

Purchase full article at:   http://goo.gl/6wvGSj

By:  Finocchario-Kessler S1, Champassak S2, Hoyt MJ3, Short W4, Chakraborty R5, Weber S6, Levison J7, Phillips J3, Storm D3, Anderson J8.

• 1 Department of Family Medicine, University of Kansas Medical Center , Kansas City, Kansas.
• 2 Health Services and Outcomes Research, Children's Mercy Hospital , Kansas City, Missouri.
• 3 François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey , Newark, New Jersey.
• 4 Division of Infectious Diseases, Perelman Schools of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.
• 5 Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine , Atlanta, Georgia .
• 6 HIVE, University of California San Francisco , San Francisco, California.
• 7 Department of Obstetrics and Gynecology, Baylor College of Medicine , Houston, Texas.
• 8 Department of Gynecology and Obstetrics, Johns Hopkins Medical Institutions , Baltimore, Maryland. 
• AIDS Patient Care STDS. 2016 Jan 29

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Lights and Shadows about the Effectiveness of IVF in HIV Infected Women: A Systematic Review

Background. 

HIV infected women have higher rates of infertility. 

Objective. 

The purpose of this literature review is to evaluate the effectiveness of fresh IVF/ICSI cycles in HIV infected women. 

Materials and Methods. 

A search of the PubMed database was performed to identify studies assessing fresh nondonor oocyte IVF/ICSI cycle outcomes of serodiscordant couples with an HIV infected female partner. 

Results and Discussion. 

Ten studies met the inclusion criteria. Whenever a comparison with a control group was available, with the exception of one case, ovarian stimulation cancelation rate was higher and pregnancy rate (PR) was lower in HIV infected women. However, statistically significant differences in both rates were only seen in one and two studies, respectively. A number of noncontrolled sources of bias for IVF outcome were identified. This fact, added to the small size of samples studied and heterogeneity in study design and methodology, still hampers the performance of a meta-analysis on the issue. 

Conclusion. 

Prospective matched case-control studies are necessary for the understanding of the specific effects of HIV infection on ovarian response and ART outcome.

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

By:  Marques C1, Guerreiro C2, Soares SR3.

• 1Maternidade Dr. Alfredo da Costa, Rua Viriato, 1069-089 Lisboa, Portugal.
• 2Fetal Maternal Department, Maternidade Dr. Alfredo da Costa, Lisbon, Portugal.
• 3Instituto Valenciano de Infertilidade (IVI-Lisboa), Lisbon, Portugal. 
• Infect Dis Obstet Gynecol. 2015;2015:517208. doi: 10.1155/2015/517208. Epub 2015 Dec 8.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Prevalence and Correlates of Heterosexual Anal Intercourse among Men and Women, 20 U.S. Cities

Heterosexual anal intercourse (HAI) is not an uncommon behavior and it confers a higher risk of HIV transmission than vaginal intercourse. 

We examined data from heterosexuals recruited in 20 US cities for the 2013 National HIV Behavioral Surveillance system. We assessed correlates of reporting HAI in the previous year. Then, among people reporting HAI in the past year, we assessed what event-level factors are associated with having HAI at last sex. 

Thirty percent of women and 35 % of men reported HAI in the past year. Among people who had HAI in the past year, those who had HAI at last sex were more likely to have a partner who was HIV-positive or of unknown status or to have exchanged money or drugs for sex at last sex. 

Information that highlights the risk of HIV transmission associated with HAI would complement existing HIV prevention messages focused on heterosexuals in the U.S.

Purchase full article at:   http://goo.gl/wPgC3Z

By:  Hess KL1, DiNenno E2, Sionean C2, Ivy W2, Paz-Bailey G2; NHBS Study Group.

• 1Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-E47, Atlanta, GA, 30329, USA. xgm0@cdc.gov.
• 2Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-E47, Atlanta, GA, 30329, USA. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health