Cruising Venues as a Context for HIV Risky Behavior among Men Who Have Sex with Men

We examined differences in sexual risk behaviors, HIV prevalence, and demographic characteristics between men who have sex with men (MSM) who visit different types of venues to meet sexual partners, and identified correlates of high-risk behaviors. 

A cross-sectional behavioral survey was conducted with a venue-based sample of 1011 MSM in Portugal. Overall, 36.3 % of MSM usually visit cruising venues to meet sexual partners (63.7 % only visit social gay venues). Cruising venues' visitors reported higher HIV prevalence (14.6 % vs. 5.5 %). Visiting cruising venues was more likely among those older, reporting high number of male sexual partners, group sex, and unprotected anal sex with a partner whose HIV status was unknown. 

Cruising venues play an important role in increasing risk of HIV transmission among MSM who frequent them. Venue-focused behavioral interventions that promote healthy sexual behaviors are needed.

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By:  Gama A1, Abecasis A2, Pingarilho M2, Mendão L3, Martins MO2, Barros H4, Dias S2.

• 1Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, n. 100, 1349-008, Lisbon, Portugal. agama@ihmt.unl.pt.
• 2Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, n. 100, 1349-008, Lisbon, Portugal.
• 3Grupo Português de Ativistas sobre Tratamentos de VIH/SIDA, Lisbon, Portugal.
• 4Institute of Public Health of University of Porto, University of Porto Medical School, Porto, Portugal. 
• Arch Sex Behav. 2016 Mar 17.

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Deaths Resulting from the Use of Firearms by Police Against Motor Vehicles: Study of Cases in Porto, Portugal

Highlights

• Bullets that struck the occupants were FMJ type and exhibited a deformed structure but no significant loss of mass.
• Entry holes in the victim's body were larger than the calibre of bullets.
• Death occurred immediately after the victim was shot only in one case, despite a vital structure has been hit in all cases.

The objective of this study was to investigate the terminal ballistics of police shootings in which the bullets went through any motor vehicle structure before fatally wounding the occupants. 6 cases that occurred in Porto district between 1998 and 2013 were studied. 

The firearms used were 7.65 mm (n = 1) or 9 mm (n = 3) calibre semi-automatic pistols and 9 mm calibre submachine guns (n = 2); the bullets were full metal jacket type. The metal jacket of the collected projectiles was totally or partially destroyed in 3 cases. It exhibited a deformed structure in all cases. The trajectories of the bullets in the vehicles were always more or less linear, even when initial impact was at an oblique angle. The entry holes in the victims' bodies were larger or much larger in size than the calibre of the bullets. They were located, with the exception of one of the cases, in the left half of the body. The trajectories in the victims' bodies were from front to back, in one case, and from back to front in all others. Exit wounds were only found in two cases. Death occurred immediately after the victim was shot only in one case, despite a vital structure has been hit in all cases. 

The cases studied support the idea that the use of firearms against vehicles with the sole intention of immobilisation entails uncontrollable danger to the lives of the occupants, and especially when done by police forces not specifically trained for that purpose. Therefore, such use of firearms should be avoided.

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By:  Rodrigues E1, Faria P2, Santos A3, Fraga S4.

• 1Faculty of Medicine of Porto University, Department of Legal Medicine and Forensic Sciences, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal. Electronic address: ezrodrigues@gmail.com.
• 2Faculty of Law of Catholic University of Portugal, Rua Diogo Botelho, 1327, 4160-005, Porto, Portugal.
• 3National Institute of Legal Medicine and Forensic Sciences, Department of Pathology - North Branch, Jardim Carrilho Videira, 4050-167, Porto, Portugal; Faculty of Medicine of Porto University, Department of Legal Medicine and Forensic Sciences, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal; School of Health Sciences of Minho University, Campus Gualtar, 4710-057, Braga, Portugal; Center of Forensic Sciences, National Institute of Legal Medicine and Forensic Sciences, Largo da Sé Nova, 3000-213, Coimbra, Portugal.
• 4EPIUnit - Institute of Public Health, University of Porto, Rua das Taipas, 135, 4050-600, Porto, Portugal.
• J Forensic Leg Med. 2016 Jan 12;39:1-9. doi: 10.1016/j.jflm.2016.01.010.  

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Factors Facilitating Implementation of School-Based Sexuality Education in Portugal

Objectives 

The aims of the study were to examine in Portuguese schools the facilitating factors at micro- and exosystem levels generally associated with more effective implementation of sexuality education (SE). 

Methods 

A representative sample of principals/lead teachers from 296 Portuguese schools completed a questionnaire about SE at school that included items related to factors at micro- and exosystem levels. Bivariate and multivariate logistic regression analyses were performed to examine factors associated with the development of an SE project. 

Results 

The majority of schools (96%) implemented some form of SE. Specifically, 79% of schools had developed an SE project. The odds that a school had designed an SE project increased significantly when the school did not implement extracurricular activities only (odds ratio [OR] 7.9), when it had an SE team (OR 7.2) and when it had established partnerships (OR 4.5). Bivariate and multivariate logistic regression models for each factor and each level revealed that other variables were associated with the development of a project, such as the perceived support offered by the regional education department. 

Conclusions 

The results highlight the importance of variables at micro- and exosystem levels as facilitating factors, and reinforce the ecological approach as being well suited for SE/health education in schools. The findings have implications for policy-makers as well as for practice.

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By:  Rocha AC1,2, Duarte C1,2.

• 1 * Faculty of Psychology and Education Sciences, University of Porto , Porto , Portugal.
• 2 Center for Psychology, University of Porto , Porto , Portugal.
• Eur J Contracept Reprod Health Care. 2016 Feb;21(1):30-8. doi: 10.3109/13625187.2015.1057809. Epub 2015 Jun 18. 

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Risk-Taking Behaviours & HIV Infection among Sex Workers in Portugal

Sex workers (SW) are key populations at an increased risk of HIV infection. This study aimed to characterise risk-taking behaviours and assess HIV prevalence among SW in Portugal.

A cross-sectional survey was conducted with 1040 SW using a participatory research approach. SW were recruited in sex-work locations and community-based organisation offices. Data were collected through a questionnaire with trained interviewers. An HIV rapid test was performed in 213 respondents.

Reported HIV prevalence was 8%: 17.6% of man-to-woman transgenders, 7.4% of women and 5% of men. Of SW reportedly living with HIV, 52.2% reported ever injecting drug use. Inconsistent condom use with clients in the last month was higher among male SW (26.5%) and with non-paying partners in the last year was higher among women (71.3%). Among reported HIV-positive SW, the proportions of inconsistent condom use were high. In multivariate regression analysis, reported HIV infection remained significantly higher among transgenders, those older, working outdoors, having ever used psychoactive substances and earning ≤€1000 per month. Of those who had an HIV rapid test, 8.9% were reactive; 73.7% were unaware of their seropositivity.

The HIV infection burden in SW is high. Efforts to promote HIV testing must be sustained in order to reduce undiagnosed infection. The diverse risk profiles of SW must be addressed in targeted HIV interventions. Prevention interventions should be systematically implemented within most-at-risk subgroups of SW.

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By: Dias S1, Gama A1, Fuertes R2, Mendão L2, Barros H3.

• 1Instituto de Higiene e Medicina Tropical & CMDT, Universidade Nova de Lisboa, Lisboa, Portugal.
• 2GAT-Grupo Português de Activistas sobre o Tratamento de VIH/Sida Pedro Santos, Lisboa, Portugal.
• 3Institute of Public Health of University of Porto, University of Porto Medical School, Porto, Portugal.  

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Incident Risk Factors as Predictors of HIV Seroconversion in the Lisbon Cohort of Men Who Have Sex with Men: First Results, 2011-2014

HIV incidence in men who have sex with men (MSM) is increasing in western countries, including Portugal. We aimed to estimate HIV incidence and to assess how individual short-term changes in exposures over time predict seroconversion. 

We evaluated participants of an open cohort of HIV-negative MSM enrolled after testing at a community-based voluntary HIV counselling and testing centre in Lisbon. At each evaluation a structured questionnaire was completed and HIV status was ascertained using rapid followed by confirmatory testing. 

Between April 2011 and February 2014, 804 MSM were followed for a total of 893 person-years. Predictors of HIV seroconversion were identified using Poisson generalised linear regression. The overall seroincidence was 2.80/100 person-years (95% confidence interval: 1.89-4.14). 

• Men who seroconverted had a higher mean number of tests per year. 
• Seroconversions were significantly associated with 
• partner disclosure of HIV status during follow-up, 
• newly-adopted unprotected anal intercourse (UAI) with a steady partner and 
• being newly-diagnosed with syphilis during follow-up. 
• Likewise, sexual intercourse with HIV-positive men, having an HIV-positive steady partner at least once during follow-up and persistent UAI with occasional partners were predictors of seroconversion. 

High HIV incidence in this cohort is likely driven by short-term contextual and behavioural changes during follow-up.

Below:  Stratified analysis of the main determinants of HIV incidence by HIV status of steady partner, cohort of men who have sex with men, Lisbon, Portugal, 2011–2014 (n=804)

Full article at: http://goo.gl/AsmEdB

By: Meireles P1, Lucas R, Carvalho C, Fuertes R, Brito J, Campos MJ, Mendão L, Barros H.

• 1EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal. 

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Predictors of Consistent Condom Use among Portuguese Women Attending Family Planning Clinics

Women account for 30% of all AIDS cases reported to the Health Ministry in Portugal and most infections are acquired through unprotected heterosexual sex with infected partners. This study analyzed socio-demographic and psychosocial predictors of consistent condom use and the role of education as a moderator variable among Portuguese women attending family planning clinics. 

A cross-sectional study using interviewer-administered fully structured questionnaires was conducted among 767 sexually active women (ages 18-65). Logistic regression analyses were used to explore the association between consistent condom use and the predictor variables. 

• Overall, 78.7% of the women were inconsistent condom users. 
• The results showed that consistent condom use was predicted by marital status (being not married), having greater perceptions of condom negotiation self-efficacy, having preparatory safer sexual behaviors, and not using condoms only when practicing abstinence. 
• Living with a partner and having lack of risk perception significantly predicted inconsistent condom use. 
• Less educated women were less likely to use condoms even when they perceive being at risk. 
• The full model explained 53% of the variance in consistent condom use. 

This study emphasizes the need for implementing effective prevention interventions in this population showing the importance of taking education into consideration.

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By: Costa EC1, Oliveira R, Ferreira D, Pereira MG.

• 1a Department of Psychology, Portuguese Catholic University, Braga , Portugal.

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