Medicine & Health

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Now showing 1 - 10 of 106
  • (2009) Adam, Philippe; de Wit, John; Toskin, I; Mathers, Bradley; Nashkhoev, I; Lyerla, Rob; Rugg, D
    Journal Article
    Background: HIV prevalence data suggest that men who have sex with men (MSM) in low-income and middle-income countries (LMIC) are at increased risk of HIV The aim of this article is to present global estimates on key HIV prevention needs and responses among MSM in LMIC. Methods: Data on HIV testing, HIV prevention coverage, HIV knowledge and condom use among MSM were derived from UNGASS country progress reports submitted in 2008. Eligible country estimates were used to calculate global and regional estimates, weighted for the size of MSM populations. Results: Of 147 LMIC, 45% reported at least 1 indicator that reflects the HIV prevention needs and responses in MSM. Global weighted estimates indicate that on average 31 % of MSM in LMIC were tested for HIV; 33% were reached by HIV prevention programs; 44% had correct HIV knowledge; and 54% used condoms the last time they had anal sex with a man. Conclusions: The 2008 UNGASS country reports represent the largest harmonized data set to date of HIV prevention needs and responses among MSM in LMIC. Although reporting is incomplete and does not always conform to requirements, findings confirm that, in many LMIC, HIV prevention responses in MSM need substantial strengthening.

  • (2009) Zablotska, I; Imrie, John; Prestage, Garrett; Crawford, June; Rawstorne, Patrick; Grulich, Andrew; Jin, Feng Yi; Kippax, Susan
    Journal Article
    We explored seroguessing (serosorting based on the assumption of HIV seroconcordance) and casual unprotected anal intercourse (UAIC) associated with seroguessing. The ongoing Positive Health and Health in Men cohorts, Australia, provided data for trends in seroconcordant UAIC and HIV disclosure to sex partners. In event-level analyses, we used log-binomial regression adjusted for within-individual correlation and estimated prevalence rate ratios (PRRs) and 95% confidence intervals (95% CIs) for the association between the knowledge of a casual partner`s seroconcordance and UAIC. UAIC and HIV disclosure significantly increased during 2001-2006. HIV-positive men knew partners were seroconcordant in 54% and assumed it in 13% of sex encounters (42 and 17% among HIV-negative men). Among HIV-positive men, the likelihood of UAIC was higher when a partner`s status was known (Adjusted PRR = 5.17, 95% CI: 3.82-7.01) and assumed seroconcordant because of seroguessing (Adjusted PRR = 3.70, 95% CI: 2.56-5.35) compared with unknown. Among HIV-negative men, the likelihood of UAIC was also higher when a partner`s status was known (Adjusted PRR = 1.88, 95% CI: 1.58-2.24) and assumed seroconcordant (Adjusted PRR = 2.12, 95% CI: 1.72-2.62) compared with unknown. As levels of UAIC remain high, seroguessing increasingly exposes gay men to the risk of HIV infection. Because both HIV-positive and HIV-negative men often seroguess, education and prevention programs should address the fact that HIV-negative men who engage in UAI due to this practice may be at high risk of HIV infection. HIV prevention should take into account these contemporary changes in behaviors, especially among HIV-negative gay men.

  • (2003) Reid, A.; Worth, Heather; McMillan, Karen
    Journal Article

  • (2004) Fin, F; Prestage, Garrett; Pell, Catherine; Donovan, Basil; van der Ven, P.; Kippax, Susan; Kaldor, John; Grulich, Andrew
    Journal Article
    Objectives: To determine the prevalence and incidence of hepatitis A (HAV) and B (HBV) infection and vaccination in HIV-negative homosexual men in Sydney, and associated risk factors. Methods: An open prospective cohort study was conducted among a community-based sample of HIV-negative homosexual men in Sydney in 2001-02. Participants underwent a face-to-face interview, regarding demographics, sexual behavioural risk factors and sexually transmitted infections, and blood samples were collected. They were followed annually. Results: Nine hundred and three men completed a baseline interview by the end of 2002. Among them, 68% were seropositive to hepatitis A. The seroprevalence of prior hepatitis B infection was 19%, and 53% had serological evidence of HBV vaccination. Younger men were much more likely to be seronegative, with 48% and 46% of <25-year-olds being seronegative to HAV and HBV respectively. In multivariate analysis HAV and HBV infection were associated with increasing age, greater number of lifetime sex partners and HBV infection was also associated with previous sexually transmitted infections. HAV vaccination was associated with increasing age, greater number of lifetime sex partners, overseas travel in the last year and self-reported anogenital warts. HBV vaccination was associated with higher occupational status, greater lifetime number of sex partners and previous sexually transmitted infections. Conclusion: Substantial proportions of gay community attached young homosexual men are still at risk of HAV and HBV infection. This study points to a need for vaccination strategies which ensure high levels of hepatitis A and B immunity in young sexually active gay men.

  • (2005) Pell, Catherine; Donovan, Basil; Kippax, Susan; Kaldor, John; Grulich, Andrew; Jin, Feng Yi; Prestage, Garrett
    Journal Article

  • (2009) Mao, Limin; Prestage, Garrett; Donovan, Basil; Imrie, John; Kippax, Susan; Kaldor, John; Grulich, Andrew; Templeton, David; Jin, Feng Yi
    Journal Article
    Objective: To assess circumcision status as a risk factor for HIV seroconversion in homosexual men. Design, setting and participants: The Health in Men (HIM) study was a prospective cohort of homosexual men in Sydney, Australia. HIV-negative men (n = 1426) were recruited primarily from community-based sources between 2001 and 2004 and followed to mid-2007. Participants underwent annual HIV testing, and detailed information on sexual risk behaviour was collected every 6 months. Main outcome measure: HIV incidence in circumcised compared with uncircumcised participants, stratified by whether or not men predominantly practised the insertive role in anal intercourse. Results: There were 53 HIV seroconversions during follow-up; an incidence of 0.78 per 100 person-years. On multivariate analysis controlling for behavioural risk factors, being circumcised was associated with a nonsignificant reduction in risk of HIV seroconversion [hazard ratio 0.78, 95% confidence interval (CI) 0.42-1.45, P = 0.424]. Among one-third of study participants who reported a preference for the insertive role in anal intercourse, being circumcised was associated with a significant reduction in HIV incidence after controlling for age and unprotected anal intercourse (UAI) (hazard ratio 0.11, 95% CI 0.03-0.80, P = 0.041). Those who reported a preference for the insertive role overwhelmingly practised insertive rather than receptive UAI. Conclusions: Overall, circumcision did not significantly reduce the risk of HIV infection in the HIM cohort. However, it was associated with a significant reduction in HIV incidence among those participants who reported a preference for the insertive role in anal intercourse. Circumcision may have a role as an HIV prevention intervention in this subset of homosexual men.

  • (2009) Grulich, Andrew; Templeton, David; Jin, Feng Yi; Prestage, Garrett; Donovan, Basil; Imrie, John; Kippax, Susan; Cunningham, Philip; Kaldor, John; Mindel, Adrian; Cunningham, Anthony
    Journal Article
    BACKGROUND: Circumcision status was examined as an independent risk factor for sexually transmissible infections (STIs) in the Health in Men cohort of homosexual men in Sydney. METHODS: From 2001 through 2004, 1427 initially human immunodeficiency virus (HIV)-negative men were enrolled and followed up until mid-2007. All participants were offered annual STI testing. The history of STIs was collected at baseline, and information on sexual risk behaviors was collected every 6 months. At annual face-to-face visits, participants reported STI diagnoses received during the previous year. RESULTS: Circumcision was not associated with prevalent or incident herpes simplex virus 1, herpes simplex virus 2, or self-reported genital warts. There was also no independent association of circumcision with incident urethral gonorrhea or chlamydia. Being circumcised was associated with a significantly reduced risk of incident (hazard ratio, 0.35 [95% confidence interval, 0.15-0.84]) but not prevalent (odds ratio, 0.71 [95% confidence interval, 0.35-1.44]) syphilis. The association was somewhat stronger among men who reported predominantly insertive unprotected anal intercourse (hazard ratio, 0.10 [95% confidence interval, 0.01-0.82]). CONCLUSIONS: These are the first prospective data obtained from homosexual men to assess circumcision status as a risk factor for STIs. Circumcised men were at reduced risk of incident syphilis but no other prevalent or incident STIs. Circumcision is unlikely to have a substantial public health impact in reducing acquisition of most STIs in homosexual men.

  • (2009) Zablotska, I; Prestage, Garrett; Rawstorne, Patrick; Imrie, John; Kippax, Susan; Donovan, Basil; Templeton, David; Kaldor, John; Grulich, Andrew; Jin, Feng Yi
    Journal Article

  • (2009) Toskin, I; Nashkhoev, Magomed; Lyerla, Rob; Rugg, D; Mathers, Bradley; Degenhardt, Louisa; Adam, Philippe
    Journal Article
    Objectives: The 2001 Declaration of Commitment from the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) set the prevention of HIV infection among injecting drug users (IDUs) as an important priority in the global fight against HIV/AIDS. This article examines data gathered to monitor the fulfillment of this commitment in low-income and middle-income countries (LMICs) where resources to develop an effective response to HIV are limited and where injecting drug use is reported to occur in 99 (of 147) countries, home to 75% of the estimated 15.9 million global IDU population. Methods: Data relating to injecting drug use submitted by LMICs to the Joint United Nations Programme on HIV/AIDS (UNAIDS) in the 2008 reporting round for monitoring the Declaration of Commitment on HIV/AIDS were reviewed. The quality of the data reported was assessed and country data were aggregated and compared to determine progress in HIV prevention efforts. For each indicator, the mean value weighted for the size of each country's IDU population was determined; regional estimates were also made. Results: Reporting was inconsistent between countries. Forty percent of LMIC (40/99), where injecting occurs, reported data for 1 or more of the 5 indicators pertinent to HIV prevention among IDUs. Many of the data reported were excluded from this analysis because the indicators used by countries were not consistent with those defined by UNAIDS Monitoring and Evaluation Reference Group and could not be compared. Data from 32 of 99 countries met our inclusion criteria. These 32 countries account for approximately two-thirds (68%) of the total estimated IDU population in all LMICs. The IDU population weighted means are as follows: 36% of IDUs tested for HIV in the last year; 26% of IDUs reached with HIV prevention programs in the last year; 45% of IDUs with correct HIV prevention knowledge; 37% of IDUs used a condom at last sexual intercourse; and 63% of IDUs used a clean syringe at last injection. Marked variance was observed in the data reported between different regions. Conclusions: Data from the 2008 United Nations General Assembly Special Session reporting round provide a baseline against which future progress might be measured. The data indicate a wide variation in HIV service coverage for IDUs and a wide divergence in HIV knowledge and risk behaviors among IDUs in different countries. Countries should be encouraged and assisted in monitoring and reporting on HIV prevention for IDUs.

  • (2002) Law, Matthew; Prestage, Garrett; Grulich, Andrew; Van De Ven, Paul; Kippax, Susan
    Journal Article