Achieving high acceptability of HIV testing in a population-based survey among immigrants in Finland.

AIMS: The aim of this study was to assess the acceptability of human immunodeficiency virus (HIV) testing among migrants in Finland and the factors contributing to non-acceptance. METHODS: The Finnish Migrant Health and Wellbeing Study 'Maamu' was the first national population-based Health Interview and Examination Survey (HIS/HES) among migrants in Finland. A total of 386 Kurdish, Russian and Somali immigrants in Helsinki participated in the study. RESULTS: Despite the participants' different sociodemographic backgrounds, a high rate of test acceptability (92%, 95% CI 90-95) was achieved. HIV test acceptance was associated with pretest counselling, ability to understand spoken Finnish or Swedish and employment status. No participants tested positive for HIV. CONCLUSIONS: The results imply that a universal HIV testing strategy is well accepted in a low-HIV prevalence immigrant population and can be included in a general health examination in immigrant population-based surveys.

Fever in travelers returning from malaria-endemic areas: don't look for malaria only.

BACKGROUND: Returning travelers with fever pose challenges for clinicians because of the multitude of diagnostic alternatives. Case data in a Finnish tertiary hospital were analyzed in order to define the causes of fever in returned travelers and to evaluate the current diagnostic approach. METHODS: A retrospective study of patient records comprised 462 febrile adults who, after traveling in malaria-endemic areas, were admitted to the Helsinki University Central Hospital (HUCH) emergency room from 2005 to 2009. These patients were identified through requests for malaria smear. RESULTS: The most common groups of diagnoses were acute diarrheal disease (126 patients/27%), systemic febrile illness (95/21%), and respiratory illness (69/15%). The most common specific main diagnosis was Campylobacter infection (40/9%). Malaria was diagnosed in 4% (20/462). Blood culture was positive for bacteria in 5% of those tested (21/428). Eight patients were diagnosed with influenza. HIV-antibodies were tested in 174 patients (38%) and proved positive in 3% of them (5/174, 1% of all patients). The cause of fever was noninfectious in 12 (3%), remaining unknown in 116 (25%). Potentially life-threatening illnesses were diagnosed in 118 patients (26%), the strongest risk factors were baseline C-reactive protein (CRP) ≥100 (OR 3.6; 95% CI 2.0-6.4) and platelet count ≤140 (OR 3.8; 95% CI 2.0-7.3). Nine patients (2%) were treated in high dependency or intensive care units; one died of septicemia. Forty-five patients (10%) had more than one diagnosis. CONCLUSION: The high proportion of patients with more than one diagnosis proves the importance of careful diagnostics. Every fourth returning traveler with fever had a potentially life-threatening illness. Septicemia was as common as malaria. The proportion of HIV cases exceeded the prevalence in population for which Centers for Disease Control and Prevention, USA (CDC) recommends routine HIV testing. Both blood cultures and HIV tests should be considered in febrile travelers.

High prevalence of unprotected sex among Finnish HIV-positive and HIV-negative injecting drug users.

AIMS: To study the prevalence of sexual risk behaviour and to identify factors associated with inconsistent condom use of Finnish injecting drug users (IDUs), and thus to examine the potential of sexual transmission of HIV within and from this population. METHODS: HIV-positive (n = 89) and HIV-negative (n = 207) IDUs from the Helsinki metropolitan area were interviewed using a standardized questionnaire. Determinants of inconsistent condom use in the past 6 months were analyzed with logistic regression. RESULTS: Inconsistent condom use was reported by 63% (39) of HIV-positive and 80% (144) of HIV-negative sexually active IDUs. Unprotected sex was more common in steady relationships (OR 5.6, CI 2.4-13.4). Inconsistent condom use was also associated with recent inpatient addiction treatment especially in the HIV-positive group (OR 15.7, 95% CI 1.7-143.0). Inpatient or outpatient addiction treatment was reported by 72% of the participants. Inconsistent condom use was not associated with age, gender, drug use frequency or markers of marginalization (unstable living, unemployment). CONCLUSIONS: Inconsistent condom use allows for the spread of HIV and other sexually transmitted infections among Finnish IDUs. Addiction treatment programmes should include interventions focused on sexual behaviour to all of their clients. Partners of IDUs should be actively offered HIV counselling and testing.

High plasma HIV load in the CRF01-AE outbreak among injecting drug users in Finland.

An explosive outbreak of HIV-1 caused by the recombinant subtype AE (CRF01-AE) was detected in 1998 among Finnish injecting drug users (IDUs). These IDUs were compared with IDUs from the Amsterdam Cohort Study (ACS) infected with subtype B, to detect possible differences between 2 western IDU cohorts infected with different subtypes. Markers for progression (viral load and CD4+lymphocyte count) were compared between 93 IDUs with CRF01-AE and 63 IDUs with subtype B. Only persons with a seroconversion interval =2 y were included. During 48 months of follow-up, both cohorts were similar in CD4+ cell decline, but the Finnish IDUs had 0.34-0.94 log10 copies/ml higher viral loads. The Amsterdam IDUs had a low viral load (<1000 copies/ml) significantly more often than the Finnish IDUs. The difference could not be explained by the use of antiretrovirals. The higher viral load may have contributed to the rapid spread of the recombinant virus in the Finnish outbreak.