Effectiveness of erectogenic condom against semen exposure among women in Vietnam: Randomized controlled trial.

A key barrier to the consistent use of condoms is their negative effect on sexual pleasure. Although sexual pleasure is a primary motivation for engaging in sex and is an integral part of overall sexual health, most programs to improve sexual health operate within a pregnancy and disease-prevention paradigm. A new condom, CSD500 (Futura Medical Developments; Surrey, UK), containing an erectogenic drug was developed for use among healthy couples to improve sexual pleasure by increasing penile firmness, size and erection duration. We conducted a randomized controlled trial to test whether promoting the novel condom CSD500 for improved sexual pleasure is effective in reducing condomless sex compared to the provision of standard condoms with counseling for pregnancy and disease prevention. We randomized 500 adult, heterosexual, monogamous couples in Thanh Hoa province, Vietnam to receive either CSD500 (n = 248) or standard condoms (n = 252). At enrollment and after 2, 4, and 6 months, we interviewed women and sampled vaginal fluid to test for the presence of prostate-specific antigen (PSA), an objective, biological marker of recent semen exposure. We registered the protocol before trial initiation at ClinicalTrials.gov (identifier: NCT02934620). Overall, 11.0% of women were PSA positive at enrollment. The proportion of follow-up visits with PSA-positivity did not differ between the intervention (6.8%) and control arms (6.7%; relative risk, 1.01; 95% confidence interval, 0.66-1.54). Thus, we found no evidence that promoting an erectogenic condom to women in a monogamous, heterosexual relationship in Vietnam reduced their exposure to their partner's semen. These findings might not hold for other populations, especially those with a higher frequency of condomless sex.

Efficacy of a Family-Based Intervention for HIV Prevention with Hispanic Adolescents with Same Gender Sexual Behaviors.

Despite the availability of efficacious and effective family-based interventions, such interventions are scarce for sexual minority adolescents, particularly among ethnic/racial minorities. Prior to creating an entirely new intervention, a prudent first step may be to determine if existing interventions are efficacious in reducing risk behaviors in sexual minority adolescents. This study assesses the relative efficacy of a general, family-based intervention (Familias Unidas) on improving substance and condom use outcomes among Hispanic adolescents with same gender sexual behaviors (HASGB). Data across five distinct trials of Familias Unidas were synthesized. HASGB were randomized either to an intervention (n = 94) or control condition (n = 100). Mediation analyses tested for intervention efficacy on past 90-day substance (cigarette/alcohol/illicit drug) use and condomless sex at last intercourse in HASGB participants and whether family functioning indicators-parent-adolescent communication, positive parenting, and parental monitoring of peers-mediated the effects. Post hoc analyses explored the moderating role of study target population based on prior risk. Familias Unidas did not impact substance use but significantly reduced condomless sex postintervention relative to the control condition. Hypothesized mediators did not explain this effect. Post hoc analyses indicated that the effect was significant in studies that recruited based on prior risk but not studies that recruited universal samples. Our results suggest that a general, family-based intervention may have positive effects on condom use in HASGB, particularly those with prior indicated risk. Identifying intervention components that drive this effect in addition to developing tailored content for HASGB is needed.

Peer education for HIV prevention among high-risk groups: a systematic review and meta-analysis.

BACKGROUND: Peer education has become a strategy for health promotion among high-risk groups for HIV infection worldwide. However, the extent to which peer education could have an impact on HIV prevention or the long-term effect of this impact is still unknown. This study thus quantifies the impact of peer education over time among high-risk HIV groups globally. METHOD: Following the PRISMA guidelines, a systematic review and meta-analysis was used to assess the effects and duration of peer education. A thorough literature search of PubMed, Web of Science, Embase and Cochrane Library was performed, and studies about peer education on high-risk HIV groups were reviewed. Pooled effects were calculated and the sources of heterogeneity were explored using meta-regression and subgroup analysis. RESULTS: A total of 60 articles with 96,484 subjects were identified, and peer education was associated with 36% decreased rates of HIV infection among overall high risk groups (OR: 0.64; 95%CI: 0.47-0.87). Peer education can promote HIV testing (OR = 3.19; 95%CI:2.13,4.79) and condom use (OR = 2.66, 95% CI: 2.11-3.36) while reduce equipment sharing (OR = 0.50; 95%CI:0.33,0.75) and unprotected sex (OR = 0.82; 95%CI: 0.72-0.94). Time trend analysis revealed that peer education had a consistent effect on behavior change for over 24 months and the different follow-up times were a source of heterogeneity. CONCLUSION: Our study shows that peer education is an effective tool with long-term impact for behavior change among high-risk HIV groups worldwide. Low and middle-income countries are encouraged to conduct large-scale peer education.

Social network interventions for health behaviours and outcomes: A systematic review and meta-analysis.

BACKGROUND: There has been a growing interest in understanding the effects of social networks on health-related behaviour, with a particular backdrop being the emerging prominence of complexity or systems science in public health. Social network interventions specifically use or alter the characteristics of social networks to generate, accelerate, or maintain health behaviours. We conducted a systematic review and meta-analysis to investigate health behaviour outcomes of social network interventions. METHODS AND FINDINGS: We searched eight databases and two trial registries from 1990 to May 28, 2019, for English-language reports of randomised controlled trials (RCTs) and before-and-after studies investigating social network interventions for health behaviours and outcomes. Trials that did not specifically use social networks or that did not include a comparator group were excluded. We screened studies and extracted data from published reports independently. The primary outcome of health behaviours or outcomes at ≤6 months was assessed by random-effects meta-analysis. Secondary outcomes included those measures at >6-12 months and >12 months. This study is registered with the International Prospective Register of Systematic Reviews, PROSPERO: CRD42015023541. We identified 26,503 reports; after exclusion, 37 studies, conducted between 1996 and 2018 from 11 countries, were eligible for analysis, with a total of 53,891 participants (mean age 32.4 years [SD 12.7]; 45.5% females). A range of study designs were included: 27 used RCT/cluster RCT designs, and 10 used other study designs. Eligible studies addressed a variety of health outcomes, in particular sexual health and substance use. Social network interventions showed a significant intervention effect compared with comparator groups for sexual health outcomes. The pooled odds ratio (OR) was 1.46 (95% confidence interval [CI] 1.01-2.11; I2 = 76%) for sexual health outcomes at ≤6 months and OR 1.51 (95% CI 1.27-1.81; I2 = 40%) for sexual health outcomes at >6-12 months. Intervention effects for drug risk outcomes at each time point were not significant. There were also significant intervention effects for some other health outcomes including alcohol misuse, well-being, change in haemoglobin A1c (HbA1c), and smoking cessation. Because of clinical and measurement heterogeneity, it was not appropriate to pool data on these other behaviours in a meta-analysis. For sexual health outcomes, prespecified subgroup analyses were significant for intervention approach (p < 0.001), mean age of participants (p = 0.002), and intervention length (p = 0.05). Overall, 22 of the 37 studies demonstrated a high risk of bias, as measured by the Cochrane Risk of Bias tool. The main study limitations identified were the inclusion of studies of variable quality; difficulty in isolating the effects of specific social network intervention components on health outcomes, as interventions included other active components; and reliance on self-reported outcomes, which have inherent recall and desirability biases. CONCLUSIONS: Our findings suggest that social network interventions can be effective in the short term (<6 months) and longer term (>6 months) for sexual health outcomes. Intervention effects for drug risk outcomes at each time point were not significant. There were also significant intervention effects for some other health outcomes including alcohol misuse, well-being, change in HbA1c, and smoking cessation.

Cash plus: exploring the mechanisms through which a cash transfer plus financial education programme in Tanzania reduced HIV risk for adolescent girls and young women.

INTRODUCTION: Cash transfers have been promoted as a means to reduce HIV risk for adolescent girls and young women (AGYW) in sub-Saharan Africa. One of the main mechanisms whereby they are hypothesized to reduce risk is by deterring transactional sex. In this paper, we use qualitative methods to explore participant experiences, perspectives and reported behaviours of a cash transfer plus financial education programme among out of school, 15- to 23-year-old AGYWs in rural Tanzania with a focus on partner choice and transactional sex. METHODS: We conducted 60 in-depth interviews (IDIs) and 20 narrative timeline interviews with participants of the PEPFAR DREAMS Sauti/WORTH+ cash transfer programme between June 2017 and July 2018. Interviews were taped, transcribed and translated from Kiswahili to English. Transcripts were coded and analysed for key themes. RESULTS: We found that participants in a cash transfer plus programme discussed behaviours that could reduce HIV risk through decreasing their dependence on male sex partners. There appeared to be two main mechanisms for this. One, young women discussed the cash transfer providing for basic needs (e.g. food, toiletries) which appeared to reduce their dependence on male sex partners who previously provided these goods (e.g. transactional sex). This experience was more pronounced among the poorest participants. Two, young women discussed how the financial education/business development aspect of the programme empowered them to refuse some sex partners; unmarried women discussed these experiences more than married women. Social support from family and programme mentors appeared to strengthen young women's ability to successful start businesses, produce income and thus be less dependent on partners. CONCLUSIONS: The cash transfer programme may have reduced AGYW engagement in transactional sex that occurred to meet basic needs (one form of transactional sex). The financial education/business development and mentorship elements of the programme appeared important in building AGYW agency, self-esteem and future orientation which may support AGYWs in refusing unwanted sex partners. Future cash plus programmes should consider adding or strengthening financial education and job skills training, mentorship and future orientation to see stronger and perhaps sustainable outcomes for HIV prevention.

Results of a Couples-Based Randomized Controlled Trial Aimed to Increase Testing for HIV.

BACKGROUND: Although couples HIV testing and counseling (CHTC) is effective for facilitating mutual disclosure and linkage to HIV care, uptake remains low. Using a randomized controlled design, we tested the efficacy of a behavioral couples-based intervention aimed to increase CHTC. SETTING: The Vulindlela district of KwaZulu-Natal, South Africa. METHODS: Couples were recruited from the community (eg, markets and community events). Couples were excluded if mutual HIV serostatus disclosure had occurred. Both partners had to report being each other's primary partner and relationship length was at least 6 months. Assessments occurred at baseline, and 3, 6, and 9 months after intervention. Eligible couples attended a group session (3-4 hours) after which randomization occurred. Intervention couples additionally received: one couples-based group session followed by 4 couples' counseling sessions (1-2 hours). Intervention topics included communication skills, intimate partner violence, and HIV prevention. Our primary outcomes were CHTC and sexual risk behavior. RESULTS: Overall, 334 couples were enrolled. Intervention couples were significantly more likely to have participated in CHTC [42% vs. 12% (P ≤ 0.001)]. In addition, their time to participate in CHTC was significantly shorter (logrank P ≤ 0.0001) (N = 332 couples). By group, 59% of those who tested HIV-positive in intervention and 40% of those who tested in control were new HIV diagnoses (P = 0.18). There were no group differences in unprotected sex. CONCLUSIONS: Our intervention improved CHTC uptake-a vehicle for mutual serostatus disclosure and entrée into HIV treatment, both of which exert a significant public health impact on communities substantially burdened by HIV.

Intervention Reach and Sexual Risk Reduction of a Multi-level, Community-Based HIV Prevention Intervention for Crack Users in San Salvador, El Salvador.

This article examines the effects of a multi-level, community-based HIV prevention intervention for crack users residing in low-income neighborhoods in San Salvador, El Salvador conducted between August 2011 and June 2016. The intervention consisted of three components introduced sequentially: (1) rapid HIV testing in community settings; (2) a social network HIV testing intervention; and (3) small group interventions with crack users who were members of the same social network. The intervention was evaluated with an interrupted time series design in which we used respondent-driven sampling to conduct 7 cross-sectional surveys with crack users along a 3-4 month period for each assessment (total n = 1597). Results revealed a significant increase in exposure to the intervention over time with 50% of the participants reporting exposure to one or more of the three components. Getting an HIV test at the community site was associated with reductions in total times each individual had sex without a condom (p < 0.05) compared to those who had been exposed to no intervention components. Being referred by another crack user through the Social Network HIV intervention was also associated with reductions in total numbers of condomless sex (p < 0.05) The cumulative effect of being exposed to more than one intervention component was associated with reductions in total number of times individuals had condomless sex (p < 0.05). In spite of the high level of intervention reach and that self-reported exposure to intervention components was associated with lower sexual risk, reductions in sexual risk over time were not observed in the full sample, indicating that the penetration of HIV prevention components was not sufficient to produce population level change.

A social systems analysis of implementation of El Salvador's national HIV combination prevention: a research agenda for evaluating Global Health Initiatives.

BACKGROUND: Global Health Initiatives (GHIs) have been instrumental in the rapid acceleration of HIV prevention, treatment access, and availability of care and support services for people living with HIV (PLH) in low and middle income countries (LMIC). These efforts have increasingly used combination prevention approaches that include biomedical, behavioral, social and structural interventions to reduce HIV incidence. However, little research has evaluated their implementation. We report results of qualitative research to examine the implementation of a national HIV combination prevention strategy in El Salvador funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria. METHODS: We conducted in-depth interviews with principal recipients of the funding, members of the Country Coordinating Mechanism (CCM) and front line peer outreach workers and their clients. We analyzed the data using a dynamic systems framework. RESULTS: El Salvador's national HIV combination prevention strategy had three main goals: 1) to decrease the sexual risk behaviors of men who have sex with men (MSM), commercial sex workers (CSW) and transgender women (TW); 2) to increase HIV testing rates among members of these populations and the proportion of PLH who know their status; and 3) to improve linkage to HIV treatment and adherence to antiretroviral therapy (ART). Intervention components to achieve these goals included peer outreach, community prevention centers and specialized STI/HIV clinics, and new adherence and retention protocols for PLH. In each intervention component, we identified several factors which reinforced or diminished intervention efforts. Factors that negatively affected all intervention activities were an increase in violence in El Salvador during implementation of the strategy, resistance to decentralization, and budget constraints. Factors that affected peer outreach and sexual risk reduction were the human resource capacity of grassroots organizations and conflicts of the national HIV strategy with other organizational missions. CONCLUSIONS: Overall, the national strategy improved access to HIV prevention and care through efforts to improve capacity building of grass roots organizations, reduced stigma, and improved coordination among organizations. However, failure to respond to environmental and organizational factors limited the intervention's potential impact.

Behavioral economics-based incentives supported by mobile technology on HIV knowledge and testing frequency among Latino/a men who have sex with men and transgender women: Protocol for a randomized pilot study to test intervention feasibility and acceptability.

BACKGROUND: Mobile Technology and Incentives (MOTIVES) is a randomized pilot study of a mobile technology-based and behavioral economics-supported HIV prevention intervention. Behavioral economics (BE) uses financial incentives in a way that departs from the traditional focus on large monetary payments. Instead, BE suggests that relatively small "nudges" can effectively initiate and sustain behavior change. This pilot study examines the feasibility and acceptability of an HIV prevention intervention that uses text messages in combination with BE incentives to improve retention of HIV prevention information and increase frequency of HIV testing among Latino/a men who have sex with men (MSM) and transgender women (TGW). The pilot will also estimate mission-critical design parameters with point and confidence interval estimates of the intervention to inform a future, fully powered effectiveness study. METHODS: The project will be conducted in collaboration with Bienestar Human Services, Inc. (Bienestar), a non-profit community-based service organization. The intervention is being tested in a small, randomized controlled trial to pilot the intervention's feasibility and acceptability among 200 Latino/a MSM and TGW from Bienestar's HIV testing sites. Information on feasibility will include recruitment, refusal, and retention rates as well as message sending success rates; acceptability will include perceived appropriateness based on responses to the intervention. Participants will be randomized into either the "information only" control group (e.g. receiving text messages with HIV prevention information) or the "information plus" intervention group (e.g. additionally receiving quiz questions that provide the possibility of winning prizes). Participants will be followed for 12 months from enrollment. In addition to using data abstracted from Bienestar's routine data collection mechanisms, we will also collect survey data (blinded outcome assessment) from participants at 0, 6, and 12 months to provide an initial assessment of whether incentives affect their level of HIV knowledge and testing frequency. DISCUSSION: If shown to be acceptable, feasible, and resource-efficient, MOTIVES will provide an innovative way to communicate the latest HIV prevention information and support trimestral HIV screening among Latino/a MSM and TGW. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03144336 . Registered on 5 May 2017.

Reducing Health Risk Behaviors and Improving Depression in Adolescents: A Randomized Controlled Trial in Primary Care Clinics.

Objective: Primary care (PC) is a major service delivery setting that can provide preventive behavioral health care to youths. To explore the hypothesis that reducing health risk behaviors (HRBs) would lower depressive symptoms, and that health risk and depression can be efficiently targeted together in PC, this study (1) evaluates an intervention designed to reduce HRBs among adolescent PC patients with depressive symptoms and (2) examines prospective links between HRBs and depressive symptoms. Method: A Randomized controlled trial was conducted comparing a behavioral health intervention with enhanced Usual PC (UC+). Participants were 187 adolescents (ages 13-18 years) with past-year depression, assessed at baseline, 6 months, and 12 months. Primary outcome was the Health Risk Behavior Index (HRBI), a composite score indexing smoking, substance use, unsafe sex, and obesity risk. Secondary/exploratory outcomes were an index of the first three most correlated behaviors (HRBI-S), each HRB, depressive symptoms, and satisfaction with mental health care. Results: Outcomes were similar at 6 and 12 months, with no significant between-group differences. HRBI, HRBI-S, and depressive symptoms decreased, and satisfaction with mental health care increased across time in both groups. HRBI, HRBI-S, and smoking predicted later severe depression. Conversely, severe depression predicted later HRBI-S and substance use. Conclusions: UC+ and the behavioral health intervention yielded similar benefits in reducing HRBs and depressive symptoms. Findings underscore the bidirectional links between depression and HRBs, supporting the importance of monitoring for HRBs and depression in PC to allow for effective intervention in both areas.

A randomized clinical efficacy trial of a psychosocial intervention to strengthen self-acceptance and reduce HIV risk for MSM in India: study protocol.

BACKGROUND: Men who have sex with men (MSM) in India are a key group at risk for HIV acquisition and transmission. They are also an extremely marginalized and stigmatized population, facing immense psychosocial stressors including, but not limited to, stigma, homophobia, discrimination, criminalization, low self-esteem, low self-acceptance, distress, and, as a result, high rates of mental health problems. Although these multi-level psychosocial problems may put MSM at high risk for HIV acquisition and transmission, currently HIV prevention interventions in India do not address them. This paper describes the design of a psychosocial intervention to reduce HIV risk for MSM in India. METHODS: Funded by the National Institute of Mental Health, this study is a two-arm randomized clinical efficacy trial of a self-acceptance based psychosocial HIV prevention intervention, informed by the minority stress model and syndemic theory, that was developed with extensive community-based formative work and input from the Indian MSM community and key informants who are knowledgeable about the experiences faced by MSM in India. Participants are MSM in Chennai and Mumbai who endorsed recent sexual behaviors placing them at high risk for HIV/sexually transmitted infection (STI) acquisition and transmission. Enrolled participants are equally randomized to either 1) the experimental condition, which consists of four group and six individual counseling sessions and includes standard of care HIV/STI testing and counseling, or 2) the standard of care condition, which includes HIV/STI testing and counseling alone. The primary outcomes are changes in the frequency of condomless anal sex acts and STI incidence (syphilis seropositivity and urethral, rectal, and pharyngeal gonorrhea and chlamydia infection. Major study assessment visits occur at baseline, 4-, 8-, and 12-months. DISCUSSION: HIV prevention interventions that address the psychosocial stressors faced by MSM in India are needed; this study will examine the efficacy of such an intervention. If the intervention is successful, it may be able to reduce the national HIV/AIDS burden in India while empowering a marginalized and highly stigmatized group. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02556294 , registered 22 September 2015.

Uso de cartilha na orientação ao idoso quanto as IST e HIV/AIDS / Use of primer in elderly counseling regarding STIs and HIV / AIDS

Em virtude do crescente aumento da população com mais de 60 anos, atrelado ao grande número de idosos infectados com HIV/Aids faz-se necessário formular novos instrumentos para assistência à saúde da população idosa, que 238 englobem as diferentes condições de saúde, respeitando suas características especiais e peculiares. Os modelos de assistência atual que abrangem promoção, prevenção, assistência e reabilitação não podem ser mecanicamente transportados para os idosos, sem que algumas adaptações importantes e significativas sejam realizadas. A cartilha acerca das infecções permitirá o conhecimento e promoverá mudanças de práticas, ajudando na implementação de políticas públicas, e contribuindo para prevenção e o diagnóstico precoce, com efeito no número de idosos infectados

Revisão sistemática sobre o olhar do idoso acerca das IST e do HIV/AIDS / Systematic review of the elderly's gaze on STIs and HIV/AIDS

Considerando os vários ganhos que a população idosa vem conquistando nas últimas décadas, destaca-se o prolongamento de sua sexualidade ativa, que aponta para importância de trabalhar essa temática de forma mais incisiva. Os resultados deste estudo evidenciam que os serviços de saúde devem atentar para esses usuários com uma perspectiva voltada para longevidade e envelhecimento saudável, abordando medidas preventivas para essas doenças e promovendo ambiente de promoção da saúde, no tocante a hábitos sexuais salutares

Infección por HPV de alto riesgo y lesiones intraepiteliales anales en hombres HIV positivos que tienen sexo con hombres / High Risk GPV infection and anal Intraepithelial lesions in HIV positive men who have sex whit men

Introducción: El cáncer anal, asociado a la infección con virus de papiloma humano de alto riesgo (HPV-AR), es muy frecuente en hombres que tienen sexo con hombres (HSH) HIV+. Objetivo: Evaluar frecuencia de infección por HPV-AR, genotipos y lesiones asociadas, y factores asociados.Materiales y métodos: Estudio en HSH HIV+ (septiembre 2012-marzo 2014, Hospital Fernández). Se recogió información demográfica, de HIV, HPV y prácticas sexuales. Se realizó citología anal, detección de HPV-AR (HC2 High-Risk HPV DNA, Digene®) y genotipificación en las muestras HPV-AR+ (Inno Lipa®, Fujirebio). Los pacientes firmaron consentimiento informado. Se indicó tratamiento según resultados. Resultados: Completaron el estudio 57 pacientes. Mediana de edad: 40 años (rango intercuartil [RIC]: 29-45); de CD4: 444 cels/mm3 (RIC: 345-568); 77% recibían tratamiento antirretroviral, 68% con carga viral no detectable. Citologías: negativas (24%); lesión intraepitelial de bajo grado (54%); lesión intraepitelial de alto grado (20%); ASCUS (2%). El 80% fue HPV-AR+. Los pacientes con diagnóstico de HPV-AR (p=0,006) y de lesión intraepitelial tuvieron CD4 <500 cels/mm3 con más frecuencia (p=0,030). Los pacientes con HPV-AR tuvieron mayor frecuencia de carga viral detectable (p=0,020, prueba de Fisher). El porcentaje de pacientes con uso consistente de preservativo fue mayor entre los pacientes sin lesión citológica (p=0,026). Genotipos de alto riesgo más frecuentes: HPV-16 (51%), HPV-31 (44%) y HPV-51 (40%); de bajo riesgo: HPV-6 (47%) y HPV-44 (35%).Conclusiones: Se encontró elevada frecuencia de lesión citológica (76%) y de HPV-AR (80%). Es necesario establecer estrategias de prevención en esta población incluyendo tamizaje, vacunación y promoción de sexo seguro.Palabras clave: HIV, lesión intraepitelial anal, HPV, citología anal, tamizaje de cáncer anal, hombres que tienen sexo con hombre

ntroduction: Anal cancer, associated with the infection with high risk Human Papillomavirus (HR-HPV), is very frequent among HIV+ men who have sex with men (MSM). Objective: To evaluate the frequency of HR-HPV infection, presence of HPV genotypes and HPV- associated lesions and associated factors.Methods: Study in HIV+ MSM (September 2012- March 2014, Hospital Fernández). Demographical, HIV, HPV and sexual behaviour information was collected. Cytology, HR-HPV detection (HC2 High-Risk HPV DNA, Digene ®) and genotyping was performed on samples positive for HR-HPV (Inno Lipa®, Fujirebio). All patients signed informed consent. Treatment was provided according to results.Results: Fifty-seven patients completed the study. Median age was 40 years old (interquartile range [IQR]: 29-45); median CD4 cell count: 444 cels/mm3 (IQR: 345-568); 77% were under ARV treatment, 68% with undetectable viral load. Cytology results: 24% negative, 54% low grade intraepithelial lesion, 20% high grade intraepithelial lesion, 2% ASCUS. Eighty percent were HR-HPV+. Patients with HR-HPV (p=0,006) and diagnosis of intraepithelial lesion had more frequent CD4 <500 cels/mm3 (p=0,030). Patients diagnosed with HR-HPV had a higher frequency of detectable viral load (p=0,020, prueba de Fisher). The percentage of patients with consistent condom use was higher among patients without cytological lesion (p=0,026).Most frequent high risk genotypes: HPV-16 (51%), HPV-31 (44%) and HPV-51 (40%); low risk genotypes HPV-6 (47%) and HPV-44 (35%).Conclusions: There was high frequency of cytological lesions (76%) and HR-HPV (80%). It is necessary to promote prevention strategies in this population including screening, vaccine and safe sex promotion

Minority Stressors Associated with Sexual Risk Behaviors and HIV Testing in a U.S. Sample of Transgender Individuals.

The majority of published research on transgender health focuses on associations between external minority stressors (e.g., discrimination) and health. Little is known about how internal minority stressors (e.g., identity concealment and expecting rejection) might predict HIV disparities. The current study addresses this gap by examining the association between external and internal minority stressors and sexual risk behaviors and HIV testing history in a sample of 300 transgender adults across the U.S. Transgender-related discrimination and expecting rejection were associated with sexual risk behaviors. When controlling for covariates, none of the minority stressors were associated with HIV testing. Results illustrate how minority stress, both external and internal, may operate uniquely for transgender individuals.

Conductas sexuales de riesgo asociadas a las infecciones de transmisión sexual en adolescentes de una comunidad / Risky sexual behaviors associated to sexually transmitted infections among adolescents in a community

Introducción:Las infecciones de transmisión sexual constituyen un grupo heterogéneo de enfermedades de extrema importancia para la salud pública mundial dada su magnitud, trascendencia y repercusión para el paciente, la familia y la sociedad. Afectan con mayor frecuencia a los adolescentes. Objetivo: Identificar conductas de riesgo asociadas a las ITS en la adolescencia. Material y métodos: Se realizó un estudio analítico de casos de estudio y control para evaluar conductas de riesgos asociadas a las ITS en adolescentes del policlínico California. Se aplicó un cuestionario semiestructurado y anónimo, para la recogida de información, los resultados fueron representados en tablas, calculándose pruebas de significación estadísticas. Resultados: El mayor número estudiado fue entre 18 y 19 años (47.0 por ciento); 50.5 por ciento presentaban cambios frecuentes de parejas; 48 por ciento mantenían relaciones sexuales desprotegidas; la percepción de riesgos de adquirir una ITS, tanto en el grupo de estudio y control fue de 23,2 por ciento y 40,3 por ciento respectivamente. Conclusiones: Las relaciones sexuales no protegidas y los cambios frecuentes de parejas constituyeron conductas sexuales de riesgos relacionadas con las Infecciones de Transmisión Sexual(AU)

Introduction: Sexually transmitted infections constitute a heterogeneous group of diseases of extreme importance for the world public health due to their magnitude, consequence, and repercussion for the patient, the family, and the society. Adolescents are more highly affected by them. Objective: To identify risky behaviors associated to STI in the adolescence. Material and Methods: An analytical case-control study was conducted to evaluate risky behaviors associated to STI in adolescents in California Polyclinic. A semi-structured and anonymous questionnaire was used to attain information, and the results were represented in charts in which significant statistics were calculated. Results: The greatest number studied was the one of 18 and 19 years of age (47.0 percent); 50.5 percent presented frequent changes in their couples; 48 percent maintained unprotected sexual relations; the risk perception of acquiring a STI both in the study and the control group was 23,2 percent and 40,3 percent, respectively. Conclusions: Unprotected sexual relations and frequent changes in couples were the risky sexual behaviors related to Sexually Transmitted Infections.

Trabajadores del sexo y salud pública: intersecciones, vulnerabilidades y resistencia / Sex workers and public health: intersections, vulnerabilities and resistance

RESUMEN Desde el siglo XIX, con la sífilis y, más recientemente, con el sida, lxs trabajadorxs del sexo pasaron a ser vistos como medios de transmisión de enfermedades y como un problema de salud pública que requiere intervención. Sin embargo, las investigaciones han demostrado que, en los países occidentales, la tasa de VIH en personas involucradas con la venta de sexo es baja, con excepción de grupos específicos, como los consumidores de drogas por vía inyectable. Además, se han puesto en evidencia los riesgos a los que están sometidos lxs trabajadorxs del sexo, por vía de la estigmatización o de otras formas de violencia. En este artículo, a partir de una etnografía urbana con trabajadorxs del sexo de calle, llevada a cabo en la ciudad de Porto (Portugal) entre 2004 y 2005, discutimos las vulnerabilidades sociales, laborales y jurídicas que afectan a las personas involucradas en el comercio del sexo y cómo interfieren en su salud. Nos centraremos en las estrategias de lxs trabajadorxs del sexo para minimizar los riesgos para la salud y el discurso de resistencia en el combate a las vulnerabilidades.

ABSTRACT Since the 19th century with syphilis and most recently with AIDS, sex workers have been seen as a means for disease transmission and a public health problem that requires intervention. However, researchers have shown that in Western countries, HIV rates in people involved in commercial sex are low, except for in specific groups, such as intravenous drug users. Moreover, the risks faced by sex workers due to stigmatization and other forms of violence have been put into evidence. Based on an urban ethnography with street sex workers carried out in Porto (Portugal), between 2004 and 2005, this article discusses the social, labor, and legal vulnerabilities affecting people involved in commercial sex and how these interfere with their health. Focus is placed on the strategies used by sex workers to minimize health risks and their discourses of resistance in fighting vulnerabilities.

Conjugalidade e HIV/AIDs: a desmesura do amor e a delicadeza da dor / Conjugality and HIV/AIDS: on disproportionality of love and tenderness of pain / Conyugalidad y el VIH/SIDA: el carácter excesivo del amor y la delicadeza del dolor

Este trabalho objetiva aprofundar o entendimento sobre os impactos subjetivos do diagnóstico de soropositividade para HIV/Aids, tanto para o sujeito, ao se descobrir portador do vírus,quanto para o seu parceiro. Participou desta pesquisa um casal homossexual masculino, que mantinha relacionamento afetivo-sexual consensualmente aberto e não preventivo, que descobriu que um de seus membros tinha HIV/Aids. Os instrumentos utilizados para a coleta de dados foram a entrevista semidirigida, a observação participante e o diário de campo. O discurso do casal foi compreendido a partir da analítica descritiva, na perspectiva foucaultiana. Os resultados evidenciaram que o diagnóstico de infecção pelo HIV foi um momento doloroso, de agonia e profunda tristeza, mas que, por outro lado, permitiu a ressignificação e construção de um novo estilo de vida. Procurou-se pensar o HIV/Aids para além de uma doença do corpo, mas como uma prática discursiva produtora de subjetividade, entrelaçada às relações sociais e atravessamentos históricos e culturais.

This paper aims to get further on understanding subjective impact on an individual and his partner when diagnosed HIV positive. Participants were a male homosexual couple who was dealing with the discovery of HIV/AIDS in one of the subjects in that relationship. They have kept a love and sexual relationship which was consensually an opened one (by means of sexual encounters) and without any use of sexual protection. Instruments used to collect data were semi-directed interviews, participant observation and field diary. Couple ́s discourse was understood using a descriptive-analytic approach in a Foucauldian perspective. Results pointed out a painful, full of agony and deep sadness moment when HIV diagnose came out, and nevertheless it allowed a construction of a new life style. We consider HIV/AIDS to be much more than a disease of the body; we also take it as a discursive practice producing subjectivity related to social relations as much as historical and cultural crossovers.

Este estudio tiene como objetivo profundizar en la comprensión del impacto subjetivo del diagnóstico de seropositividad para VIH/SIDA, tanto para el sujeto que se descubre portador del virus cuanto para su pareja amorosa. Los participantes fueran una pareja homosexual masculina que mantuvo relación afectivo-sexual consensuada abierta y no preventiva y descubrió que uno de los miembros tenía el VIH/SIDA. Los instrumentos utilizados para la recolección de datos fueron entrevistas semiestructuradas, observación participante y el diario de campo. El discurso de la pareja se analizó desde el punto de vista analítico descriptivo en la perspectiva de Foucault. Los resultados mostraron que el diagnóstico de la infección por el VIH fue un momento doloroso, de agonía y tristeza profunda, pero, por otro lado, permitió la construcción de un nuevo estilo de vida. Buscamos pensar el síndrome del VIH/SIDA más allá de una enfermedad del cuerpo, sino como una práctica discursiva que produce subjetividad, entrelazada a las relaciones sociales y los cambios históricos y culturales.

Práticas de risco e imunização contra hepatite B em mulheres profissionais do sexo / Risk practices and immunization against hepatitis B among female sex workers

Identificar o uso da vacina contra hepatite B e práticas de risco entre mulheres profissionais do sexo. Métodos: pesquisa transversal, utilizando-se a metodologia Respondent Driven Sampling. Foram estudadas 153 profissionais do sexo. Resultados: as práticas de risco foram relacionadas ao início precoce de atividades sexuais, múltiplas parceiros com até 17 clientes por semana 34(22,2%), sem uso do preservativo9(5,9%), 124(81,0%) compartilhavam objetos cortantes e 53(34,6%) não reportaram vacina contra hepatite B. Conclusão: as profissionais do sexo encontravam-se expostas a várias situações de risco ao vírus da hepatite B, em função da falta de esquema vacinal, precocidade sexual, múltiplos parceiros sexuais sem uso de preservativo, compartilhamento de objetos cortantes. Urge investir na promoção da saúde, com orientação sobre a importância da realização da vacina, adoção de medidas protetivas e ampliação do acesso das profissionais do sexo às unidades de saúde.

Objective: to identify the use of hepatitis B vaccine and risk practices among female sex workers. Methods: cross-sectional research using the Respondent Driven Sampling methodology. One-hundred and fifty-three sex workers were studied. Results: risk practices were related to the early onset of sexual activity, multiple partners with up to 17 clients per week 34 (22.2%), lack of use of condom 9 (5.9%), 124 (81.0%) shared sharps and 53 (34.6%) reported no vaccine against hepatitis B. Conclusion: sex workers found themselves exposed to various risk situations to the hepatitis B virus, due to the lack of immunization schedule, sexual precocity, multiple sex partners lack of use of condom, habit of sharing sharp objects. It is urgent to invest in health promotion with guidance on the importance of the vaccine, the adoption of protective measures and increased access of sex workers to health facilities.

Does screening for and intervening with multiple health compromising behaviours and mental health disorders amongst young people attending primary care improve health outcomes? A systematic review.

BACKGROUND: Adolescence and young adulthood are important developmental periods. Screening for health compromising behaviours and mental health disorders during routine primary care visits has the potential to assist clinicians to identify areas of concern and provide appropriate interventions. The objective of this systematic review is to investigate whether screening and subsequent interventions for multiple health compromising behaviours and mental health disorders in primary care settings improves the health outcomes of young people. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, literature searches were conducted in Medline, PsycINFO, Scopus and Cochrane Library databases (Prospero registration number CRD42013005828) using search terms representing four thematic concepts: primary care, young people, screening, and mental health and health compromising behaviour. To be eligible for inclusion, studies had to: include a measure of health outcome; include at least 75 % of participants aged under 25 years; use a screening tool that assessed more than one health domain; and be conducted within a primary care setting. Risk of bias was assessed using the Quality Rating Scale. RESULTS: From 5051 articles identified, nine studies fulfilled the inclusion criteria and were reviewed: two randomised controlled trials (RCTs), one pilot RCT, two clustered RCTs, one randomised study with multiple intervention groups and no control group, one cluster RCT with two active arms, one longitudinal study and one pre-post study. Seven studies, including two RCTs and one clustered RCT, found positive changes in substance use, diet, sexual health or risky sexual behaviour, alcohol-related risky behaviour, social stress, stress management, helmet use, sleep and exercise. Of only two studies reporting on harms, one reported a negative health outcome of increased alcohol use. CONCLUSIONS: There is some evidence that the use of screening and intervention with young people for mental health disorder or health compromising behaviours in clinical settings improves health outcomes. Along with other evidence that young people value discussions of health risks with their providers, these discussions should be part of the routine primary care of young people. Further quality studies are needed to strengthen this evidence.