Delivering integrated strategies from a mobile unit to address the intertwining epidemics of HIV and addiction in people who inject drugs: the HPTN 094 randomized controlled trial protocol (the INTEGRA Study).

BACKGROUND: Persons with opioid use disorders who inject drugs (PWID) in the United States (US) face multiple and intertwining health risks. These include interference with consistent access, linkage, and retention to health care including medication for opioid use disorder (MOUD), HIV prevention using pre-exposure prophylaxis (PrEP), and testing and treatment for sexually transmitted infections (STIs). Most services, when available, including those that address substance misuse, HIV prevention, and STIs, are often provided in multiple locations that may be difficult to access, which further challenges sustained health for PWID. HPTN 094 (INTEGRA) is a study designed to test the efficacy of an integrated, "whole-person" strategy that provides integrated HIV prevention including antiretroviral therapy (ART), PrEP, MOUD, and STI testing and treatment from a mobile health delivery unit ("mobile unit") with peer navigation compared to peer navigation alone to access these services at brick and mortar locations. METHODS: HPTN 094 (INTEGRA) is a two-arm, randomized controlled trial in 5 US cities where approximately 400 PWID without HIV are assigned either to an experimental condition that delivers 26 weeks of "one-stop" integrated health services combined with peer navigation and delivered in a mobile unit or to an active control condition using peer navigation only for 26 weeks to the same set of services delivered in community settings. The primary outcomes include being alive and retained in MOUD and PrEP at 26 weeks post-randomization. Secondary outcomes measure the durability of intervention effects at 52 weeks following randomization. DISCUSSION: This trial responds to a need for evidence on using a "whole-person" strategy for delivering integrated HIV prevention and substance use treatment, while testing the use of a mobile unit that meets out-of-treatment PWID wherever they might be and links them to care systems and/or harm reduction services. Findings will be important in guiding policy for engaging PWID in HIV prevention or care, substance use treatment, and STI testing and treatment by addressing the intertwined epidemics of addiction and HIV among those who have many physical and geographic barriers to access care. TRIAL REGISTRATION: ClinicalTrials.gov NCT04804072 . Registered on 18 March 2021.

Unmet sexual health needs of young men in contemporary society regarding condom use: Qualitative study.

OBJECTIVE: In contemporary societies young men receive much misleading information about sex from friends, the media and the internet (porn) which can make them feel insecure and under pressure regarding sex. The purpose of this study is therefore to understand their sexual world better and learn about their sexual health needs, especially regarding condom use. METHODS: The study is based on two qualitative studies: focus groups and individual interviews. Recruitment of participants took place through schools, a Sexually Transmitted Infection (STI) Clinic and a Gay and Lesbian Organisation. The interviews were thematically analysed using the framework method. RESULTS: Forty-nine individuals, 18-25 years old, participated in both studies. The findings showed that the participants had a number of unmet needs regarding condom use which reduced this use. They described uncertainty regarding condom use by not prioritising them, showing lack of knowledge and communication skills. It was of high priority for them to seek sexual pleasure and not be disturbed in the process of having sex. CONCLUSIONS: The results suggest that young men have a great need to perform sexually and not to fail. This need represents insecurity in a sexual relationship. When insecurity, inability to communicate and feeling under pressure come together using a condom is not prioritised. These young men are in great need of holistic sex education that would enable them to become secure in mastering condom use.

Digital Triage Tools for Sexually Transmitted Infection Testing Compared With General Practitioners' Advice: Vignette-Based Qualitative Study With Interviews Among General Practitioners.

BACKGROUND: Digital triage tools for sexually transmitted infection (STI) testing can potentially be used as a substitute for the triage that general practitioners (GPs) perform to lower their work pressure. The studied tool is based on medical guidelines. The same guidelines support GPs' decision-making process. However, research has shown that GPs make decisions from a holistic perspective and, therefore, do not always adhere to those guidelines. To have a high-quality digital triage tool that results in an efficient care process, it is important to learn more about GPs' decision-making process. OBJECTIVE: The first objective was to identify whether the advice of the studied digital triage tool aligned with GPs' daily medical practice. The second objective was to learn which factors influence GPs' decisions regarding referral for diagnostic testing. In addition, this study provides insights into GPs' decision-making process. METHODS: A qualitative vignette-based study using semistructured interviews was conducted. In total, 6 vignettes representing patient cases were discussed with the participants (GPs). The participants needed to think aloud whether they would advise an STI test for the patient and why. A thematic analysis was conducted on the transcripts of the interviews. The vignette patient cases were also passed through the digital triage tool, resulting in advice to test or not for an STI. A comparison was made between the advice of the tool and that of the participants. RESULTS: In total, 10 interviews were conducted. Participants (GPs) had a mean age of 48.30 (SD 11.88) years. For 3 vignettes, the advice of the digital triage tool and of all participants was the same. In those vignettes, the patients' risk factors were sufficiently clear for the participants to advise the same as the digital tool. For 3 vignettes, the advice of the digital tool differed from that of the participants. Patient-related factors that influenced the participants' decision-making process were the patient's anxiety, young age, and willingness to be tested. Participants would test at a lower threshold than the triage tool because of those factors. Sometimes, participants wanted more information than was provided in the vignette or would like to conduct a physical examination. These elements were not part of the digital triage tool. CONCLUSIONS: The advice to conduct a diagnostic STI test differed between a digital triage tool and GPs. The digital triage tool considered only medical guidelines, whereas GPs were open to discussion reasoning from a holistic perspective. The GPs' decision-making process was influenced by patients' anxiety, willingness to be tested, and age. On the basis of these results, we believe that the digital triage tool for STI testing could support GPs and even replace consultations in the future. Further research must substantiate how this can be done safely.

Characterizing Socioecological Markers of Differentiated HIV Risk Among Men Who Have Sex with Men in Indonesia.

HIV prevention programs typically focus on changing individuals' risk behaviors, often without considering the socioecological factors that can moderate this risk. We characterized HIV risk among men who have sex with men (MSM) in Indonesia (n = 1314) using latent class analysis and used multinomial logistic regression to identify latent class relationships with demographics, social/sexual networks, and community-level socioecological indicators of HIV risk. Three HIV risk latent classes were identified-"Sexually Moderate" (n = 333), "Sexual Explorative" (n = 575), and "Navigating Complexities" (n = 406). Using "Sexually Moderate" (lowest risk) as the reference group, MSM in the "Sexual Explorative" class had additional social/sexual network-level risks (meeting partner(s) using both online and offline methods [RR = 3.8; 95%CI 1.7-8.6] or general social media and gay-specific online platforms [RR = 2.6; 95%CI 1.9-3.6] to meet partners, group sex [RR = 10.9; 95%CI 4.5-25.4], transactional sex [RR = 1.6; 95%CI 1.2-2.2]), and community-level risks (experiencing homosexual-related assaults [RR = 1.4; 95%CI 1.1-1.9]). MSM in the "Navigating Complexities" class had additional social/sexual network-level risks (low social support [RR = 1.6; 95%CI 1.1-2.5], less disclosure of their sexuality [RR = 1.4; 95%CI 1.0-1.9]) and community-level risks (higher internalized homonegativity scores [RR = 1.2; 95%CI 1.1-1.4], ever experiencing homosexual-related assaults [RR = 1.4:95%CI 1.1-1.9], less exposure to HIV/STI health promotion [RR = 0.7; 95%CI 0.5-0.9], attending STI-related services in the past 6 months [RR = 0.6; 95%CI 0.4-0.8]). Co-occurring individual and socioecological risk recommend holistic HIV prevention strategies tailored to consider the social and structural conditions of MSM in Indonesia are needed.

Increasing Spiritual Beliefs are Associated With Lower HIV Incidence Among Black Men Who Have Sex With Men: Results From HPTN 061 Longitudinal Study.

BACKGROUND: There is a limited understanding about the impact of spiritual beliefs and activities on HIV seroconversion among black men who have sex with men (BMSM), which we investigate in this study. SETTING: United States. METHODS: The HIV Prevention Trials Network Study 061 collected demographic and biomedical assessments among BMSM across 6 United States cities for longitudinal analysis. Spiritual beliefs and spiritual activities are constructed composite scales. Bivariate analyses among 894 who provided data at 12-month follow-up compared men who seroconverted to HIV between baseline and 6 months with those who remained uninfected with HIV at 12 months. Cox proportional hazard regression among 944 men tested spiritual beliefs and activities on the longitudinal risk of HIV seroconversion adjusting for age and any sexually transmitted infection (STI). RESULTS: Among this sample, HIV incidence between baseline and 6 months was 1.69%, (95% confidence intervals [CI]: 1.04 to 2.77). Men who seroconverted to HIV were significantly younger than those who remained uninfected at the 12-month follow-up: (mean age 27, SD = 11 vs 37, SD = 12) and a higher proportion reported any STI (46.67% vs 11.39%, P < 0.01). A one-unit increase in spiritual beliefs was associated with lower hazard rate of seroconverting to HIV at follow-up [adjusted hazard ratio (aHR) = 0.37, 95% CI: = (0.16 to 0.87)]. Religious service attendance and spiritual activities were unrelated to seroconverting. CONCLUSIONS: Spirituality is important in the lives of BMSM. Biomedical and behavioral HIV prevention interventions should consider assessing spiritual beliefs in HIV care among BMSM.

Rebound in sexually transmitted infections after the COVID-19 pandemic.

Sexually transmitted infections (STIs) have become the second in the global rating of infectious diseases after respiratory infections. Globally, over 1 million, new STI is diagnosed every day. Although four conditions are the most representative and of obligatory declaration (gonorrhea, syphilis, chlamydia, and human immunodeficiency virus [HIV]), there are many other prevalent STI, including trichomona, herpes simplex, papillomavirus, and viral hepatitis. Herein, we perform a narrative and retrospective review, analyzing information from public databases from distinct Spanish government institutions. STI significantly declined in Spain during 2020 as a result of lockdown and social isolation measures dictated in response to the COVID-19 pandemic. After releasing restrictions, a major STI rebound occurred in 2021. Increases were 49% for gonorrhea, 45% for HIV, 39% for chlamydia, and 32% for syphilis. Based on nationwide statistics, we build a narrative review of the recent STI surge after COVID-19. In summary, we propose a holistic approach to confront the current re-emergence of STI. On one hand, new innovative medical advances must be implemented, including new rapid tests, novel vaccines, pre-exposure prophylaxis beyond HIV, and long-acting antivirals. On the other hand, information to citizens needs to be reformulated with interventions aimed to build a healthier society, alike it has been undertaken with tobacco, alcohol, diet, and lifestyle. STI determines important sexual, reproductive, and maternal-child health consequences. To promote human well-being or flourishing, the education of adolescents and young adults should be aligned with human ecology. Therefore, it is urgent to address new approaches in sexual health that represent a clear benefit for individual persons and society. In this way, favoring a cultural evolution aimed to delay the age of first sexual intercourse and the avoidance of multiple sex partners should be prioritized.

'Taking Care': A qualitative study of emerging adult-aged women's sexual and reproductive health definitions.

OBJECTIVE: Emerging adult-aged (EA;18-25 years) women have disproportionately high rates of unintended pregnancy and sexually transmitted infections compared to other women of reproductive age. Little is known about how EA women define and prioritize various aspects of sexual and reproductive health. The purpose of this study was to identify EA women determined definitions of sexual and reproductive health. METHODS: Between September 2019 and September 2020, 13 women were interviewed about their sexual and reproductive health. Interview transcripts were used to conduct qualitative content analysis. RESULTS: Definitions provided by participants were grouped according to three distinct thematic categories, Being Safe, Healthcare as a Tool, and Mind-Body Connection. Being Safe included using condoms and taking steps to prevent sexually transmitted infections. Healthcare as a Tool referred to utilization of healthcare services (e.g., an annual exam) to manage sexual and reproductive health. Mind-Body Connection included acknowledgement of both the physical and mental aspects of sexual and reproductive health, as well as awareness of physical and emotional discomfort related to it. These categories highlight EA women's holistic definitions of sexual and reproductive health. CONCLUSIONS: Healthcare providers and researchers can use the holistic sexual and reproductive health definitions endorsed by EA women in this study as a starting point for creating and delivering sexual and reproductive healthcare and counseling that is developmentally appropriate and sensitive to population-specific needs.

Development of an HIV/STI and partner violence health promotion intervention for abused US Virgin Islands women.

Women in the US Virgin Islands (USVI) experience intimate partner violence (IPV) and human immunodeficiency virus (HIV) at disproportionate rates compared to women on the US mainland. Women in violent relationships report experiencing controlling behaviours that decrease their ability to negotiate for sex using condoms or to prevent unwanted pregnancies. Though several evidence-based interventions exist to prevent either IPV or HIV, few address them through an integrated health promotion approach or attend to particular USVI cultural mores. This article describes the systematic development of a theory based, culturally tailored, integrated health promotion intervention that addresses IPV and HIV among USVI women experiencing abuse. The process included: (i) identifying and integrating evidence-based health promotion interventions, (ii) conducting formative research using focus groups, (iii) synthesizing focus group data to inform intervention development and (iv) developing a culturally and linguistically appropriate intervention specific to the needs and concerns of USVI women. The Empowered Sisters Project: Making Choices Reducing Risks (ESP) was developed through this research. ESP is a three-session health promotion curriculum focussed on enhancing sexual health and safety among women experiencing abuse. The ESP intervention components included promoting condom use, increasing IPV and HIV knowledge and developing a personalized safety plan. Health professionals facilitated individual intervention sessions using culturally tailored visual media and scripts. This program focussed on experiences of women living in the USVI and has implications for utility across the Caribbean diaspora.

Ensino sobre Infecções Sexualmente Transmissíveis Incuráveis para Estudantes de Graduação em Enfermagem: Protocolo de revisão de escopo / Enseñanza sobre infecciones de transmisión sexual incurables para estudiantes de grado en enfermería: Protocolo de revisión del alcance / Teaching about Incurable Sexually-Transmitted Infections to Undergraduate Nursing Students: Scoping Review Protocol

Introdução: O enfermeiro possui um papel fundamental na prevenção de Infecções Sexualmente Transmissíveis incuráveis; porém, para que sua atuação seja efetiva, faz-se necessária uma educação de qualidade com infraestrutura adequada. Objetivo: Mapear estudos no âmbito mundial que abordem o ensino das Infecções Sexualmente Transmissíveis Incuráveis para estudantes de graduação em enfermagem. Metodologia: Protocolo de revisão do escopo de acordo com a metodologia do Joanna Briggs Institute. A estratégia de busca será aplicada nas bases de dados Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, Embase, Web of Science e Literatura Latino-Americana e do Caribe em Ciências da Saúde; assim como bases de dados de literatura cinzenta (e.g., Research Gate, OpenGrey). Serão considerados estudos que abordem o ensino das Infecções Sexualmente Transmissíveis Incuráveis voltados para estudantes de graduação em enfermagem no mundo. Serão considerados estudos de acesso público disponibilizados de 1981 até 2020. Dois revisores independentes farão a triagem dos artigos de acordo com os critérios de inclusão pré-definidos, extrairão e farão a análise de dados. A apresentação dos dados será por meio de figura e quadros conforme o Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Resultados: Os resultados provenientes deste estudo possibilitarão o conhecimento amplo sobre a educação dos estudantes de enfermagem relacionada com as infecções sexualmente transmissíveis incuráveis, assim como com as metodologias utilizadas e efetividade das mesmas. Conclusão: Este estudo pode contribuir para melhoria de metodologias, infraestrutura e currículos de ensino sobre infecções sexualmente transmissíveis incuráveis para estudantes de enfermagem.

Introducción: Las personas profesionales en enfermería tienen un rol fundamental en la prevención de las infecciones de transmisión sexual incurables; sin embargo, para que su desempeño sea efectivo es necesaria una educación de calidad con infraestructura adecuada. Objetivo: Mapear estudios a nivel mundial que aborden la enseñanza de las infecciones de transmisión sexual incurables para estudiantes de graduación en enfermería. Metodología: Protocolo de revisión de alcance según la metodología del Instituto Joanna Briggs. La estrategia de búsqueda se aplicará a las bases de datos Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, Embase, Web of Science y Literatura Latinoamericana y del Caribe en Ciencias de la Salud, así como bases de datos de literatura gris (p. ej., Research Gate, OpenGrey). Se considerán estudios que aborden la enseñanza de las infecciones de transmisión sexual incurables dirigida a estudiantes de graduación en enfermería de todo el mundo. Así como, los estudios de acceso público disponibles desde 1981 hasta 2020. Dos revisores independientes examinarán los artículos, de acuerdo con los criterios de elegibilidad predefinidos, extraerán y analizarán los datos. La presentación de los datos será a través de una figura y tablas de acuerdo al Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Resultados: Los resultados de este estudio permitirán un amplio conocimiento sobre la enseñanza de las infecciones de transmisión sexual incurables a estudiantes de enfermería, así como sobre las metodologías utilizadas y su efectividad. Conclusión: Este estudio puede contribuir para la mejora de las metodologías, la infraestructura y los currículos de enseñanza de las infecciones de transmisión sexual incurables para estudiantes de enfermería.

Introduction: Nurses have a fundamental role in the prevention of incurable sexually-transmitted infections; however, for their performance to be effective, quality education with adequate infrastructure is required. Objective: To map out the worldwide studies that address the teaching of incurable sexually-transmitted infections to undergraduate nursing students. Methodology: Scoping review protocol according to the Joanna Briggs Institute methodology. The search strategy will be applied to the Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, Embase, Web of Science and Latin American and Caribbean Literature in Health Sciences databases, as well as to the gray literature databases (e.g., Research Gate, OpenGrey). This document will address those studies addressing the teaching of incurable sexually-transmitted infections aimed at undergraduate nursing students around the world; it will also consider the public access studies from 1981 to 2020 available. Two independent reviewers will screen the articles according to pre-defined inclusion criteria; they will also extract and analyze the data. The presentation of data will be through figures and tables according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Results: The results from this study will grant broad knowledge about the teaching of incurable sexually-transmitted infections to nursing students, as well as the methodologies used and their effectiveness. Conclusion: This study can contribute to the improvement of methodologies, infrastructure, and teaching curricula of incurable sexually-transmitted infections to nursing students.

Multidrug-Resistant Trichomoniasis: Successful Treatment With 3 Months of Twice-Daily Intravaginal Boric Acid.

ABSTRACT: Trichomoniasis is the most common nonviral sexually transmitted infection. 1 For patients with resistance to standard treatment with 5-nitroimidazoles, alternative therapies are limited. We present a case of a 34-year-old woman with multidrug-resistant trichomoniasis who was successfully treated with 600 mg intravaginal boric acid twice daily for 3 months.

Alcohol and drug use during sex and its association with sexually transmitted infections: a retrospective cohort study among young people aged under 25 years visiting Dutch STI clinics.

INTRODUCTION: Alcohol use and drug use are common behaviours among young people. STI positivity is higher in young people than in people aged above 25 years. While there is an increasing amount of knowledge about drug use during sex among men who have sex with men (MSM), data on this behaviour among young women and heterosexual men are scarce. Therefore, this study aims to assess the proportion and characteristics of women and heterosexual men aged under 25 years reporting alcohol and/or drug use during sex and its association with STI positivity. METHODS: Surveillance data of heterosexual individuals younger than 25 years visiting two Dutch STI clinics between 2016 and 2019 were assessed (n=11 714). We used multivariable logistic regression analyses to assess associations between alcohol and drug use during sex and STI positivity (Chlamydia trachomatis and/or Neisseria gonorrhoeae diagnosis), adjusting for sociodemographic characteristics (sex, age, ethnicity, educational level, socioeconomic status and urbanisation) and sexual behaviour (condom use, number of sex partners). RESULTS: Alcohol use during sex was reported by 45.3% (5311/11 714; 49.5% in men vs 43.2% in women, p<0.001) and drug use during sex by 22.0% (2580/11 714; 30.7% in men vs 17.6% in women, p<0.001). The most reported drugs were cannabis (17.9%), ecstasy (XTC)/methylenedioxymethamphetamine (MDMA) (6.9%) and cocaine (4.7%). The use of at least one of the following drugs (XTC/MDMA, cocaine, speed, ketamine, gamma-hydroxybutyrate (GHB)/gamma-butyrolactone (GBL), heroin, crystal meth and/or designer drugs) was significantly associated with STI positivity after adjustment for sociodemographic characteristics (adjusted OR (aOR): 1.3, 95% CI 1.1 to 1.4), but this association did not remain significant after adjustment for sexual behaviour (aOR: 1.12, 95% CI 0.94 to 1.34). Significant associations between drug use during sex and inconsistent condom (aOR: 2.5, 95% CI 1.9 to 3.2) use and having four or more sex partners (aOR: 3.2, 95% CI 2.8 to 3.6) in the past 6 months were assessed. DISCUSSION: Alcohol and drug use during sex was highly prevalent among young women and heterosexual men visiting the STI clinic and drug use during sex was associated with an increased risk for STI, probably mediated by sexual behaviour. This indicates that a holistic health promotion strategy, addressing STI prevention and alcohol and drug use-related harm reduction, is important in this group. STI clinics should address this behaviour not only among MSM, but also among young women and heterosexual men.

Syndemic Conditions and Their Association with HIV/STI Sexual Risk Behaviors Among Transgender Women and Cisgender Men Sex Workers in Catalonia: The SexCohort Project.

BACKGROUND: Transgender women and cisgender men sex workers are vulnerable to HIV and sexually transmitted infections (STIs). This study aimed to explore in depth the prevalence of syndemic conditions and their association with the sexual risk behaviors for HIV/STI acquisition in cis men and trans women sex workers in Barcelona (Catalonia, Spain). METHOD: We conducted a study between 2014 and 2018 to determine whether syndemic conditions (frequent alcohol consumption and polydrug use (> 2) during sex with clients; experience of violence; and lack of healthcare access) are associated with HIV/STI sexual risk behaviors. A "syndemic index" was calculated based on the cumulative number of syndemic conditions (0 to 4). RESULTS: In the last year (2018), 78.8% of cisgender men and 68.1% of transgender women reported at least one syndemic condition. The most prevalent syndemic factor in both cisgender men and transgender women was violence (38.8% and 43.6% respectively). In multivariable analysis, an association was found between condomless anal sex and violence (aOR = 1.81), and frequent alcohol consumption and violence with reporting > 10 clients/week (aOR = 2.73 and 1.88, respectively). The higher the number of syndemic factors, the greater probability of having > 10 clients/week and reporting condomless anal sex with clients. CONCLUSION: Psychosocial conditions have a syndemic effect on risky sexual behaviors highlighting the need for a more holistic approach to HIV/STI prevention targeting these populations.

Militância enquanto convite ao diálogo: o caso da militância monodissidente / Activism as an invitation for the dialogue: the case of monodissident activism / La militancia como invitación al diálogo: el caso de la militancia monodisidente

Este artigo é uma produção teórica de caráter reflexivo que focaliza a relação entre pesquisa e militância a partir do construtivismo semiótico-cultural em psicologia, tendo como base o caso da militância monodissidente. A noção de monodissidência foi cunhada no percurso da militância bissexual para se referir a uma ferramenta analítica de ordem político-comunitária que contempla todas as pessoas que se atraem sexual e/ou romanticamente por mais de um gênero. São contrapostas concepções distintas de militância político-social em psicologia: de um lado, militância é entendida a partir de um autocentramento do militante, vinculado a uma rede de exclusões, negações, vedação e defesas psicológicas em relação à experiência; de outro, há uma compreensão dialógica de militância. Metodologicamente, a proposta de pesquisa se fundamenta no campo da participação observante, entendendo que o pesquisador está, primeiro, na condição de participante de certo campo sociocultural, a partir do qual passa a observar e refletir sobre fenômenos que ocorrem nele. Tomamos como ilustração a trajetória de construção da militância monodissidente do primeiro autor, trazendo tensionamentos dialógicos para a análise, postos em discussão com outras reflexões situadas sobre o tema. O conjunto de tensionamentos dialógicos emergidos nesse percurso foi mapeado e compreendido como um processo de multiplicação dialógica no encontro de self pesquisador com o self militante.(AU)

This paper is a theoretical production of reflective character that focuses on the relationship between research and activism from the semiotic-cultural constructivism in psychology, based on the case of monodissident activism. The notion of monodissent was coined during bisexual activism to refer to an analytical tool of a political-community order that includes all people who are sexually and/or romantically attracted to more than one gender. Different conceptions of political-social activism in psychology are opposed: on the one hand, activism is understood from the militant's self-centeredness, linked to a network of exclusions, denials, gatekeeping, and psychological defenses regarding experience; on the other hand, there is a dialogical understanding of activism. Methodologically, the research proposal is based on the field of observant participation, understanding that the researcher is, first, in the condition of a participant in a certain sociocultural field, from which he starts to observe and reflect on phenomena that occur there. We take as an illustration the trajectory of the construction of the monodissident activism of the first author, bringing dialogical tensions to the analysis, discussed with other reflections on the subject. The set of dialogic tensions that emerged in this path was mapped and understood as a process of dialogic multiplication in the encounter of the researcher self with the activist self.(AU)

Este artículo realiza una producción teórica y reflexiva sobre la relación entre investigación y activismo desde el constructivismo semiótico-cultural en Psicología, a partir del caso del activismo monodisidente. La noción de monodisidencia fue acuñada en el transcurso de la militancia bisexual para referirse a una herramienta analítica de orden político-comunitario que incluye a todas las personas que se sienten atraídas sexual y / o románticamente por más de un género. Se contraponen distintas concepciones de la militancia político-social en Psicología: por un lado, la militancia se entiende desde el egocentrismo del militante, vinculado a un entramado de exclusiones, negaciones, sellamientos y defensas psicológicas con relación a la experiencia; por otro, existe una comprensión dialógica de la militancia. La investigación utiliza como metodología la participación del observador, entendiendo que el investigador se encuentra, en primer lugar, en la condición de participante de determinado campo sociocultural, desde donde comienza a observar y reflexionar sobre los fenómenos que allí ocurren. Tomamos como ilustración la trayectoria de la construcción de la militancia monodisidente del primer autor, trayendo tensiones dialógicas al análisis, discutidas con otras reflexiones sobre el tema. El conjunto de tensiones dialógicas que surgieron en este camino se caracteriza y se comprende como un proceso de multiplicación dialógica en el encuentro del self investigador con el self militante.(AU)

ß-Caryophyllene: A Therapeutic Alternative for Intestinal Barrier Dysfunction Caused by Obesity.

Obesity is an excessive accumulation of fat that exacerbates the metabolic and inflammatory processes. Studies associate these processes with conditions and dysregulation in the intestinal tract, increased concentrations of lipopolysaccharides (LPSs) in the blood, differences in the abundance of intestinal microbiota, and the production of secondary metabolites such as short-chain fatty acids. ß-Caryophyllene (BCP) is a natural sesquiterpene with anti-inflammatory properties and with the potential purpose of fighting metabolic diseases. A diet-induced obesity model was performed in 16-week-old C57BL/6 mice administered with BCP [50 mg/kg]. A reduction in the expression of Claudin-1 was observed in the group with a high-fat diet (HFD), which was caused by the administration of BCP; besides BCP, the phylaAkkermansia and Bacteroidetes decreased between the groups with a standard diet (STD) vs. HFD. Nevertheless, the use of BCP in the STD increased the expression of these phyla with respect to fatty acids; a similar effect was observed, in the HFD group that had a decreasing concentration that was restored with the use of BCP. The levels of endotoxemia and serum leptin increased in the HFD group, while in the HFD + BCP group, similar values were found to those of the STD group, attributing the ability to reduce these in conditions of obesity.

Profiles and health risks (STIs, HCV, HIV) of injecting drug users.

OBJECTIVE: The aim of this article is twofold: to present the sociodemographic profiles of people who inject drugs (PWID) in Togo and to assess the prevalence of health risks (sexually transmitted infections [STIs], the hepatitis C virus, and HIV), the problems linked to drug injection, and the factors characterizing PWIDs. PARTICIPANTS AND METHODS: Using a questionnaire, this cross-sectional descriptive study was conducted on 384 PWIDs in Togo. The questionnaire focused on sociodemographic characteristics, consumption history, and known health problems and risks. Snowball sampling allowed for data collection in all regions of the country. RESULTS: In the sampling, the results revealed prevalence of 17% for STIs and 53% for the hepatitis C virus. The onset of medical problems and STI signs was significantly triggered when the person was female, over 25 years of age, polygamous, not attending school, unemployed, and had been using drugs for more than five years. Moreover, reused injection equipment was shown to be associated with the high STI prevalence. CONCLUSION: Drug injection is dangerous and results in numerous health problems. This study shows that PWID vulnerability of stems from specific characteristics, such as being uneducated, single, unemployed, bereft of parents, and having a low monthly income. Additional research is required to further investigate the health risks associated with drug injection in view of providing PWIDs with comprehensive care.

The impact of alfentanil supplementation on the sedation of bronchoscopy: A meta-analysis of randomized controlled trials.

BACKGROUND: The efficacy of alfentanil supplementation for the sedation of bronchoscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of alfentanil supplementation on the sedation during bronchoscopy. METHODS: We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through December 2019 for randomized controlled trials (RCTs) assessing the effect of alfentanil supplementation versus placebo for the sedation during bronchoscopy. This meta-analysis is performed using the random-effect model. RESULTS: Five RCTs are included in the meta-analysis. Overall, compared with control group for bronchoscopy, alfentanyl supplementation is associated with significantly reduced coughing scores (Std. MD = -0.55; 95% CI = -0.96 to -0.14; P = 0.009) and dose of propofol (Std. MD = -0.34; 95% CI = -0.64 to -0.04; P = 0.03), but reveals the increase in hypoxemia (RR = 1.56; 95% CI = 1.17 to 2.08; P = 0.002). CONCLUSIONS: Alfentanyl supplementation benefits to reduce coughing scores and dose of propofol for bronchoscopy, but increases the incidence of hypoxemia. The use of alfentanyl supplementation for bronchoscopy should be with caution.

Married men's sexual and reproductive health concerns and related health-seeking behavior in Bangladesh: A mixed methods study.

BACKGROUND: In Bangladesh, men's sexual and reproductive health (SRH) needs and related services are often neglected. Little is known of men's SRH concerns, and of the phenomenal growth of the informal and private health actors in the provision of sexual health services to men in rural and urban areas of Bangladesh. METHODS: Using a mixed methods approach, a survey of 311 married men in three rural and urban sites was conducted in three different districts of Bangladesh and 60 in-depth interviews were conducted to understand their SRH concerns and choice of providers to seek treatment. RESULTS: The research findings reveal that- men's various SRH concerns are embedded in psychosocial and cultural concerns about their masculinity and expectations of themselves as sexual beings, with worries about performance, loss of semen and virility being dominant concerns. Sexually transmitted infections (STIs) were also mentioned as a concern but ranked much lower. Informal providers such as village doctors (rural medical practitioners and palli chikitsoks), drug store salespeople, homeopaths, traditional healers (Ojha/pir/fakir, kabiraj, totka) and street sellers of medicines are popular, accessible and dominate the supply chain. CONCLUSION: There is a need of appropriate interventions to address men's anxieties and worries about their sexual abilities, well-being and choice of providers. This would go a long way to address and alleviate concerns, as well as identify and push men to seek  formal care for asymptomatic STIs, and thereby reduce costs incurred and gender tensions in households.

Prevalence of genital and oral human papillomavirus infection among psoriasis patients on biologic therapy.

Current knowledge about human papillomavirus (HPV) infection in psoriasis patients treated with biologics is limited. In this study we evaluated the prevalence of oral and genital HPV infection in psoriasis patients treated with biologics or topical therapy for at least 6 months. The presence of HPV DNA in oral rinse and genital smears was evaluated. In total, 267 patients who met the inclusion criteria and agreed to participate were enrolled: 110 (41.2%) on topical therapy, 84 (31.5%) on anti-TNF-alpha therapy, 31 (11.6%) on anti-IL-12/23 therapy and 42 (15.7%) on anti-IL-17 therapy. The presence of genital HPV infection was detected in 34.6% of men receiving anti-TNF-α treatment, in 25.0% of patients on anti-IL-12/23 and 18.8% of patients on anti-IL-17 therapy. The difference in prevalence was not statistically different from men on topical treatment (26.3%). Prevalence of oral HPV infection was higher across all of the biologic groups (11.9% for anti-TNF-α, 12.9% for anti-IL-12/23 and 19.0% for anti-IL-17) compared to patients on topical therapy (7.3%), but statistically significant only for anti-IL-17 (p < 0.05). The presence of oral HPV infection in patients treated with biologics was significantly higher (44.0%) in patients on long-term biologic treatment (>8 years) compared to patients taking biologics for a shorter period (9.1%; p < 0.01). Our results suggest that patients on biologics for psoriasis have a higher prevalence of oral HPV infection compared to patients on topical treatment. Long-term treatment with biologics seems to be associated with a higher prevalence of oral HPV infection, independent of previous conventional immunosuppressive therapy.

Maternal free fatty acid concentration during pregnancy is associated with newborn hypothalamic microstructure in humans.

OBJECTIVE: This study tested the hypothesis, in a prospective cohort study design, that maternal saturated free fatty acid (sFFA) concentration during pregnancy is prospectively associated with offspring (newborn) hypothalamic (HTH) microstructure and to explore the functional relevance of this association with respect to early-childhood body fat percentage (BF%). METHODS: In N = 94 healthy newborns (born mean 39.3 [SD 1.5] weeks gestation), diffusion-weighted magnetic resonance imaging was performed shortly after birth (25.3 [12.5] postnatal days), and a subgroup (n = 37) underwent a dual-energy x-ray absorptiometry scan in early childhood (4.7 [SD 0.7] years). Maternal sFFA concentration during pregnancy was quantified in fasting blood samples via liquid chromatography-mass spectrometry. Infant HTH microstructural integrity was characterized using mean diffusivity (MD). Multiple linear regression was used to test the association between maternal sFFA and HTH MD, accounting for newborn sex, age at scan, mean white matter MD, and image quality. Multiple linear regression models also tested the association between HTH MD and early-childhood BF%, accounting for breastfeeding status. RESULTS: Maternal sFFA during pregnancy accounted for 8.3% of the variation in newborn HTH MD (ß-std = 0.25; p = 0.006). Furthermore, newborn HTH MD prospectively accounted for 15% of the variation in early-childhood BF% (ß-std = 0.32; p = 0.019). CONCLUSIONS: These findings suggest that maternal overnutrition during pregnancy may influence the development of the fetal hypothalamus, which, in turn, may have clinical relevance for childhood obesity risk.

Plan estratégico nacional multisectorial de VIH e ITS 2022-2026 / National multisectoral strategic plan for HIV and STIs 2022-2026

El Plan Estratégico Nacional Multisectorial de VIH e ITS 2022-2026 (PENM 2022-2026) constituye la síntesis del esfuerzo nacional y multisectorial, el cual responde a las necesidades identificadas y expuestas por los diferentes sectores que trabajan la respuesta nacional al VIH, el presente plan permitirá afrontar la prevalencia e incidencia de casos por el Virus de Inmunodeficiencia humana (VIH) y de otras infecciones de transmisión sexual (ITS). El presente plan cuenta con mecanismos de respuesta en los diferentes momentos de la "Cascada del continuo de la atención": diagnóstico, confirmación, vinculación a una clínica de atención integral, retención en el Sistema Nacional Integrado de Salud, promoción de la adherencia al tratamiento en los servicios de salud y supresión viral. Su elaboración se ha basado en una posición consolidada de los compromisos gubernamentales con la respuesta al VIH, manifestada de diversas formas, tales como la sostenibilidad de la respuesta al VIH, posicionamiento político definido y acciones impulsoras de la participación de la sociedad civil y los diferentes actores de la vida social y económica del país

The National Multisectoral Strategic Plan for HIV and STIs 2022-2026 (PENM 2022-2026) constitutes the synthesis of the national and multisectoral effort, which responds to the needs identified and exposed by the different sectors that work the national response to HIV, the present The plan will make it possible to address the prevalence and incidence of cases of the Human Immunodeficiency Virus (HIV) and other sexually transmitted infections (STIs). This plan has response mechanisms at the different moments of the "Cascade of the continuum of care": diagnosis, confirmation, link to a comprehensive care clinic, retention in the National Integrated Health System, promotion of adherence to treatment in health services and viral suppression. Its preparation has been based on a consolidated position of government commitments to the response to HIV, manifested in various ways, such as the sustainability of the response to HIV, a defined political position and actions that promote the participation of civil society and the different actors of the social and economic life of the country