Prevalence of HIV and Associated Risk Factors Among Long Distance Truck Drivers in Inchope, Mozambique, 2012.

This is the first integrated biological and behavioral surveillance survey among long-distance truck drivers (LDTD) in Mozambique. Using modified time-location sampling in 2012 at a key transportation junction (Inchope), we enrolled 327 male LDTD. HIV prevalence was 15.4 % (95 % confidence interval : 11.4-19.4 %, n = 318 tested). Among HIV-positive LDTD, 83.7 % did not know their status. One-third of LDTD had never tested for HIV and three-quarters had not received free condoms, lubricants or HIV literature in the past 12 months. In that same period, 61.4 % of LDTD had at least four sexual partners and 27.1 % paid for sex. Among sexually-active LDTD, 76.5 % did not use a condom at last sex. HIV was associated (p < 0.05) with primary education or lower (AOR 2.1), residence in Mozambique (AOR 2.3) and never having tested for HIV (AOR 2.2). Our findings reveal that broader coverage of HIV prevention and comprehensive care services for LDTD are urgently needed.

High Burden of HIV Infection and Risk Behaviors Among Female Sex Workers in Three Main Urban Areas of Mozambique.

This is the first integrated biological and behavioral survey among female sex workers (FSW) in Mozambique. Using respondent-driven sampling, 400, 411 and 429 FSW were enrolled respectively in Maputo, Beira and Nampula in 2011-2012. Estimates were produced using RDSAT 7.1. HIV prevalence was 31.2, 23.6, and 17.8 % in each location respectively. Among HIV-positive FSW, 48.1, 79.8 and 89.6 % in each city, were unaware of their serostatus. Condom use at last sex with a client was 85.8, 73.4 and 62.8 % among FSW, respectively. HIV was associated with current age, age of first sex for money, low educational level, and having had a genital ulcer in the last 6 months. Results suggest the urgent need to increase behavioral and structural interventions in this key population.

Identifying barriers to HIV testing: personal and contextual factors associated with late HIV testing.

Late diagnosis of HIV is associated with increased morbidity, mortality, and health care costs. Despite the availability of HIV testing, persons continue to test late in the course of HIV infection. We used the HIV/AIDS case registry of San Francisco Department of Public Health to identify and recruit 41 persons who developed AIDS within 12 months of their HIV diagnosis to participate in a qualitative and quantitative interview regarding late diagnosis of HIV. Thirty-one of the participants were diagnosed with HIV because of symptomatic disease and 50% of the participants were diagnosed with HIV and AIDS concurrently. Half of the subjects had not been tested for HIV prior to diagnosis. Fear was the most frequently cited barrier to testing. Other barriers included being unaware of improved HIV treatment, free/low cost care, and risk for HIV. Recommendations for health care providers to increase early diagnosis of HIV include routine ascertainment of HIV risk behaviors and testing histories, stronger recommendations for patients to be tested, and incorporating testing into routine medical care. Public health messages to increase testing include publicizing that (1) effective, tolerable, and low cost/free care for HIV is readily available, (2) early diagnosis of HIV improves health outcomes, (3) HIV can be transmitted to persons who engage in unprotected oral and insertive anal sex and unprotected receptive anal intercourse without ejaculation and from HIV-infected persons whose infection is well-controlled with antiretroviral therapy, (4) persons who may be infected based upon these behaviors should be tested following exposure, (5) HIV testing information will be kept private, and (6) encouraging friends and family to get HIV tested is beneficial.

Do people who develop AIDS within 12 months of HIV diagnosis delay HIV testing?

OBJECTIVE: Individuals diagnosed with AIDS within 12 months of HIV diagnosis have been considered "late testers." Prevalence estimates of late testers have been made using HIV/AIDS surveillance data, and high rates of late testing have been reported. However, studies evaluating this definition have not been conducted. We measured the degree of misclassification of delayed testing based on this surveillance definition of late testing. METHODS: We used dates of negative HIV tests among people who met this definition of late testing in San Francisco from 2007 to 2008 to reclassify people as "verified non-late testers" if there was a negative HIV test within five years of HIV diagnosis, as "verified late testers" if there were no prior tests or if negative tests were recorded five or more years prior to diagnosis, or as "late-tester status not verified." We measured misclassification of late-tester status and the prevalence of late testing using the different definitions of late testing. RESULTS: Of the 270 people who developed AIDS within 12 months of HIV diagnosis, we found that 89 (33.0%) were verified late testers, 131 (48.5%) were verified non-late testers, and 50 (18.5%) were unverifiable. Using the surveillance definition (individuals who develop AIDS within 12 months of HIV diagnosis), the prevalence of late testing was 26.3%, whereas it was 9.0% when restricted to individuals verified as late testers. CONCLUSION: Defining people who develop AIDS within 12 months of HIV diagnosis without taking into consideration the dates of prior negative HIV tests leads to substantial misclassification of late testing.