Sex-Specific Pathways Lead to Statural Growth Impairment in Children with Crohn's Disease.

OBJECTIVES: To examine the underlying mechanisms that lead growth impairment to occur more commonly in males than females with Crohn's disease (CD). STUDY DESIGN: Children and adolescents with CD were enrolled in a prospective multicenter longitudinal cohort study. Height Z-score difference was computed as height Z-score based on chronological age (height chronological age-Z-score) minus height Z-score based on bone age (height bone age-Z-score) using longitudinal data. Specific serum cytokines were measured, hormone Z-scores were calculated based on bone age (bone age-Z), and their longitudinal associations were examined. RESULTS: There were 122 children with CD (63% male) who completed 594 visits. The mean ± SD chronological age was 11.70 ± 1.79 years. The mean ± SD height chronological age-Z-score was -0.03 ± 0.99 in males and -0.49 ± 0.87 in females. The mean ± SD height bone age-Z-score was 0.23 ± 0.93 in males and 0.37 ± 0.96 in females. The magnitude of the mean height Z-score difference was greater in females (-0.87 ± 0.94) than males (-0.27 ± 0.90; P = .005), indicating growth was better in females than males. The following negative associations were identified: in females, interleukin (IL)-8 (P < .001) and IL-12p70 (P = .035) with gonadotropin-bone age-Z-scores; IL-8 (P = .010), IL-12p70 (P = .020), and interferon-γ (P = .004) with sex hormone-bone age-Z-scores, and IL-8 (P = .044) and interferon-γ (P < .001) with insulin-like growth factor 1-bone age-Z-scores; in males, IL-1 beta (P = .019) and IL-6 (P = .025) with insulin-like growth factor 1-bone age-Z-scores. CONCLUSIONS: Our data suggest that sex-specific molecular pathways lead to growth impairment in children with CD (primarily growth hormone/insulin-like growth factor-1 axis in males and primarily hypothalamic-pituitary-gonadal axis in females). Mapping these sex-specific molecular pathways may help in the development of sex-specific treatment approaches targeting the underlying inflammation characteristic of CD.

Transgender Women's Experiences Using a Home HIV-Testing Kit for Partner-Testing.

HIV partner-testing (PT) may represent a unique and empowering HIV prevention strategy for groups that face structural and institutional barriers to HIV testing and care, including transgender women. We report on in-depth interviews (IDIs) with N = 10 transgender women who used HIV self-test kits for three months to screen potential sexual partners in a randomized controlled trial (iSUM; "I'll Show You Mine") that took place in New York City and San Juan, Puerto Rico. Participants were assigned to intervention (supplied with 10 self-test kits immediately) or control groups (received 6 test kits after 3 months). We conducted IDIs with the first N = 10 transgender women to enroll in the intervention group after three months in the study (after participants used kits with partners) to understand their experiences. Themes discussed in IDIs included: partners' reaction to HIV testing, participants' reactions to partners' test results or refusal to test, partners' own reaction to their test results, and decision-making around test use. Data were independently analyzed by two coders. Overwhelmingly, participants' experiences with PT was positive. Participants reported kits were convenient and acceptable to most partners. Transgender women felt that PT could pose additional risk for them; one woman experienced violence related to kit use. Furthermore, the availability of kits appeared to encourage participants and their partners to think about their HIV status and, in some cases, modify sexual behavior. Work suggests that HIV PT could be a viable risk-reduction strategy for transgender women.

Few Aggressive or Violent Incidents are Associated with the Use of HIV Self-tests to Screen Sexual Partners Among Key Populations.

Men who have sex with men and transgender women who had multiple sexual partners in the prior 3 months participated in ISUM, a randomized, controlled trial of self- and partner-testing in New York City and San Juan, PR. Only 2% of screened participants were ineligible to enroll due to anticipating they would find it very hard to avoid or handle violence. The intervention group received free rapid HIV self-test kits. During the trial, 114 (88%) of intervention participants who were assessed at follow-up used self-tests with at least one potential partner. Only 6% of participants who asked a partner in person to test reported that at least one of their partners got physically violent, some in the context of sex work. In total, 16 (2%) partners reacted violently. Post-trial, only one participant reported finding it very hard to handle violence, and none found it very hard to avoid potential violence.

Use of Rapid HIV Self-Test to Screen Potential Sexual Partners: Results of the ISUM Study.

ISUM ("I'll show you mine") was a randomized controlled trial in which 272 transgender women and men who have sex with men in New York, NY (NYC) and San Juan, Puerto Rico (SJU) were assigned to an intervention group (n = 136), in which they had access to free HIV self-testing (ST) kits, or to a control group (n = 136). The trial aimed to determine whether the intervention group would use ST to screen sexual partners and have fewer condomless anal intercourse (CAI) occasions with serodiscordant or unknown status partners than the control group. The intervention group had on average 10 (32%) fewer CAI occasions; though clinically relevant, this difference fell short of statistical significance (p = .08). In NYC (n = 166) intervention participants had significantly fewer CAI occasions, whereas in SJU (n = 106) they reported non-significantly more CAI occasions. Two devastating hurricanes hit SJU during the study and may have impacted results in unmeasured ways.

Reseña del estudio "LINKS": Factores asociados a la infección por VIH en hombres que tienen sexo con hombres de Buenos Aires, Argentina / Review of the "LINKS" study: Factors associated with HIV infection in men who have sex with men in Buenos Aires, Argentina

Este artículo resume resultados publicados del proyecto LINKS. Un to-tal de 500 hombres que tienen sexo con hombres se incluyeron en un estudio de factores asociados a la infección por VIH, utilizando la meto-dología de Muestreo Dirigido por los Participantes (Respondent Driven Sampling, RDS, en inglés). El 24,5 % se identificó como homosexual, 36,2 % como bisexual, 21,9 % como heterosexual y 17,4 % como "otro". El 33 % de los participantes reportó haber tenido relaciones sexuales con hombres, mujeres y mujeres trans durante los 2 meses previos. La prevalencia de VIH, hepatitis B y sífilis fue de 17,3 %, 22,9 % y 20,5 %, respectivamente. Los participantes que sólo reportaron parejas sexua-les masculinas tuvieron prevalencias significativamente mayores. Más de dos tercios reportaron coito anal o vaginal sin protección durante los últimos dos meses. El 52 % nunca se había realizado el diagnóstico de VIH. El 25 % informó consumo ex-cesivo de alcohol y 34 % poli-consumo de drogas du-rante los dos meses previos. El 18 % de participantes reportó una experiencia sexual antes de los 13 años con una pareja al menos cuatro años mayor de edad. La aceptabilidad de los microbicidas y de la prueba casera del VIH fue alta

[Summary of the LINKS Study: Factors associated with HIV infection among men who have sex with men in Buenos Aires, Argentina]. / Reseña del estudio "LINKS": Factores asociados a la infección por VIH en hombres que tienen sexo con hombres de Buenos Aires, Argentina.

This article summarizes published findings from Project LINKS. A total of 500 men who have sex with men were recruited through Respondent Driven Sampling into this study on factors associated with HIV infection. Among participants, 24.5 % identified as gay, 36.2 % as bisexual, 21.9 % as heterosexual, and 17.4 % as "other"; 33 % reported having sex with men, women, and transgender women during the prior two months. Prevalence of HIV, Hepatitis B, and syphilis was 17.3 %, 22.9 %, and 20.5 %, respectively; rates were significantly higher among participants who only had male sex partners. Over two-thirds of participants reported unprotected anal or vaginal intercourse during the prior two months, and 52 %had never been tested for HIV. Twenty-five percent reported heavy drinking, and 34 % reported poly-drug use during the past two months. Eighteen percent of participants reported a sexual experience prior to the age of thirteen with a partner who was at least four years older. Acceptability of microbicides and HIV home testing was high.

Rectal-specific microbicide applicator: evaluation and comparison with a vaginal applicator used rectally.

An applicator designed for rectal delivery of microbicides was tested for acceptability by 95 young men who have sex with men, who self-administered 4 mL of placebo gel prior to receptive anal intercourse over 90 days. Subsequently, 24 of the participants self-administered rectally 4 mL of tenofovir or placebo gel over 7 days using a vaginal applicator, and compared both applicators on a Likert scale of 1-10, with 10 the highest rating. Participants reported high likelihood to use either applicator in the future (mean scores 9.3 and 8.8 respectively, p = ns). Those who tested both liked the vaginal applicator significantly more than the rectal applicator (7.8 vs. 5.2, p = 0.003). Improvements in portability, conspicuousness, aesthetics, tip comfort, product assembly and packaging were suggested for both. This rectal-specific applicator was not superior to a vaginal applicator. While likelihood of future use is reportedly high, factors that decrease acceptability may erode product use over time in clinical trials. Further attention is needed to develop user-friendly, quick-acting rectal microbicide delivery systems.

The Motivations and Experiences of Young Women in a Microbicide Trial in the USA and Puerto Rico.

Young women are an important target group in microbicide research, yet little is known about why they participate and stay in microbicide trials. Our study examined motivations for participating in a Phase I microbicide trial among 61 women ages 18 - 24 years in the continental USA and Puerto Rico. We also examined their perspectives on study participation. Participants underwent a semi-structured in-depth interview in which they were asked about factors that motivated enrollment and their experiences while participating. They also completed a Web-based Computer Assisted Self Interview in which they were asked to rate study burden (1 = low to 4 = high). Factors that motivated enrollment were altruism (29%), compensation (17%), a combination of altruism and compensation (37%) and free medical exams (17%). Factors that encouraged participants to stay in the study were study staff (95%), confirmation of good health (41%), and the opportunity to learn about their bodies (17%). Mean ratings of study burden ranged from 1.83 (having to travel to site) to 2.41 (colposcopy), indicating that participants were not highly bothered by visits or procedures. Although Phase I trials require invasive procedures, participants were not highly bothered by them and recognized them as necessary. Good relationships with staff and clear information about how procedures contribute to study goals may encourage participants to remain in trials. Young women may be motivated to enter microbicide trials by stressing the role they will play in discovering better HIV-prevention methods and highlighting the comprehensive preventive exams they will receive.

HIV/AIDS surveillance data for New York City West Indian-born Blacks: comparisons with other immigrant and US-born groups.

OBJECTIVES: Although the risk of HIV among New York City West Indian-born Black immigrants often is assumed to be high, population-based data are lacking, a gap we aimed to address. METHODS: Using 2006-2007 HIV/AIDS surveillance data from the New York City Department of Health and Mental Hygiene and population data from the US Census American Community Survey 2007, we compared the rate of newly reported HIV diagnoses, prevalence of people living with HIV/AIDS, and distribution of transmission risk categories in West Indian-born Blacks, 2 other immigrant groups, and US-born Blacks and Whites. RESULTS: The age-adjusted rate of newly reported HIV diagnoses for West Indian-born Blacks was 43.19 per 100 000 (95% confidence interval [CI] = 38.92, 49.10). This was higher than the rate among US-born Whites (19.96; 95% CI = 18.63, 21.37) and Dominican immigrants and lower than that among US-born Blacks (109.48; 95% CI = 105.02, 114.10) and Haitian immigrants. Heterosexual transmission was the largest risk category in West Indian-born Blacks, accounting for 41% of new diagnoses. CONCLUSIONS: Although much lower than in US-born Blacks, the rate of newly reported HIV diagnoses in West Indian-born Blacks exceeds that among US-born Whites. Additional work is needed to understand the migration-related sources of risk.

HIV and other sexually transmitted infections among men who have sex with men recruited by RDS in Buenos Aires, Argentina: high HIV and HPV infection.

BACKGROUND: The aim of this study was to estimate the prevalence of HIV and other STIs, among MSM from Buenos Aires (2007-2009). METHODS: Responding Driven Sampling was used for recruitment of MSM. Participants completed a structured web-based survey and provided biological samples. RESULTS: A total of 496 MSM were studied for HIV, HBV, HCV, and T. pallidum infections. Chlamydia and HPV diagnoses were only performed in 98 and 109 participants, respectively. Prevalence of HIV was 17.3%, HBV 22.9%, HCV 7.5%, T. pallidum 20.5%, HPV 83.5%, and C. trachomatis 1.7%. In the year prior to the evaluation, 71% of the participants had had sex with men and/or trans and women (MMW) while 29% had not had sex with women (MM). Comparing MM to MMW, prevalence of HIV (30.7% vs. 11.9%, p<0.001), HBV (36.4% vs. 17.8%, p<0.001), T. pallidum (32.1% vs. 15.7%, p<0.001), and HPV (88.3% vs. 70.4%, p = 0.039) were significantly higher among MM, whereas no significant differences were found for HCV and C. trachomatis. The MM group had also significantly higher HIV incidence (5.60 vs. 4.28 per 100 persons-year, p = 0.032). HPV genotypes 16, 6, and 11 were the most frequently found; 40.7% of the MSM had more than one genotype and one high risk genotype was detected in 43.6% of participants. CONCLUSIONS: Both MM and MMW are at high risk of infection for HIV and other STIs. Rates of HIV, HBV, T. pallidum and HPV infections are higher in the MM group.

"Tell Juliana": acceptability of the candidate microbicide VivaGel® and two placebo gels among ethnically diverse, sexually active young women participating in a phase 1 microbicide study.

This study assessed acceptability of the candidate microbicide VivaGel(®) and two placebo gels among 61 sexually active young US and Puerto Rican women at three sites. Participants were randomly assigned to use one of the gels twice per day for 14 days. At trial completion, 59% of the women in the VivaGel(®) group reported being likely to use the gel in the future, whereas 23% were unlikely to use it and 18% were undecided. Participants reported problems with all three gels, including the "universal" placebo containing hydroxyethyl cellulose (HEC). The most frequent complaints were leakage, interference with sexual behavior, and decreased sexual satisfaction. Some of the complaints are not new but remain unresolved. Women's perceived risk of HIV infection may determine whether the gels are used. Users also may want a choice of viscosity. Poor acceptability of vaginal microbicide formulations may result in poor adherence to gel use during efficacy trials and compromise validity of results.

Use of respondent driven sampling (RDS) generates a very diverse sample of men who have sex with men (MSM) in Buenos Aires, Argentina.

BACKGROUND: Prior research focusing on men who have sex with men (MSM) conducted in Buenos Aires, Argentina, used convenience samples that included mainly gay identified men. To increase MSM sample representativeness, we used Respondent Driven Sampling (RDS) for the first time in Argentina. Using RDS, under certain specified conditions, the observed estimates for the percentage of the population with a specific trait are asymptotically unbiased. We describe, the diversity of the recruited sample, from the point of view of sexual orientation, and contrast the different subgroups in terms of their HIV sexual risk behavior. METHODOLOGY: 500 MSM were recruited using RDS. Behavioral data were collected through face-to-face interviews and Web-based CASI. CONCLUSION: In contrast with prior studies, RDS generated a very diverse sample of MSM from a sexual identity perspective. Only 24.5% of participants identified as gay; 36.2% identified as bisexual, 21.9% as heterosexual, and 17.4% were grouped as "other." Gay and non-gay identified MSM differed significantly in their sexual behavior, the former having higher numbers of partners, more frequent sexual contacts and less frequency of condom use. One third of the men (gay, 3%; bisexual, 34%, heterosexual, 51%; other, 49%) reported having had sex with men, women and transvestites in the two months prior to the interview. This population requires further study and, potentially, HIV prevention strategies tailored to such diversity of partnerships. Our results highlight the potential effectiveness of using RDS to reach non-gay identified MSM. They also present lessons learned in the implementation of RDS to recruit MSM concerning both the importance and limitations of formative work, the need to tailor incentives to circumstances of the less affluent potential participants, the need to prevent masking, and the challenge of assessing network size.

Perceived mental illness stigma and HIV risk behaviors among adult psychiatric outpatients in Rio de Janeiro, Brazil.

We examined the associations between perceived mental illness stigma and HIV risk and protective behaviors among adults with severe mental illness (SMI) in Rio de Janeiro, Brazil. We measured mental illness stigma across three domains ("Personal Experiences," "Perceived Attractiveness," and "Relationship Discrimination"), and examined the relationship between experiences of stigma in each domain and HIV risk and protective behaviors over the past 3 months in 98 outpatients with SMI. Those who reported greater "Relationship Discrimination" stigma were significantly more likely to be sexually active and to have unprotected sex; they were significantly less likely to report deliberately having fewer partners as a way to protect themselves from HIV. The role of stigma in unprotected sexual behavior should be examined further and considered in any HIV prevention intervention for people with SMI.