HIV and syphilis infection among gold and diamond miners - Guyana, 2004 / La Infección por sífilis o VIH entre los mineros de oro y diamante - Guyana, 2004

BACKGROUND: Guyana had an estimated HIV prevalence of 1.5% among pregnant women in 2006 (95% confidence interval [CI] = 1.1-1.9). However, a survey of miners in one mine found a 6.5% HIV prevalence in 2002. To determine whether Guyanese miners are at high risk for HIV infection we conducted a HIV and syphilis prevalence survey of miners in several mines. METHODS: Adult male consenting miners in 45 Guyanese mines were interviewed, counselled, tested for HIV and syphilis with rapid tests and provided onsite test results. The survey was cross-sectional and used a multi-stage cluster sampling design; population estimates were calculated using SUDAAN. RESULTS: Of 651 miners approached, 539 (83%) were interviewed and 509 (78%) tested. The estimated prevalence for HIV was 3.9% (CI = 2.1, 7.1) and for life-time syphilis exposure was 6.4% (CI = 4.5, 9.1). Fifty-four per cent (CI = 41.3, 66.7) of miners had casual sex during the preceding year, of whom 44.4% (CI = 34.3, 55.0) had always used condoms with these partners. CONCLUSION: The estimated HIV prevalence among Guyanese miners was higher than that of the general population. Targeted interventions including condom promotion are recommended to prevent further spread of HIV and other sexually transmitted infections among miners.

ANTECEDENTES: Guyana tenía un estimado de prevalencia de VIH de 1.5% entre las mujeres embarazadas en 2006 (95% intervalo de confianza [CI] =1.1-1.9). Sin embargo, una encuesta realizada a mineros en una mina, reveló una prevalencia de un 65% de VIH en 2002. Para determinar si los mineros guyaneses se hallan en un alto riesgo de infección por VIH, llevamos a cabo un estudio de la prevalencia de sífilis y VIH entre los mineros en varias minas. MÉTODOS: Mineros varones adultos en 45 minas guyaneses, fueron entrevistados previo consentimiento, recibieron aconsejamiento (counselling), y fueron sometidos a pruebas de detección de VIH y sífilis mediante tests rápidos que proveyeron resultados en el sitio. La encuesta fue transversal y usó un diseño de muestreo por conglomerados en etapas múltiples. Los estimados de la población fueron calculados usando SUDAAN. RESULTADOS: De 651 mineros abordados, 539 (83%) fueron entrevistados y a 509 (78%) se les aplicó la prueba. El estimado de la prevalencia de VIH fue 3.9% (CI = 2.1, 7.1) y la de la exposición a la sífilis de por vida fue 6.4% (CI = 4.5, 9.1). Cincuenta y cuatro por ciento (CI = 41.3, 66.7) de los mineros tuvieron sexo casual el año anterior, de los cuales 44.4% (CI = 34.3, 55.0) había usado siempre condones con sus parejas. CONCLUSIÓN: La prevelancia estimada de VIH entre los mineros guyaneses fue más alta que la de la población general. Se recomiendan intervenciones, incluyendo la promoción de condones, dirigidas a prevenir la ulterior difusión del VIH y otras enfermedades de trasmisión sexual entre los mineros.

HIV and syphilis infection among gold and diamond miners--Guyana, 2004.

BACKGROUND: Guyana had an estimated HIVprevalence of 1.5% among pregnant women in 2006 (95% confidence interval [CI] = 1.1-1.9). However, a survey of miners in one mine found a 6.5% HIV prevalence in 2002. To determine whether Guyanese miners are at high risk for HIV infection we conducted a HIV and syphilis prevalence survey of miners in several mines. METHODS: Adult male consenting miners in 45 Guyanese mines were interviewed, counselled, tested for HIV and syphilis with rapid tests and provided onsite test results. The survey was cross-sectional and used a multi-stage cluster sampling design; population estimates were calculated using SUDAAN. RESULTS: Of 651 miners approached, 539 (83%) were interviewed and 509 (78%) tested. The estimated prevalence for HIV was 3.9% (CI = 2.1, 7.1) and for life-time syphilis exposure was 6.4% (CI = 4.5, 9.1). Fifty-four per cent (CI = 41.3, 66.7) of miners had casual sex during the preceding year, of whom 44.4% (CI = 34.3, 55.0) had always used condoms with these partners. CONCLUSION: The estimated HIV prevalence among Guyanese miners was higher than that of the general population. Targeted interventions including condom promotion are recommended to prevent further spread of HIV and other sexually transmitted infections among miners.

Evaluation of the consistency of refills for antiretroviral medications in two hospitals in the state of Rio de Janeiro, Brazil.

We conducted a retrospective cohort study using pharmacy records to assess the frequency of delay in picking up antiretroviral (ARV) medication refills from the pharmacy and to identify determinants of delay among HIV-infected patients at two Brazilian hospitals. We selected patients who were on ARV therapy before January 2001 at Nova Iguaçu Hospital (NIPRH) (N = 265) and Evandro Chagas (N=424) Clinical Research Institute. We abstracted medical records and pharmacy data using standardised forms and analysed potential associations between delay in refilling medications and patients' demographic characteristics, type of ARV drug regimen and evolution of HIV disease. Sixty-nine patients (26%) had delays in medication refills >1 month at least once in 2001 at NIPRH compared with 140 (33%) patients at IPEC (p=0.052). No factor was found to be associated with having a delay in medication refill >1 month at NIPRH. At IPEC, delays in medication refill >1 month were associated with a median CD4+ T cell count <200/mm(3) versus >500/mm(3) (adjusted odds ratio (AOR) = 3.8; 95% confidence interval (CI) =1.6-8.9) and with dual protease inhibitor-based ARV regimens versus other regimens (AOR = 4.3; 95% CI = 1.9-9.4). In conclusion, rates of delay in medication refills were similar to rates of adherence to ARV therapy found in other studies in Brazil, suggesting that delay in medication refills could be used as a surrogate for adherence. Analysing ARV medication refills can complement self-reported information on adherence.