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1.
Clin Lab ; 66(12)2020 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-33337847

RESUMEN

BACKGROUND: Human papillomavirus (HPV) is a major risk factor for cervical dysplasia and invasive cervical cancer; therefore, regular screening by cervical smear cytology or HPV testing is recommended. We aimed to determine the overall and risk group-specific HPV prevalence, age distribution, and temporal trends and to appraise the correlation of HPV positivity with abnormal cervical cytological findings. METHODS: This retrospective, single-center study involved a total of 751 women (aged 18 - 67) concurrently subjected to HPV DNA testing and cervical cytology evaluation over a 10-year period in Zagreb, Croatia. Digene HC2 HPV DNA test (Qiagen Corporation, USA) was employed in screening specimens for both low-risk and high-risk HPV risk groups. The cytology was reported using the Bethesda system and in accordance with uniform classification of uterine cervix cytological findings in Croatia "Zagreb 2002". Statistical significance was set at p < 0.05. RESULTS: The overall HPV prevalence in our study population was 48.6%, and the 18 - 30 age group presented with the highest infection burden (p = 0.046). A decrease in low-risk and high-risk mono-positivity has been observed over the 10-year period; conversely, there was a significant increase in low-risk/high-risk co-positivity (p = 0.007). Low-risk/high-risk HPV co-infection resulted in a compounding effect which increased the occurrence of abnormal cells, HPV-associated changes and low grade squamous intraepithelial lesions (LSIL/cervical intraepithelial neoplasia grade I) in cervical cytology when compared to mono-infection with either low-risk or high-risk HPV. On the other hand, such effect has not been demonstrated for high grade squamous intraepithelial lesions (HSIL/ cervical intraepithelial neoplasia grades II and III). CONCLUSIONS: The overall HPV prevalence in female outpatients was high, underscored with rising co-positivity rates. Such co-infection with both low-risk and high-risk HPV (predominantly seen in women younger than 30) can exhibit a compounding effect in the occurrence of cytological abnormalities and low grade squamous intra-epithelial lesions (LSIL), which has to be considered in future diagnostic and screening algorithms.

2.
BMC Public Health ; 20(1): 1604, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33097015

RESUMEN

BACKGROUND: There are limited data globally on HIV in men who engage in casual and transactional sex with female tourists. METHODS: In 2018 we carried out a respondent-driven sampling (RDS) survey among beach boys in Galle, Sri Lanka, to determine prevalence of HIV and other infections, HIV risk behaviours and utilisation of HIV prevention services. Eligibility criteria included men who cruise in and around beach areas and who had anal and/or vaginal sex with female or male tourists in the 12 months before the survey. RESULTS: We recruited 373 beach boys. Approximately 49.6% of the participants were married, while 45.7% were single and 4.7% divorced, separated or widowed. A lower percentage of beach boys reported regular partners in the past 12 months (52.3%) compared to casual partners (95.4%). Condom use at last sex with a casual partner was higher (76.7%) compared to condom use with regular partners (58.3%). Condom use at last sex with a tourist was reported by 75.3%. Ever receiving money, goods or services in exchange for sex was reported by 39.7%. For 85.5% of beach boys who sold sex, the last paying partner was a tourist (85.5%) and a woman (82.0%). In the past 12 months before the survey, 32.3% of beach boys paid money for sex, and 99.5% did so from women. Ever been tested for HIV was reported by 35.3, and 69.1% of those were tested in the 6 months before the survey. In the adjusted multivariate analysis, significant correlates of never testing for HIV were lack of comprehensive knowledge about HIV and unprotected last sexual intercourse with tourists. The prevalent infections were: HIV, 0.3% (95% CI 0.0-0.4%); syphilis, 0.5% (0.0-1.2%); herpes virus type-2, 5.0% (2.5-7.5%). CONCLUSIONS: There are low level HIV and syphilis prevalence among beach boys in Galle but a high level of sexual risk taking. Beach boys may be acting as a bridge for HIV transmission between higher-risk groups (paying female tourists, men who have sex with men) and lower-risk heterosexual female population in Sri Lanka. More research is needed in South-East Asia on men who trade sexual services to female and male tourists.

3.
PLoS One ; 15(10): e0239951, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33002081

RESUMEN

Sri Lanka has a low-level HIV epidemic. This study aims to provide evidence on HIV, syphilis and hepatitis B (HBV) prevalence, sexual risk behaviours and utilisation of HIV prevention interventions among female sex workers (FSW) in the cities Colombo, Galle, and Kandy. Using respondent-driven sampling (RDS), we recruited a total of 458 FSW in Colombo, 360 in Galle and 362 in Kandy from November 2017 to March 2018. Participants provided biological specimens for testing for infections and completed a behavioural questionnaire. We found no HIV nor HBV infections in Galle and Kandy, and low HIV (0.4%) and HBV surface antigen (0.6%) prevalence in Colombo. FSW in Colombo had higher positivity on Treponema pallidum-particle agglutination test (8.4%) compared to Galle (2.0%) and Kandy (2.5%). About two thirds of FSW heard of HIV in each of the cities. Around 90% of FSW used condom at last sex with a client in both Colombo and Galle, but considerably less in Kandy (57.1%). However, lower proportion of FSW used condoms every time during sex with clients in the past 30 day: 22.9% of FSW in Colombo, 26.6% in Kandy and 68.4% in Galle. Across cities, 17.5%-39.5% of FSW reported being tested for HIV in the past 12 months or knowing HIV positive status. The commonest reasons for never testing for HIV was not knowing where to test (54.2% in Colombo, 41.8% in Galle, 48.1% in Kandy) followed by inconvenient testing location (23.7% in Colombo and 31.1% in Kandy). HIV has not yet been firmly established among FSW in three cities in Sri Lanka, but the vulnerability towards HIV and STIs is substantial. HIV interventions should be intensified by expanding community-based HIV testing approaches, increasingawareness of HIV risks and addressing socio-structural vulnerabilities of FSW to HIV.


Asunto(s)
Seropositividad para VIH/epidemiología , Hepatitis B/epidemiología , Trabajadores Sexuales/estadística & datos numéricos , Sífilis/epidemiología , Serodiagnóstico del SIDA/estadística & datos numéricos , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Sri Lanka , Serodiagnóstico de la Sífilis/estadística & datos numéricos , Sexo Inseguro/estadística & datos numéricos
4.
PLoS One ; 15(1): e0227689, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31940404

RESUMEN

We implemented population size estimation of female sex workers (FSW) and transgender women (TGW) in Sri Lanka in 2018 using several approaches (geographical mapping, service and unique object multiplier and a modified Delphi method during the stakeholder consensus meeting). Mapping was done in 49 randomly selected Divisional Secretariats, which provided a basis for extrapolation of size estimates to the national level. Two types of adjustments were applied on the mean (minimum-maximum) population estimate obtained during mapping: (1) an adjustment for mobility to reduce double counting of FSW and TGW frequenting multiple spots, obtained during mapping; (2) an adjustment for "a hidden population", obtained from surveys among FSW and TGW. For the multiplier method, we used data from services of non-governmental organisations that FSW and TGW were in contact with, and surveys based on respondent-driven sampling. Surveys were carried out in the cities of Colombo (FSW, TGW), Kandy (FSW), Galle (FSW) and Jaffna (TGW). We estimated that there are 30,000 FSWs in Sri Lanka, with a plausible range of 20,000-35,000, which implies a prevalence of FSW of 0.56% (0.37-0.65%) among adult females. This study provided baseline estimates of 2,200 TGW in the country, with a plausible range of 2,000-3,500, which is 0.04% (0.04-0.07%) of adult male population. Our estimates of the proportional contribution of the FSW and TGW populations among the adult population in Sri Lanka are consistent with the The Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended estimates for Asia and the Pacific. The results provide an important point for macro- and micro-level planning of HIV services, allocating programme resources and assessing programme coverage and quality.


Asunto(s)
Vigilancia de la Población/métodos , Trabajadores Sexuales/estadística & datos numéricos , Personas Transgénero/estadística & datos numéricos , Adolescente , Adulto , Femenino , Infecciones por VIH/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Densidad de Población , Prevalencia , Factores de Riesgo , Trabajo Sexual/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Sri Lanka , Encuestas y Cuestionarios , Transexualidad , Adulto Joven
5.
Int J Drug Policy ; 64: 95-102, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30641451

RESUMEN

BACKGROUND: Drug overdose is the major cause of morbidity and mortality among persons who inject drugs (PWID). We assessed factors associated with the non-fatal drug overdose among PWID in three Croatian cities and national trends of overdose-related mortality (OM), and rates of uptake of opioid agonist drug treatment (OAT). METHODS: We used a respondent-driven sampling method to recruit 830 PWID in Zagreb, Split and Rijeka in 2014/2015. Participants completed behavioural questionnaires that included questions about overdose history, and we used Poisson regression to assess factors associated with self-reported overdose. We used joinpoint regression to calculate national trends of OM from 2001 to 2015 and rates of uptake of drug treatment from 2005 to 2015. RESULTS: Lifetime prevalence of self-reported drug overdose in our RDS sample was 45.2%, while 4.1% of PWID reported overdose in the past 12 months; PWID who injected more than one type of drug in the past 12 months (adjusted prevalence ratio [aPR] = 4.56, 95% confidence intervals [CI] = 1.35-15.38) compared to injecting only heroin, and those enrolled in OAT (aPR = 1.94, 95% CI = 1.01-3.74) were more likely to report overdose in the past 12 months. We observed an increase in annual percent change (APC) of the national OM rates from 2001 to 2007 (APC = 22.5%, 95% CI = 16.3-29.0) and a decline from 2007 to 2015 (APC = -8.0%, 95% CI = -5.3- -10.5). The national rates of drug treatment enrollment increased from 2005 to 2010 (APC = 12.0%, 95% CI = 10.3-13.8), mostly due to increase in provision of buprenorphine from 2005 to 2008 (APC = 130.4%, 95% CI = 102.1-162.7). CONCLUSION: Injecting more than one type of drugs and enrollment in OAT while still injecting drugs was positively associated with non-fatal overdose in our sample. To further reduce OM in Croatia we suggest improvements in coverage and delivery of OAT and establishment of provision of naloxone for PWID.


Asunto(s)
Sobredosis de Droga/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adulto , Buprenorfina/uso terapéutico , Croacia/epidemiología , Estudios Transversales , Femenino , Reducción del Daño , Humanos , Masculino , Metadona/uso terapéutico , Persona de Mediana Edad , Mortalidad , Naloxona/uso terapéutico , Tratamiento de Sustitución de Opiáceos , Autoinforme , Encuestas y Cuestionarios
6.
Sex Transm Infect ; 94(7): 515-517, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-28596369

RESUMEN

OBJECTIVES: To determine prevalence of HIV and HIV-related behaviours in female seasonal farm workers (FSFWs) in two provinces of Souss Massa Draa (SMD) region in Morocco. SMD has a higher burden of HIV compared with other parts of Morocco and is characterised by a substantial aggregation of FSFW. METHODS: We carried out a cross-sectional HIV biobehavioural survey using cluster-based sampling of farms in the provinces Chtouka Aït Baha and Taroudant Ouled Teïma in 2014. HIV testing was done using the Determine HIV-1/2 rapid test and reactive specimens were tested using ELISA and western blot. Collected data were post hoc weighted for region-based stratification and adjusted for clustering effects using complex survey functions of SPSS (V.21). RESULTS: Among those eligible to participate, the response rate was 92.8%. HIV prevalence was 0.9% (95% CI 0.4% to 2.4%) among 520 recruited participants. A high proportion of respondents (67.7%) had no education. Ever having sex was reported by 79.8% and among these, 12.7% ever exchanged sex for money or goods. Sixty-one per cent reported condom use at most recent commercial vaginal sex in the past 12 months. STI symptom recognition was found to be low because 62.4% and 46.8% of FSFW could not report any STI symptoms in men and women, respectively. Twenty-seven per cent of respondents had an HIV test in the past 12 months. In multivariable analysis, those with primary or higher education (adjusted OR (aOR)=2.38, 95% CI 1.33 to 4.27) and those who participated in an HIV educational session at their workplace (aOR=11.00, 95% CI 3.99 to 30.31) had higher odds of ever been tested for HIV. CONCLUSIONS: Although we found a relatively low HIV prevalence among FSFW in SMD, HIV interventions should be intensified, in particular, in a subgroup of women who are involved in sex work.


Asunto(s)
Agricultores/estadística & datos numéricos , Infecciones por VIH/epidemiología , Conducta Sexual/estadística & datos numéricos , Adolescente , Adulto , Análisis por Conglomerados , Condones/estadística & datos numéricos , Estudios Transversales , Agricultores/psicología , Femenino , VIH/aislamiento & purificación , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Marruecos/epidemiología , Prevalencia , Factores de Riesgo , Asunción de Riesgos , Estaciones del Año , Trabajadores Sexuales/estadística & datos numéricos , Parejas Sexuales , Encuestas y Cuestionarios , Adulto Joven
7.
JMIR Public Health Surveill ; 3(2): e41, 2017 06 23.
Artículo en Inglés | MEDLINE | ID: mdl-28645888

RESUMEN

BACKGROUND: Capacity building of the national HIV strategic information system is a core component of the response to the HIV epidemic as it enables understanding of the evolving nature of the epidemic, which is critical for program planning and identification of the gaps and deficiencies in HIV programs. OBJECTIVE: The study aims to describe the results of the assessment of the needs for further development of capacities in HIV strategic information systems in the non-European Union (EU) countries in the World Health Organization European Region (EUR). METHODS: Self-administered questionnaires were distributed to national AIDS programs. The first questionnaire was sent to all countries (N=18) to find out, among other issues, the priority level for strengthening a range of HIV surveillance areas and their key gaps and weaknesses. The second questionnaire was sent to 15 countries to more specifically determine capacities for the analysis of the HIV care cascade. RESULTS: Responses to the first questionnaire were received from 10 countries, whereas 13 countries responded to the second questionnaire. Areas that were most frequently marked as being of high to moderate priority for strengthening were national electronic patient monitoring systems, evaluation of HIV interventions and impact analysis, implementation science, and data analysis. Key weaknesseses were lack of electronic reporting of HIV cases, problems with timeliness and completeness of reporting in HIV cases, under-estimates of the reported number of HIV-related deaths, and limited CD4 count testing at the time of HIV diagnosis. Migrant populations, internally displaced persons, and refugees were most commonly mentioned as groups not covered by surveillance, followed by clients of sex workers and men who have sex with men. The majority of countries reported that they were able to provide the number of people diagnosed with HIV who know their HIV status, which is important for the analysis of cross-sectional and longitudinal HIV care cascades. Ability to report on some of the key impact indicators of HIV programs-viral load suppression and mortality-should be considerably strengthened. CONCLUSIONS: The assessment found a substantial need to invest in surveillance capacities, which is a cornerstone in the development of an evidence-informed response to HIV epidemics.

8.
Drug Alcohol Depend ; 171: 132-139, 2017 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-28088084

RESUMEN

BACKGROUND: We assessed correlates of anti-hepatitis C (anti-HCV) positivity and utilization of needle and syringe exchange programs (NSEP) and opioid agonist treatment (OAT) among people who inject drugs (PWID) in two Croatian cities. METHODS: We conducted a cross-sectional study using respondent-driven (RDS) sampling among PWID in Rijeka (N=255) and Split (N=399). We used RDS-weighted population estimates and multivariable logistic regression to explore correlates of anti-HCV positivity and NSEP and OAT utilization. RESULTS: Seventy-eight percent (78.0%) of PWID in Rijeka and 61.5% in Split had been tested previously for HCV, while 21.5% and 7.0%, respectively, were tested for HCV in the past 12 months. Among PWID who report being infected with HCV, 24.9% in Rijeka and 11.3% in Split received anti-HCV treatment. In Rijeka, PWID who utilized NSEP and, in Split, those who were ever imprisoned, had higher odds of anti-HCV positivity. In Rijeka, PWID on OAT were more likely to use non-sterile injecting equipment and to inject for longer than 10 years. PWID enrolled in NSEP were more likely to inject opioid agonist medication (OAM) and less likely to use non-sterile injecting equipment. More than half of PWID reported misuse of OAM in the past month, while out of PWID enrolled in OAT, 65.4% in Rijeka and 88.7% in Split injected OAM in the month prior to the survey. CONCLUSIONS: Key findings of the paper point to the need to scale up HCV testing and treatment, improve access to NSEP and the quality of OAT provisions in order to prevent its misuse among PWID.


Asunto(s)
Ciudades/epidemiología , Reducción del Daño , Hepatitis C/epidemiología , Hepatitis C/terapia , Abuso de Sustancias por Vía Intravenosa/epidemiología , Abuso de Sustancias por Vía Intravenosa/terapia , Adulto , Croacia/epidemiología , Estudios Transversales , Femenino , Hepatitis C/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Programas de Intercambio de Agujas/métodos , Abuso de Sustancias por Vía Intravenosa/diagnóstico , Encuestas y Cuestionarios , Jeringas
9.
Int J Drug Policy ; 32: 57-63, 2016 06.
Artículo en Inglés | MEDLINE | ID: mdl-27160504

RESUMEN

BACKGROUND: There are limited data on HIV and hepatitis C virus (HCV) epidemiology among people who inject drugs (PWID) in Croatia. This study aims to provide data on HIV and HCV prevalence and sexual and injecting risk behaviours among PWID in Zagreb, Split, and Rijeka. METHODS: Using respondent-driven sampling (RDS) we recruited from November 2014 to February 2015 a total of 176 PWID in Zagreb, 255 in Rijeka and 399 in Split. Participants provided biological specimens for HIV and HCV testing and completed a behavioural questionnaire. RESULTS: The proportion of female PWID ranged from 19.5% in Zagreb to 26.0% in Split. In the month before the survey, 2.5% of PWID in Split, 5.6% in Rijeka and 8.0% in Zagreb reported sharing non-sterile needles and syringes. Many PWID injected opioid substitution therapy (OST) in the month before the survey (57.0% in Zagreb and 57.5% in Split and Rijeka, respectively). Among PWID who had a casual sexual partner in the past 12 months (ranging from 39.2% in Split to 44.4% in Rijeka) condom use was low. Although HIV prevalence was low (0.2% in Rijeka and Zagreb, 0.3% in Split), HCV antibody prevalence was considerable (29.1% in Zagreb, 31.5% in Rijeka, 38.3% in Split). HIV and HCV testing coverage in the past 12 months was insufficient (6.8% and 7.0% in Split; 13.2% and 13.5% in Zagreb; 20.2% and 21.5% in Rijeka, respectively). CONCLUSION: We found a low-level HIV epidemic and a sizable HCV epidemic among PWID in Zagreb, Split and Rijeka. Presence of high-risk injecting and sexual behaviours together with inadequate HIV and HCV testing coverage call for development of a comprehensive approach to harm reduction and introduction of needle and syringe exchange programmes in prisons, as well as strengthening sexual health interventions.


Asunto(s)
Infecciones por VIH/epidemiología , Hepatitis C/epidemiología , Conducta Sexual/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adulto , Ciudades/estadística & datos numéricos , Croacia/epidemiología , Femenino , Reducción del Daño , Humanos , Masculino , Tratamiento de Sustitución de Opiáceos/métodos , Prevalencia , Riesgo , Asunción de Riesgos , Encuestas y Cuestionarios
10.
AIDS Behav ; 19(10): 1938-40, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26070886

RESUMEN

We analyzed data on reported mode of transmission in case reports of HIV-infections among men in Ukraine. The number of men who were reported to have acquired HIV through heterosexual transmission increased substantially in 2006-2011. However, we estimate that up to 40 % of reported cases of heterosexual transmission among men may actually represent misclassified men who have sex with men or persons who inject drugs. These findings indicate a need to improve the quality of data on reported mode of HIV transmission. Accurate information has important public health implications in planning prevention and treatment services.


Asunto(s)
Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Heterosexualidad , Homosexualidad Masculina , Vigilancia de la Población/métodos , Adulto , Consumidores de Drogas/estadística & datos numéricos , Femenino , Infecciones por VIH/prevención & control , Humanos , Incidencia , Masculino , Factores de Riesgo , Asunción de Riesgos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Ucrania/epidemiología
11.
Harm Reduct J ; 12: 2, 2015 Feb 28.
Artículo en Inglés | MEDLINE | ID: mdl-25884194

RESUMEN

BACKGROUND: People who inject drugs (PWID) have significantly higher rates of blood borne and sexually transmitted infections due to unsafe injecting practices and risky sexual behaviors. METHODS: We carried out an HIV bio-behavioral survey using respondent-driven sampling (RDS) in people who use drugs (PWID) in Podgorica, Montenegro in 2013 in order to determine the prevalence of HIV, hepatitis C (HCV), hepatitis B surface antigen (HBsAg) and risk behaviors. Data were analyzed using RDS Analyst and SPSS 12.0 to obtain prevalence estimates of key bio-behavioral indicators and assess correlates of needle and syringe sharing using multivariate logistic regression. RESULTS: A total of 402 PWID were recruited. HIV prevalence was 1.1%, while the prevalence of HCV and HBsAg was 53.0% and 1.4%, respectively. In the multivariate analysis, significant correlates of needle and syringe sharing in the past month were being older than 26 years, female, injecting drugs more than once per day, injecting in parks or on streets, not being able to obtaining free-of-charge sterile needles and syringes and reporting more than four partners in the past 12 months. CONCLUSIONS: The results indicate that the HIV epidemic in PWID in Montenegro might still be at a low level, though the HCV epidemic is well-established.


Asunto(s)
Infecciones por VIH/epidemiología , Encuestas Epidemiológicas/estadística & datos numéricos , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Compartición de Agujas/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adulto , Comorbilidad , Estudios Transversales , Femenino , Humanos , Masculino , Montenegro/epidemiología , Prevalencia , Asunción de Riesgos , Factores Socioeconómicos
12.
AIDS Care ; 27(6): 767-71, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25566879

RESUMEN

Harm reduction-based HIV prevention has been in place among female sex workers (FSWs) in Croatia for more than a decade. However, little is known about how well the existing programs meet the needs of FSWs in an environment where sex work remains criminalized and highly stigmatized. This study aims to assess changes in FSWs' vulnerability to HIV infection in the 2008-2014 period. Using convenience samples of FSWs in Croatia's two largest urban settings, behavioral data were collected in 2007-2008 and 2014. Outreach workers interviewed 154 FSWs in the first wave of the survey and 158 in the second. The period under observation was characterized by a stable prevalence of most HIV-relevant risk behaviors and experiences. Significant changes in client-based victimization and HIV knowledge were observed only among FSWs in the capital city. Substantial and mostly sustained levels of sexual and nonsexual victimization call for more research into the limits of the current behavior-based harm reduction approach to HIV prevention in the country.


Asunto(s)
Condones/estadística & datos numéricos , Infecciones por VIH/prevención & control , Trabajo Sexual/estadística & datos numéricos , Trabajadores Sexuales/estadística & datos numéricos , Sexo Inseguro/estadística & datos numéricos , Adulto , Croacia/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/transmisión , Reducción del Daño , Humanos , Prevalencia , Factores de Riesgo , Trabajadores Sexuales/psicología , Encuestas y Cuestionarios , Sexo Inseguro/psicología , Población Urbana/estadística & datos numéricos
13.
PLoS One ; 9(9): e103657, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25251080

RESUMEN

BACKGROUND: Ukraine developed Europe's most severe HIV epidemic due to widespread transmission among persons who inject drugs (PWID). Since 2004, prevention has focused on key populations; antiretroviral therapy (ART) coverage has increased. Recent data show increases in reported HIV cases through 2011, especially attributed to sexual transmission, but also signs of potential epidemic slowing. We conducted a data triangulation exercise to better analyze available data and inform program implementation. METHODS AND FINDINGS: We reviewed data for 2005 to 2012 from multiple sources, primarily national HIV case reporting and integrated biobehavioral surveillance (IBBS) studies among key populations. Annually reported HIV cases increased at a progressively slower rate through 2011 with recent increases only among older, more immunosuppressed individuals; cases decreased 2.7% in 2012. Among women <25 years of age, cases attributed to heterosexual transmission and HIV prevalence in antenatal screening declined after 2008. Reported cases among young PWID declined by three-fourths. In 2011, integrated biobehavioral surveillance demonstrated decreased HIV prevalence among young members of key populations compared with 2009. HIV infection among female sex workers (FSW) remains strongly associated with a personal history of injecting drug use (IDU). CONCLUSIONS: This analysis suggests that Ukraine's HIV epidemic has slowed, with decreasing reported cases and older cases predominating among those diagnosed. Recent decreases in cases and in prevalence support decreased incidence among young PWID and women. Trends among heterosexual men and men who have sex with men (MSM) are less clear; further study and enhanced MSM prevention are needed. FSW appear to have stable prevalence with risk strongly associated with IDU. Current trends suggest the Ukrainian epidemic can be contained with enhanced prevention among key populations and increased treatment access.


Asunto(s)
Epidemias/estadística & datos numéricos , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Vigilancia de la Población/métodos , Adolescente , Adulto , Consumidores de Drogas/estadística & datos numéricos , Femenino , Geografía , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Incidencia , Masculino , Embarazo , Prevalencia , Análisis de Regresión , Medición de Riesgo/estadística & datos numéricos , Medición de Riesgo/tendencias , Factores de Riesgo , Trabajadores Sexuales/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Ucrania/epidemiología
14.
J Int AIDS Soc ; 17: 18962, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24815415

RESUMEN

The aim of the paper is to provide an overview of HIV case reporting data for the year 2011 from the countries of the World Health Organization Eastern Mediterranean Region (WHO EMR). Fourteen countries provided data for the year 2011 and reported a total of 4263 HIV cases of which 66.8% were men. The highest number of reported HIV cases in men per 100,000 population was in Oman (5.8), Somalia (5.5) and Iran (3.3), while in women in Somalia (7.6), Oman (3.9) and Morocco (2.4). In the majority of the countries, the most common reported mode of transmission was heterosexual. This could be due to under-reporting of male-to-male transmission and more frequent testing of men than women.


Asunto(s)
Infecciones por VIH/epidemiología , África del Norte/epidemiología , Femenino , Infecciones por VIH/transmisión , Humanos , Masculino , Medio Oriente/epidemiología , Vigilancia de la Población , Factores Sexuales
15.
J Infect Dis ; 210(6): 837-45, 2014 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-24740630

RESUMEN

BACKGROUND: Human papillomavirus (HPV) vaccines are recommended for girls prior to sexual debut because they are most effective if administered before girls acquire HPV. Little research has been done on HPV prevalence in girls who report not having passed sexual debut in high HPV-prevalence countries. METHODS: Using attendance registers of randomly selected primary schools in the Mwanza region of Tanzania, we enrolled girls aged 15-16 years who reported not having passed sexual debut. A face-to-face interview on sexual behavior and intravaginal practices, and a nurse-assisted self-administered vaginal swab were performed. Swabs were tested for 13 high-risk and 24 low-risk HPV genotypes. RESULTS: HPV was detected in 40/474 (8.4%; 95% confidence interval [CI], 5.9-11.0) girls. Ten different high-risk and 21 different low-risk genotypes were detected. High-risk genotypes were detected in 5.3% (95% CI, 3.5-7.8). In multivariable analysis, only intravaginal cleansing (practiced by 20.9%) was associated with HPV detection (adjusted odds ratio = 2.19, 95% CI, 1.09-4.39). CONCLUSION: This cohort of adolescent Tanzanian girls had a high HPV prevalence prior to self-reported sexual debut, and this was associated with intravaginal cleansing. This most likely reflects underreporting of sexual activity, and it is possible that intravaginal cleansing is a marker for unreported sexual debut or nonpenetrative sexual behaviors.


Asunto(s)
Infecciones por Papillomavirus/epidemiología , Adolescente , Femenino , Genotipo , Humanos , Higiene , Entrevistas como Asunto , Papillomaviridae/genética , Infecciones por Papillomavirus/virología , Prevalencia , Conducta Sexual/estadística & datos numéricos , Tanzanía/epidemiología , Vagina/virología
16.
Sex Transm Infect ; 89 Suppl 3: iii17-22, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23996450

RESUMEN

OBJECTIVES: To assess HIV and syphilis prevalence, HIV-related behaviours and testing for HIV in female sex workers (FSW) in Sudan. DESIGN: Bio-behavioural surveys using respondent-driven sampling were carried out among FSW in the capital cities of 14 states in Sudan in 2011-2012. HIV and syphilis testing was done by rapid tests. RESULTS: 4220 FSW aged 15-49 years were recruited. The median age of recruited women varied from 21 to 28 years per site. The highest HIV prevalence was measured at two sites in the eastern zone (5.0% and 7.7%), while in the other zones it ranged from 0% to 1.5%. Syphilis prevalence ranged from 1.5% in the northern zone to 8.9% in the eastern zone. Ever having been tested for HIV was reported by 4.4%-23.9% of FSW across all sites. Condom use at last sex with a client varied from 4.7% to 55.1%, while consistent condom use with clients in the month preceding the surveys was reported by 0.7%-24.5% of FSW. The highest reporting of ever injecting drugs was measured at a site in the western zone (5.0%). CONCLUSIONS: The surveys' findings indicate that the highest burden of HIV in FSW is in the eastern states of the country. Condom use and HIV testing data demonstrate the need for HIV interventions that should focus on HIV testing and risk reduction strategies that include stronger condom promotion programmes in FSW and their clients.


Asunto(s)
Seropositividad para VIH/epidemiología , Trabajo Sexual/estadística & datos numéricos , Trabajadores Sexuales , Conducta Sexual/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Sífilis/epidemiología , Adolescente , Adulto , Distribución por Edad , Condones/estadística & datos numéricos , Femenino , Seropositividad para VIH/diagnóstico , Conocimientos, Actitudes y Práctica en Salud/etnología , Encuestas Epidemiológicas , Humanos , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Conducta de Reducción del Riesgo , Vigilancia de Guardia , Trabajo Sexual/psicología , Trabajadores Sexuales/psicología , Trabajadores Sexuales/estadística & datos numéricos , Conducta Sexual/psicología , Parejas Sexuales , Sudán/epidemiología , Encuestas y Cuestionarios , Sífilis/diagnóstico
17.
Sex Transm Infect ; 89 Suppl 3: iii11-16, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23434789

RESUMEN

OBJECTIVES: To provide an overview of the current level of development and results from the national HIV surveillance systems of the 23 countries of the Middle East and North Africa (MENA), and to assess the quality of HIV surveillance systems in the period 2007-2011. METHODS: A questionnaire was used to collect the information about the structure, activities and the results of HIV surveillance systems from the National AIDS Programmes. Assessment of the quality was based on four indicators: timeliness of data collection, appropriateness of populations under surveillance, consistency of the surveillance sites and groups measured over time, and coverage of the surveillance system. RESULTS: Only in four countries did surveillance systems enable assessment of epidemic trends in the same populations and locations over time, such as in pregnant women (Morocco, Iran), injecting drug users (Iran, Pakistan), female sex workers (Djibouti, Morocco) and male sex workers (Pakistan). There is increasing evidence of HIV infection being firmly established in at least one of the populations most at risk of HIV in nine MENA countries, while lower risk populations show elevated HIV prevalence in South Sudan, Djibouti and some parts of Somalia. CONCLUSIONS: The performance of HIV surveillance systems in several of the MENA countries has improved in recent years. The extent of HIV epidemics in the populations most at risk of HIV is still largely unknown in 10 countries. Multiple data sources that most of the countries still lack would enable indirectly estimation not only of the patterns of HIV epidemics but also the effectiveness of HIV responses.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Seropositividad para VIH/epidemiología , Vigilancia de Guardia , Trabajadores Sexuales/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , África del Norte/epidemiología , Recolección de Datos , Epidemias , Femenino , Humanos , Masculino , Medio Oriente/epidemiología , Embarazo , Prevalencia , Medición de Riesgo , Encuestas y Cuestionarios
18.
AIDS Behav ; 17(5): 1906-13, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22968396

RESUMEN

Injection risk practices and risky sexual behaviors place injection drug users (IDUs) and their sexual partners particularly vulnerable to HIV. The purpose of the study was to describe and understand determinants of high-risk sexual behavior among IDUs in Georgia. A cross-sectional, anonymous survey assessed knowledge, behavior and HIV status in IDUs in five Georgian cities (Tbilisi, Gori, Telavi, Zugdidi, Batumi) in 2009. The study enrolled in total 1,127 (1,112 males, 15 females) IDUs. Results indicate that occasional sexual relationships are common among male IDUs, including married ones. A subsample of 661 male IDUs who reported having occasional and paid sex partners during the last 12 months was analyzed. Multivariate analysis shows that not having a regular partner in the last 12 month (adjusted odds ratio (aOR) 1.57, 95 % CI 1.04 2.37), and using previously used needles/syringes at last injecting (aOR 2.37, 95 % I 1.10-5.11) are independent correlates of inconsistent condom use with occasional and paid sexual partners among IDUs. Buprenorphine injectors have lower odds of inconsistent condom use with occasional and paid sexual partners compared to heroin injectors (aOR 0.47, 95 % CI 0.27-0.80), and IDUs who live in Telavi are twice more likely to engage in such risky sexual behavior than capital city residents (aOR 2.55, 95 % CI 1.46-4.48). More effective programs focused on sexual risk behavior reduction strategies should be designed and implemented.


Asunto(s)
Abuso de Sustancias por Vía Intravenosa/psicología , Sexo Inseguro/psicología , Adolescente , Adulto , Factores de Edad , Condones/estadística & datos numéricos , Estudios Transversales , Femenino , Georgia (República)/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Parejas Sexuales/psicología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Sexo Inseguro/estadística & datos numéricos , Adulto Joven
19.
Sex Transm Infect ; 88(7): 539-44, 2012 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-22628664

RESUMEN

OBJECTIVE: To determine the prevalence of HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) in Zagreb, Croatia, and assess correlates of testing for HIV in the past 12 months. METHODS: The authors carried out a bio-behavioural survey using respondent-driven sampling (RDS) from September 2010 to February 2011. Participants completed a questionnaire and were asked to provide blood, urine, oropharyngeal and rectal swabs for the detection of infections. Data were analysed using RDS Analysis Tool 6.0.1 and STATA V.8.0. RESULTS: A total of 387 MSM were recruited at the University Hospital for Infectious Diseases. The age range of recruited men was 18-57 years. HIV prevalence was 2.8% (95% CI 1.1% to 5.1%) (3.6%, unadjusted), lower than that found in the first RDS survey carried out in 2006 (4.5%, 95% 2.2% to 7.3%) (4.9%, unadjusted). The seroprevalence of herpes virus type 2 was 5.9% (6.9, unadjusted) and that of syphilis measured by Treponema pallidum haemagglutination assay was 7.6% (6.7%, unadjusted). The authors found urethral and/or rectal infections with Chlamydia trachomatis in 7.2% (8.5%, unadjusted) of men and gonoccocal in 2.7% (2.1%, unadjusted). HIV testing in the past 12 months was reported by 32.7% (38.9%, unadjusted). In the multivariate analysis, significant correlates of recent HIV testing were having more than three partners in the past 12 months and the knowledge of HIV status of a regular partner. CONCLUSIONS: The results indicate that there might have not been a progression of an HIV and STI epidemic in the past 5 years among MSM in Croatia. Prevention should expand by providing better uptake of HIV and STI testing services, thus enabling timely treatment.


Asunto(s)
Homosexualidad Masculina , Aceptación de la Atención de Salud/estadística & datos numéricos , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Adulto , Sangre/microbiología , Sangre/virología , Croacia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Orofaringe/microbiología , Orofaringe/virología , Prevalencia , Recto/microbiología , Recto/virología , Encuestas y Cuestionarios , Orina/microbiología , Orina/virología , Adulto Joven
20.
Arch Sex Behav ; 41(6): 1497-505, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22441770

RESUMEN

Following the demise of socialism in 1989, religious identification substantially increased in most countries of Central, East, and Southeast Europe. Considering that there is evidence that religiosity is associated with reduced sexual risk taking among young people, this study explored associations between religiosity--assessed at three different levels (religious upbringing, personal religiosity, and social network religiosity)--and sexual risks among young Croatian adults. In addition, we examined whether religiosity predicted chlamydial infection among women and men aged 18-25. The data were collected in a national probability survey carried out in 2010 (n = 1,005). Overall, the effects of religiosity were sporadic, present primarily among women, and of small size. This lack of a sizeable impact of religiosity on young adults' sexuality was likely related to a particular type of religiosity, characterized by individualized morality, found among young people in the country. Although Croatia seems to be one of the most religious countries in Europe, our findings suggest that promoting religious morality--as recently attempted by an abstinence-based educational program--may not be an efficient tool in reducing sexual risks.


Asunto(s)
Infecciones por Chlamydia/diagnóstico , Conocimientos, Actitudes y Práctica en Salud , Religión , Salud Reproductiva , Conducta Sexual/estadística & datos numéricos , Adolescente , Adulto , Croacia , Femenino , Humanos , Masculino , Encuestas y Cuestionarios
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