Disparities in HIV Testing and PrEP Awareness for Black Women who Inject Drugs in San Francisco, California.

HIV disproportionately affects Black/African Americans (AA), while PrEP is under-utilized by Black/AA, women, and people who inject drugs (PWID). In San Francisco, California's National HIV Behavioral Surveillance among PWID in 2022, Black/AA women were the least likely to be tested for HIV among all groups by sex and race/ethnicity and the least likely to be aware of PrEP among women. Yet, Black/AA women were no less likely to see a healthcare provider in the last year. Data suggest that providers' failure to discuss and address HIV risk with Black/AA female PWID is a major barrier to accessing effective care and prevention. El VIH afecta de manera desproporcionada a Black/afroamericanos (AA), mientras que la PrEP está infrautilizada por los Black/AA, las mujeres y las personas que se inyectan drogas (PWID). En la National HIV Behavioral Surveillance de PWID de San Francisco, California en 2022, las mujeres Black/AA eran las que menos probabilidades tenían de someterse a la prueba del VIH entre todos los grupos por sexo y raza/etnia y las que menos probabilidades tenían de conocer la PrEP entre las mujeres. Sin embargo, las mujeres Black/AA no tenían menos probabilidades de acudir a un profesional sanitario en el último año. Los datos sugieren que el hecho de que los proveedores no hablen ni aborden el riesgo de VIH con las PWID de raza Black/AA es un obstáculo importante para acceder a una atención y prevención eficaces.

Continuing Low Awareness and Use of Pre-exposure Prophylaxis (PrEP) for HIV among People Who Inject Drugs (PWID), San Francisco, 2022.

Clinical trials provide evidence that pre-exposure prophylaxis (PrEP) prevents HIV acquisition including through sharing of injection equipment among people who inject drugs (PWID). However, uptake among many populations at risk for HIV has been slow, particularly among PWID. We examined data from the National HIV Behavioral Surveillance (NHBS) from San Francisco in 2022 to measure PrEP uptake and identify factors associated with PrEP awareness among PWID. Of 479 PWID with HIV-negative or unknown HIV status, 54.9% were aware of PrEP, 5.9% had discussed PrEP with a healthcare provider, and 1.5% had used PrEP in the past year. Lack of PrEP awareness was associated with being age 50 years and older (adjusted odds ratio [aOR] 0.40, 95% CI 0.27-0.60), being men who have sex with women (vs. men who have sex with men, aOR 0.47, 95% CI 0.24-0.92), having a disability (aOR 0.58, 95% CI 0.35-0.95), using heroin as their most frequently injected drug (aOR 0.51, 95% CI, 0.34-0.78), not having tested for HIV, HCV, or an STD in the past year (aOR 0.43, 95% CI 0.28-0.64), and not having access to new sterile needles in the past year (aOR 0.28, 95%CI 0.08-1.00). We found negligible change in the awareness and uptake of PrEP among PWID since previously measured in NHBS in 2018. Low PrEP use among PWID may be addressed by increasing provider discussion of PrEP with their PWID patients and clients during routine care, expanding testing for injection-related infections among PWID, and integrating PrEP access into harm reduction programs.

Mortalidad intrahospitalaria de pacientes con COVID-19 complicados con neumonías bacterianas en asistencia respiratoria mecánica en Cuidados Intensivos de Adultos en un Hospital del Paraguay / In-hospital mortality of patients with COVID-19 complicated by bacterial pneumonia on mechanical ventilation in Adult Intensive Care in a Hospital in Paraguay

Introducción: los pacientes con COVID-19 ingresan en mayor proporción a asistencia respiratoria mecánica, aumentando: el riesgo de neumonía asociada a ventilador (NAV) las tasas de mortalidad, los días de permanencia en las unidades de terapia intensiva (UCI) y los costos sanitarios. Objetivo: determinar la Mortalidad intrahospitalaria de pacientes con COVID-19 complicados con neumonías bacterianas en asistencia respiratoria mecánica en Cuidados Intensivos de Adultos en un Hospital del Paraguay durante los años 2020 a 2021. Metodología: estudio analítico de tipo cohorte retrospectiva. Se registraron variables demográficas, comorbilidades, puntajes en scores de gravedad como el APACHE II al ingreso, la cifra más baja de oxigenación durante la internación expresado por la PaO2 / FIO2, días de ventilación, colocación en decúbito prono, traqueotomía, medidas terapéuticas farmacológicas y no farmacológicas, días de internación, así como las complicaciones y la mortalidad. Resultados: fueron incluidos 214 pacientes, 135 ingresaron a asistencia respiratoria mecánica (ARM) de los cuales 58 (42,9 %) desarrollaron NAV, con edad mediana de 52 años (40-60). Los microorganismos de NAV fueron cocos Gram negativos en 98,3 %, incluyendo Acinetobacter baumanii en 46,5 %, Klebsiella pneumoniae en 22,8 %, Pseudomona aeruginosa en 15,5 % y 5,2 % Stenotrophomona maltofilia. La mortalidad intrahospitalaria fue del 44,8 %. Los menores de 50 años tienen una sobrevida mayor que los mayores (34 días vs 22 días, con p de 0,026). Conclusión: la mortalidad intrahospitalaria fue del 44,8 %. La edad fue un factor de riesgo independiente para la mortalidad en pacientes con NAV, por lo que los profesionales de la salud deben estar atentos a la posibilidad de NAV en pacientes que requieren asistencia respiratoria mecánica, especialmente en pacientes mayores de 50 años.

Introduction: patients with COVID-19 are more likely to require mechanical ventilation, which increases the risk of ventilator-associated pneumonia (VAP), mortality rates, length of stay in intensive care units (ICUs), and healthcare costs. Objective: to determine the in-hospital mortality of patients with COVID-19 complicated by bacterial pneumonia on mechanical ventilation in Adult Intensive Care in a Hospital in Paraguay during the years 2020 to 2021. Methodology: this is a retrospective cohort analytical study. Demographic variables, comorbidities, severity scores such as APACHE II on admission, the worst oxygenation during hospitalization expressed by PaO2/FiO2, days of ventilation, prone position, tracheostomy, pharmacological and non-pharmacological therapeutic measures, days of hospitalization, as well as complications and mortality were recorded. Results: a total of 214 patients were included, 135 were admitted to mechanical ventilation (MRA), of which 58 (42.9%) developed VAP, with a median age of 52 years (40-60). VAP microorganisms were Gram-negative cocci in 98.3%, including Acinetobacter baumanii in 46.5%, Klebsiella pneumoniae in 22.8%, Pseudomona aeruginosa in 15.5%, and Stenotrophomona maltophilia in 5.2%. In-hospital mortality was 44.8%. Those under 50 years of age have a longer survival than those older (34 days vs. 22 days, with p of 0.026). Conclusion: the overall mortality rate was 44.8%. Age was an independent risk factor for mortality in patients with VAP, so healthcare professionals should be aware of the possibility of VAP in patients who require mechanical ventilation, especially in patients over 50 years of age.

Increase in human immunodeficiency virus and syphilis prevalence and incidence among men who have sex with men, vietnam 2015 - 2020.

INTRODUCTION: We assessed trends in HIV and syphilis prevalence, HIV incidence, related risk factors, and preventive behaviors among men who have sex with men (MSM) in Vietnam from 2015 to 2020. METHODS: Data originated from the HIV Sentinel Surveillance Plus system, which sampled MSM at venues and hotspots in seven of Vietnam's 63 provinces in 2015, 2016, 2018, and 2020 (N = 1100-1445 per year; ∼150-300 per province per year). RESULTS: HIV prevalence estimates increased from 6.6% (95% CI 4.5-9.6) in 2015 to 13.8% (95% CI 10.5-18.2, p = .001 for trend) in 2020 overall, and separately in An Giang, Can Tho, Hai Phong, and Khanh Hoa provinces but not in Ho Chi Minh City, Hanoi, or Kien Giang. Syphilis prevalence increased from 2.7% (95% CI 1.4-5.1) in 2015 to 12.6% (95% CI 8.7-18.0) in 2020 overall (p < .001 for trend), and separately in An Giang, Can Tho, and Hai Phong provinces but not in Ho Chi Minh City or Kien Giang. We calculated time-at-risk from first anal sex to first HIV-positive or last HIV-negative test to estimate HIV incidence. Estimated HIV incidence suggested increasing rates of seroconversion from 1.36 per 100 person-years experienced by participants in 2015 to 2.61 per 100 person-years among participants in 2020 (hazard ratio per year 1.13, 95% CI 1.08-1.18, p < .001). There was a statistically significant increase in HIV testing, STI testing, and receipt of free condoms over the period (p < .05 for trend), and a statistically significant decrease in amphetamine use (p = .043 for trend). CONCLUSIONS: Despite prevention efforts and improvements in some risk indicators, consecutive cross-sectional sampling results provide evidence of increasing incidence of HIV and syphilis among MSM in Vietnam, especially outside the major cities. Aggressive HIV prevention and treatment services can be expanded while conducting deeper investigations into the causes of these increases.

A Year of Deaths Due to or With COVID-19 Under Universal Postmortem Testing in San Francisco.

ABSTRACT: The Health Officer of the City and County of San Francisco, California, issued the order that all decedents were required to have a documented COVID-19 test effective from June 2020 to June 2021. The justification for the requirement was that complete data on COVID-19 status at the time of death were needed to help protect first responders and funeral home workers, identify missed cases, and characterize the places of death for otherwise unknown COVID-19 cases. To fill the gap in COVID-19 testing for all decedents, particularly among persons dying outside of hospitals, a specialized Decedent Testing Unit was created along with an increased capacity of the Office of the Chief Medical Examiner. From July 1, 2020, to June 30, 2021, the Decedent Testing Unit and Office of the Chief Medical Examiner provided postmortem testing results for 2776 decedents. Of these, 80 tested positive for COVID-19 for a positivity rate of 2.97%. The largest number of COVID-19-positive specimens were collected from persons who died at home (n = 37, 46.3%), followed by those who died in hospice (n = 20, 25.0%), other places outside of homes or facilities (n = 8, 10.0%), and in skilled nursing or long-term care facilities (n = 7, 8.8%). Follow-up of California death records found that 17 of these 80 cases (21.3%) had COVID-19 listed as one of the causes of death, 22 (27.5%) mentioned COVID-19 under "other conditions," and 41 (51.3%) made no mention of COVID-19. In the context of providing the COVID-19 status of decedents not otherwise known to have infection, our data help gauge the likelihood of missing deaths due to or with COVID-19 and inform future public health decisions on whether to require universal postmortem testing with COVID-19 resurgences or with new deadly epidemics.

Evaluating a Targeted Minimum Loss-based Estimator for Capture-Recapture Analysis: An Application to HIV Surveillance in San Francisco, CA.

Capture-recapture is a common tool in epidemiology to estimate the size of "hidden" populations and correct the under-ascertainment of cases, based on incomplete and overlapping lists of the target population. Log-linear models are often used to estimate the population size yet may produce implausible and unreliable estimates due to model misspecification and small cell sizes. A novel Targeted Minimum Loss-based Estimation (TMLE) model developed for capture-recapture makes several notable improvements to conventional modeling: "targeting" the parameter of interest, flexibly fitting the data to alternative functional forms, and limiting bias from small cell sizes. Using simulations and empirical data from the San Francisco Department of Public Health's HIV surveillance registry, we evaluated the performance of the TMLE model and compared results to other common models. Based on 2,584 people observed on three lists reporting to the surveillance registry, the TMLE model estimated the number of San Francisco residents living with HIV as of 12/31/2019 to be 13,523 (95% CI: 12,222 - 14,824). This estimate, compared to a "ground truth" of 12,507, was the most accurate and precise of all models examined. The TMLE model is a significant advancement in capture-recapture studies, leveraging modern statistical methods to improve the estimation of hidden populations.

Double counting of clients using services in Iran: implications for assessing the reach of harm reduction programs.

BACKGROUND: Many people with high-risk sexual or injection behaviors use harm reduction services with different identities and are therefore counted more than once in client databases. This practice results in inaccurate statistics on the number of clients served and the effective reach of these services. This study aimed to determine the levels of double counting of clients of harm reduction services, including needle and syringe programs, condom distribution, HIV testing and counseling, and methadone maintenance in five cities in Iran. METHODS: Between September and March 2020, our study included 1630 clients, 115 staff of harm reduction centers, and 30 experts in the field of harm reduction in five cities in Iran. Clients of harm reduction services were asked about using harm reduction services multiple times at the same center or at different centers in the last year using different identities. Estimates of double counting derived from client responses were validated by panels of center staff and experts in harm reduction. RESULTS: Synthesizing data from clients, staff, and experts, the final estimates of double counting of clients using harm reduction services were: HIV testing 10% (95% confidence interval [CI] 0-15), needle and syringe programs 17% (95% CI 8.5-20), condom distribution programs 13% (95% CI 3-19), HIV/STI counseling 10% (95% CI 0-16), and methadone maintenance 7% (95% CI 2-10). CONCLUSION: Double counting of clients in harm reduction services in Iran is substantial. Data on clients reach by harm reduction services need to be corrected for double counting to improve program planning, client population size estimation, and efficient resource allocation.

Impact of HCV Testing and Treatment on HCV Transmission Among Men Who Have Sex With Men and Who Inject Drugs in San Francisco: A Modelling Analysis.

BACKGROUND: Men who have sex with men who ever injected drugs (ever MSM-IDU) carry a high hepatitis C virus (HCV) burden. We estimated whether current HCV testing and treatment in San Francisco can achieve the 2030 World Health Organization (WHO) HCV elimination target on HCV incidence among ever MSM-IDU. METHODS: A dynamic HCV/HIV transmission model among MSM was calibrated to San Francisco data, including HCV antibody (15.5%, 2011) and HIV prevalence (32.8%, 2017) among ever MSM-IDU. MSM had high HCV testing (79%-86% ever tested, 2011-2019) and diagnosed MSM had high HCV treatment (65% ever treated, 2018). Following coronavirus disease 2019 (COVID-19)-related lockdowns, HCV testing and treatment decreased by 59%. RESULTS: Among all MSM, 43% of incident HCV infections in 2022 were IDU-related. Among ever MSM-IDU in 2015, HCV incidence was 1.2/100 person-years (95% credibility interval [CrI], 0.8-1.6). Assuming COVID-19-related declines in HCV testing/treatment persist until 2030, HCV incidence among ever MSM-IDU will decrease by 84.9% (95% CrI, 72.3%-90.8%) over 2015-2030. This decline is largely attributed to HCV testing and treatment (75.8%; 95% CrI, 66.7%-89.5%). Slightly greater decreases in HCV incidence (94%-95%) are projected if COVID-19 disruptions recover by 2025 or 2022. CONCLUSIONS: We estimate that HCV incidence will decline by >80% over 2015-2030 among ever MSM-IDU in San Francisco, achieving the WHO target.

The association between religiosity and resilience among young trans women.

INTRODUCTION: Young transgender women (trans women) experience poor health in part due to discrimination. Factors that promote resilience may help young trans women positively adapt to discrimination, resulting in attenuation of poor health outcomes. While religion is sometimes a source of stigma and transphobia, qualitative studies have identified religiosity as an important resilience resource for young trans women. The goals of this study were to quantitatively measure religiosity and resilience among young trans women and to assess whether they are associated. METHODS: From 2012-2013, 300 young trans women between the ages of 16-24 years were enrolled in a longitudinal study; we examined the cross-sectional baseline data on demographics, religiosity, and resilience. Bivariate and multivariable logistic regression analysis examined the correlation between demographics (age, gender, race/ethnicity, education, income) and religiosity among young trans women. Additionally, bivariate and multivariable logistic regression analysis examined the association between religiosity and resilience among young trans women, controlling for age, gender, race/ethnicity, education, and income. RESULTS: Participants who reported high religiosity had significantly greater odds (aOR 1.78, 95% CI 1.05-3.01, p = .03) of reporting high resilience compared to those reporting low religiosity. Black/African American participants had significantly higher odds (aOR 6.16, 95% CI 2.34-16.20, p = < .001) of reporting high religiosity compared to those who identified as White. CONCLUSION: Religiosity may be an important resilience resource for young trans women. Gender affirming religious and spiritual interventions may promote resilience among some young trans women.

Stigma and discrimination against transgender men in Bhutan.

BACKGROUND: While transgender people worldwide face high rates of stigma and discrimination, there are few studies of transgender men (also "trans men") in Asia. We measured the prevalence of, and factors associated with, stigma and discrimination faced by trans men in Bhutan to bring visibility to their experiences and inform health and social policy changes. METHODS: This cross-sectional survey was conducted in nine regions in Bhutan from November 2019 to January 2020. A total of 124 trans men were recruited using a hybrid venue-based and peer-referral approach. Data were collected using an interviewer-administered questionnaire. Multivariate logistic regression characterized associations with experiencing stigma and discrimination when accessing health services. FINDINGS: Participants were young (48.0% 18-24 years) and 48.4% had migrated from a rural to an urban area. The majority (95.2%) experienced stigma because people knew or thought they were trans men. Associations with frequent experiences of stigma were living with their partner as a couple (adjusted odds ratio [AOR] 3.07, 95% CI 1.27-7.44) and being unemployed or a student (3.22, 1.44-7.19). Nearly half (47.6%) said they experienced discrimination when accessing health care because people knew or thought they were a trans man; this experience was associated with migration (2.42, 1.08-5.39) and having >15 trans men in their social network (3.73, 1.69-8.26). Most (94.4%) experienced verbal violence, 10.5% experienced physical violence, and 4.8% experienced sexual violence. INTERPRETATION: Our study found high rates of stigma, discrimination, and interpersonal violence due to being a trans man in Bhutan. Findings highlight the urgent need for strengthening laws and regulations to protect the rights of transgender persons, particularly when accessing health services, recognizing partnerships, and preventing violence in public spaces.

Low Human Papillomavirus Vaccination in a Low-Income Urban Population.

Despite widespread availability of human papillomavirus (HPV) vaccines and recommendations for routine use, awareness and uptake of HPV vaccination are not universal. We assessed self-reported history of HPV vaccination in a sample of low-income men and women recruited from the community using respondent-driven sampling as part of the National HIV Behavioral Surveillance (NHBS) survey in San Francisco. Of the 384 respondents, a minority (12.5%) reported they had received the HPV vaccine. In multivariate analysis, independent associations with HPV vaccination history were female sex (adjusted odds ratio [AOR] = 3.76, 95% confidence interval [CI] = [1.73, 8.17]), younger age (AOR = 0.89 per year, 95% CI = [0.86, 0.92]), and education above high school (AOR = 2.84, 95% CI = [1.37, 5.90]). Missed opportunities for HPV vaccination were evident in 84.4% of respondents having visited a health care provider in the last year, including 40.1% tested for a sexually transmitted infection, and entry into higher education programs (33.4%).

Intergenerational sex and early sexual debut are associated with HIV infection among transgender women in Paraguay.

INTRODUCTION: HIV prevalence among transgender women is high worldwide. The objectives of the present study were to estimate the current prevalence of HIV and identify factors associated with high HIV burden among transgender women in Paraguay. METHODS: Transgender women aged ≥15 years in four regions of Paraguay were recruited by Starfish sampling between February and March 2021. RESULTS: In total, 322 transgender women were included. Mean age was 31 years (range 15-67), and 102 had positive HIV test results (31.7%, 95% confidence interval [CI] 26.6-37.1). In multivariable analysis, factors associated with HIV infection were age at first intercourse ≤17 years (adjusted odds ratio [aOR] 5.47; 95% CI 1.05-28.42), >10 years difference in age with the last sexual partner (aOR 1.60; 95% CI 1.04-2.46), substance use (mostly cocaine) (aOR 3.00; 95% CI 1.47-6.12), higher risk perception (aOR 3.08; 95% CI 1.53-6.17), not testing for HIV (aOR 1.23; 95% CI 1.09-1.39), and accessed by a peer educator (aOR 3.86; 95% CI 1.77-8.38). CONCLUSIONS: Sexual debut as a minor and a large age difference with sexual partners are associated with high burden of HIV among transgender women in Paraguay. Our study corroborates the finding of cocaine use during sex as a risk factor for HIV. Prevention programmes must address structural and social vulnerabilities to stem the tragically high burden of HIV among transgender women.

Through a Different Lens: Occupational Health of Sex-Working Young Trans Women.

Purpose: Sex work is a common form of work among young trans women (YTW). Methods: Using an occupational health frame, we measured associations between demographics, sex work, and vocational outcomes in 18-month visit data from the SHINE study (n=263, San Francisco). Results: Overall, 41.8% reported lifetime sex work, primarily escorting/paid sex. Motivations included "better pay" and "can't get a job due to gender discrimination." Occupational injuries included anxiety (53.6%) and depression (50%), with significantly higher relative risk for YTW doing multiple types of sex work. Criminalization experiences (i.e., incarceration, arrests, and police interaction) were common. Conclusion: Results echo calls for sex worker-affirming mental health care for YTW.

Respondent-Driven Sampling for Estimation of the Cumulative Lifetime Incidence of Abortion in Soweto, Johannesburg, South Africa: A Methodological Assessment.

Respondent-driven sampling (RDS) is a potential strategy for addressing challenges in accurate estimation of abortion incidence, but it relies on often untested assumptions. We conducted an RDS study to estimate the cumulative lifetime incidence of abortion in Soweto, Johannesburg, South Africa (April-December 2018), to evaluate whether RDS assumptions were met, and to compare RDS estimates of incidence with estimates adjusted for employment and age based on census data. A total of 849 participants were recruited from 11 seed participants between April and December 2018. The assumption that individuals can identify target population members and the assumption of approximation of sampling with replacement was met. There were minor violations of the assumptions of seed independence from the final sample and reciprocity of ties. Assumptions of accurate degree reporting and random recruitment were not met. Failure to meet assumptions yielded a study sample with different employment characteristics than those of the target population; this could not be resolved by standard RDS methods. The RDS estimate of cumulative lifetime abortion incidence was 12.1% (95% confidence interval: 9.8, 14.3), and the employment-adjusted estimate was 16.9% (95% confidence interval: 12.8, 22.1). We caution researchers in using RDS for representative estimates of abortion incidence. Use of postsurvey weights to adjust for differences in characteristics between the sample and the target population may yield more representative results.

Hepatitis C virus prevalence, determinants, and cascade of care among people who inject drugs in Iran.

BACKGROUND: People who inject drugs (PWID) continue to experience the highest burden of hepatitis C virus (HCV). We aimed to characterize HCV antibody prevalence, determinants of infection, and the cascade of engagement in HCV care among PWID in Iran. METHODS: Participants were recruited in 11 cities of Iran using respondent-driven sampling. PWID underwent a structured interview capturing measures on socio-demographics, behaviors, and the HCV cascade of care. HCV and HIV were tested using antibody rapid tests. Multivariable logistic regression models identified characteristics associated with HCV seropositivity. RESULTS: HCV antibody prevalence was 26.0% among 2684 PWID enrolled. Of 699 participants who were HCV antibody positive, 88 (12.6%) were aware of past infections. HCV antibody prevalence was associated with older age (adjusted odds ratio [aOR] 2.09; 95% CI 1.18, 3.71), lower education (aOR 1.31; 95% CI 1.02, 1.69), >10 years of injecting (aOR 6.03; 95% CI 4.10, 8.85), methamphetamine injection (aOR 1.46; 95% CI 1.07, 1.99), daily injection drug use (aOR 1.26; 95% CI 1.01, 1.58), needle/syringe sharing (aOR 2.04; 95% CI 1.24, 3.34), recent incarceration (aOR 1.74; 95% CI 1.30, 2.32), and HIV seropositivity (aOR 7.93; 95% CI 4.12, 15.24). Additionally, 12.0% had ever tested for HCV, 4.0% had previously tested reactive for HCV antibody, and 3.7% had received an HCV diagnosis. Of diagnosed cases, 44.4% were linked to care, 15.2% initiated treatment, and 3.0% achieved sustained virologic response. CONCLUSION: Our data show a high prevalence of HCV antibody and low engagement in HCV care, underscoring an unmet need for HCV prevention, screening, and treatment among PWID in Iran. HCV prevention and treatment programs tailored for PWID are needed to enhance harm reduction efforts and access to HCV care in Iran.

Opium Use and the Risk of Cataract: a Hospital-based, Group-matched, Case-control Study in Iran.

PURPOSE: Cataract is the most prevalent cause of reversible blindness worldwide. Although studies have identified risk factors for cataract, its association with opium use has not been studied. This study aimed to evaluate the association between opium use and cataract in Iran in 2020. METHODS: In a hospital-based, group-matched case-control study in Kerman, a city in southeast Iran, 160 new cases of cataract and 320 controls without cataract underwent ophthalmological examination and were interviewed. Logistic regression models tested the association between cataract and history of opium use, adjusting for demographic characteristics and history of hypertension, coronary heart disease, renal disease, smoking, alcohol use, and unprotected sun exposure. RESULTS: After controlling for potential confounders, opium use increased the odds of cataract, exhibiting a dose-response relationship. The adjusted odds ratio (aOR) for mild use was 1.44 (95% confidence intervals [CI] 0.80-2.58), and 2.10 (95% CI 1.04-4.25) for heavy use. Exposure to opium juice use further increased the odds of cataract (aOR 2.24, 95% CI 1.00-5.10). Other significant associations with cataract were lower education level (aOR 5.46, 95% CI 2.45-11.29), being unmarried (aOR 2.88, 95% CI 1.65-5.00), both underweight (BMI <18.5, aOR 5.27, 95% CI 2.02-13.70) and overweight (BMI >25, aOR 1.82, 95% CI 1.15-2.87), and family history of cataract (aOR 2.07, 95% CI 1.32-3.23). CONCLUSION: Our study provides evidence that opium use could increase the odds of cataract. Results also support the association of cataract with other modifiable risk factors, such as very low and high BMI and unprotected sun exposure.

Mental Distress and Use of Stimulants: Analysis of a Longitudinal Cohort of Transgender Women.

Purpose: The purpose of our study was to examine the effects of mental distress (depression, anxiety, and post-traumatic stress disorder [PTSD]), incarceration, and hate crime on stimulant use (methamphetamine, crack, and cocaine) among transgender women. Methods: We conducted a secondary analysis of longitudinal data collected from 2016 to 2018 with 429 transgender women in the San Francisco Bay Area. Generalized estimating equation log-binomial regressions were used to calculate relative risks of stimulant use associated with mental distress, incarceration, and hate crime. Results: At baseline, transgender women experienced transphobic hate crime (46.4%), incarceration (53.0%), mental distress (69.2%), and stimulant use (28.4%). Transgender women who used stimulants reported lower education (45.1%, χ2 = 14.3, p = 0.001) and significantly more had been incarcerated (62.3%, χ2 = 5.9, p = 0.015), and reported diagnoses of depression (67.8%, χ2 = 6.1, p = 0.014), anxiety (62.8%, χ2 = 4.3, p = 0.039), and PTSD (43.8%, χ2 = 6.7, p = 0.010). Longitudinal multivariate analysis found that depression (adjusted relative risk [aRR] = 1.46, 95% confidence interval [CI] 1.09-1.95), anxiety (aRR = 1.42, 95% CI = 1.05-1.93), and PTSD (aRR = 1.38, 95% CI = 1.02-1.87) were associated with methamphetamine use but not with crack or cocaine use. Incarceration was associated with methamphetamine use and crack use, whereas experiencing hate crime was associated with crack use. Conclusions: Mental distress, incarceration, and hate crime were key exposures of stimulant use among transgender women. Intervention targets for reducing stimulant use should consider working upstream by addressing underlying stressors impacting mental health for transgender women, including laws to protect transgender women from hate crime and to reduce their disproportionate representation in the criminal justice system.

Influence of risk perception on attitudes toward blood donation among Brazilian men who have sex with men who donated blood.

BACKGROUND: We hypothesize that awareness of individuals' risk behaviors may influence aspects of attitude toward blood donation (i.e., intentions and self-efficacy). Investigating this association in the population of MSM was the objective of the present study. STUDY DESIGN AND METHODS: This is a cross-sectional study based on an open web survey. The online survey was developed and applied on the Research Electronic Data Capture (REDCap) platform. The study's information, invitation to participate, and link to access the online survey were disseminated using social media. Analyses were performed using structural equation modeling. RESULTS: A total of 764 young adults MSM participated, with the majority self-reporting as homosexual, single, in good health, and having completed higher education. A total of 297 (39.5%) reported having donated blood at least once in their lives. Among blood donors, 72.0% admitted to lying about their sexual behavior during the blood donation clinical screening interview; 81.0% did not believe that their behaviors put them at risk for HIV infection; 83.7% believed that their blood is safe enough to be transfused. Structural equation analysis provided evidence that the perception of being at risk for HIV and the perception of having non-safe blood to be transfused contributed to an attitude against future blood donation (explained variance 50%). DISCUSSION: Attitude plays an important role in blood donation decision-making by young adults MSM. This is the first study to provide evidence that the self-perceptions of being at risk for HIV and having non-safe blood may deter MSM from blood donation.

Evaluating tools for capture-recapture model selection to estimate the size of hidden populations: it works in practice, but does it work in theory?

PURPOSE: Capture-recapture methods estimate the size of hidden populations by leveraging the proportion of overlap of the population on independent lists. Log-linear modeling relaxes the assumption of list independence, but best model selection criteria remain uncertain. Incorrect model selection can deliver incorrect and even implausible size estimates. METHODS: We used simulations to model when capture-recapture methods deliver biased or unbiased estimates and compare model selection criteria. Simulations included five scenarios for list dependence among three incomplete lists of population of interest. We compared metrics of log-linear model selection, accuracy, and precision. We also compared log-linear model performance to the decomposable graph approach (a Bayesian model average), the sparse multiple systems estimation (SparseMSE) approach that accounts for zero or low cell counts, and the Sample Coverage approach. RESULTS: Log-linear models selected by Akaike's information criterion (AIC) calculated accurate population size estimates in all scenarios except for those with sparse or zero cell counts. In these scenarios, the decomposable graph and the Sample Coverage models produced more accurate size estimates. CONCLUSIONS: Conventional capture-recapture model selection fails with sparse cell counts. This naïve approach to model selection should be replaced with the implementation of multiple different models in order triangulate the truth in real-world applications.

Prevalence and correlates of substance use and associations with HIV-related outcomes among trans women in the San Francisco Bay Area.

BACKGROUND: Trans women face tremendous social inequities as well as disproportionate rates of HIV and substance use, yet disaggregated substance use data specific to trans women remain limited. METHODS: We conducted a secondary analysis of baseline data from the Trans*National Study (2016-2017) surveying trans women in the San Francisco Bay Area (n = 629). Multivariable logistic regression was used to analyze socio-demographic and environmental correlates of substance use, and bivariate associations between substance use and HIV-associated outcomes are presented alongside prevalence data. RESULTS: Over half (52.9%) reported using substances in the prior year, most frequently marijuana, methamphetamine, and crack/cocaine. Those with unmet gender-affirming health care needs, lack of insurance, or a history of experiencing racial violence, transphobic violence, adult housing instability, or extreme poverty had higher odds of substance use. Sex work and condomless anal sex were also independently associated with substance use. CONCLUSIONS: Among this sample of trans women, substance use and substance use concurrent with sex were highly prevalent, and associated with a number of socioeconomic and health care needs. These findings corroborate the need for holistic and intersectional efforts to reduce substance use and HIV risk.