The City Clinic Cohort Study: Hepatitis B, HTLV-III/LAV, and CDC AIDS Project 24.

Anticipating the availability of a safe vaccine, scientists at the Center for Disease Control (CDC) planned for a multicenter study of the prevalence, incidence, and efficacy of an experimental vaccine for hepatitis B in 1977, conducted the study among homosexual male volunteers in five collaborating sexually transmitted infection (STI) clinics in the United States from April 1978 through 1980, and concluded that the candidate vaccine was highly efficacious in preventing infections with the hepatitis B virus. Then something completely unexpected and portentous happened. Some successfully vaccinated as well as other homosexual and bisexual men began to show signs and symptoms of a rare cancer, Kaposi's sarcoma, and opportunistic infections typically associated with severe immunodeficiency. As early as October 1983, members of the Hepatitis B study cohort in San Francisco were invited to return to the city STI clinic for further examinations, testing, and confidential interviews about their sexual and other practices. CDC AIDS Project 24 was designed to help describe the natural history of AIDS, define risk factors, and predict future trends. It produced some of the earliest and most convincing scientific evidence about the seriousness and extent of the AIDS epidemic among homosexual and bisexual men in the United States. How the City Clinic Cohort Study came about and evolved is the focus of this commentary.

RESUMEN: Anticipando la disponibilidad de una vacuna segura, los científicos del Centro para el Control de Enfermedades (CDC) planearon un estudio multicéntrico sobre la prevalencia, incidencia y eficacia de una vacuna experimental contra la hepatitis B en 1977; realizaron el estudio entre voluntarios varones homosexuales en cinco colaboraron con clínicas de infecciones de transmisión sexual (ITS) en los Estados Unidos desde abril de 1978 hasta 1980, y concluyeron que la vacuna candidata era muy eficaz para prevenir infecciones por el virus de la hepatitis B. Entonces sucedió algo completamente inesperado y portentoso. Algunos hombres vacunados con éxito, así como otros hombres homosexuales y bisexuales, comenzaron a mostrar signos y síntomas de un cáncer poco común, el sarcoma de Kaposi, e infecciones oportunistas típicamente asociadas con una inmunodeficiencia grave. Ya en octubre de 1983, se invitó a los miembros de la cohorte del estudio de la hepatitis B en San Francisco a regresar a la clínica de ITS de la ciudad para realizar más exámenes, pruebas y entrevistas confidenciales sobre sus prácticas sexuales y de otro tipo. El Proyecto 24 del CDC sobre SIDA fue diseñado para ayudar a describir la historia natural del SIDA, definir factores de riesgo y predecir tendencias futuras. Produjo algunas de las primeras y más convincentes pruebas científicas sobre la gravedad y el alcance de la epidemia de SIDA entre los hombres homosexuales y bisexuales en los Estados Unidos. El tema central de este comentario es cómo surgió y evolucionó el estudio de cohorte de City Clinic.

Early Detection of Severe Acute Respiratory Syndrome Coronavirus 2 Variants Using Traveler-based Genomic Surveillance at 4 US Airports, September 2021-January 2022.

We enrolled arriving international air travelers in a severe acute respiratory syndrome coronavirus 2 genomic surveillance program. We used molecular testing of pooled nasal swabs and sequenced positive samples for sublineage. Traveler-based surveillance provided early-warning variant detection, reporting the first US Omicron BA.2 and BA.3 in North America.

Confronting AIDS in the Early 1980s: Biomedicine, Public Health, and the Fourth Estate.

Detection of a mysterious and fatal disease among young, previously healthy, homosexual men in spring 1981 warranted a rapid and effective response. An adequate response failed to materialize during the first 5 years of the AIDS pandemic. The failure of biomedicine, public health, and The Press to stop the outbreak was attributed by Randy Shilts to institutional failures. This commentary considers the possibility that organizations, agencies, and authorities failed to safeguard the public's health because they succeeded in carrying out their appropriate tasks of (1) meticulously conducting systematic, scientific, research, (2) cautiously reporting evidence-based observations and alternative interpretations, and (3) carefully exercising rigorous controls over unauthorized and potentially wasteful spending. As practiced in the early 1980s by the National Institutes of Health, Centers for Disease Control and Prevention, and major newspapers and other media outlets, essential features of biomedicine, public health, and The Press inhibited a rapid and effective response.

RESUMEN: La detección de una enfermedad misteriosa y mortal entre hombres homosexuales jóvenes, previamente sanos, en la primavera de 1981 justificó una respuesta rápida y efectiva. Una respuesta adecuada no se materializó durante los primeros cinco años de la pandemia del SIDA. El fracaso de la biomedicina, la salud pública y The Press para detener el brote fue atribuido por Randy Shilts a fallas institucionales. Este comentario considera la posibilidad de que las organizaciones, agencias y autoridades no hayan salvaguardado la salud pública porque lograron llevar a cabo sus tareas apropiadas de (1) realizar meticulosamente investigaciones sistemáticas, científicas, (2) informar cautelosamente observaciones basadas en evidencia e interpretaciones alternativas, y (3) ejercer cuidadosamente controles rigurosos sobre gastos no autorizados y potencialmente derrochadores. Como se practicó a principios de la década de 1980 por los Institutos Nacionales de Salud, los Centros para el Control y la Prevención de Enfermedades y los principales periódicos y otros medios de comunicación, las características esenciales de la biomedicina, la salud pública y la prensa inhibieron una respuesta rápida y efectiva.

The First 40 Years of AIDS: Promising Programs, Limited Success.

HIV-prevention program planning, implementation, and evaluation began in the United States shortly after reports of a mysterious, apparently acquired, immune deficiency syndrome appeared in summer 1981. In San Francisco, New York City, and elsewhere, members of LGBT communities responded by providing accurate information, giving support, and raising money. During the first decade of the AIDS pandemic (1981-1990), social and behavioral scientists contributed by designing theory-based and practical interventions, combining interventions into programs, and measuring impact on behavior change and HIV incidence. In the second decade (1991-2000), federal, state, and local agencies and organizations played a more prominent role in establishing policies and procedures, funding research and programs, and determining the direction of intervention efforts. In the third decade (2001-2010), biomedical interventions were prioritized over behavioral interventions and have dominated attempts in the fourth decade (2011-2020) to integrate biomedical, behavioral, and structural interventions into coherent, efficient, and cost-effective programs to end AIDS.

RESUMEN: La planificación, implementación y evaluación de programas de prevención del VIH comenzaron en los Estados Unidos poco después de que aparecieran informes de un misterioso síndrome de inmunodeficiencia aparentemente adquirida en el verano de 1981. En San Francisco, la ciudad de Nueva York y otros lugares, los miembros de las comunidades LGBT respondieron proporcionando información precisa, apoyo y recaudación de fondos. Durante la primera década de la pandemia del SIDA (1981­1990), los científicos sociales y del comportamiento contribuyeron diseñando intervenciones prácticas y basadas en la teoría, combinando intervenciones en programas y midiendo el impacto en el cambio de comportamiento y la incidencia del VIH. En la segunda década (1991­2000), las agencias y organizaciones federales, estatales y locales desempeñaron un papel más destacado en el establecimiento de políticas y procedimientos, la financiación de investigaciones y programas y la determinación de la dirección de los esfuerzos de intervención. En la tercera década (2001­2010), las intervenciones biomédicas se le dieron prioridad sobre las intervenciones conductuales y han dominado los intentos en la cuarta década (2011­2020) de integrar intervenciones biomédicas, bio conductuales y estructurales en programas coherentes, eficientes y económicos para acabar con el SIDA.

Development of a Computer-Guided Workflow for Catalyst Optimization. Descriptor Validation, Subset Selection, and Training Set Analysis.

Modern, enantioselective catalyst development is driven largely by empiricism. Although this approach has fostered the introduction of most of the existing synthetic methods, it is inherently limited by the skill, creativity, and chemical intuition of the practitioner. Herein, we present a complementary approach to catalyst optimization in which statistical methods are used at each stage to streamline development. To construct the optimization informatics workflow, a number of critical components had to be subjected to rigorous validation. First, the critically important molecular descriptors were validated in two case studies to establish the importance of conformation-dependent molecular representations. Next, with a large data set available, it was possible to investigate the amount of data necessary to make predictive models with different modeling methods. Given the commercial availability of many catalyst structures, it was possible to compare models generated with algorithmically selected training sets and commercially available training sets. Finally, the augmentation of limited data sets is demonstrated in a method informed by unsupervised learning to restore the accuracy of the generated models.

Rhodium Complexes of Carbaporphyrins, Carbachlorins, adj-Dicarbaporphyrins, and an adj-Dicarbachlorin.

The macrocyclic cavities in carbaporphyrins are well suited for the formation of metalated derivatives. A carbaporphyrin diester and a naphthocarbaporphyrin reacted with [Rh(CO)2Cl]2 to give good-to-excellent yields of rhodium(I) complexes, and these were fully characterized by X-ray crystallography. Both rhodium(I) derivatives were converted into rhodium(III) complexes in refluxing pyridine, albeit in moderate yields. Carbachlorins also formed rhodium(I) complexes, but these could not be further transformed into rhodium(III) products. The rhodium(III) complexes incorporate two axial pyridine ligands, which exhibit strongly shielded resonances in their 1H NMR spectra, and the rhodium(III) carbaporphyrin diester was further characterized by X-ray crystallography. adj-Dicarbaporphyrins also formed rhodium(I) complexes, but these reactions involved the relocation of a proton to generate an internal methylene unit. The environments associated with the two faces of the resulting macrocycles are very different from one another, and this results in the 1H NMR chemical shifts for the two internal methylene protons being separated by well over 3 ppm. Although the diatropicities of rhodium(I) complexes for monocarbaporphyrins and carbachlorins are comparable to those of the parent ligands, the chemical shifts for rhodium(I) dicarbaporphyrins are consistent with a significant reduction in the porphyrinoid aromaticity. A dicarbachlorin also gave a rhodium(I) complex, but this species fully retained the diatropic characteristics of the parent ligand. Nevertheless, the internal CH2 unit still gave two widely separated doublets indicative of radically differing environments for the two faces of the macrocycle. Rhodium(I) dicarbaporphyrin and dicarbachlorin complexes were further characterized by X-ray crystallography.

And the Band Played on: Before and After.

In fall 1987, Randy Shilts published his second book, "And the Band Played on: Politics, People, and the AIDS Epidemic." The jacket proclaimed that "the epidemic spread widely because the federal government put budget ahead of the nation's welfare; health authorities placed political expediency before the public health; and scientists were more often more concerned with international prestige than saving lives." In the Prologue Shilts wrote, "The bitter truth was that AIDS did not just happen to America-it was allowed to happen by an array of institutions, all of which failed to perform their appropriate tasks to safeguard the public health." This essay reviews the controversial book published by Randy Shilts 30 years ago in light of some of the events that have followed. First, the context and content of the book-and reactions to its publication-are summarized. Secondly, several major developments after publication of the book are noted. Thirdly, a critical assessment of the author and his work is offered in an era when some politicians and physicians in the United States are imagining "an AIDS-free generation."

A needs assessment of health department employees in Puerto Rico and Florida.

Public health training centers were established to enhance competencies in skills required to meet 21st-century public health challenges. In 2011, the Puerto Rico-Florida Public Health Training Center conducted surveys to assess the training needs of two populations of public health workers serving Hispanic communities: Florida Department of Health employees and workers at the regional and central offices of the Puerto Rico Department of Health. The two surveys were similar, but not identical in content and administration. A 52.6% response rate was achieved in the Commonwealth of Puerto Rico, where limited computer access necessitated use of a pen-and-paper survey. A 20.7% response rate was achieved in Florida, where an online survey was used and incomplete responses were problematic. Puerto Rico respondents (n = 1,414) were similar in age (Mdn age = 48 years) to Hispanic Florida respondents (n = 546, Mdn age =45 years). They also reported higher levels of academic achievement and more years of experience in public health. Nevertheless, self-assessed public health competency scores were in the low- to mid-range for Hispanic respondents in both locales. Although self-assessed training priorities differed, Hispanic employees in both jurisdictions preferred hands-on and face-to-face training to distance learning. Findings indicate a need for training based on adult learning theory, targeted to entry-level employees, and addressing the top five self-assessed training needs, especially health promotion and disease prevention and public health law and policy, which emerged as priority training areas in both survey populations.

Coalition contract management as a systems change strategy for HIV prevention.

Racial and Ethnic Approaches to Community Health (REACH) 2010 provided a unique opportunity for minority community-based organizations (CBOs) to work together to eliminate disparities in HIV disease. A coalition was formed in Broward County to respond to the REACH 2010 program announcement, a university was chosen to coordinate efforts, and contracts were negotiated with CBO partners to develop, implement, and evaluate a community action plan. Contract management provided stability, focus, and a mechanism for coalition partners to measure progress toward achieving project objectives. By emphasizing documentation as well as the delivery of services, however, contract conditions also placed a heavy burden on educational outreach workers, restricted the reimbursable activities of member organizations, and created friction between minority agencies and university staff. Although the coalition met many of its objectives, the introduction and enforcement of a mutually agreed on set of rules and obligations as a way of promoting systems change in Broward County failed to make a lasting impact among community partners. CBOs continued to compete with one another for HIV prevention project funding and stopped collaborating as closely with another when federal support for our REACH 2010 community demonstration project ran out.

AIDS-related stigma among Black and Hispanic young adults.

Telephone surveys with national probability samples of English-speaking adults have suggested that popular support for punitive policies toward people living with HIV/AIDS (PLWHA) declined in the 1990s, but AIDS-related stigma persists in the United States. Our aim was to assess the prevalence and impact of AIDS-related stigma in non-Hispanic Black and Hispanic communities. A cross-sectional computer-assisted telephone-interview survey was conducted in summer 2003 with African-American, Afro-Caribbean, Haitian, and Hispanic 18-39 year-old residents of 12 high AIDS-incidence areas in Broward County, Florida. Stigma items were adopted from national surveys, but interviews were conducted in Spanish and Haitian Creole as well as in English. Stigma scores were higher than those reported for national samples, especially among Haitians interviewed in Creole. AIDS-related stigma was associated with never receiving an HIV-antibody test (adjusted odds ratio [AOR] = 0.78, 95% confidence interval [CI]: 0.62-0.99, P = .046), an elevated perception of HIV risk (AOR = 1.32, 95% CI: 1.01-1.73, P = .045) and a failure to participate in HIV-prevention efforts (AOR = 0.53, 95% CI: 0.34-0.85, P = .008). Interventions are needed to mitigate the pernicious effects of AIDS-related stigma.

Improving Human Papillomavirus-Related Knowledge and Attitudes Among Ethnically Diverse Young Adults.

Purpose: To make baseline comparisons and evaluate the efficacy of an intervention designed to improve human papillomavirus (HPV) and HPV vaccine awareness, knowledge, and attitudes among ethnically diverse participants. Methods: Design: Pre- and post-intervention surveys. Setting: An urban, Hispanic-Serving South Florida university. Subjects: Three hundred eighty-seven diverse college students attending a gender studies course. Intervention: Students received a brief educational message designed to improve HPV-related knowledge and attitudes. Baseline and follow-up survey data were collected. Measures: Outcome measures included baseline and follow-up awareness of HPV, perceived knowledge of HPV and HPV vaccination, measured knowledge score, vaccine attitudes, and doses of HPV vaccine received. Analysis: Chi-square, analysis of covariance (ANCOVA), and Wilcoxon rank-sum tests were used to compare baseline differences and evaluate the efficacy of the intervention. Results: Hispanic participants had more positive attitudes toward HPV vaccination (62% vs. 44%, p=0.009) and were more willing to become vaccinated (66% vs. 46%, p=0.02) than non-Hispanic participants at baseline. Hispanic women (48%) were more likely to have initiated HPV vaccination than Hispanic men (27%, p=0.006). At baseline, only 30% of participants scored ≥4/7 points in knowledge. Participants' HPV knowledge improved by 41% after the intervention, with no difference by ethnicity in the post-intervention score. Conclusion: The intervention was useful in improving HPV-related knowledge and attitudes among diverse college students. Future studies should examine barriers to vaccination among ethnic minorities.

Are Men Being Left Behind (Or Catching Up)? Differences in HPV Awareness, Knowledge, and Attitudes Between Diverse College Men and Women.

The aim of this cross-sectional survey was to assess awareness, knowledge, and attitudes in regard to human papillomavirus (HPV) and vaccination against HPV among college students. From 2015 to 2017, 386 diverse undergraduates were recruited from a south Florida university. A survey, part of which was researcher developed, of HPV awareness, knowledge, and attitudes was conducted. The majority (84%) of participants had heard of HPV, and 70% had favorable attitudes toward vaccination. Only 28% of men and 55% of women had received ≥1 dose vaccine (p = .01), and 4% of all participants reported that they had received 3 doses. Those with ≥1 dose (n = 123, 40.1%) were more knowledgeable about HPV (p = .01). High knowledge scores were recorded for 30% of respondents and were strongly associated with HPV vaccine initiation among both men and women (p < .001) and perceived knowledge among women only (p < .001). Negative attitudes toward HPV vaccine acceptance were associated with low knowledge scores (p = .01) and undervaccination (p < .001). Vaccinated women (n = 95) were over seven times more likely than were unvaccinated women (n = 115) to report positive vaccine attitudes (relative risk = 7.1). HPV vaccination status was not associated with vaccine attitudes among men. HPV knowledge and vaccine uptake remain problematic among college students, and deficits in both are associated with negative HPV vaccine attitudes. Although the knowledge gap is narrowing, HPV vaccination efforts should target young men, as HPV-related cancer morbidity continues to rise in men.

Exploring the Determinants of Risky Sexual Behavior Among Ethnically Diverse University Students: the Student Behavioral Health Survey-Web.

Universities create policies and develop programs to prevent HIV and other sexually transmitted infections. Unfortunately, most historically Black colleges and Hispanic-serving institutions have limited information about student practices and program effectiveness. This study examined the prevalence and determinants of risky sex among students attending a Hispanic-serving university. A cross-sectional online survey was conducted to obtain sensitive data from a random sample of students. Nearly two-thirds (65.2%) of 632 respondents reported engaging in risky sex. Sexual risk was significantly associated with older age (AOR = 2.16, 95% CI 1.09-4.30), lower self-control (AOR = 0.58, 95% CI 0.34-0.97), and higher alcohol (AOR = 2.10, 95% CI 1.20-3.67) and drug use (AOR = 2.59, 95% CI 1.48-4.50). Most respondents were unaware of university policies and programs. Programs to improve sexual health must influence risk-taking students. Perceptions of self-control and use of alcohol and drugs affected sexual decision-making. These factors should be ascertained and addressed by behavioral interventions aimed at minimizing risky behaviors and limiting the transmission of sexually transmitted infections.

Progress and Challenges in "Getting to Zero" New HIV Infections in Miami, Florida.

OBJECTIVES: Miami has the highest rate of new HIV diagnoses in the United States. We examined the early successes and challenges in fulfilling recommendations made by the Miami-Dade County HIV/AIDS Getting to Zero Task Force, formed by local experts in 2016. METHODS: We used a host of surveillance data, published empirical studies, public reports, and unpublished data from partners of the Task Force to evaluate progress and challenges in meeting the recommendations. RESULTS: Improvements in prevention and care included routinized HIV testing in emergency departments, moving the linkage-to-care benchmark from 90 to 30 days, increased viral suppression, and awareness of pre-exposure prophylaxis. However, treatment enrollment, viral suppression, and pre-exposure prophylaxis uptake remained low. CONCLUSIONS: Recommendations from the Task Force provide excellent guidance for implementing evidence-based HIV prevention in Miami, yet success in achieving the recommendations will require continued or increased support in many public health sectors in South Florida.

Prediction of higher-selectivity catalysts by computer-driven workflow and machine learning.

Catalyst design in asymmetric reaction development has traditionally been driven by empiricism, wherein experimentalists attempt to qualitatively recognize structural patterns to improve selectivity. Machine learning algorithms and chemoinformatics can potentially accelerate this process by recognizing otherwise inscrutable patterns in large datasets. Herein we report a computationally guided workflow for chiral catalyst selection using chemoinformatics at every stage of development. Robust molecular descriptors that are agnostic to the catalyst scaffold allow for selection of a universal training set on the basis of steric and electronic properties. This set can be used to train machine learning methods to make highly accurate predictive models over a broad range of selectivity space. Using support vector machines and deep feed-forward neural networks, we demonstrate accurate predictive modeling in the chiral phosphoric acid-catalyzed thiol addition to N-acylimines.

Short-term impact evaluation of a social marketing campaign to prevent syphilis among men who have sex with men.

OBJECTIVES: We carried out an independent short-term impact evaluation of a social marketing campaign designed to reduce syphilis infections among men who have sex with men in south Florida in 2004. METHODS: Venue-based surveys were conducted shortly after the campaign began and 6 months later to assess changes in exposure to campaign materials, awareness, knowledge about syphilis, perceptions of risk, sexual behavior, clinic visits, and testing and treatment for syphilis among participants. RESULTS: Exposure to social marketing campaign materials increased from 18.0% at baseline to 36.5% at follow-up (P< .001). Awareness of syphilis and perceptions of risk increased among Broward County residents but not among Miami-Dade County residents. Risky sexual practices and patterns of recreational drug use did not change. No significant increases in knowledge, clinic visits, or testing or treatment for syphilis among participants were detected over the 6-month study period. CONCLUSIONS: None of the campaign objectives were fully met. The interventions were insufficient to produce a significant impact among men who have sex with men in south Florida.

Zika Virus Awareness and Prevention Practices Among University Students in Miami: 2016.

In January 2016, the first case of mosquito-borne Zika infection in the mainland United States was confirmed in Miami, Florida. The first locally acquired case was reported 6 months later. Local public health and school officials began warning students of the outbreak on their return to the classroom in August 2016. In November-December 2016, we conducted a survey of students attending a large public university in Miami to determine how well informed they were about Zika. A multistage sampling design was used to contact teaching assistants and ask them for help in recruiting their students. Eligible students had to be 18 years of age or older and enrolled in at least one three-credit course during fall semester. A 25-item questionnaire based on the World Health Organization Zika Knowledge, Attitudes, and Practice Resource Pack was developed, pretested, and approved by the university's institutional review board before it was made available to eligible students through Blackboard Learn or a survey link. About half (50.4%) of the 139 respondents had heard about Zika prior to 2016. Only one student was unaware of Zika before our survey. Most (47.1%) first learned about Zika through television, 18.8% from family or friends, and 15.2% from the Internet, social media, or university e-mail. Two thirds (66.2%) believed Zika could be prevented, 15.1% thought it might be prevented, and 85.7% had taken some precautions. A high level of awareness of the risk of Zika infection was apparent. Most students reported taking steps to avoid exposure to the Zika virus.

HIV risk reduction among young minority adults in Broward County.

We examined changes in perceptions of HIV risk, abstinence, condom use, and intentions to use condoms for disease protection among African American, Hispanic, Haitian, and Afro-Caribbean unmarried and married men and women living in Broward County, Florida. Data were collected through computer-assisted telephone interview surveys conducted during 2001, 2002, and 2003 with cross-sectional probability samples of 18-39 year old residents of 12 high AIDS incidence ZIP code areas. Perceptions of HIV risk increased over time for men, but not for women. Unmarried Haitian women 18-22 years old were most likely to report abstinence. Condom use during the last 12 months increased among sexually active respondents. Among residents reporting exposure to project interventions, condom use increased from 53.6% in 2001 to 64.7% in 2002 and 71.6% in 2003. HIV-prevention programs should (1) consider locally collected data; (2) take into account cultural, living situation, and other significant differences; and (3) be evaluated to assess differentiated impact.

Associations between Health and Academic Success at a Florida University: An Exploratory Cross-sectional Study.

The aims of the study were to explore the associations between college students' perception of their overall physical and psychological health and four measures of academic performance. College students (N = 265) completed a 65-item Web-based survey in a university's student health services building during the spring 2015 semester. Poorer psychological health was associated with seriously considering dropping out of college and missing more classes during the current school year "due to physical or psychological health reasons." Poorer physical health was associated with enrollment in more credit hours. Students who reported a grade point average (GPA) below 2.0 missed more classes "because of physical or psychological reasons" during the current school year than those with a 2.0 or higher GPA. A longitudinal study is needed to clarify whether better health leads to more successful academic performance or vice versa and which specific health indicators play the largest role.