The impact of regional socioeconomic deprivation on the timing of HIV diagnosis: a cross-sectional study in Germany.

BACKGROUND: HIV infections which are diagnosed at advanced stages are associated with significantly poorer health outcomes. In Germany, the proportion of persons living with HIV who are diagnosed at later stages has remained continuously high. This study examined the impact of regional socioeconomic deprivation on the timing of HIV diagnosis. METHODS: We used data from the national statutory notification of newly diagnosed HIV infections between 2011 and 2018 with further information on the timing of diagnosis determined by the BED-Capture-ELISA test (BED-CEIA) and diagnosing physicians. Data on regional socioeconomic deprivation were derived from the German Index of Socioeconomic Deprivation (GISD). Outcome measures were a non-recent infection based on the BED-CEIA result or an infection at the stage of AIDS. The effect of socioeconomic deprivation on the timing of diagnosis was analysed using multivariable Poisson regression models with cluster-robust error variance. RESULTS: Overall, 67.5% (n = 10,810) of the persons were diagnosed with a non-recent infection and 15.2% (n = 2746) with AIDS. The proportions were higher among persons with heterosexual contact compared to men who have sex with men (MSM) (76.8% non-recent and 14.9% AIDS vs. 61.7% non-recent and 11.4% AIDS). MSM living in highly deprived regions in the countryside (< 100 k residents) were more likely to have a non-recent infection (aPR: 1.16, 95% CI: 1.05-1.28) as well as AIDS (aPR: 1.41, 95% CI: 1.08-1.85) at the time of diagnosis compared to MSM in less deprived regions in the countryside. No differences were observed among MSM from towns (100 k ≤ 1 million residents) or major cities (≥ 1 million residents), and no differences overall in the heterosexual transmission group. CONCLUSIONS: An effect of socioeconomic deprivation on the timing of HIV diagnosis was found only in MSM from countryside regions. We suggest that efforts in promoting HIV awareness and regular HIV testing are increased for heterosexual persons irrespective of socioeconomic background, and for MSM with a focus on those living in deprived regions in the countryside.

Associations between sexual identity, living with disability, bully victimisation, and HIV status and intimate partner violence among residents in Nigeria.

BACKGROUND: The aim of the study was to determine the associations between sexual identity, disability and HIV status and bullying victimisation, and a history of physical, emotional and sexual violence in Nigeria. METHODS: This was a secondary analysis of a primary dataset generated through an online survey conducted between February 7 and 19, 2021. The 3197 participants for the primary study were recruited through snowballing. The dependent variables were physical, emotional and sexual violence. The independent variables were sexual identity (heterosexual and sexual minority), HIV status (negative, positive and unknown), bullying victimisation (yes/no) and living with disability (yes/no). A multivariate logistic regression model was developed for each form of IPV. Each model was adjusted for age, sex assigned at birth, marital status and education level. RESULTS: Respondents living with HIV had higher odds for physical (AOR: 2.01; 95% CI: 1.46-2.76; p < 0.001), sexual (AOR: 2.17; 95%CI: 1.55-3.05; p < 0.001), and emotional (AOR: 1.59; 95%CI: 1.24-2.06; p < 0.001) violence. Also, those with history of bullying victimisation had higher odds for physical (AOR: 3.79; 95%CI: 2.86 - 5.68; p < 0.001), sexual (AOR: 3.05; 95%CI: 2.27 - 4.10; p < 0.001) and emotional (AOR: 2.66; 95%CI: 2.10 - 3.37; p < 0.001) violence. In addition, females had higher odds of physical (AOR: 1.52; 95%CI: 1.13-2.043; p < 0.001) and sexual (AOR: 1.83; 95%CI: 1.34 - 2.50; p < 0.001) violence; and respondents cohabiting (AOR: 1.95; 95%CI: 1.12 - 3.28; p = 0.012) had higher odds for emotional violence. Respondents who were married have significantly lower odds of experiencing physical (AOR: 0.66; 95%CI: 0.45 - 9.60; p = 0.029), sexual (AOR: 0.40; 95%CI: 0.26 - 0.62; p < 0.001) and emotional (AOR: 0.68; 95%CI: 0.50 - 0.93; p = 0.015) violence when compared to singles. Younger respondents also had lower odds of experiencing sexual violence (AOR: 0.97; 95%CI: 0.95-0.99; p = 0.016). CONCLUSION: HIV positive status and bullying victimisation seem to increase the risk for all forms of IPV while the experience of IPV did not differ by sexual identity and disability status. The associations between age, sex, marital status and IPV may suggest moderating roles of the factors taking cognisance of the cultural context of these relationships. Future relational analysis is necessary to further understand the pathways for the associations found between the variables in this study.

Knowledge of sexual partner's HIV serostatus and the practice of safer sex among heterosexual men of African descent in London, Ontario.

Objective: Poor knowledge of sexual partners' HIV status is a major contributing factor in the heterosexual spread of HIV in Canada. This study examined knowledge of sexual partner's HIV serostatus and the practice of safer sex among self-identified heterosexual African, Caribbean and Black (ACB) men in London, Ontario.Design: A cross-sectional data was collected from 156 heterosexual ACB men in London. The negative log-log link function was fitted to estimate the relationship between knowledge of sexual partner's HIV status and condom use among ACB men.Results: Findings show that ACB men who know their sexual partner's HIV status are less likely to use condoms compared to men who do not know the serostatus of their sexual partner, controlling for other theoretically relevant covariates. In addition, the findings show that sexually active, single ACB men are less likely to use condoms. On the other hand, ACB men with higher education, employed and with income over 60 thousand dollars a year have a higher likelihood of using condoms.Conclusions: Heterosexual ACB men who used condoms even when they did not know their sexual partners' HIV status could be explained as a resilience-building strategy in response to their increasing HIV vulnerabilities. Heterosexual ACB men's use of condoms is further associated with socioeconomic factors including income, employment and education that need to be addressed for an improved safer sex.

The Effect of Social Networks and Social Constructions on HIV Risk Perceptions.

Roughly 1 in 7 people living with HIV in the United States is unaware of their sero-status, signaling that individuals may be underestimating their risk for HIV. Few studies have examined the effect of socio-structural and socio-cognitive factors on HIV risk perceptions. This analysis identifies individual, interpersonal and network influences on HIV risk perceptions among high-risk heterosexuals. Data come from the Colorado Springs study, a CDC-funded project focused on HIV transmission among high-risk heterosexuals. Using social network data, analyses were first conducted at the individual-level using a partial proportional odds regression to identify predictors of self-perceived HIV risk. Next, multivariate binary logistic regression using GEE was used to examine  predictors of perceptions of network member's  HIV risk. Interpersonal characteristics such as perceptions of network member's HIV risk, racial homophily, and engagement in multiplexity (co-occurrence of drug-use, needle sharing and sex within relationships) were significantly associated with respondents' self-perceived HIV risk. Factors associated with perceptions of network member's HIV risk include self-perceived HIV risk, emotional closeness within relationships, and density of drug ties. Analyses found HIV risk perception is the product of not only individual-level factors, but also interpersonal and social network processes. We also found a reciprocal relationship between individuals' perceptions of their own risk and the risk of their associates/network members. Findings highlight the need for understanding risk perception as a function of interpersonal relationships, social constructions, including socio-cognitive processes.

Place-based predictors of HIV viral suppression and durable suppression among heterosexuals in New York city.

Scant research has explored place-based correlates of achieving and maintaining HIV viral load suppression among heterosexuals living with HIV. We conducted multilevel analyses to examine associations between United Hospital Fund (UHF)-level characteristics and individual-level viral suppression and durable viral suppression among individuals with newly diagnosed HIV in New York City (NYC) who have heterosexual HIV transmission risk. Individual-level independent and dependent variables came from NYC's HIV surveillance registry for individuals diagnosed with HIV in 2009-2013 (N = 3,159; 57% virally suppressed; 36% durably virally suppressed). UHF-level covariates included measures of food distress, demographic composition, neighborhood disadvantage and affluence, healthcare access, alcohol outlet density, residential vacancy, and police stop and frisk rates. We found that living in neighborhoods where a larger percent of residents were food distressed was associated with not maintaining viral suppression. If future research should confirm this is a causal association, community-level interventions targeting food distress may improve the health of people living with HIV and reduce the risk of forward transmission.

Monitoring of the HIV Epidemic Using Routinely Collected Data: The Case of the United Kingdom.

We report on measures used to monitor the response to the UK HIV epidemic. We present analyses of routine data on HIV testing, diagnosis and care, and of CD4 back-calculation models to estimate country of HIV acquisition and incidence. Over the past decade, HIV and AIDS diagnoses and deaths declined while HIV testing coverage increased. Linkage into care, retention in care, and viral suppression was high with few socio-demographic differences. However, in 2013, incidence among MSM, and undiagnosed infection, also remained high, and more than half of heterosexuals newly diagnosed with HIV (the majority of whom were born-abroad) probably acquired HIV in the UK and were diagnosed late. HIV care following diagnosis is excellent in the UK. Improvements in testing and prevention are required to reduce undiagnosed infection, incidence and late diagnoses. Routinely collected laboratory and clinic data is a low cost, robust and timely mechanism to monitor the public health response to national HIV epidemics.

Interpersonal Attacks on the Dignity of Members of HIV Key Populations: A Descriptive and Exploratory Study.

Attacks on peoples' dignity help to produce and maintain stigmatization and interpersonal hostility. As part of an effort to develop innovative measures of possible pathways between structural interventions or socially-disruptive Big Events and HIV outbreaks, we developed items to measure dignity denial. These measures were administered to 300 people who inject drugs (PWID), 260 high-risk heterosexuals who do not inject drugs, and 191 men who have sex with men who do not inject drugs (MSM). All of the PWID and many of the high risk heterosexuals and MSM were referred to our study in 2012-2015 by a large New York city study that used respondent-driven sampling; the others were recruited by chain-referral. Members of all three key populations experienced attacks on their dignity fairly often and also reported frequently seeing others' dignity being attacked. Relatives are major sources of dignity attacks. MSM were significantly more likely to report having their dignity attacked by police officers than were the other groups. 40 % or more of each key population reported that dignity attacks are followed "sometimes" or more often both by using more drugs and also by using more alcohol. Dignity attacks and their health effects require more research and creative interventions, some of which might take untraditional forms like social movements.

Estimating gonorrhoea prevalence in young heterosexual men and women attending community-based sexual health services to inform decisions on gonorrhoea testing.

In England, dual tests detecting chlamydia and gonorrhoea are used in specialist and community-based sexual health services (SHSs). Test performance is poor when prevalence is low, therefore UK national guidelines recommend against opportunistic gonorrhoea screening unless there is a clear local public health need. While surveillance data on gonorrhoea prevalence is comprehensive in specialist SHSs, it is sparse in community SHSs. We aimed to estimate gonorrhoea prevalence in heterosexual men and women aged 15-24 attending community SHSs to inform testing care pathways. We used linear and quadratic regression to model the relationship between prevalence in community and specialist SHSs in local authorities (LAs) with available surveillance data. We applied best-fitting models to predict prevalence in community SHSs in remaining LAs. Data from community SHSs were available for 102/326 LAs. There was a weak positive association between gonorrhoea prevalence in community and specialist SHSs in corresponding LAs within (R 2 = 0·13, P = 0·058) and outside (R 2 = 0·07, P = 0·02) London. Applying best-fitting models, we estimated a median gonorrhoea prevalence of 0·5% (mean 0·6%; range 0·2%-2·7%) in heterosexuals attending community SHSs. Despite some unexplained variation, our analyses suggest gonorrhoea prevalence in young heterosexuals attending community SHSs is below 1% in most English LAs. Our findings re-inforce the current national guidelines that recommend care pathways for gonorrhoea testing in community SHSs include confirmatory testing to reduce the risk of misdiagnosis and inappropriate management.

It takes two to tango: information-sharing with offspring among heterosexual parents following identity-release sperm donation.

STUDY QUESTION: How do heterosexual parents reason about and experience information-sharing with offspring following identity-release sperm donation? SUMMARY ANSWER: Sharing information about using donor-conception with offspring is a complex process at several levels, with the parent's personal beliefs and the child's responses serving as driving or impeding forces for the information-sharing process. WHAT IS KNOWN ALREADY: The overall view of disclosure in gamete donation has shifted from secrecy to openness, but there is still uncertainty among parents concerning how and when to tell the child about his/her genetic origin. Most research on donor-conceived families has focused on donation treatment under anonymous or known circumstances, and there is a lack of studies in settings with identity-release donations. STUDY DESIGN, SIZE, DURATION: A qualitative interview study among 30 parents following identity-release sperm donation treatment. Interviews were conducted from February 2014 to March 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS: The present study is part of the prospective longitudinal Swedish Study on Gamete Donation (SSGD), including all fertility clinics performing gamete donation in Sweden. A sample of participants in the SSGD, consisting of heterosexual parents with children aged 7-8 years following identity-release sperm donation, participated in individual semi-structured interviews. MAIN RESULTS AND THE ROLE OF CHANCE: The analysis revealed one main theme: information-sharing is a process, with three subthemes; (i) the parent as process manager, (ii) the child as force or friction and (iii) being in the process. The first two subthemes were viewed as being linked together and their content served as driving or impeding forces in the information-sharing process. LIMITATIONS, REASONS FOR CAUTION: The fact that the study was performed within the context of the Swedish legislation on identity-release donation must be taken into consideration as regards transferability to other populations, as this may affect parents' reasoning concerning their information-sharing with the child. WIDER IMPLICATIONS OF THE FINDINGS: The present findings highlight the role of the donor-conceived child in the information-sharing process and may contribute to develop counselling that increases parents' confidence in handling children's reactions to information about their genetic origin. STUDY FUNDING/COMPETING INTERESTS: Financial support from The Swedish Research Council, The Family Planning Fund in Uppsala and Ferring Pharmaceuticals. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: N/A.

A Comparison of Men Who Have Sex with Men, People Who Inject Drugs and High-Risk Heterosexuals' Risk for HIV Infection, San Francisco.

HIV in the United States is concentrated in populations such as men who have sex with men (MSM), people who inject drugs (PWID), women of color and people living in poverty. These populations are labeled high-risk for HIV infection because of the higher levels of HIV or HIV risk taking behaviors seen in these groups compared to other sub-populations. It is also possible that a group may engage in behaviors that are "high-risk" for HIV infection but never become infected since HIV is not present or not present to a great extent in their social or sexual networks. We analyzed samples of MSM, PWID and high-risk heterosexuals (HRH) collected through the National HIV Behavioral Surveillance (NHBS) system in San Francisco to examine HIV risk taking and HIV burden to determine if the label "high-risk" is appropriately applied. NHBS samples MSM using time location sampling and PWID and HRH using Respondent Driven Sampling. We sampled 508 MSM in 2011, 570 PWID in 2012 and 267 HRH in 2013. There were, as expected, differences in demographic characteristics across the three groups. HRH had a greater number of high-risk behaviors compared to MSM and PWID but had the lowest HIV prevalence. Focusing on risk behavior alone to label populations without considering the background HIV prevalence in communities, the types of risks engaged in and actual HIV infections may obscure which populations truly merit the label "high-risk" for HIV infection.

Efforts to Find Heterosexual HIV in San Francisco, 2007-2013.

Nationally heterosexuals are an HIV prevention priority. In addition to case based HIV surveillance, behavioral surveillance surveys are conducted among heterosexuals living in high AIDS morbidity neighborhoods. We report on risk behaviors and HIV prevalence among "high-risk" heterosexuals in San Francisco. National HIV Behavioral Surveillance System is coordinated by the CDC and implemented in 21 health jurisdictions. The studies were conducted in 2006, 2010 and 2013 in San Francisco. Respondent driven sampling was used to sample participants. Eligible persons were 18-50 years old and had sex with at least one opposite gender partner in the past year. We obtained samples of 371, 421, 165 heterosexuals in 2007, 2010 and 2013, respectively. Some demographics varied across the 3 years. Residential neighborhoods changed, homelessness and healthcare coverage increased. Binge drinking, cocaine and heroin use increased while methamphetamine use declined. There were no changes in numbers of partners, unprotected vaginal intercourse or unprotected anal intercourse. Commercial sex work increased. Even with "fine tuning" of eligibility criteria to attempt to find heterosexual HIV cases, we estimate that HIV prevalence was 0.3, 0.2 and 2.4 % in 2007, 2010 and 2013 respectively. The increase was not statistically significant. For the present, effective prevention among persons in the populations most severely affected by HIV remains the priority, for their own benefit and to prevent transmission to other vulnerable populations to which they may be connected.

Partnership Dynamics of LGB People and Heterosexuals: Patterns of First Partnership Formation and First Cohabitation.

In this study we examine partnership dynamics among people with different sexual orientations in Germany. More specifically, we explore the process of first partnership formation and first cohabitation among men and women who self-identify as heterosexual, homosexual or bisexual. Given the various discriminations against same-sex lifestyles, and the limited opportunities to meet potential partners, we assume that lesbian, gay and bisexual (LGB) people form partnerships later in life and less frequently than heterosexuals. We further expect that the constantly improving social and legal climate for sexual minorities will lead to a reduction in differences in partnership behaviour by sexual orientation. We use retrospectively reported partnership biographies from the German Socio-Economic Panel, which was supplemented in 2019 with a boost sample of sexual and gender minority households. Using discrete-time event history models, we analyse nearly 15,000 episodes of being single and nearly 20,000 episodes of living without a partner in the household. Around 4.5% of these episodes are from people who self-identify as LGB. The results clearly show that patterns of partnership and coresidential union formation differ by sexual orientation. People with a homosexual orientation-and to a lesser extent people with a bisexual orientation-are less likely to enter into a first partnership and a first cohabitation than people with a heterosexual orientation. Significant changes occur across cohorts: LGB people from younger birth cohorts enter (cohabiting) partnerships much earlier and more frequently than those from older cohorts. Thus, the union formation patterns of LGB and straight people have converged slightly.

Immune reconstitution efficacy after combination antiretroviral therapy in male HIV-1 infected patients with homosexual and heterosexual transmission.

We aimed to explore the impact of sexual transmission modes on immune reconstitution after combined antiretroviral therapy (cART). We have retrospectively analyzed longitudinal samples from 1557 treated male patients with virological suppression (HIV-1 RNA < 50 copies/ml) for at least 2 years. Both heterosexuals (HET) and men who have sex with men (MSM) patients showed an increasing annual trend in CD4+ T cell counts after receiving cART (HET, ß: 23.51 (cell/µl)/year, 95% CI: 16.70-30.31; MSM, ß: 40.21 (cell/µl)/year, 95% CI: 35.82-44.61). However, the CD4+ T cell recovery rate was much lower in HET patients than MSM patients, determined by both the generalized additive mixed model (P < 0.001) and generalized estimating equations (P = 0.026). Besides HIV-1 subtypes, baseline CD4+ T cell counts and age at cART initiation, HET was an independent risk factor for immunological non-responders (adjusted OR: 1.73; 95% CI: 1.28-2.33). HET was also associated with lower probability of achieving conventional immune recovery (adjusted HR: 1.37; 95%CI: 1.22-1.67) and optimal immune recovery (adjusted HR: 1.48, 95%CI: 1.04-2.11). Male HET patients might have poorer immune reconstitution ability even after effective cART. Early initiation of cART after diagnosis and clinical monitoring for male HET patients should be highly emphasized.

Changes in Diagnoses of Heterosexually Acquired HIV Infection Among Black/African American Males and Females in Seven Southern United States, 2014-2018.

Racial and geographical disparities exist in HIV infections in the USA. The highest burden of HIV diagnoses remains among Black/African American persons and is concentrated in the Southern region. This paper describes within-race changes in HIV diagnoses among heterosexually active Black/African American persons in seven states with the highest rates/100,000 population of HIV diagnoses in the South, during 2014-2018. The total number of diagnoses among Black males and females with infection attributed to heterosexual contact decreased in 2018 compared to 2014. Diagnoses decreased among Black males and females in Louisiana and among Black females in Texas. While the declines indicate progress, Black males and females in the South remain disproportionately affected by HIV. Results support a need for the development, implementation, and evaluation of evidence-based HIV prevention interventions and strategies for heterosexually active persons in jurisdictions that have not seen decreases in HIV diagnoses.

Internet Study about Risk Factors Associated with HIV among Heterosexuals in Puerto Rico.

OBJECTIVE: Heterosexual intercourse is the main mode of HIV transmission among heterosexual women in Puerto Rico and the third for men. We conducted an Internetbased study of heterosexual young adults in Puerto Rico to explore their sexual practices, beliefs and decision-making skills for HIV prevention. Data presented in this study will help to understand the factors that contribute to the sexual transmission of HIV among heterosexuals within the Puerto Rican context. METHODS: We administered an online-based survey to a sample of 618 young adult heterosexual men and women. Data were collected using Perseus Survey Solutions software. RESULTS: Overall, most participants expressed they had the same sexual partner in the previous six months, never or almost never used male condoms with their main partner and did not perceive themselves at-risk of contracting HIV (have a low HIV risk perception). Men reported using male condoms more frequently than women (e.g. male condom on their male partner) during vaginal sex, in particular single and younger men. Women expressed more positive attitudes toward male condoms than men. CONCLUSION: Results confirm the need to implement interventions that increases the sense of vulnerability among heterosexuals, as well as skills and use of male condoms. This study contributes additional data on sexual practices and attitudes to encourage the identification of new or current changes in HIV protective or risk factors, specifically for an understudied population of Heterosexuals in Puerto Rico.

Awareness and uptake of pre-exposure prophylaxis for HIV among low-income, HIV-negative heterosexuals in San Francisco.

We examined pre-exposure prophylaxis (PrEP) awareness and uptake among low-income heterosexual men and women in San Francisco in 2019. Of 294 HIV-negative survey participants, 42.5% were aware of PrEP. Few women (12.5%) and men (8.9%) had discussed PrEP with a healthcare provider; 3.8% of women and 0% of men had used PrEP in the last year. White participants (adjusted odds ratio (aOR) 5.39, 95% CI 1.02, 28.56), women (aOR 2.19, 95% CI 1.30, 3.70), and age 60 years or above (aOR 4.00, 95% CI 1.12, 14.34) had greater odds of being aware of PrEP. Testing for HIV or sexually transmitted infection in the past year was marginally associated with a greater PrEP awareness. Our findings reveal gaps in PrEP implementation associated with social disparities among low-income heterosexuals. Testing services and targeted promotional and educational materials are needed lest high-risk, low-income populations are left behind in San Francisco's aggressive "Getting to Zero" efforts.

Trajectories of and disparities in HIV prevalence among Black, White, and Hispanic/Latino High Risk Heterosexuals in 89 U.S. Metropolitan statistical areas, 1992-2013.

PURPOSE: Estimates of HIV prevalence, and how it changes over time, are needed to inform action (e.g., resource allocation) to improve HIV-related public health. However, creating adequate estimates of (diagnosed and undiagnosed) HIV prevalence is challenging due to biases in samples receiving HIV testing and due to difficulties enumerating key risk populations. To our knowledge, estimates of HIV prevalence among high risk heterosexuals in the United States produced for geographic areas smaller than the entire nation have to date been only for single years and/or for single cities (or other single geographic locations). METHODS: The present study addresses these gaps by using multilevel modeling on multiple data series, in combination with previous estimates of HIV prevalence among heterosexuals from the extant literature, to produce annual estimates of HIV prevalence among high risk heterosexuals for each of 89 metropolitan statistical areas, from 1992 to 2013. It also produces estimates for these MSAs and years by racial/ethnic subgroup to allow for an examination of change over time in racial/ethnic disparities in HIV prevalence among high risk heterosexuals. RESULTS: The resulting estimates suggest that HIV prevalence among high risk heterosexuals has decreased steadily, on average, from 1992 to 2013. Examination of these estimates by racial/ ethnic subgroup suggests that this trend is primarily due to decreases among Black and Hispanic/Latino high risk heterosexuals. HIV prevalence among white high risk heterosexuals remained steady over time at around 1% during the study period. Although HIV prevalence among Black and Hispanic/Latino high risk heterosexuals was much higher (approximately 3.5% and 3.3%, respectively) than that among whites in 1992, over time these differences decreased as HIV prevalence decreased over time among these subgroups. By 2013, HIV prevalence among Hispanic/Latino high risk heterosexuals was estimated to be very similar to that among white high risk heterosexuals (approximately 1%), with prevalence among Black high risk heterosexuals still estimated to be almost twice as high. CONCLUSIONS: It is likely that as HIV incidence has decreased among heterosexuals from 1992 to 2013, mortality due to all causes has remained disparately high among racial/ethnic minorities, thereby outpacing new HIV cases. Future research should aim to empirically examine this by comparing changes over time in estimated HIV incidence among heterosexuals to changes over time in mortality and causes of death among HIV-positive heterosexuals, by racial/ethnic subgroup.

Evidence for HIV transmission across key populations: a longitudinal analysis of HIV and AIDS rates among Black people who inject drugs and Black heterosexuals in 84 large U.S. metropolitan areas, 2008-2016.

PURPOSE: To assess cross-population linkages in HIV/AIDS epidemics, we tested the hypothesis that the number of newly diagnosed AIDS cases among Black people who inject drugs (PWID) was positively related to the natural log of the rate of newly diagnosed HIV infections among Black non-PWID heterosexuals in 84 large U.S. metropolitan statistical areas (MSAs) in 2008-2016. METHODS: We estimated a multilevel model centering the time-varying continuous exposures at baseline between the independent (Black PWID AIDS rates) and dependent (HIV diagnoses rate among Black heterosexuals) variables. RESULTS: At MSA level, baseline (standardized ß = 0.12) Black PWID AIDS rates and change in these rates over time (standardized ß = 0.11) were positively associated with the log of new HIV diagnoses rates among Black heterosexuals. Thus, MSAs with Black PWID AIDS rates that were 1 standard deviation= higher at baseline also had rates of newly diagnosed HIV infections among Black non-PWID heterosexuals that were 10.3% higher. A 1 standard deviation increase in independent variable over time corresponded to a 7.8% increase in dependent variable. CONCLUSIONS: Black PWID AIDS rates may predict HIV rates among non-PWID Black heterosexuals. Effective HIV programming may be predicated, in part, on addressing intertwining of HIV epidemics across populations.

Near Full-Length Genomic Characterization of a Novel HIV-1 Circulating Recombinant Form (CRF106_cpx) Identified Among Heterosexuals in China.

In our study, we reported a novel CRF01_AE/B/C human immunodeficiency virus type 1 (HIV-1) recombinant form among six epidemiologically unlinked heterosexual patients in Yunnan, China. It was named CRF106_cpx (this is temporary as we have not received the circulating recombinant form [CRF] number from HIV databases). After sequencing and analyzing of the near full-length genome, we found that CRF106_cpx was generated by three B segments and two CRF01_AE segments inserted into the C backbone. There was quite a bit of diversity between sequences of CRF106_cpx, so this seems to be a CRF that has been spreading for many years.

HIV/AIDS in Japan: Route and Age of Infection that Shaped the Epidemics in 1987-2016.

In Japan, HIV infection is classified as "HIV" or "AIDS" depending upon whether the infection was detected before or after the development of AIDS. In male homosexuals, in the plot of the number of "AIDS" notified annually versus the that of "HIV" notified annually, the plot fell on a straight line with a slope close to 1. When the number of "HIV" no longer increased, that of "AIDS" also stopped increasing. The number of "HIV" notified in one region or age group was correlated with that of other regions or age groups, respectively. However, no such correlation was observed among male heterosexuals. "HIV" was detected more frequently among male homosexuals and females than among male heterosexuals. The rate of "AIDS" detection increased with age in all infection categories. Our analysis, supported by findings of other studies, suggested that the higher rate of "HIV" detection among male homosexuals and females was attributed to the increased risk of receptive sexual intercourse, while the higher rate of "AIDS" detection among the elderly people was attributed to immunological senescence.