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PubMed2000

Risk factors for HIV-2 seropositivity among older people in Guinea-Bissau. A search for the early history of HIV-2 infection.

Because the seroprevalence of HIV-2 has been shown to be high in older age groups, we conducted a survey of all persons aged 50 years or over in two districts in Bissau, investigating the presence of HIV antibodies and possible risk factors for HIV infection with a particular emphasis on age, the impact of the war of independence (1963-74), traditional marital and extramarital sex patterns, blood contact and contact with monkeys. In 670 participants, the HIV-2 prevalence was 14.3%; 16.1% in women and 12.3% in men. The HIV-1 prevalence was only 0.5% (3/670). The HIV-2 prevalence peaked for men in the 60-69 years age group, and for women in the 50-59 years age group, declining markedly in the following age group for both men and women (OR = 0.09 (0.01-0.51), OR = 0.37 (0.15-0.82), respectively). This pattern could be due to differential mortality for HIV-2 infected individuals or to a cohort effect for a generation who were sexually active at the time of the war of independence in the 1960s and early 1970s in Bissau. Supporting the link with the colonial army, women who had had sex with a white man had a higher seroprevalence (OR = 3.63 (1.12-11.24)). The ethnic group indigenous to Bissau city had a much lower prevalence, but demographic and cultural risk factors such as marital status, religion, education and having lived outside Bissau were not associated with HIV-2. In the multivariate analyses for women, variables related to extramarital sex or prostitution (having sex with a white man, having lived in Senegal, not living with husband, and not marrying first sexual partner) were associated with higher risk. For men, previous spouses who had died or had divorced were associated with higher prevalence. Having married the first sexual partner was protective against HIV-2 infection for both men (OR = 0.29 (0.09-0.76)) and women (OR = 0.19 (0.04-1.00)). Hospitalizations, possibly due to transfusions, tended to be associated with higher risk, but only for women (OR = 1.83 (0.97-3.48)). The focus of the HIV-2 epidemic in Guinea-Bissau is likely to be endogenous, and the war of independence and the colonial army with its associated prostitution may have played an important part in propagating the virus.

Aged↗

PubMed1996

Messages of distinction: the HIV/AIDS media campaign in Thailand.

In predominantly rural Thailand, television is a primary source of HIV/AIDS knowledge. Since 1990, HIV/AIDS warning messages have been aired regularly and repeatedly on television as part of the national strategy to minimize transmission of HIV. The education and prevention messages chosen do more than suggest measures to avoid infection. Within a logic of risk, these messages also define characteristics of people who are signified as threatening agents of infection. In Thailand, prostitutes and drug users are portrayed as the feared Other. Because commercial sex is so widespread, the demarcation of prostitutes as a high risk group signals a diffuse threat not easily subject to conceptual distancing. It is the pervasive and often fear-based associations born of the media material that, in large part, establish the basis for emergent practice when thoughts or actions are triggered by consideration of HIV/AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Sociodemographic characteristics and HIV risk behaviour patterns of male sex workers in Madrid, Spain.

This paper describes the sociodemographic and work characteristics, prevalence of HIV infection and associated risk behaviours among male sex workers (MSWs) in Madrid (Spain). Using an anonymous semi-structured questionnaire, educators attached to a mobile unit under a street-based prostitution programme surveyed 84 MSWs from several Madrid areas. Of the total surveyed: 35% were immigrants, mean age was 23 years, mean period in prostitution was four years; 21% had no primary education; 16% had injected drugs at some time; 11% reported private sexual relationships exclusively with women; 89% always used condoms in anal practices with clients; and 41% were in sexual relationships with their partners. Only 11% had ever used fortified condoms. In the preceding month, 37% had experienced condom failure, 82% without having used any lubricant. In all, 67% reported having undergone HIV testing, with a higher percentage of positive results among injecting (60%) versus non-injecting drug users (17%). Immigrants had a lower level of education, made less use of condoms, had more condom failures and, in their private lives, a greater proportion reported sexual relationships exclusively with women. In Spain, MSWs should be included in HIV prevention programmes, which ought to be specifically adapted to immigrants. Priority should be given to reducing the condom failure rate in anal intercourse, by improving access to fortified condoms.

Adolescent↗

PubMed2006

The role of sympathy on avoidance intention toward persons living with HIV/AIDS in Jamaica.

As the number of persons living with HIV/AIDS (PLWHA) continues to increase in Jamaica, concerns of attitudes become more important. As such, the objective of the present study is to examine the attitudes of university students in Jamaica toward PLWHA including sympathy and avoidance intentions. A large sample of university students (N=1,252) was surveyed between June 2001 and February 2002 using a 193-item questionnaire that measured HIV-related knowledge, attitudes and behaviors. Results revealed that less than half of the students reported sympathetic attitudes toward homosexual males or female prostitutes living with HIV/AIDS (41% and 44%, respectively) while the majority reported sympathetic attitudes toward heterosexual males and non-prostitute females living with the disease (67% and 81%, respectively). Most students (80%) reported no avoidance intentions toward family members or friends living with the disease. Sympathy, HIV knowledge, education and awareness were associated with no avoidance intention of HIV-positive family members and friends. These findings suggest that sympathy could be important in improving prosocial intentions toward PLWHA and warrants further research.

Adult↗

PubMed1994

Why do men buy sex and what are their assessments of the HIV-related risks when they do?

The belief that female prostitution might play a key role in the heterosexual spread of HIV infection has led to a great deal of attention being focused on the activities of women who sell sex. By contrast, the activities of men who buy sex has been largely ignored. One of the reasons for this has undoubtedly been the difficulties of contacting such men. In this paper data from telephone interviews with 70 men who had recently purchased sex are presented. It is shown that there was a wide range of factors that the men cited in explaining the appeal of commercial sex. The paper also reports on the males' views as to the risks of HIV associated with commercial sex. Although the men believed HIV to be very widespread amongst women selling sex, hardly any of them felt at risk themselves as a result of their commercial sexual encounters. The basis for the men's optimism about avoiding HIV and their preparedness to inform other sexual partners about their prostitute contacts are also described.

Adult↗

PubMed1993

The prevalence of antibodies to the human T lymphotropic virus (HTLV) in Ghana, West Africa.

We conducted a population-based serosurvey of urban areas and rural regions of southern Ghana, West Africa. Subjects (3763) of all ages were enrolled from 25 city and village sites and in studies of groups of special interest. "Positive" results were difficult to define because of a high frequency of results that were indeterminate on immunoblotting, the current standard for confirmation of HTLV-I. However, polymerase chain reaction results and HTLV type-specific discriminatory tests proved HTLV-I was present in Ghana. No HTLV-2 positivity was observed. By using strict criteria that considered indeterminate results as negative, the overall prevalence was found to be between 1 and 2% in all areas, with no difference by geographic location. Prevalence rose with age and was higher in adult women than men. However, in substudies of selected populations, we found HTLV prevalence among 124 persons with lymphomas and hematological malignancies was not different from that in the general population. Furthermore, the prevalence in prostitutes was similar to that in the general population and in pregnant women. HTLV-I is present in West Africa, but we were unable to associate HTLV-I seropositivity with malignancy or with prostitution.

Adolescent↗

PubMed1995

Extraordinary high rate of HTLV type II seropositivity in intravenous drug abusers in south Vietnam.

Serum specimens (n = 1899) were assayed for infections with HTLV-I, HTLV-II, and HIV-1 in seven classified groups of normal healthy controls, children, pregnant women, prostitutes, intravenous drug abusers, patients under going hemodialysis, and hemophiliacs in South and North Vietnam. Surprisingly, 125 of 954 samples from South Vietnam exhibited seropositivity for HTLV-II and 119 of these belonged to the group of IVDAs (n = 200). The remaining six positives were a healthy control, a prostitute, two children, and two patients under going hemodialysis. Two IVDAs who were seropositive for HTLV-I and 10 of 15 seropositives for HIV-1 were also positive for HTLV-II in this population. In contrast, no seropositives to any of the viruses were detected in the North Vietnamese samples (0 of 945). The HTLV-II-seropositive IVDAs exhibited increased seropositivity with age compared with HIV-1 seropositivity in the population, and there was no statistical relation between seropositivity for HTLV-II and HIV-1. The HTLV-IIs in South Vietnam IVDAs appeared, by subtype-specific peptide ELISA, to be a mixture of both subtypes a and b, with subtype a predominant. It seems possible that HTLV-II may have been introduced into this population from IVDAs from the United States during the Vietnam conflict, but in a period prior to, or early in, the introduction of HIV-1 to IVDAs.

Adult↗

PubMed1996

Endemicity and phylogeny of the human T cell lymphotropic virus type II subtype A from the Kayapo Indians of Brazil: evidence for limited regional dissemination.

Long terminal repeat (LTR)-based restriction fragment length polymorphism (RFLP) analysis of human T cell lymphotropic virus type II (HTLV-II) from 17 seropositive Kayapo Indians from Brazil showed that all 17 samples contained a unique HTLV-IIa subtype (A-II). Additional RFLP screening demonstrated the presence of this subtype in two of three Brazilian blood donors and a Mexican prostitute and her child. In contrast, 129 samples from blood donors and intravenous drug users (IDUs) from the United States, two Pueblo Indian samples, five samples from Norwegian IDUs, and two samples from blood donors from Denmark were all found to be a different HTLV-IIa subtype (A-III). Phylogenetic analysis of two Kayapo and one Mexican LTR sequences showed that they cluster with a subtype A-II sequence from a Brazilian blood donor and with sequences from two prostitutes from Ghana and Cameroon. These results demonstrate that infection with the A-II subtype is endemic among the Kayapo Amerindians, has disseminated to non-Indian populations in Brazil, and is also present in Mexico. Furthermore, the A-II subtype does not appear to represent an origin for the HTLV-IIa infection in urban areas of the United States and Europe. This study provides evidence that HTLV-IIa may be a Paleo-Indian subtype as previously suggested for HTLV-IIb.

Base Sequence↗

PubMed2001

Human papillomaviruses and cervical cancer in Bangkok. III. The role of husbands and commercial sex workers.

Between September 1991 and September 1993, husbands of women with and without cervical neoplasia and commercial sex workers in one brothel and one massage parlor in Bangkok, Thailand, were interviewed; serologic tests for sexually transmitted infections were performed; and cervical and penile scrapings were tested for human papillomavirus (HPV) DNA. The risks of cervical carcinoma in monogamous women and of oncogenic HPV in their husbands were associated with the men's having unprotected intercourse with prostitutes. The prevalence of oncogenic HPV was higher in commercial sex workers than in women attending gynecologic and family planning clinics. Oncogenic HPV prevalence declined with age in human immunodeficiency virus (HIV)-negative, but not in healthy HIV-positive, commercial sex workers and was weakly associated with hepatitis B antigenemia, suggesting that persistence of HPV infection is due to subtle changes in immunity. Associations of HPV with recent pregnancy and oral contraceptive use suggest that hormonal factors may increase the risk of cervical neoplasia by enhancing persistence of HPV infection. The prevalence of high-grade squamous intraepithelial lesions was strongly related to oncogenic HPV types and weakly to HIV infection only in their presence. Commercial sex workers in Bangkok are reservoirs of oncogenic HPV, and cervical cancer in monogamous Thai women develops in part as a result of transmission of these viruses to them by their husbands from prostitutes.

Adolescent↗

PubMed1992

A review and assessment of non-governmental organization-based STD/AIDS education and prevention projects for marginalized groups.

A review of projects run by non-governmental organizations (NGOs) in primarily developing countries, which have aimed to provide STD/AIDS education and prevention skills to various marginalized groups, reveals that past quantitative and formative research has failed to identify key programmatic factors which lead to more successful project implementation and sustainability. In observations, interviews with field staff, visits to program sites and information drawn from the literature, a variety of methods to reach a wide range of groups such as men who have sex with men, prostitutes, clients of prostitutes, prisoners, street children, migrant workers and refugees are explored. Factors found to facilitate project success include the following: at least one full-time committed staff member; respectful treatment and appropriate motivation of the target group; suitable and sufficient equipment and supplies (particularly condoms); planning ahead for the participation of HIV-positive individuals and ways to meet their needs; focusing on qualitative rather than quantitative evaluation; planning in advance beyond a 9 or 12 month 'model'. Despite some evidence that marginalized groups can be successfully motivated to practise safer sex through prevention education, long-term behaviour change still presents major challenges--even when specific conditions are met.

Acquired Immunodeficiency Syndrome↗

PubMed1991

Risk factors for human immunodeficiency virus infection in 581 intravenous drug users, northeast Italy, 1984-1988. The AIDS and Related Syndromes Study Group.

Prevalence and risk factors for human immunodeficiency (HIV) virus infection were assessed in 581 heterosexual intravenous drug users (IVDUs), recruited from eight public drug assistance centres in the northeast of Italy, an area at low risk for AIDS. The overall seroprevalence for HIV antibody was rather high, 39% (95% confidence interval (CI): 35-43%). HIV prevalence had risen from 32% in 1984-1985 to 52% in 1987-1988. Thirty-three per cent of female and 41% of male IVDUs had antibodies to HIV (p = 0.07). Seropositivity rates showed a strong east-west geographical gradient (from 16% to 60%, p = 0.005): IVDUs living in the western part of the study area had a nearly sevenfold higher risk of infection (odds ratio (OR) = 6.9, 95% CI: 4.4-13.9) than those living in the eastern part. Sharing of drug injection equipment (OR = 3.6), duration of drug addiction (OR = 2.6), use of heroin in high-incidence cities (OR = 2.3), use of cocaine in addition to heroin (OR = 1.5) and history of prostitution (OR = 2.3) increased the risk of acquiring HIV infection. Over the study period, the ORs associated with area of residence decreased, whereas those associated with the use of heroin in high-incidence cities and with prostitution increased.

Adult↗

PubMed2000

Antibodies to human herpes virus type 8 (HHV8) in general population and in individuals at risk for sexually transmitted diseases in Western Sicily.

BACKGROUND: Human herpes virus 8 (HHV8) appears to be the primary aetiologic agent of Kaposi sarcoma (KS). To study the distribution of HHV8, a seroepidemiological study was carried out in western Sicily, where a high incidence rate of classical KS is well documented. METHODS: A total of 970 sera of healthy human immunodeficiency virus (HIV) negative individuals of general population (1-70 years old) and 742 sera of individuals in different risk groups for HIV infection were evaluated by means of an indirect immunofluorescence assay able to detect antibodies to lytic and latent HHV8 antigens. RESULTS: Crude seroprevalence to HHV8 antigens was 11.5% in the general population, and it increased significantly with age from 6% under age 16 to 22% after age 50. Significantly higher HHV8 seroprevalence rates were detected among HIV positive and negative homosexual men (62% and 22%, respectively), men who had sex with prostitutes (40% and 29%, respectively); female prostitutes (42% and 30%, respectively), and clients at a sexually transmitted disease clinic (male: 60% and 33%, respectively, female: 63% and 43%, respectively). In contrast, heterosexual intravenous drug users had seroprevalence rates comparable to those found in the general population. CONCLUSIONS: The results suggest that HHV8 infection is widespread in Western Sicily. The high seroprevalence in individuals with high risk sexual activity point to the role of sexual behaviour in the transmission of the infection in adults, whereas the detection of antibodies in younger population (under 16 years old) is suggestive of a non-sexual route of transmission, probably occurring during childhood by close personal contact.

Adolescent↗

PubMed1993

Evidence for mother-to-child transmission of human T lymphotropic virus type II.

Serologic analysis of the children of 2 married human T lymphotropic virus type II (HTLV-II)-infected prostitutes demonstrated antibodies to HTLV-II in an 8-year-old boy whose only recognizable risk for HTLV-II infection was breast-feeding during his first 4 years of life. Limited sequence analysis of isolates infecting the mother and child demonstrated 100% identical sequences in the long terminal repeat (LTR65-297; 236 bp), pol4762-4919 (157 bp), and env5523-6003 (480 bp) regions (both isolates were subtype a), suggesting mother-to-child transmission. In contrast, isolates obtained from 2 other prostitutes from the same geographic region had sequences different from those of the first woman and her child, and the second and third women were infected with HTLV-II subtype b. Although vertical transmission of HTLV-II in this 8-year-old child cannot be conclusively ascertained, the probability is overwhelming that infection occurred through breast-feeding for an extended period of time.

Adolescent↗

PubMed1994

Association between cervical inflammation and cervical shedding of human immunodeficiency virus DNA.

A cross-sectional study was conducted among prostitutes in Nairobi, Kenya, to determine the prevalence and correlates of cervical human immunodeficiency virus (HIV) DNA. Ninety-two HIV-seropositive prostitutes were evaluated during 137 clinic visits. Cervical HIV DNA was detected by polymerase chain reaction assay in 36 (39%) women at initial visits and in 40 (44%) women at any visit. There was a significant correlation between cervical HIV and microscopic evidence of cervical inflammation (odds ratio [OR], 7.2; 95% confidence interval [CI], 2.1-24.6). Using multivariate analysis to adjust for possible confounding, the adjusted OR for the association between cervical inflammation and cervical HIV DNA was 8.7 (95% CI, 2.0-37.2). Conditions associated with cervical inflammation are associated with the detection of HIV proviral DNA. Whether such conditions lead to increased infectivity remains to be proven.

Adult↗

PubMed1981

Factors relating to transmission of viral hepatitis in a United States military population stationed in Thailand.

To determine the incidence of clinical and inapparent hepatitis in a US military population stationed in Thailand, the authors prospectively studied a cohort of 326 men during one year. Clinical hepatitis A occurred in one man (clinical attack rate = 3.1/1000 men/year), and clinical hepatitis B was found in four men (clinical attack rate = 12.3/1000 men/year). No non-A, non-B hepatitis was identified. There was no serologically identified inapparent hepatitis A but inapparent hepatitis B occurred in 17 men. The apparent/inapparent ratio for hepatitis B was 1:4.25. Serotype analysis suggested that hepatitis B virus largely originated from Thai contacts, although 23% of cases were derived from western sources. To determine the relative contribution of 16 statistically significant (out of 67 studied) behavioral variables to the transmission of HBV, a factor analysis and a multivariate correlation analysis were employed. Factor analysis indicated that social and sexual contact with the indigenous population, including prostitutes, residence within the Thai community and marijuana use were behavioral areas that were associated with the acquisition of hepatitis B. Residence in the Thai community during the first four-month period in Thailand, sexual contact with a prostitute during the third four-month period, and ever having maintained a Thai mistress were found to be significant and independent risk factors by multiple regression analysis.

Adolescent↗

PubMed1989

A pilot study of sexual lifestyle in a random sample of the population of Great Britain.

Rates of sexual-partner change and patterns of high-risk behaviour are important determinants of the spread of HIV. We carried out a survey to assess the feasibility of studying sexual lifestyle in a random sample of the British population, aged 16-64 years, in November 1987. Two thousand and seventy-seven households were selected using a multi-stage probability sampling procedure. Seven hundred and eight-five adults participated in a structured interview. The schedule included demographic details, attitudes to AIDS, numbers of sexual partners in different time periods, history of homosexuality and contact with prostitutes. An interview was obtained in 61% of households where contact was made, but the overall response rate was low (48%). There was marked variability between individuals in numbers of sexual partners in given time intervals. Men and women in younger cohorts had experienced first sexual intercourse earlier and had higher numbers of sexual partners than people in older cohorts. Surprisingly few reported high-risk behaviour such as homosexuality and use of prostitution. The methodological problems in trying to obtain unbiased and valid data on sexual behaviour are discussed. Further work is necessary to improve the response rate and questionnaire design.

Adolescent↗

PubMed1990

Heterosexual behaviour of intravenous drug users in Amsterdam: implications for the AIDS epidemic.

In order to assess the potential role of intravenous drug users (IVDUs) in Amsterdam in the heterosexual transmission of HIV, we studied the sexual behaviour of 243 male and female IVDUs with regard to their private ('steady' and 'casual') and commercial partners. The majority of the study group appear heterosexually active, especially female IVDUs, who often have commercial as well as one or more private partners. Vaginal contact is the most frequent method of sexual contact; condoms are used infrequently with private partners but much more frequently with commercial partners. A history of sexually transmitted disease is common, not only among IVDU prostitutes but also among IVDUs without a history of prostitution. IVDUs who know that they are HIV-infected reported fewer commercial partners and more frequent condom use with private partners than IVDUs who are negative or do not know their test result. We conclude that IVDUs may form an important source for heterosexual transmission of HIV. Voluntary testing of IVDUs on a large scale, together with intensive counselling, may slow down the further spread of HIV from infected IVDUs to their private and commercial partners, but is unlikely to stop heterosexual transmission completely.

Acquired Immunodeficiency Syndrome↗

PubMed1991

Sexual risk behavior among heterosexual intravenous drug users: ethnic and gender variations.

We analyzed the relationship of ethnicity and gender to high-risk sexual behavior among 457 male and female heterosexual intravenous drug users (IVDUs) interviewed in street and clinic settings in San Francisco. Over two-thirds said they never used condoms. More of the black respondents had not been enrolled in treatment. White IVDUs were more likely to report 10 or more partners, anal sex, and a steady drug-injecting partner; black respondents more often reported prostitution. More men said they never used condoms, and more women said they engaged in prostitution. These high-risk sexual behaviors were significantly and independently associated with ethnicity or gender when other sociodemographic variables were held constant. Sexual risk reduction for IVDUs, focusing on condom use, needs to be expanded to reach non-injecting partners. Intervention is critical for the black community, where a high proportion of IVDUs have steady non-injecting partners.

Adult↗