Migration and Sexual Resocialisation: The Case of Central and East Europeans in London

Based upon a survey of more than three thousand respondents and forty in-depth interviews, the aim of this article is to examine the impact of migration on sexual resocialisation. In particular, we show how living in London influenced the attitudes of Central and East European migrants towards pre-marital sex and homosexuality. While the general acceptability of pre-marital sex was not affected by time spent in London, differences were noted in the meaning attached to sex outside marriage in the United Kingdom compared with Central and Eastern Europe. Particularly significant changes were observed in our respondents? attitudes towards homosexuality, with a greater liberalisation the result of extrication from mechanisms of social control, re-socialisation into new social norms regarding sex and sexuality, greater visibility of sexual difference in London and, in particular, inter-personal contacts with gays and lesbians. Limitations to the general liberalisation of attitudes were also noted

Increasing the uptake of HIV testing to reduce undiagnosed infection and prevent transmission among black African communities living in England: Barriers to HIV testing

Globally, the HIV epidemic continues to have an impact on the lives of millions of people. In 2008, there were an estimated 83,000 people living with HIV (both diagnosed and undiagnosed), equivalent to 1.3 per 1000 population in the UK. In that same year, 7,798 people were newly diagnosed with HIV. The global epidemic is reflected in the UK; around 38% (2,790) of these newly diagnosed infections were among black Africans who acquired their HIV through heterosexual contact. It is thought that most (87%) of these infections among black Africans in the UK were acquired abroad, mainly in sub-Saharan Africa (Health Protection Agency 2009). Late diagnosis of HIV is defined as diagnosis taking place after anti-retroviral treatment would normally have begun, or when the person has an illness which defines them as having AIDS. It is the most important factor associated with HIVrelated disease and death in the UK and is a particular problem among black Africans. In 2007, over 40% of new diagnoses among black Africans were classified as ‘late’. HIV testing can help reduce transmission of the virus. People who find out they have HIV may change their sexual behaviour as a result of the diagnosis. A negative HIV test provides an opportunity for preventive education and advice and may also lead to changes in behaviour. Increasing the frequency of testing may result in earlier detection of HIV following infection - when it is most virulent - providing greater opportunity to reduce transmissio

PRIME (Positive Transitions Through the Menopause) Study: a protocol for a mixed-methods study investigating the impact of the menopause on the health and well-being of women living with HIV in England

Introduction Advances in antiretroviral therapy have transformed HIV into a long-term condition with near-normal life expectancy for those in whom viral replication is well controlled on treatment. This means that age-related events, including menopause, is of increasing importance in the care of people living with HIV. The PRIME (Positive Transitions Through the Menopause) Study aims to explore the impact of the menopause on the health and well-being of women living with HIV (WLHIV). Methods and analysis The PRIME Study is a multicentre, mixed-methods observational study deploying a multiphase sequential design with explanatory and exploratory phases. Phase 1 comprised three focus group discussions with WLHIV. In phase 2 we aimed to administer questionnaires comprising detailed assessment of menopausal status and symptoms to 1500 WLHIV aged 45–60 attending HIV clinics in England. Phase 3 comprised semistructured interviews with a subsample of phase 2 participants. Ongoing quantitative follow-up of 100 participants is planned between October 2018 and September 2019. Qualitative and quantitative data will be kept analytically distinct and analysed using appropriate methods. We will integrate quantitative and qualitative findings using coding matrices. Ethics and dissemination The PRIME Study has ethical approval from the South East Coast-Surrey Research Ethics Committee on behalf of all National Health Service (NHS) sites, and approval from University College London Research Ethics Committee for qualitative work conducted in non-NHS sites. In conjunction with the study Expert Advisory Group (which includes WLHIV), we have drafted a dissemination strategy that takes into account a wide range of stakeholders, including patients, policy makers and healthcare providers. This includes at least five empirical research papers to be submitted to peer-reviewed journals, as well as an accessible report aimed primarily at a non-technical audience (published in May 2018 and launched at a live-streamed event). Both quantitative and qualitative data are held by the PRIME Study team and are available by request

All-cause hospitalisation according to demographic group in people living with HIV in the current ART era: Recent findings from a cohort study in the UK

OBJECTIVE: We investigated differences in all-cause hospitalisation between key demographic groups among people with HIV in the UK in the current ART era. DESIGN/METHODS: We used data from the Royal Free HIV Cohort study between 2007 and 2018. Individuals were classified into five groups: men who have sex with men (MSM), Black African men who have sex with women (MSW), MSW of other ethnicity, Black African women and women of other ethnicity. We studied hospitalisations during the first year after HIV diagnosis (Analysis-A) separately from those more than one year after diagnosis (Analysis-B). In Analysis-A, time to first hospitalisation was assessed using Cox regression adjusted for age and diagnosis date. In Analysis-B, subsequent hospitalisation rate was assessed using Poisson regression, accounting for repeated hospitalisation within individuals, adjusted for age, calendar year, time since diagnosis. RESULTS: The hospitalisation rate was 30.7/100 person-years in the first year after diagnosis and 2.7/100 person-years subsequently; 52% and 13% hospitalisations respectively were AIDS-related. Compared to MSM, MSW and women were at much higher risk of hospitalisation during the first year [aHR (95%CI): 2.7 (1.7-4.3), 3.0 (2.0-4.4), 2.0 (1.3-2.9), 3.0 (2.0-4.5) for Black African MSW; other ethnicity MSW; Black African women; other ethnicity women respectively, Analysis-A] and remained at increased risk subsequently [corresponding aIRR (95% CI): 1.7 (1.2-2.4), 2.1 (1.5-2.8), 1.5 (1.1-1.9), 1.7 (1.2-2.3), Analysis-B]. CONCLUSIONS: In this setting with universal healthcare, substantial variation exists in hospitalisation risk across demographic groups, both in early and subsequent periods after HIV diagnosis, highlighting the need for targeted interventions

Associations with sub-optimal clinic attendance and reasons for missed appointments among heterosexual women and men living with HIV in London

Poor engagement in HIV care is associated with poorer health outcomes and increased mortality. Our survey examined experiential and circumstantial factors associated with clinic attendance among women (n = 250) and men (n = 106) in London with heterosexually-acquired HIV. While no associations were found for women, among men, sub-optimal attendance was associated with insecure immigration status (25.6% vs. 1.8%), unstable housing (32.6% vs. 10.2%) and reported effect of HIV on daily activities (58.7% vs. 40.0%). Among women and men on ART, it was associated with missing doses of ART (OR = 2.96, 95% CI:1.74-5.02), less belief in the necessity of ART (OR = 0.56, 95% CI:0.35-0.90) and more concern about ART (OR = 3.63, 95% CI:1.45-9.09). Not wanting to think about being HIV positive was the top reason for ever missing clinic appointments. It is important to tackle stigma and the underlying social determinants of health to improve HIV prevention, and the health and well-being of people living with HIV

The association between use of chemsex drugs and HIV clinic attendance among gay and bisexual men living with HIV in London

OBJECTIVES: To investigate the association between chemsex drug use and HIV clinic attendance among gay and bisexual men in London. METHODS: A cross-sectional survey of adults (> 18 years) diagnosed with HIV for > 4 months, attending seven London HIV clinics (May 2014 to August 2015). Participants self-completed an anonymous questionnaire linked to clinical data. Sub-optimal clinic attenders had missed one or more HIV clinic appointments in the past year, or had a history of non-attendance for > 1 year. RESULTS: Over half (56%) of the 570 men who identified as gay or bisexual reported taking recreational drugs in the past 5 years and 71.5% of these men had used chemsex drugs in the past year. Among men reporting chemsex drug use (past year), 32.1% had injected any drugs in the past year. Sub-optimal clinic attenders were more likely than regular attenders to report chemsex drug use (past year; 46.9% vs. 33.2%, P = 0.001), injecting any drugs (past year; 17.1% vs. 8.9%, P = 0.011) and recreational drug use (past 5 years; 65.5% vs. 48.8%, P < 0.001). One in five sub-optimal attenders had missed an HIV clinic appointment because of taking recreational drugs (17.4% vs. 1.8%, P < 0.001). In multivariable logistic regression, chemsex drug use was significantly associated with sub-optimal clinic attendance (adjusted odds ratio = 1.71, 95% confidence interval: 1.10-2.65, P = 0.02). CONCLUSIONS: Our findings highlight the importance of systematic assessment of drug use and development of tools to aid routine assessment. We suggest that chemsex drug use should be addressed when developing interventions to improve engagement in HIV care among gay and bisexual men

Determining the likely place of HIV acquisition for migrants in Europe combining subject-specific information and biomarkers data

In most HIV-positive individuals, infection time is only known to lie between the time an individual started being at risk for HIV and diagnosis time. However, a more accurate estimate of infection time is very important in certain cases. For example, one of the objectives of the Advancing Migrant Access to Health Services in Europe (aMASE) study was to determine if HIV-positive migrants, diagnosed in Europe, were infected pre- or post-migration. We propose a method to derive subject-specific estimates of unknown infection times using information from HIV biomarkers' measurements, demographic, clinical, and behavioral data. We assume that CD4 cell count (CD4) and HIV-RNA viral load trends after HIV infection follow a bivariate linear mixed model. Using post-diagnosis CD4 and viral load measurements and applying the Bayes' rule, we derived the posterior distribution of the HIV infection time, whereas the prior distribution was informed by AIDS status at diagnosis and behavioral data. Parameters of the CD4-viral load and time-to-AIDS models were estimated using data from a large study of individuals with known HIV infection times (CASCADE). Simulations showed substantial predictive ability (e.g. 84% of the infections were correctly classified as pre- or post-migration). Application to the aMASE study ( n = 2009) showed that 47% of African migrants and 67% to 72% of migrants from other regions were most likely infected post-migration. Applying a Bayesian method based on bivariate modeling of CD4 and viral load, and subject-specific information, we found that the majority of HIV-positive migrants in aMASE were most likely infected after their migration to Europe

Development and application of a new measure of engagement in out-patient HIV care.

OBJECTIVES: Commonly used measures of engagement in HIV care do not take into account that the frequency of attendance is related to changes in treatment and health status. This study developed a new measure of engagement in care (EIC) incorporating clinical factors. METHODS: We conducted semi-structured interviews with eight HIV physicians to identify factors associated with the timing of patients' next scheduled appointments. These factors informed the development of an algorithm to classify each month of follow-up as "in care" (on or before the time of the next expected attendance) or "out of care" (after the time of the next expected attendance). The EIC algorithm was applied to data from the UK Collaborative HIV Cohort (UK CHIC) study, a large clinical cohort study. RESULTS: The interviews indicated that time to next appointment varied depending on psychosocial and physical comorbidities, and clinical factors (time since diagnosis, AIDS diagnosis, treatment status, CD4 count and viral load). The resulting EIC algorithm was applied to 44 432 patients; 83.9% of the 3 021 224 person-months were "in care". Greater EIC was independently associated with older age, white ethnicity, HIV acquisition through sex between men, current use of antiretroviral therapy (ART), a higher nadir CD4 count, later calendar year and being seen at the clinic for the first time within the last year. CONCLUSIONS: This algorithm describing engagement in HIV care incorporates a time-updated measure of patients' treatment and health status. It adds to the options available for measuring this key performance indicator

Review of effectiveness and cost effectiveness: Increasing the uptake of HIV testing to reduce undiagnosed infection and prevent transmission among black African communities living in England

Globally, the HIV epidemic continues to have an impact on the lives of millions of people. In 2008, there were an estimated 83,000 people living with HIV (both diagnosed and undiagnosed), equivalent to 1.3 per 1000 population in the UK. In that same year, 7,798 people were newly diagnosed with HIV. The global epidemic is reflected in the UK; around 38% (2,790) of these newly diagnosed infections were among black Africans who acquired their HIV through heterosexual contact. It is thought that most (87%) of these infections among black Africans in the UK were acquired abroad, mainly in sub-Saharan Africa Health Protection Agency 2009). Late diagnosis of HIV is defined as diagnosis taking place after anti-retroviral treatment would normally have begun, or when the person has an illness which defines them as having AIDS. It is the most important factor associated with HIVrelated disease and death in the UK and is a particular problem among black Africans. In 2007, over 40% of new diagnoses among black Africans were classified as ‘late’. HIV testing can help reduce transmission of the virus. People who find out they have HIV may change their sexual behaviour as a result of the diagnosis. A negative HIV test provides an opportunity for preventive education and advice and may also lead to changes in behaviour. Increasing the frequency of testing may result in earlier detection of HIV following infection - when it is most virulent - providing greater opportunity to reduce transmission

Human airway construct model is suitable for studying transcriptome changes associated with indoor air particulate matter toxicity

In vitro models mimicking the human respiratory system are essential when investigating the toxicological effects of inhaled indoor air particulate matter (PM). We present a pulmonary cell culture model for studying indoor air PM toxicity. We exposed normal human bronchial epithelial cells, grown on semi‐permeable cell culture membranes, to four doses of indoor air PM in the air‐liquid interface. We analyzed the chemokine interleukin‐8 concentration from the cell culture medium, protein concentration from the apical wash, measured tissue electrical resistance, and imaged airway constructs using light and transmission electron microscopy. We sequenced RNA using a targeted RNA toxicology panel for 386 genes associated with toxicological responses. PM was collected from a non‐complaint residential environment over 1 week. Sample collection was concomitant with monitoring size‐segregated PM counts and determination of microbial levels and diversity. PM exposure was not acutely toxic for the cells, and we observed up‐regulation of 34 genes and down‐regulation of 17 genes when compared to blank sampler control exposure. The five most up‐regulated genes were related to immunotoxicity. Despite indications of incomplete cell differentiation, this model enabled the comparison of a toxicological transcriptome associated with indoor air PM exposure