Rural and urban disparities in health-seeking for fever in Myanmar: findings from a probability-based household survey.

BackgroundThe World Health Organization (WHO) recognizes Myanmar as having the highest burden of malaria in the Greater Mekong Sub-region (GMS). Early diagnosis and proper treatment are critical in containing malaria. The objective of this study was to assess determinants of seeking treatment for fever from trained providers across rural and urban areas in Eastern Myanmar.MethodsA cross-sectional survey was conducted during the high malaria seasons in the eastern part Myanmar between August and September 2014. Multi-staged cluster sampling was used to sample households. A series of questions related to treatment-seeking for fever were asked. Bivariate and multivariate logistic regressions were conducted to identify independent correlates of seeking treatment for fever from trained providers.ResultsThe analysis was restricted to 637 participants who reported either themselves or their family members having had fever 2 weeks prior to the interview. In the multivariate analysis, rural residents were less likely to have sought treatment from trained providers (AOR = 0.60, 95 % CI 0.42-0.88; p = 0.01) while residents who had fever patients between the ages of 5 and 14 years (AOR = 1.60, 95 % CI 0.90-2.53; p = 0.05); and those who knew that sleeping under bed nets can prevent malaria (AOR = 2.08, 95 % CI 1.00-4.30; p = 0.05); were borderline more likely to have sought treatment.ConclusionThis study suggests that rural populations need improved access to trained providers. Additionally, future programmes should focus on increasing knowledge around malaria prevention and treatment

AN EXAMINATION OF PROTECTIVE FACTORS AGAINST HIV INFECTION AMONG ASIAN/PACIFIC ISLANDER MEN WHO HAVE SEX WITH MEN

This dissertation project examined protective factors against HIV infection among API MSM. First, we evaluated the literature for scientific evidence that may explain the lower HIV prevalence among API MSM. Four of the ten hypotheses provided some partial explanations or needed further investigation: 1) API MSM's sexual networks may be primarily composed of MSM of low HIV risk profiles; 2) Prevalence of seroadaptive behaviors is higher among API MSM; 3) HIV-positive API MSM have better access to care and treatment; 4) Ethnic heritage acculturation may be protective. Second, we examined race and age mixings among API MSM. It appeared that overall patterns of race and age mixing among API MSM tended to be more assortative. API MSM were more likely to be partnered with other API men than expected and the age difference between API participants and their partners were narrower than that among other participants. In addition, young API MSM were more likely to be aware of their partners's HIV status as a majority of their partners were main partners. Finally, we found that prevalence of seroadaptive behaviors differed little by race/ethnicities, which does not point to seroadaptation as protecting API MSM against HIV infection. Of concern, the significantly lower prevalence of serodisclosure behaviors among API MSM did not appear to translate into lower levels of seroadaptation. Our findings have significant public health implications. First, more research on how structural factors affect HIV infections among MSM are needed. Second, the socio-cultural and structural contexts of partner selection need to be explored. Third, public health professionals should be aware of changing behaviors within MSM communities so that new and innovative interventions can be developed. Fourth, a strength-based approach to studying protective factors against HIV infection among API MSM is overdue. Qualitative studies are needed to develop some strength-based conceptual frameworks. Fifth, it seems that certain Asian/API cultural issues or values would be worth investigating. Lastly, while HIV prevalence remains low among API MSM, bio-behavioral surveillance should keep monitoring HIV incidence and risk behaviors among this population and culturally appropriate interventions should be delivered to them, before it is too late to intervene

Design of Spatially Varying Orientation Lattice Structures Using Triply Periodic Minimal Surfaces

Interest continues to grow for lattice structures produced by additive manufacturing methods that are described by triply periodic minimal surface (TPMS). Tunable parameters that define the TPMS provide unique design flexibility where prior research has focused on designing hybrid or functionally graded TPMS structures. In this paper, a new strategy is proposed to include an orientation angle and volume fraction of each lattice cell simultaneously when defining structures derived from TPMS. The algorithm iteratively solves an underlying partial differential equation with the finite difference method to obtain a smooth, continuous lattice structure with a spatially varying orientation angle. The resulting lattice structure can be combined with other types of TPMS models using Gaussian radial basis and distance functions to achieve multi-TPMS lattice designs. The spatially varying lattice structures can also take the advantage of the directional effective modulus of TPMS to improve the strength the performance of lattice design.Mechanical Engineerin

A genome-wide transcriptome profiling reveals the early molecular events during callus initiation in Arabidopsis multiple organs

AbstractInduction of a pluripotent cell mass termed callus is the first step in an in vitro plant regeneration system, which is required for subsequent regeneration of new organs or whole plants. However, the early molecular mechanism underlying callus initiation is largely elusive. Here, we analyzed the dynamic transcriptome profiling of callus initiation in Arabidopsis aerial and root explants and identified 1342 differentially expressed genes in both explants after incubation on callus-inducing medium. Detailed categorization revealed that the differentially expressed genes were mainly related to hormone homeostasis and signaling, transcriptional and post transcriptional regulations, protein phosphorelay cascades and DNA- or chromatin-modification. Further characterization showed that overexpression of two transcription factors, HB52 or CRF3, resulted in the callus formation in transgenic plants without exogenous auxin. Therefore, our comprehensive analyses provide some insight into the early molecular regulations during callus initiation and are useful for further identification of the regulators governing callus formation

Barriers and facilitators of linkage to HIV care among HIV-infected young Chinese men who have sex with men: a qualitative study

Background: The Four Free and One Care Policy (HIV/AIDS-related free services) has been in place in China since 2004. However, linkage to human immunodeficiency virus (HIV) care is not yet achieved very well among people living with HIV. We conducted a qualitative study to explore individual and contextual factors that may influence a linkage to HIV care from the perspective of young HIV-infected men who have sex with men (MSM) in a highly centralized HIV care context of China. Methods: Purposive sampling was used to recruit 21 HIV-infected MSM in Shandong Province, with in-depth interviews conducted between March and July 2015. Thematic content analysis was subsequently used for data analysis. Results: Key barriers and facilitators related to a linkage to HIV care emerged from participants’ narratives. The barriers included perceived healthy status, low health literacy, and stigma associated with receiving HIV care. The facilitators included an awareness of responsibility, knowledge associated with health literacy, social support, and trusting and relying on services provided by the Center for Disease Control and Prevention (CDC) and the government. These were related to the quality of current HIV counselling and testing, service promotion, and the cost and placement of these HIV services. Conclusions: In order to improve the MSM linkage to HIV care in China, it is imperative to improve the quality of the current on-going counselling and testing. Further critical linkage support includes increasing supportive services among local CDC systems, designated hospitals and community-based organizations (CBOs), and more financial support for HIV/ AIDS related testing, medical checkups and treatments

HIV Risk among Substance-Using Men Who Have Sex with Men and Women (MSMW): Findings from South Florida

Compared with men who have sex with men only (MSMO), men who have sex with men and women (MSMW) consistently report higher rates of two HIV risk behaviors: transactional sex (TS) and concurrent substance use and sex (CSS). Within MSMW, little is known about how synergistic epidemics ( syndemics ) affect TS and CSS. Using a sample of substance-using MSM (n = 515) in South Florida, we compared TS and CSS among MSMO and MSMW; examined whether, within MSMW (n = 86), TS and CSS predict unprotected anal intercourse with partners of serodiscordant/unknown HIV status (SU-UAI); and tested whether syndemics predict TS and CSS. MSMW reported higher rates of engaging in both TS and CSS (AOR = 1.7; 95 % CI 1.0-3.0). Within MSMW, engagement in both TS and CSS predicted SU-UAI (AOR = 3.3; 95 % CI 1.2-9.6); and syndemics predicted TS and CSS involvement (p \u3c 0.01). Substance-using MSMW may benefit from interventions targeting TS, CSS, and background syndemics

Sex tourism among Chinese men who have sex with men: a cross-sectional observational study.

BACKGROUND: Sex tourism among men who have sex with men (MSM) may exacerbate transmission of HIV and other sexually transmitted infections (STIs). Sex tourism is defined as purchasing sex with gifts or money outside of one's hometown. Our objective was to characterize the frequency, socio-demographic characteristics, and sexual risk behaviors among Chinese MSM sex tourists. METHODS: An online, cross-sectional survey for high-risk MSM throughout China was conducted in November 2015 covering sociodemographic characteristics, sexual risk behaviors, and sex tourism. Univariate and multivariable logistic regressions were performed to identify correlates of sex tourism. The mean MSM HIV prevalence of sex tourism journey origins and destinations were compared. RESULTS: Of 1189 MSM who completed the survey, 62 (5%) men identified as sex tourists; among these sex tourists, twenty (32%) traveled primarily to purchase sex and the remainder purchased sex while traveling for another purpose. There was minimal socio-demographic and behavioral difference between the two groups. In multivariable analyses, adjusting for age and income, sex tourism was correlated with high-risk sexual behaviors, higher income (aOR 4.44, 95%CI 1.77-11.18) and living with HIV (aOR 2.79, 95%CI 1.03-7.55). Sex tourism was more often from locations with lower to higher MSM HIV prevalence (mean = 4.47, SD = 2.01 versus mean = 6.86, SD = 5.24). CONCLUSION: MSM sex tourists were more likely to have risky sexual behaviors and travel to locations with a higher HIV prevalence. MSM sex tourists may be part of core groups that are disproportionately responsible for MSM HIV transmission. Enhanced surveillance and interventions tailored to MSM sex tourists should be considered

Crowdsourcing to Improve HIV and Sexual Health Outcomes: a Scoping Review.

PURPOSE OF REVIEW: This review synthesizes evidence on the use of crowdsourcing to improve HIV/sexual health outcomes. RECENT FINDINGS: We identified 15 studies, including four completed randomized controlled trials (RCTs), one planned RCT, nine completed observational studies, and one planned observational study. Three of the four RCTs suggested that crowdsourcing is an effective, low-cost approach for improving HIV testing and condom use among key populations. Results from the observational studies revealed diverse applications of crowdsourcing to inform policy, research, and intervention development related to HIV/sexual health services. Crowdsourcing can be an effective tool for informing the design and implementation of HIV/sexual health interventions, spurring innovation in sexual health research, and increasing community engagement in sexual health campaigns. More research is needed to examine the feasibility, acceptability, and effectiveness of crowdsourcing interventions, particularly in low- and middle-income countries

HIV test uptake among MSM in China: Implications for enhanced HIV test promotion campaigns among key populations

Despite global efforts to increase HIV test uptake among men who have sex with men (MSM), social stigma and negative attitudes toward homosexuality hinder the effectiveness of traditional test promotion campaigns. Increasing HIV test uptake requires greater understanding of the conditions that facilitate decisions to get tested. We conducted an online survey hosted by two of the most highly frequented MSM web portals in China. A generalised ordered logistic regression analysis was conducted to determine factors associated with HIV testing behaviour. Compared to men who had never tested for HIV, men who had tested in the past year were more likely to have never engaged in sex with women, have multiple male sex partners in the past 3 months and have disclosed their sexual orientation to others. MSM found testing at local Chinese Centers for Disease Control and Prevention (80.7%), gay men’s community-based organisations (80.2%) and public hospitals (70.9%) to be acceptable, while saunas (50.5%) and gay bars (41.8%) were found to be unacceptable testing venues. Our study shows that MSM in China prefer to test at venues that guarantee confidentiality, quality and quick results. Our study also suggests that self-testing may be a feasible approach to increase test uptake

Transgender sexual health in China: a cross-sectional online survey in China

Transgender individuals are at increased risk for HIV infection around the world, yet few studies have focused on transgender individuals in China. We conducted an online cross-sectional survey of men who have sex with men (MSM) and transgender individuals to examine sociodemographics, intimate partner violence (IPV) and sexual behaviours in China