Effect of Rectal Hygiene on Sexually Transmitted Infections Among HIV-Negative Men Who Have Sex with Men (MSM)

Abstract Background Rectal gonorrhea (NG) and chlamydia (Connecticut) infections are common among men who have sex with men (MSM). Rectal douching/enema (RDE) is a common practice among MSM that can affect the rectal microbiome. It is unclear if this practice is associated with acquiring rectal infections (RI) with either NG or CT. Methods From 2013–2015, 398 adult HIV-negative MSM and transwomen were enrolled in a randomized controlled study on text messaging for adherence to pre-exposure prophylaxis (PrEP). Participants were surveyed on sexual behavior, frequency of RDE, drug use, and nutritional habits in conjunction with routine sexually transmitted infection testing. Pearson’s χ 2 and two sample t-tests were used to measure significance of RDE and other risk factors with RI. Multivariable logistic regression model was used to control for confounding and assess the association of RDE with RIs. Confounders (i.e., age, number anal receptive sex, number sex partners) were selected a priori for inclusion in the final model based on a causal model and statistical significance. Results Of 397 participants, 262 (67%) performed RDE and 132 (33%) had at least one NG or CT rectal infection over 48 weeks. Number of condomless anal receptive sex acts (mean = 19, P < 0.001), condom use for anal receptive sex (P = 0.017), number of male sex partners in past 3 months (mean = 14, P = 0.001), and the use of poppers (P < 0.001) were associated with RI. There was no significant association between nutritional habits, probiotic foods or supplements and RI, with the exception of energy bars (P = 0.029). Controlling for confounders, RI was associated with RDE less than weekly with OR = 1.02 (95% CI 0.52–1.99) while RDE weekly or more had OR = 2.08 (95% CI 1.03–4.17). Stratified by number of partners, MSMs with more than the median (>6) number of partners had OR = 4.96 (95% CI 1.29–19.03) if performing RDE less than weekly, and OR = 6.03 (95% CI 1.55–23.49) if weekly or more. Conclusion Rectal hygiene with douching/enemas is a common practice among MSMs on PrEP, which increases the odds of acquiring rectal NG and/or CT. This finding is suggestive for the use of rectal hygiene products/practices as potential targets for sexually transmitted infection prevention. Disclosures All authors: No reported disclosures

COVID-19 and the global cruise ship industry: potential recovery and reformation pathways

The cruise ship industry was one of the fastest growing subsectors of the tourism industry before the advent of COVID-19. This paper examines the prospects and recovery of the cruise ship industry from the devastating impacts of COVID-19 on the industry. The study relied mostly on event study and secondary data, including survey data from authoritative sources, data from representative organisations, news reports and academic literature. The results show that the industry exhibited high levels of customer loyalty and resilience to the COVID-19-induced downturn. The industry also adopted additional protocols to improve public health on board and protect the health and safety of customers, crews and visited communities. However, continued travel restrictions at both source and destination markets, as well as the continued resurgence of the virus and related uncertainties, threaten the recovery of the industry. Mandatory vaccination of both crew and passengers needs to be considered

Frame me if you must: PrEP framing and the impact on adherence to HIV Pre-exposure Prophylaxis

Abstract Background “PrEP whore” has been used both as a pejorative by PrEP opponents in the gay community and, reactively, by PrEP advocates as a method to reclaim the label from stigmatization and “slut-shaming.” The actual prevalence and impact of such PrEP-directed stigma on adherence have been insufficiently studied. Methods CCTG 595 was a randomized controlled PrEP demonstration project in 398 HIV-uninfected MSM and transwomen. Intracellular tenofovir-diphosphate (TFV-DP) levels at weeks 12 and 48 were used as a continuous measure of adherence. At study visits, participants were asked to describe how they perceived others’ reactions to them being on PrEP. These perceptions were categorized a priori as either “positively framed,” “negatively framed,” or both. We used Wilcoxon rank-sum to determine the association between positive and negative framing and TFV-DP levels at weeks 12 and 48. Results By week 4, 29% of participants reported perceiving positive reactions from members of their social groups, 5% negative, and 6% both. Reporting decreased over 48 weeks, but positive reactions were consistently reported more than negative. At week 12, no differences in mean TFV-DP levels were observed in participants with positively-framed reactions compared with those reporting no outcome or only negatively-framed (1338 [IQR, 1036-1609] vs. 1281 [946-1489] fmol/punch, P = 0.17). Additionally, no differences were observed in those with negative reactions vs. those without (1209 [977–1427] vs. 1303 [964–1545], P = 0.58). At week 48, mean TFV-DP levels trended toward being higher among those that report any reaction, regardless if positive (1335 [909–1665] vs. 1179 [841–1455], P = 0.09) or negative (1377 [1054–1603] vs. 1192 [838–1486], P = 0.10) than those reporting no reaction. At week 48, 46% of participants reported experiencing some form of PrEP-directed judgment, 23% reported being called “PrEP whore,” and 21% avoiding disclosing PrEP use. Conclusion Over 48 weeks, nearly half of participants reported some form of judgment or stigmatization as a consequence of PrEP use. However, individuals more frequently perceived positively framed reactions to being on PrEP than negative. Importantly, long-term PrEP adherence does not appear to suffer as a result of negative PrEP framing. Disclosures All authors: No reported disclosures

Associations Between Major Depression, Health-risk Behaviors, and Medication Adherence Among Hiv-positive Adults Receiving Medical Care in Georgia

Background: There are approximately 1.2 million people in the United States living with HIV, and 25.6% of HIV-positive adults suffer from depression. The purpose of this study is to examine the contribution of depression to substance use and medication adherence among HIV-positive adults receiving medical care for HIV in Georgia. Methods: Secondary data with a probability sample of 775 HIV-positive adults who took part in the 2009-2013 Georgia Medical Monitoring Project (MMP) were analyzed. Descriptive analyses and multivariate logistic regressions were conducted to assess relationships between depression and current cigarette smoking, injection drug use, other non-injection drug use, and medication adherence, adjusting for sociodemographic covariates (age, gender, race, and education). All analyses accounted for non-response and complex sampling design. Results: Among HIV-positive adults in Georgia, 8.5% met the criteria for major depression, including 13.7% of women and 6.5% of men. Heterosexual adults had a higher percentage of major depression (10.7%) compared to adults who identified as bisexual (7.4%) or homosexual (5.8%). Major depression was also higher among adults with a high school diploma or GED (12.7%) compared to adults with a higher level of education (5.2%). Major depression was associated with a greater odds of current cigarette smoking (AOR 2.7; 95% CI: 1.5, 5.2) and other non-injection drug use (2.5; 95% CI: 1.4, 4.4), after adjusting for sociodemographic variables. The three measures of medication adherence were not statistically significantly associated with major depression. Conclusions: As previously observed for the general population, we found, among HIV-positive adults, significant associations between depression and smoking and other non-injection drug use. Because HIVpositive adults have ongoing encounters with healthcare providers, screening and treatment for depression and other co-morbid substance use is needed to reduce an additional health burden in this population

Recent HIV Risk Behavior and Partnership Type Predict PrEP Adherence in Men Who Have Sex with Men

Abstract Background Individuals engaging in higher risk behavior are often more adherent to PrEP but it is unclear if partnership type itself affects PrEP adherence. We examined the effect of recent HIV risk behaviors and partnership type on PrEP adherence in men who have sex with men (MSM) taking PrEP. Methods CCTG 595 is a 48-week PrEP demonstration study of 398 HIV− at-risk MSM. At baseline and week 48, HIV risk score was estimated as the probability of seroconversion over the next year based on number of condomless anal sex acts with HIV+/unknown partners in the last month and any STI diagnosed at study visit. HIV risk score was categorized as low (<0.12), moderate (0.12−0.59) and high (>0.59) risk based on population seroconversion probabilities. Partnership type was assigned as no/single HIV− partner, single HIV+ partner, or multiple partners of any serostatus in the past 3 months. PrEP adherence was estimated by intracellular tenofovir-diphosphate (TFV-DP) levels as a continuous variable at week 48. Statistical methods included McNemar’s test, Wilcoxon rank-sum test, and linear regression model where appropriate. Results Of 313 MSM who completed week 48, there was no significant change in HIV risk category from baseline to week 48 (low: 44 to 42%; moderate: 27 to 24%; high: 28 to 34%; P = 0.25). There was a significant change in partnership type, with the proportion of those with no or single HIV− partnerships increasing (1 to 9%, P < 0.001). In univariate analysis, moderate and high-risk groups had higher TFV-DP levels than the low-risk group at week 48 (P = 0.018). Participants with no/single HIV− partner had significantly lower TFV-DP levels than those with one HIV+ partner or multiple partners (P = 0.007). In a multivariable linear regression model, only low-risk partnerships remained significant where no/single HIV− partnerships were associated with lower TFV-DP levels (mean difference = −344fmol/punch [−617, −71], P = 0.014). Conclusion Although there was a shift in partnership type towards lower risk partnerships, objective HIV risk behavior remained stable over time. Individuals with higher HIV risk behaviors and risk partnerships had higher TFV-DP levels suggesting maintained strong motivation for PrEP adherence. Thus, recent sexual risk behavior and partnership type may be important predictors of PrEP adherence in MSM. Disclosures All authors: No reported disclosures

Fiber-optic three axis magnetometer prototype development

The goal of this research program was to develop a high sensitivity, fiber optic, interferometric, three-axis magnetometer for interplanetary spacecraft applications. Dynamics Technology, Inc. (DTI) has successfully integrated a low noise, high bandwidth interferometer with high sensitivity metallic glass transducers. Also, DTI has developed sophisticated signal processing electronics and complete data acquisition, filtering, and display software. The sensor was packaged in a compact, low power and weight unit which facilitates deployment. The magnetic field sensor had subgamma sensitivity and a dynamic range of 10(exp 5) gamma in a 10 Hz bandwidth. Furthermore, the vector instrument exhibited the lowest noise level when only one axis was in operation. A system noise level of 1 gamma rms was observed in a 1 Hz bandwidth. However, with the other two channels operating, the noise level increased by about one order of magnitude. Higher system noise was attributed to cross-channel interference among the dither fields

Characteristics of a cohort of high-risk men who have sex with men on pre-exposure prophylaxis reporting transgender sexual partners.

Transgender people continue to be at high-risk for HIV acquisition, but little is known about the characteristics of their sexual partners. To address this gap, we examined sociodemographic and sexual characteristics of cisgender men who have sex with men (MSM) on pre-exposure prophylaxis (PrEP) reporting transgender sexual partners.A cohort of 392 MSM in southern California in a randomized clinical trial for PrEP adherence were followed from 2013 to 2016. Multivariable generalized estimating equation and logistic models identified characteristics of MSM reporting transgender sexual partners and PrEP adherence.Only 14 (4%) MSM reported having transgender sexual partners. MSM were more likely to report transgender partners if they were African American, had incident chlamydia, reported injection drug-using sexual partners, or received items for sex. Most associations remained significant in the multivariable model: African American (adjusted odds ratio [AOR] 11.20, P = .01), incident chlamydia (AOR 3.71, P = .04), and receiving items for sex (AOR 5.29, P = .04). There were no significant differences in PrEP adherence between MSM reporting transgender partners and their counterpart.MSM who report transgender sexual partners share characteristics associated with individuals with high HIV prevalence. Identifying this group distinct from larger cohorts of MSM could offer new HIV prevention opportunities for this group of MSM and the transgender community

Critical assessment of the human resource capacity needs of senior management at Thaba Chweu Municipality in Mpumalanga Province, South Africa

The terrain of local government is not only very complex, dynamic, and challenging, but also very unique. The quality of human resources is vital in a public institution, particularly in institutions that are meant to service communities by providing sustainable basic services. Amongst the concerns raised at a municipal level are the lack of professionalism and the required competency and capacity amongst the workforce that must perform the actual duties of servicing the local communities. This study was aimed at identifying and analysing human resource development and human resource management policies, strategies and needs in line with the current circumstances and conditions at a particular municipality. A series of challenges (that a number of community members, newspaper articles, community leaders and both the Mpumalanga Provincial Government and other spheres of government raised and complained about) prompted this study. Constant complaints are leveled against municipalities about appropriate and well qualified candidates being overlooked for employment opportunities at the expense of nepotism, cronyism and blatant corrupt activities. This study is a combination of both quantitative and qualitative methods. In line with the quantitative method of generating and assembling information, the researcher used the judgement sampling method. Questionnaires were administered to collect quantitative data while primary data was collected via interviews. Data was obtained from 45 participants in Thaba Chweu Municipality. The findings show that the majority of respondents (in the form of percentages) spoke against the capacity of the officials. A smaller percentage spoke in favour of the availability of capacity. These respondents stated that municipal officials have the required skills and capacity to perform their duties. Furthermore, the study found that there was inconsistency in the implementation of council resolutions and interference in administrative matters. These factors compromised achieving the objectives of the municipal strategies and policies. The study recommends that the municipality ensures that the human resource management and development departments are consonant with current and modernised needs and that delegations to line functionaries are properly assigned and documented

Nighttime chemistry at a high altitude site above Hong Kong

Nighttime reactions of nitrogen oxides influence ozone, volatile organic compounds, and aerosol and are thus important to the understanding of regional air quality. Despite large emissions and rapid recent growth of nitrogen oxide concentrations, there are few studies of nighttime chemistry in China. Here we present measurements of nighttime nitrogen oxides, NO3 and N2O5, from a coastal mountaintop site in Hong Kong adjacent to the megacities of the Pearl River Delta region. This is the first study of nighttime chemistry from a site within the residual layer in China. Key findings include the following. First, highly concentrated urban NOx outflow from the Pearl River Delta region was sampled infrequently at night, with N2O5 mixing ratios up to 8 ppbv (1 min average) or 12 ppbv (1 s average) in nighttime aged air masses. Second, the average N2O5 uptake coefficient was determined from a best fit to the available steady state lifetime data as γ(N2O5) = 0.014 ± 0.007. Although this determination is uncertain due to the difficulty of separating N2O5 losses from those of NO3, this value is in the range of previous residual layer determinations of N2O5 uptake coefficients in polluted air in North America. Third, there was a significant contribution of biogenic hydrocarbons to NO3 loss inferred from canister samples taken during daytime. Finally, daytime N2O5 mixing ratios were in accord with their predicted photochemical steady state. Heterogeneous uptake of N2O5 in fog is determined to be an important production mechanism for soluble nitrate, even during daytime. Key Points Large (up to 12 ppbv N2O5) but infrequent nocturnal NOx outflow from the Pearl River Delta Average N2O5 uptake coefficients 0.014 ± 0.007, in line with residual layer measurements in the U.S. Daytime N2O5 follows predicted steady state but rapidly produces soluble nitrate in fog.Department of Civil and Environmental Engineerin