Do penile cutting practices other than full circumcision protect against HIV?

Introduction: Male circumcision provides a high level of protection against sexually acquired HIV infection and is a key element of prevention in countries with extensive heterosexual transmission. In some countries, penile cutting practices other than full circumcision are a part of the cultural landscape, raising the question of their ability to modify the risk of HIV. One such country is Papua New Guinea. Methods: We reviewed information on prevalence of HIV, sexually transmitted infection (STI), and penile cutting practices, and their possible relationships. Results: Based on antenatal testing, the prevalence of HIV infection among pregnant women in Papua New Guinea is around 0.9%. Surveys of STI in pregnant women have found prevalences of chlamydia, gonorrhoea and trichomonas in the range 15-25%, and infectious syphilis at 2-3%. In three studies of penile cutting around half the men have some form of procedure; 10% had full foreskin removal with a further 30-40% having dorsal slits, with lateral retraction of the foreskin and exposure of the glans. There is evidence of an inverse geographic correlation between HIV prevalence and partial cutting practice. Conclusions: Levels of curable STIs in Papua New Guinea are very high by international levels, while HIV infection is at moderate levels compared to the countries in which male circumcision is now being promoted. The role of partial penile cutting procedures deserves further examination to see whether it provides protection, and if so what this tells us of the biology of HIV transmission

The \u3cem\u3eLancet\u3c/em\u3e–O’Neill Institute/Georgetown University Commission on Global Health and Law: The Power of Law to Advance the Right to Health

The Lancet–O’Neill Institute/Georgetown University Commission on Global Health and Law published its report on the Legal Determinants of Health in 2019. The term ‘legal determinants of health’ draws attention to the power of law to influence upstream social and economic influences on population health. In this article, we introduce the Commission, including its background and rationale, set out its methodology, summarize its key findings and recommendations and reflect on its impact since publication. We also look to the future, making suggestions as to how the global health community can make the best use of the Commission’s momentum in relation to using law and legal tools to advance population health

Cost-effectiveness of adult circumcision in a resource-rich setting for HIV prevention among men who have sex with men

Background.&nbsp; We examined the effects and cost‐effectiveness of 4 strategies of circumcision in a resource‐rich setting (Australia) in a population of men who have sex with men (MSM).Method.&nbsp; We created a dynamic mathematical transmission model and performed an economic analysis to estimate the costs, outcomes, and cost‐effectiveness of different strategies, compared with those of the status quo. Strategies included circumcision of all MSM at age 18 years, circumcision of all MSM aged 35&ndash;44 years, circumcision of all insertive MSM aged 18 years, and circumcision of all MSM aged 18 years . All costs are reported in US dollars, with a cost‐effectiveness threshold of 42,000 per quality‐adjusted life‐year.Results.  We find that 2%–5% of human immunodeficiency virus (HIV) infections would be averted per year, with initial costs ranging from 3.6 million to $95.1 million, depending on the strategy. The number of circumcisions needed to prevent 1 HIV infection would range from 118 through 338. Circumcision of predominately insertive MSM would save$21.7 million over 25 years with a $62.2 million investment. Strategies to circumcise 100% of all MSM and to circumcise MSM aged 35&ndash;44 years would be cost‐effective; the latter would require a smaller investment. The least cost‐effective approach is circumcision of young MSM close to their sexual debut. Results are very sensitive to assumptions about the cost of circumcision, the efficacy of circumcision, sexual preferences, and behavioral disinhibition.Conclusions.&nbsp; Circumcision of adult MSM may be cost‐effective in this resource‐rich setting. However, the intervention costs are high relative to the costs spent on other HIV prevention programs.<br /

Characterizing trends in HIV infection among men who have sex with men in Australia by birth cohorts: results from a modified back-projection method

<p>Abstract</p> <p>Background</p> <p>We set out to estimate historical trends in HIV incidence in Australian men who have sex with men with respect to age at infection and birth cohort.</p> <p>Methods</p> <p>A modified back-projection technique is applied to data from the HIV/AIDS Surveillance System in Australia, including "<it>newly diagnosed HIV infections</it>", "<it>newly acquired HIV infections</it>" and "<it>AIDS diagnoses</it>", to estimate trends in HIV incidence over both calendar time and age at infection.</p> <p>Results</p> <p>Our results demonstrate that since 2000, there has been an increase in new HIV infections in Australian men who have sex with men across all age groups. The estimated mean age at infection increased from ~35 years in 2000 to ~37 years in 2007. When the epidemic peaked in the mid 1980s, the majority of the infections (56%) occurred among men aged 30 years and younger; 30% occurred in ages 31 to 40 years; and only ~14% of them were attributed to the group who were older than 40 years of age. In 2007, the proportion of infections occurring in persons 40 years or older doubled to 31% compared to the mid 1980s, while the proportion of infections attributed to the group younger than 30 years of age decreased to 36%.</p> <p>Conclusion</p> <p>The distribution of HIV incidence for birth cohorts by infection year suggests that the HIV epidemic continues to affect older homosexual men as much as, if not more than, younger men. The results are useful for evaluating the impact of the epidemic across successive birth cohorts and study trends among the age groups most at risk.</p

Male circumcision and HIV transmission: what do we know?

Male circumcision (MC) has been shown to be protective against heterosexual HIV transmission and is being explored in some parts of the world as a means of combating the epidemic. The World Health Organization (WHO) recommends that MC be considered as an important component of HIV prevention in high prevalence settings. We review evidence that demonstrates that the inner foreskin is likely to be the main portal of entry for the HIV virus in males. Whether removal of the inner foreskin accounts for all the protection afforded by circumcision is yet to be established. The proposed mechanisms of protection range from inherent immunohistological factors of foreskin such as difference in thickness of keratin layer and density of target cells for HIV between inner and outer foreskin to physiological mechanisms that follow male circumcision such as drying of secretions underneath foreskin after sexual intercourse, loss of microbiome that attract target cells to the genital mucosa and lack of priming the genital mucosa with less abundant sexual transmitted infections among circumcised men. The aim of this review is to give an updated account on the mechanisms proposed so far on the demonstrated 50-70% protection from HIV transmission through heterosexual intercourse, by male circumcision

HIV knowledge, risk perception, and safer sex practices among female sex workers in Port Moresby, Papua New Guinea

Sex workers are considered a high-risk group for sexually transmitted infections, including human immunodeficiency virus (HIV), and are often targeted by prevention interventions with safer sex messages. The purpose of this study was to explore the extent to which knowledge of HIV and perception of risk influence safer sex practices among female sex workers (FSWs) in Port Moresby, Papua New Guinea. FSWs (n = 174) were recruited from 19 sites to participate in the study. Qualitative data were collected using semistructured interviews with FSWs (n = 142) through focus group discussions and (n = 32) individual interviews. In addition, quantitative data were collected from all FSWs using a short structured, demographic questionnaire. Data were analyzed using recurring themes and calculations of confidence intervals. Despite some common misperceptions, overall, most FSWs were basically aware of the risks of HIV and informed about transmission and prevention modalities but used condoms inconsistently. Most reported using condoms ‘sometimes’, almost one-sixth ‘never’ used condoms, only a fraction used condoms ‘always’ with clients, and none used condoms ‘always’ with regular sexual partners (RSPs). Among these FSWs, being knowledgeable about the risks, transmission, and prevention of HIV did not translate into safe sex. The findings suggest that certain contextual barriers to safer sex practices exist. These barriers could heighten HIV vulnerability and possibly may be responsible for infection in FSWs. Specific interventions that focus on improving condom self-efficacy in FSWs and simultaneously target clients and RSPs with safer sex messages are recommended

Childhood hepatitis C virus infection: An Australian national surveillance study of incident cases over five years

NHMRC: Enabling Grant No: 402784ARC Linkage Project Grant(LP110200277

Adverse pregnancy and birth outcomes associated with Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum: a systematic review and meta-analysis.

OBJECTIVES Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum (genital mycoplasmas) commonly colonise the urogenital tract in pregnant women. This systematic review aims to investigate their role in adverse pregnancy and birth outcomes, alone or in combination with bacterial vaginosis (BV). METHODS We searched Embase, Medline and CINAHL databases from January 1971 to February 2021. Eligible studies tested for any of the three genital mycoplasmas during pregnancy and reported on the primary outcome, preterm birth (PTB) and/or secondary outcomes low birth weight (LBW), premature rupture of membranes (PROM), spontaneous abortion (SA) and/or perinatal or neonatal death (PND).Two reviewers independently screened titles and abstracts, read potentially eligible full texts and extracted data. Two reviewers independently assessed risks of bias using published checklists. Random effects meta-analysis was used to estimate summary ORs (with 95% CIs and prediction intervals). Multivariable and stratified analyses were synthesised descriptively. RESULTS Of 57/1194 included studies, 39 were from high-income countries. In meta-analysis of unadjusted ORs, M. hominis was associated with PTB (OR 1.87, 95% CI 1.49 to 2.34), PROM, LBW and PND but not SA. U. urealyticum was associated with PTB (OR 1.84, 95% CI 1.34 to 2.55), PROM, LBW, SA and PND. U. parvum was associated with PTB (1.60, 95% CI 1.12 to 2.30), PROM and SA. Nine of 57 studies reported any multivariable analysis. In two studies, analyses stratified by BV status showed that M. hominis and U. parvum were more strongly associated with PTB in the presence than in the absence of BV. The most frequent source of bias was a failure to control for confounding. CONCLUSIONS The currently available literature does not allow conclusions about the role of mycoplasmas in adverse pregnancy and birth outcomes, alone or with coexisting BV. Future studies that consider genital mycoplasmas in the context of the vaginal microbiome are needed. PROSPERO REGISTRATION NUMBER CRD42016050962

Identity and Religion in Contemporary Australia

This paper draws on data from two national surveys conducted by Edith Cowan University and NCLS Research to examine the nature of religious identification in Australia. It finds that the importance of religion to people's sense of identity is closely related to church attendance, religious beliefs, and the importance of ethnic identity. Some people describe themselves as 'spiritual' rather than 'religious', although most people opt to describe themselves using both terms or neither. The lower levels of importance of religion to identity among younger people are associated with lower levels of involvement in religious organizations. The importance attributed to spirituality has been largely retained through the generations, but is now expressed somewhat differently. For many younger people, spirituality is being explored quite apart from involvement in, or identification with, religious communities