International mobility, sexual behaviour and HIV-related characteristics of men who have sex with men residing in Belgium

BACKGROUND: European men who have sex with men (MSM) continue to be disproportionally affected by the human immunodeficiency virus (HIV). Several factors are contributing to the rates of new HIV infections among MSM. The aim of this study was to investigate the potential role of travel behaviour and sexual mobility in the spread of HIV and sexually transmitted infections (STI) among European MSM. METHODS: Belgian data from the first pan-European MSM internet survey EMIS was used (n=3860) to explore individual and contextual determinants of sexual behaviour among MSM, who resided in Belgium at the time of data collection and who reported having had sexual contact abroad in the last 12 months. Descriptive and bivariate analyses were performed. Odds ratios and 95% confidence intervals were calculated by means of logistic regression. RESULTS: MSM who practiced unprotected anal intercourse UAI during their last sexual encounter abroad were less likely to be living in a large city (OR:0.62, 95% CI:0.45-0,86, p<0.01) and more likely to be HIV positive (OR:6.20, 95% CI:4.23-9.06, p<0.001) ), to have tested HIV positive in the last 12 months (OR:3.07, 95% CI:1.07-8.80, p<0.05), to have been diagnosed with any STI in the last 12 months (OR:2.55; 95% CI:1.77-3.67, p<0.05), to have used party drugs (OR:2.22, 95% CI:1.59-3.09, p<0.001), poppers (OR:1.52, 95% CI:1.07-2.14, p<0.001) and erection enhancing substances (OR:2.23, 95% CI:1.61-3.09, p<0.001) compared to MSM who did not have UAI with their last sexual partner abroad. Men having had UAI in the last 12 months were more likely to have done so in a neighbouring country of Belgium (OR:1.66, 95% CI:1.21-2.29, p<0.001). Different sexual behavioural patterns related to condom use and drug use were identified according to HIV test status among travelling men. CONCLUSIONS: The results of this study provide evidence for the role of international mobility and sexual behavior while travelling, in the spread of HIV and STI among MSM in Europe. Further, the findings underline the need for development of European cross-border HIV and STI interventions with coherent messages and prevention policies for MSM

High prevalence of HIV and sexually transmitted infections among male sex workers in Abidjan, Côte d'Ivoire: need for services tailored to their needs

Objectives: To assess condom use and prevalence of sexually transmitted infections (STI) and HIV among male sex workers (MSW) in Abidjan, Cote d'Ivoire.MethodsA cross-sectional survey was conducted between October 2007 and January 2008 among MSW attending a sex worker clinic in Abidjan. A short questionnaire was administered in a face-to-face interview, and the participants were asked to provide a urine sample for STI testing and to self-collect transudate of the gingival mucosa for anonymous HIV testing, using a rapid test. A rectal swab for STI testing was taken by a physician. Molecular amplification assays were performed for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis.Results96 MSW participated in the survey, their median age was 27 years and the median duration of sex work was 5 years. Consistent condom use with clients during the last working day was 86.0%, and consistent condom use with the regular partner during the last week was 81.6%. HIV infection was detected in 50.0% of the participants. The prevalence of N gonorrhoeae was 12.8%, chlamydia infection was present in 3.2% and T vaginalis in 2.1% of the study participants.ConclusionsHIV and STI rates found in this study confirm the high risk and vulnerability status of MSW in Cote d'Ivoire. There is a definite need for studies exploring risk and risk perceptions among MSW in more depth and for services tailored to their needs, including developing and validating simple algorithms for the diagnosis of STI in MSW and men who have sex with men

Health and budget impact of combined HIV prevention : first results of the BELHIVPREV model

Objectives: We developed a pragmatic modelling approach to estimate the impact of treatment as prevention (TasP); outreach testing strategies; and pre-exposure prophylaxis (PrEP) on the epidemiology of HIV and its associated pharmaceutical expenses. Methods: Our model estimates the incremental health (in terms of new HIV diagnoses) and budget impact of two prevention scenarios (outreach+TasP and outreach+TasP+PrEP) against a 'no additional prevention' scenario. Model parameters were estimated from reported Belgian epidemiology and literature data. The analysis was performed from a healthcare payer perspective with a 15-year-time horizon. It considers subpopulation differences, HIV infections diagnosed in Belgium having occurred prior to migration, and the effects of an ageing HIV population. Results: Without additional prevention measures, the annual number of new HIV diagnoses rises to over 1350 new diagnoses in 2030 as compared to baseline, resulting in a budget expenditure of (sic)260.5 million. Implementation of outreach+TasP and outreach+TasP+PrEP results in a decrease in the number of new HIV diagnoses to 865 and 663 per year, respectively. Respective budget impacts decrease by (sic)20.6 million and (sic)33.7 million. Conclusion: Foregoing additional investments in prevention is not an option. An approach combining TasP, outreach and PrEP is most effective in reducing the number of new HIV diagnoses and the HIV treatment budget. Our model is the first pragmatic HIV model in Belgium estimating the consequences of a combined preventive approach on the HIV epidemiology and its economic burden assuming other prevention efforts such as condom use and harm reduction strategies remain the same

HIV and STI Prevalence among Female Sex Workers in Côte d'Ivoire: Why Targeted Prevention Programs Should Be Continued and Strengthened

Objective: To assess condom use and prevalence of STIs and HIV among female sex workers (FSWs), as part of a comprehensive monitoring and evaluation plan of a nationwide sex worker prevention project in Côte d’Ivoire. Design and Methods: Cross sectional surveys were conducted among FSWs attending five project clinics in Abidjan and San Pedro (2007), and in Yamoussoukro and Gagnoa (2009). A standardized questionnaire was administered in a face-toface interview, which included questions on socio-demographic characteristics, sexual behaviour and condom use. After the interview, the participants were asked to provide samples for STI and HIV testing. Results: A total of 1110 FSWs participated in the surveys. There were large differences in socio-demographic and behavioural characteristics between FSW coming for the first time as compared to FSW coming on a routine visit. The prevalence of N. gonorrhoeae or C.trachomatis was 9.1%, 11.8 % among first vs. 6.9 % routine attendees (p = 0.004). The overall HIV prevalence was 26.6%, it was lower among first time attendees (17.5 % as compared to 33.9 % for routine attendees, p,0.001). The HIV prevalence among first attendees was also lower than the proportion of HIV positive tests from routine testing and counselling services in the same clinics. Conclusions: The results show a relatively high STI and HIV prevalence among FSWs in different cities in Côte d’Ivoire. In th

Reducing contacts to stop SARS-CoV-2 transmission during the second pandemic wave in Brussels, Belgium, August to November 2020

To evaluate the effect of physical distancing and school reopening in Brussels between August and November 2020, we monitored changes in the number of reported contacts per SARS-CoV-2 case and associated SARS-CoV-2 transmission. The second COVID-19 pandemic wave in Brussels was the result of increased social contact across all ages following school reopening. Physical distancing measures including closure of bars and restaurants, and limiting close contacts, while primary and secondary schools remained open, reduced social mixing and controlled SARS-CoV-2 transmission

The Paleocene/Eocene boundary Global Standard Stratotype-section and Point (GSSP): Criteria for Characterisation and Correlation

The choice of a Paleocene/Eocene (P/E) Global Standard Stratotype-section and Point (GSSP) is complicated by the fact that there exists confusion on the exact denotation of the Paleocene and Eocene Series and their constituent lower rank (stage) units. While we can now resolve this problem by recourse to rigorous historical analysis, actual placement of the GSSP is further exacerbated by an embarrassment of riches (in regards to 7 criteria suitable for characterising and correlating a PIE GSSP but which span a temporal interval of greater than 2 my). Following the precept that the boundaries between higher level chronostratigraphic units are to be founded upon the boundaries of their lowest constituent stages in a nested hierarchy, we note that one of the criteria providing global correlation potential (a stable isotope excursion in marine and terrestrial stratigraphies) lies at a stratigraphic level more than !my older than the base of the stratotypic Ypresian Stage to which the base of the Eocene Series has been subordinated until now. Lowering a chronostratigraphic unit by this extent risks a significant modification to the original geohistorical denotation of the Ypresian Stage and the Eocene Series. We discuss here four options that are open to Voting Members of the Paleogene Subcommission. One solution consists in adjusting slightly the base of the Ypresian Stage (and, thus, the Eocene Series) so as to be correlatable on the basis of the lowest occurrence/First Appearance Datum (LO/FAD) of the calcareous nannofossil species Tribrachiatus.digitalis. Another solution would be to decouple series and stages so that the Ypresian Stage remains essentially unaltered but the base of tbe Eocene is relocated so as to be correlated on the basis of the Carbon Isotope Excursion (CIE). Two (compromise) solutions consist in erecting a new stage for the upper/terminal Paleocene (between the Thanetian [sensu Dollfus] and Ypresian Stages) characterised at its base by the global stable isotope excursion. The P/E GSSP may then be placed at the base of the stratotypic Ypresian Stage (thus preserving historical continuity and conceptual denotation and stability) or at the base of the newly erected stage (facilitating correlation of the base of the Eocene series, at least in principle). Both GSSPs should be placed in suitable marine stratigraphic sections yet to be determined but upon which there is considerable current investigative activity

“No good man will ever want me”. How structural social inequality increases women’s vulnerability to HIV transmission: a qualitative study from Bandung, Indonesia

Understanding the pathways that expose women to HIV transmission are vital in improving HIV prevention, especially among a “hidden” group of women without pre-established known risk for HIV. We investigated the pathways which place certain women at greater risk for HIV in a qualitative exploratory study with theoretical sampling using an emergent theory study design in an urban setting in Indonesia. We conducted semi-structured interviews with 47 HIV-infected women, one focus group discussion with five young women who occassionally engage in sex work, participant observation at six sex work venues and two midwife clinics, and 11 informal interviews with midwives, nurses, and obstetricians. Our research found that many women not characterized as belonging to a “high-risk group” or “key population” were nevertheless at increased risk for HIV. A history of sexual abuse, premarital sex, divorce, or involvement in sex work, often precipitated by poverty coupled with discriminatory public health policies further heightened women’s exposure to HIV. While reaching at-risk populations is a key strategy in HIV prevention, a novel and more tailored approach is needed to reach more hidden categories of women with less apparent risk behavior yet considerable risk for HIV infection

Outcomes of antiretroviral treatment program in Ethiopia: Retention of patients in care is a major challenge and varies across health facilities

BACKGROUND: Many resource-limited countries are scaling up antiretroviral treatment (ART) towards universal access. However, there are few studies which evaluated outcomes of ART programs in these countries. In addition, these studies generally include a limited number of facilities and patients creating a clear need for studies with a wide range of facilities and large numbers of patients. In this study, we intended to evaluate the outcomes of the ART services in 55 health facilities in Ethiopia. METHODS: A retrospective longitudinal study was conducted to determine levels of patient retention in care, CD4 count and shift to second-line ART regimen in 30 hospitals and 25 health centers selected as sentinel sites for monitoring the outcomes of ART program in the country. The outcomes were determined at baseline, after 6, 12 and 24 months on ART. Data was collected from routine patient registers and charts, and entered and analyzed using EPI-Info statistical software. RESULTS: Health facilities were able to retain 29,893 (80%), 20,079 (74%) and 5,069 (68%) of their patients after 6, 12 and 24 months on ART, respectively. Retention rates vary across health facilities, ranging from 51% to 85% after 24 months on ART. Mortality was 5%, 6% and 8% after 6, 12 and 24 months on ART. More than 79% of patients with available CD4-cell counts had a baseline CD4-cell counts less than 200 cells per micro-liter of blood. The median CD4-cell counts (based on patients who were retained after 24 months on ART) increased from 125 (inter-quartile (IQ), 68-189) at baseline to 242 (IQ, 161-343), 269 (IQ, 185-380) and 316 (IQ, 226-445) cells per micro-liter after 6, 12, and 24 months on ART, respectively. The transition to second-line ART remained very low, 0.33%, 0.58% and 2.13% after 6, 12 and 24 months on ART. Discussion and conclusion: The outcomes of the ART services in the 55 health facilities in Ethiopia are similar to those in other countries. Retention of patients in care is a major challenge and varies across health facilities with high, medium and low retention rates. We therefore recommend further studies to understand the organization of care in health facilities with high, medium and low retention rates. It is also imperative that early initiation of patients on ART is taken seriously as more than 79% of the patients had baseline CD4-cell counts less than 200 cells per micro-liter of blood. Finally, we recommend that the shift to second-line ART might be too low and warrants close monitoring