Developing a Conceptual Framework of Seroadaptive Behaviors in HIV-Diagnosed Men Who Have Sex With Men

Background. Seroadaptive behaviors are strategies employed by men who have sex with men (MSM) to reduce the transmission risk for human immunodeficiency virus (HIV). It has been suggested that they contribute to the increasing diagnoses of sexually transmitted infections in HIV-diagnosed MSM. To understand the context in which the reemerging sexually transmitted infections appear, we developed a social epidemiological model incorporating the multiple factors influencing seroadaptive behaviors. Methods. A literature review of seroadaptive behaviors in HIV-diagnosed MSM was conducted. The literature was synthesized using a social epidemiological perspective. Results. Seroadaptive behaviors are adopted by MSM in high-income countries and are a way for HIV-diagnosed men to manage and enjoy their sexual lives. Influences are apparent at structural, community, interpersonal, and intrapersonal levels. There is little evidence of whether and when the behavior forms part of a premeditated strategy; it seems dependent on the social context and on time since HIV diagnosis. Social rules of HIV disclosure and perception of risk depend on the setting where partners are encountered. Conclusions. Seroadaptive behaviors are strongly context dependent and can reduce or increase transmission risk for different infectious diseases. Further data collection and mathematical modeling can help us explore the specific conditions in more detail

The price of sex: condom use and the determinants of the price of sex among female sex workers in eastern zimbabwe.

Background. Higher prices for unprotected sex threaten the high levels of condom use that contributed to the decline in Zimbabwe's human immunodeficiency virus (HIV) epidemic. To improve understanding of financial pressures competing against safer sex, we explore factors associated with the price of commercial sex in rural eastern Zimbabwe. Methods. We collected and analyzed cross-sectional data on 311 women, recruited during October–December 2010, who reported that they received payment for their most-recent or second-most-recent sex acts in the past year. Zero-inflated negative binomial models with robust standard errors clustered on female sex worker (FSW) were used to explore social and behavioral determinants of price. Results. The median price of sex was $10 (interquartile range [IQR],$5–$20) per night and$10 (IQR, $5–$15) per act. Amounts paid in cash and commodities did not differ significantly. At the most-recent sex act, more-educated FSWs received 30%–74% higher payments. Client requests for condom use significantly predicted protected sex (P < .01), but clients paid on average 42.9% more for unprotected sex. Conclusions. Within a work environment where clients' preferences determine condom use, FSWs effectively use their individual capital to negotiate the terms of condom use. Strengthening FSWs' preferences for protected sex could help maintain high levels of condom use

The incorporation of carbon nanofibres to enhance the properties of hot compacted self-reinforced single polymer composites

Nanoscale fillers offer the potential for significant enhancement of a range of polymer properties, as they are available in a wide variety of shapes and properties. Carbon nanotubes (CNT) and nanofibres (CNF) have been used extensively in the literature, yet very few analytical studies of the material properties have been reported. Here we use the Cox-Krenchel model to interpret the experimentally measured changes in Young’s modulus from particle aspect ratio reduction during to processing, in addition to the measurement of the mechanical properties of the composite. Hot Compaction, a process developed at the University of Leeds [1], utilises high modulus, highly oriented elements to form thick section, homogeneous sheets without the need to introduce a second phase of different chemical composition. These ‘single polymer’ composites are produced by selective melting on the surface of the oriented elements; on cooling, this molten material re-crystallises to form a matrix phase and bind the oriented elements together. CNF filled polypropylene (PP) tapes have been produced and successfully hot compacted into sheets. The properties of these nanofilled self-reinforced single polymer composites is reported. Of particular interest has been to investigate the introduction of interleaved films, an extension of recent work conducted by two of this papers authors [2] of the same polymer or nanocomposite in order to establish the change in properties when the CNF are incorporated in the drawn tapes, in the interleaved films or both

Triggering information by context

With the increased availability of personal computers with attached sensors to capture their environment, there is a big opportunity for context-aware applications; these automatically provide information and/or take actions according to the user's present context, as detected by sensors. When wel l designed, these applications provide an opportunity to tailor the provision of information closely to the user's current needs. A sub-set of context-a ware applications are discrete applications, where discrete pieces of i nformation are attached to individual contexts, to be triggered when the user enters those contexts. The advantage of discrete applications is that authori ng them can be solely a creative process rather than a programming process: it can be a task akin to creating simple web pages. This paper looks at a general system that can be used in any discrete context- aware application. It propounds a general triggering rule, and investigates how this rule applies in practical applications

Evaluation of risk management practices: data analysis of NHS England hospitals

Risk management practices are applied in the National Health Service (NHS) England hospitals to reduce harm rates and to ensure safety. This study evaluates current risk management practices in the NHS England hospitals through highlighting non-compliance issues within the practice and through explaining board level risk priorities. All data were collected for selected (N=34) NHS England hospitals. Data were gathered from the NHS Litigation Authority (NHSLA) reports to reveal risk management problems and from Board Assurance Frameworks (BAF) to define top risks. Results from an external authority of the NHSLA show that local induction of staff is a major non-compliance issue for risk management practice with more than half of the hospitals having difficulties. Following that supervision of medical staff in training is the second highly observed deficiency. Results from hospitals’ board level demonstrate that top risks in hospitals were regarding quality and performance issues. Additionally, most of the board level defined top risks were categorized as organizational and clinical-related risks. Within these, workforce issues and non-compliance with requirements are highlighted as top risks for organizational-related risks while Accident and Emergency (A&E) targets and treatment delays are prioritized as part of clinical-related risks. Financial deficit is also frequently defined at board level as a top risk for financial-related risks. Both the NHSLA and hospital board level assessments show that workforce related issues are still a major concern in hospital risk management practices. It is therefore a slight influence of an external authority (NHSLA) has been recognized on prioritization of board level defined risks

How Many HIV Infections May Be Averted by Targeting Primary Infection in Men Who Have Sex With Men? Quantification of Changes in Transmission-Risk Behavior, Using an Individual-Based Model

In the United Kingdom, human immunodeficiency virus (HIV) transmission among men who have sex with men (MSM) is not under control, despite readily available treatment, highlighting the need to design a cost-effective combination prevention package. MSM report significantly reduced transmission risk behavior following HIV diagnosis. To assess the effectiveness of HIV diagnosis in averting transmission during highly infectious primary HIV infection (PHI), we developed a stochastic individual-based model to calculate the number of HIV-transmission events expected to occur from a cohort of recently infected MSM with and those without the behavior changes reported after diagnosis. The model incorporates different types of sex acts, incorporates condom use, and distinguishes between regular and casual sex partners. The impact on transmission in the 3 months after infection depends on PHI duration and testing frequency. If PHI lasts for 3 months and testing is performed monthly, then behavior changes after diagnosis would have reduced estimated transmission events by 49%–52%, from 31–45 to 15–23 events; a shorter duration of PHI and/or a lower testing frequency reduces the number of infections averted. Diagnosing HIV during PHI can markedly reduce transmission by changing transmission-risk behavior. Because of the high infectivity but short duration of PHI, even short-term behavior change can significantly reduce transmission. Our quantification of the number of infections averted is an essential component of assessment of the cost-effectiveness of strategies to increase detection and diagnoses of PHI

Complex picture for likelihood of ENSO-driven flood hazard

El Niño and La Niña events, the extremes of ENSO climate variability, influence river flow and flooding at the global scale. Estimates of the historical probability of extreme (high or low) precipitation are used to provide vital information on the likelihood of adverse impacts during extreme ENSO events. However, the nonlinearity between precipitation and flood magnitude motivates the need for estimation of historical probabilities using analysis of hydrological datasets. Here, this analysis is undertaken using the ERA-20CM-R river flow reconstruction for the 20th Century. Our results show that the likelihood of increased or decreased flood hazard during ENSO events is much more complex than is often perceived and reported; probabilities vary greatly across the globe, with large uncertainties inherent in the data and clear differences when comparing the hydrological analysis to precipitation