Prevalence of and Barriers to Dual-Contraceptive Methods Use among Married Men and Women Living with HIV in India

Objective. To describe the prevalence and correlates of dual-contraceptive methods use (condoms and an effective pregnancy prevention method) and barriers to their use among married persons living with HIV (PLHIV) in India. Methods. We conducted a quantitative survey (93 men, 97 women), 25 in-depth interviews, seven focus groups, and five key informant interviews. Results. Prevalence of dual- contraceptive method use increased from 5% before HIV diagnosis to 23% after diagnosis (P < 0.001). Condoms were the most common contraceptive method, with prevalence increasing from 13% before diagnosis to 92% after diagnosis (P < 0.001). Barriers to using noncondom contraceptives were lack of discussion about noncondom contraceptives by health care providers, lack of acceptability of noncondom contraceptives among PLHIV, and lack of involvement of husbands in family planning counseling. Conclusion. There is a need for interventions, including training of health care providers, to increase dual-contraceptive methods use among married PLHIV

Sexual Risk Behaviour among HIV-Positive Individuals in Clinical Care in Urban KwaZulu-Natal, South Africa

Objectives: To assess the prevalence and predictors of unprotected sex among HIV+ individuals in clinical care in urban KwaZulu-Natal, South Africa. Design: Cross-sectional survey of 152 HIV+ individuals attending a hospital-based HIV-clinic. Methods: Structured interviews were conducted by bilingual interviewers. Sexual risk behaviour in the preceding 3 months was assessed via event counts. Results: In one of the first studies of its kind in South Africa we found that nearly half of the sample reported vaginal or anal sex during the preceding 3 months, and 30% of these patients reported unprotected vaginal or anal sex. Among sexually active patients, a total of 171 unprotected sex events were reported, 40% of which were with partners perceived to be HIV negative or HIV-status unknown. Nine such partners were potentially exposed to HIV. Alcohol use during sex, being forced to have sex, sex with a perceived HIV+ partner, and sex with a casual partner predicted more unprotected sex, whereas HIV-status disclosure was related to less unprotected sex. Conclusions: HIV+ individuals in clinical care in South Africa may engage in unprotected sex that place others at risk of HIV infection and themselves at risk for infection with STIs. With a national ARV rollout currently underway in South Africa, increasing numbers of HIV+ individuals are entering care. This affords a crucial opportunity to link HIV prevention with HIV care, an approach that aims to reduce transmission risk behaviour among HIV+ individuals and is consistent with international agencies’ current prevention priorities

An updated genetic marker for detection of Lake Sinai Virus and metagenetic applications

Background. Lake Sinai Viruses (LSV) are common RNA viruses of honey bees (Apis mellifera) that frequently reach high abundance but are not linked to overt disease. LSVs are genetically heterogeneous and collectively widespread, but despite frequent detection in surveys, the ecological and geographic factors structuring their distribution in A. mellifera are not understood. Even less is known about their distribution in other species. Better understanding of LSV prevalence and ecology have been hampered by high sequence diversity within the LSV clade. Methods. Here we report a new polymerase chain reaction (PCR) assay that is compatible with currently known lineages with minimal primer degeneracy, producing an expected 365 bp amplicon suitable for end-point PCR and metagenetic sequencing. Using the Illumina MiSeq platform, we performed pilot metagenetic assessments of three sample sets, each representing a distinct variable that might structure LSV diversity (geography, tissue, and species). Results. The first sample set in our pilot assessment compared cDNA pools from managed A. mellifera hives in California (n = 8) and Maryland (n = 6) that had previously been evaluated for LSV2, confirming that the primers co-amplify divergent lineages in real-world samples. The second sample set included cDNA pools derived from different tissues (thorax vs. abdomen, n = 24 paired samples), collected from managed A. mellifera hives in North Dakota. End-point detection of LSV frequently differed between the two tissue types; LSV metagenetic composition was similar in one pair of sequenced samples but divergent in a second pair. Overall, LSV1 and intermediate lineages were common in these samples whereas variants clustering with LSV2 were rare. The third sample set included cDNA from individual pollinator specimens collected from diverse landscapes in the vicinity of Lincoln, Nebraska. We detected LSV in the bee Halictus ligatus (four of 63 specimens tested, 6.3%) at a similar rate as A. mellifera (nine of 115 specimens, 7.8%), but only one H. ligatus sequencing library yielded sufficient data for compositional analysis. Sequenced samples often contained multiple divergent LSV lineages, including individual specimens. While these studies were exploratory rather than statistically powerful tests of hypotheses, they illustrate the utility of high-throughput sequencing for understanding LSV transmission within and among species

HIV transmission risk behavior among HIV-positive patients receiving antiretroviral therapy in KwaZulu-Natal, South Africa.

CAPRISA, 2014.The aim of this investigation was to identify factors associated with HIV transmission risk behavior among HIV-positive women and men receiving antiretroviral therapy (ART) in KwaZulu-Natal, South Africa. Across 16 clinics, 1,890 HIV? patients on ART completed a risk-focused audio computer-assisted self-interview upon enrolling in a prevention-with-positives intervention trial. Results demonstrated that 62% of HIV-positive patients’ recent unprotected sexual acts involved HIV-negative or HIV status unknown partners. For HIV-positive women, multivariable correlates of unprotected sex with HIV-negative or HIV status unknown partners were indicative of poor HIV prevention-related information and of sexual partnership-associated behavioral skills barriers. For HIV positive men, multivariable correlates represented motivational barriers, characterized by negative condom attitudes and the experience of depressive symptomatology, as well as possible underlying information deficits. Findings suggest that interventions addressing gender-specific and culturally-relevant information, motivation, and behavioral skills barriers could help reduce HIV transmission risk behavior among HIV-positive South Africans

Impact of an adherence intervention on the effectiveness of tenofovir gel in the CAPRISA 004 trial.

CAPRISA, 2014.Abstract not available in pdf

What Primary Care Providers Can Do to Address Barriers to Self-Monitoring of Blood Glucose

Self-monitoring of blood glucose (SMBG) can be instrumental in achieving glycemic control in individuals with type 11,2 or type 23–8 diabetes. SMBG can help people with diabetes understand the effects of food and exercise on blood glucose and assist them to make healthy choices; provide insights to patients and clinicians concerning the effectiveness of therapies; and provide direction in efforts to achieve and maintain glycemic control.5,9–1

An updated genetic marker for detection of Lake Sinai Virus and metagenetic applications

Background. Lake Sinai Viruses (LSV) are common RNA viruses of honey bees (Apis mellifera) that frequently reach high abundance but are not linked to overt disease. LSVs are genetically heterogeneous and collectively widespread, but despite frequent detection in surveys, the ecological and geographic factors structuring their distribution in A. mellifera are not understood. Even less is known about their distribution in other species. Better understanding of LSV prevalence and ecology have been hampered by high sequence diversity within the LSV clade. Methods. Here we report a new polymerase chain reaction (PCR) assay that is compatible with currently known lineages with minimal primer degeneracy, producing an expected 365 bp amplicon suitable for end-point PCR and metagenetic sequencing. Using the Illumina MiSeq platform, we performed pilot metagenetic assessments of three sample sets, each representing a distinct variable that might structure LSV diversity (geography, tissue, and species). Results. The first sample set in our pilot assessment compared cDNA pools from managed A. mellifera hives in California (n = 8) and Maryland (n = 6) that had previously been evaluated for LSV2, confirming that the primers co-amplify divergent lineages in real-world samples. The second sample set included cDNA pools derived from different tissues (thorax vs. abdomen, n = 24 paired samples), collected from managed A. mellifera hives in North Dakota. End-point detection of LSV frequently differed between the two tissue types; LSV metagenetic composition was similar in one pair of sequenced samples but divergent in a second pair. Overall, LSV1 and intermediate lineages were common in these samples whereas variants clustering with LSV2 were rare. The third sample set included cDNA from individual pollinator specimens collected from diverse landscapes in the vicinity of Lincoln, Nebraska. We detected LSV in the bee Halictus ligatus (four of 63 specimens tested, 6.3%) at a similar rate as A. mellifera (nine of 115 specimens, 7.8%), but only one H. ligatus sequencing library yielded sufficient data for compositional analysis. Sequenced samples often contained multiple divergent LSV lineages, including individual specimens. While these studies were exploratory rather than statistically powerful tests of hypotheses, they illustrate the utility of high-throughput sequencing for understanding LSV transmission within and among species

An information-motivation-behavioral skills (IMB) model-based HIV prevention intervention for truck drivers in India

The incidence of HIV/AIDS in India is increasing drastically, and truck drivers are seen as critical sources of HIV transmission due to their high rates of unprotected sex with multiple partners. An intervention based on the Information-Motivation-Behavioral Skills (IMB) model was compared to an information-only control condition in a randomized trial. IMB constructs were assessed among 250 male truck drivers immediately prior to and following implementation of the intervention, and sexual and condom use behaviors were assessed approximately 10 months later. The intervention consisted of a single-session group workshop with 5 interactive activities designed to address HIV prevention-related IMB constructs and to motivate condom use. Findings showed mixed support for the effectiveness of the intervention. There was an effect of the IMB intervention on attitudes, norms, behavioral skills, and intentions specific to condom use with marital partners, but no effects on constructs related to non-marital partners. There was some evidence of greater condom use with marital and non-marital partners at behavioral follow-up for participants in the IMB condition, and effects on condom use with marital partners were mediated by changes in IMB constructs. These findings provide initial evidence for the effectiveness of theoretically-based approaches to HIV prevention in India.HIV/AIDS Information-motivation-behavioral skills model IMB model Prevention intervention Truck drivers India

Sexual Risk Behaviour among HIV-Positive Individuals in Clinical Care in Urban KwaZulu-Natal, South Africa

Objectives: To assess the prevalence and predictors of unprotected sex among HIV+ individuals in clinical care in urban KwaZulu-Natal, South Africa. Design: Cross-sectional survey of 152 HIV+ individuals attending a hospital-based HIV-clinic. Methods: Structured interviews were conducted by bilingual interviewers. Sexual risk behaviour in the preceding 3 months was assessed via event counts. Results: In one of the first studies of its kind in South Africa we found that nearly half of the sample reported vaginal or anal sex during the preceding 3 months, and 30% of these patients reported unprotected vaginal or anal sex. Among sexually active patients, a total of 171 unprotected sex events were reported, 40% of which were with partners perceived to be HIV negative or HIV-status unknown. Nine such partners were potentially exposed to HIV. Alcohol use during sex, being forced to have sex, sex with a perceived HIV+ partner, and sex with a casual partner predicted more unprotected sex, whereas HIV-status disclosure was related to less unprotected sex. Conclusions: HIV+ individuals in clinical care in South Africa may engage in unprotected sex that place others at risk of HIV infection and themselves at risk for infection with STIs. With a national ARV rollout currently underway in South Africa, increasing numbers of HIV+ individuals are entering care. This affords a crucial opportunity to link HIV prevention with HIV care, an approach that aims to reduce transmission risk behaviour among HIV+ individuals and is consistent with international agencies’ current prevention priorities