South African national household survey of HIV/AIDS prevalence, behavioural risks and mass media impact-detailed methodology and response rate results

Objectives. To describe the methodology used in a recent survey of HIV/AIDS in South Africa and to present the response rates.Methods. A cross-sectional, national household-based survey was conducted using second-generation surveillance procedures. A complex multistage sampling technique was used to create a master sample of 1 000 census enumerator areas out of a total of 86 000 nationally. Aerial photographs were taken and used to randomly select more than 10 197 households and ultimately 13 518 individuals from a sampling frame of 31 321 people. Phase 1 of the study involved notifying the household residents about the study and collecting key demographic information on respondents aged 2 years and older. This information was used to randomly select up to 3 respondents from each household: 1 adult (25 years and older), 1 youth (15- 24 years), and 1 child (2- 14 years). In phase 2 nurses interviewed respondents and collected oral fluid specimens for HIV testing. In the case of children aged 2 - 11 years, parents or guardians were interviewed, but HIV testing was performed on the selected children. Questionnaire data were anonymously linked with HIV test results.Results. A total of 9 963 persons agreed to be interviewed and 8 840 were tested for HIV, yielding a response rate of 73.7% and 65.4% respectively. However, only 8 428 (62.3%) HIV test results were correctly matched with behavioural data. The results showed that those tested for HIV did not differ from those not tested in terms of key determinants.Conclusion. It is possible to use community-based surveys to study the prevalence of HIV in the general population

Alcohol expectations and risky drinking among men and women at high-risk for HIV infection in Cape Town, South Africa

This study examined the differential patterns of alcohol outcome expectancies in relation to drinking before sex and having sex partners who drink before sex among men (N = 614) and women (N = 158) sexually transmitted infections clinic patients in Cape Town South Africa. Hierarchical regressions, controlling for age, education, and alcohol use showed that men's sexual enhancement alcohol expectancies were associated with drinking before sex and having sex partners who drank before sex. Behavioral disinhibition expectancies were inversely related to drinking before sex. For women, there were no associations between alcohol expectancies and drinking before sex, although sexual enhancement expectancies were related to having sex partners who drank before sex. We conclude that alcohol outcome expectancies, particularly expectancies that alcohol will enhance sexual experiences, are related to HIV transmission risks. Sexual risk reduction interventions for those at greatest risk for HIV/AIDS should directly address alcohol expectancies.

Sensation seeking, alcohol use, and sexual behaviours among sexually transmitted infection clinic patients in Cape Town, South Africa

Alcohol use is associated with risks for HIV/AIDS. The association between alcohol and sexual risk may be accounted for by sensation seeking personality. However, sensation seeking in relation to substance use and HIV risk has not been examined in Africa. In this study, 292 men and 219 women receiving sexually transmitted infection (STI) diagnostic and treatment services in Cape Town, South Africa, completed anonymous behavioral surveys.

Coital bleeding and HIV risks among men and women in Cape Town, South Africa

South Africa has one of the world's fastest growing HIV epidemics. Genital bleeding during sexual intercourse may play a role in facilitating HIV transmission in South Africa. The purpose of this study was to examine the prevalence and sources of coital bleeding among men and women living in a Cape Town South Africa township.

Vorapaxar in the secondary prevention of atherothrombotic events

Item does not contain fulltextBACKGROUND: Thrombin potently activates platelets through the protease-activated receptor PAR-1. Vorapaxar is a novel antiplatelet agent that selectively inhibits the cellular actions of thrombin through antagonism of PAR-1. METHODS: We randomly assigned 26,449 patients who had a history of myocardial infarction, ischemic stroke, or peripheral arterial disease to receive vorapaxar (2.5 mg daily) or matching placebo and followed them for a median of 30 months. The primary efficacy end point was the composite of death from cardiovascular causes, myocardial infarction, or stroke. After 2 years, the data and safety monitoring board recommended discontinuation of the study treatment in patients with a history of stroke owing to the risk of intracranial hemorrhage. RESULTS: At 3 years, the primary end point had occurred in 1028 patients (9.3%) in the vorapaxar group and in 1176 patients (10.5%) in the placebo group (hazard ratio for the vorapaxar group, 0.87; 95% confidence interval [CI], 0.80 to 0.94; P<0.001). Cardiovascular death, myocardial infarction, stroke, or recurrent ischemia leading to revascularization occurred in 1259 patients (11.2%) in the vorapaxar group and 1417 patients (12.4%) in the placebo group (hazard ratio, 0.88; 95% CI, 0.82 to 0.95; P=0.001). Moderate or severe bleeding occurred in 4.2% of patients who received vorapaxar and 2.5% of those who received placebo (hazard ratio, 1.66; 95% CI, 1.43 to 1.93; P<0.001). There was an increase in the rate of intracranial hemorrhage in the vorapaxar group (1.0%, vs. 0.5% in the placebo group; P<0.001). CONCLUSIONS: Inhibition of PAR-1 with vorapaxar reduced the risk of cardiovascular death or ischemic events in patients with stable atherosclerosis who were receiving standard therapy. However, it increased the risk of moderate or severe bleeding, including intracranial hemorrhage. (Funded by Merck; TRA 2P-TIMI 50 ClinicalTrials.gov number, NCT00526474.)