•Higher HIV prevalence among men who have sex with men (MSM) who primarily inject meth than among other MSM who inject drugs.•Higher HIV risk among MSM who inject meth was explained by sexual, not ...injection, risk behaviors.•MSM who inject meth were less likely to share needles.•MSM who inject meth more likely to have multiple condomless anal sex partners, sexually transmitted infections.
Men who have sex with men (MSM) and inject drugs are at risk for HIV infection. Although research exists on non-injection methamphetamine (meth) use and sexual risk among MSM, less is known about meth injection and its association with HIV infection among MSM who inject drugs.
We analyzed data from men aged ≥18 years who reported injecting drugs and male-to-male sexual contact. Men were recruited using respondent-driven sampling, interviewed, and tested for HIV during the 2012 and 2015 cycles of National HIV Behavioral Surveillance among persons who inject drugs. We included data from 8 cities where ≥10 MSM reported meth as the primary drug injected. We assessed differences in demographic characteristics, past 12 months risk behaviors, and HIV infection between MSM who primarily injected meth and those who primarily injected another drug.
Among 961 MSM, 33.7% reported meth as the drug they injected most often. Compared to MSM who primarily injected other drugs, MSM who primarily injected meth were more likely to have had ≥5 condomless anal sex partners, have been diagnosed with syphilis, and were less likely to report sharing syringes. In multivariable analysis, injecting meth was associated with being HIV-positive (adjusted prevalence ratio 1.48; 95% confidence interval 1.08–2.03). Including number of condomless anal sex partners in mediation analysis rendered this association no longer significant.
HIV prevalence among MSM who primarily injected meth was almost 50% higher than among MSM who primarily injected other drugs, and this association was mediated by sexual risk.
This study assessed the prevalence of exchanging sex for money or drugs among men who have sex with men (MSM) in the 2011 US National HIV Behavioral Surveillance system. Prevalence of HIV, being ...HIV-positive but unaware (HIV-positive–unaware), risk behaviors and use of services were compared between MSM who did and did not receive money or drugs from one or more casual male partners in exchange for oral or anal sex in the past 12 months. Among 8411 MSM, 7.0 % exchanged sex. MSM who exchanged sex were more likely to be non-Hispanic black, live in poverty, have injected drugs, have multiple condomless anal sex partners, be HIV-positive and be HIV-positive–unaware. In multivariable analysis, exchange sex was associated with being HIV-positive–unaware (aPR 1.34, 95 % CI 1.05–1.69) after adjusting for race/ethnicity, age, education, poverty, and injecting drugs. MSM who exchange sex represent an important group to reach with HIV prevention, testing, and care services as they were more likely to report behavioral risk factors that put them at risk of HIV.
Hepatitis B virus (HBV) epidemiology in Europe differs by region and population risk group, and data are often incomplete. We estimated chronic HBV prevalence as measured by surface antigen (HBsAg) ...among general and key population groups for each country in the European Union, European Economic Area and the United Kingdom (EU/EEA/UK), including where data are currently unavailable.
We combined data from a 2018 systematic review (updated in 2021), data gathered directly by the European Centre for Disease Control (ECDC) from EU/EEA countries and the UK and further country-level data. We included data on adults from the general population, pregnant women, first time blood donors (FTBD), men who have sex with men (MSM), prisoners, people who inject drugs (PWID), and migrants from 2001 to 2021, with three exceptions made for pre-2001 estimates. Finite Mixture Models (FMM) and Beta regression were used to predict country and population group HBsAg prevalence. A separate multiplier method was used to estimate HBsAg prevalence among the migrant populations within each country, due to biases in the data available.
There were 595 included studies from 31 countries (N = 41,955,969 people): 66 were among the general population (mean prevalence (Formula: see text) 1.3% range: 0.0-7.6%), 52 among pregnant women (Formula: see text1.1% 0.1-5.3%), 315 among FTBD (Formula: see text0.3% 0.0-6.2%), 20 among MSM (Formula: see text1.7% 0.0-11.2%), 34 among PWID (Formula: see text3.9% 0.0-16.9%), 24 among prisoners (Formula: see text2.9% 0.0-10.7%), and 84 among migrants (Formula: see text7.0% 0.2-37.3%). The FMM grouped countries into 3 classes. We estimated HBsAg prevalence among the general population to be < 1% in 24/31 countries, although it was higher in 7 Eastern/Southern European countries. HBsAg prevalence among each population group was higher in most Eastern/Southern European than Western/Northern European countries, whilst prevalence among PWID and prisoners was estimated at > 1% for most countries. Portugal had the highest estimated prevalence of HBsAg among migrants (5.0%), with the other highest prevalences mostly seen in Southern Europe.
We estimated HBV prevalence for each population group within each EU/EAA country and the UK, with general population HBV prevalence to be < 1% in most countries. Further evidence is required on the HBsAg prevalence of high-risk populations for future evidence synthesis.
Limited data exist in the United States on the prevalence of HIV among women who exchange sex.
We estimate HIV prevalence of women who exchange sex from a 2016 survey in Chicago, Detroit, Houston, ...and Seattle and compare it with the prevalence of HIV among women of low socioeconomic status (SES), who did not exchange sex, and women in the general population.
Women who exchange sex were recruited via respondent-driven sampling among some cities participating in National HIV Behavioral Surveillance, interviewed, and offered HIV testing. We estimate HIV prevalence and, using prevalence ratios, compare it with the prevalence among women of low SES who did not exchange sex in the 2013 National HIV Behavioral Surveillance cycle, and to women in the general population estimated using 2015 National HIV Surveillance data.
One thousand four hundred forty women reported exchange sex in 2016. Aggregated HIV prevalence was 4.9% 95% confidence interval (CI): 2.7 to 7.1 among women who exchanged sex, 1.6% (95% CI: 0.3 to 2.8) among women of low SES who did not exchange sex, and 0.6% (95% CI: 0.5% to 0.6%) among women in the general population. HIV prevalence among women who exchanged sex was 3.1 times (95% CI: 1.6 to 5.9) as high as among women of low SES who did not exchange sex, and 8.8 times (95% CI: 7.0 to 11.1) as high as among women in the general population.
HIV prevalence was significantly higher among women who exchanged sex compared with women in the general population and women of low SES who did not exchange sex.
BACKGROUNDLittle is known about the extent to which HIV-infected street youth (living part or full time on the streets) exhibit behaviors associated with HIV transmission in their interactions with ...youth not living on the streets (“non–street youth”). We aimed to determine prevalences and predictors of such “bridging behaviors”inconsistent condom use and needle sharing between HIV-positive street youth and non–street youth.
METHODSA total of 171 street youth in 3 Ukrainian cites were identified as HIV infected after testing of eligible participants aged 15 to 24 years after random selection of venues. Using data from these youth, we calculated prevalence estimates of bridging behaviors and assessed predictors using logistic regression.
RESULTSOverall, two-thirds of HIV-infected street youth exhibited bridging behaviors; subgroups with high prevalences of bridging included females (78.3%) and those involved in transactional sex (84.2%). In multivariable analysis, inconsistent condom use with non–street youth was associated with being female (adjusted prevalence ratio aPR, 1.2; 95% confidence interval CI, 1.1–1.4), working (aPR, 1.2; 95% CI, 1.03–1.4), multiple partners (aPR, 1.4; 95% CI, 1.2–1.6), and “never” (aPR, 1.4; 95% CI, 1.1–1.6) or “sometimes” (aPR, 1.3; 95% CI, 1.02–1.8) versus “always” sleeping on the street. Needle sharing with non–street youth was associated with being male (aPR, 1.4; 95% CI, 1.02–2.0), orphaned (aPR, 2.3; 95% CI, 1.8–3.0), and 2 years or less living on the streets (aPR, 1.8; 95% CI, 1.5–2.1).
CONCLUSIONSBridging behaviors between HIV-infected street youth and non–street youth are common. Addressing the comprehensive needs of street and other at-risk youth is a critical prevention strategy.
A short interpregnancy interval (IPI) is a risk factor for preterm delivery among women of reproductive age. As limited data exist concerning adolescents, we aimed to examine the association between ...short IPIs and preterm birth among adolescents using a majority of US births. Using 2007–2008 US natality data, we assessed the relationship between IPIs <3, 3–5, 6–11, and 12–17 months and moderately (32–36 weeks) and very (<32 weeks) preterm singleton live births among mothers <20 years, relative to IPIs 18–23 months. Adjusted odds ratios (aORs) and 95 % confidence intervals (95 % CIs) adjusted for maternal race, age, previous preterm deliveries, marital status, smoking and prenatal care were determined from a multivariable multinomial logistic regression model. In 2007–2008, there were 85,077 singleton live births to women aged <20 who had one previous live birth, 69 % of which followed IPIs ≤18 months. Compared with IPIs 18–23 months, short IPIs were associated with
moderately
preterm birth for IPIs <3 months (aOR 1.89, 95 % CI 1.70–2.10), 3–5 months (aOR 1.33, 95 % CI 1.22–1.47), and 6–12 months (aOR 1.11, 95 % CI 1.02–1.21). IPIs <3 and <6 months were also associated with
very
preterm birth, with aORs of 2.52 (95 % CI 1.98–3.22) and 1.68 (95 % CI 1.35–2.10) respectively. Many adolescent mothers with repeat births have short IPIs, and shorter IPIs are associated with preterm birth in a dose-dependent fashion. Increasing adolescent mothers’ use of effective contraception postpartum can address both unintended adolescent births and preterm birth.
BackgroundThe HIV epidemic in the United States (US) is mainly concentrated in so-called ‘key populations’ including men who have sex with men (MSM) and people who inject drugs (PWID). In addition, ...other groups such as people of low socioeconomic status and people belonging to some ethnic minorities have a higher prevalence of HIV. Globally, people who exchange sex for money or drugs are recognised as another key population with high HIV prevalence, but there is limited recent data from rigorous studies in the United States on HIV prevalence among people who exchange sex.High prevalence among certain groups may be a combination of individual risk behaviours such as condomless sex, drug use and unsafe injection practices, and structural factors such as poverty, violence and residential segregation that can impact HIV risk indirectly. This thesis examines whether, among populations known to be at high risk for HIV, prevalence is higher among those who belong to more than one key population or vulnerable group and for whom several risk factors intersect. Furthermore, it examines sociodemographic factors and sexual and drug-use risk behaviours in these populations and how they may be relevant to HIV acquisition and transmission.MethodsData:worked with the US National HIV Behavioral Surveillance System (NHBS), which is a surveillance system that collects data from three populations at high risk for HIV in annual rotating cycles: men who have sex with men (MSM), people who inject drugs and heterosexuals at increased risk of HIV (referred to as ‘IDU’ and ‘HET’, respectively). We recruited participants for all three cycles in around 20 large US cities on an annual rotating schedule. For the IDU and HET cycles, we use respondent-driven sampling (RDS), which is a sampling method specifically designed to reach hidden populations and approximate a random sample and where participants recruit each other using coupons. In 2016 I led a pilot data collection focused specifically on women in five cities who exchange sex, also using RDS. During the MSM cycle we recruited participants through venue-based sampling which allows random sampling of venues in a city, time-slots within venues and individual men attending the venue. In all cycles participants take an interviewer-administered survey asking about demographic characteristics, sexual and drug-use risk behaviours and access to services such as frequency of HIV testing and use of health care and preventive services. Participants are also offered a rapid HIV test and receive an incentive for taking the survey and the HIV test.Analysis:For Papers 1 and 2, I looked at women who inject drugs and MSM to examine whether people who exchange sex are more likely to be HIV-infected, including being HIV-positive but unaware of one’s positive status (HIV-positive–unaware), compared with those who do not exchange sex belonging to the same populations. Paper 3 estimates the HIV prevalence among women who exchange sex and compares it with the prevalence among women of low socioeconomic status who do not exchange sex from the same cities three years earlier. In these papers, exchange sex is defined as having had oral, vaginal or anal sex with a male partner in the past 12 months.
Women involved in the criminal justice system experience multiple risk factors that increase the likelihood of acquiring HIV infection. We evaluated the prevalence of incarceration and compared ...behaviors among women with and without an incarceration history.
We use the 2013 National HIV Behavioral Surveillance data, which uses respondent-driven sampling. We evaluate the association between incarceration and the following past 12 months outcomes: exchange sex, multiple casual sex partners (≥3), multiple condomless sex partners (≥3), HIV test, and sexually transmitted infection diagnoses. Log-linked Poisson regression models, adjusted for demographics and clustered on city, with generalized estimating equations were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals.
Of 5154 women, 11% were incarcerated within the previous year, 36% were ever incarcerated but not in the past 12 months, and 53% were never incarcerated. Prevalence of exchange sex (aPR 1.32, 1.20-1.46), multiple casual partners (aPR 1.59, 1.2-2.1), multiple casual condomless partners (aPR 1.47, 1.07-2.03), and sexually transmitted infection diagnosis (aPR 1.61, 1.34-1.93) were all higher among recently incarcerated women compared with those never incarcerated. We also found higher prevalence of recent HIV testing among women recently incarcerated (aPR 1.30, 1.18-1.43).
Nearly half of women in our study had been incarcerated. Recent incarceration was associated with several factors that increase the risk of HIV acquisition. HIV prevention, testing, and early treatment among women with a history of incarceration can maximize the effectiveness of the public health response to the HIV epidemic.
Background. Pre-exposure prophylaxis (PrEP) is an effective prevention tool for people at substantial risk of acquiring human immunodeficiency virus (HIV). To monitor the current state of PrEP use ...among men who have sex with men (MSM), we report on willingness to use PrEP and PrEP utilization. To assess whether the MSM subpopulations at highest risk for infection have indications for PrEP according to the 2014 clinical guidelines, we estimated indications for PrEP for MSM by demographics. Methods. We analyzed data from the 2014 cycle of the National HIV Behavioral Surveillance (NHBS) system among MSM who tested HIV negative in NHBS and were currently sexually active. Adjusted prevalence ratios and 95% confidence intervals were estimated from log-linked Poisson regression with generalized estimating equations to explore differences in willingness to take PrEP, PrEP use, and indications for PrEP. Results. Whereas over half of MSM said they were willing to take PrEP, only about 4% reported using PrEP. There was no difference in willingness to take PrEP between black and white MSM. PrEP use was higher among white compared with black MSM and among those with greater education and income levels. Young, black MSM were less likely to have indications for PrEP compared with young MSM of other races/ethnicities. Conclusions. Young, black MSM, despite being at high risk of HIV acquisition, may not have indications for PrEP under the current guidelines. Clinicians may need to consider other factors besides risk behaviors such as HIV incidence and prevalence in subgroups of their communities when considering prescribing PrEP.
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