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Studies have shown that sexual transmission, both heterosexually and homosexually, is one of the main ways of HBV infection. Based on this fact, we propose a mathematical model to study the sexual transmission of HBV among adults by classifying adults into men and women and considering both same-sex and opposite-sex transmissions of HBV in adults. Firstly, we calculate the basic reproduction number $ R_{0} $ and the disease-free equilibrium point $ E_{0} $ . Secondly, by analysing the sensitivity of $ R_{0} $ in terms of model parameters, we find that the infection rate among people who have same-sex partners, the frequency of homosexual contact and the immunity rate of adults play important roles in the transmission of HBV. Moreover, we use our model to fit the reported data in China and forecast the trend of hepatitis B. Our results demonstrate that popularizing the basic knowledge of HBV among residents, advocating healthy and reasonable sexual life style, reducing the number of adult carriers, and increasing the immunization rate of adults are effective measures to prevent and control hepatitis B.

Background Understanding the demographic characteristics of people living with HIV/AIDS (PLWHA) infected through commercial heterosexual contact (CHC) or nonmarital noncommercial heterosexual contact (NMNCHC) is important for HIV/AIDS prevention and control. Methods Cases reported through the Chinese HIV/AIDS Case Reporting System (CRS) from 2015 to 2018 were analyzed. A descriptive and preliminary inferential analysis were performed for those demographic characteristics deemed of interest. Results Overall, 523,121 identified PLWHA between 2015 and 2018 in the CRS were analyzed. The constituent ratio of heterosexual transmission increased from 66.25% in 2015 to 71.48% in 2018. The proportion of CHC heterosexual transmission decreased from 40.18% in 2015 to 37.99% in 2018, while that of NMNCHC increased from 46.33% in 2015 to 49.02% in 2018. PLWHA infected through NMNCHC were significantly younger than those who were infected through CHC (Student’s t test, P 2 = 8909.00(2015), 9941.90(2016), 11,004.00 (2017), 12,836.00(2018), all P 2 = 94.67 (2015), 109.88(2016), 58.18(2017), 152.38(2018), all P P Conclusions We found that heterosexual transmission was the primary mode of HIV transmission in China from 2015 to 2018. PLWHA infected through CHC and NMNCHC had different characteristics in age, gender, marital status, and educational level. The frequency of PLWHA infected through CHC increased substantially in the age group of 65 and above. This study provides useful baseline data for future studies on the heterosexual transmission of HIV in China.

The aim of the study was to explore the common misconceptions about HIV as a determinant of the HIV epidemic growth and as a factor affecting disease outcomes.Materials and methods. The study involved 136 persons (50 persons with blood-borne infection route, 50 persons with heterosexual transmission, 36 persons without HIV). As research methods a special clinical map was used, as well as an author’s questionnaire, which allows to register the characteristics of risky behavior in relation to infection and the characteristics of the life situation of the disease. Statistical data processing included the definition of primary statistics, the Fisher criterion, ANOVA.Study results. A frequent occurrence of distorted representations about HIV was noted in all groups. It has been established that people living with HIV and healthy respondents do not differ in the frequency of HIV testing. The features of the life situation of the disease related to the method of the disease transmission were revealed in the study. It has been established that people living with HIV with different infection route differ in the frequency of late HIV diagnosis, the presence of AIDS, refusal of treatment. The results determine the need to increase public awareness of the disease and correct distorted representations about it.

Injection drug use and heterosexual transmission from male key populations to their female partners have been the dominant modes of HIV transmission in Vietnam. A demonstration project was conducted to offer immediate antiretroviral therapy (ART) (regardless of CD4 cell count) to HIV-seropositive partners in serodiscordant couples. During March–December 2013, couples HIV testing and counselling (HTC) and immediate ART were offered in two drug use-affected provinces. Of 256 couples receiving couples HTC, 146 (57%) were serodiscordant; 134 (92%) seropositive partners initiated ART irrespective of CD4 cell count. Of these, 86% were male; 57% reported ever using illicit drugs; median CD4 cell count before ART initiation was 374 cells/mm3. Consistent condom use was reported by 58, 70 and 71% among HIV-positive partners at months 0, 3 and 12. At 12 months after ART initiation, 119 (89%) HIV-positive partners were retained in care; 96 (95% of those tested) achieved viral suppression (

Background Heterosexual transmission has contributed greatly to the current HIV-1 epidemic in China. However, the HIV-1 genetic characteristics in the heterosexually transmitted population in Jiangsu province remained unclear. Methods A molecular epidemiological investigation on heterosexual transmission of HIV-1 was conducted across Jiangsu province. 301 HIV-1 patients infected through heterosexual transmission were involved in this study. The epidemiological information was investigated by trained staff via face-to-face interviews. Blood samples were taken from each patient, HIV-1 RNA was extracted from the plasma, and used for amplifying the gag and env genes followed by further products sequencing. The genotypes of HIV-1 were determined using phylogenetic tree analyses in the neighbor-joining method. Results A total of 262 samples were successfully taken for genotyping. The main subtypes which accounted for 90.5% of all HIV-1 strains are CRF01_AE (45.4%), CRF07_BC (21.4%), subtype B (12.6%), CRF08_BC (11.1%). Minor subtypes were also detected, such as CRF68_01B, subtype C, CRF55_01B, CRF02_AG and subtype A. Time trend analysis suggested the prevalence of subtype B and CRF08_BC decreased gradually, but the prevalence of CRF01_AE increased over time. A relatively higher prevalence of CRF07_BC in Central Jiangsu and subtype B were detected in South Jiangsu, while a relatively lower prevalence of subtype B and CRF08_BC were detected in Central Jiangsu. Conclusion Complex and unbalanced HIV distribution characteristics suggest that heterosexual transmission of HIV needs to be taken seriously. It is necessary to implement more effective and comprehensive intervention strategies for further control of HIV-1 dissemination.

STUDY QUESTION What is the recommended management for medically assisted reproduction (MAR) in patients with a viral infection or disease, based on the best available evidence in the literature? SUMMARY ANSWER The ESHRE guideline on MAR in patients with a viral infection/disease makes 78 recommendations on prevention of horizontal and vertical transmission before, during and after MAR, and the impact on its outcomes, and these also include recommendations regarding laboratory safety on the processing and storage of gametes and embryos testing positive for viral infections. WHAT IS KNOWN ALREADY The development of new and improved anti-viral medications has resulted in improved life expectancy and quality of life for patients with viral infections/diseases. Patients of reproductive age are increasingly exploring their options for family creation. STUDY DESIGN, SIZE, DURATION The guideline was developed according to the structured methodology for the development of ESHRE guidelines. After the formulation of nine key questions for six viruses (hepatitis B virus, hepatitis C virus, human immunodeficiency virus, human papilloma virus, human T-lymphotropic virus I/II and Zika virus) by a group of experts, literature searches and assessments were performed. Papers published up to 2 November 2020 and written in English were included in the review. Evidence was analyzed by female, male or couple testing positive for the virus. PARTICIPANTS/MATERIALS, SETTING, METHODS Based on the collected evidence, recommendations were formulated and discussed until consensus was reached within the guideline group. There were 61 key questions to be answered by the guideline development group (GDG), of which 12 were answered as narrative questions and 49 as PICO (Patient, Intervention, Comparison, Outcome) questions. A stakeholder review was organized after the finalization of the draft. The final version was approved by the GDG and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE This guideline aims to help providers meet a growing demand for guidance on the management of patients with a viral infection/disease presenting in the fertility clinic. The guideline makes 78 recommendations on prevention of viral transmission before and during MAR, and interventions to reduce/avoid vertical transmission to the newborn. Preferred MAR treatments and interventions are described together with the effect of viral infections on outcomes. The GDG formulated 44 evidence-based recommendations—of which 37 were formulated as strong recommendations and 7 as weak—33 good practice points (GPP) and one research only recommendation. Of the evidence-based recommendations, none were supported by high-quality evidence, two by moderate-quality evidence, 15 by low-quality evidence and 27 by very low-quality evidence. To support future research in the field of MAR in patients with a viral infection/disease, a list of research recommendations is provided. LIMITATIONS, REASONS FOR CAUTION Most interventions included are not well-studied in patients with a viral infection/disease. For a large proportion of interventions, evidence was very limited and of very low quality. More evidence is required for these interventions, especially in the field of human papilloma virus (HPV). Such future studies may require the current recommendations to be revised. WIDER IMPLICATIONS OF THE FINDINGS The guideline provides clinicians with clear advice on best practice in MAR for patients with a viral infection/disease, based on the best evidence currently available. In addition, a list of research recommendations is provided to stimulate further studies in the field. STUDY FUNDING/COMPETING INTEREST(S) The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not receive any financial incentives, all work was provided voluntarily. A.D. reports research fees from Ferring and Merck, consulting fees from Ferring, outside the submitted work. C.P. reports speakers fees from Merck and MSD outside the submitted work. K.T. reports speakers fees from Cooper Surgical and Ferring and consultancy fees as member of the advisory board BioTeam of Ferring, outside the submitted work. The other authors have no conflicts of interest to declare. DISCLAIMER This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgment to each individual presentation, nor variations based on locality and facility type. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. (Full disclaimer available at www.eshre.eu/guidelines.)

The global HIV policy environment changed dramatically for same-sex practising men from 2000 to 2020. These changes were especially pronounced in African countries, where research, prevention, and surveillance focused almost exclusively on heterosexual transmission for the previous 20 years. In stark contrast to the beginning of the century, by 2020, nearly all African countries identified same-sex practicing men as key populations in need of targeted HIV prevention and surveillance to control their epidemics. Drawing on a rich collection of archival, qualitative interview, and quantitative data, this chapter illuminates the global policy changes and initiatives that facilitated the recognition of the burden of HIV among same-sex practising men in African contexts, examines whether and when African countries have integrated same-sex practising men into the national HIV responses, and identifies key drivers of both inclusion and resistance to inclusion of same-sex practising men in the national HIV responses of African countries.

Transmission modeling suggests that screening guidelines focused on men who have sex with men are likely insufficient for syphilis control in contexts with substantial infection burden in heterosexual populations. Supplemental digital content is available in the text., Background The current syphilis epidemic in the United States is concentrated in gay, bisexual, and other men who have sex with men (MSM), but substantial heterosexual transmission is reported in some parts of the country. Using the US states of Louisiana and Massachusetts as case studies, we investigated how epidemic context influences the impact of population screening approaches for syphilis control. Methods We constructed a compartmental metapopulation model parameterized to describe observed patterns of syphilis transmission. We estimated the impact of different approaches to screening, including perfect adherence to current US screening guidelines in MSM. Results In Louisiana, where syphilis cases are more evenly distributed among MSM and heterosexual populations, we projected that screening according to guidelines would contribute to no change or an increase in syphilis burden, compared with burden with current estimated screening coverage. In Massachusetts, which has a more MSM-focused outbreak, we projected that screening according to guidelines would be as or more effective than current screening coverage in most population groups. Conclusions Men who have sex with men–focused approaches to screening may be insufficient for control when there is substantial transmission in heterosexual populations. Epidemic characteristics may be useful when identifying at-risk groups for syphilis screening.

Background: In recent years, HIV transmission through heterosexual contact has been on the rise, accounting for more than 69% in 2017{Cui, 2020 #27}. Therefore, an in-depth understanding of the characteristics of heterosexual transmission will greatly improve our effectiveness in preventing AIDS.Methods: All identified People Living With HIV/AIDS (PLWHAs) reported as transmitted through heterosexual transmission in the Chinese HIV/AIDS Case Reporting System (CRS) in 2018 were included in this study. A multivariate logistic regression model was applied to evaluate the relationship between socio-demographic characteristics and the overall risk of being transmitted through commercial heterosexual contact (CHC) or non-marital non-commercial heterosexual contact (NMNCHC).Results: A total of 92026 cases of non-marital heterosexual transmission with no missing data were included in the analysis. There were 40244 (43.73%) cases infected through CHC and 51782 (56.27%) infected through NMNCHC. One year increase in age was associated with 0.98 times the odds of being reported as infected through NMNCHC (aOR = 0.98, 95% CI = 0.9783-0.9806, p < 0.0001), significantly higher odds of infection through NMNCHC was observed with females (aOR = 8.39, 95% CI = 8.03-8.77, p < 0.0001), non-farmers (OR =1.22, 95% CI = 1.18-1.26, p < 0.0001), minorities (aOR = 1.94, 95% CI = 1.86-2.02, p < 0.0001), those with education level of college and above (aOR = 1.49, 95% CI = 1.38-1.61, p < 0.0001), and migrants in the different city of the same province (aOR = 1.28, 95% CI = 1.21-1.34, p < 0.0001). Conclusions: Among heterosexual transmission, Younger people, ethnic minorities, migrants within province, as well as those with comparatively higher socioeconomic status were more likely to be transmitted through non-marital non-commercial heterosexual contact (NMNCHC). More interfere measures and targeted strategies should be made for the HIV transmission through this route.

We report a case of HIV-1 superinfection in a patient with established HIV-2 infection. The patient was not taking antiretroviral therapy, in line with criteria in national guidelines, and reported no risk for infection with HIV-1. This case serves as a reminder that patients infected with HIV-2 remain susceptible to HIV-1 infection. The protective effect of antiretroviral treatment against HIV-1 infection should be a consideration in treatment decisions for individuals with HIV-2 infection.

ObjectivesTrichomoniasis is the most prevalent curable STI globally, with the highest incidence and prevalence in sub-Saharan Africa (sSA). STIs have largely been associated with an increase in HIV acquisition. Our objective was to assess the existing literature available in English regarding the association of Trichomoniasis and HIV-1 acquisition.MethodsThe review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) under number CRD42018082702. We searched MEDLINE, Embase and Scopus databases to collect articles measuring the association of Trichomonas vaginalis infection and HIV acquisition and performed a meta-analysis and qualitative synthesis of the literature.ResultsWe identified 1806 unduplicated citations, of which 18 papers and 1 conference abstract were eligible for inclusion in the review after applying our inclusion and exclusion criteria. All the studies included in the systematic review had been carried out in sSA. The articles reported various measures of effects, namely: HRs, rate ratios, risk ratios and ORs. In a meta-analysis restricted to 11 studies reporting HR, individuals infected with T. vaginalis were 1.5 times more likely to acquire HIV compared with individuals not infected with T. vaginalis (95% CI 1.3 to 1.7; pConclusionsT. vaginalis is an important factor in HIV acquisition especially in sSA where the prevalence of both T. vaginalis and HIV-1 are high. This systematic review and meta-analysis confirms the evidence that infection with T. vaginalis augments HIV acquisition with 50%. Diagnosis and treatment of T. vaginalis infection in both high-risk and low-risk individuals may be a potential tool to reduce new HIV infections.Trial registration numberCRD42018082702

A surge in heterosexual transmission of HIV among men in post-Soviet countries prompts the need to understand the determinants of HIV testing in the region. Survey data from Belarus (n = 2,769), Moldova (n = 1,545), and Ukraine (n = 3,620) were used to assess an influence of psychosocial determinants on testing among men. A mediation analysis for binary outcomes was used to assess effects of knowledge and stigma on testing. While knowledge had a positive influence on testing in each country, an indirect influence of knowledge through stigma was unique for each country. Implications for interventions and social work are discussed in the light of findings.

Background Although effective, some oral pre-exposure prophylaxis (PrEP) users face barriers to adherence using daily pills, which could be reduced by long-acting formulations. Long-acting cabotegravir (CAB LA) is a potential new injectable formulation for human immunodeficiency virus (HIV) PrEP being tested in phase III trials. Methods We use a mathematical model of the HIV epidemic in South Africa to simulate CAB LA uptake by population groups with different levels of HIV risk. We compare the trajectory of the HIV epidemic until 2050 with and without CAB LA to estimate the impact of the intervention. Results Delivering CAB LA to 10% of the adult population could avert more than 15% of new infections from 2023 to 2050. The impact would be lower but more efficient if delivered to populations at higher HIV risk: 127 person-years of CAB LA use would be required to avert one HIV infection within 5 years if used by all adults and 47 person-years if used only by the highest risk women. Conclusions If efficacious, a CAB LA intervention could have a substantial impact on the course of the HIV epidemic in South Africa. Uptake by those at the highest risk of infection, particularly young women, could improve the efficiency of any intervention., Using injectable cabotegravir for HIV prevention could, if efficacious, be a valuable addition to the portfolio of HIV prevention options in South Africa and could have a substantial impact on the progression of the epidemic.

Guangxi Zhuang Autonomous Region is one of the least economically developed regions in China and has been granted the status of autonomous region due to the high share of Zhuang minority population in the region. HIV was initially spread mainly among drug users, later to be transmitted further to the general population. The epidemic also shows some specific patterns that are not as prevalent in other parts of the country. For instance, the region has the highest rate of heterosexual transmission in China, and the prevalence among senior citizens has become alarmingly high in later years (the share of reported cases age 50 and above, makes up almost 60%). In addition to this, Guangxi faces issues with a large number of late diagnosed cases; around 50% of those diagnosed are already in an advanced clinical stage. Also related to this, the region exhibits the highest HIV-related mortality rates in China. In comparison with other Chinese regions, the HIV epidemic is relatively evenly distributed throughout the region, making it difficult to target the response. In response to these issues, there have been a large number of programs implemented to increase testing and facilitate treatment.

HIV remains a public health concern in Tanzania and other Eastern and Southern African countries. Estimates show that there were about 1.4 million people living with HIV in Tanzania in the year 2013. HIV is a generalized epidemic in Tanzania with heterosexual transmission being the main route of transmission. Recently, however, there has been growing concern on the potential role of the key populations in HIV epidemic in the country. Studies done have shown significantly higher HIV prevalence in these populations compared to the general population. These studies have also reported high risky behaviors among members of these populations. This review aims at discussing the possible role of the key populations in the HIV epidemic in Tanzania.

Introduction Some studies suggest that use of the injectable contraceptive depot medroxyprogesterone acetate (DMPA) may increase susceptibility to HIV infection. We aim to determine the influence that such an association could have had on the HIV epidemic in South Africa. Methods We simulate the heterosexual adult HIV epidemic in South Africa using a compartmental model stratified by age, behavioural risk group, sex, male circumcision status and contraceptive use. We model two possible scenarios: (1) The “With Effect” scenario assumes that DMPA increases susceptibility to HIV infection by 1.20‐fold (95% confidence interval 1.06 to 1.36) based on a combination of the results of a recent randomised controlled trial (ECHO trial) and a number of observational studies. (2) The “No Effect” scenario assumes that DMPA has no effect on HIV acquisition risk. We calculate the difference in HIV‐related outcomes between the With Effect and No Effect scenarios to determine the potential impact that DMPA use could have had on the HIV epidemic. Results A causal association between DMPA and HIV acquisition could have caused 430,000 (90% of model runs 160,000 to 960,000) excess HIV infections and 230,000 (90,000 to 470,000) AIDS deaths in South Africa from 1980 to 2017. These figures represent 4.3% (1.6% to 9.6%) and 6.9% (2.6% to 15.2%) of the total modelled estimates of HIV infections and AIDS deaths respectively in South Africa in that period. Of the additional infections, 36% (25% to 48%) would have occurred among men. If DMPA use continues at current levels, a potential causal association could cause an additional 130,000 (50,000 to 270,000) infections between 2018 and 2037. The excess infections would have required an additional 640,000 (190,000 to 1,660,000) years of ART from 1980 to 2017, and a further 2,870,000 (890,000 to 7,270,000) years of ART from 2018 to 2037. Conclusions If there is a causal association between DMPA use and HIV risk, it could have substantially increased the scale of the HIV epidemic in South Africa, affecting not only the users of DMPA, but also their partners and the wider population. The magnitude of this potential effect demands careful data collection and a careful consideration of policy choices for contraception in settings with large HIV epidemics.

BACKGROUND: The level of evidence for HIV transmission risk through condomless sex in serodifferent gay couples with the HIV-positive partner taking virally suppressive antiretroviral therapy (ART) is limited compared with the evidence available for transmission risk in heterosexual couples. The aim of the second phase of the PARTNER study (PARTNER2) was to provide precise estimates of transmission risk in gay serodifferent partnerships.METHODS: The PARTNER study was a prospective observational study done at 75 sites in 14 European countries. The first phase of the study (PARTNER1; Sept 15, 2010, to May 31, 2014) recruited and followed up both heterosexual and gay serodifferent couples (HIV-positive partner taking suppressive ART) who reported condomless sex, whereas the PARTNER2 extension (to April 30, 2018) recruited and followed up gay couples only. At study visits, data collection included sexual behaviour questionnaires, HIV testing (HIV-negative partner), and HIV-1 viral load testing (HIV-positive partner). If a seroconversion occurred in the HIV-negative partner, anonymised phylogenetic analysis was done to compare HIV-1 pol and env sequences in both partners to identify linked transmissions. Couple-years of follow-up were eligible for inclusion if condomless sex was reported, use of pre-exposure prophylaxis or post-exposure prophylaxis was not reported by the HIV-negative partner, and the HIV-positive partner was virally suppressed (plasma HIV-1 RNA FINDINGS: Between Sept 15, 2010, and July 31, 2017, 972 gay couples were enrolled, of which 782 provided 1593 eligible couple-years of follow-up with a median follow-up of 2·0 years (IQR 1·1-3·5). At baseline, median age for HIV-positive partners was 40 years (IQR 33-46) and couples reported condomless sex for a median of 1·0 years (IQR 0·4-2·9). During eligible couple-years of follow-up, couples reported condomless anal sex a total of 76 088 times. 288 (37%) of 777 HIV-negative men reported condomless sex with other partners. 15 new HIV infections occurred during eligible couple-years of follow-up, but none were phylogenetically linked within-couple transmissions, resulting in an HIV transmission rate of zero (upper 95% CI 0·23 per 100 couple-years of follow-up).INTERPRETATION: Our results provide a similar level of evidence on viral suppression and HIV transmission risk for gay men to that previously generated for heterosexual couples and suggest that the risk of HIV transmission in gay couples through condomless sex when HIV viral load is suppressed is effectively zero. Our findings support the message of the U=U (undetectable equals untransmittable) campaign, and the benefits of early testing and treatment for HIV.FUNDING: National Institute for Health Research.

Heterosexual transmission of HIV and other sexually transmitted diseases (STDs) is increasing in older adult populations around the world. This study compares Hispanic and non-Hispanic men ages 50 years and older currently using prescribed erectile dysfunction medications in relation to their perception of the effect of condoms on sexual experience. A sample of 86 men (40 Hispanic and 46 non-Hispanic men) ages 50-79 years completed the 10-item Effect on Sexual Experience (ESE) subscale. Although there was no difference between the 2 groups on the subscale mean score, t(84) = 1.449, p = .151, analysis of the subscale items found 1 item that was significantly different (p = .005) between the 2 groups, although this difference could have been related to different perceptions of the word disgusting. Hispanic men were also less concerned than non-Hispanic men about condom-related loss of erection. This study adds to the literature on HIV and STD prevention for older Hispanic/Latinos.

Introduction : Nigeria has the second largest number of people living with HIV (PLWH) (3.1 million) after South Africa (5.6 million) and accounts for 10% of the global HIV burden. Lagos State is one of the priority States in Nigeria with a high population (over 20 million). Sero-discordance applies when one partner of an intimate couple pair’s HIV result is positive and other negative. A discordant status is particularly risky because regular coitus without condoms is more probable in stable long-term partnerships (married or cohabiting). The aim is to study the trends of HIV sero-positivity among antenatal clinic attendees and their discordant partners. Methods : secondary data from the National Health Management Information System (NHMIS) was extracted through the District Health Information System (DHIS) platform, cleaned and analysed with Microsoft excel for frequency and proportion. Results : in 2013 the HIV prevalence amongst ANC attendee in the health facilities of Lagos state was 2.83% with slight increase to 4.77% in 2014 and a decline to 2.77% and 1.88% in 2015 and 2016 respectively. In 2013 only 2.35% of women knew their HIV status at antenatal (ANC), the proportion increased slightly to 4.35% in 2014 with a decline to 2.54% and 1.69% in 2015 and 2016 respectively. There were 2300 (37.6%), 2347 (27.0%), 2314 (32.6%) and 1527(35.6%) sero-discordant partners in 2013, 2014, 2015 and 2016 respectively. Of the sero discordant partners 1780, 1770, 1573 and 1276 were partners of HIV Positive women who tested Negative in 2013, 2014, 2015 and 2016 respectively. Also, of the sero discordant partners 520 (22.6%), 577 (24.6%), 741(32%) and 251(16.4%) were partners of HIV Negative pregnant women who tested HIV Positive for 2013, 2014, 2015 and 2016 respectively. Conclusion : the data revealed a decline in HIV prevalence among pregnant women in Lagos State; however HIV sero-discordant partners may be responsible for new Paediatric infection within heterosexual transmission setting. We therefore recommend that couple counseling should be enforced during ANC.

Introduction: Post-Soviet countries of Eastern Europe and Central Asia have witnessed a recent growth of HIV infection through heterosexual transmission. Women’s low levels of knowledge about HIV prevention and transmission methods have been found to account for the higher female-to-male ratio among cases infected through the heterosexual route. This cross national comparison study assessed comprehensive HIV/AIDS knowledge and its key determinants among women of seven post-Soviet countries and identified which countries face the highest levels of risk due to the low levels of HIV/AIDS awareness.Methods: Study data were obtained from the third wave of the Multiple Indicator Cluster Surveys (MICS3) (conducted in 2005 and 2006), nationally representative samples of women aged 15-49 years. Data on HIV/AIDS knowledge were analyzed for women in Kazakhstan (N=14,310), Kyrgyzstan (N=6,493), Tajikistan (N=4,676), Uzbekistan (N=13,376), Belarus (N=5,884), Ukraine (N=6,066), and Georgia (N=7,727) using descriptive statistics and ordinary least squares (OLS) regressions.Results: We found that the percentage of women who could correctly identify all five modes of HIV/AIDS transmission and prevention was highest in Eastern European countries of Belarus (34.98%) and Ukraine (31.67%). Across all countries, the strongest predictors of comprehensive HIV/AIDS knowledge were age, education, and region of residence. Marital status, area of residence (urban vs. rural), and household wealth were significant predictors for several countries.Conclusion: High rates of comprehensive HIV/AIDS knowledge were found among women of Belarus and Ukraine. To reduce the spread of HIV in the region, programs promoting comprehensive HIV/AIDS knowledge for women of younger ages and with lower education are recommended.

Background: Latinos in the USA have been disproportionally affected by HIV and sexually transmitted infection (STI) epidemics and the prevalence of heterosexual transmission of HIV among this population is increasing. Latino day laborers (workers who seek jobs at day labor sites) are especially vulnerable to these risks due to their immigration status, poverty, and social isolation. While day laborers remain marginalized and vulnerable, studies on their HIV-related risks are limited. Methods: A total of 40 male day laborers were recruited from a day labor site in a semi-rural area in central Texas. Semi-structured interviews were conducted in Spanish by male interviewers and subsequently transcribed and translated. Results: Most day laborers were from Mexico, and ranged in age from 21 to 51 (mean = 43, SD = 11.5); about three-quarters of them were undocumented. More than 80% of the men were married, 65.8% of men were married but their wives were in their country of origin. Many participants had short-term...

A Mathematical Model of HIV/AIDS with Heterosexual transmission in the presence of treatment was examine in this paper, it ascertained the impact of treated individuals on the transmission dynamics of HIV/AIDS. Equilibrium points of the model system were found, stability analysis and numerical simulation were carried out, it was discovered that HIV/AIDS can die out with test of time as Ro < 1 . It was observed that the model had a disease free equilibrium which was asymptotically stable for Ro < 1 and unstable for Ro > 1. Graphical representations of the numerical analysis showing the effect of treatment on the model were also presented.

Background: Heterosexual transmission (HST) has become the current predominant transmission pathways of the HIV-1 epidemic in China. The aim of this study was to explore the geographic and dynamic change of HIV-1 subtypes through HST in China from published studies. Methods: Several electronic databases were searched to identify the studies, and the overall prevalence of HIV-1 subtypes was estimated by a meta-analysis method. Subgroup analysis was conducted by study region and time period. Publication bias was evaluated using Egger’s test. The χ2 test was used to evaluate the proportion differences among subgroups. Sensitivity analysis was carried out to assess the stability of the overall prevalence estimates. Results: 42 studies were included in our final analysis. The overall prevalence of CRF01_AE was 46.34% (95% CI: 40.56–52.17%), CRF07_BC was 19.16% (95% CI: 15.02–23.66%), B/B’ was 13.25% (95% CI: 9.68–17.25%), CRF08_BC was 10.61% (95% CI: 7.08–14.70%), and C was 4.29% (95% CI: 1.85–7.48%). In subgroup analysis, the prevalence of CRF01_AE and CRF07_BC increased, while the prevalence of B/B’ decreased over time, whereby the prevalence of CRF07_BC and CRF08_BC have exceeded that of B/B’ since 2010. A significant higher prevalence of CRF01_AE was found in the South provinces, CRF07_BC in East provinces, CRF08_BC and C in Southwest provinces, and B/B’ in North provinces. Conclusions: The HIV-1 prevalent strains have evolved into complicated and diverse subtypes, and the proportion of HIV-1 subtypes through HST has changed constantly in different regions and periods in China. This highlights the urgent need to vigorously strengthen the prevention and control of the HIV-1 epidemic.

Indian HIV policy is based on the misguided assumption that most sex in India takes place within monogamous, heterosexual settings. This over-emphasis on the heterosexual transmission of the disease has meant the rise of prevalence in the population vulnerable to non-heterosexual transmission of the disease. This article will place the disavowal of same-sex desire in post-colonial India within a historic context, and go behind the veil of heteronormative silence to tell the stories of sexual minorities, doubly stigmatized by poverty, as they seek sexual gratification in the shadows of Indian society.

We analyzed data on reported mode of transmission in case reports of HIV-infections among men in Ukraine. The number of men who were reported to have acquired HIV through heterosexual transmission increased substantially in 2006-2011. However, we estimate that up to 40 % of reported cases of heterosexual transmission among men may actually represent misclassified men who have sex with men or persons who inject drugs. These findings indicate a need to improve the quality of data on reported mode of HIV transmission. Accurate information has important public health implications in planning prevention and treatment services.

Tenofovir was incorporated in controlled-release polycaprolactone (PCL) matrices designed for production of vaginal inserts for prevention of HIV transmission. Rapid cooling of suspensions of the drug powder in PCL solution resulted in micro-porous matrices with tenofovir loadings up to 12% (w/w) and high incorporation efficiencies in excess of 90%. The release behaviour of tenofovir in simulated vaginal fluid (SVF) demonstrated high delivery efficiency of 85%-99% over 30 days and could be described effectively by a first-order kinetics model giving a mean value of 0.126 day-1 for the release constant (k1 ). Tenofovir released from PCL matrices into SVF exhibited high relative activity ranging from 70 to 90%, against pseudo-typed HIV-1-infected HeLa cells. The inhibitory activity of tenofovir standard solutions in SVF provided an IC50 value of 2.38 μM. Besides confirming high levels of in vitro antiviral activity, the predicted concentrations of tenofovir, which would be released from a PCL intra-vaginal ring in vivo, exceeded the IC50 value for HIV-1 by a factor of 35-200 and clinically protective concentrations by a factor of 50. These findings recommend further investigations of antiviral-loaded PCL matrices for controlling heterosexual transmission of HIV.

We aim to characterize sexual behavioral aspects of heterosexual Neisseria gonorrhoea (NG) acquisition in two Sexually Transmitted Diseases clinics in Sydney, Australia, in 2008–2012. Of 167 NG cases, 102 were heterosexually acquired with a trend of increasing NG prevalence in heterosexuals from 1.1% (95% CI 0.6–2.1) in 2008 to 3.0% (95% CI 2.0–4.0) in 2012 (P=0.027). Of heterosexual male cases, unprotected fellatio was the likely sexual activity for NG acquisition in 21/69 (30.4%) and commercial sex work (CSW) contact the likely source in 28/69 (40.6%). NG prevalence overall in CSW (2.2%) was not significantly higher than in non-CSW (1.2%) (P=0.15), but in 2012 there was a significant increase in NG prevalence in CSW (8.6%) compared to non-CSW (1.6%) (P<0.001). Pharyngeal NG was found in 9/33 (27.3%) female cases. Decreased susceptibility to ceftriaxone (MIC ≥ 0.03 mg/L) occurred in 2.5% NG isolates, none heterosexually acquired. All were azithromycin susceptible. A significant trend of increasing prevalence of heterosexual gonorrhoea in an urban Australian STD clinic setting is reported. We advocate maintenance of NG screening in women, including pharyngeal screening in all women with partner change who report fellatio, as pharyngeal NG may be an important reservoir for heterosexual transmission. Outreach to CSW should be enhanced.

INTRODUCTION: Globally the majority of human immunodeficiency virus (HIV) epidemic is through heterosexual transmission; The complex interaction between STD and the HIV has been demonstrated in many epidemiological, in vitro and clinical studies over the last number of years. Classic STD could facilitate HIV 1 transmission by increasing either the infectiousness of the index case, the susceptibility of the partner, or both.

Understanding the factors that promote or prevent HIV transmission remains a critical component of the global battle against HIV/AIDS. Gosmann et al. (2017) reveal a putative role for the vaginal microbiome in modulating heterosexual transmission of HIV, uncovering a potential strategy for protecting women from acquisition of the virus.

The human immunodeficiency virus (HIV) poses a formidable risk to the health of women, who made up almost 20% of new HIV infections in 2014 in the U.S. (the most recent year for which data are available). Women represent 25% of those infected with HIV. Sixty-two percent of infected women are African American; Latina and White women each represent 17% of cases in women. The CDC reports that heterosexual transmission accounts for 87% of HIV cases in women. However, it is not clear why some women in HIV-dense neighborhoods become infected, and others do not.

BACKGROUND: Some but not all observational studieshave suggested an increase in risk of HIV acquisition for women using injectable hormonal contraception (IHC). METHODS: We used country-level data to explore the effects of reducing IHC use on the number of HIV infections the number of live births and the resulting net consequenceson AIDS deaths and maternal mortality for each country. RESULTS: High IHC use coincides with high HIV incidence primarily in southern and eastern Africa. If IHC does increase the risk of HIV acquisition this could generate 27 000-130 000 infections per year globally 87-88% of which occur in this region. Reducing IHC use could result in fewer HIV infections but also a substantial increase in live births and maternal mortality in countries with high IHC use high birth rates and high maternal mortality: mainly southern and eastern Africa South-East Asia and Central and South America. For most countries the net impactof reducing IHC use on maternal and AIDS-related deaths is dependent on the magnitude of the assumed IHC-HIV interaction. CONCLUSIONS: If IHC use increases HIV acquisition risk reducing IHC could reduce new HIV infections; however this must be balanced against other important consequences including unintended pregnancy which impacts maternal and infant mortality. Unless the true effect size approaches a relative risk of 2.19 it is unlikely that reductions in IHC could result in public health benefit with the possible exception of those countries in southern Africa with the largest HIV epidemics.

Viver com o VIH pode diferir de forma importante segundo o modo de aquisição do VIH. Considerar esta diferença é essencial para evitar abordagens one-size-fits-all. O objetivo deste estudo consistiu em avaliar os perfis de qualidade de vida (QdV) segundo a categoria de transmissão do VIH e analisar os domínios que contribuem para a QdV geral. A amostra deste estudo transversal foi composta por 1112 doentes infetados com o VIH, recrutados nos serviços de doenças infeciosas de 10 hospitais de Portugal. Todos os participantes preencheram o questionário WHOQOL-HIV-Bref. Os resultados revelaram diferenças significativas nos domínios de independência, ambiente e espiritualidade, e na faceta geral de QdV. O grupo que reportou aquisição do VIH por via de drogas intravenosas (DIV) reportou pior QdV que o grupo de homens que têm sexo com homens (HSH) e o grupo que referiu transmissão heterossexual. Este último apresentou significativamente pior QdV no domínio ambiente e na faceta geral que o grupo HSH. Os domínios psicológico e independência contribuíram para a QdV geral de todos os grupos, porém, os domínios físico e ambiente só contribuíram para a QdV geral dos grupos de transmissão por DIV e heterossexual. Os resultados sugerem importantes diferenças segundo o modo de transmissão do VIH e reforçam a importância de intervenções de promoção da QdV adaptadas às características e necessidades destes diferentes subgrupos da população com VIH. Living with HIV may differ significantly in function of the acquisition mode of HIV. Considering this difference is crucial to avoid one-size-fits-all approaches. The aim of this study was to assess the profiles of quality of life (QoL) according to the mode of HIV transmission and to analyze the domains that contribute to the overall QoL. The sample of this cross-sectional study comprised 1112 HIV-infected patients, recruited at the departments of infectious diseases of 10 Portuguese hospitals. All participants completed the WHOQOL-HIV-Bref questionnaire. The results revealed significant differences in the independence, environment, and spirituality domains, and in the overall facet of QoL. The group that reported HIV acquisition through intravenous drug use (IDU) reported poorer QoL than group of men who have sex with men (MSM) and the group that reported heterosexual transmission. This last group also presented significantly worse QoL in the environment domain and in the overall facet than the MSM group. The psychological and independence domains contributed significantly to the overall QoL of all groups; however, the physical and environment domains were only significant contributors to the overall QoL of IDU and heterosexual transmission groups. The results suggest important differences in function of the category of HIV transmission and reinforce the importance interventions for promoting QoL tailored to the characteristics and needs of these different subgroups of the HIV population.

New HIV-1 infections are increasing in older American women largely through heterosexual transmission. Activated CD4+ T cells and CCR5 expression are linked to HIV-1 susceptibility, but whether these parameters are altered in the cervix of older women is unknown.Whole blood and in some instances endocervical brush samples were collected from healthy premenopausal (n = 22) and postmenopausal women (n = 24). Percentages of HLA-DR(DR)+CD38(38)+CD4+ T cells and HIV-1 chemokine coreceptor expression were determined by flow cytometry.Percentages of DR+38+CD4+ T cells were 6 times greater in cervix (median: 6.4%) than blood (median: 1.1%; P0.001) but did not differ within each compartment between premenopausal and postmenopausal women (P = 0.2). Postmenopausal women had greater percentages of CCR5+CD4+ and CCR5+DR+38+CD4+ T cells compared with premenopausal women in cervix (median: 70% vs. 42%, P = 0.005; and 80% vs. 57%; P = 0.05, respectively) and blood (medians: 22% vs. 13%, and 76% vs. 62%, respectively; P0.001). Postmenopausal women had more CCR5 molecules on cervical DR+38+CD4+ T cells (median: 3176) than premenopausal women (median: 1776; P = 0.02). Age and percent CCR5+CD4+ and CCR5+DR+38+CD4+ cells were linearly related in cervix (r(2) = 0.47, P0.001 and r(2) = 0.25, P = 0.01, respectively) and blood (r(2) = 0.20, P = 0.001 and r(2) = 0.31, P0.001; respectively), but confounding of age with menopause could not be excluded. Cervical CXCR4 expression did not differ substantially between premenopausal and postmenopausal women.Elevated cervical CCR5 expression in postmenopausal women may increase their risk for HIV-1 acquisition. Studies are needed to confirm whether elevated CCR5 expression confers increased HIV-1 susceptibility in postmenopausal women, and if it is related to hormonal or nonhormonal effects of aging.

Increased heterosexual transmission of HIV among young women and their difficulties with safer sex communication calls for women-focused research. This qualitative phenomenological study explored the meaning and lived experiences of women, as part of larger pre-dissertation pilot on health protective sexual communication among young women in Gaborone, Botswana. This was a study conducted in two Gaborone City Council MCH clinics. Twenty women participated in individual in-depth interviews conducted in Setswana, tape-recorded, transcribed verbatim, translated into English for line by line analysis to extract themes and subthemes. Six main themes and nine subthemes emerged from the data. The main themes were: the meaning of HPSC, responsibility for HPSC, HPSC content, facilitating factors, partner’s response. Batswana women communicate with their male sexual partners about safer sex but face some difficulties. Further quantitative research can further explore women’s experiences with safer sex communication.

A sex-structured staged progression model for heterosexual transmission dynamics of HIV/AIDS in a community to theoretically assess the effects of gender parameter accounting for population heterogeneity is formulated and analyzed. The basic model without this parameter is analyzed, and then extended to include gender heterogeneity in order to explore its role on the transmission dynamics of the disease. Mathematical properties including epidemic thresholds known as reproductive numbers are derived. The models are numerically analysed using some demographic and epidemiological parameters for Zimbabwe. These simulations suggest that the use of identical gender attributes simplifies computation at the expense of reality as it underestimates the size of the epidemic by 5%. This study demonstrates that the use of gender related parameter in the transmission dynamics of HIV gives a better estimate of the prevalence of the epidemic and should be given prominence.

Objective: To ascertain the role of HIV-1 gp120 env PNGs variations and sequence length polymorphism following transmission events as possible supporting forensic evidence to determine directionality of HIV transmission. Method: An observational study of HIV-1 infected family members, where median and range values of the amino acid lengths and PNGs for the genotyped C2V5 region were calculated. Wilcoxon rank-sum test was used to determine differences in these parameters between different family members. Results: For heterosexual transmission, two mothers had longer C3 sequences relative to that of their spouses; p=0.006 and=0.025 whilst the opposite was observed for one mother, p = 0.028. No clear trends were observed for PNGs. Index children had longer C2V5 amino acid sequences compared to their mothers p = 0.013, 0.040, 0.043 for families 205, 375, 567 respectively. Second siblings “V4 and V5 sequences were generally shorter relative to the maternal ones p = 0.039 and 0.028, respectively. Adults had longer V3 amino acid sequences compared to children; p = 0.018. Similar trends were also observed regarding PNGs within the entire C2V5 region, C3 and V4 sub-regions; p= 0.0025, 0.005 and 0.008, respectively. First siblings’ C2V5 and C3 sequence lengths were significantly longer relative to those of the second siblings; p = 0.005 and 0.007, respectively. Conclusion: Our results are suggestive that HIV-1 env C2V5 amino acid length polymorphism and PNGs tend to increase with age and HIV disease progression. Though sensitive and should be cautiously handled, it is tempting to propose the direc-tionality of the HIV transmission events with respect to C3 sequence length polymorphisms. Correlating HIV-1 env C2V5 amino acid length polymorphism and age of infection may be the first step towards a possible valuable piece of forensic evidence which may be useful in criminalisation of willful HIV infections. However, bigger studies are war-ranted to substantiate the authenticity of this potentially useful application.

Sexual transmission of HIV is the most common mode of infection in the global HIV epidemic. In the absence of an effective vaccine, there is an urgent need for additional strategies to prevent new HIV infections. An emerging body of evidence now indicates that Langerhans cells (LC) are initial cellular targets in the sexual transmission of HIV, and CD4- and CCR5-mediated infection of LC plays a crucial role in virus dissemination. I focus on the recent advances regarding the cellular events that may occur during heterosexual transmission of HIV.

The diagnosis of acute hepatitis C (HCV) infection is rare since the majority of cases are asymptomatic, which makes the infection usually detected in a chronic phase, most of the time using serological tests. The main route of HCV transmission is percutaneous, with sexual transmission occurring more often in men who have sex with men. The analytical alterations of acute hepatitis C are varied but usually present with ALT elevation higher than AST, very rarely with hepatic insufficiency. We report a case of a patient with a clinical and analytical picture compatible with toxic acute hepatitis, accompanied by hepatic insufficiency, with negative serology for hepatotropic viruses and with no history compatible with the use of substances with hepatic toxicity other than alcohol. During the diagnostic investigation it was concluded that the patient had acute HCV hepatitis and that the transmission route was heterosexual. Keywords: Hepatitis C, Acute infection, Heterosexual transmission

A sex-structured model for heterosexual transmission of HIV/AIDS for addressing the epidemic as a gender-based issue in African heterosexual settings is presented. The epidemic threshold and equilibria for the model are determined and stabilities are investigated. Comprehensive qualitative analysis of the model including positivity and boundedness of solutions, as well as persistence are carried out. The epidemic threshold for the model is computed and used to assess the effects of gender-inequality affecting women in heterosexual settings. The obtained gender-inequality-induced reproductive number [Formula: see text] is greater than the reproductive number in the absence of gender-inequality [Formula: see text] suggesting that gender-inequality affecting women in heterosexual settings enlarges the HIV/AIDS epidemic. Numerical simulations are carried out using demographic and epidemiological parameters for Zimbabwe and the obtained results confirm that gender-inequality increases HIV/AIDS prevalence in heterosexual settings. We conclude from the study that gender-inequality affecting women among heterosexuals should be properly addressed for the effective control of the HIV/AIDS epidemic.

Resumen Objetivo Describir las caracteristicas epidemiologicas y evolutivas durante 25 anos de una cohorte de pacientes infectados por el VIH en Madrid. Metodos Estudio de cohortes longitudinal prospectivo de todos los pacientes diagnosticados de infeccion por VIH vistos en el Hospital de Mostoles (1983–2008). Resultados De los 2.156 pacientes atendidos, el 73% fueron hombres. En el 68% la via de contagio fue el consumo de drogas. Se describe un maximo de nuevos diagnosticos en 1991 (188 pacientes) y un descenso posterior paulatino. Durante estos ultimos anos han aumentado los contagios por via sexual (mayor ascenso de la via heterosexual). El porcentaje de inmigrantes tambien ha aumentado (superior al 60% en los ultimos 3 anos); Africa subsahariana es la region de origen predominante en nuestra area. El 5% de los pacientes se diagnostica en la fase de infeccion aguda y el diagnostico de sida en un plazo inferior a un ano desde el diagnostico de infeccion por VIH oscila entre el 20–30% en todos estos anos. La tasa estimada de nuevos diagnosticos de infeccion por VIH en 2006 fue de 195 por millon de habitantes (269 por millon de habitantes en hombres y 121 por millon en mujeres). Conclusiones En estos 25 anos se han producido grandes cambios epidemiologicos de la infeccion por VIH en nuestra area. Realizar de forma sistematica serologias sin esperar datos de alarma seria una practica de impacto en el diagnostico precoz y en la mejora del pronostico de los pacientes.

Several strategies are being investigated for the prevention of heterosexual transmission of HIV. Of these, topical vaginal drug delivery systems, microbicides, are being actively pursued. HIV prevention by means of a topical microbicide has several drug delivery challenges. These challenges include the vaginal mucosal barriers and potential degradation of the drugs in the vaginal lumen due to pH and enzymes present. Also, new drugs being evaluated as microbicides have specific mechanisms of action, which in some cases require drug targeting to a specific site of action. Nanoparticles provide a delivery strategy for targeted or controlled delivery to the vagina which can be applied in the field of HIV prevention.This review summarizes nanoparticulate systems and their use in mucosal delivery to date. The sexual transmission of HIV along with the various targets to prevent transmission are discussed as well as the potential opportunities, challenges and advantages in using a nanoparticle-based approach for microbicidal drug delivery.This review provides a general understanding of vaginal drug delivery, its challenges, and nanoparticulate delivery systems. Additionally, insight will be gained as to the limited existing application of this technology to the field of HIV prevention.To date, few studies have been published that exploit nanoparticle-based microbicidal delivery to the vagina. The use of nanoparticles for vaginal drug delivery provides an approach to overcome the existing barriers to success.

Resume Introduction et methodologie Le retard au diagnostic de l’infection a VIH constitue un obstacle majeur a la prise en charge optimale de cette affection a l’ere de la tritherapie. Nous avons realise chez les patients infectes par le VIH nouvellement depistes a la clinique des maladies infectieuses de Fann : une etude descriptive des aspects epidemiocliniques, evolutifs et des antecedents pathologiques recents ; et une enquete socio-anthropologique pour comprendre et decrire la logique des processus decisionnels dans la quete therapeutique des patients. Resultats Cent patients ont ete inclus, avec une moyenne d’âge de 39,5 ± 11,1 ans et un sex-ratio de 1,08. La diarrhee chronique (64 %) et/ou la toux chronique (66 %) ont ete les principales circonstances de decouverte. Le retard diagnostic etait de 5 ± 4,27 mois en moyenne. Les principaux diagnostics retenus etaient la tuberculose (44 cas) et les enterocolites infectieuses (23 cas). La majorite des patients (97 %) etaient au stade de sida et 30 % sont decedes en cours d’hospitalisation. Dans les antecedents, 68 % des patients avaient consulte au moins trois fois, le plus souvent un « tradipraticien » la premiere fois et 43 % des patients avaient ete hospitalises au moins une fois. L’enquete qualitative a revele que la « representation » et le « sentiment de gravite » de la maladie sont les principaux elements qui ont motive la consultation du « tradipraticien » et du medecin, respectivement. Conclusion Une sensibilisation des praticiens et une education des populations sont necessaires pour un depistage plus precoce du VIH.

International audience; OBJECTIVES: A synergy between HIV and herpes simplex virus type 2 (HSV-2) infections has been reported in observational studies. The objectives of this study were to estimate the per-sex-act female-to-male transmission probabilities (FtoMTPs) of HIV and HSV-2, the effect of each infection on the FtoMTP of the other and the effect of male circumcision on these FtoMTPs. DESIGN: We used longitudinal data collected during the male circumcision trial conducted in Orange Farm (South Africa). METHODS: Results were obtained by specific mathematical modeling of HIV and HSV-2 statuses of the men as functions of their sexual behavior and male circumcision status. The model took into account an estimation of the HIV and HSV-2 statuses of each of their female partners. Confidence intervals (CI) were estimated using a bootstrap resampling method. RESULTS: The HIV and HSV-2 FtoMTPs, during an unprotected sexual contact for an uncircumcised male in the absence of the other virus in both partners, were 0.0047 (95% CI: 0.0014-0.017) and 0.0067 (95% CI: 0.0028-0.014), respectively. HSV-2 in either partner increased HIV FtoMTP with a relative risk (RR) of 3.0 (95% CI: 1.01-7.3). Conversely, HIV in either partner increased HSV-2 FtoMTP (RR= 2.5; 95% CI: 1.1- 6.3). Male circumcision significantly decreased these probabilities with RRs of 0.24 (95% CI: 0.11-0.44) and 0.59 (95% CI: 0.36-0.91), respectively. CONCLUSION: This study gave the first estimates of HSV-2 per-sex-act FtoMTPs in Africa. It demonstrated a synergy between HIV and HSV-2 infections and a protective effect of male circumcision on HSV-2 acquisition by males.

We use a simple mathematical model to estimate the probability and its time dependence that one or more HIV virions successfully infect target cells. For the transfer of a given number of virions to target cells we derive expressions for the probability P(inf), of infection. Thus, in the case of needlestick transfer we determine P(inf) and an approximate time window for post-exposure prophylaxis (PEP). For heterosexual transmission, where the transfer process is more complicated, a parameter gamma is employed which measures the strength of the infection process. For the smaller value of gamma, P(inf) is from 6 x 10(-5) to 0.93 or from 7.82 x 10(-6) to 0.29, where the lower figures are for the transfer of 100 virions and the upper figures are for the transfer of 4.4 million virions. We estimate the reductions in P(inf) which occur with a microbicide of a given efficacy. It is found that reductions may be approximately as stated when the number of virions transferred is less than about 10(5), but declines to zero for viral loads above that number. It is concluded that PEP should always be applied immediately after a needlestick incident. Further, manufacturers of microbicides should be encouraged to investigate and report their effectiveness at various transferred viral burdens.

A man who, only in 1979 and on a few occasions, had homosexual contacts, transmitted AIDS virus HTLV-III in 1980 and 1981 to two previously healthy women who did not belong to any AIDS risk group. One of them now has an early form of AIDS, while the other died of AIDS in its full form and her child, born in 1983, has fairly far progressed early symptoms of AIDS. Serum antibodies against HTLV-III were demonstrated in all four subjects.

We present a sex-structured model for heterosexual transmission of HIV/AIDS with explicit incubation period for modelling the effect of male circumcision as a preventive strategy for HIV/AIDS. The model is formulated using integro-differential equations, which are shown to be equivalent to delay differential equations with delay due to incubation period. The threshold and equilibria for the model are determined and stabilities are examined. We extend the model to incorporate the effects of condom use as another preventive strategy for controlling HIV/AIDS. Basic reproductive numbers for these models are computed and compared to assess the effectiveness of male circumcision and condom use in a community. The models are numerically analysed to assess the effects of the two preventive strategies on the transmission dynamics of HIV/AIDS. We conclude from the study that in the continuing absence of a preventive vaccine or cure for HIV/AIDS, male circumcision is a potential effective preventive strategy of HIV/AIDS to help communities slow the development of the HIV/AIDS epidemic and that it is even more effective if implemented jointly with condom use. The study provides insights into the possible community benefits that male circumcision and condom use as preventive strategies provide in slowing or curtailing the HIV/AIDS epidemic.

Background : The male-to-female ratio of infection for HIV/AIDS has rarely been reported since the 1990s. We previously calculated the country-specific male-to-female ratio of people living with HIV/AIDS, in 1999, 2001, and 2003. Methods : The data of people living with HIV/AIDS and the HIV adult rate were obtained from the table of country-specific HIV/AIDS estimates in the Report on the global HIV/AIDS epidemic, UNAIDS. Results : The male-to-female ratios of the countries in Africa region were reported to be below 1.00 in 1999, 2001, and 2003. The ratios of the countries in other regions were all over 1.00, except for the Bahamas in 2001, Haiti in 2001 and 2003, Jamaica in 2001, Guyana in 2001 and 2003, and Honduras in 2001 and 2003. The male-to-female ratios significantly decreased in Africa and Latin America region between 1999 and 2003 according to the Wilcoxon signed rank test (p< 0.0005). The countries with a high HIV adult rate tended to have lower male-to-female ratios and vice versa in 1999, 2001, and 2003 according to the Wilcoxon rank sum test (p< 0.005). In the 1980s homosexual or bisexual transmission and transmission through drug-injecting behavior were the major modes of spreading HIV in North America, Australia, and Europe where the male-to-female ratios were 10-15. In contrast, heterosexual transmission predominated in Africa, the Caribbean and Latin America where the male-to-female ratios were 1-5. Conclusions : These results indicate that the ratios have therefore been declining in most countries recently, and even within the four-year period between 1999 and 2003, a decreasing tendency was observed in Africa and Latin America.