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The human immunodeficiency virus (HIV) is a global public health problem, disproportionally affecting sub-Saharan African countries including Mozambique. In 2019, of 150,000 estimated HIV-infected children in Mozambique, only 95,080 were on antiretroviral treatment and 73% virally suppressed. The objective of this study was to determine the characteristics associated with viral suppression in children. A cross-sectional study was carried out using records of viral load samples from children aged 0 to 14 years old who underwent viral load tests in 2019 in Mozambique. Secondary analyses were conducted on data obtained from Data Intensive Systems and Applications (DISA) of children enrolled in health facilities who had viral load tests registered. Viral suppression was defined as the presence of less than 1,000 copies/ml of blood. Multivariate logistic regression analysis was used to evaluate the characteristics associated with viral suppression. Of the 33,559 viral load sample records analyzed, 53% (17,794/33,559) were female. The average patient age was 8 (sd ± 4) years old. About 44% (14,888/33,559) of the children had a suppressed viral load, with 55% (8,258/14,888) being female and 16% (2,319/14,888) belonging to the 1–4 years old age group. Characteristics associated with viral suppression were the age groups of 5–9 years [AOR = 1.73; 95% CI 1.34–2.23; p<0.001] and 10–14 years old [AOR = 1.92; 95% CI 1.50–2.48; p<0.001] versus < 1 year. Other factors such as living in Maputo City [AOR = 1.61; 95% CI 1.26–2.05; p <0.001] versus Tete Province were also associated with viral suppression. Factors such as being male [AOR = 0.83; 95% CI 0.80–0.87; p <0.001)], living in the provinces of Niassa [AOR = 0.75; 95% CI 0.56–0.99; p <0.003], Cabo Delgado [AOR = 0.77; 95% CI 0.60–0.99; p <0.045] and Zambezia [AOR = 0.72 (95% CI: 0.56–0.92, p<0.008)] versus Tete Province, or being on ART for 2–5 years [AOR = 0.72 (95% CI: 0.61–0.85, p<0.001)] versus 11–14 years were associated with not being virally suppressed. More than half of children did not achieve viral suppression. The odds of viral suppression were highest among children aged 5–14 years and among children living in Maputo city. Further research is needed to better understand the challenges in achieving viral suppression in children. [ABSTRACT FROM AUTHOR]

Understanding how HIV is acquired can inform interventions to prevent infection. We constructed a risk profile of 10-24 year olds participating in the 2012 Kenya AIDS Indicator Survey and classified them as perinatally infected if their biological mother was infected with HIV or had died, or if their father was infected with HIV or had died (for those lacking mother's data). The remaining were classified as sexually infected if they had sex, and the remaining as parenterally infected if they had a blood transfusion. Overall, 84 (1.6%) of the 5298 10-24 year olds tested HIV positive; 9 (11%) were aged 10-14 and 75 (89%) 15-24 years. Five (56%) 10-14 year olds met criteria for perinatal infection; 4 (44%) did not meet perinatal, sexual or parenteral transmission criteria and parental HIV status was not established. Of the 75 HIV-infected, 15 to 24 year olds, 5 (7%) met perinatal transmission, 63 (84%) sexual and 2 (3%) parenteral criteria; 5 (7%) were unclassified. Perinatal transmission likely accounted for 56% and sexual transmission for 84% of infections among 10-14 year olds and 15-24 year olds, respectively. Although our definitions may have introduced some uncertainty, and with the number of infected participants being small, our findings suggest that mixed modes of HIV transmission exist among adolescents and young people.

IntroductionAt the individual level, there is clear evidence that Human Immunodeficiency Virus (HIV) transmission can be substantially reduced by lowering viral load. However there are few data describing population-level HIV viremia especially in high-burden settings with substantial under-diagnosis of HIV infection. The 2nd Kenya AIDS Indicator Survey (KAIS 2012) provided a unique opportunity to evaluate the impact of antiretroviral therapy (ART) coverage on viremia and to examine the risks for failure to suppress viral replication. We report population-level HIV viral load suppression using data from KAIS 2012.MethodsBetween October 2012 to February 2013, KAIS 2012 surveyed household members, administered questionnaires and drew serum samples to test for HIV and, for those found to be infected with HIV, plasma viral load (PVL) was measured. Our principal outcome was unsuppressed HIV viremia, defined as a PVL ≥ 550 copies/mL. The exposure variables included current treatment with ART, prior history of an HIV diagnosis, and engagement in HIV care. All point estimates were adjusted to account for the KAIS 2012 cluster sampling design and survey non-response.ResultsOverall, 61·2% (95% CI: 56·4-66·1) of HIV-infected Kenyans aged 15-64 years had not achieved virological suppression. The base10 median (interquartile range [IQR]) and mean (95% CI) VL was 4,633 copies/mL (0-51,596) and 81,750 copies/mL (59,366-104,134), respectively. Among 266 persons taking ART, 26.1% (95% CI: 20.0-32.1) had detectable viremia. Non-ART use, younger age, and lack of awareness of HIV status were independently associated with significantly higher odds of detectable viral load. In multivariate analysis for the sub-sample of patients on ART, detectable viremia was independently associated with younger age and sub-optimal adherence to ART.DiscussionThis report adds to the limited data of nationally-representative surveys to report population- level virological suppression. We established heterogeneity across the ten administrative and HIV programmatic regions on levels of detectable viral load. Timely initiation of ART and retention in care are crucial for the elimination of transmission of HIV through sex, needle and syringe use or from mother to child. Further refinement of geospatial mapping of populations with highest risk of transmission is necessary.

IntroductionRespondent-driven sampling (RDS) offers a recruitment strategy for hard-to-reach populations. However, RDS faces logistical and theoretical challenges that threaten efficiency and validity in settings worldwide. We present innovative adaptations to conventional RDS to overcome barriers encountered in recruiting a large, representative sample of men who have sex with men (MSM) who travel internationally.MethodsNovel methodological adaptations for the "International Travel Research to Inform Prevention" or "I-TRIP" study were offering participants a choice between electronic and paper coupons referrals for recruitment and modifying the secondary incentives structure from small cash amounts to raffle entries for periodic large cash prize raffle drawings. Staged referral limit increases from 3 to 10 referrals and progressive addition of 70 seeds were also implemented.ResultsThere were 501 participants enrolled in up to 13 waves of growth. Among participants with a choice of referral methods, 81% selected electronic referrals. Of participants who were recruited electronically, 90% chose to remain with electronic referrals when it was their turn to recruit. The mean number of enrolled referrals was 0.91 for electronic referrals compared to 0.56 for paper coupons. Median referral lag time, i.e., the time interval between when recruiters were given their referrals and when a referred individual enrolled in the study, was 20 days (IQR 10-40) for electronic referrals, 20 days (IQR 8-58) for paper coupons, 20 days (IQR 10-41) for raffle entries and 33 days (IQR 16-148) for small cash incentives.ConclusionsThe recruitment of MSM who travel internationally required maximizing known flexible tools of RDS while at the same time necessitating innovations to increase recruitment efficiency. Electronic referrals emerged as a major advantage in recruiting this hard-to-reach population who are of high socio-economic status, geographically diffuse and highly mobile. These enhancements may improve the performance of RDS in target populations with similar characteristics.

BackgroundHIV-1 acute infection, recent infection and transmitted drug resistance screening was integrated into voluntary HIV counseling and testing (VCT) services to enhance the existing surveillance program in San Francisco. This study describes newly-diagnosed HIV cases and characterizes correlates associated with infection.Methodology/principal findingsA consecutive sample of persons presenting for HIV VCT at the municipal sexually transmitted infections (STI) clinic from 2004 to 2006 (N = 9,868) were evaluated by standard enzyme-linked immunoassays (EIA). HIV antibody-positive specimens were characterized as recent infections using a less-sensitive EIA. HIV-RNA pooled testing was performed on HIV antibody-negative specimens to identify acute infections. HIV antibody-positive and acute infection specimens were evaluated for drug resistance by sequence analysis. Multivariable logistic regression was performed to evaluate associations. The 380 newly-diagnosed HIV cases included 29 acute infections, 128 recent infections, and 47 drug-resistant cases, with no significant increases or decreases in prevalence over the three years studied. HIV-1 transmitted drug resistance prevalence was 11.0% in 2004, 13.4% in 2005 and 14.9% in 2006 (p = 0.36). Resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI) was the most common pattern detected, present in 28 cases of resistance (59.6%). Among MSM, recent infection was associated with amphetamine use (AOR = 2.67; p

Examined HIV risk behaviors among runaway youth by age at onset and sexual orientation. Adolescents age 12-21 years seeking health care at two clinics completed interviews and blood testing. Gay/lesbian/bisexual youth reported higher levels and earlier onset of sexual and drug-using behavior than heterosexual youth and were at exceptionally high risk for HIV infection. (SM)

Objective To provide guidance for male circumcision programmes in Kenya by estimating the population of uncircumcised men and investigating the association between circumcision and infection with the human immunodeficiency virus (HIV), with particular reference to uncircumcised, HIV-uninfected men. Methods Data on men aged 15 to 64 years were derived from the 2007 Kenya AIDS Indicator Survey, which involved interviews and blood collection to test for HIV and herpes simplex virus 2 (HSV-2). The prevalence of HIV infection and circumcision in Kenyan provinces was calculated and the demographic characteristics and sexual behaviour of circumcised and uncircumcised, HIV-infected and HIV-uninfected men were recorded. Findings The national prevalence of HIV infection in uncircumcised men was 13.2% (95% confidence interval, Cl: 10.8-15.7) compared with 3.9% (95% CI: 3.3-4.5) among circumcised men. Nyanza province had the largest estimated number of uncircumcised, HIV-uninfected men (i.e. 601 709), followed by Rift Valley, Nairobi and Western Province, respectively, and most belonged to the Luo ethnic tribe. Of these men, 77.8% did not know their HIV status and 33.2% were HSV-2-positive. In addition, 65.3% had had unprotected sex with a partner of discordant or unknown HIV status in the past 12 months and only 14.7% consistently used condoms with their most recent partner. However, only 21.8% of the uncircumcised, HIV-uninfected men aged 15 to 19 years were sexually active. Conclusion The Kenyan male circumcision strategy should focus on the provinces with the highest number of uncircumcised, HIV-uninfected men and target young men before or shortly after sexual debut. [TEXT NOT REPRODUCIBLE IN ASCII.] Programmes de circoncision masculine au Kenya: lecons tirees de l'enquete de 2007 sur les indicateurs du SIDA au Kenya Objectif Conseiller des programmes de circoncision masculine au Kenya en estimant le nombre d'hommes non circoncis et en recherchant l'association entre la circoncision et l'infection par le virus de l'immunodeficience humaine (VIH), avec une reference particuliere aux hommes non circoncis et non infectes par le VIH. Methodes Des donnees sur des hommes ages de 15 a 64 ans ont ete obtenues de l'enquete de 2007 sur les indicateurs du SIDA au Kenya, impliquant des entretiens et des prises de sang afin de rechercher la presence du VIH et du virus de l'herpes simplex 2 (VHS-2). La prevalence de l'infection par le VlH et la circoncision dans les provinces kenyanes a ete calculee, et les caracteristiques demographiques ainsi que le comportement sexuel des hommes circoncis et non circoncis, des hommes infectes et non infectes par le VIH ont ete enregistres. Resultats La prevalence nationale de l'infection par le VIH chez les hommes non circoncis s'elevait a 13,2% (intervalle de confiance de 95%, IC: 10,8-15,7) par rapport a un pourcentage de 3,9% (IC de 95%: 3,3-4,5) chez les hommes circoncis. La province de Nyanza presentait l'estimation du plus grand nombre d'homme non circoncis et d'hommes non infectes par le VIH (601 709), suivie de la vallee du Rift, de Nairobi et de la province occidentale, respectivement, dont la plus grande partie appartenait a la tribu ethnique des Luo. Chez ces hommes, 77,8% ne connaissaient pas leur seropositivite et 33,2% etaient positifs au VHS-2. De plus, 65.3% d'entre eux avaient eu des rapports sexuels non proteges avec une partenaire de statut HIV inconnu ou discordant au cours des 12 derniers mois, et seuls 14,7% d'entre eux utilisaient constamment des preservatifs avec leur derniere partenaire. Cependant, seuls 21,8% des hommes non circoncis et non infectes par le VIH ages de 15 a 19 ans etaient sexuellement actifs. Conclusion La strategie de circoncision des hommes kenyans doit s'orienter sur les provinces presentant le plus grand nombre d'hommes non circoncis et non infectes par le VIH, mais aussi cibler les jeunes hommes avant ou peut de temps apres leur premiere experience sexuelle. [TEXT NOT REPRODUCIBLE IN ASCII.] Los programas de circuncision masculina en Kenia: lecciones de la Encuesta de indicadores del SIDA en Kenia 2007 Objetivo Proporcionar orientacion para las programas de circuncision masculina en Kenia calculando la poblacion de hombres circuncidados e investigando la relacion entre la circuncision y la infeccion con el virus de la inmunodeficiencia humana (VIH), haciendo alusion especial a las hombres no circuncidados ni infectados par el VIH. Metodos Las datos acerca de las hombres con edades comprendidas entre 15 y 64 anos se obtuvieron de la Encuesta de indicadores del SIDA en Kenya del ano 2007, que incluyo entrevistas y la recogida de muestras de sangre para realizar las pruebas del VIH y del virus del herpes simple de tipo 2 (VHS-2). Se calculo la prevalencia de la infeccion par el VIH y la circuncision en las provincias de Kenia y se registraron las caracteristicas demograficas y el comportamiento sexual de las hombres circuncidados y no circuncidados, infectados y no infectados con el VIH. Resultados La prevalencia nacional de la infeccion par VIH en las hombres circuncidados fue del 13,2% (intervalo de confianza del 95%, IC: 10,8 -15,7) comparada con el 3,9% (IC 95%: 3,3 - 4,5) entre los hombres circuncidados. La provincia de Nyanza tuvo el mayor numero estimado de hombres no circuncidados y no infectados par el VIH (esto es, 601 709), seguida par la provincia Rift Valley, Nairobi y la provincia Occidental, respectivamente, y la mayoria de ellos pertenecia a la tribu etnica Luo. De esos hombres, el 77,8% no canada su estado serologico y el 33,2% estaba infectado con el VHS-2. Ademas, el 65,3% habia mantenido relaciones sexuales sin proteccion con una pareja serodiscordante o que no canada su estado serologico en las ultimos 12 meses y solo el 14,7% habia empleado preservativos de manera sistematica con su pareja mas reciente. No obstante, solo el 21,8% de las hombres circuncidados e infectados par el VIH con edades entre los 15 y las 19 anos era sexualmente activo. Conclusion La estrategia de circuncision masculina en Kenya deberia centrarse en las provincias con el mayor numero de hombres no circuncidados y no infectados por el VIH y dirigirse a las hombres jovenes antes o poco despues de la primera relacion sexual., Introduction Of an estimated 33.4 million people living with human immunodeficiency virus (HIV) infections worldwide, approximately 22.4 million live in sub-Saharan Africa and, of these, 1.5 million live in Kenya. [...]

Three practical methods are used to estimate human HIV incidence rates using existing data from persons seeking anonymous testing in San Francisco between the years 1996-2002. The 3 methods had complementary strengths and limitations, which might prevent proper interpretation of HIV incidence if any one method is analyzed alone.

Trends in HIV are compared among sexually transmitted disease patients in 4 Western urban centers. Relative levels of HIV differed little by demographic and behavioral risk group despite differences in the severity of each country's epidemic.

Research has been conducted on the HIV tests performed for the persons previously tested. Repeat testing rates have been estimated for each risk level strata and behavior risk hierarchy has been created, and the results indicate that the highest users of repeat testing are the persons practicing the highest risk behaviors.

Objectives. This study assessed the countervailing effects on HIV incidence of highly active anti-retroviral treatment (HAART) among San Francisco men who have sex with men (MSM). Methods. Behavioral risk was determined on the basis of responses to cross-sectional community interviews. HIV incidence was assessed through application of an enzyme-linked immunoassay testing strategy. Results. Use of HAART among MSM living with AIDS increased from 4% in 1995 to 54% in 1999. The percentage of MSM who reported both unprotected anal intercourse and multiple sexual partners increased from 24% in 1994 to 45% in 1999. The annual HIV incidence rate increased from 2.1% in 1996 to 4.2% in 1999 among MSM who sought anonymous HIV testing, and the rate was high (5.3%) but stable in a blinded survey of MSM seeking sexually transmitted disease services. Conclusions. Any decrease in per contact risk of HIV transmission due to HAART use appears to have been counterbalanced or overwhelmed by increases in the number of unsafe sexual episodes. (Am J Public Health. 2002;92:388-394)

HIV infection in San Francisco is spreading to men who have had a sex change, particularly African-Americans and those who engage in unprotected anal sex. Overall, 35% of male transsexuals in San Francisco are HIV-positive, but among African-American male transsexuals, 63% are HIV-positive.

The authors estimate HIV incidence, HIV transmission temporal trends and HIV seroconversion correlates among patients tested for HIV by a San Francisco county hospital. Results demonstrate that the seroconversion rate in this hospital is very high and that HIV transmission among injection drug users has not decreased over the years.

In a study of 688 drug addicts attending a drug treatment center, there were no new HIV infections among the 233 addicts who were seen more than once in a three-year period. In anonymous sequential testing, sequential samples are linked to each other by a code.

The authors have learned that individuals who have HIV testing done through home collection (HC) are demographically different from those who have testing done at anonymous publicly funded (PF) locations. Those who have HC testing tend to be lower risk and higher income, with a higher proportion being tested for the first time than in PF tests.

Lesbian and bisexual women may be at greater risk for HIV infection than commonly believed. By frequenting venues where lesbian women congregate, researchers were able to survey and take blood samples from 498 lesbian and bisexual women. Overall, 1.2% of the group were HIV positive. Four of the six HIV-positive women reported having injected drugs as well as having had unprotected sex with men who were gay, bisexual or injection drug users. The other two reported having intercourse with men of unknown HIV risk status. Four percent of women had injected drugs, and of those, 71% shared needles, and 31% shared needles with homosexual or bisexual men. Of 468 women who reported sexual contact with women, 92% reported unprotected oral sex with other women and one-quarter or more reported unprotected vaginal penetration with a fist or dildo. Fifteen percent reported sadomasochistic practices that broke the skin. Of 405 women who reported sex with men, 40% reported unprotected intercourse with men, 10% reported it with homosexual or bisexual men, and 6% reported sadomasochistic practices.