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Background: The objective of this paper is to analyze social inequalities in COVID-19 incidence, stratified by age, sex, geographical area, and income in Barcelona during the first two waves of the pandemic. Methods: We collected data on COVID-19 cases confirmed by laboratory tests during the first two waves of the pandemic (1 March to 15 July and 16 July to 30 November, 2020) in Barcelona. For each wave and sex, we calculated smooth cumulative incidence by census tract using a hierarchical Bayesian model. We analyzed income inequalities in the incidence of COVID-19, categorizing the census tracts into quintiles based on the income indicator. Results: During the two waves, women showed higher COVID-19 cumulative incidence under 64 years, while the trend was reversed after that threshold. The incidence of the disease was higher in some poor neighborhoods. The risk ratio (RR) increased in the poorest groups compared to the richest ones, mainly in the second wave, with RR being 1.67 (95% Credible Interval-CI-: 1.41&ndash, 1.96) in the fifth quintile income group for men and 1.71 (95% CI: 1.44&ndash, 1.99) for women. Conclusion: Our results indicate the existence of inequalities in the incidence of COVID-19 in an urban area of Southern Europe.

This study describes the prevalence of anabolic-androgenic steroid (AAS) injection, their main correlates, and the prevalence of specific AAS injection risk behaviours among men who have sex with men (MSM), an area insufficiently addressed in scientific research. Participants were HIV-negative MSM attending four HIV/STI diagnosis services: two clinics and two community programmes in Madrid and Barcelona. Participants answered an online self-administered questionnaire. Crude and adjusted lifetime prevalence and prevalence ratios (PRs) were calculated by different factors and using Poisson regression models with robust variance. Of the 3510 participants, 6.1% (95% CI: 5.3–6.9) had injected AAS before and 3.5% (95% CI: 2.9–4.2) had done so in the last 12 months. In the multivariate analysis, AAS injection was independently associated with being over 40 years old (aPR = 3.6, 95% CI: 2.0–6.5) and being born in Latin America (aPR = 2.5, 95% CI:1.9–3.4), and was less strongly associated (aPRs of around two) with having been recruited into STI clinics, having ever been paid for sex before, injected drugs, used drugs for sex, having been diagnosed with an STI before, and having been diagnosed with HIV at the recruitment consultation. Only three participants, 1.4%, of those who had injected AAS before had shared AAS or equipment for preparation or injecting before. Conclusions: In contrast to drugs, AAS injecting behaviours do not play a relevant, direct role in the transmission of blood-borne infections among MSM. However, AAS injectors have a higher prevalence of sexual risk behaviours. These findings should be confirmed using new studies that employ other sampling procedures.

This study explored the role of circuit parties on the incidence of gonorrhea among men who have sex with men (MSM) in Barcelona (Spain). Specifically, it aimed to detect cyclic peaks in the number of reported diagnoses of gonorrhea after gay circuit parties. We analyzed monthly cases of gonorrhea reported from January 2007 through December 2016 after the main annual gay circuit parties in Barcelona. We used the integer autoregressive model for time series with discrete values. The performance of the model was tested in heterosexual men and women, in whom the circuit parties could be expected to have no impact. A sensitivity analysis was conducted, changing post-event diagnosis windows to 1 week later/1 week before. In the study period, a total of 4182 of gonorrhea cases were detected, of which 74.8% (n = 2181) occurred in men who identified themselves as MSM. The average annual increase in gonorrhea cases reported among MSM was 32.57%. In an independent analysis of each gay circuit party, cases increased significantly in two of them. The results were also similar for same-sex practices among men only. On controlling for the increasing trend over the study period and the seasonal effect, an average of 1.16 gonorrhea cases in MSM (95% CI: 0.68, 1.64) were attributable to the celebration of one of the gay circuit parties considered. During the expected outbreak, an average of 13 gonorrhea cases were detected and between 5 and 13% were attributable to one of the circuit parties. In view of these findings, participants should consider seeking advice from their healthcare provider and practice safer sex using condoms to prevent sexually transmitted infections. Local public health services should be reinforced to ensure care for participants during and after gay circuit parties. More research is needed to design and implement preventive programs.

Objectives To analyse social inequalities in the association between ambient temperature and mortality by sex, age and educational level, in the city of Barcelona for the period 1992–2015. Methods Mortality data are represented by daily counts for natural mortality. As a measure of socioeconomic position, we used the educational level of the deceased. We also considered age group and sex. We considered, as a measure of exposure, the daily maximum temperatures. Time-series Poisson regression with distributed lag non-linear models was fitted for modelling the relationship between temperature and mortality. Results Women had higher risk of mortality by hot temperatures than men. Temperature–mortality association (heat and cold) was evident for the elderly, except for heat-related mortality in women which was present in all age groups. Men with primary education or more were more vulnerable to moderate or extreme temperatures than those without studies. Finally, women were vulnerable to heat-related mortality in all educational levels while women without studies were more vulnerable to cold temperatures. Conclusions Social and economic individual characteristics play an important role in vulnerability to high and low temperatures. It is important that decision-making groups consider identified vulnerable subgroups when redacting and implementing climate change resilience and adaptation plans., This article was partially funded by CIBER Epidemiología y Salud Pública (CIBERESP). Dr. Gasparrini was supported from a grant from Medical Research Council UK (Grant ID: MR/M022625/1). Moreover, we want to thank “Servei Meteorològic de Catalunya” (METEOCAT) for providing temperature data.

Para conocer la salud de la población es necesario realizar un análisis conjunto y continuado de su estado de salud y de sus determinantes. El objetivo de esta nota de campo es describir el desarrollo y el funcionamiento de la herramienta Infobarris, que permite visualizar una amplia batería de indicadores y determinantes de la salud de la población de la ciudad de Barcelona según el barrio de residencia. Para el desarrollo de Infobarris se ha usado una metodología ágil que permite el desarrollo de un proyecto de forma iterativa e incremental en etapas: selección de indicadores, diseño del prototipo, desarrollo de la herramienta de visualización, carga de datos, revisión y mejora de la herramienta. Infobarris permite la visualización interactiva de 64 indicadores de salud y de sus determinantes, mediante gráficos, mapas y tablas, lo que facilita la vigilancia de la salud y de sus determinantes en los barrios de la ciudad de Barcelona. In order to know about the health of the population, it is necessary to perform a systematic and continuous analysis of their health status and social and economic health determinants. The objective of this paper is to describe the development and implementation of the Infobarris tool, which allows to visualize a wide battery of indicators and social determinants of health by neighbourhoods in the city of Barcelona (Spain). For the development of the Infobarris tool, we used an agile methodology that allows the development of a project in iterative and incremental stages, which are the following: selection of indicators, design of the prototype, development of the tool, data loading, and tool review and improvements. Infobarris displays 64 indicators of health and its determinants through graphics, maps and tables, in a friendly, interactive and attractive way, which facilitates health surveillance in the neighbourhoods of Barcelona.

Resumen Esta etnografía se realizó en Barcelona, ciudad que ofrece diferentes recursos de ocio homosexual, como las saunas gay. El objetivo fue analizar desde los estudios sobre género y masculinidades, cómo se articula la sexualidad, la percepción sobre la infección por VIH y otras infecciones de transmisión sexual (ITS), y las medidas preventivas en trabajadores sexuales masculinos (TSM) usuarios de saunas gay. Se realizaron 10 entrevistas en profundidad y observación entre 2012 y 2016. Las prácticas de sexo seguro son más frecuentes con clientes, mientras que las de riesgo se realizan más con parejas no comerciales. La orientación sexual juega un rol relevante, los homosexuales asumen más prácticas de riesgo en el trabajo sexual que los heterosexuales. Consumo de drogas o la escasez de redes de apoyo se relacionaron con mayor vulnerabilidad social y conductas de riesgo. Contraer el VIH aún genera miedo, mientras que tener otras ITS se percibe como parte de la vida sexual de un hombre. El TSM afianza una masculinidad con múltiples parejas sexuales, breadwinner y por otra parte, cuestiona un modelo heteronormativo. Las intervenciones para la prevención del VIH e ITS en este colectivo, deberían considerar los determinantes sociales como las precarias alternativas laborales y el ofrecer mayor soporte social. Abstract This ethnography was conducted in Barcelona, a city that provides different gay leisure resources, such as gay saunas. We aimed to analyze from studies on gender and masculinities, how sexuality, perception of HIV infection and other sexually transmitted infections (STIs), and preventive measures are articulated in gay sauna male sex workers (MSW). Ten in-depth interviews and observation were conducted between 2012 and 2016. Safe sex practices are more frequent with clients, while risk practices are carried out more with non-commercial partners. Sexual orientation plays an important role. Homosexuals assume riskier practices in sex work than heterosexuals. Drug use or lack of support networks were associated with higher social vulnerability and risk behaviors. Contracting HIV still creates fear, while having other STIs is perceived as part of a man’s sexual life. The MSW affirms masculinity with concurrent sexual partners, breadwinner, and on the other hand, questions a heteronormative model. Interventions for the prevention of HIV and STIs in this group should consider social determinants such as inferior work alternatives and the provision of more significant social support.

Background Advances in the development of information and communication technologies have facilitated social and sexual interrelationships, thanks to the websites and apps created to this end. However, these resources can also encourage sexual contacts without appropriate preventive measures in relation to HIV and other sexually transmitted infections (STIs). How can users be helped to benefit from the advantages of these apps while keeping in mind those preventive measures? Objective This study aimed to prevent STIs by helping users to remember preventive measures in the risky situations. Methods We have used the design and creation methodology and have developed a software system. This system has two parts: an Android operating system app with emphasis on ubiquitous computing and gamification as well as a server with a webpage. First, a functional test with 5 men who have sex with men (MSM) allowed us to test the app with end users. In addition, a feasibility test with 4 MSM for a month allowed us to try the UBESAFE system with all its functionalities. Results The main output is a system called UBESAFE that is addressed to MSM. The system has two main parts: (1) an app that sends preventive contextualized messages to users when they use a contact app or when they are near a point where sexual contacts are likely and (2) a server part that was managed by the public health agency of Barcelona (ASPB), which preserves the quality and pertinence of messages and places and offers instant help to users. To increase users’ adherence, UBESAFE uses a gamified system to engage users in the creation of preventive messages. Users increased the initial pool of messages by more than 100% (34/30) and created more than 56% (9/16) of places (named hot zones). Conclusions The system helped MSM who used it to become conscious about HIV and other STIs. The system also helped the ASPB to stay in contact with MSM and to detect behaviors that could benefit from preventive measures. All functions were performed in a nonintrusive manner because users used the app privately. Furthermore, the system has shown how important it is to make users a part of the creation process as well as to develop apps that work by themselves and thus become useful to the users.

This study aimed to describe the methodological characteristics of publications on HIV and masculinity, to identify possible information gaps and determine the main thematic areas. A systematic review was conducted of gender, masculinity, HIV infection and other sexually-transmitted infections in original articles published between 1992 and 2015. Original studies published from Pubmed and Scopus were included. A total of 303 articles were identified, of which 187 were selected. Most of the studies were qualitative and the most widely used technique was the interview. Twenty-nine-point five percent of studies were performed in South Africa, 20.8% in the USA, and 3.2% in Europe. Fifteen percent of the studies were performed in heterosexuals, 12.8% in men who have sex with men, and 60% did not specify the sexual orientation of the population. Eight thematic areas were defined, the most frequent being sexuality and risk behaviours, defined by men's need to demonstrate they were sexually active and a breadwinner. Most studies on HIV and masculinity show a gender bias by not specifying the sexual identity of the population. Studies should consider diversity in sexual and cultural identity in different contexts, including in Europe, to carry out more effective HIV interventions from a masculinity perspective.

ObjectiveUndiagnosed HIV continues to be a hindrance to efforts aimed at reducing incidence of HIV. The objective of this study was to provide an estimate of the HIV undiagnosed population in Catalonia and compare the HIV care cascade with this step included between high-risk populations.MethodsTo estimate HIV incidence, time between infection and diagnosis and the undiagnosed population stratified by CD4 count, we used the ECDC HIV Modelling Tool V.1.2.2. This model uses data on new HIV and AIDS diagnoses from the Catalan HIV/AIDS surveillance system from 2001 to 2013. Data used to estimate the proportion of people enrolled, on ART and virally suppressed in the HIV care cascade were derived from the PISCIS cohort.ResultsThe total number of people living with HIV (PLHIV) in Catalonia in 2013 was 34 729 (32 740 to 36 827), with 12.3% (11.8 to 18.1) of whom were undiagnosed. By 2013, there were 8458 (8101 to 9079) Spanish-born men who have sex with men (MSM) and 2538 (2334 to 2918) migrant MSM living with HIV in Catalonia. A greater proportion of migrant MSM than local MSM was undiagnosed (32% vs 22%). In the subsequent steps of the HIV care cascade, migrants MSM experience greater losses than the Spanish-born MSM: in retention in care (74% vs 55%), in the proportion on combination antiretroviral treatment (70% vs 50%) and virally suppressed (65% vs 46%).ConclusionsBy the end of 2013, there were an estimated 34 729 PLHIV in Catalonia, of whom 4271 were still undiagnosed. This study shows that the Catalan epidemic of HIV has continued to expand with the key group sustaining HIV transmission being MSM living with undiagnosed HIV.

ResumenObjetivoConocer las explicaciones sobre prácticas sexuales de riesgo, la percepción del virus de la inmunodeficiencia humana (VIH) y propuestas de intervención para prevenir infecciones por VIH en un grupo de hombres que tienen sexo con hombres.MétodosEstudio cualitativo con una muestra de 13 hombres que tenían sexo con hombres, participantes de una cohorte de VIH seronegativos contactados en saunas gay de Barcelona. Se realizaron entrevistas en profundidad semiestructuradas y un posterior análisis de contenido temático.ResultadosLas prácticas sexuales de riesgo se atribuyeron a una masculinidad asociada a una alta necesidad sexual, a determinados lugares de intercambio sexual (como saunas, fiestas privadas y clubs), al consumo de drogas y al deseo de experimentar con el riesgo y la propia sexualidad. La infección por VIH se percibía como una enfermedad normalizada, aunque contraerla se asociaba a vergüenza y culpa. Entre las propuestas de intervención se encontraban: concienciar sobre lo que significa vivir con el VIH, generar más alarma social, incorporar las nuevas tecnologías en la prevención y aumentar las acciones en lugares de encuentro gay.ConclusionesEl concepto de la masculinidad desempeña un papel fundamental en las prácticas sexuales entre los hombres que tienen sexo con hombres. Se sugiere innovar en los programas preventivos e incorporar la percepción de riesgo y la infección por el VIH desde una perspectiva de género.AbstractObjectiveTo explore views about risky sexual behaviors and perceptions of HIV, and to propose interventions for preventing HIV infections in a group of men who have sex with men.MethodsWe performed a qualitative study in a sample of 13 men who have sex with men, who were participating in an HIV-seronegative cohort, and who we contacted via saunas for the gay community in Barcelona (Spain). We performed in-depth semi-structured interviews, followed by content analysis.ResultsRisky sexual behaviors were associated with masculinity related to strong sexual needs, certain sexual exchange venues (such as saunas, private parties and clubs), drug use, and a desire to experiment with risk and one's own sexuality. HIV infection was perceived as a normalized disease, although becoming infected was still associated with shame and guilt. Proposed interventions included raising awareness of what it is like to live with HIV, generating greater social alarm, incorporating new technologies in prevention, and intensifying activity at gay venues.ConclusionsThe concept of masculinity plays a fundamental role in sexual practices among men who have sex with men. We suggest renewed innovation in preventive programs and incorporating the perception of risk and HIV infection from a gender perspective.

Resumen Introduccion El objetivo de este estudio fue describir la evolucion y las caracteristicas epidemiologicas de los pacientes con shigelosis durante 25 anos en una gran ciudad. Metodos La shigelosis es una enfermedad de declaracion obligatoria en Espana desde 1988. Se analizan los casos de residentes en Barcelona incluidos en el registro entre 1988-2012. Se presenta un analisis descriptivo segun sexo, edad, via de transmision y especies de Shigella . Se realizo un analisis de tendencias y de series temporales. Resultados De los 559 casos analizados, el 60,15% correspondian a hombres. Se observo un incremento sostenido de la tendencia en hombres desde 2008 (p S. flexneri (desde 2009) como para S. sonnei (desde 2003). En 2012 se observo que, en los hombres con S. flexneri , el 63% tenian sexo con hombres. Conclusiones Se detecto un incremento de la tendencia en los casos en hombres que no tenian antecedentes de toxiinfeccion alimentaria ni de viajes a zonas endemicas. Este incremento apunta a un cambio en el patron de la shigelosis, pasando a ser predominantemente masculina, y cuyo mecanismo principal serian las relaciones sexuales.

This ethnography was conducted in Barcelona, a city that provides different gay leisure resources, such as gay saunas. We aimed to analyze from studies on gender and masculinities, how sexuality, perception of HIV infection and other sexually transmitted infections (STIs), and preventive measures are articulated in gay sauna male sex workers (MSW). Ten in-depth interviews and observation were conducted between 2012 and 2016. Safe sex practices are more frequent with clients, while risk practices are carried out more with non-commercial partners. Sexual orientation plays an important role. Homosexuals assume riskier practices in sex work than heterosexuals. Drug use or lack of support networks were associated with higher social vulnerability and risk behaviors. Contracting HIV still creates fear, while having other STIs is perceived as part of a man's sexual life. The MSW affirms masculinity with concurrent sexual partners, breadwinner, and on the other hand, questions a heteronormative model. Interventions for the prevention of HIV and STIs in this group should consider social determinants such as inferior work alternatives and the provision of more significant social support.Esta etnografía se realizó en Barcelona, ciudad que ofrece diferentes recursos de ocio homosexual, como las saunas gay. El objetivo fue analizar desde los estudios sobre género y masculinidades, cómo se articula la sexualidad, la percepción sobre la infección por VIH y otras infecciones de transmisión sexual (ITS), y las medidas preventivas en trabajadores sexuales masculinos (TSM) usuarios de saunas gay. Se realizaron 10 entrevistas en profundidad y observación entre 2012 y 2016. Las prácticas de sexo seguro son más frecuentes con clientes, mientras que las de riesgo se realizan más con parejas no comerciales. La orientación sexual juega un rol relevante, los homosexuales asumen más prácticas de riesgo en el trabajo sexual que los heterosexuales. Consumo de drogas o la escasez de redes de apoyo se relacionaron con mayor vulnerabilidad social y conductas de riesgo. Contraer el VIH aún genera miedo, mientras que tener otras ITS se percibe como parte de la vida sexual de un hombre. El TSM afianza una masculinidad con múltiples parejas sexuales, breadwinner y por otra parte, cuestiona un modelo heteronormativo. Las intervenciones para la prevención del VIH e ITS en este colectivo, deberían considerar los determinantes sociales como las precarias alternativas laborales y el ofrecer mayor soporte social.

The role of pre- and post-test counselling in new HIV testing strategies to reduce delayed diagnosis has been debated. Data on time devoted to counselling are scarce. One approach to this problem is to explore patients' views on the time devoted to counselling by venue of their last HIV test.We analysed data from 1568 people with a previous HIV test who attended a mobile HIV testing program in Madrid between May and December 2008.The majority (71%) were men (48% had had sex with other men), 51% were30 years, 40% were foreigners, 56% had a university degree, and 40% had the most recent HIV test within the last year. As regards pre-test counselling, 30% stated they were told only that they would receive the test; 26.3% reported10 min; 20.4% about 10 min; and 24.2%, 15 min or more. For post-test counselling: 40.2% stated they were told only that the test was negative; 24.9% reported 2-6 min; 16.4% about 10 min; and 18.5%, 15 min or more. The percentage of participants who reported no counselling time was higher among those tested in general health services: primary care, hospital settings and private laboratories (over 40% in pre-test, over 50% in post-test counselling). Women received less counselling time than men in almost all settings.Policies to expand HIV testing in general health services should take this current medical behaviour into account. Any mention of the need for counselling can be a barrier to expansion, because HIV is becoming less of a priority in developed countries. Oral consent should be the only requirement.

An outbreak of acute gastroenteritis due to staphylococcal food poisoning occurred in July 2011 at a summer school held by a sports club in Barcelona (Catalonia, Spain). Of the 42 cases involved, 20 were hospitalised. To identify the outbreak source, a retrospective cohort study was performed on the group at risk, which included 73 summer school students and 18 staff members. Food exposure at the sports club restaurant was identified as the most relevant common link among the study cohort. Although the preliminary microbiological investigation suggested that enterotoxigenic Staphylococcus aureus (S. aureus) infections were the possible source, enterotoxin types A and D were identified, quantified and confirmed in the different biological samples collected. A descriptive, in-depth epidemiological and clinical investigation subsequently pointed to food intoxication rather than bacterial infection as being the cause of the outbreak. Molecular investigation of the strain isolates, using pulsed-field gel electrophoresis typing, revealed that all eight strains of S. aureus had the same profile and spa type (t008). Samples of the incriminated foods, i.e., boiled macaroni, tuna and fresh tomatoes, specimens of vomit of those affected, and bilateral fingernail scrapings and nasal swabs of food handlers were shown to be the common source of transmission of the contamination. Following the outbreak, appropriate hygiene and control measures could be implemented to prevent any recurrence. (C) 2013 Published by Elsevier Ltd.

In order to know about the health of the population, it is necessary to perform a systematic and continuous analysis of their health status and social and economic health determinants. The objective of this paper is to describe the development and implementation of the Infobarris tool, which allows to visualize a wide battery of indicators and social determinants of health by neighbourhoods in the city of Barcelona (Spain). For the development of the Infobarris tool, we used an agile methodology that allows the development of a project in iterative and incremental stages, which are the following: selection of indicators, design of the prototype, development of the tool, data loading, and tool review and improvements. Infobarris displays 64 indicators of health and its determinants through graphics, maps and tables, in a friendly, interactive and attractive way, which facilitates health surveillance in the neighbourhoods of Barcelona.

We analyze the impact of HIV rapid testing (RT) programs in non-clinical settings (NCS) by evaluating their contribution to new diagnoses reported to the Spanish HIV Surveillance System (SINIVIH) from 2007 to 2012. We estimate the proportion of new diagnoses reported to SINIVIH attributable to them and the maximum annual contribution (MAC). Of 95.575 rapid tests conducted, 2061 were reactive; 1582 in men who have sex with men (MSM). The contribution of RT in NCS increased from 3.4% in 2007 to 11.0% in 2012 (8.1%-16.6% in MSM). RT programs contributed 25.3% of the new diagnoses reported in Catalonia (MAC:30.6%), 15% in the Canary Islands (MAC:16.2%) and 13.7% in the Basque Country (MAC:21.0%). Among MSM, contribution was of 45.2% in Catalonia (MAC:60.7%), 20.2% in the Canary Islands (MAC:21.3%) and 16.6% in the Basque country (MAC:20.9%). Especially among MSM, RT in NCS contributed a large proportion of the new HIV cases diagnosed in regions with a very high HIV incidence.

BACKGROUND We examined differences by geographical origin (GO) in time from HIV seroconversion (SC) to AIDS, death, and initiation of antiretroviral therapy (cART). METHODS Data from HIV seroconverter cohorts in Europe, Australia and Canada (CASCADE) was used; GO was classified as: western countries (WE), North Africa and Middle East (NAME), sub-Saharan Africa (SSA), Latin America (LA), and Asia (ASIA). Differences by GO were assessed using Cox models. Administrative censoring date was 30 June 2008. RESULTS Of 16 941 seroconverters, 15 548 were from WE, 158 NAME, 762 SSA, 349 LA, and 124 ASIA. We found no differences by GO in risks of AIDS (P = .99) and death (P = .12), although seroconverters from NAME (adjusted hazard ratio [aHR]: 0.57; 95% CI: 0.33-.94) and SSA (aHR: 0.74; 95% CI: 0.50-1.10) appeared to have lower mortality than WE. Chances of initiating cART differed by GO (P

Background: Immigration can affect the evolution of TB as an AIDS-defining disease (AIDS TB). Methods: The Barcelona AIDS register for 1994-2005 was analyzed, and the global characteristics of AIDS TB and AIDS non-TB cases were compared. The Mantel-Haenszel test was used in the trend analysis, and logistic regression was used in the multivariate analysis. Results: Of the 3600 cases studied, 1130 had both AIDS and TB. A declining trend in AIDS TB rates was observed in both sexes among both immigrants and native residents. The percentage of AIDS TB was significantly higher among immigrants (P = 0.02). The number of cases among immigrants remained constant over the period of study, but decreased among native residents. The sociodemographic and immunological characteristics associated with TB were male sex, age younger than 36 years, inner city residence, a record of incarceration, greater than 200 CD4+ T-cells/mm(3), injecting drug use, heterosexual sex, and immigration from Latin America, the Caribbean, or sub-Saharan Africa. Conclusions: The incidence of TB as an AIDS-defining disease decreased in Barcelona during a recent 10-year period in both native and immigrant populations. However, immigrants remain a high-risk group for AIDS TB and should be targeted for surveillance and control of both diseases.

Objective: This clinical trial, carried out among injection drug users and the HIV-infected with tuberculin skin test ≥ 5 mm, aimed to evaluate the compliance and tolerability of two preventive strategies against tuberculosis (TB). Methods: Study protocol prospectively compares adherence to nine months of daily therapy with isoniazid (9H) versus two months of daily therapy with rifampin plus pyrazinamide (2RZ) administered randomly. All patients were concurrently admitted to a methadone maintenance programme. To assess toxicity, liver function was monitored monthly. Results: From 305 assessable patients, those in 2RZ arm showed better adherence (84% vs. 59%, p < 0.0001). Results on liver toxicity did not show significant differences between 9H and 2RZ (4.5% vs. 6.9%; odds ratio = 1.58, 95% confidence interval = 0.42—7.24). Conclusion: 2RZ should be considered an option to prevent TB in selected groups of patients infected with HIV, such as injection drug users on methadone treatment.

Objective: To analyze the factors associated with survival and to describe the specific causes of death in a large cohort of individuals with Acquired Immune Deficiency Syndrome (AIDS) in the Highly Active Antiretroviral Therapy (HAART) era. Methods: Subjects over 13 years old recorded in the AIDS registry of Barcelona and diagnosed between 1997-2005 were included. Survival analysis was performed. Causes of death were classified as being HIV-related or non- HIV-related. Results: A total of 1,759 cases were analyzed, 640 (36.3%) of them died during the follow-up. The cumulative probability of survival at five years was of 64% (95% C.I. 62%-67%). The cause of death was non-HIV-related in 28.9% of the cases, among which the most frequent were cancers (20.8%) and liver diseases (18.8%). Conclusion: An increase in the proportion of non-HIV-related deaths has been observed compared to that in the pre-HAART era. The case management of HIV-infected people must be re-directed to influence the risk factors associated with these increasing causes of death.

Objetivo Describir la investigacion de un brote comunitario de legionelosis originado en unas torres de refrigeracion de un hospital. Pacientes y metodos Pacientes diagnosticados de neumonia por Legionella pneumophila serogrupo 1 (L. pneumophila) asociados con el barrio de Vallcarca (Barcelona) en agosto de 2004. La exposicion se determine mediante una encuesta estandarizada. Se llevo a cabo una investigacion ambiental para identificar el foco emisor. Se realizo un analisis descriptivo con calculo de tasas de incidencia, asi como el estudio molecular para documentar la identidad genetica entre las cepas humanas y ambientales aisladas. Resultados Se detectaron 33 casos de neumonia por L. pneumophila. La edad media fue de 68 anos y el 70% de los afectados eran varones. La tasa de incidencia en los mayores de 65 anos residentes a una distancia menor o igual a 200 m del foco emisor fue de 888,9 casos/100.000 habitantes. La tasa de letalidad fue del 6%. Se identificaron cuatro torres de refrigeracion estacionales no censadas ubicadas en un centro sanitario. En todas se aislo L. pneumophila y al menos una colonia de cada instalacion compartia perfil genetico con las cepas aisladas en los pacientes. Conclusiones Se muestra la asociacion de un brote comunitario de neumonia por Legionella y las torres de refrigeracion de un centro sanitario que no estaban censadas. Se remarca la necesidad de notificar cualquier instalacion de riesgo y de realizar un seguimiento para asegurar que cumplen con la legislacion.

Background: Advances in the development of information and communication technologies have facilitated social interrelationships, but also sexual contacts without appropriate preventive measures. In this paper, we will focus on situations in which people use applications to meet sexual partners nearby, which could increase their chance of exposure to sexually transmitted infections (STI). How can we encourage users to adopt preventive measures without violating their privacy or infringing on the character of the application? Methods: To achieve the goal of preventing STI, we have used the design and creation methodology and have developed a prototype software package. This prototype follows the RESTful services principles and has two parts: an Android OS application with emphasis on ubiquitous computing and designed according to General Responsibility Assignment Software Patterns (GRASP), and a server with a web page. To choose the preventive messages, we performed a test in 17 men who have sex with men (MSM). Results: Our software sends preventive notifications to users when it detects situations such as the activation of particular applications on their smartphones, or their proximity to areas with a high probability of intercourse (hot zones). The underlying idea is the same as that for warning messages on cigarette packets, since users read the message just when they are going to smoke. The messages used have been selected from a list that has been rated by the users themselves. The most popular message is "Enjoy sex and enjoy life. Do not expose yourself to HIV". The user is unaware of the software, which runs in the background. Conclusions: Ubiquitous computing may be useful for alerting users with preventive and educational messages. The proposed application is non-intrusive because: 1) the users themselves decide to install it and, therefore, users' privacy rights are preserved; 2) it sends a message that helps users think about taking appropriate preventive measures; and 3) it works in the background without interfering with users unless a trigger situation is detected. Thus, this type of application could become an important tool in the complex task of STI prevention.

Background An estimated 30% of HIV cases in the European Union are not aware of their serological status. This study aimed to assess the effectiveness of a pilot HIV partner notification program. Methods HIV cases diagnosed between January 2012 and June 2013 at two healthcare settings in Barcelona were invited to participate in a prospective survey. We identified process and outcome measures to evaluate this partner notification program, including the number of partners identified per interviewed index case, the proportion of partners tested for HIV as a result of the partner notification, and the proportion of new HIV diagnoses among their sex or needle-sharing partners. Results Of the 125 index cases contacted, 108 (86.4%) agreed to provide information about partners. A total of 199 sexual partners were identified (1.8 partners per interviewed index case). HIV outcome was already known for 58 partners (70.7% were known to be HIV-positive), 141 partners were tested as result of partner notification, and 26 were newly diagnosed with HIV. The case-finding effectiveness of the program was 18.4%. Conclusion This pilot program provides evidence of the effectiveness of a partner notification program implemented in healthcare settings. This active partner notification program was feasible, acceptable to the user, and identified a high proportion of HIV-infected patients previously unaware of their status.

Background: The aim of this study is to determine whether socioeconomic AIDS mortality inequalities before and after the introduction of highly active antiretroviral therapy (HAART) have increased or decreased in a Spanish city where HAART is free. Methods: The study used a trend design, including all Barcelona residents older than 19 years of age. All AIDS deaths, which occurred among these residents between 1991 and 2001 were included. The variables studied were age, sex, socioeconomic (SES) group and HIV transmission group. AIDS age-standardized mortality rates for each year were estimated. Poisson regression models were fitted to obtain the relative risk (RR) of AIDS death for each socioeconomic group with respect to the reference group. Results: AIDS mortality increased up until 1995 and subsequently decreased due to the introduction of HAART. The increase in AIDS mortality was greater in the lowest SES group, which had higher rates and a RR of dying larger than that of the highest SES group, fact that remained fairly stable over the whole period. A similar pattern was observed in intravenous drug users. In the homosexual transmission group, rates for the lowest SES group were higher for the whole period and increased until 1996, while rates for the other SES groups were lower and decreased over the entire period. Conclusions: The fact that inequalities in AIDS mortality by SES group remained fairly stable for the whole period suggests that perhaps access to HAART, or adherence, is lower than desirable, in people of lower SES groups. These results ought to be taken into account when implementing treatment and prevention strategies.

Objetivo Analizar la prevalencia de infeccion tuberculosa latente (ITL) en inmigrantes. Metodo Se revisaron los pacientes de una unidad de enfermedades importadas de Barcelona menores de 35 anos. Resultados Se practicaron 837 pruebas de tuberculina. Se leyeron 728 y se detectaron 351 casos (48,2%) de ITL. Tenian mayor prevalencia los de mayor edad y los africanos. Conclusiones Los inmigrantes presentan elevadas prevalencias de ITL. Pocas personas siguen todas las indicaciones, lo que hace necesario mejorar las estrategias de cribado, diagnostico, prescripcion y cumplimiento del tratamiento preventivo.

An unexplained resurgence of Group A streptococci (GAS) infections has been observed since the mid-1980s in the United States and Europe, particularly among intravenous drug users (IDUs). Several risk factors have been identified. Mutations in the capsule synthesis regulator genes (csrRS) have been associated with an increase in virulence. From January 1998 to December 2003, we conducted a prospective and retrospective descriptive analysis of invasive GAS soft-tissue infections in IDUs in Barcelona, Spain. Clinical features were collected, and we conducted a surveillance study to identify risk factors associated with GAS soft-tissue infections. We analyzed chromosomal DNA by low cleavage restriction enzymes and used pulsed-field gel electrophoresis (PFGE) and variable gene sequence typing (VGST) of the emm gene to disclose the epidemiologic relationship between the strains. We analyzed the influence of clonality (M-type) and mutations in csrRS genes of these strains on clinical features. We identified 44 cases, all of which were grouped in 3 clusters: fall 2000, fall 2002, and fall 2003. Cellulitis with or without abscesses (75%) and fever (90.9%) were the most common clinical manifestations. Distant septic complications were infrequent (18.2%). Although all patients had severe infections (mainly bacteremic needle abscesses), their outcome with antibiotic therapy, usually beta-lactam, was successful in all cases. However, surgery was needed in 40.9% of patients. Through the surveillance study we found that infected patients had a higher number of drug injections per day (odds ratio [OR], 18.84; 95% confidence interval [CI], 4.83-79.4; p

Objective To study trends in progression to AIDS, all-cause mortality, and cause-specific mortality (AIDS-related, liver disease, and hemorrhagic complications) over calendar periods with different exposure to highly active antiretroviral therapy (HAART) in a cohort of hemophiliacs in Spain, taking into account the competing risks of the causes of death. Methods Multicenter cohort of HIV-infected hemophiliacs. HIV seroconversion was estimated using mathematic techniques for interval-censored data from 1979 through 1985. Rates of AIDS and cause-specific death were calculated by Poisson regression, allowing for late entry, for the periods 1985 through 1992, 1993 through 1996, 1997 through 2000 (early HAART), and 2001 through 2003 (late HAART), also allowing for competing risks. Results Of 585 subjects, 44% were younger than 15 years of age, 82% had severe hemophilia, 86% had type A hemophilia, and the median seroconversion date was October 1982. Calendar period and age at HIV seroconversion strongly influenced AIDS and death rates. Compared with 1993 through 1996, decreases of 75% (relative risk [RR] = 0.25, 95% confidence interval [CI]: 0.14 to 0.43) and 72% (RR = 0.28, 95% CI: 0.12 to 0.63) in the RR of AIDS were observed in early and late HAART. For all-cause mortality, 72% (RR = 0.28, 95% CI: 0.18 to 0.42) and 83% (RR = 0.17, 95% CI: 0.09 to 0.33) decreases were observed by 1997 through 2000 and 2001 through 2003. For liver-related deaths, increases were observed in the late-HAART period (RR = 2.80, 95% CI: 0.94 to 8.36) compared with 1993 through 1996, but using competing risks, this RR was substantially reduced (RR = 1.70, 95% CI: 0.57 to 5.04). Discussion Major reductions in AIDS and death rates were observed from 1997 to 2003 in hemophiliacs. These survival improvements are largely attributable to decreases in AIDS-related deaths and have been accompanied by increases in liver disease death rates, which are overestimated if competing risks are not taken into account.

La nueva situación sociodemográfica del Estado español, vinculada a la incorporación de poblaciones inmigrantes, requiere mejorar el conocimiento de su estado de salud y determinar las prioridades preventivas y asistenciales. Se realiza una revisión bibliográfica de la información disponible sobre salud e inmigración, analizando sus contenidos desde una óptica de salud pública. Entre los resultados encontrados cabe destacar la elevada proporción de recién nacidos de mujeres de origen extranjero, las necesidades en salud mental, la detección de los déficit en salud bucodental y el incremento de casos de tuberculosis que, junto a limitaciones de las coberturas vacunales en la población infantil, definen el espectro de la salud de esta población. Del análisis de los servicios de salud se desprende la elevada frecuentación de los servicios de ginecología y obstetricia y pediatría por parte de la población inmigrante. La población inmigrante, a pesar de no presentar necesidades específicas en materia de salud, incluye colectivos que requieren una especial atención respecto a la tuberculosis, la salud materno-infantil y la prevención y promoción de la salud. Se recomienda reforzar y adaptar los recursos y servicios de salud potenciando la figura del agente de salud y los recursos humanos y formativos de los profesionales. The new social and demographic framework in Spain that has appeared since the arrival of new migrant populations, raises the need to improve the knowledge of their health status and to identify preventive measures and priorities in heath services. A bibliographic review of the available information on migration and health in Spain is performed, together with an analysis of their contents from a Public Health point of view. The high proportion of new borns from foreign mothers, the mental needs, deficits in oral and dental health, and the increase of tuberculosis in migrants, together with limited vaccine coverage in children, define the main health needs of these populations. The analysis of health services, reveals a high use of pediatric, obstetric and gynecologic resources by migrant populations. Conclusions; although no particular health needs have been identified for migrants, special attention for tuberculosis, mother and child health and health promotion and prevention, have to be funded for specific migrant populations. Health resources and services have to be reinforced with health agents, human resources, and specialized education for health professionals.

To explore views about risky sexual behaviors and perceptions of HIV, and to propose interventions for preventing HIV infections in a group of men who have sex with men.We performed a qualitative study in a sample of 13 men who have sex with men, who were participating in an HIV-seronegative cohort, and who we contacted via saunas for the gay community in Barcelona (Spain). We performed in-depth semi-structured interviews, followed by content analysis.Risky sexual behaviors were associated with masculinity related to strong sexual needs, certain sexual exchange venues (such as saunas, private parties and clubs), drug use, and a desire to experiment with risk and one's own sexuality. HIV infection was perceived as a normalized disease, although becoming infected was still associated with shame and guilt. Proposed interventions included raising awareness of what it is like to live with HIV, generating greater social alarm, incorporating new technologies in prevention, and intensifying activity at gay venues.The concept of masculinity plays a fundamental role in sexual practices among men who have sex with men. We suggest renewed innovation in preventive programs and incorporating the perception of risk and HIV infection from a gender perspective.

The aim of this study was to describe the evolution and epidemiologic characteristics of shigellosis patients over a 25 year period in a large city.Shigellosis is a notifiable disease in Spain since 1988. Cases are analyzed in Barcelona residents included in the registry between 1988-2012. A descriptive analysis by sex, age, mode of transmission and Shigella species is presented. Trend analysis and time series were performed.Of the 559 cases analyzed, 60.15% were males. A sustained increase was observed in the trend since 2008 in males (p0,05), especially at the expense of males who had no history of food poisoning or travel to endemic areas. The increasing tendency was greater in males from 21 to 60 years, both for S. flexneri (since 2009), and for S. sonnei (since 2004). In 2012 it was noted that in the men with S. flexneri, the 63% were men who have sex with men.An increased trend was detected in men who had no history of food poisoning or travel to endemic areas. This increase points to a change in the pattern of shigellosis, becoming predominantly male and its main mechanism probably by sexual transmission.

The evidence that supports the preventive effect of combination antiretroviral treatment (cART) in HIV sexual transmission suggested the so-called ‘treatment as prevention’ (TAP) strategy as a promising tool for slowing down HIV transmission. As the messages and attitudes towards condom use in the context of TAP appear to be somehow confusing, the aim here is to assess whether relying on cART alone to prevent HIV transmission can currently be recommended from the Public Health perspective. A review is made of the literature on the effects of TAP strategy on HIV transmission and the epidemiology of other sexual transmitted infections (STIs) in the cART era, and recommendations from Public Health institutions on the TAP as of February 2014. The evolution of HIV and other STIs in Barcelona from 2007 to 2012 has also been analysed. Given that the widespread use of cART has coincided with an increasing incidence of HIV and other STIs, mainly amongst men who have sex with men, a combination and diversified prevention methods should always be considered and recommended in counselling. An informed decision on whether to stop using condoms should only be made by partners within stable couples, and after receiving all the up-to-date information regarding TAP. From the public health perspective, primary prevention should be a priority; therefore relying on cART alone is not a sufficient strategy to prevent new HIV and other STIs.

FUNDAMENTO: Determinar la tasa de notificacion de SIDA en Cataluna. METODO: Se utilizan como fuentes de contraste las solicitudes de las determinaciones de linfocitos T CD4+ y la prescripcion de antirretrovirales en siete hospitales universitarios de Cataluna entre el 1 de enero y el 31 de junio de 1994. Se considero que un caso no estaba declarado cuando en la historia clinica existia un diagnostico de sida (segun la definicion de Europa 93) y dicho caso no se encontraba incluido en el registro de sida de Cataluna. RESULTADOS: De los 1.370 casos analizados, se detectaron 50 casos de sida no declarados. La tasa de notificacion global fue del 98,6%, con un intervalo de confianza del 95% (IC del 95%):98,2-99,0. La mayoria de los casos no declarados eran hombres (72%) con una edad media de 37,3 anos (DS:11,8), el 52% eran usuarios de drogas por via parenteral (UDVP), siendo la tuberculosis extrapulmonar la enfermedad diagnostica mas frecuente (16%), el 81,4% presentaban un nivel de linfocitos T CD4+ menor o igual a 200 celulas /mm3. El 92% de estos casos se detectaron a partir de los registros de determinaciones de linfocitos T CD4+. CONCLUSIONES: La exhaustividad detectada se considera adecuada. Se recomienda usar los registros de determinaciones linfocitarias para este tipo de estudios.

HIV-risk populations are over-represented in prisons. It is very important to identify late HIV infection diagnosis in this setting from a public health perspective. The objectives of this study are to estimate the prevalence of late diagnosis and identify the predictive factors among inmates of two prisons in Barcelona from 2010 to 2012, and to review late diagnosis in other prisons. A cross-sectional study design was used on inmates with newly-diagnosed HIV infection. Less than 350 CD4 lymphocytes/µl was considered late diagnosis. A Medline search was performed. Of the 3,933 total inmates, 1.2% (n = 47) were diagnosed with HIV infection, 1.7% from Prison A and 0.6% from Prison B (p0.001). Late diagnosis occurred in 47.7% of cases. A higher number of cases with late diagnosis were found in Prison A, among the immigrant population, and among intravenous drug users (p = 0.026, p = 0.007, p = 0.03, respectively). The proportion of late diagnosis decreased from 60% in 2010, to 44.4% in 2011 and 20% in 2012 (p = 0.05). The multivariate analysis confirmed an association between late diagnosis and immigrant status (OR: 7.85; 95% CI: 1.8-34.13) and the declining prevalence (p = 0.032). This is the first study to estimate late diagnosis in a prison population. Late diagnosis occurs mainly among the immigrant inmate population. The prison can serve as an opportunity to identify and treat HIV infection among people who have little contact with health services, thus avoiding further transmission.

Background. AIDS is among the leading causes of death in prisons, but there is little information about AIDS patients with a history of imprisonment. Methods. AIDS patients diagnosed in Barcelona between 1988 and 1993 were studied. Those with prison histories were compared to those without, with respect to epidemiological variables, including survival analysis. Results. 28.5% of 2336 AIDS patients, 49.4% of intravenous drug users (IVDU) and only 2.6% of homosexuals who were not IVDU had a prison history. Those with prison histories, compared to those without, were younger (median age of 30.6 versus 36.4, P < 0.0001), more often IVDU than homosexuals (87.8% versus 35.8%, OR = 36.9, 95% Cl : 22.6-60.8, P< 0.0001), and diagnosed with AIDS because of extrapulmonary tuberculosis (32.0% versus 14.7%, P< 0.001). Among IVDU, those with prison histories were more frequently males (OR : 2.2 ; 95% Cl : 1.6-2.9), lived in the poorest district of Barcelona more frequently than in the richest district (OR : 6.6 ; 95% Cl : 3.4-12.9) and presented with extrapulmonary tuberculosis more frequently than Pneumocystis carinii pneumonia (OR : 1.7 ; 95% Cl : 1.2-2.4). Longer survival in the prison group did not persist when adjusted for age and AIDS-defining disease. Those with prison histories who presented with AIDS with only extrapulmonary tuberculosis had better probability of survival than those who presented only with P. carinii pneumonia (P < 0.001). Conclusions. AIDS patients in Barcelona with prison histories tended to be younger, more likely to be IVDU, and to present with extrapulmonary tuberculosis as an AIDS-defining illness than other patient groups. Better survival appears to be related to age and AIDS-defining illnesses in the prison group. The fact that half the IVDU AIDS cases had prison histories has important implications for the care and prevention of HIV, tuberculosis, and drug abuse in comparable prison settings.