Showing posts with label infectivity. Show all posts
Showing posts with label infectivity. Show all posts

Friday, March 16, 2012

Johns Hopkins: Studies Show the Likelihood of HIV Infection in Female Sex Workers

via Johns Hopkins School of Public Health

Female sex workers in low- and middle-income countries are nearly 14 times more likely to be infected by HIV compared to the rest of country’s population, according to an analysis by researchers at the Johns Hopkins Bloomberg School of Public Health. The findings suggest an urgent need to scale up access to quality HIV prevention programs in these countries. The study was published online in The Lancet Infectious Diseases.

“Although female sex workers have long been understood to be a key affected population, the scope and breadth of their disproportionate risk for HIV infection had not been systematically documented,” said Stefan Baral, MD, MPH, MBA, lead author of the study and associate director of the Bloomberg School’s Center for Public Health and Human Rights. “In addition to antiretroviral treatment and ongoing HIV prevention for sex workers, considerations of the legal and policy environments in which sex workers operate, and the important role of stigma, discrimination, and violence targeting female sex workers globally will be required to reduce the disproportionate disease burden among these women.”

For the study, Johns Hopkins conducted a meta-analysis of 102 previous published studies representing almost 100,000 female sex workers in 50 countries. Overall, HIV prevalence in female sex workers in low- and middle-income countries was found to be about 12 percent, which equated to an increased risk of infection for sex workers 14 times that of other women in these countries. In 26 countries where background levels of HIV were considered “medium” to “high,” approximately 31 percent of the female sex workers were found to have HIV and were 12 times more likely to be infected compared with women from the general population. Sex workers in Asia had a 29 percent increased risk for HIV infection compared to other women, which was the greatest disparity among the regions studied. Sex workers in Africa and Latin America were 12 times increased risk compared to other women in these regions.

This analysis was conducted as part of a larger project entitled, "The Global Epidemics of HIV among Sex Workers: Epidemiology, prevention, access to care, costs, and human rights" led by Johns Hopkins researchers Deanna Kerrigan, PhD, MPH, and Chris Beyrer, MD, MPH. The larger project assesses not only the epidemiology of HIV among sex workers in low- and middle-income countries, but also documents the current state of HIV prevention interventions and the social context surrounding sex work in different settings, and uses mathematical modeling and cost-effectiveness analysis to assess the potential impact and resources necessary to scale up of comprehensive HIV prevention, treatment and care services among sex workers.

“Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis” was written by Stefan Baral, Chris Beyrer, Kathryn Manning, Tonia Poteat, Andrea L. Wirtz, Michele R. Decker, Susan G. Sherman, and Deanna Kerrigan.

 
[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Thursday, August 12, 2010

HIV Transmission Risk Through Anal Intercourse: systematic review, meta-analysis and

Via International Journal of Epidemiology by Rebecca F Baggaley, Richard G White, and Marie-Claude Boily

Background
The human immunodeficiency virus (HIV) infectiousness of anal intercourse (AI) has not been systematically reviewed, despite its role driving HIV epidemics among men who have sex with men (MSM) and its potential contribution to heterosexual spread. We assessed the per-act and per-partner HIV transmission risk from AI exposure for heterosexuals and MSM and its implications for HIV prevention.

Methods
Systematic review and meta-analysis of the literature on HIV-1 infectiousness through AI was conducted. PubMed was searched to September 2008. A binomial model explored the individual risk of HIV infection with and without highly active antiretroviral therapy (HAART).

Results
A total of 62 643 titles were searched; four publications reporting per-act and 12 reporting per-partner transmission estimates were included. Overall, random effects model summary estimates were 1.4% [95% confidence interval (CI) 0.2–2.5)] and 40.4% (95% CI 6.0–74.9) for per-act and per-partner unprotected receptive AI (URAI), respectively. There was no significant difference between per-act risks of URAI for heterosexuals and MSM. Per-partner unprotected insertive AI (UIAI) and combined URAI–UIAI risk were 21.7% (95% CI 0.2–43.3) and 39.9% (95% CI 22.5–57.4), respectively, with no available per-act estimates. Per-partner combined URAI–UIAI summary estimates, which adjusted for additional exposures other than AI with a ‘main’ partner [7.9% (95% CI 1.2–14.5)], were lower than crude (unadjusted) estimates [48.1% (95% CI 35.3–60.8)]. Our modelling demonstrated that it would require unreasonably low numbers of AI HIV exposures per partnership to reconcile the summary per-act and per-partner estimates, suggesting considerable variability in AI infectiousness between and within partnerships over time. AI may substantially increase HIV transmission risk even if the infected partner is receiving HAART; however, predictions are highly sensitive to infectiousness assumptions based on viral load.

Conclusions
Unprotected AI is a high-risk practice for HIV transmission, probably with substantial variation in infectiousness. The significant heterogeneity between infectiousness estimates means that pooled AI HIV transmission probabilities should be used with caution. Recent reported rises in AI among heterosexuals suggest a greater understanding of the role AI plays in heterosexual sex lives may be increasingly important for HIV prevention.

For the full study click here.
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