Christopher S. Murrill

HIV incidence among injection drug users in New York City, 1992-1997: evidence for a declining epidemic.

OBJECTIVESnWe assessed recent (1992-1997) HIV incidence in the large HIV epidemic among injection drug users in New York City.nnnMETHODSnData were compiled from 10 separate studies (N = 4979), including 6 cohort studies, 2 repeat service user studies, and 2 analyses of voluntary HIV testing and counseling services within drug treatment programs.nnnRESULTSnIn the 10 studies, 52 seroconversions were found in 6344 person-years at risk. The observed incidence rates among the 10 studies were all within a narrow range, from 0 per 100 person-years at risk to 2.96 per 100 person-years at risk. In 9 of the 10 studies, the observed incidence rate was less than 2 per 100 person-years at risk. The weighted average incidence rate was 0.7 per 100 person-years at risk.nnnCONCLUSIONSnThe recent incidence rate in New York City is quite low for a high-seroprevalence population of injection drug users. The very large HIV epidemic among injection drug users in New York City appears to have entered a declining phase, characterized by low incidence and declining prevalence. The data suggest that very large high-seroprevalence HIV epidemics may be reversed.

Age-Specific Seroprevalence of HIV, Hepatitis B Virus, and Hepatitis C Virus Infection Among Injection Drug Users Admitted to Drug Treatment in 6 US Cities

OBJECTIVESnThis study measured age-specific seroprevalence of HIV, hepatitis B virus, and hepatitis C virus (HCV) infection among injection drug users (IDUs) admitted to drug treatment programs in 6 US cities.nnnMETHODSnRemnant sera collected from persons entering treatment with a history of illicit drug injection were tested for antibodies to HIV, hepatitis C (anti-HCV), and hepatitis B core antigen (anti-HBc).nnnRESULTSnPrevalence of anti-HBc and anti-HCV increased with age and reached 80% to 100% among older IDUs in all 6 cities. Although overall age-specific HIV prevalence was lower than anti-HCV or anti-HBc, this prevalence was greater in the Northeast than in the Midwest and West.nnnCONCLUSIONSnThe need continues for effective primary prevention programs among IDUs specifically targeting young persons who have recently started to inject drugs.

Homophobia is associated with sexual behavior that increases risk of acquiring and transmitting HIV infection among black men who have sex with men.

We investigated whether the experience of homophobic events increases the odds of engaging in unprotected anal intercourse (UAI) among black men who have sex with men (MSM) and whether social integration level buffered the association. Participants (Nxa0=xa01,154) reported homophobic events experienced in the past 12xa0months. Social integration measures included social support, closeness with family members and friends, attachment to the black gay community, openness about sexuality within religious communities, and MSM social network size. Logistic regression analyses indicated that experiencing homophobia was associated with (1) UAI among men not previously diagnosed with HIV and (2) sexual HIV transmission risk behavior among men who knew they were HIV-infected. None of the social integration measures buffered these associations. Homophobia may promote acquisition and transmission of HIV infection among black MSM. Interventions are needed to reduce homophobia experienced by black MSM.

Global Epidemiology of HIV

The number of persons living with HIV worldwide reached approximately 35.3 million in 2012. Meanwhile, AIDS-related deaths and new HIV infections have declined. Much of the increase in HIV prevalence is from rapidly increasing numbers of people on antiretroviral treatment who are now living longer. There is regional variation in epidemiologic patterns, major modes of HIV transmission, and HIV program response. It is important to focus on HIV incidence, rather than prevalence, to provide information about HIV transmission patterns and populations at risk. Expanding HIV treatment will function as a preventive measure through decreasing horizontal and vertical transmission of HIV.

Incidence of HIV Among Injection Drug Users Entering Drug Treatment Programs in Four US Cities

We estimated seroincidence of human immunodeficiency virus (HIV) and prevalence of risk behaviors among injection drug users (IDUs) who accepted voluntary HIV testing on entry to drug treatment. Record-based incidence studies were conducted in 12 drug treatment programs in New York City (n = 890); Newark, New Jersey (n = 521); Seattle, Washington (n = 1,256); and Los Angeles, California (n = 733). Records of confidential HIV tests were abstracted for information on demographics, drug use, and HIV test results. More detailed data on risk behaviors were obtained by a standardized questionnaire. Although overall incidence rates were relatively low in this population (<1/100 person-years), there was a high prevalence of risk behaviors. Needle sharing was reported by more than one-third of the participants in each of the cities. HIV seroincidence rates were up to three-fold higher among younger ID Us. We found that HIV continued to be transmitted among ID Us who had received both drug treatment and HIV counseling and testing. HIV/AIDS (acquired immunodeficiency syndrome) prevention education should continue to be an important component of drug treatment.

Respondent Driven Sampling for HIV Biological and Behavioral Surveillance in Latin America and the Caribbean

Since 2005, respondent driven sampling (RDS) has been widely used for HIV biological and behavioral surveillance surveys (BBSS) in Latin America and the Caribbean (LAC). In this manuscript, we provide a focused review of RDS among hard-to-reach high-risk populations in LAC and describe their principal operational, design, and analytical considerations. We reviewed published and unpublished reports, protocols, and manuscripts for RDS studies conducted in LAC between January 1, 2005 and December 31, 2011. We abstracted key operational information and generated summary statistics across all studies. Between 2005 and 2011, 87 RDS studies were conducted in 15 countries in LAC (68xa0% in South America, 18xa0% in Mexico and Central America, and 14xa0% in the Caribbean). The target populations were primarily men who have sex with men (43xa0%), sex workers (29xa0%), and drug users (26xa0%). Study considerations included establishing clear eligibility criteria, measuring social network sizes, collecting specimens for biological testing, among others. Most of the reviewed studies are the first in their respective countries to collect data on hard-to-reach populations and the first attempt to use a probability-based sampling method. These RDS studies allowed researchers and public health practitioners in LAC to access hard-to-reach HIV high-risk populations and collect valuable data on the prevalence of HIV and other infections, as well as related risk behaviors.ResumenDesde el 2005, el muestreo dirigido por participantes (o respondent driven sampling, RDS) se ha utilizado ampliamente en Latinoamérica y el Caribe (LAC) para las encuestas de vigilancia biológica y de comportamientos de riesgo para el VIH. En este artículo, ofrecemos una revisión enfocada de los estudios RDS que se han realizado en LAC entre las poblaciones de alto riesgo y difícil de acceder y describe retos operacionales, de diseño, y analíticos y sus consideraciones. Examinamos informes publicados e inéditos, protocolos, y manuscriptos sobre los estudios RDS realizados en LAC entre enero 1, 2005 a diciembre 31, 2011. Resumimos la información operacional clave de todos los estudios y generamos estadísticas sumarias. Encontramos que entre el 2005 al 2011 se realizaron 87 estudios RDS en 15 países de LAC (68xa0% en Sudamérica, 18xa0% en México y Centroamérica, y 14xa0% en el Caribe). Las poblaciones objetivas fueron principalmente hombres que tienen sexo con hombres (43xa0%), trabajadoras sexuales (29xa0%) y usuarios de drogas (26xa0%). Los desafíos principales incluyeron el establecimiento de criterios de elegibilidad, la medición del tamaño de la red social, la toma de muestras para las pruebas biológicas, entre otros. La mayoría de los estudios revisados son los primeros en sus respectivos países que recopilan datos sobre las poblaciones de difícil acceso y el primer intento de utilizar un método de muestreo basado en la probabilidad. Estos estudios RDS permitieron a los investigadores y a los profesionales de salud pública accesar a poblaciones de alto riesgo de difícil acceso y recolectar valiosos datos sobre la prevalencia del VIH y de otras infecciones, así como riesgos de conducta relacionados.

The Epidemiology of HIV and Prevention Needs of Men Who Have Sex with Men in Abidjan, Cote d’Ivoire

To determine HIV prevalence and associated risk factors among men who have sex with men (MSM) in Abidjan, Côte d’Ivoire. We conducted a cross-sectional RDS survey of MSM in Abidjan from October 2011 to February 2012. Eligibility criteria included age ≥ 18 years and having had oral or anal sex with another man in the last 12 months. Weighted data analysis was conducted with RDSAT and SAS. We enrolled 603 participants, of whom 601 (99.7%) completed the questionnaire and 581 (96.7%) consented to HIV testing. HIV population prevalence was estimated as 18.0% (95% CI: 13.0-23.1); 86.4% (95% CI: 75.1-94.9) of HIV-positive MSM were unaware of their serostatus. In multivariable analysis, adjusting for age, education, and income, HIV infection was associated with unprotected sex at last sex with a woman, more than two male anal sex partners in last 12 months, inconsistent condom use during anal sex with a man, self-perceived risk of HIV, history of forced sex, history of physical abuse due to MSM status, and not receiving last HIV test result prior to study. HIV prevalence among MSM in Abidjan is more than four times as high as that of general population men. MSM engage in high-risk sexual behavior and most HIV-positive MSM are unaware of their serostatus. Greater access to HIV prevention, care, and treatment services targeted to MSM is necessary.

Self-Reported Tuberculosis Disease and Tuberculin Skin Testing in the New York City House Ballroom Community

OBJECTIVESnWe sought to describe the history of tuberculosis disease and tuberculin skin testing among the New York City House Ballroom community--a social network of diverse sexual and gender identities or expressions.nnnMETHODSnMembers of the House Ballroom community were convenience sampled, surveyed, and tested for HIV in 2004. We identified characteristics associated with history of tuberculosis, tuberculin skin testing, and test positivity and described the timing of skin testing.nnnRESULTSnOf 504 participants, 1.4% (n=7) reported a history of tuberculosis and 81.1% (n=404 of 498) had received a tuberculin skin test. Of those tested, 16 (4%) had positive results, which indicated latent infection, and 68% had received a test in the 2 years prior to the survey. Participants with health insurance were more likely and those with little education were less likely to have received a skin test. HIV-infected participants (16%) were not more likely to have received a tuberculin skin test compared with non-HIV-infected individuals. Foreign-born participants and self-identified heterosexuals and bisexuals were more likely to have had positive skin tests.nnnCONCLUSIONSnSelf-reported history of tuberculosis was high among the House Ballroom community. Although many community members had a recent skin test, further efforts should target services to those who are HIV infected, have low education, lack health insurance, or are foreign born.

Using Acute Flaccid Paralysis Surveillance as a Platform for Vaccine-Preventable Disease Surveillance

Abstract Surveillance for acute flaccid paralysis (AFP) is a fundamental cornerstone of the global polio eradication initiative (GPEI). Active surveillance (with visits to health facilities) is a critical strategy of AFP surveillance systems for highly sensitive and timely detection of cases. Because of the extensive resources devoted to AFP surveillance, multiple opportunities exist for additional diseases to be added using GPEI assets, particularly because there is generally 1 district officer responsible for all disease surveillance. For this reason, integrated surveillance has become a standard practice in many countries, ranging from adding surveillance for measles and rubella to integrated disease surveillance for outbreak-prone diseases (integrated disease surveillance and response). This report outlines the current level of disease surveillance integration in 3 countries (Nepal, India, and Nigeria) and proposes that resources continue for long-term maintenance in resource-poor countries of AFP surveillance as a platform for surveillance of vaccine-preventable diseases and other outbreak-prone diseases.

Respondent-Driven Sampling in a Multi-Site Study of Black and Latino Men Who Have Sex with Men

PURPOSEnRespondent-driven sampling (RDS) was used to recruit four samples of Black and Latino men who have sex with men (MSM) in three metropolitan areas to measure HIV prevalence and sexual and drug use behaviors. We compared demographic and behavioral risk characteristics of participants across sites, assessed the extent to which the RDS statistical adjustment procedure provides estimates that differ from the crude results, and summarized our experiences using RDS.nnnMETHODSnFrom June 2005 to March 2006 a total of 2,235 MSM were recruited and interviewed: 614 Black MSM and 516 Latino MSM in New York City, 540 Black MSM in Philadelphia, and 565 Latino MSM in Los Angeles County. Crude point estimates for demographic characteristics, behavioral risk factors and HIV prevalence were calculated for each of the four samples. RDS Analysis Tool was used to obtain population-based estimates of each sampled populations characteristics.nnnRESULTSnRDS adjusted estimates were similar to the crude estimates for each study sample on demographic characteristics such as age, income, education and employment status. Adjusted estimates of the prevalence of risk behaviors were lower than the crude estimates, and for three of the study samples, the adjusted HIV prevalence estimates were lower than the crude estimates. However, even the adjusted HIV prevalence estimates were higher than what has been previously estimated for these groups of MSM in these cities. Each site faced unique circumstances in implementing RDS.nnnCONCLUSIONSnOur experience in using RDS among Black and Latino MSM resulted in diverse recruitment patterns and uncertainties in the estimated HIV prevalence and risk behaviors by study site.