María José Belza

Influence of age and geographical origin in the prevalence of high risk human papillomavirus in migrant female sex workers in Spain.

Objectives: To estimate the prevalence and risk factors of high risk human papillomavirus (HPV) infection in migrant female sex workers (FSW) according to age and geographical origin. Methods: Cross sectional study of migrant FSW attending a sexually transmitted infection (STI) clinic in Madrid during 2002. Information on sociodemographic characteristics, reproductive and sexual health, smoking, time in commercial sex work, history of STIs, HIV, hepatitis B, hepatitis C, syphilis, and genitourinary infections was collected. High risk HPV Infection was determined through the Digene HPV Test, Hybrid Capture II. Data were analysed through multiple logistic regression. Results: 734 women were studied. Overall HPV prevalence was 39%; 61% in eastern Europeans, 42% in Ecuadorians, 39% in Colombians, 29% in sub-Saharan Africans, and 24% in Caribbeans (p = 0.057). HPV prevalence showed a decreasing trend by age; 49% under 20 years, 35% in 21–25 years,14% over 36 years% (p<0.005). In multivariate analyses, area of origin (p = 0.07), hormonal contraception in women not using condoms (OR 19.45 95% CI: 2.45 to 154.27), smoking, age, and an interaction between these last two variables (p = 0.039) had statistically significant associations with HPV prevalence. STI prevalence was 11% and was not related to age or geographical origin. Conclusions: High risk HPV prevalence in migrant FSW is elevated and related to age, area of origin, and use of oral contraceptives in women not using condoms. These data support the role of acquired immunity in the epidemiology of HPV infection and identifies migrant FSW as a priority group for sexual health promotion.

Epidemiological characteristics and predictors of late presentation of HIV infection in Barcelona (Spain) during the period 2001-2009

BackgroundEarly diagnosis of HIV infection can prevent morbidity and mortality as well as reduce HIV transmission. The aim of the present study was to assess prevalence, describe trends and identify factors associated with late presentation of HIV infection in Barcelona (Spain) during the period 2001-09.MethodsDemographic and epidemiological characteristics of cases reported to the Barcelona HIV surveillance system were analysed. Late presentation was defined for individuals with a CD4 count below 350 cells/ml upon HIV diagnosis or diagnosis of AIDS within 3 months of HIV diagnosis. Multivariate logistic regression were used to identify predictors of late presentation.ResultsOf the 2,938 newly diagnosed HIV-infected individuals, 2,507 (85,3%) had either a CD4 cell count or an AIDS diagnosis available. A total of 1,139 (55.6%) of the 2,507 studied cases over these nine years were late presenters varying from 48% among men who have sex with men to 70% among heterosexual men. The proportion of late presentation was 62.7% in 2001-2003, 51.9% in 2004-2005, 52.6% in 2006-2007 and 52.1% in 2008-2009. A decrease over time only was observed between 2001-2003 and 2004-2005 (p = 0.001) but remained constant thereafter (p = 0.9). Independent risk factors for late presentation were older age at diagnosis (p < 0.0001), use of injected drugs by men (p < 0.0001), being a heterosexual men (p < 0.0001), and being born in South America (p < 0.0001) or sub-Saharan Africa (p = 0.002).ConclusionLate presentation of HIV is still too frequent in all transmission groups in spite of a strong commitment with HIV prevention in our city. It is necessary to develop interventions that increase HIV testing and facilitate earlier entry into HIV care.

Condiciones sociolaborales, conductas de riesgo y prevalencia de infecciones de transmisión sexual en mujeres inmigrantes que ejercen la prostitución en Madrid

Objetivo: Describir las caracteristicas sociodemograficas, las condiciones de trabajo, las conductas sexuales y la prevalencia de infecciones por el virus de la inmunodeficiencia humana (VIH), el virus de la hepatitis B (VHB), el virus de la hepatitis C (VHC) y otras infecciones de transmision sexual (ITS) en un grupo de mujeres inmigrantes que ejercen la prostitucion en Madrid. Metodos: Estudio transversal de 579 mujeres inmigrantes que ejercian la prostitucion, atendidas en un centro de ITS de Madrid entre 1999 y 2000. Se analizan las caracteristicas sociodemograficas, las condiciones de trabajo, el consumo de drogas por via parenteral y las practicas sexuales con los clientes y en su vida privada. La atencion incluia un control de las principales ITS y el estudio serologico para el VIH, el VHB y el VHC. Resultados: La media de edad fue de 28,7 anos, el 96% procedia de Latinoamerica y ninguna habia consumido drogas por via parenteral. La edad media de inicio en la prostitucion fue de 27,4 anos y el 93,3% habia comenzado en Espana. En el ultimo mes, el 98% habia utilizado siempre el preservativo en las penetraciones vaginales o anales con los clientes, pero solo el 17,6% en sus relaciones privadas. Un 30% refirio alguna rotura del preservativo durante un servicio. La prevalencia de infeccion por el VIH fue del 0,2%, y por el VHC del 0,9%. El 8,1% tenia anticuerpos anti-core para el VHB y el 0,5% antigeno de superficie. La prevalencia de otras ITS fue del 18,0% y la de otras infecciones genitales no necesariamente de transmision sexual, del 27,3%. Conclusiones: Se observa un uso generalizado del preservativo con los clientes, aunque tambien una elevada frecuencia de roturas. La prevalencia de marcadores de infeccion para el VIH, el VHB y el VHC es baja, aunque la de otras ITS es elevada.

Never tested for HIV in Latin-American migrants and Spaniards: prevalence and perceived barriers

Increasing the uptake of HIV testing and decreasing the number of undiagnosed people is a priority for HIV prevention. Understanding the barriers that hinder people from testing is vital, particularly when working with especially vulnerable populations like migrants. Most data available on migrants are based on African migrants in the UK, while barriers to HIV testing in Latin‐American migrants living in Europe remain unexplored. Still, they account for a quarter of new diagnosis in Spain and suffer higher rates of delayed diagnosis.

Men who pay for sex in Spain and condom use: prevalence and correlates in a representative sample of the general population

Objective: To estimate the percentage of men who have paid for heterosexual sex in Spain and the percentage who used condoms. To identify the main factors associated with these behaviours and to describe opinions about condoms. Methods: Sexual behaviour probability sample survey in men aged 18–49 years resident in Spain in 2003 (n = 5153). Computer-assisted face to face and self interview was used. Bivariate and multivariate logistic regression analyses were performed. Results: 25.4% (n = 1306) of the men had paid for heterosexual sex at some time in their lives; 13.3% (n = 687) in the last 5 years and 5.7% (n = 295) in the last 12 months. In the logistic analysis this behaviour was associated with older age, lower education, being unmarried, foreign birth, being a practicing member of a religious group, unsatisfactory communication with parents about sex, age under 16 years at first sexual intercourse and having been drunk in the last 30 days. Of the men who had paid for sex in the previous 5 years, 95% (n = 653) had used a condom in the most recent paid contact. In the multivariate analysis, not using a condom was associated with age over 30 years and first sexual intercourse before age 16 years. Men who did not use condoms in the last commercial intercourse had more negative opinions about condoms. Conclusions: The prevalence of paying for heterosexual sex among Spanish men is the highest ever described in developed countries. The many variables associated with paying for sex and condom use permit the characterisation of male clients of prostitution and should facilitate targeting HIV prevention policies.

Harm reduction interventions for drug injectors or heroin users in Spain: expanding coverage as the storm abates

AIMS To show the utility of analysing time trends of need and coverage of needle-exchange programmes (NEPs) and opioid substitution treatment (OST) to assess harm reduction policies targeting drug injectors or heroin users. DESIGN Multiple methods applied to secondary data. SETTING Spain. PARTICIPANTS Thousands of drug injectors or heroin users included in administrative registers, surveys and published studies during 1987-2010. MEASUREMENTS Coverage for the general population was calculated as the ratio between interventions provided (obtained directly from the sources) and interventions needed (estimated by multiple methods), and as the difference between the two. Timeliness was estimated by time elapsed between year of highest need and year in which coverage reached a reference level. FINDINGS In 2010 NEPs provided 138 syringes per drug injector [95% confidence interval (CI) 100-223], covering 25.7% (95% CI 18.3-43.3) of their need. OST coverage was 60.3% (95% CI 44.3-94.2). Syringe and OST provision increased between 1991 and 2001 and then declined. Syringe and OST coverage also increased substantially during this period and then stabilized, due mainly to decreases in drug injection or heroin use. Medium-level coverage for both syringes and OST was not achieved until 2000, 8 years after the peak in need (1992). CONCLUSIONS In Spain, the expansion of harm reduction interventions was greatly delayed, although the concomitant decrease in heroin and injecting drug use led to reasonable coverage after 2000. A longitudinal measurement of need and coverage provides insight into the timeliness and potential population impact of interventions, enabling better assessment of their adequacy.

Social and work conditions, risk behavior and prevalence of sexually transmitted diseases among female immigrant prostitutes in Madrid (Spain)

OBJECTIVE To describe the sociodemographic characteristics, work conditions, sexual behavior, and prevalence of HIV, hepatitis B (HBV), and hepatitis C (HCV) infection and of other sexually transmitted infections among a group of female immigrant prostitutes in Madrid. METHODS We performed a descriptive study of a group of immigrant women who worked as prostitutes and who attended a sexually transmitted diseases (STD) clinic in Madrid in 1999 and 2000. Information was collected on sociodemographic characteristics, work conditions, use of injected drugs, and sexual practices with their clients and in their private lives. The services provided included screening for the main STDs and serological studies for HIV, HBV and HCV. RESULTS A total of 579 female immigrants were analyzed. The mean age was 28.7 years. Ninety-six percent were from Latin America. None reported having consumed injected drugs. They began to work as prostitutes at a mean age of 27.4 years and 93.3% of them began in Spain. In the previous month, 98% had always used condoms for vaginal and anal penetrations with their clients and 17.6% had used them in their private sexual relations. Thirty percent reported condom breakage during intercourse. The prevalence of HIV and HCV infection was 0.2 and 0.9%, respectively; 8.1% showed HIV anticore antibodies and 0.5% showed surface antigens. An ulcerative STD was diagnosed in 2.1% and a non-ulcerative STD was diagnosed in 16%. CONCLUSIONS Condoms are generally used with clients although the frequency of breakage is high. Condom use in prostitutes personal lives is dramatically lower. The prevalence of markers for HIV, HBV and HCV is low and the frequency of STD is moderate.

HIV testing policies for migrants and ethnic minorities in EU/EFTA Member States

Background: In the context of an European Centre for Disease Prevention and Control (ECDC) research project, our objective was to describe current recommendations regarding HIV testing and counselling targeting migrants and ethnic minorities in the European Union/European Economic Area/European Free Trade Association (EU/EEA/EFTA) Member States. Methods: An on-line survey was conducted among 31 EU/EEA/EFTA Member States. The survey inquired on the existence of specific HIV testing and counselling recommendations or policies for migrants and/or ethnic minorities and the year of their publication. Additionally, we performed a review of national recommendations, guidelines or any other policy documents retrieved from an Internet search through the different countries’ competent bodies. Results: Twenty-nine (94%) country representatives responded the survey, and 28 documents from 27 countries were identified. National guidelines on HIV testing are heterogeneous and tailored, according to the epidemiological situation. Twenty-two countries identify migrants and four countries identify ethnic minorities as particularly vulnerable to HIV. Sixteen countries explicitly recommend offering an HIV test to migrants/ethnic minorities. Guidelines especially target people originating from HIV endemic countries, and benefits of HIV early detection are highlighted. HIV testing is not mandatory in any country, but some countries overtly facilitate this practice. Conclusion: Benefits of HIV testing in migrants and ethnic minorities, at both individual and community levels are recognized by many countries. In spite of this, not all countries identify the need to test these groups.

Estamos diagnosticando a tiempo a las personas infectadas por el VIH

Objetivo Describir la proporcion de casos de sida que no conocian su infeccion por el VIH hasta que desarrollaron sida y los factores asociados a esta situacion. Diseno Estudio descriptivo de datos del Registro Nacional de Sida. Emplazamiento Espana. Pacientes Casos de sida mayores de 14 anos diagnosticados entre 1997 y 1999. Resultados De los 6.910 casos de sida estudiados, un 35% (n = 2.421) supo que estaba infectado por el VIH coincidiendo con el diagnostico de sida (en el mismo mes o en el anterior). En el analisis multivariante esta situacion fue menos frecuente en mujeres (OR, 0,61; IC del 95%, 0,53–0,71); en los casos diagnosticados en prision (OR, 0,19; IC del 95%, 0,13–0,27) o en los que habian estado presos con anterioridad (OR, 0,49; IC del 95%, 0,41–0,60) frente al resto, y los residentes en provincias con tasas de sida mayores que la espanola (OR, 0,88; IC del 95%, 0,78–0,99). Por el contrario, el desconocimiento de su infeccion por el VIH hasta el diagnostico de sida se asocio a la edad menor de 25 o mayor de 34 anos, a las categorias de transmision homo/bisexual (OR, 3,20; IC del 95%, 2,69–3,80) y heterosexual (OR, 4,88; IC del 95%, 4,21–5,65) en comparacion con los usuarios de drogas por via parenteral, y a la procedencia de paises distintos de Espana, tanto desarrollados (OR, 2,78; IC del 95%, 1,89–4,08) como en desarrollo (OR, 1,85; IC del 95%, 1,26–2,72). Conclusiones Una proporcion importante de las personas diagnosticadas de sida desconocia su infeccion por el VIH, especialmente aquellas que nunca habian usado drogas por via patenteral. Se debe mejorar el diagnostico precoz del VIH para conseguir un mayor impacto de la prevencion y de los tratamientos.

Supervised blood-based self-sample collection and rapid test performance: a valuable alternative to the use of saliva by HIV testing programmes with no medical or nursing staff

Objectives Some saliva-based HIV testing programmes have resulted in an unacceptable percentage of false positives. Many countries require blood-based testing programmes to have doctors/nurses. The authors evaluate whether, after brief training and under the supervision of a skilled counsellor, blood-based self-sample collection and rapid test performance could be a valuable alternative. Methods 208 Spanish-speaking attendees at a street-based HIV testing programme in Madrid participated in the study. Participants were tested twice, first in the study and then in the programme, using the same finger-stick whole-blood rapid test (Determine HIV-1/2 Ag/Ab Combo®). Based on previously adapted instructions, the study counsellor explained the procedure to follow throughout the test. Participants then performed the test under the guidance of the counsellor. Demographic and risk behaviour data were collected by a self-administered questionnaire. The test results in the programme and the study were read by the study counsellor. Results 99.0% (95% CI 96.6% to 99.9%) of participants had a valid result in the study test, the same percentage as in the programme test conducted by the doctor/nurse. Two persons had invalid test results in both the study and the programme, but they were not the same persons. Conclusion The study provides clear evidence that this methodology is a valuable alternative to saliva for HIV testing programmes when medical or nursing staff required to take blood samples is not available.