Sanny Chen

Trends in prevalence of HIV syphilis hepatitis C hepatitis B and sexual risk behavior among men who have sex with men. Results of 3 consecutive respondent-driven sampling surveys in Beijing 2004 through 2006.

Background:Studies tracking trends in HIV prevalence and risk behavior among men who have sex with men (MSM) in China are rare. We report on 3 consecutive cross-sectional surveys measuring the prevalence of HIV, other infectious diseases, and related risk behavior among MSM in Beijing in 2004, 2005, and 2006. Methods:We applied respondent-driven sampling (RDS) to recruit MSM for a structured face-to-face interview on demographic characteristics and HIV risk-related behavior. Blood specimens were drawn for HIV, syphilis, hepatitis B virus, and hepatitis C virus (HCV) testing. Results:A total of 325 MSM participated in 2004, 427 in 2005, and 540 in 2006. HIV prevalence was 0.4% (95% confidence interval [CI]: 0.1 to 0.8) in 2004, 4.6% (95% CI: 2.2 to 7.6) in 2005, and 5.8% (95% CI: 3.4 to 8.5) in 2006. This apparent rise was accompanied by an increase in syphilis and self-reported history of sexually transmitted diseases (STDs), high prevalence of multiple sex partners, and low consistent condom use. HCV prevalence also increased, from 0.4% (95% CI: 0.1 to 0.8) in 2004 to 5.2% (95% CI: 2.3 to 8.2) in 2006. Conclusions:We detected a possible rising prevalence of HIV and related risk behavior among MSM in Beijing using RDS in each of 3 consecutive years. Practical measures, including MSM-friendly HIV testing, STD services, and health provider education, are urgently needed to stop the further spread of HIV in this population.

2008 Outbreak of Salmonella Saintpaul Infections Associated with Raw Produce

BACKGROUND Raw produce is an increasingly recognized vehicle for salmonellosis. We investigated a nationwide outbreak that occurred in the United States in 2008. METHODS We defined a case as diarrhea in a person with laboratory-confirmed infection with the outbreak strain of Salmonella enterica serotype Saintpaul. Epidemiologic, traceback, and environmental studies were conducted. RESULTS Among the 1500 case subjects, 21% were hospitalized, and 2 died. In three case-control studies of cases not linked to restaurant clusters, illness was significantly associated with eating raw tomatoes (matched odds ratio, 5.6; 95% confidence interval [CI], 1.6 to 30.3); eating at a Mexican-style restaurant (matched odds ratio, 4.6; 95% CI, 2.1 to ∞) and eating pico de gallo salsa (matched odds ratio, 4.0; 95% CI, 1.5 to 17.8), corn tortillas (matched odds ratio, 2.3; 95% CI, 1.2 to 5.0), or salsa (matched odds ratio, 2.1; 95% CI, 1.1 to 3.9); and having a raw jalapeño pepper in the household (matched odds ratio, 2.9; 95% CI, 1.2 to 7.6). In nine analyses of clusters associated with restaurants or events, jalapeño peppers were implicated in all three clusters with implicated ingredients, and jalapeño or serrano peppers were an ingredient in an implicated item in the other three clusters. Raw tomatoes were an ingredient in an implicated item in three clusters. The outbreak strain was identified in jalapeño peppers collected in Texas and in agricultural water and serrano peppers on a Mexican farm. Tomato tracebacks did not converge on a source. CONCLUSIONS Although an epidemiologic association with raw tomatoes was identified early in this investigation, subsequent epidemiologic and microbiologic evidence implicated jalapeño and serrano peppers. This outbreak highlights the importance of preventing raw-produce contamination.

Low socioeconomic status is associated with a higher rate of death in the era of Highly active antiretroviral therapy, San Francisco

Highly active antiretroviral therapy (HAART) has dramatically improved survival after AIDS. The benefits of HAART have not been equally realized for all communities, however. We characterize the association of socioeconomic status (SES) with survival after AIDS diagnosis in San Francisco in the period before (1980-1995) and after (1996 - 2001) the wider use of HAART. Using citywide surveillance data, we examined differences in survival after AIDS diagnosis by neighborhood household income using Kaplan-Meier survival analysis and Cox proportional hazards analysis to adjust for significant covariates. Residing in higher SES neighborhoods significantly predicted better survival after AIDS from 1996 to 2001 (hazard ratio = 0.92 per

Brief cognitive counseling with HIV testing to reduce sexual risk among men who have sex with men: results from a randomized controlled trial using paraprofessional counselors.

10,000 increase in neighborhood household income, 95% CI: 0.85-0.99) after adjusting for CD4 count at diagnosis, age, and injection drug user status. Persons living in poorer neighborhoods were less likely to use HAART at any time in the past compared with persons in wealthier neighborhoods. Moreover, no association between survival and neighborhood SES was evident in the era prior to the wide use of HAART. Finally, the difference in survival by neighborhood income level disappeared after controlling for the use of HAART, suggesting that use of or access to treatment explained the association. From 1996 to 2001, survival with AIDS was worse for people living in poorer neighborhoods compared with those living in wealthier neighborhoods of San Francisco as a result of unequal access to or use of HAART.

Factors in the Delayed HIV Presentation of Immigrants in Northern California: Implications for Voluntary Counseling and Testing Programs

Objectives:To test the efficacy and acceptability of a single-session personalized cognitive counseling (PCC) intervention delivered by paraprofessionals during HIV voluntary counseling and testing. Methods:HIV-negative men who have sex with men (MSM; n = 336) were randomly allocated to PCC or usual counseling (UC) between October 2002 and September 2004. The primary outcome was the number of episodes of unprotected anal intercourse (UAI) with any nonprimary partner of nonconcordant HIV serostatus in the preceding 90 days, measured at baseline, 6 months, and 12 months. Impact was assessed as “intent to treat” by random-intercept Poisson regression analysis. Acceptability was assessed by a standardized client satisfaction survey. Results:Men receiving PCC and UC reported comparable levels of HIV nonconcordant UAI at baseline (mean episodes: 4.2 vs. 4.8, respectively; P = 0.151). UAI decreased by more than 60% to 1.9 episodes at 6 months in the PCC arm (P < 0.001 vs. baseline) but was unchanged at 4.3 episodes for the UC arm (P = 0.069 vs. baseline). At 6 months, men receiving PCC reported significantly less risk than those receiving UC (P = 0.029 for difference to PCC). Risk reduction in the PCC arm was sustained from 6 to 12 months at 1.9 (P = 0.181), whereas risk significantly decreased in the UC arm to 2.2 during this interval (P < 0.001 vs. 6 months; P = 0.756 vs. PCC at 12 months). Significantly more PCC participants were “very satisfied” with the counseling experience (78.2%) versus UC participants (59.2%) (P = 0.002). Conclusions:Both interventions were effective in reducing high-risk sexual behavior among MSM repeat testers. PCC participants demonstrated significant behavioral change more swiftly and reported a more satisfying counseling experience than UC participants.

Increasing condom use without reducing HIV risk: results of a controlled community trial in Uganda.

To describe the determinants of delayed HIV presentation in one Northern California County, the authors identify persons with an opportunistic infection (OI) at HIV diagnosis. From 2000–2002, a sample of HIV patients attending a public AIDS program (n=391) were identified. Immigrants composed 24% of our sample; 78.7% of immigrants were Hispanic. Immigrants, compared to U.S.-born patients, presented with lower initial CD4+ counts at diagnosis than U.S.-born patients (287 cells/mm3 vs. 333 cells/mm3, p=0.143), were more likely to have an OI at HIV diagnosis (29.8% vs. 17.2%, p=0.009), and were more likely to be hospitalized at HIV diagnosis (20.2% vs. 12.5%, p=0.064). We found only immigrant status was significantly and independently associated with delayed presentation. Interviews with 20 newly HIV diagnosed Hispanic patients suggest lack of knowledge regarding HIV risk, social stigma, secrecy and symptom driven health seeking behavior all contribute to delayed clinical presentation. The main precipitants of HIV testing for immigrants were HIV/AIDS related symptoms and sexually transmitted infection (STI)/HIV diagnosis in a sexual partner. These results support augmentation of STI/HIV voluntary clinical testing and partner notification services along the Mexico-California migrant corridor.

Enhanced surveillance of coccidioidomycosis, Arizona, USA, 2007-2008.

Background:Although consistent condom use is effective in reducing individual risk for HIV infection, the public health impact of condom promotion in a generalized epidemic is less clear. We assess the change in condom uptake and number of sex partners after a condom promotion trial in Kampala, Uganda. Methods:Two similar poor urban communities near Kampala were randomized. One received a condom promotion program that taught condom technical use skills in workshops for men aged 18 to 30 years (n = 297) and encouraged condom use. Men in the control community (n = 201) received a brief informational presentation about AIDS. Participants received coupons redeemable for free condoms from distributors in both communities and completed questionnaires at baseline and 6 months later. Results:Six-month follow-up was completed for 213 men (71.7%) in the intervention group and for 165 (82.1%) men in the control group. Men in the intervention group redeemed significantly more condom coupons than men in the control group (on average, 110 vs. 13 each; P = 0.002). Men in the intervention group increased their number of sex partners by 0.31 compared with a decrease of 0.17 partners in the control group (P = 0.004). Other measures did not support a net reduction in sexual risk in the intervention community compared with the control community and, in fact, showed trends in the opposite direction. Conclusions:In this study, gains in condom use seem to have been offset by increases in the number of sex partners. Prevention interventions in generalized epidemics need to promote all aspects of sexual risk reduction to slow HIV transmission.

HIV Prevention fatigue among high-risk populations in San Francisco

Additional public and provider education are needed to reduce delays in diagnosis.

Risk factors for human immunodeficiency virus infection among blood donors in Sao Paulo, Brazil, and their relevance to current donor deferral criteria

To the Editor:Since the late 1990s, HIV-related risk behavior among men who have sex with men (MSM) has increased in San Francisco and other cities worldwide. 1–9 This increase in risk behavior is corroborated by rises in sexually transmitted diseases and, in some places, HIV incidence. 1,4 For exam

Characteristics and survival of AIDS patients with hepatitis C: the Brazilian National Cohort of 1995-1996.

BACKGROUND: The objective of this study was to investigate risk factors of human immunodeficiency virus (HIV)‐seropositive blood donors in Brazil and to determine if current donor deferral criteria are appropriate.