cytology specimens. The good agreement with LA, an assay previ- ously evaluated in anal specimens, suggests that the cobas assay could be used to identify individuals at increased risk of anal can- cer by anal HPV DNA testing. Almost 80% of the men enrolled in this study were positive for carcinogenic HPV DNA, and about 20% of them had AIN2 or AIN3. These figures are similar to those reported in a large meta-analysis of HPV infections and HPV- related disease in MSM, demonstrating the high HPV burden in HIV-positive MSM (3). Due to the high HPV prevalence among HIV-infected MSM, the specificity of any HPV DNA-based assay is expected to be low. We previously evaluated the performance of HPV mRNA testing for the detection of precancers, since the ex- pression of HPV oncogenes is increased in precancerous lesions over that in productive infections. However, we found only a slight increase in the specificity of mRNA testing over that of HPV DNA detection of the same types (19). Other tests, such as Pap cytology and p16/Ki-67 cytology, have also shown increased spec- ificities for anal precancers and may help to decide who among the HPV-positiveHIV-positive population of MSM should be re- ferred for further diagnostic evaluation (7). Prospective studies are needed to evaluate whether the reassurance of not having anal precancer or cancer following a negative anal HPV test is compa- rable to that from a negative HPV test in cervical cancer screening. The strengths of this study include the large homogeneous population of HIV-infected MSM who had highly standardized anal cytology samples collected. All the molecular assays evaluated in this study were conducted in reference laboratories. All the men enrolled in the study had thorough disease ascertainment based on anal cytology and high-resolution anoscopy. Due to the lack of a true gold standard for cervical or anal HPV DNA status, studies evaluating new HPV assays usually rely on comparisons with es- tablished assays and evaluation of associations with disease end- points (20). Since cobas does not provide genotyping information beyond HPV16 and HPV18, a more extensive comparison of in- dividual genotyping results with LA was not possible.
Gay, bisexual and other menwhohavesex with men (MSM) have the highest prevalence of HIV in Canada . Between 1985 and 2011, 54.7 % of diagnosed HIV cases with known exposure status in Canada were attrib- utable to MSM (n = 69,856), even though self-identified MSM comprise only an estimated 2.1 % of the Canadian population [1, 2]. In the first two decades of the epi- demic, this disproportionate burden was characterized by premature mortality across MSM communities , with the estimated life expectancy of gay men in some urban environments being 8 to 20 years less than that of the general male population . Since the implementa- tion of combination antiretroviral therapy (cART), people living with HIV/AIDS (PHAs) have experienced significant improvements in health outcomes and can now achieve life expectancy near that of the general population [5–7]. High levels of adherence to cART, usually defined as taking >95 % of prescribed medication , usually results in full suppression of HIV-1-RNA levels in plasma, markedly improving health outcomes and similarly reducing the risk of HIV transmission . Adherent patients generally achieve viral suppression be- tween 8 and 24 weeks after initiating treatment .
In this synthesis, bias in the included studies may arise in the form of selection bias, misclassification of exposure or outcome, and confounding due to non-comparability of the groups being compared. The quality rating procedure that will be employed is based on the Newcastle–Ottawa Scale, which assigns quality ratings to studies in relation to these threats to internal validity (selection bias, mis- classification and non-comparability) . Some types of bias will be addressed through screening of reports for eli- gibility. For example, we will exclude reports that may have misclassified HCV exposure (sexual vs injection re- lated) by failing to exclude MSM who inject drugs from their analyses. Eligibility screening also will address poten- tial misclassification of the outcome (e.g., acute or recent vs chronic HCV infection). In addition to the Newcastle– Ottawa Scale, publication bias will be examined by comparing mean effect sizes between published and unpublished studies and by the use of funnel plots .
Data extracted from the electronic record included age, sex, country of birth, risk factor for HIV acquisi- tion and results of anorectal chlamydia by NAAT. Anorectal chlamydia was chosen because it is associ- ated with condomless receptive anal intercourse, which has also been associated with HCV infection, but not usually with a significant breach in the anorectal mu- cosa, i.e. ulceration, and because highly sensitive NAAT detection was used throughout the study period [9–12]. Gonorrhoea was not chosen because there was a change in detection method from culture to NAAT testing during the study period. Country of birth was defined as being within or outside Australia and New Zealand because of the large numbers of patients born in New Zealand and the similar HIV epidemiology in that country . Data provided by the external labora- tory included HIV viral load, CD4 cell count, HCV anti- body and RNA testing, liver function tests and HBV serology for all HIV-positive patients at MSHC from January 1 st 2002 to March 31 st 2016. MSHC began an- nual screening for hepatitis C for all HIVpositive pa- tients in 2005.
Sexual health and behavior among HIV-positivemenwhohavesex with men (MSM) have attracted attention in Japan and elsewhere. It has been reported that perceptions about sex are one factor leading to a reduction in HIV-preventive behaviors. This study investigated types of perceptions, termed self-talk, which allow HIV-positive Japanese MSM to permit them- selves to participate in unprotected anal intercourse (UAI). A package of in- ternet surveys for MSM including 20 items assessing self-talk on UAI and condom usage in anal intercourse was administered in 2014. Data from 479 HIV-positive Japanese MSM were analyzed. Exploratory factor analysis was conducted to reveal the factor structure of the self-talk. In addition, using the Kruskal-Wallis test, we examined the relationship between the types of self-talk and the tendency to have UAI. Factor analysis of 20 items assessing self-talk on UAI produced four dimensions: “Diversion/Desire for Stimula- tion,” “Optimism/Defiant Attitude,” “Denial of Concern of Transmitting,” and “Concern about Relationships.” The score of the subscale “Diver- sion/Desire for Stimulation” was significantly higher than the other three subscales. It was shown that there was a tendency for the self-talk assessed to be associated with the UAI frequency. The types of perceptions permit- ting UAI and the psychological stress of being an HIV-positive MSM in Ja- pan were discussed. This study was the first to reveal the factorial structure of perceptions in reducing HIV-preventive behaviors among HIV-positive MSM in Japan. We found positive associations between certain types of self-talk and risky sexual behaviors. We provided recommendations for psychosocial support and HIV risk-reduction intervention for HIV-positive MSM.
pendently associated with the behaviors HIV infection; we used multiple logistic regression models in which we entered all variables that were associated with the outcome in the bivariate analysis at a P-value ≤ 0.05. A total of 80% of the participants were in the modeling sample and 20% were in the model validity test and evaluation. Forecasting accuracy and the area under the receiver operating char- acteristic (ROC) curve were used to evaluate the accuracy of the prediction model. The probability of HIV infection among the HIV-negative participants was predicted by the established logistic regression model. The bound was set at 0.5 and if the predicted score was > 0.5, then the predicted result was regarded as positive; otherwise, it was negative.
Given the high levels of depression and anxiety symp- toms and continued perceptions of HIV stigma in MSM, there is a need to better understand the psychological pro- cesses linking HIV stigma to mental health outcomes. This study will examine the role of metacognitions in explaining differences in depression and anxiety symptoms in response to perceptions of HIV stigma in MSM living with HIV. Metacognition refers to the stored knowledge and experi- ences of thought processes and the strategies likely to reach one’s objective, and involves beliefs and appraisals of one’s cognitions (Flavell, 1979). One model of metacognition that has shown to be helpful in explaining psychopathology is the metacognitive model developed by Adrian Wells (1995). In this model, Wells (2008) proposed that depres- sion and anxiety result from an unhelpful internal state called the cognitive attentional syndrome (CAS), which consists of perseverative thinking such as worry or rumina- tion, threat monitoring and ineffective cognitive coping strategies. For example, someone experiencing high levels of social anxiety may have a CAS that involves a perse- verative thinking style of worry that others will reject her or him, an attentional bias towards threat cues such as facial expressions of others or unhelpful cognitive coping strate- gies such as thought suppression. The experience of worry, attentional bias to threat cues and the use of ineffective coping strategies manifest themselves in the symptoms associated with the social anxiety. The CAS is thought to be triggered and maintained by metacognitive beliefs (i.e. unhelpful beliefs and appraisals of one’s cognitions) (Wells, 2008). The meta-beliefs can be classified as positive meta-beliefs (such as ‘If I worry about all possibilities I can avoid failure’), which provide the motivation to engage in perseverative thinking, and negative meta-beliefs (e.g. ‘Worrying is uncontrollable’), which provide the motivation to employ a coping strategy to manage the perseverative thinking (Wells, 2008). An attentional bias towards threat cues and ineffective coping strategies are then linked to the maintenance of psychological disorders (Wells and Carter, 2009; Wells and Davies, 1994). While Well’s metacognitive model was initially developed to explain the pathology of anxiety and depression, more recent developments have shown the application of the model to other forms of psy- chopathology such as alcohol misuse (Spada et al., 2013) and eating disorders (Vann et al., 2013).
Our study has several limitations. First, heterosexual transmission was not discussed in our model, although 17 – 35% of Chinese MSM are married . Second, we only targeted up to 75% of high-risk MSM for PrEP. Targeting a larger percentage or expanding to low-risk MSM would lead to a higher impact on the HIV epidemic but a reduced cost-effectiveness. We chose the 75% coverage strategy because awareness of PrEP is low among Chinese MSM , and a targeted program aimed at high-risk MSM could be more achievable and feasible. Third, we also did not include false-positive results, resistance to ART, and adverse events of PrEP in our model, but unless extreme negative events happen during the intervention period, their effects on the impact of interventions are not likely to be substantial. Fourth, three of our PrEP scenarios (scenarios 5 – 7) include the assumption of high rates of voluntary counselling and testing, that might be infeasible in the current environment in China. However, to account for this we also considered three basic scenarios (scenarios 2 – 4) where PrEP was offered to high-risk MSM, but these MSM did not increase their testing rates to high levels. Even in these more realistic scenarios, we found PrEP was effective. Finally, our study used commonly-accepted cost-effectiveness thresholds of 1-3x per capita GDP for identifying which strategies would be cost-effective, but recent research has shown that these thresholds may not be appropriate for low- and middle-income countries, where use of these thresholds may lead to adoption of lower priority interventions . Using a proposed alter- native threshold for China of approximately 50% of GDP  would potentially change our conclusion regarding the cost-effectiveness of many of the interventions we considered, but even under this much stricter experimen- tal alternative cost-effectiveness threshold, the test-and- treat strategy, and test-and-treat with 25% PrEP, remain cost-effective. This shows the enormous public health po- tential of improved HIV interventions in China.
Chlamydia screening among HIV-infected MSM in care could have an impact on reducing HIV transmission, be- cause chlamydia infection may increase HIV infectivity. Moreover, chlamydia screening could be implemented during the existing visits of HIV-infected men at HIV treatment centres. To investigate the impact of such a program, we examined three hypothetical scenarios with different screening frequencies: every twelve months, every six months, or every four months. In these scenar- ios, it is assumed that: only HIV-infected MSM in care are screened; routine screening is added to (and not re- placing) the current opportunistic screening; participa- tion in the routine screening program is 100%, which means that all HIV-infected MSM in care are screened (and treated if positive) every twelve, six, or four months. The three scenarios are referred to as routine screening at HIV treatment centres; we present its impact on reducing HIV incidence in the whole MSM population.
higher in the vaccine arm, the lack of baseline antibody levels precludes a definite conclusion that the vaccine is immunogenic. The prevalence of patients with detectable antibody against HPV is lower than in a previous clinical trial carried-out in HIV MSM patients in whom 98% of the patients developed antibodies against the four HPV genotypes in the quadrivalent vaccine . These differ- ences could result from different assay sensitivities, and there is a lack of a standardized diagnostic test to meas- ure Ab of HPV in blood; the different study design in that trial limits direct comparison with this study; the clini- cal significance of antibodies following qHPV vaccination is not known. On the other hand, there is no established relationship between antibody titres and vaccine efficacy in EGL, anal intra-epithelial neoplasia, and cervix, vulva or vaginal cancer [25, 26]. The response rates in this study were lower than previously reported , though they Table 3 Baseline demographics of HIV-positive MSM enrolled in clinical trial
The level of education is one of the factors that play a role in influencing a person's decision to behave healthy. Someone who is highly educated will be less susceptible to the risk of being infected with HIV and AIDS compared to those whohave low education or drop out of school (Annisa & Harahap, 2011). Higher levels of education will make it easier for someone or community to receive information and implement it in daily life, especially in the health sector (Pratiwi 2015). MSM who study less than 12 years are at 2.12 times more likely to experience HIV seroconversion compared to MSM whohave studied more than 12 years (AHR = 2.12; 95% CI = 1.12-4.03; p = 0.02) (Li et al., 2012). But often higher education does not guarantee someone to apply good behavior. 65% of respondents have low education (Cowan & Haff 2008). 97.7% of respondents have low education (Kamilah & Hastono, 2014). This study is in line with previous studies showing that there was no statistically significant association between the level of education of MSM and the incidence of HIV (IRR = 1.48; 95% CI = 0.72-3.02) (Meireles et al., 2015). In this study the level of education does not always affect a person's health attitudes and behaviors where respondents who are highly educated also become MSM and diagnosed as HIVpositive. Peers here are very influential on a person's behavior such as respondents who are initially normal and friends with MSM are also affected so that unnatural sexual activities that result in addiction, become a necessity and ultimately impact HIV / AIDS. The level of risk of the spread of HIV infection in the community is quite varied depending on each job. The type of work has a role in causing disease (Notoatmodjo, 2012). Communities at risk for the spread of HIV infection are quite diverse such as jobs as laborers, drivers, freelancers and employers are more at risk of being seropositive to HIV than those who do not work (Agarwal et al. 2015). MSM who did not work more in the HIVpositive group (29%) than the HIV negative group (24%) (MacKellar et al., 2005). This research is in line with previous research which states that the proportion of unemployed HIVpositive groups (43.1%) is more than HIV negative (22%) and there is a relationship between employment status and HIV incidence in MSM (p = 0.02) OR = 2.69 (Logie et al. 2018). According to the research results, respondents who did not work were more at risk of getting HIV compared to people who worked. Some respondents
Isolates that were characterized as subclade F1 by PCR amplification and DNA sequencing of the pol-IN frag- ment but failed to be amplified by PCR using the L-pol specific primers suggested that these isolates may be recombinant viruses. To address this issue, forward pri- mers were used to amplify a 727-bp product (denoted as M-pol). These primers were able to amplify a broad range of HIV-1 variants including subtype B and F1. These primers were used in combination with the re- verse pol-IN primers in a nested PCR assay, using the same conditions described for the pol-IN PCR assay ex- cept for an annealing temperature at 55°C and a 2 mi- nute extension time. Both PCR assays, L-pol and M-pol, had a sensitivity of 25 and 15 copies per reaction, respectively. All assays were performed in duplicate for each fragment using the primer combinations shown in Table 2. Positive and negative controls (healthy donor PMNs) were included in each assay. Strict laboratory precautions were taken to avoid cross contamination. Specimens that had a clear amplification in each dupli- cate reaction were considered to be positive.
Although many advantages of HIV self tests are recognized in the literature, HIV self tests are still legally forbidden in the Netherlands. Opponents of HIV self tests argue against the use of HIV self tests without educated, professional counseling and support (Greensides, Berkelman, Lansky & Sullivan, 2003). According to them lay people might use HIV self tests inappropriately and might cause application errors (Walensky & Paltiel, 2006; Whellams, 2009). Concerns against approval of HIV self test further include consumers who might mi- sinterpret test results even though the test was appropriately conducted (Lee, Tan, Earnest, Seong, Tan, Leo, 2007). As reported by Haddow & Robbinson (2005) possible test errors such as false positive or false negative test results can “[…] dramatically impact people´s lives.” Psychological consequences from HIV self testing could not be treated when the users remain anonymous. Following up registration at public health authorities would not be guar- anteed. The financial costs that are connected to HIV self testing is also reported as a disad- vantage of HIV self tests, since some people are less motivated to pay for HIV testing (Colfax, Lehman, Bindman, Vittinghoff, Vranizan, & Fleming, 2002).
This also compares with a study in Zambia which found that 33% of the MSM self- reported infection with HIV, compared to a national adult HIV prevalence of 15.2% (Baral et al., 2009). However, according to UNAIDs (2009), Prevalence statistics indicated that 23 percent of MSM in Mombasa and 25 percent in Nairobi are HIVpositive. Most Sub-Saharan countries in this study have generalized HIV epidemics, but data on the proportion of cases among MSM is unknown. Further, 23% of the HIVpositive MSM were not under any treatment. This is due to high stigma and discrimination against MSM which hampers their ability to access and use life-saving HIV prevention and treatment services from formal health systems. Uptake of HIV services among MSM remains unsatisfying due to fear of discrimination and associated stigma. This agrees with another study (Gender dynamix, 2012) which reported that such a situation make HIV go undetected hence causing serial infections within the group and in general population due to existence of multiple female sexual partners.
8 Unreported deferrable risks were defined as transfusion-transmissible viral infection risk behaviours that would have de- ferred a prospective donor from giving blood if reported during the screening process. Unreported deferrable risks for men included: having a positiveHIV test, been diagnosed with AIDS, used injected drugs or illegal steroids [IDU], was born in a country where HIV-1 Group O viruses are endemic; since 1977, had sex with a man or has taken money or drugs for sex; in the past year had sex, with a prostitute, with an IDU, or with a recipient of clotting factor concentrates; or in the past year, had a positive test for syphilis, was treated for syphilis/gonorrhoea, had a blood transfusion, received a transplant, was struck by a sharp instrument or a needle that contained someone else’s blood, or was jailed for seventy-two continuous hours. Sanchez, supra note 30 at 06.
Although HIV-infected MSM in this study were in- volved in behaviors which were associated with a greater sexual risk, such as the use of party drugs, erectile dys- function medications and early first sexual debut, they were generally more compliant in using condoms with their HIV sero-discordant/unknown HIV-status partners, as also found in another study . However, they re- ported that they expected that the responsibility of using a condom would be shared by their partner/s. In cases in which the issue of HIV was not raised before sex, then HIV-infected MSM might have assumed that their partner was either careless or sero-concordant, and chose to perform UAI. Shifting the responsibility to the sex partner was found to be associated with additional risky sexual behaviors  and also with ‘sex on prem- ises venues’ or anonymous sex, when there are fewer bonds of social obligations, implying reciprocal care of the sexual encounter/s . The results of this study demonstrate the complexity of disclosure of their HIV status to their partners. On one hand, HIV-infected MSM are probably aware that they are morally and pos- sibly legally obliged  to inform their partner of their sero-status, or at least use a condom in anal sex, espe- cially if they are not treated or have not achieved un- detectable viral load. On the other hand, they are concerned that the HIV-uninfected partner/s may reject them upon disclosure or that their confidentiality is breached . HIV prevention should therefore include social support for HIV-infected MSM to encourage them to disclose their sero-status to their partner, or use a condom with HIV-discordant/unknown HIV-status part- ner/s to make personal responsibility more salient, or to adhere to their ART. Concomitantly, HIV-uninfected MSM should also be encouraged to raise the issue of HIV sero-status with their sex partner/s, and be in- formed that sex with HIV-infected partner/s is safe as long as proper biological or mechanical protection is used, rather than avoiding sex partners whose HIV sero- status is positive [14, 15].
The factor analysis of reasons for never having been tested for HIV (subject to item ratio 623/20 = 31) suggested that the twenty items should be grouped into nine factors (Table 4), the majority of which showed a low correlation between them. The nine-factor solution accounted for 89 percent of the variance in the data. Four of the factors were single-item factors. Two of these indicated that the participants did not consider themselves to need an HIV test: 1) no risk taking and 2) have not thought of it. The other two single-item factors were both related to a lack of easily accessible test services: 3) having been denied HIV test and 4) do not know where to get tested. For analytical purposes, these last two factors can be placed under the same umbrella as two other factors also relating to test service structure and availability: 5) concerns related to confidentiality and being recognized by staff or other visitors combined with not being monogamous (possibly related to the worries of being recognized by other visitors) and 6) test services’ locations and opening hours. The remaining three factors could all be associated with anxiety and fear related to a potential positive test result. Factor 7 comprised six items, including several items related to the participant’s own health but also to fear of social
Since most microbiome studies aimed at understand- ing gut microbiome differences with HIVhave not con- trolled for MSM behavior [14–16, 36–38], we still have an incomplete understanding of HIV-associated micro- biome characteristics. Many of the species and genera that we have found to be increased in MSM compared to non-MSM have been previously reported to differ with HIV in studies not controlled for MSM risk behavior including H. biformis , Prevotella [14–17], Catenibacterium [14, 15], and Desulfovibrio . Add- itionally, we confirm a prior report of an increase in alpha diversity in MSM . The high number of MSM in our previous HIV-positive cohorts is likely to be the driver of our previously reported result of an increase in alpha diversity with HIV . This significant increase in alpha diversity in MSM challenges popular opinion that higher alpha diversity always equates to a healthier gut microbiome, especially with preliminary results suggesting the MSM microbiome may be more inflam- matory . Unlike Noguera-Julian et al., we did not find a significant decrease in alpha diversity with HIV infec- tion status in MSM . However, the cohort with the lowest alpha diversity in that study were immunologic non-responders to ART (i.e., individuals with poor CD4 + T cell recovery after ART) and our current cohort had few individuals who would fit this definition.
Diagnosing individuals with HIV early after infection is 1 of the 4 pillars of the new federal “Ending the HIV Epidemic” initiative. 1 Diagnosis is the entry point to life-saving treatment, which can prevent HIV transmission if viral suppression to undetectable levels is sustained. 2 The Centers for Disease Control and Prevention (CDC) estimates that in the United States, 14.5% of all HIV infections are undiagnosed, but 51.4% of HIV- positive 13- to 24-year-olds are undiagnosed. 3 In this age range, 80% of estimated new infections occur among menwhohavesex with men (MSM). 3 Although there has been little epidemiological research on HIV incidence among adolescent menwhohavesex with men (AMSM), 2 studies suggest incidence is high, particularly among African American and
The HSS in India was carried out in representative popula- tions among various subgroups, including female sex workers (FSWs), MSM, IDUs, and patients attending STI clinics. Although the first HSS was conducted in the year 1985 by the Indian Council of Medical Research, the formal annual survey among high-risk groups started in 1998, after the National AIDS Control Organization (NACO) implemented it as part of monitoring the national level program. MSM sites were first included in the HSS in the year 2003 at three dif- ferent locations. These surveillance sites were increased to 98 by the year 2010. The target sample size for the surveillance was set at 250 MSMs at each sentinel site (usually held during June to August every year). Respondents for the surveillance are usually drawn from one of the following service points located in each of the sites: deaddiction centers, drop-in cen- ters, and nongovernmental organization (NGO) clinics. With coverage of over 85% of the MSM population by the year 2006–07, little may be the bias with regard to generalization of the MSM epidemic using HSS data. However, for cor- roboration of HIV prevalence estimated using annual HSS, other data sources such as external surveys involving HIV testing, mapping of the populations, and factors associated with HIV risk among MSM are crucial.