High risk sexual behaviours associated with traditional beliefs about gender roles among men interested in medical male circumcision in South Africa

Background Beliefs about gender roles and high-risk sexual behaviours underlie the human immunodeficiency virus (HIV) epidemic in South Africa. Yet, there is limited information on the relationships between beliefs about gender roles and risky sexual behaviours. Few studies have explored the association between beliefs about gender roles, high risk sexual behaviour, and health-seeking behaviour among men. Methods We investigated associations between gender beliefs (dichotomised as traditional or progressive) and high-risk sexual behaviour among South African men presenting for medical male circumcision (Apr 2014 to Nov 2015). Results Of 2792 enrolled men, 47.4% reported traditional gender beliefs. Participant ages ranged between 18–46 years (median age 26 years; interquartile range, 21–31 years). Most participants had at least one sex partner over the last 12 months (68.2%). Younger men (18–24 years old vs. 25–46 years old) (odds ratio [OR], 1.5 [95% confidence interval (CI) 1.0–2.0]), those with multiple partners ([OR], 1.5 (CI) 1.3–1.8]) and participants unsure of their last partner’s HIV status (OR, 1.4 [95% CI 1.1–1.7]) were more likely to have traditional beliefs on gender roles. Conclusion Young men with traditional beliefs on gender roles may be more likely to engage in high-risk sexual behaviour and could be good candidates for HIV prevention programmes. N = 206 (max 350) Trial registration Name of registry: Clinicaltrials.gov; Trial registration number: NCT02352961; Date of registration: 30 January 2015 “Retrospectively registered”; URL of trial registry record: https://www.clinicaltrials.gov/

Impact of victimization during youth on adult high-risk sexual behaviour among gay and bisexual men

Based on the minority stress model, this study examines the impact of general and gay-specific childhood teasing on adult high-risk sexual behaviour among gay and bisexual men, mediated by depression and social anxiety. High-risk sexual behaviour was operationalized as the number of acts of unprotected anal intercourse with a partner of opposite or unknown HIV status, and also as the number of partners of opposite or unknown HIV status with whom an individual engaged in unprotected anal intercourse. Depression, social anxiety, and retrospective self-report of childhood teasing were measured at baseline, and sexual behaviour was measured at 6-month follow-up. Results indicate that gay-specific teasing, but not general teasing, was indirectly associated with number of high-risk sex acts via depression. Additionally, both types of teasing were directly associated with number of high-risk sex partners after accounting for depression and social anxiety.

Impact of victimization during youth on adult high-risk sexual behaviour among gay and bisexual men

Based on the minority stress model, this study examines the impact of general and gay-specific childhood teasing on adult high-risk sexual behaviour among gay and bisexual men, mediated by depression and social anxiety. High-risk sexual behaviour was operationalized as the number of acts of unprotected anal intercourse with a partner of opposite or unknown HIV status, and also as the number of partners of opposite or unknown HIV status with whom an individual engaged in unprotected anal intercourse. Depression, social anxiety, and retrospective self-report of childhood teasing were measured at baseline, and sexual behaviour was measured at 6-month follow-up. Results indicate that gay-specific teasing, but not general teasing, was indirectly associated with number of high-risk sex acts via depression. Additionally, both types of teasing were directly associated with number of high-risk sex partners after accounting for depression and social anxiety.

Moth-Eaten Essential Syphilitic Alopecia in Human Immunodeficiency Virus-Positive Patient: A Case Report

Hair loss is rare to be reported as sole manifestation of secondary syphilis. Syphilitic alopecia consists of symptomatic syphilitic alopecia that presents with other secondary syphilis manifestation, and essential syphilitic alopecia which can be patchy ("moth-eaten" type), diffuse, or combination without other manifestations of secondary syphilis. Here we report a case of secondary syphilis in patient with Human Immunodeficiency Virus (HIV) that present with moth-eaten alopecia as a sole manifestation. A 35-year-old male with HIV complained hair loss on his scalp and eyebrows. Physical examination showed non scarring moth-eaten alopecia on his scalp and lossof lateral third of his eyebrows without other lesions. Serological test for syphilis was positive. He was treated with 2.4 millions unit of benzathine penicillin G (BPG), single dose intramuscular injection. Six months after injection, patient showed clinical and serological improvement. Syphilitic alopecia cannot be ruled out in patients with non scarring hair loss with unclear etiology. Serological tests are recommended especially for patients with history of high risk sexual behaviour.

The Rhythm of Risk: Sexual Behaviour, PrEP Use and HIV Risk Perception Between 1999 and 2018 Among Men Who Have Sex with Men in Amsterdam, The Netherlands

HIV risk perception plays a crucial role in the uptake of preventive strategies. We investigated how risk perception and its determinants changed between 1999 and 2018 in an open, prospective cohort of 1323 HIV-negative men who have sex with men (MSM). Risk perception, defined as the perceived likelihood of acquiring HIV in the past 6 months, changed over time: being relatively lower in 2008–2011, higher in 2012–2016, and again lower in 2017–2018. Irrespective of calendar year, condomless anal intercourse (AI) with casual partners and high numbers of partners were associated with higher risk perception. In 2017–2018, condomless receptive AI with a partner living with HIV was no longer associated with risk perception, while PrEP use and condomless AI with a steady partner were associated with lower risk perception. We showed that risk perception has fluctuated among MSM in the past 20 years. The Undetectable equals Untransmittable statement and PrEP coincided with lower perceived risk.

Evaluating the Effectiveness of Incentives to Improve HIV Prevention Outcomes for Young Females in Eswatini: Sitakhela Likusasa Impact Evaluation Protocol and Baseline Results

Background: Eswatini continues to have the highest prevalence of HIV in the world, and one of the highest HIV incidences among adult populations (aged 15-49). This analysis reports on both key elements of study design/protocol and baseline results from an impact evaluation of an intervention incentivizing (i) initiation, enrolment, attendance or completion of some form of education, and (ii) lower risk sexual behaviour. Methods: The impact evaluation employs a two by two factorial design in which participants are enrolled in either the incentive for education arm (‘education treatment arm’ providing a conditional cash incentive) or the control arm (‘education control arm’). In each of these arms, 50% of participants were randomized to also be eligible for selection – three times a year – to participate in a conditional raffle conditional on testing negative for curable STIs (syphilis and Trichomonas vaginalis). Results: Baseline recruitment and screening occurred in 2016 when a total of 6,055 individuals were screened of which 4,863 participated in the baseline survey, and 4,819 individuals were randomized into one of the study arms. The baseline prevalence of HIV, Trichomonas vaginalis, and syphilis among adolescent girls and young women 8.20% (397/4,840), 3.31% (150/4,533) and 0.17% (8/4,830) respectively. Conclusions: An educational cash incentive and raffle incentive impact evaluation that addresses adolescent girls and young women who are in-education and out-of-education has the potential to reduce HIV risk in adolescent girls and young women in Eswatini.Name of the registry: Pan African Clinical Trials RegistryTrial registration number: PACTR201811609257043Date of registration: May 11, 2018 ‘Retrospectively registered’URL of trial registry record: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=4685

Evaluating the Effectiveness of Incentives to Improve HIV Prevention Outcomes for Young Females in Eswatini: Sitakhela Likusasa Impact Evaluation Protocol and Baseline Results

Background: Eswatini continues to have the highest prevalence of HIV in the world, and one of the highest HIV incidences among adult populations (aged 15-49). This analysis reports on both key elements of study design/protocol and baseline results from an impact evaluation of an intervention incentivizing (i) initiation, enrolment, attendance or completion of some form of education, and (ii) lower risk sexual behaviour. Methods: The impact evaluation employs a two by two factorial design in which participants are enrolled in either the incentive for education arm (‘education treatment arm’ providing a conditional cash incentive) or the control arm (‘education control arm’). In each of these arms, 50% of participants were randomized to also be eligible for selection – three times a year – to participate in a conditional raffle conditional on testing negative for curable STIs (syphilis and Trichomonas vaginalis). Results: Baseline recruitment and screening occurred in 2016 when a total of 6,055 individuals were screened of which 4,863 participated in the baseline survey, and 4,819 individuals were randomized into one of the study arms. The baseline prevalence of HIV, Trichomonas vaginalis, and syphilis among adolescent girls and young women 8.20% (397/4,840), 3.31% (150/4,533) and 0.17% (8/4,830) respectively. Conclusions: An educational cash incentive and raffle incentive impact evaluation that addresses adolescent girls and young women who are in-education and out-of-education has the potential to reduce HIV risk in adolescent girls and young women in Eswatini.Name of the registry: Pan African Clinical Trials RegistryTrial registration number: PACTR201811609257043Date of registration: May 11, 2018 ‘Retrospectively registered’URL of trial registry record: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=4685

Evaluating the Effectiveness of Incentives to Improve HIV Prevention Outcomes for Young Females in Eswatini: Sitakhela Likusasa Impact Evaluation Protocol and Baseline Results

Background: Eswatini continues to have the highest prevalence of HIV in the world, and one of the highest HIV incidences among adult populations (aged 15-49). This analysis reports on both key elements of study design/protocol and baseline results from an impact evaluation of an intervention incentivizing (i) initiation, enrolment, attendance or completion of some form of education, and (ii) lower risk sexual behaviour. Methods: The impact evaluation employs a two by two factorial design in which participants are enrolled in either the incentive for education arm (‘education treatment arm’ providing a conditional cash incentive) or the control arm (‘education control arm’). In each of these arms, 50% of participants were randomized to also be eligible for selection – three times a year – to participate in a conditional raffle conditional on testing negative for curable STIs (syphilis and Trichomonas vaginalis). Results: Baseline recruitment and screening occurred in 2016 when a total of 6,055 individuals were screened of which 4,863 participated in the baseline survey, and 4,819 individuals were randomized into one of the study arms. The baseline prevalence of HIV, Trichomonas vaginalis, and syphilis among adolescent girls and young women 8.20% (397/4,840), 3.31% (150/4,533) and 0.17% (8/4,830) respectively. Conclusions: An educational cash incentive and raffle incentive impact evaluation that addresses adolescent girls and young women who are in-education and out-of-education has the potential to reduce HIV risk in adolescent girls and young women in Eswatini.

PrEPping for a healthier future – a concise update of current pharmacological HIV-prophylaxis practices

Pre-exposure prophylaxis (PrEP) refers to the use of antiretroviral drugs to prevent one from acquiring human immunodeficiency virus (HIV) infection when engaging in high-risk sexual behaviour. Adequate PrEP initiation is key in the clinical outcome and survival of not only vulnerable and high-risk populations, but also to ensure that a society which is free of HIV, is built.