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Background: Men who have sex with men (MSM) in China have a high risk for HIV infection but experience suboptimal rates of HIV testing and service engagement due to various social and structural barriers. We developed a mobile health (mHealth) intervention entitled "WeTest-Plus" (WeTest+) as a user-centered "one-stop service" approach for delivering access to comprehensive information about HIV risk, HIV self-testing, behavioral and biomedical prevention, confirmatory testing, treatment, and care., Objective: The goal of the current study was to investigate the feasibility of WeTest+ to provide continuous HIV services to high-risk MSM., Methods: Participants completed a 3-week pilot test of WeTest+ to examine acceptability, feasibility, and recommendations for improvement. Participants completed a structured online questionnaire and qualitative exit interviews facilitated by project staff. "Click-through" rates were assessed to examine engagement with online content., Results: 28 participants were included, and the average age was 27.6 years (standard deviation = 6.8). Almost all participants (96.4%) remained engaged with the WeTest+ program over a 3-week observational period. The majority (92.9%) self-administered the HIV self-test and submitted their test results through the online platform. Overall click-through rates were high (average 67.9%). Participants provided favorable comments about the quality and relevance of the WeTest+ information content, the engaging style of information presentation, and the user-centered features., Conclusion: This pilot assessment of WeTest+ supports the promise of this program for promoting HIV self-testing and linkage to in-person services for MSM in China. Findings underscore the utility of a user-centered approach to mHealth program design., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objectives: Some of community mitigation efforts on COVID-19 created challenges to ongoing public health programs, including HIV care and prevention services among men who have sex with men (MSM). The goal of the current study was to explore sociodemographic factors and the impact of COVID-19 on HIV testing among Chinese MSM during state-enforced quarantine., Methods: We conducted a community based survey between May 1st to June 30th, 2020 on COVID-19 related impacts on HIV testing among 436 China MSM during the COVID-19 state-enforced quarantine., Results: One-third (33.7%) of MSM received HIV testing during the quarantine period. Few participants reported difficulty accessing facility-based testing (n = 13, 3.0%) or obtaining HIV self-test kit online (n = 22, 5.0%). However, 12.1% of participants reported being afraid of getting facility-based HIV test due to concerns about the risk of COVID-19. In the multivariate logistic regression model, participants who were married (aOR: 1.89, 95%CI: 1.19-3.01), reported increased quality of sleep (aOR: 2.07, 95%CI: 1.11-3.86), and increased difficulty in accessing health care (aOR: 2.34, 95%CI: 1.37-3.99) were more likely to get an HIV test during the state-enforced quarantine., Conclusion: The mitigation measures of COVID-19 have created various barriers to access HIV related prevention services in China, including HIV testing. To mitigate these impacts on HIV prevention and care services, future programs need to address barriers to HIV-related services, such as providing high-quality HIV self-testing. Meanwhile, psychological services or other social services are needed to those experiencing mental distress., Competing Interests: The authors have declared that no competing interests exist.

Background: People involved in the criminal justice system (PICJS) are at a disproportionate risk for HIV infection. Pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention; however, there are barriers to accessing and remaining on PrEP. We explored perspectives on partnering with a community health worker (CHW) to link PICJS to PrEP., Methods: We interviewed PICJS (n=21) and relevant stakeholders (n=15)., Results: The following themes emerged: 1) All participants were receptive to the idea of a CHW program and believed it would be valuable; 2) the PICJS participating in the CHW program would need immediate contact post-release and continuous follow-up with the CHW; 3) desirable program components included HIV education and information about PrEP; 4) participants mentioned several facilitators and barriers to successfully implementing the CHW program; and 5) the CHW needs to be relatable., Conclusion: Our findings suggest that a PrEP linkage program facilitated by a CHW would be desirable.

This research qualitatively explored user preferences for an app-based mHealth approach to support HIV self-testing and linkage to HIV prevention or care services developed for men who have sex with men (MSM) in China. We conducted 12 online focus group discussions with MSM participants (N = 48) about their preferences for using an app to meet their HIV self-testing and service linkage needs. Data were examined using thematic analysis. Participants specified four domains to align program delivery with their preferences for app-based intervention: (1) expanding HIV prevention/antiretroviral therapy concepts beyond basic knowledge; (2) enhancing the style and presentation of app-based messages; (3) incorporating interactive and dynamic app-engagement features; and (4) creating a "one station" app that covers the continuum of HIV services. Given the changing landscapes of HIV knowledge and community/user preferences for app-based interaction, findings underscore how engagement with end-user participants is essential to optimize mHealth interventions for HIV.

This study investigates PrEP willingness, adherence self-efficacy and potential impact of PrEP among HIV-negative, Chinese men who have sex with men (MSM; n = 622) with recent condomless anal sex. Facilitative factors of PrEP willingness included migrant status, sexual risk, and prior PrEP use, whereas barriers included concerns over being treated as an HIV/AIDS patient, recent HIV testing, identity concealment, and HIV prevention service usage. Adherence self-efficacy was associated with PrEP knowledge and confidence in PrEP efficacy of HIV prevention. A total of 39.3% anticipated increase in sex partners, 25.6% anticipated decrease in condom use, and 38.0% anticipated increased HIV testing following PrEP uptake. Results suggest a two-step approach to (1) promote PrEP acceptance among Chinese MSM and (2) enhance adherence and risk monitoring among PrEP-willing MSM. Efforts to reduce stigma, incorporate PrEP in the HIV prevention continuum, and increase PrEP knowledge will be crucial to optimize PrEP implementation., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Non-Hispanic Black/African American men who have sex with men (AAMSM) have been disproportionately affected by criminal justice (CJ) involvement and HIV. One potential pathway between CJ involvement and high HIV prevalence and incidence among AAMSM is through risky sexual behavior. The goal of this study was to explore the association between recent CJ involvement, i.e., having been arrested and/or in prison/jail in the past 6 months, and transactional sex in a sample of AAMSM in Baltimore. We analyzed the baseline data of 396 AAMSM from a pilot behavioral HIV intervention conducted in Baltimore, MD, between October 2012 and November 2015. A multivariate logistic regression model was conducted to explore the association between recent CJ involvement and transactional sex. A total of 65 (16%) participants reported recent CJ involvement, and 116 (29%) reported transactional sex in the past 90 days. After adjusting for age, education, employment, sexual identity, HIV status, and drug use, recent CJ involvement was significantly associated with transactional sex (AOR 3.31; 95% CI 1.72; 5.70). Being 24-40 years (AOR 2.73; 95% CI 1.17, 6.33) or over 40 years older (AOR 3.80; 95% CI 1.61, 8.98) vs. younger and using drugs (AOR 4.47; 95% CI 2.43, 8.23) also remained independently associated with recent transactional sex. Findings of the current study contribute to the literature on the association between recent history of CJ involvement and transactional sex among AAMSM. More evidence-based HIV prevention interventions for people involved in the CJ system who are at high risk for contracting HIV, particularly racial and sexual minorities such as AAMSM, are urgently needed.

Objective: To understand the actual needs for the pre-exposure prophylaxis (PrEP) for HIV infection and the factors hindering PrEP utilization in men who have sex with men (MSM). Methods: Participants were recruited by using MSM social application software Blued 6.5.0 and through MSM peer referral, sample size was 600. An electronic questionnaire survey was conducted anonymously with guidance of investigators via "Questionnaire Star" platform. The contents of the survey included demographic characteristics of the participants, the awareness of PrEP related knowledge, willingness and concerns about using PrEP, actual need for PrEP and self-efficacy of using PrEP. Results: A total of 622 MSM completed the survey, of whom 56.4 % (351/622) and 4.3 % (27/622) ever heard of and received PrEP, respectively. The need assessment of PrEP showed that 67.2 % (418/622) of the participants had actual needs for PrEP and 21.2 % (132/622) used PrEP with good self-efficacy. Structural equation modeling analysis showed that the awareness of PrEP related knowledge and concerning about PrEP utilization in MSM played a direct positive role in their self-efficiency of using PrEP, and the effect coefficients were 0.08 and 0.13, respectively. MSM self-discrimination indirectly affected the self-efficiency of using PrEP through concerns about PrEP use, the effect coefficient was 0.035. The result of generalized linear mixed model analysis demonstrated that the utilization of PrEP can improve the self-efficacy of using PrEP ( OR =5.55), which increased by 0.14 times and 0.07 times with the increase of 1 score of the awareness of PrEP related knowledge and concern about using PrEP respectively. In addition, this survey found that in the participants, the main concerns about using PrEP were side effects, HIV prevention effect and its expense, accounting for 61.1 % (380/622), 60.1 % (374/622) and 53.2 % (331/622), respectively. Most participants hoped to obtain PrEP services from CDC, MSM social organization and internet, accounting for 75.6 % (470/622), 65.4 % (407/622), and 63.8 % (397/622), respectively. Conclusions: MSM showed difference of high need but low utilization of PrEP services. Low awareness of PrEP related knowledge, concerns about the prevention effect, side effects and expense of PrEP as well as self-discrimination were the factors hindering the use of PrEP in MSM. It is necessary to establish a suitable PrEP service model to meet the needs for PrEP in MSM.

Pre-exposure prophylaxis (PrEP) may be an effective approach to prevent HIV among people who are currently incarcerated or who have been recently released from incarceration. However, awareness and interest in PrEP are largely unknown in this population. This study assessed 417 incarcerated men's lifetime HIV risk engagement and gauged their interest and willingness to take PrEP. Twenty percent reported ever injecting drugs and 4% ever having sex with a man without a condom; 88% had never heard of PrEP. More White men had heard of PrEP, but higher percentages of men of color were interested in learning more about PrEP and willing to take PrEP to prevent HIV. Future interventions should focus on PrEP education and uptake among individuals who are incarcerated.

This study tested a mobile health (mHealth) intervention program entitled WeTest, delivered via the WeChat mobile app, to promote oral HIV self-testing (HIVST) among MSM in Hefei, China. A total of 100 MSM participants enrolled, completed baseline assessment, were randomly assigned to intervention or control, and completed 6-month follow-up surveys. Intervention participants (n = 50) received two oral HIVST kits and access to WeTest, a private WeChat group which provided app-based messages and referrals to health services related to HIV. Control participants (n = 50) received two oral HIVST kits only. All participants received instructions to upload photographic results of their oral HIVST, which were sent to the project counselor via a secure WeChat online portal; immediate contact and referrals were made to any participants who tested HIV-positive. In GEE analyses adjusting for time effects and baseline confounders, intervention participants had significantly higher rates of HIV testing (adjusted rate ratio RR = 1.99, 95% confidence interval (CI) 1.07-3.84) and, in particular, higher rates of testing via oral HIVST (adjusted RR = 2.17, 95% CI 1.08-4.37) compared with the control group. Significant time effects were also found such that all participants, regardless of group allocation, had significantly higher rates of reporting consistent condom use with main partners (adjusted RR = 18.13, 95% CI 5.19-63.31) and with non-main partners (adjusted RR = 5.33, 95% CI 2.35-12.08). Findings from this study provide evidence for the feasibility, acceptability and preliminary effects of this mHealth approach to promoting oral HIVST among MSM in China.

Background: HIV self-testing (HIVST) has demonstrated potential to expand HIV testing among key populations, including men who have sex with men (MSM) in China who have low testing rates. However, due to the autonomous nature of self-testing, people who undergo HIVST may lack access to relevant information and counseling support typically provided by in-person HIV testing counselors. WeChat, a popular smartphone application in China, offers a potential source of mobile health (mHealth) information and support for individuals using HIVST. This paper aimed to explore the opinions of MSM in China about the feasibility and potential concerns of using WeChat to support HIVST and reduce risk for HIV infection., Methods: We conducted in-depth interviews with 36 MSM about their mobile smartphone usage and the use of WeChat for helping MSM self-administer HIVST kits in Hefei, China. Each interview was digitally recorded and transcribed. Transcripts were analyzed used content analysis method according to Elo and Kyngas., Results: MSM described their use of WeChat and expressed cautious endorsement about using this platform to promote HIVST and disseminate HIV-related information. They described their preferences about the implementation features of an mHealth intervention to promote HIVST, including the delivery source of intervention messages, as well as message timing, frequency, form, tone, and content. Participants also described privacy-related concerns about receiving messages via WeChat and offered potential solutions., Conclusions: Findings from this study show the potential utility of WeChat app-based messaging for engaging MSM in HIV self-testing and prevention. Future research is needed to integrate the concerns expressed in this analysis and evaluate a WeChat-based intervention to promote oral HIV self-testing, risk reduction, and health promotion among MSM in China.

Purpose of Review: We reviewed the HIV and opioid literature relevant to harm reduction strategies for those with criminal justice experience., Recent Findings: Opioid use in the United States has risen at an alarming rate recently. This has led to increased numbers of people who inject drugs, placing new populations at risk for HIV, including those who have criminal justice experience. In recent years, there has been a gradual decrease in the number of individuals under the supervision of the criminal justice system. However, concurrently, there has been a rise in the number of individuals incarcerated in jails in rural counties that are at the center of the current opioid epidemic. We provide a number of harm reduction strategies that could be implemented in correctional settings such as access and linkage to medication-assisted treatment, connection to syringe exchange programs and safe injection facilities (where available), and the repackaging of pre-exposure prophylaxis as a harm reduction tool.

An estimated one in seven HIV-infected individuals pass through U.S. correctional facilities each year. Transitioning from correctional to community settings may increase HIV treatment interruptions and increase the risk of continued HIV transmission in the community. This study assessed access to HIV providers in the community, antiretroviral treatment, and viral suppression to inform the development of interventions to improve HIV treatment outcomes among individuals involved in community corrections. The sample included 100 individuals under community supervision (probation or parole) in Baltimore, Maryland. While a large proportion of the study sample had undetectable HIV viral loads, 39% did not, and this represents a significant HIV transmission risk. Given the large proportion of individuals involved in the criminal justice system who are under community supervision, community corrections may be an important point of intervention to engage or reengage HIV-positive individuals who are currently out of care.

Sexual behavior is the dominant mode of HIV transmission in China, and young female migrants are among the populations at highest risk. This article examines how HIV-related risk behaviors among female migrants might vary according to workplace settings. Participants were young female migrants recruited from three workplace settings-factories, restaurants and entertainment venues. In a cross-sectional survey, we assessed 457 participants' sociodemographic characteristics, HIV/AIDS-related knowledge, condom use knowledge, sexual behaviors, condom use behavior and reproductive health factors. Participants working in entertainment venues were significantly more likely than those working in factories and restaurants to report sexual behavior, unprotected sex, multiple pregnancy terminations and sexually transmitted infections (STI). However, participants working in factories and restaurants reported significantly lower levels of HIV/AIDS knowledge, condom use knowledge, condom use self-efficacy and history of HIV/AIDS counseling and testing. Independent correlates of unprotected sex included employment in an entertainment venue, abortion history and sexual self-efficacy. Independent correlates of STI or genitourinary tract infection included employment in an entertainment venue, abortion history, recent migration and recent unprotected sex. These findings indicate a need for sexual and reproductive health interventions prioritizing young female migrants, and call for programs that can be incorporated into different workplace settings., (© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Previous studies have reported that approximately 30% of men who have sex with men (MSM) in China have concurrent female partners. Men who have sex with men and women (MSMW) might "bridge" HIV transmission to their female sex partners. This study aimed to explore (a) motivations for why MSMW in China engage in relationships and sexual behaviors with female partners; (b) patterns of sexual behaviors and condom use between MSMW and their female partners; and (c) barriers to and strategies for encouraging MSMW and their female partners to undergo HIV testing. The authors conducted in-depth interviews with 30 MSMW in two urban cities in China, Guangzhou and Chengdu, and used thematic analysis methods to code and interpret the data. MSMW described family, social, and workplace pressures to have a female partner, and expressed futility about their ability to form stable same-sex relationships. Although participants reported concern about the risk of personally acquiring and transmitting HIV or other sexually transmitted infections (STIs) to their female partners, they described the challenges to using condoms with female partners. HIV-positive participants described how stigma restricted their ability to disclose their HIV status to female partners, and HIV-negative participants displayed less immediate concern about the need for female partners to undergo HIV testing. Participants described a range of possible strategies to encourage HIV testing among female partners. These findings highlight the urgent need for HIV risk reduction and testing interventions for Chinese MSMW in the context of heterosexual partnerships, and they also underscore the additional need for privacy and cultural sensitivity when designing future studies.

This study evaluates the prevalence of mental/emotional distress and its specific correlates among people living with HIV/AIDS (PLWHA) in 20 jail systems across the United States. Of the 878 PLWHA jail detainees, 52% had high levels of mental/emotional distress, defined by the composite Addiction Severity Index score. High mental/emotional distress was found to be associated with the inmate living in a city with lower income inequality, lower health ranking, and higher degree of danger. Proximate variables included being female, bisexual orientation, poorer physical health, and increased severity of substance abuse. Inmates in jails with accredited health services and those satisfied with family support had lower mental/emotional distress scores. These findings indicate the need for expanded mental health assessment of PLWHAs entering jail., (© The Author(s) 2015.)

Objectives: We sought to assess 6-month outcomes for HIV-infected people released from New York City jails with a transitional care plan., Methods: Jail detainees in New York City living with HIV who accepted a transitional care plan during incarceration were asked to participate in a multi-site evaluation aimed at improving linkages to community-based care. The evaluation included a 6-month follow-up; HIV surveillance data were used to assess outcomes for those considered lost to follow-up., Results: Participants (n=434) completed baseline surveys during incarceration in a jail in New York City. Of those seen at 6 months (n=243), a greater number were taking antiretroviral medications (92.6% vs 55.6%), had improved antiretroviral therapy adherence (93.2% vs 80.7%), and reported significant reductions in emergency department visits (0.20 vs 0.60 visits), unstable housing (4.15% vs 22.4%), and food insecurity (1.67% vs 20.7%) compared with baseline., Conclusions: Transitional care coordination services facilitate continuity of care and improved health outcomes for HIV-positive people released from jail.

Background: Ukraine has the highest HIV burden of any European country with much of the current HIV epidemic concentrated among people who inject drugs (PWIDs) and their sexual partners. Opiate substitution therapy (OST) is limited in Ukraine and expansion of OST is urgently needed to help stem the tide of the HIV epidemic., Methods: We accessed publicly available data in Ukraine in order to explore geographic variability with respect to prevalence of HIV, PWIDs and OST programmes., Results: The regions of Ukraine with the largest number of opioid dependent persons (the south and eastern portions of the country) correspond to the regions with the highest HIV prevalence and HIV incidence. The number of opioid PWIDs per 100,000 population as well as the number of all OST treatment slots per 100,000 varied significantly across the three HIV prevalence categories. Overall, the proportion of individuals receiving either methadone maintenance therapy (MMT) or buprenorphine maintenance therapy (BMT) was quite low: average across categories: 7.3% and 0.4%, respectively. Additionally, less than half of OST patients receiving MMT or BMT were HIV positive patients., Conclusion: There is significant geographic variability in both numbers of HIV positive individuals and numbers of PWIDs across Ukraine, however, there may be a more concentrated epidemic among PWIDs in many regions of the country. Scale up of addiction treatment for PWID, especially OST, can have a significant impact on preventing injection related morbidity, such as HIV and HCV infection. Ukraine can learn from the mistakes other nations have made in denying critical treatment opportunities to PWID., (Copyright © 2014 Elsevier B.V. All rights reserved.)

China has experienced a surge in internal migration during the past decade, and migrant populations have been identified as a high-risk group for HIV and other sexually transmitted infections (STIs). Young female migrants often find employment in entertainment venues (bars, karaoke parlors, and massage parlors) located in metropolitan cities, and sex work transactions frequently occur in these venues. We examined factors associated with risk for HIV, other STIs, and reproductive health challenges in a cross-sectional study of 358 young female migrants, ages 18-29, working in entertainment venues in a rapidly growing urban city in China. Results indicate high levels of behavioral risk for HIV and other STIs, low rates of HIV testing, and high prevalence of problem drinking and mental health problems, including recent depression symptoms and suicidal ideation. Factors associated with increased STIs and genitourinary tract infections included commercial sex work, early sexual debut, abortion history, illicit drug use, and anxiety. Factors associated with increased HIV testing included employment in an affluent entertainment venue, education level, knowledge about where to obtain free HIV tests, condom use, and general HIV/AIDS knowledge. Findings of this study highlight the insufficient coverage of current public health services to female migrants working in entertainment venues and call for more assertive prevention interventions to mitigate risk for sexual, reproductive, behavioral, and mental health problems in this mobile population.

The aims of this study were to understand the prevalence and correlates of syphilis infection among HIV-positive men who have sex with men (MSM) in Shanghai, China. A total of 200 HIV-positive MSM participants were recruited using "snowball" sampling. Participants were tested for syphilis and completed a one-time questionnaire which included demographic characteristics, sexual behaviours with male and female sexual partners, substance use, and use of antiretroviral medications. Prevalence of syphilis infection was 16.5%. Among HIV/syphilis co-infected participants, 63.6% reported having anal sex with male partners and 24.2% did not use condoms consistently during the past six months; 66.7% reported having oral sex with male partners and 51.5% reported unprotected oral sex during the past six months. Factors associated with testing seropositive for syphilis infection included receptive anal sex with a male partner in the past six months (AOR = 12.61, 90% CI = 2.38-66.89), illicit drug use in the past six months (AOR = 11.47, 90% CI = 2.47-53.45), and use of antiretroviral medication (AOR = 4.48, 90% CI = 1.43-14.05). These data indicate a need for "positive prevention" interventions targeting HIV-positive MSM in China.

In the wake of new recommendations to offer HIV screening to everyone aged 13-64 years and to start all people living with HIV/AIDS on highly active antiretroviral therapy (HAART) regardless of CD4 count, the need to generate widespread, scalable HIV screening programs is greater than ever. Nearly 50,000 new HIV infections occur in the United States each year, and the Centers for Disease Control and Prevention estimates that approximately half of these new infections are transmitted by individuals who are unaware of their HIV serostatus. Numerous barriers to screening exist, including the lack of primary care for many at-risk patients, expense of screening in traditional settings, and need for repeat testing in high-risk populations. With their relative accessibility and affordability, community pharmacies and retail clinics within those pharmacies are practical and appealing venues for expanded HIV screening. For widespread pharmacy-based testing to become a reality, policymakers and corporate pharmacy leadership would need to develop innovative solutions to the existing time pressures of pharmacists' behind-the-counter functions and absence of reimbursement for direct patient care services. Pharmacists nationwide should also receive training to assist with risk reduction counseling and linkage to care for customers purchasing the new over-the-counter HIV test.

HIV testing in jails has provided public health officials with the opportunity to not only identify new cases of HIV but to also reestablish contact with previously diagnosed individuals, many of whom never entered care following diagnosis or entered care but then dropped out. The presence of inmates throughout the HIV/AIDS continuum of care suggests that jails can play a strategic role in engaging persons living with HIV and AIDS in care. In order to be successful in structuring HIV/AIDS programs in jails, health care and correctional officials will be well-served to: (1) understand the HIV/AIDS continuum of care from the standpoint of engagement interventions that promote participation; (2) be aware of jail, community, and prison interventions that promote engagement in care; (3) anticipate and plan for the unique barriers jails provide in implementing engagement interventions; and, (4) be creative in designing engagement interventions suitable for both newly and previously diagnosed individuals.

To better understand the behavioural characteristics and the factors associated with high risky behaviours among men who have sex with men and women (MSMW) with different orientation, we analyzed data from a cross-sectional survey of 600 MSMW in two large cities in China. Participants completed a questionnaire and underwent serological testing. Overall, human immunodeficiency virus (HIV) prevalence was 26%. In multivariable analysis of risk factors for unprotected anal intercourse in the past six months, factors associated with unprotected vaginal intercourse (UVI) were as follows: gay-identified orientation, having anal sex with a boyfriend, having multiple male partners, and never or sometimes using a condom for vaginal intercourse. In multivariate analyses of risk factors for UVI in the past 12 months, factors associated with UVI were as follows: non-gay-identified MSMW, having multiple male partners, having multiple female partners, and never or sometimes using a condom for anal intercourse. This study revealed a high prevalence of HIV and risky sexual behaviours.

HIV and substance use are inextricably intertwined. One-sixth of people living with HIV/AIDS (PLWHA) transition through the correctional system annually. There is paucity of evidence on the impact of substance use disorders on HIV treatment engagement among jail detainees. We examined correlates of HIV treatment in the largest sample of PLWHA transitioning through jail in 10 US sites from 2007 to 2011. Cocaine, alcohol, cannabis, and heroin were the most commonly used substances. Drug use severity was negatively and independently correlated with three outcomes just before incarceration: (1) having an HIV care provider (AOR = 0.28; 95 % CI 0.09-0.89); (2) being prescribed antiretroviral therapy (AOR = 0.12; 95 % CI 0.04-0.35) and (3) high levels (>95 %) of antiretroviral medication adherence (AOR = 0.18; 95 % CI 0.05-0.62). Demographic, medical and psychiatric comorbidity, and social factors also contributed to poor outcomes. Evidence-based drug treatments that include multi-faceted interventions, including medication-assisted therapies, are urgently needed to effectively engage this vulnerable population.

HIV-infected individuals with substance use disorders have a high prevalence of medical and psychiatric morbidities that complicate treatment. Incarceration further disrupts healthcare access and utilization. Without appropriate diagnosis and treatment, drug relapse upon release exceeds 85 %, which contributes to poor health outcomes. A prospective cohort of 1,032 HIV-infected jail detainees were surveyed in a ten-site demonstration project during incarceration and six-months post-release, in order to examine the effect of predisposing factors, enabling resources and need factors on their subsequent drug use. Homelessness, pre-incarceration cocaine and opioid use, and high drug and alcohol severity were significantly associated with cocaine and opioid relapse. Substance abuse treatment, though poorly defined, did not influence post-release cocaine and opioid use. An approach that integrates multiple services, simultaneously using evidence-based substance abuse, psychiatric care, and social services is needed to improve healthcare outcomes for HIV-infected persons transitioning from jails to the community.

To know the status of HIV infection and the correlates for HIV infection among MSMW in China. This research examined the risks for HIV in 600 MSMW in Chengdu and Guangzhou, China. Participants completed a structured behavioral risk survey and were tested for HIV status. Overall, 26.2 % (n = 157) of the sample were HIV-positive, and 7 % (n = 41) were newly diagnosed and previously unaware of their HIV-positive status. Independent correlates of new HIV infection were Chengdu residence, being currently married, and sometimes using condoms during anal intercourse. Compared with previously diagnosed participants, newly diagnosed participants were more likely to have unprotected sex in the anal and vaginal sexes. Given the high risk for HIV in MSMW in these Chinese cities, public health interventions are needed to promote frequent HIV testing and to address sexual risk behaviors with both male and female partners.

Background: A minority of HIV/HCV coinfected patients with opiate addiction undergo HCV treatment. HCV therapy for HCV-monoinfected methadone maintenance (MM) recipients is safe and effective. We evaluated treatment efficacy and adherence to pegylated interferon (pegIFN) among HIV/HCV coinfected MM recipients., Methods: HCV treatment-naïve, HIV-infected persons 18-65 years with chronic HCV genotype 1 on MM were prospectively enrolled in an HCV treatment study at two HIV clinics. At weekly visits pegIFN alfa-2a injections were directly administered. Daily MM recipients had morning ribavirin delivered with methadone at off-site methadone clinics. Weekly take-home MM recipients took ribavirin unsupervised. Target enrollment was 30 participants., Results: During 18 recruitment months, 11 participants were enrolled, 6 of whom received daily methadone. Mean age was 46, 64% were female, 5 were Caucasian, 4 Black and 2 Hispanic. At baseline, 82% had high HCV RNA and 55% had stage 2 fibrosis or greater. The majority (91%) were on HAART, and 82% had undetectable HIV RNA with a median CD4(+) of 508cells/μL. All had polysubstance use history, non-substance-based psychiatric diagnoses and were on psychotropic medications pre-enrollment. Two (18%) participants achieved a Sustained Virologic Response (SVR). Two completed 48 treatment weeks, 5 were withdrawn due to adverse events, 2 dropped out prematurely and 2 had treatment discontinued for virologic non-response. Of on-treatment weeks, adherence to pegIFN was >99%., Conclusions: SVR rate was comparable to historic controls for coinfected genotype 1 patients, with optimal pegIFN adherence. Adverse effects often prevented therapy completion in this population., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

African Americans are disproportionately infected with HIV/AIDS. Despite Centers for Disease Control and Prevention (CDC) guidelines recommending routine opt-out testing for HIV, most HIV screening is based on self-perceived HIV risks. Philadelphia launched a rapid HIV testing program in seven public health clinics in 2007. The program provides free rapid oral HIV tests to all patients presenting for health services who provide informed consent. We analyzed demographic, risk behavior, and HIV serostatus data collected during the program between September 2007 and January 2009. We used multivariable logistic regression to estimate the association between behavioral and demographic factors and newly diagnosed HIV infection. Of the 5871 individuals testing for HIV, 47% were male, 88% were African American, and the mean age was 34.7 years. Overall HIV prevalence was 1.1%. All positive tests represented new HIV diagnoses, and 72% of individuals reported testing previously. Approximately 90% of HIV-positive individuals and 92% of individuals with more than five recent sex partners never, or only sometimes, used condoms. Two thirds of individuals testing positive and 87% of individuals testing negative assessed their own HIV risk as zero or low. Individuals reporting cocaine use and ever having a same sex partner both had 2.6 times greater odds of testing positive. Condom use in this population was low, even among high-risk individuals. Philadelphia's program successfully provided HIV testing to many underserved African Americans who underestimate their HIV risk. Our results nevertheless suggest greater efforts are needed to encourage more individuals to undergo HIV testing in Philadelphia, particularly those who have never tested.

Increased access to sterile syringes among injection drug users (IDUs) has been correlated with reduced syringe sharing. Many states, including Rhode Island, have legalized non-prescription (NP) sale of syringes in pharmacies. Previous studies have suggested that training pharmacists to provide HIV-related services to IDUs may be an important opportunity to engage IDUs and provide them with such services. However, it is not clear to what extent pharmacy staff are willing to expand their roles in providing services to IDUs who come in to purchase syringes. We recruited pharmacists and pharmacy staff from the 48 pharmacies indicating NP sale of syringes in the greater Providence, RI area, to participate in an online survey consisting of demographic information; views about the current syringe laws in Rhode Island; willingness to provide HIV-related services, including referral for HIV testing, substance use treatment, and medical and social services, to IDUs; and past experiences with IDU customers. One hundred and forty-six individuals completed the online survey (32 pharmacies, 114 pharmacy staff). Most participants were employed by chain pharmacies (92%). Most participants thought that pharmacies are important resources for IDU customers (77%) and that they would be willing to provide health and prevention information/referrals to IDU customers who purchase NP syringes (59%). With respect to willingness to offer HIV prevention-related services, access to confidential space and concern about personal safety had the strongest associations with willingness to provide HIV prevention services (OR, 4.3 and 0.1, respectively). As the nature of the retail pharmacy shifts, researchers, pharmacy executives, and health care officials can build upon the willingness of pharmacists and pharmacy staff in order to address the health needs of injection drug users and other underserved populations.

Jails provide an underutilized public health opportunity for screening for HIV, sexually transmitted infections (STIs), and viral hepatitis, and for such other infectious diseases as tuberculosis. Incarcerated individuals are more likely to be men, poor, persons of color, and at high risk for HIV. The vast majority of jails in the United States do not screen routinely for HIV or STIs, thereby missing an opportunity for HIV and STI diagnosis, treatment, and prevention. Nesting HIV testing within STI testing and treatment in conjunction with testing and treatment for other infectious diseases, as appropriate based on community prevalence, provides a public health opportunity and will enhance HIV prevention. HIV testing and linkage to care, both within corrections and in the community, comprise an important component of the "seek and treat" strategy to further prevent HIV infection. Jail-based screening of infectious diseases, especially for HIV and STIs, in conjunction with treatment and linkage to community care has thus far been a neglected component of HIV prevention among high-risk communities.

Health care within correctional facilities has traditionally been marginalized from excellence in academic medicine. The armamentarium of a medical school, which includes excellence in research, teaching and clinical care, can be successfully applied to the correctional setting both in the United States and internationally. At any one time, there are over 2 million people incarcerated in the US who are disproportionately poor and from communities of color. Rates of human immunodeficiency virus (HIV) and hepatitis C virus infection (HCV) in prisons are 5 and 17-28-times higher than in the general population, respectively. The correctional setting provides an excellent opportunity to screen for and treat sexually transmitted infections (STIs), HIV, HCV, chronic hepatitis B virus (HBV) infections and tuberculosis (TB) and to develop effective prevention programs.

There is a high burden of underlying substance use and mental illness in HIV-infected populations. HIV-care settings provide an important opportunity to assess substance and mental health needs among HIV-positive patients and to provide or make referrals for appropriate treatment services. In 2003, with funding from the Center for Substance Abuse Treatment (CSAT), we developed a model of integrated substance-use counselling and referral for treatment within a primary care HIV-care setting at The Miriam Hospital in Providence, Rhode Island. The project uses a multidisciplinary approach to provide linkage to treatment services for substance use and mental illness as well as to help participants with social service needs, such as housing and medical coverage, to ensure continuity of care and optimal HIV treatment adherence. Twelve percent of the 965 HIV-infected patients in care at our center have been enrolled in the project. Of these, all have a current substance-use disorder and 79.3% have been diagnosed with a mental illness. In addition, most participants are hepatitis C-positive (HCV) (65.5%). The majority of participants are on antiretroviral therapy (76.7%). Participants have been referred for the following treatment modalities: intensive outpatient services, methadone, buprenorphine, outpatient services and residential as well as individual and group counselling. Our model has been successful in assessing the substance-use and mental health needs of HIV-infected individuals with numerous co-morbidities and referring them for ancillary medical and social services.

Objective: Correctional facilities provide a critical opportunity to treat and manage human immunodeficiency virus (HIV) and HIV-related complications among inmates. Inmates bear a higher HIV burden than the general population, and many have never received HIV care prior to incarceration. The standard of care in the community and in corrections for the treatment of HIV is highly active antiretroviral therapy (HAART). This study evaluated U.S. correctional expenditures for antiretrovirals (ARVs) and compared them to the estimated need for ARVs among HIV-infected prisoners in the U.S. to treat this population successfully., Methods: The total number of HIV-infected prisoners in the United States was estimated using Bureau of Justice Statistics data. The National Sales Perspectives Audit, Combined Retail and Nonretail, July 1999 to December 2004 was used to estimate correctional ARV expenditures in 2004. Both measures were used to calculate treatment costs for ARV therapy., Results: The analysis demonstrates that, in 2004, total ARV sales represented only 29% of the total necessary to treat all HAART eligible inmates with known HIV infection., Conclusion: There is a substantial unmet need for ARVs in correctional health care. Although many barriers exist to treating all eligible HIV-infected prisoners, treatment reduces costs associated with HIV-related complications and may encourage linkage to HIV care in the community. Treatment of all eligible HIV-infected inmates should be a public health priority.

Background: New HIV diagnoses related to injection drug use (IDU) have declined in the United States. Access to clean syringes and decreasing HIV transmission among injection drug users have been HIV prevention priorities of the Rhode Island (RI) HIV community. To examine trends in IDU-related new HIV diagnoses in RI, we performed a retrospective analysis of new HIV diagnoses according to HIV risk factor from 1990-2003., Results: There has been an 80% absolute reduction in IDU-related new HIV diagnoses in RI coincident with IDU-specific prevention efforts., Conclusion: There has been a greater decline in IDU-related new HIV diagnoses in Rhode Island compared to national data reported by the Centers for Disease Control and Prevention. We hypothesize that this dramatic decline in Rhode Island is related to extensive HIV prevention efforts targeting IDUs. Further research is needed to examine the impact of specific HIV prevention interventions for injection drug users.