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Despite declines in HIV prevalence among all U.S. women, HIV remains a serious concern for Black women. PrEP is an effective biomedical intervention and has high acceptability among Black women. Therefore, offering PrEP, in addition to screening and testing for STI/HIV consistently, can reduce HIV risk among this population. We examine the associations of preventive sexual health service utilization (PSHSU) and PrEP interest among young Black women (YBW) (N = 209) in the United States in 2018. YBW, ages 18–25, completed a self-administered questionnaire, assessing sexual risk and prevention behaviors, HIV/STI testing, and PrEP interest. More than half of YBW were aware of PrEP and its benefits. YBW, who received an HIV test within the past three to six months, had higher odds of PrEP interest. The proportion of YBW who reported being interested in PrEP did not differ by PSHSU. Active contraceptive use was associated with PrEP interest. The results suggest YBW engage in preventive sexual health services, including HIV/STI testing, reproductive health, and sexual health behavioral counseling. Additional efforts should be made to normalize PrEP education for heterosexual, cisgender women at student health centers on college and university campuses, and other venues outside of traditional HIV/STI testing facilities.

Following high levels of efficacy in PrEP clinical trials, demonstration projects were launched to assess its real-world effectiveness when rolled out as part of programmes. Based on an ethnographic study of a PrEP demonstration project in South India among female sex workers, we analyse a curious set of narratives in which participants claim PrEP as a ‘cure all’ for a range of physical ailments. What becomes clear is how participation in this project has intensified a relationship with their bodies, one that has led these women to reflect on and track various changes pertaining to bodily wellness. ‘The body’ becomes a highly reactive site that entangles global HIV science, sex workers’ engagements in health promotion, and regimes of self-care. Engaging with these local biologies holds important insights for designing and implementing future biomedical interventions.

Voluntary Medical Male Circumcision (VMMC) has been promoted as an effective biomedical intervention in the reduction of the risk of new HIV and STI infections. The government of Malawi and its stakeholders including the World Health Organization have committed a lot of resources to VMMC programming. However, research shows that its uptake among men is still low in Malawi. This study, therefore, investigated the communication-related factors that influence decision-making in the uptake of VMMC among men in Lilongwe, Malawi. To achieve this aim, twenty-five men, aged between 18 and 35 years old were interviewed on what influenced them to undergo VMMC. The study found that the respondents were influenced to uptake VMMC mostly by peer pressure and the need for conformity; partner/girlfriend demand and considerations; and advice from health personnel. The paper concludes that although the final decision was theirs to make, the men in the study underwent circumcision under duress and/or coercion. It cannot be said to be voluntary. The medical necessity of VMMC can be said to be voluntary if it is negotiated and consented to without duress. Although the respondents mentioned the HIV and STI infection risk reduction properties, hygienic advantages, and cervical cancer reduction properties of VMMC as benefits of VMMC, these had very little influence on their decision. It is recommended that current intervention messages be reviewed and modified to incorporate new ideas that can address the shortcomings that the current crop of messages has with the aim of increasing the uptake of VMMC programmes or other health focused behaviour change programmes.

PrEP, pre-exposure prophylaxis, is a novel HIV prevention strategy. Highly efficacious, its development and delivery has caused significant debate. This paper explores the ways in which PrEP is signified and some of the new identities it gives rise to through the analysis of PrEP discourses among ‘bugchasers’. Bugchasers comprise a niche group of gay men who eroticise HIV and fantasise with or seek to get infected. The research explores how bugchasers negatively conceptualise PrEP as a barrier to thrill and masculinity and discusses PrEP as a positive intervention that allows them to understand their own desires for risk-taking. Finally, it addresses a new identity position, the ‘poz pleaser’ who identifies as a bugchaser yet uses PrEP. Findings link to current debates about PrEP meanings and signification by using bugchasing as a niche yet illustrative example of how men make sense of this intervention based on their existing frameworks. Discussion highlights how this helps us understand how people make sense of biomedical interventions, the importance of emotional ‘side effects’, and the development of new identity positions. In so doing, it advances existing work on PrEP signification and contributes to ongoing debates about bugchasing.

Transgender people, i.e., those whose gender identity differs from the sex they were assigned at birth, have been shown to be disproportionately affected by HIV. Transgender women have an estimated...

With widespread treatment, HIV is now considered a chronic, manageable condition, yet little is known of the social networks that support people living with HIV (PLHIV) to transition toward self-management. Using a person-centred, qualitative social network approach, this study examined the role, characteristics and evolution of social support networks from the perspective of PLHIV and key support providers in Queensland, Australia. Beyond treatment and monitoring, HIV self-management involves negotiating disclosures and navigating stigma. Alongside biomedical interventions, facilitating recently diagnosed PLHIV to develop strong and sustainable personal support networks, including linkage with peers, is an important aspect of contemporary HIV care.

Youths are disproportionately affected by HIV infection. This article presents the achievements and implications of HIV Programme Development Project among Out-of-School Youths (OSY) in Osun State, Nigeria. A total of 5934 peer educators from randomly selected areas of the State were trained. The Minimum Prevention Package for Intervention (MPPI) strategy including structural, behavioural and biomedical interventions was used. Data from DHIS2 platform was analysed with Microsoft Excel and qualitative interviews with the stakeholders was reported. Two hundred and sixty-three community dialogues were held within the period of the project with 2406 participants and 27,449 peers recruited by the peer educators. A total of 15,984 OSY were counselled, tested and received results for HIV and 167 (1.05%) of them tested positive to HIV infection. There is a need to scale-up this programme in Osun State and efforts at reaching the OSY based on MPPI should be intensified.

In Ghana, men who have sex with men (MSM) are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is an intervention that reduces risk for HIV infection but is not currently available in Ghana. This paper explores knowledge and acceptability of HIV PrEP among Ghanaian MSM. Qualitative content analysis was conducted on 22 focus group discussions(N=137) conducted between March-June 2012 in Accra, Kumasi, and Manya Krobo. Overall, participants reported low knowledge of PrEP. However, once information about PrEP was provided, there was high acceptability. The primary reason for acceptability was that PrEP provided an extra level of protection against HIV. Acceptability of PrEP was conditioned on it having minimal side effects, being affordable and efficient in preventing HIV infection. No acceptability of PrEP was attributed to limited knowledge of side effects and perceived lack of effectiveness. The reasons provided to utilize PrEP and condoms was condoms protect against other STIs, and sexual partner factors. This is the first known study to explore PrEP knowledge and acceptability among Ghanaian MSM. It is important that key stakeholders preemptively address potential barriers to PrEP acceptability, uptake, and adherence, especially among MSM, once PrEP becomes available in Ghana.

Community-based organizations (CBOs) are critical to delivery of effective HIV prevention because of their reach to key populations. This online survey of a national sample of CBOs assessed their awareness of, interest in, and resources needed to provide nonoccupational postexposure prophylaxis (nPEP), preexposure prophylaxis (PrEP), and HIV treatment as prevention (TasP). One hundred seventy-five CBOs participated: 87 clinical and 88 nonclinical CBOs. For nPEP, PrEP, and TasP, program managers reported that awareness was high (94%, 90%, 85%), meeting current client need was low (20%, 13%, 18%), and the likelihood of increasing their current provision with additional resources was somewhat high (62%, 64%, 62%). Clinical CBOs were more prepared to support expansion of these biomedical interventions than nonclinical CBOs. Meeting the information, training, and resource needs of CBOs is critical for effective collaboration to reduce the number of new HIV infections through expanded delivery of PrEP, nPEP, and TasP.

There is no viable substitute for re-energizing, funding and supporting culturally attuned, locally staffed HIV advocacy and prevention programmes, especially in resource poor settings. The evidence that such interventions are effective remains compelling; and although the cost implications are not negligible, the medium to long-term outcomes must be regarded not as complementary, but as integral, to biomedical interventions. The success of the anti-retroviral drugs upscale has enabled a noticeable improvement in AIDS related morbidity and mortality in the recent years; yet the underlying dynamics of the epidemic remains undetermined by the rate at which new infections are taking place in relation to the number of AIDS deaths. While the rate of new HIV infections is stabilising in some of the hardest hit countries, it remains far too high and the future cost of maintaining an ever-expanding pool of people reliant on daily drugs for survival is unsustainable. Countries must exercise caution in continuing to focus on treatment as a ‘quick fix’ to end AIDS as a public health concern. HIV is a socially culturally induced crisis and, as such, a variety of measures are needed simultaneously to appeal to different people, groups and circumstances.

Background The new HIV treatment guidelines in China recommend antiretroviral therapy (ART) for all people living with HIV, but significant gaps in implementation still exist. Pre-exposure prophylaxis (PrEP) can effectively reduce the risk of HIV transmission among men who have sex with men (MSM). This study assessed the epidemiological impact and cost effectiveness of PrEP, enhanced biomedical interventions and their combination among MSM in China. Methods A deterministic mathematical model was developed and projected over 20 years to assess the impact of the PrEP, biomedical interventions and their combinations. Incidence and prevalence of HIV were measured, and cost-effectiveness was assessed using incremental cost (international dollars, Int.$) per quality-adjusted life year (QALY) gained. Results A total of 0.78 million new HIV infections were estimated to occur over the next 20 years if no additional interventions are implemented among MSM. The PrEP-only strategy covering 25–75% of HIV-negative high-risk MSM can prevent 0.09–0.20 million (12.1–25.7%) new infections, at a cost of 17,277–18,452 Int.$/QALY. The optimal cost-effectiveness path is from test-and-treat to the combination strategy of test-and-treat and PrEP. Some strategies could almost eliminate new HIV infections over the next 20 years. Conclusions PrEP, test-and-treat, and their combinations among MSM are effective and cost-effective relative to current policy. PrEP is an important and cost-effective addition to current policy in China. Electronic supplementary material The online version of this article (10.1186/s12879-018-3516-8) contains supplementary material, which is available to authorized users.

El objetivo del presente artículo es la exposición sucinta de la exclusión de las mujeres en la resolución del 27 de Julio de 2017 en el que se explicita el convenio de colaboración entre la Dirección General de Salud Pública, Calidad e Innovación y la empresa Gilead Servicios S.L.U. Este convenio es la formalización de la entrada e implementación de la profilaxis preexposición ante el VIH en el territorio nacional. La profilaxis preexposición ante el VIH es una novedosa intervención biomédica de carácter preventivo aplicada en personas que no viven con el VIH, que contiene como parte fundamental la ingesta diaria de un medicamento llamado Truvada, formado por dos componentes farmacológicos, emtricitabine y tenofovir, y capaz de inhibir la reproducción exponencial del virus en el caso de que se produzca la exposición de los tejidos del mismo al VIH sin variar de forma radical los hábitos sexuales. The objective of this article is the succinct exposition of the exclusion of women in the resolution of July 27, 2017 in which the collaboration agreement between the Public Health General Office, Quality and Innovation and the company Gilead Servicios S.L.U. This agreement is the formalization of the entry and implementation of pre-exposure prophylaxis against HIV in the national territory. Pre-exposure prophylaxis against HIV is a novel biomedical intervention of a preventive nature applied in people who do not live with HIV that contains as a fundamental part the daily intake of a drug called Truvada, composed of two pharmacological components, emtricitabine and tenofovir, which is able to inhibit the exponential reproduction of the virus in the event of the exposure of the tissues of the virus to HIV without radically changing sexual habits.

Effective HIV prevention techniques for women are of critical importance, as nearly half of all HIV infections globally are in women. This article reviews the recent literature on biomedical approaches to HIV prevention in women. In trials in which women were adherent to oral pre-exposure prophylaxis (PrEP), PrEP was equally efficacious in men and women. However, in studies of oral PrEP exclusively in women, adherence was low, and it was not efficacious. In trials of topical PrEP, including vaginal tenofovir gel and the monthly dapivirine ring, efficacy was also dependent upon adherence. Treatment as prevention (TasP) is a very effective HIV prevention strategy, though limited in that it is not controlled by the HIV-uninfected partner. Adherence is an important factor in the efficacy of biomedical interventions for HIV prevention in women; continued research is needed to identify the most efficacious and acceptable agents for women. Oral PrEP is currently recommended for the following groups of HIV-negative women: heterosexual women in ongoing sexual relationships with a partner infected with or at substantial risk of HIV infection and women who inject drugs and share injection or drug preparation equipment.

Men who have sex with men (MSM) in the USA continue to have high rates of HIV infection. Increasingly, in addition to behavioral factors, biomedical interventions have been found to play important roles in HIV prevention. In this analysis, we used four waves of cross-sectional data (2004, 2008, 2011, and 2014) from the National HIV Behavioral Surveillance System (NHBS) to examine trends in key behaviors and biomedical interventions among MSM in Chicago (N = 3298). Logistic regression was used to determine changes in behaviors and use of biomedical interventions. Condomless sex increased significantly in waves 3 and 4, compared to wave 1: wave 3 (AOR = 2.07; 95% CI 1.53, 2.78) and wave 4 (AOR = 2.19; 95% CI 1.62, 2.96). Compared to those aged 18–24, older participants were significantly less likely to be routinely tested for HIV: 30–39 (AOR = 0.63; 95% CI 0.48, 0.83), 40–49 (AOR = 0.40; 95% CI 0.29, 0.55), and >50 (AOR = 0.28; 95% CI 0.18, 0.43). Awareness of both post-exposure prophylaxis (PEP)(​AOR = 3.13; 95% CI 1.22, 8.03) and pre-exposure prophylaxis (PrEP)(​AOR = 10.02; 95% CI 2.95, 34.01) increased significantly in wave 4, compared to wave 3. These results suggest a potential increase in HIV rates among men with main and casual partners and should be monitored closely as PrEP becomes more widespread among MSM of all races and ethnicities in Chicago. This study also suggests that further analyses of the barriers to PEP and PreP uptake among high-risk populations are necessary.

Non-medical, community-based workers play a critical role in supporting people living with (or at risk of acquiring) HIV along the care continuum. The biomedical nature of promising advances in HIV prevention, such as pre-exposure prophylaxis and treatment-as-prevention, requires frontline workers to be knowledgeable about HIV science and treatment. This study was developed to: measure knowledge of HIV science and treatment within the HIV non-medical workforce, evaluate workers' familiarity with and attitudes toward recent biomedical interventions, and identify factors that may affect HIV knowledge and attitudes. A 62-question, web-based survey was completed in English or Spanish between 2012 and 2014 by 3663 US-based employees, contractors, and volunteers working in AIDS service organizations, state/local health departments, and other community-based organizations in a non-medical capacity. Survey items captured the following: respondent demographics, HIV science and treatment knowledge, and familiarity with and attitudes toward biomedical interventions. An average of 61% of HIV knowledge questions were answered correctly. Higher knowledge scores were associated with higher education levels, work at organizations that serve people living with HIV/AIDS or who are at a high risk of acquiring HIV, and longer tenure in the field. Lower knowledge scores were associated with non-Hispanic Black or Black race/ethnicity and taking the survey in Spanish. Similarly, subgroup analyses showed that respondents who were non-Hispanic Black or Hispanic (versus non-Hispanic white), as well as those located in the South (versus other regions) scored significantly lower. These subpopulations were also less familiar with and had less positive attitudes toward newer biomedical prevention interventions. Respondents who took the survey in Spanish (versus English) had lower knowledge scores and higher familiarity with, but generally less positive attitudes toward, biomedical interventions. In summary, low knowledge scores suggest the need for additional capacity-building efforts and training for non-medical HIV workers, particularly those who provide services in the communities most affected by HIV.

In the past two decades, major advances in biomedical intervention approaches to prevent HIV and many sexually transmissible infections (STIs) have shown great promise. However, challenges to prevention remain in the area of achieving population-level impact for biomedical prevention approaches. In this paper we address what social and behavioural research approaches can contribute beyond well-known behaviour change and counselling interventions. We organise work into five areas. Adherence and disinhibition research is primarily into individual-level constructs pertaining to maximising intervention effectiveness. Coverage research represents a population-level construct germane to maximising efficient prioritisation for prevention. Research covering social determinants, a second population-level construct, contributes to both prioritisation and effectiveness. Finally, disparities and social inequities need to be incorporated into prevention, given the pervasive and persistent disparities found in rates of HIV and STIs and in their antecedents.

This article presents an overview of pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention. The authors describe the past animal and human research that has been conducted that informs our current understanding of PrEP; summarize ongoing research in the area, including describing new regimens and delivery mechanisms being studied for PrEP; and highlight key issues that must be addressed in order to implement and optimize the use of this HIV prevention tool.

Background. Sexually transmitted infections (STIs) continue to be a significant public health problem especially among women of reproductive age in Africa. Methods. A total of 2236 women that had enrolled in the MDP301 vaginal microbicide trial were tested for the presence of Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), Treponema pallidum, and Trichomonas vaginalis (TV). Results. CT was identified as the most prevalent STI (11%) followed by TV (10%), NG, and Syphilis (3%). The highest prevalence of coinfection was reported between T. pallidum and TV (19.67%, P=0.004), followed by CT and TV (13.52%, P≤0.001). Risk factors that were significantly associated with STI acquisition were women of 23 years of age or younger (HR: 1.50, 95% CI 1.17, 1.93), baseline STI with CT (HR: 1.77, 95% CI 1.32, 2.35), TV (HR: 1.58, 95% CI, 1.20, 2.10), and T. pallidum (HR: 5.13, 95% CI 3.65, 7.22), and a low education level (HR: 1.30, 95% CI 1.02, 1.66). Conclusion. Young women with lower education and a history of STIs are at high risk of multiple STIs. Prevention programs should consider target approach to STI prevention among young women. This trial is registered with ISRCTN64716212.

Pre-exposure prophylaxis (PrEP) with antiretroviral drugs is a novel biomedical intervention that can prevent HIV transmission among high-risk populations. As findings from multiple PrEP studies have suggested that adherence is vital to achieve the full prevention benefits of PrEP, it is important to understand the clinical pharmacology and pharmacokinetic (PK) properties of PrEP antiretrovirals, the association of PK and PrEP efficacy and the potential for drug concentration measurement to be used as a tool to monitor PrEP adherence. In this review, we examine studies related to PrEP adherence with attention to the clinical pharmacology and pharmacokinetics of current and novel PrEP agents. Studies of animal models, pharmacokinetics and clinical trials related to PrEP and adherence were reviewed. In summary, when combined as part of a comprehensive prevention strategy that includes use of condoms and risk reduction counseling, PrEP has tremendous promise as a adjunctive biomedical HIV prevention intervention, providing that adherence is maintained.

Sub-Saharan Africa has the highest number of HIV infected individuals in the world. Developing and implementing effective biomedical interventions still remains urgent. Poor adherence has been commonly identified as one of the major barriers for the success of HIV prevention trials. A better understanding of how to improve adherence remains a research priority. In this analysis, younger age (

Oral and topical pre-exposure prophylaxis (PrEP) with antiretroviral drugs are novel biomedical interventions recently found to prevent HIV transmission among high-risk populations. In this review, we outline lessons learned from animal studies and discuss next steps in preclinical PrEP research including the study of new PrEP modalities, pharmacologic correlates of protection, and biological factors that may modulate PrEP efficacy.Studies using macaque or humanized mice models of mucosal simian immunodeficiency virus (SIV), HIV, or simian/human immunodeficiency virus (SHIV) transmission have provided efficacy data against rectal and vaginal infection. A multitude of oral and topical PrEP regimens including drugs such as tenofovir (TFV), tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) were tested against either wild-type or drug-resistant viruses. These models have also helped define prophylactic windows of protection of nondaily dosing and are being used increasingly to study pharmacokinetic and pharmacodynamic relationships.As human data from PrEP trials validate animal models or help fine tune them, it is expected that these models will play increasingly important roles in PrEP development as the field extends into new drug classes and combinations, episodic dosing, and novel long-acting drug formulations. By providing both efficacy and pharmacologic information these models can define correlates and mechanisms of protection, inform dose selection, and advance the most promising PrEP candidates and dosing modalities.

To examine the population-level effects of introducing and/or expanding biomedical interventions for prevention of human immunodeficiency virus (HIV) sexually transmitted infections through mathematical modeling.Successes of several ground-breaking clinical trials have invigorated the field of HIV prevention with new enthusiasm and opportunities for research into and application of biomedical HIV prevention. Mathematical modeling has advanced in tandem with valuable contributions to both investigative science and public health. New models provide qualitative and quantitative insights regarding the epidemiological impact of the uptake of biomedical interventions, singly and/or in combination including treatment of sexually transmitted infections, condom use, male circumcision, antiretroviral treatment and pre-exposure prophylaxis and vaccine for HIV prevention.Biomedical interventions are critical for reversing the HIV pandemic. Mathematical modeling is invaluable for informed biomedical HIV prevention research, policy and practice.

In the absence of an effective vaccine, HIV continues to spread worldwide, emphasizing the need for new biomedical interventions to limit its transmission. Appreciation of the challenges that HIV has to face to initiate an infection mucosally has spurred interest in evaluating the use of antiretroviral drugs to prevent infection. Recent animal studies using macaques or humanized mice models of mucosal transmission of SIV or HIV have shown that daily or intermittent pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) can exploit early virus vulnerabilities and effectively prevent establishment of infection. These preclinical findings have fueled interest in evaluating the safety and efficacy of PrEP in humans. We provide an overview of the rationale behind PrEP and discuss the next steps in PrEP research, including the need to better define the ability of current drugs to reach and accumulate in mucosal tissues and protect cells that are primary targets during early HIV infection.

Whereas the human immunodeficiency virus (HIV)-positive Global South body is placed within a zone of antiretroviral exclusion, the “at-risk” HIV-negative body in the Global North is able to occupy a zone of viral exclusion through the incorporation of the emergent biomedical intervention of pre-exposure prophylaxis (PrEP). PrEP exemplifies the e℞otics of HIV, whereby pharmaceutical technologies immunise against both the transmission of the virus and the social contract of disavowing erotic pleasure in favour of individual and collective sexual health. This chapter situates PrEP and its cultural articulation within the context of the geocorpographies of HIV, illustrating how immunity separates bare life from barebackers.

Monitoring the cascade or continuum of HIV services – ranging from outreach services to anti-retroviral treatment – has become increasingly important as the focus in prevention moves toward biomedical interventions, in particular, ‘Treatment as Prevention.’ The HIV continuum typically utilises clinic-based care and treatment monitoring data and helps identify gaps and inform programme improvements. This paper discusses the merits of a population-based survey-informed continuum of services. Surveys provide individual-level, population-based data by sampling persons both in and outside the continuum, which facilitate the estimation of population fractions, such as the proportion of people living with HIV in care, as well as the examination of determinants for being in or outside the continuum. Survey-informed cascades of services may especially benefit key populations at increased risk for HIV infection for who social marginalisation, criminalisation, and stigma result in barriers to access and retention in services, a low social visibility, mobility, and outreach-based services can compromise clinic-based monitoring. Adding CD4+ T-cell count and viral load measurements to such surveys may provide population-level information on viral load suppression, stage of disease, treatment needs, and population-level transmission potential. While routine clinic-based reporting will remain the mainstay of monitoring, a survey-informed service cascade can address some of its limitations and offer additional insights.

With no vaccine in sight, AIDS researchers are testing a range of surprising biomedical interventions.

Safe and effective HIV prevention strategies are needed for transwomen. Transwomen in the US have a 34 times greater odds of being infected with HIV than all adults age 15-49, and in San Francisco, California 42.4% of transwomen are estimated to be infected with HIV. Pre-exposure prophylaxis (PrEP) is the first biomedical intervention with promise for reducing HIV acquisition in transwomen. However, little is known about whether transwomen know about PrEP, are taking PrEP and would be good candidates for PrEP based on their risk profile and behaviors. A population-based dataset was analyzed to determine how many transwomen in San Francisco knew about PrEP by the end of 2013 – more than a year after iPrex results demonstrated efficacy of PrEP in preventing HIV. We found that of 233 transwomen, only 13.7% had heard of PrEP. Transwomen who were living with HIV compared to those who were HIV-negative, and those who recently injected drugs compared to non-injection drug users were more likely to have heard of PrEP. Based on CDC guidelines for PrEP among MSM and IDU, 45 (30.2%) transwomen of the 149 HIV-negative transwomen in the sample were candidates for PrEP. This estimate based on CDC criteria is arguably low. Given that almost half of transwomen in San Francisco are living with HIV, this findings points to a need for further consideration of PrEP criteria that are specific and tailored to the risks for HIV faced by transwomen that are different from MSM and injection drug users. Research to scale up access and test the effectiveness of PrEP for transwomen is also urgently needed.

Black men who have sex with men (BMSM) have the highest rates of HIV in the United States. Despite increased attention to social and sexual networks as a framework for biomedical intervention, the role of family in these networks and their relationship to HIV prevention have received limited attention.A network sample (N = 380) of BMSM (n = 204) and their family members (n = 176) was generated through respondent-driven sampling of BMSM and elicitation of their personal networks. The proportion of personal network members who were family was calculated, and the weighted logistic regression was used to assess the relationship between this proportion and unprotected anal intercourse, sex-drug use (SDU), and group sex (GS), as well as intravention efforts to discourage these risk behaviors among their MSM social networks.45.3% of respondents listed at least 1 family member in their close personal network. Greater family network proportion (having 2 or more family members in the close network) was associated with less SDU [adjusted odds ratio (AOR) 0.38, 95% CI: 0.17 to 0.87] and participation in GS (AOR 0.25, 95% CI: 0.10 to 0.67). For intravention, BMSM with greater family proportion were more likely to discourage GS (AOR 3.83, 95% CI: 1.56 to 9.43) and SDU (AOR 2.18, 95% CI: 1.35 to 3.54) among their MSM friend network. Moreover, increased male family network proportion was associated with lower HIV risk and greater intravention than increased female network proportion.Nearly half of BMSM have a close family member with whom they share personal information. Combination prevention interventions might be made more potent if this often overlooked component of personal networks was incorporated.

In the United States, most new cases of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) occur among women of color (primarily African American and Hispanic women). Most women of color acquire the disease from heterosexual contact, often from a partner who has undisclosed risk factors for HIV infection. Safe sex practices, especially consistent condom use, must be emphasized for all women, including women of color. A combination of testing, education, and brief behavioral interventions can help reduce the rate of HIV infection and its complications among women of color. In addition,biomedical interventions such as early treatment of patients infected with HIV and pre-exposure antiretroviral prophylaxis of high-risk individuals offer promise for future reductions in infections.

Vaginal microbicides (VMB) are currently among the few women-initiated biomedical interventions for preventing heterosexual transmission of HIV. In this paper we use a deterministic model of HIV transmission to assess the public-health benefits of a VMB intervention and evaluate its gender-specific impact over short (initial) and extended periods of time. We define two distinct quantitative benefit ratios (QBRs) based on infections prevented in men and women to create and study regions of male advantage in different parameter spaces. Our analysis exposes complicated temporal correlations between the QBRs and series of pre-intervention (e.g., HIV acquisition risks per act) and intervention parameters (e.g., VMB efficacy mechanisms, rates of resistance development and reversion) and indicates that different QBRs may often disagree on the gender distribution of the benefits from a VMB intervention. We also outline the strong influence of some modeling assumptions on the reported results and conclude that the assessment of VMB and other biomedical interventions must be based on more comprehensive analyses than calculations of infections prevented over a fixed period of time.

A combination of prevention and treatment modalities will be needed to successfully control the global spread of HIV. Microbicides, drug products topically applied to mucosal surfaces to prevent HIV infection, are one of these biomedical interventions that hold great promise. In order to be efficacious, microbicides must overcome several challenges imposed by the mucosal microenvironment they intend to protect and the mischievous human immunodeficiency virus with its enormous capacity to adapt. Recent data, however, supports the establishment of the primo-infection by only a small number of founder viruses, which are highly vulnerable to microbicidal intervention at the initial stages of mucosal invasion. The biological foundation of these challenges and opportunities in microbicide development is explored in this review. This article forms part of a special supplement on presentations covering HIV transmission and microbicides, based on the symposium "Trends in Microbicide Formulations", held on 25 and 26 January 2010, Arlington, VA.

Background The incidence and prevalence of HIV infection among adolescents and young adults in South Africa is high. National seroprevalence surveys estimate the prevalence of HIV among 15–24 year olds to be 15.5% amongst females and 4.8% amongst males. Despite current sociobehavioural efforts, HIV infection rates have not shown a significant decline. Should a biomedical intervention be efficacious with adults it will be critical to test this product in adolescents and young adults. We examined adolescent willingness to participate in future HIV prevention trials.

Purpose of review To summarize our current understanding of the restricted diversity and biological characteristics of newly transmitted HIV-1 variants. Recent findings Transmission of HIV-1 involves a reduction in viral diversity, supporting the concept of a genetic bottleneck. In most cases, transmission appears to be mediated by a single infectious unit. Transmission of multiple variants has also been observed and is associated with factors that compromise the genital mucosa. The biological characteristics of the newly transmitted variants are influenced by the mode of transmission and perhaps the viral subtype. For sexual transmission, the integrity of the mucosal barrier is likely to impose a major restriction on the infecting virus, whereas mother-to-child transmission is also influenced by the presence of maternal antibody. Summary Transmission of HIV-1 is complex, multimodal, and poorly understood, but one common feature appears to be a window of opportunity when the infection is localized and viral diversity is limited; at this time the virus is at its most vulnerable. A better understanding of the restrictions inflicted upon transmitting HIV-1 should therefore lead to improved biomedical interventions that have the potential to protect against HIV infection.

Randomised controlled trials that test biomedical interventions to reduce sexually transmitted infections (STIs) have had very mixed results,1 2 as have behavioural trials.3 4 It is only in the past 10 years that the field has recognised that chlamydia resolves itself without treatment in 50% of the cases,4 although the estimates range from 13% to 60%.5–7 The length of time to clear chlamydia infection varies from 60 days in women to up to 15 months in men.5 The speed of resolution is also subject …

Gay men with diagnosed HIV can adopt a number of strategies to reduce the risk of transmitting HIV to others, although research has typically focussed on condom use. Interviews with 42 HIV-positive gay men who reported recent engagement in anal intercourse without condoms explored their awareness of sexual risk and their perceptions of non-condom-related strategies to reduce it. In articulating men’s ambivalence for strategies that can only reduce the risk of transmission, rather than eliminating, the findings have implications for the consideration and integration of new biomedical interventions to reduce the likelihood of HIV transmission.