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BackgroundIn 2022 and 2023, a global outbreak of mpox affected mostly gay, bisexual and other men having sex with men (GBMSM). Outbreak control in the Netherlands included isolation, quarantine, post-exposure prophylaxis vaccination and primary preventive vaccination (PPV).AimWe describe the course of the outbreak, the vaccination programme, vaccine effectiveness (VE) of full vaccination against symptomatic disease, and trends in behaviour to generate hypotheses about factors that influenced the outbreak's decline.MethodsIn this observational study, we collected data from public health services on notified cases, number of PPV invitations and PPV doses administered. We calculated PPV uptake and coverage. Trends in behavioural data of GBMSM visiting sexual health centres were analysed for all consultations in 2022. We estimated VE using the screening method.ResultsUntil 31 December 2023, 1,294 mpox cases were reported. The outbreak peaked in early July 2022 and then declined sharply. PPV started on 25 July 2022; in total 29,851 doses were administered, 45.8% received at least one dose, 35.4% were fully vaccinated. The estimated VE was 68.2% (95% CI 4.3-89.5%). We did not observe an evident decrease in high-risk behaviour.DiscussionIt is unlikely that PPV was a driver of the outbreak's decline, as incidence started to decline well before the start of the PPV programme. The possible impact of behavioural change could not be demonstrated with the available indicators, however, the data had limitations, hampering interpretation. We hypothesise that infection-induced immunity in high-risk groups was an important factor explaining the decline.

Weight loss interventions are delivered through various mediums including, increasingly, mobile phones. This systematic review and meta-analysis assesses whether interventions delivered via mobile phones reduce body weight and which intervention characteristics are associated with efficacy. The study included randomised controlled trials assessing the efficacy of weight loss interventions delivered via mobile phones. A meta-analysis to test intervention efficacy was performed, and subgroup analyses were conducted to determine whether interventions' delivery mode(s), inclusion of personal contact, duration and interaction frequency improve efficacy. Pooled body weight reduction (d = -0.23; 95% confidence interval = -0.38, -0.08) was significant. Interventions delivered via other modes in addition to the mobile phone were associated with weight reduction. Personal contact and more frequent interactions in interventions were also associated with greater weight reduction. In conclusion, the current body of evidence shows that interventions delivered via mobile phones produce a modest reduction in body weight when combined with other delivery modes. Delivering interventions with frequent and personal interactions may in particular benefit weight loss results., (© 2017 World Obesity Federation.)

Fishermen in Southeast Asia have been found to be highly vulnerable to HIV, with research evidence highlighting the role of sexual risk behaviors. This study aims to estimate the rate of HIV as well as hepatitis C virus (HCV) infections among Malaysian fishermen, and the risky sexual and injection drug use behaviors that may contribute to these infections. The study also includes an assessment of socio-demographic, occupational and behavioral correlates of testing positive for HIV or HCV, and socio-demographic and occupational correlates of risk behaviors. The study had a cross-sectional design and recruited 406 fishermen through respondent-driven sampling (RDS). Participants self-completed a questionnaire and provided biological specimens for HIV and HCV testing. We conducted and compared results of analyses of both unweighted data and data weighted with the Respondent-Driven Sampling Analysis Tool (RDSAT). Of the participating fishermen, 12.4% were HIV positive and 48.6% had HCV infection. Contrary to expectations and findings from previous research, most fishermen (77.1%) were not sexually active. More than a third had a history of injection drug use, which often occurred during fishing trips on commercial vessels and during longer stays at sea. Of the fishermen who injected drugs, 42.5% reported unsafe injection practices in the past month. Reporting a history of injection drug use increased the odds of testing HIV positive by more than 6 times (AOR = 6.22, 95% CIs [2.74, 14.13]). Most fishermen who injected drugs tested positive for HCV. HCV infection was significantly associated with injection drug use, being older than 25 years, working on a commercial vessel and spending four or more days at sea per fishing trip. There is an urgent need to strengthen current harm reduction and drug treatment programs for Malaysian fishermen who inject drugs, especially among fishermen who work on commercial vessels and engage in deep-sea fishing.

Objective: To examine whether there have been recent changes in Australian antiretroviral treatment (ART) prescribers' perceptions and practices relating to early ART initiation, which was defined as commencing ART when a patient's CD4+ T-cell count approaches 500 cells/mm3 or immediately after a patient is diagnosed with HIV., Design, Participants and Setting: Self-completed, anonymous, cross-sectional surveys, targeting all ART prescribers in Australia, were conducted online in 2012 and 2013. The surveys included questions on prescriber factors, CD4+ T-cell count at which prescribers would most strongly recommend ART initiation, and perceived patient characteristics that could change prescribers' practices of early initiation of ART., Main Outcome Measures: Proportions of ART prescribers recommending early ART initiation., Results: We analysed responses from 108 participants in 2012 and 82 participants in 2013. In both years, more male than female prescribers participated. The median age of participants was 49 years in 2012 and 50 years in 2013. In both rounds, over 60% had more than 10 years' experience in treating HIV-positive patients. More prescribers in 2013 stated that they would most strongly recommend early ART initiation compared with those in 2012 (50.0% [95% CI, 38.7%-61.3%] v 26.9% [95% CI, 18.8%-36.2%]; P=0.001). The prescribers' primary concern was more about individual patient than public health benefit. Out of 824 patients for whom ART was initiated, as reported by prescribers in 2013, only 108 (13.1% [95% CI, 10.9%-15.6%]) were given ART primarily to prevent onward HIV transmission. The number of patients for whom ART was initiated was significantly associated with prescribers' HIV caseload even after adjusting for prescriber type (adjusted odds ratio, 1.73 [95% CI, 1.47-2.03]; P<0.001); of the 37 who had initiated ART for 10 or more patients, 29 had a high HIV caseload. In 2013, 60 prescribers (73.2% [95% CI, 62.2%-82.4%]) reported that they routinely recommended ART to treatment-naive, asymptomatic patients with a CD4+ T-cell count of 350-500 cells/mm3., Conclusion: Our findings show increasing acceptance of and support for early ART initiation primarily as treatment and not as prevention.

Although there is evidence of increasing overall rates of HIV status disclosure among gay and bisexual men, little is known about men's disclosure expectations and practices. In this study, we investigate the importance non-HIV-positive men in Australia vest in knowing the HIV status of their sexual partners, and the extent to which they restrict sex to partners of the same HIV status, and their HIV disclosure expectations. Data were collected through a national, online self-report survey. Of the 1044 men included in the study, 914 were HIV negative and 130 were untested. Participants completed the assessment of socio-demographic characteristics, HIV status preferences, and disclosure expectations and practices. Participants also completed reliable multi-item measures of perceived risk of HIV transmission, expressed HIV-related stigma, and engagement with the gay community and the community of people living with HIV. A quarter (25.9%) of participants wanted to know the HIV status of all sexual partners, and one-third (37.2%) restricted sex to partners of similar HIV status. Three quarters (76.3%) expected HIV-positive partners to disclosure their HIV status before sex, compared to 41.6% who expected HIV-negative men to disclose their HIV status. Less than half (41.7%) of participants reported that they consistently disclosed their HIV status to sexual partners. Multivariate linear regression analysis identified various covariates of disclosure expectations and practices, in particular of disclosure expectations regarding HIV-positive men. Men who expected HIV-positive partners to disclose their HIV status before sex more often lived outside capital cities, were less educated, were less likely to identify as gay, perceived more risk of HIV transmission from a range of sexual practices, were less engaged with the community of people living with HIV, and expressed more stigma towards HIV-positive people. These findings suggest that an HIV-status divide is emerging or already exists among gay men in Australia. HIV-negative and untested men who are most likely to sexually exclude HIV-positive men are less connected to the HIV epidemic and less educated about HIV risk and prevention.

As HIV epidemics among gay and other men who have sex with men (GMSM) persist worldwide, the importance of novel prevention approaches is recognised. Evidence that antiretroviral therapy (ART) can decrease the likelihood of infection is informing emerging HIV prevention approaches, encompassing early initiation of treatment as prevention by people living with HIV and use of antiretroviral drugs as pre-exposure prophylaxis for people presumed to be uninfected. Despite widespread excitement, robust evidence of the beneficial effects of ART-based HIV prevention for GMSM remains limited. Also, theoretical models project widely varying effects of ART-based prevention on the future course of HIV epidemics among GMSM, drawing attention to the possible moderating role of differences in the achievements of local HIV responses and the critical importance of sustained protective sexual practices into the future. Ecological analyses and simulations of ongoing epidemics in major gay communities illustrate that the preventive effects of ART in many settings are being offset by increased sexual risk-taking, as reflected in stable or increasing HIV infection rates. Also, the effects of scaling up HIV testing and treatment among GMSM in settings that are often considered prime examples of the success of ART-based prevention may be levelling as 'scope for improvement' diminishes. ART-based approaches further extend the HIV prevention toolkit and substantially increase people's options to protect themselves and others. The future impact of ART-based prevention on HIV epidemics among GMSM ultimately depends on whether heralded responses offset, attenuate or compound the ongoing social and behavioural changes that drive increased sexual risk.

Human immunodeficiency virus (HIV) and sexually transmitted infections (STI) testing rates are amongst the highest in the world among men who have sex with men (MSM) in Australia. However, notable minorities have never tested and many MSM have not tested recently. To examine testing routines and assess covariates of testing, an online survey was conducted among MSM in New South Wales. Five hundred and eighty non-HIV positive MSM (Mean age: 29.33 years) were randomized to answer questions on barriers to testing for HIV or STI. One in five (20.9 %) non-HIV-positive participants had never tested for HIV, 27.2 % had no HIV testing routines, 22.8 % had a moderate HIV testing routines, and 29.1 % had strong HIV testing routines. Similar patterning was observed for STI testing. In multivariate analyses participants' knowledge, beliefs, attitudes, subjective norms and perceived behavioral control were moderately related to HIV and/or STI testing routines and some associations were specific to either HIV or STI testing or to particular routines. Findings highlight that multiple social-cognitive factors each play a role in explaining HIV and STI testing among MSM. To effectively promote regular testing in MSM, programs face the challenge of having to address a range of hurdles, rather than a few major obstacles.

Introduction: Concerns have been voiced that the use of sexually explicit materials (SEMs) may adversely affect sexual behaviors, particularly in young people. Previous studies have generally found significant associations between SEM consumption and the sexual behaviors investigated. However, most of these studies have focused on sexual behaviors related to sexually transmitted infections or sexual aggression and/or failed to adequately control for relevant covariates. Thus, research more thoroughly investigating the association between SEM consumption and a broader range of sexual behaviors is needed., Aims: The study aims to investigate SEM consumption patterns of young people, and to assess the strength of the association between SEM consumption and a range of sexual behaviors, controlling for a comprehensive array of variables previously shown to affect these relationships., Methods: Online cross-sectional survey study of 4,600 young people, 15-25 years of age, in The Netherlands was performed., Main Outcomes Measures: The main outcome measures were self-reported SEM consumption and sexual practices., Results: The study found that 88% of men and 45% of women had consumed SEM in the past 12 months. Using hierarchical multiple regression analyses to control for other factors, the association between SEM consumption and a variety of sexual behaviors was found to be significant, accounting for between 0.3% and 4% of the total explained variance in investigated sexual behaviors., Conclusions: This study suggests that, when controlling for important other factors, SEM consumption influences sexual behaviors. The small to moderate associations that emerged between SEM consumption and sexual behavior after controlling for other variables suggest that SEM is just one factor among many that may influence youth sexual behaviors. These findings contribute novel information to the ongoing debates on the role of SEM consumption in sexual behaviors and risk, and provide appropriate guidance to policy makers and program developers concerned with sexual education and sexual health promotion for young people., (© 2013 International Society for Sexual Medicine.)

Seeking sexual partners online is associated with sexual risk-taking among men who have sex with men (MSM), but it is not well understood how this use of the Internet is implicated in potential sexual risks. The present study explores whether fantasizing about unprotected anal intercourse (UAI) during online chatting is associated with UAI with partners met online. An online survey of 2058 MSM in France included assessments of UAI with partners met online, responses to erotic chatting about UAI, intentions to use condoms, attitudes regarding UAI, practicing UAI with casual partners, alcohol and drug use with sex and biographical characteristics. While intentions to use condoms with casual partners were high, one-third (32.1%) of respondents reported UAI with partners met online. Responding positively to online chatting about UAI was significantly associated with UAI with partners met online, controlling for intentions, attitudes, behavior and biographic characteristics. These findings suggest that, while MSM may not go online to seek UAI, some engage in online fantasizing about UAI that is associated with possible sexual risk-taking. This speaks critically to the assumption that online fantasizing has no behavioral implications, and underscores the importance of human immunodeficiency virus prevention that addresses the dynamics of online chatting.

Background: HIV prevalence data suggest that men who have sex with men (MSM) in low-income and middle-income countries (LMIC) are at increased risk of HIV. The aim of this article is to present global estimates on key HIV prevention needs and responses among MSM in LMIC., Methods: Data on HIV testing, HIV prevention coverage, HIV knowledge and condom use among MSM were derived from UNGASS country progress reports submitted in 2008. Eligible country estimates were used to calculate global and regional estimates, weighted for the size of MSM populations., Results: Of 147 LMIC, 45% reported at least 1 indicator that reflects the HIV prevention needs and responses in MSM. Global weighted estimates indicate that on average 31% of MSM in LMIC were tested for HIV; 33% were reached by HIV prevention programs; 44% had correct HIV knowledge; and 54% used condoms the last time they had anal sex with a man., Conclusions: The 2008 UNGASS country reports represent the largest harmonized data set to date of HIV prevention needs and responses among MSM in LMIC. Although reporting is incomplete and does not always conform to requirements, findings confirm that, in many LMIC, HIV prevention responses in MSM need substantial strengthening.

Objectives: To assess the extent to which sexual risk-taking among men who have sex with men (MSM) is influenced by their sexual desires, as reflected in sexual sensation seeking, and to establish whether men's sexual self-control moderates the influence of sexual sensation seeking., Methods: An online survey in the Netherlands recruited 1613 MSM; 1129 men who had sex with casual partners and reported full data were included in this study. Potential sexual risk-taking in the preceding 12 months was indexed by number of casual partners (<10 vs > or =10), unprotected anal intercourse with casual partners (UAI-C; no vs yes) and sexually transmitted infections (no vs yes)., Results: Potential sexual risk-taking with casual partners was highly prevalent in this online sample of MSM; 51.0% had 10 or more casual sex partners, 38.8% had engaged in UAI-C and 22.9% reported having had a sexually transmitted disease. Multivariate logistic regression analyses showed that sexual sensation seeking was significantly related to more risk-taking according to each outcome variable, while all effects of sexual self-control were significantly protective. As expected, sexual self-control attenuated the effects of high sexual sensation seeking on UAI-C, but not on numbers of partners and infection with a sexually transmitted infection., Conclusions: Although MSM who are higher in sexual sensation seeking are more likely to engage in sexual risk-taking, some men successfully self-regulate the influence of their sexual desires on UAI-C. While men high in sexual self-control may spontaneously control their sexual desires, men low in sexual self-control may benefit from a generation of prevention tools that promote planning ahead of time.

To contribute to the evidence-based understanding of the psychosocial factors that influence individuals' uptake of testing for HIV, we assessed and synthesized the pertinent published literature in the fields of public health, behavioural medicine, and (health) psychology. Although the evidence base appears too limited to allow firm conclusions and definition on psychological barriers to HIV testing in high-income countries, we identified convergent themes from the available studies. Testing for HIV seems to be more likely when individuals perceive that they have been at risk, though this association is not perfectly observed. Fear of the consequences of testing positive -mainly worries related to discrimination and rejection - also hinders HIV testing. Finally, individuals appear more likely to test for HIV when they perceive more benefits from testing. The perspective of targeted individuals, in particular the social connotations and consequences of HIV diagnoses, is crucial to understand testing decisions.