Articles tagged as "Biomedical interventions and prevention tools"

Condoms

Liao SS, He QY, et al. Working to Prevent HIV/STIs Among Women in the Sex Industry in a Rural Town of Hainan, China. AIDS Behav 2006 Jul 6; [Epub ahead of print]

Liao and colleagues evaluated a two-phase HIV and (other) sexually transmitted infections prevention programme for female sex workers in a resource-limited rural town in Hainan Province, China. The primary strategy, undertaken from 1997 to 2000, was a condom promotion campaign conducted through outreach to sex workers. Four serial cross-sectional surveys were carried out before and after the programme. Over a period of 2 years, reported condom use during the most recent sexual encounter increased from about 50% to more than 70%; and condom use in more than 50% of sexual acts during the past 6 months increased from less than 40% to near 80% of respondents. Controlling for education, ethnicity and age, reading of educational materials (the intervention variable) was a significant contributor to a higher knowledge score, motivation to use condoms, and reported condom use. This study demonstrates that outreach to female sex workers, if appropriately tailored to local settings, can increase condom use in a resource-limited rural area.

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Male Circumcision

Ngalande RC, Levy J, et al. Acceptability of Male Circumcision for Prevention of HIV Infection in Malawi. AIDS Behav 2006 May 31; [Epub ahead of print]

Numerous epidemiological and biological studies report male circumcision (MC) to have a significant protective effect against HIV-1 acquisition. This study assesses the acceptability of MC in four districts in Malawi, a country with high HIV-1 prevalence and low prevalence of MC. Thirty-two focus group discussions were conducted with 159 men and 159 women ages 16-80 years. Acceptability was lower in the north where the practice was little known, higher in younger participants and higher in central and southern districts where MC is practiced by a minority Muslim group (Yao). Barriers to circumcision included fear of infection and bleeding, cost, and pain. Facilitators included hygiene, reduced risk of STI, religion, medical conditions, and enhanced sexual pleasure. The authors conclude that if MC services are introduced in Malawi, acceptance is likely to vary by region, but many parents and young men would use the services if they were safe, affordable and confidential.

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Condom Use

Maharaj P. Reasons for condom use among young people in KwaZulu-Natal: prevention of HIV, pregnancy or both? Int Fam Plan Perspect 2006;32:28-34. http://www.guttmacher.org/pubs/journals/3202806.html

High levels of HIV and unintended pregnancy among young people are urgent public health problems in South Africa. Studies among youth have generally focused on protection against one or the other of these risks, but not both. Maharaj analysed data collected in 2001 from 2,067 sexually active men and women aged 15-24 in KwaZulu-Natal (South Africa) to assess reasons for condom use, and levels and determinants of use. Overall, 59% of respondents said that they used condoms at last sexual intercourse, including 6% who used them with another method. The main reason for use (cited by 64% of users) was protection against both pregnancy and HIV infection. Two-thirds of respondents thought that becoming or making someone pregnant in the next few weeks would be a big problem; fewer than one in five viewed their risk of HIV infection as medium or high. Among both sexes, young people who would consider a pregnancy highly problematic were more likely to use condoms than their counterparts who would view a pregnancy as no problem. In sharp contrast, after controlling for fear of pregnancy, young men and women who perceived themselves as having a medium to high risk of HIV infection were less likely to use condoms than their counterparts who perceived themselves as being at no risk. The author concludes that prevention programmes could increase condom use in this population by increasing awareness of the twin risks of pregnancy and HIV infection, and by promoting condoms for protection against these dual risks.

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Microbicides

Mantell JE, Morar NS, et al."We have our protector": misperceptions of protection against HIV among participants in a microbicide efficacy trial. Am J Public Health 2006;96:1073-77. http://www.ajph.org/cgi/content/abstract/96/6/1073

Mantell and colleagues examined perceptions of the effectiveness and acceptability of a candidate microbicide among 94 South African female sex workers who had participated in a microbicide efficacy trial for HIV prevention. The conducted 16 focus groups in 2001, 12 to 15 months after participants were informed that the candidate microbicide had been determined to be ineffective in preventing HIV and other sexually transmitted infections (STIs). Participants clearly indicated that they understood the experimental nature of the candidate microbicide, and they recognized that they had been informed after the trial that the product was ineffective. Nevertheless, most continued to believe that the candidate microbicide helped prevent HIV and other STIs, alleviated reproductive tract pain and STI symptoms, and helped to clean the vagina. These findings underscore the importance of understanding women's perceptions of the efficacy of candidate microbicides and the rationale for these beliefs. These issues need to be addressed in counselling throughout microbicide trials for HIV prevention. These results also demonstrate how desperate many women at high risk of HIV infection may be for new HIV prevention technologies.

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Condom Use

Agha S, Hutchinson P, Kusanthan T. The effects of religious affiliation on sexual initiation and condom use in Zambia. Does religious affiliation reduce HIV risk among young women in Zambia? J Adolescent Health 2006;38:550-55.

Agha et al analyzed data from a representative probability sample of 5,534 women aged 13-20. The women were questioned about their sexual initiation, condom use during first sex, religious affiliation and sociodemographic characteristics. These young women were found to be more likely to delay sexual initiation but less likely to use condoms during first sex. The authors conclude that denominations which are not only strongly opposed to premarital sex and condom use, but are able to exercise control over adolescents through socialization or the threat of social exclusion, are likely to create conflicting behaviors among adolescents that cancel each other in terms of HIV risk. Overall, these findings suggest that affiliation with conservative religious groups is unlikely to reduce the risk of HIV infection.

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Male Circumcision

Atashili J. Adult male circumcision to prevent HIV? Int J Infect Dis 2006;10:202-5.

The author summarizes and discusses the main findings of studies of the evidence underlying adult male circumcision to prevent HIV, explores its feasibility and the implication for policy and future research. While the existing biological and epidemiological evidence suggest potential reduction of the risk of HIV acquisition in circumcised men, additional evidence from randomized trials are needed to confirm this. Even if the findings are confirmed, the practical aspects of implementing adult circumcision would have to be carefully considered. The feasibility of such an intervention, particularly with respect to its cost-effectiveness, safety and acceptability, is still to be demonstrated.

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Microbicides

Cohen JA, Steele MS, Urena FI, Beksinska ME. Microbicide Applicators: Understanding Design Preferences Among Women in the Dominican Republic and South Africa. Sex Transm Dis 2006 May 9; [Epub ahead of print].

Cohen et al aimed to identify acceptable microbicide applicator designs in 2 low-resource settings. They surveyed 895 women, randomly sampled from clinics in the Dominican Republic (n = 449) and South Africa (n = 446), with questions on sociodemographics, applicator attribute preferences, and price/design tradeoffs. They found that single-use design was the most valued attribute, and reusable design and low price were the least valued attributes in both populations. Preference for single-use design was associated with concern about reusable applicators spreading germs, secondary or higher education, older age, having children, and perception of moderate to high HIV risk. They conclude that acceptability factors related to microbicide delivery mechanisms should continue to be evaluated among potential microbicide users to directly inform product development and introduction of microbicides.


El-Sadr WM, Mayer KH, Maslankowski L, et al. Safety and acceptability of cellulose sulfate as a vaginal microbicide in HIV-infected women. AIDS 2006;20:1109-116.

El-Sadr et al conducted a randomized placebo-controlled trial to evaluate the safety and acceptability of 6% cellulose sulfate (CS) gel as a vaginal microbicide in sexually abstinent and active HIV-infected women. Sexually abstinent women applied the gel once or twice daily and sexually active women used gel once daily for 14 days. The authors found the CS gel to be safe with no reported severe or life-threatening adverse events (AE). 39 of 59 (66%) participants experienced urogenital AE probably or possibly related to gel, with no significant difference noted between the CS and placebo arms in the prevalence. There was no increase in AE by frequency of gel use or sexual activity with the exception of abdominal/pelvic pain which was noted more frequently with twice daily use among sexually abstinent women. Women and men found the gel highly acceptable. The authors conclude that they have demonstrated the vaginal gel was safe, well tolerated and acceptable by HIV-infected women and their male partners, and recommend further development of the gel as a potential method to prevent HIV transmission and acquisition.


Holt BY, Morwitz VG, Ngo L, et al. Microbicide preference among young women in California. J Womens Health 2006;15:281-94.

Holt et al integrated conjoint analysis with more traditional epidemiological and behavioural research to examine potential users' preferences for different microbicide formulations. Focus group discussions (n = 67) were held with a diverse population of young men and women (aged 18-32 years) from Northern California. Then young women participated in structured surveys (n = 321) that included a conjoint study, a methodology not yet used in microbicide acceptability. Participants' responses suggested that the ideal microbicide would (1) offer protection from pregnancy, HIV, STIs, and vaginal infections, (2) offer as much protection as condoms, (3) allow insertion up to 8 hours prior to sexual activity, (4) be available over the counter, (5) be inserted with an applicator, and (6) have only slight leakage not requiring a panty liner. The average predicted purchase probability for this ideal microbicide was 69%. The authors conclude that their findings help illustrate microbicide product preferences and demand among young women in California, and that the methodological approach should lend itself to other populations as well as during clinical trials when understanding product use and non-use is critical.

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Vaccines

Buffa V, Negri DR, Leone P, et al. A single administration of lentiviral vectors expressing either full-length human immunodeficiency virus 1 (HIV-1) HXB2 Rev/Env or codon-optimized HIV-1JR-FL gp120 generates durable immune responses in mice. J Gen Virol 2006;87:1625-34.

Buffa et al evaluated a self-inactivating lentiviral vector for the delivery of HIV-1 envelope sequences in mice in order to elicit specific immune responses. BALB/c mice were immunized with a single injection of self-inactivating lentiviral vectors carrying either the full-length HIV-1(HXB2) Rev/Env (TY2-IIIBEnv) or the codon-optimized HIV-1(JR-FL) gp120 (TY2-JREnv) coding sequence. Both vectors were able to elicit specific cellular responses efficiently, as measured by gamma interferon ELISPOT and chromium-release assays, upon in vitro stimulation of splenocytes from BALB/c immunized mice. However, only the TY2-JREnv-immunized mice were able to elicit specific humoral responses, measured as anti-gp120 antibody production. These data provide the first evidence that a single, direct, in vivo administration of a lentiviral vector encoding a viral gene might represent a useful strategy for vaccine development.

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