ORCID Profile
0000-0002-7724-691X
Current Organisations
University of California, San Diego
,
Johns Hopkins University
,
Simon Fraser University
,
San Diego State University
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Publisher: Elsevier BV
Date: 08-2022
Publisher: American Public Health Association
Date: 02-2011
Abstract: Objectives. We investigated whether the intention to have children varied according to HIV status and use of highly active antiretroviral therapy (HAART) among women in Soweto, South Africa. Methods. We used survey data from 674 women aged 18 to 44 years recruited from the Perinatal HIV Research Unit in Soweto (May through December 2007) 217 were HIV-positive HAART users (median duration of use = 31 months interquartile range = 28, 33), 215 were HIV-positive and HAART–naive, and 242 were HIV negative. Logistic regression models examined associations between HIV status, HAART use, and intention to have children. Results. Overall, 44% of women reported intent to have children, with significant variation by HIV status: 31% of HAART users, 29% of HAART-naive women, and 68% of HIV-negative women (P .001). In adjusted models, HIV-positive women were nearly 60% less likely to report childbearing intentions compared with HIV-negative women (for HAART users, adjusted odds ratio [AOR] = 0.40 95% confidence interval [CI] = 0.23, 0.69 for HAART-naive women, AOR = 0.35 95% CI = 0.21, 0.60), with minimal differences according to use or duration of HAART. Conclusions. Integrated HIV, HAART, and reproductive health services must be provided to support the rights of all women to safely achieve their fertility goals.
Publisher: Oxford University Press (OUP)
Date: 06-1997
DOI: 10.1093/IJE/26.3.657
Abstract: To assess how HIV infection and AIDS (HIV/AIDS) impacts on mortality rates for gay and bisexual men. Vital statistics data were obtained for a large Canadian urban centre from 1987 to 1992. Three scenarios were utilized with assumed proportions of gay and bisexual men of 3%, 6% and 9% among the male population age 20 years. For each scenario, non-HIV deaths were distributed according to the assumed proportion of the total population (3%, 6% or 9%) but 95% of HIV deaths were distributed to gay and bisexual men as this is the proportion of AIDS cases in gay and bisexual men in this centre. The main outcome measures of interest were age-specific patterns of death, life expectancy and life expectancy lost due to HIV/AIDS at exact age 20 years, and the probability of living from age 20 to 65 years. Estimates of the mid-period gay and bisexual population ranged from 5406 to 16,219 for the three scenarios, and total deaths in these men from 953 to 1703. Age-specific mortality was significantly higher for gay and bisexual men than all men aged 30-44. Life expectancy at age 20 for gay and bisexual men ranged from 34.0 years to 46.3 years for the 3% and 9% scenarios respectively. These were all lower than the 54.3 year life expectancy at age 20 for all men. The probability of living from age 20 to 65 years for gay and bisexual men ranged from 32% for the 3% scenario, to 59% for the 9% scenario. These figures were considerably lower than for all men where the probability of living from 20 to 65 was 78%. In a major Canadian centre, life expectancy at age 20 years for gay and bisexual men is 8 to 20 years less than for all men. If the same pattern of mortality were to continue, we estimate that nearly half of gay and bisexual men currently aged 20 years will not reach their 65th birthday. Under even the most liberal assumptions, gay and bisexual men in this urban centre are now experiencing a life expectancy similar to that experienced by all men in Canada in the year 1871.
Publisher: Springer Science and Business Media LLC
Date: 08-07-2012
DOI: 10.1007/S11904-012-0130-Z
Abstract: The scope and scale of the HIV outbreak that occurred among injection drug users in Vancouver in the late 1990s was unprecedented and resulted in some 2,000 new HIV infections, with incidence rates reaching 18 per 100 person-years. This outbreak, localized mainly in one neighbourhood, cost the Canadian health care system more than 1 billion dollars to diagnose, care and treat. A number of factors combined to stabilize HIV incidence: 1) HIV prevalence became saturated among those at highest risk 2) several public health policies focused on drug users were implemented, including increased and additional decentralized needle exchange programs, expanded methadone maintenance services, better addiction treatment services, improved housing, and mental health programs and 3) increased access and expansion of Highly Active Antiretroviral Therapy. To ensure that a similar outbreak never occurs again in Vancouver and other cities, future health policy must consider the political, psychosocial and socioeconomic factors that contributed to this outbreak. These policies must address the unintended adverse consequences of past policies and their repercussions for marginalized in iduals living in this community and beyond.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2001
Publisher: Springer Science and Business Media LLC
Date: 15-02-2006
Publisher: BMJ
Date: 06-03-2015
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.DRUGPO.2016.01.002
Abstract: In this commentary, we take the recent introduction of methadone treatment in response to emerging problems of HIV linked to heroin addiction in Kenya as a case for reflecting on the social science of implementation science. We offer a framework of 'evidence-making intervention' which we hold as distinct from mainstream 'evidence-based intervention' approaches. Whilst accepting that interventions are shaped in their contexts, evidence-based intervention approaches tend to imagine a stable intervention object with universal effect potential. By contrast, an evidence-making intervention approach investigates how an intervention, and the knowledge which constitutes it, is made locally, through its processes of implementation. Drawing on qualitative research generated in Kenya prior to (2012-2013) and during (2014-2015) the implementation of methadone treatment, we explore the making of 'methadone promise' as a case of evidence-making intervention. We show how enactments of methadone promise make multiple methadones, through which a binary is negotiated between the narratives of methadone as hope for addiction recovery and methadone as hope for HIV prevention. Addiction recovery narratives predominate, despite methadone's incorporation into policy via its globally supported HIV prevention evidence-base. Key practices in the making of methadone promise in Kenya include its medicalization, and renaming, as 'medically assisted treatment' - or simply 'MAT' - which distance it from prior constitutions elsewhere as a drug of substitution, and the visualisation of its effects wherein unhealthy people can be seen and shown to have become well. We also show how actors seek to protect the story of methadone promise from counter narratives, including through mass media projects. We conclude that there is no single biomedical object of methadone intervening on a single biological body across contexts, and no single universe of evidence. By giving weight to local rather than outside expert knowledge, and by tracing how the meaning of intervention is made locally through its implementation, we can make visible the multiple enactments of an intervention and how these shape local ecologies of care, including in ways beyond those foreseen by an intervention's evidencing elsewhere.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2008
Publisher: Springer Science and Business Media LLC
Date: 12-2005
Abstract: There is considerable concern about the spread of HIV disease among Aboriginal peoples in British Columbia. To estimate the number of Aboriginal British Columbians infected with HIV. A population-based analysis of Aboriginal men and women in British Columbia, Canada from 1980 to 2001. Epidemic curves were fit for gay and bisexual men, injection drug users, men and women aged 15 to 49 years and persons over 50 years of age. HIV prevalence for the total Aboriginal population was modeled using the UNAIDS/WHO Estimation and Projection Package (EPP). Monte Carlo simulation was used to estimate potential number infected for select transmission group in 2001. A total of 170,025 Aboriginals resided in British Columbia in 2001, of whom 69% were 15 years and older. Of these 1,691 (range 1,479 – 1,955) men and women aged 15 years and over were living with HIV with overall prevalence ranging from 1.26% to 1.66%. The majority of the persons infected were men. Injection drug users (range 1,202 – 1,744) and gay and bisexual men (range 145, 232) contributed the greatest number of infections. Few persons infected were from low risk populations. More than 1 in every 100 Aboriginals aged 15 years and over was living with HIV in 2001. Culturally appropriate approaches are needed to tailor effective HIV interventions to this community.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2003
Publisher: Informa UK Limited
Date: 10-2008
DOI: 10.1080/13691050802183899
Abstract: This paper examines cultural and social meanings associated with semen, along with related issues of unprotected receptive anal intercourse, HIV seroconversion, treatment optimism and viraemia. The findings are derived from qualitative interviews conducted with 12 HIV-positive young gay men and 12 HIV-negative counterparts who participated in a prospective cohort study in Vancouver, Canada. Focussing on the narratives of young gay men, the analysis reveals a erse range of knowledge, values and functions of semen, especially in relation to its exchange. Beliefs about semen appeared to differ by HIV serostatus and were linked with intimacy, identity and pleasure, particularly among the HIV-positive men. Against dominant representations of semen in relation to issues of loss, anxiety and infertility, this unique study sheds much needed light on its role within the cultural construction of sexuality among gay men. As such, these narratives are of direct importance to primary and secondary HIV prevention, including condom promotion and the development of rectal microbicides.
Publisher: American Medical Association (AMA)
Date: 12-08-1998
Abstract: In British Columbia, human immunodeficiency virus (HIV)-infected persons eligible for antiretroviral therapy may receive it free but the extent to which HIV-infected injection drug users access it is unknown. To identify patient and physician characteristics associated with antiretroviral therapy utilization in HIV-infected injection drug users. Prospective cohort study with record linkage between survey data and data from a provincial HIV/AIDS (acquired immunodeficiency syndrome) drug treatment program. British Columbia, where antiretroviral therapies are offered free to all persons with HIV infection with CD4 cell counts less than 0.50 x 10(9)/L (500/microL) and/or HIV-1 RNA levels higher than 5000 copies/mL. A total of 177 HIV-infected injection drug users eligible for antiretroviral therapy, recruited through the prospective cohort study since May 1996. Patient use of antiretroviral drugs through the provincial drug treatment program and physician experience treating HIV infection. After a median of 11 months after first eligibility, only 71 (40%) of 177 patients had received any antiretroviral drugs, primarily double combinations (47/71 [66%]). Both patient and physician characteristics were associated with use of antiretroviral drugs. After adjusting for CD4 cell count and HIV-1 RNA level at eligibility, odds of not receiving antiretrovirals were increased more than 2-fold for females (odds ratio [OR], 2.53 95% confidence interval [CI], 1.08-5.93) and 3-fold for those not currently enrolled in drug or alcohol treatment programs (OR, 3.49 95% CI, 1.45-8.40). Younger drug users were less likely to receive therapy (OR, 0.47/10-y increase 95% CI, 0.28-0.80). Those with physicians having the least experience treating persons with HIV infection were more than 5 times less likely to receive therapy (OR, 5.55 95% CI, 2.49-12.37). Despite free antiretroviral therapy, many HIV-infected injection drug users are not receiving it. Public health efforts should target younger and female drug users, and physicians with less experience treating HIV infection.
Publisher: Oxford University Press (OUP)
Date: 22-05-2014
DOI: 10.1093/CID/CIU387
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2015
Publisher: American Public Health Association
Date: 06-2008
Abstract: Objectives. We sought to determine incidence of, prevalence of, and risk factors for sexual orientation–related physical assault in young men who have sex with men (MSM). Methods. We completed a prospective open cohort study of young MSM in Vancouver, British Columbia, surveyed annually between 1995 and 2004. Correlates of sexual orientation–related physical assault before enrollment were identified with logistic regression. Risk factors for incident assaults were determined with Cox regression. Results. At enrollment, 84 (16%) of 521 MSM reported ever experiencing assault related to actual or perceived sexual orientation. Incidence was 2.3 per 100 person-years cumulative incidence at 6-year follow-up was 10.8 per 100 person-years. Increased risk of incident sexual orientation–related physical assault was observed among MSM 23 years or younger (relative hazard=3.1 95% confidence interval [CI] = 1.6, 5.8), Canadian Aboriginal people (relative hazard = 3.0 95% CI=1.4, 6.2), and those who previously experienced such assault (relative hazard=2.5 95% CI=1.3, 4.8). Conclusions. These data underscore the need for increased public awareness, surveillance, and support to reduce assault against young MSM. Such efforts should be coordinated at the community level to ensure that social norms dictate that such acts are unacceptable.
Publisher: Elsevier BV
Date: 11-1995
Publisher: Public Library of Science (PLoS)
Date: 05-11-2010
Publisher: SAGE Publications
Date: 09-1999
Abstract: Young Aboriginal men face marginalization distinct in cause but similar in pattern to those seen among men who have sex with men (MSM) and may be at increased risk for HIV infection. We compared sociodemographic characteristics and risk taking behaviours associated with HIV infection among MSM of Aboriginal and non-Aboriginal descent. Data for this comparison were gathered from baseline questionnaires completed by participants in a cohort study of young MSM. Data collection included: demographic characteristics such as age, length of time residing in the Vancouver region, housing, employment, income and income sources mental health and personal support instances of forced sex and sex trade participation and sexual practices with regular and casual male sex partners. Data were available for 57 Aboriginal and 624 non-Aboriginal MSM. Aboriginal MSM were significantly less likely to be employed, more likely to live in unstable housing, to have incomes of $10,000 and to receive income assistance than non Aboriginals (all P .01). Aboriginals also had higher depression scores (P .01), were more likely to report non-consensual sex (P=0.03), sexual abuse during childhood (P=0.04) and having been paid for sex (P .01). In the past year they were no more likely to have had sex with a male partner they knew to be HIV positive, to have had more than 50 male partners or to have unprotected anal insertive or receptive intercourse with their male partners (all P 0.05). Our data indicate that among MSM, Aboriginal men are at increased risk of antecedent risk factors for HIV infection including sexual abuse, poverty, poor mental health and involvement in the sex trade.
Publisher: Elsevier BV
Date: 04-2006
DOI: 10.1016/J.JINF.2005.07.008
Abstract: We examined the time to antiretroviral therapy (ART) use among antiretroviral naïve HIV infected injection drug users participating in a prospective cohort study in Vancouver, Canada. Time to the initiation of ART was evaluated using Kaplan-Meier methods and Cox proportional hazards regression. The cohort was stratified based on Aboriginal and non-Aboriginal (primarily Caucasian) ethnicity. Between May 1996 and May 2003, 312 HIV-infected in iduals were enrolled into the cohort. At 24 months after enrollment, the rate of ART use was 29.2% among Aboriginal participants and was 53.7% among non-Aboriginal participants (log-rank P=0.023), and lower uptake of ART persisted in multivariate analyses (relative hazard = 0.37 [95% CI: 0.15-0.93] P = 0.035). These findings demonstrate lower uptake of HIV/AIDS care among Aboriginal injection drug users and demonstrate the need for interventions to improve access to HIV care among indigenous populations.
Publisher: Wiley
Date: 09-2006
DOI: 10.1080/09595230600883313
Abstract: Improving access to antiretroviral therapy among injection drug users remains an urgent public health concern. We examined the time to antiretroviral therapy (ART) use among antiretroviral naive HIV-infected injection drug users who were unaware of their HIV status to examine the impact of receipt of HIV test results on uptake of ART. Time to ART use was examined using Kaplan - Meier methods, and factors associated with the time to ART were evaluated using Cox proportional hazards regression. Between May 1996 and May 2003, 312 HIV-infected in iduals were enrolled into the Barriers to Antiretroviral Therapy (BART) cohort, among whom 105 (33.7%) reported not knowing their HIV status at baseline. At 24 months post-baseline, those participants who returned for test results within 8 months initiated ART at a significantly elevated rate [adjusted relative hazard = 1.87 (95% CI: 1.05 - 3.33)]. These findings demonstrate the potential to improve uptake of ART among injection drug users through targeted HIV testing and counselling initiatives that encourage the receipt of HIV test results, and suggest that strategies to improve awareness of HIV infection may improve access to antiretroviral therapy.
Publisher: Informa UK Limited
Date: 2008
DOI: 10.1080/09540120701426540
Abstract: The purpose of this study was to determine whether current HAART use is associated with recent sexual intercourse among HIV-infected women (18-49 years) from Brazil, South Africa and Uganda. We conducted an analysis of survey data from a cross-sectional study, which enrolled 179 HIV-infected women receiving regular care from the Mbarara Hospital HIV Clinic in Uganda (n=85) the Perinatal HIV Research Unit in Soweto, South Africa (n=50) and the IPEC-Fiocruz cohort in Rio de Janeiro, Brazil (n=44). The primary outcome was sexual intercourse in the previous month. Secondary outcomes were protected sex and contraceptive use. We found that overall, 46% reported recent sexual intercourse. After adjusting for covariates, recent sexual intercourse was not associated with HAART use (AOR: 0.76 95%CI: 0.34-1.72) however, it was significantly associated with being currently married, wanting to have more children and having higher HAART optimism. Among women reporting recent sexual intercourse (n=83), HAART users were significantly more likely to practice protected sex (crude OR: 3.64 95%CI: 1.41-9.38) and non-significantly more likely to use contraceptive methods (crude OR: 2.15 95%CI: 0.77-5.99). In summary, self-reported recent sexual intercourse is not more likely among women on HAART. Moreover, sexually active HAART users may be more likely to practice protected sex and use contraceptives.
Publisher: Informa UK Limited
Date: 10-2007
DOI: 10.1080/09540120701352258
Abstract: HIV vaccine development remains an urgent priority. This article is a systematic review of HIV vaccine preparedness studies in the high-income 30 Organization for Economic Co-operation and Development countries, to identify factors important for HIV vaccine trial development in injection drug users (IDU), men who have sex with men (MSM), and women at heterosexual risk (WAHR) across these countries. Of 27 articles we identified, willingness to participate (WTP) was assessed in eight studies involving IDU, 11 involving MSM, and one involving WAHR. WTP ranged in IDU at 41-86%, MSM at 23-94%, and in WAHR, it was at 81%. Studies reported recruitment of high-risk in iduals. Retention was assessed in eight studies involving IDU, five involving MSM, and three involving WAHR. IDU were retained at a range of 3-98%, MSM at 70-95% and WAHR at 67-92%. This review provides an in-depth summary of HIV vaccine preparedness studies that were conducted in the Organization for Economic Co-operation and Development countries.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2006
DOI: 10.1097/01.QAI.0000179429.57531.47
Abstract: The identification of in iduals at highest risk of HIV infection is critical for targeting prevention strategies. We evaluated the HIV status of the sex partners of injection drug users (IDUs) and rates of subsequent HIV seroconversion among a prospective cohort study of IDUs. We performed an analysis of the time to HIV infection among baseline HIV-negative IDUs enrolled in the Vancouver Injection Drug Users Study. IDUs were stratified based on whether or not they reported having an HIV-positive sex partner. Kaplan-Meier methods were used to estimate cumulative HIV incidence rates, and Cox regression was used to determine adjusted relative hazards (RHs) for HIV seroconversion. Of 1013 initially HIV-negative IDUs, 4.8% had an HIV-positive partner at baseline. After 18 months, the cumulative HIV incidence rate was significantly elevated among those who reported having an HIV-positive sex partner (23.4% vs. 8.1% log-rank P < 0.001). In a Cox regression model adjusting for all variables that were associated with the time to HIV infection in univariate analyses, including drug use characteristics, having an HIV-positive sex partner (RH = 2.42 [95% confidence interval: 1.30 to 4.60] P = 0.005) remained independently associated with time to HIV seroconversion. Having an HIV-positive sex partner was strongly and independently associated with seroconversion after adjustment for risk factors related to drug use. Our findings may aid public health workers in their efforts to identify IDUs who should be targeted with education and prevention efforts and indicate the need for ongoing development of prevention interventions for IDU sex partners who are HIV discordant.
Publisher: Elsevier BV
Date: 09-2005
DOI: 10.1016/J.SOCSCIMED.2004.12.024
Abstract: There is increasing appreciation of the need to understand how social and structural factors shape HIV risk. Drawing on a review of recently published literature, we seek to describe the social structural production of HIV risk associated with injecting drug use. We adopt an inclusive definition of the HIV 'risk environment' as the space, whether social or physical, in which a variety of factors exogenous to the in idual interact to increase vulnerability to HIV. We identify the following factors as critical in the social structural production of HIV risk associated with drug injecting: cross-border trade and transport links population movement and mixing urban or neighbourhood deprivation and disadvantage specific injecting environments (including shooting galleries and prisons) the role of peer groups and social networks the relevance of 'social capital' at the level of networks, communities and neighbourhoods the role of macro-social change and political or economic transition political, social and economic inequities in relation to ethnicity, gender and sexuality the role of social stigma and discrimination in reproducing inequity and vulnerability the role of policies, laws and policing and the role of complex emergencies such as armed conflict and natural disasters. We argue that the HIV risk environment is a product of interplay in which social and structural factors intermingle but where political-economic factors may play a predominant role. We therefore emphasise that much of the most needed 'structural HIV prevention' is unavoidably political in that it calls for community actions and structural changes within a broad framework concerned to alleviate inequity in health, welfare and human rights.
Publisher: Springer Science and Business Media LLC
Date: 12-2006
DOI: 10.1007/S11904-006-0015-0
Abstract: Approximately 14 million women of child-bearing age are living with HIV/AIDS in sub-Saharan Africa. Women with HIV infection have between 25% and 40% lower fertility than noninfected women. As antiretroviral (ARV) therapy becomes increasingly accessible in sub-Saharan Africa, it is important to understand whether and how the associated clinical improvements correspond with changes in the incidence of pregnancy and fertility. Accordingly, this paper reviews the literature on the potential impact of ARV therapy on the fertility of women with HIV infection in sub-Saharan Africa. We use Bongaarts' proximate determinants of fertility framework (adapted for conditions of a generalized HIV epidemic) to examine the underlying mechanisms through which use of ARV therapy may impact the fertility of women with HIV infection. A conceptual framework is proposed to guide future research aimed at understanding how widespread use of ARV therapy may impact fertility in sub-Saharan Africa.
Publisher: Elsevier BV
Date: 07-2018
Publisher: Elsevier BV
Date: 04-2011
Publisher: Wiley
Date: 05-2009
DOI: 10.1111/J.1468-1293.2008.00684.X
Abstract: The aim of the study was to compare the risks of death among HIV-infected patients on highly active antiretroviral therapy (HAART) in two proximate, yet distinct neighbourhoods: a neighbourhood with a high concentration of gay men, and a neighbourhood with a high concentration of injecting drug users. We compared the clinical and socioeconomic characteristics of HIV-infected patients from the two neighbourhoods entering the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program from 1 September 1997 to 30 November 2005, using contingency table statistics. Cox survival models and Kaplan-Meier methods were used to estimate the cumulative mortality rates. We found significant differences between patients from the two neighbourhoods for all socioeconomic variables. Patients in the neighbourhood with a high concentration of injecting drug users were more likely to be female, have a history of injecting drug use, have a less HIV-experienced physician and be less adherent. Patients in the neighbourhood with a high concentration of gay men were more likely to have AIDS. Mortality was significantly higher for patients in the neighbourhood with a high concentration of injecting drug users [hazard ratio (HR) 3.01 95% confidence interval (CI) 1.73, 5.24]. A threefold increase was observed in the risk of death among HIV-infected in iduals on HAART in the neighbourhood with a high concentration of injecting drug users relative to the neighbourhood with a high concentration of gay men. The implications of this study should be assessed in similar HIV/AIDS epicentres.
Publisher: Springer Science and Business Media LLC
Date: 2006
Publisher: Springer Science and Business Media LLC
Date: 2007
Publisher: Springer Science and Business Media LLC
Date: 2008
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1111/AJT.15503
Publisher: Public Library of Science (PLoS)
Date: 25-06-2014
Publisher: Elsevier BV
Date: 07-2010
Publisher: Informa UK Limited
Date: 18-06-2020
Publisher: Oxford University Press (OUP)
Date: 20-02-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2000
DOI: 10.1097/00002030-200002180-00013
Abstract: To compare demographic characteristics, sexual practices, unprotected receptive and insertive anal intercourse, substance use and rates of HIV-1 seroconversion between two prospective cohorts of HIV-negative men who have sex with men. Comparative analysis of two independent cohorts. Between May 1995 and April 1996, 235 HIV-negative Vanguard Project (VP) participants were enrolled and between January and December 1985, 263 HIV-negative participants in the Vancouver Lymphadenopathy AIDS Study (VLAS) completed a follow-up visit. The VP participants were compared with VLAS participants with respect to self-reported demographic variables, sexual behaviors, unprotected sex, substance use and rates of HIV-1 seroconversion during follow-up. In comparison with the VLAS participants the VP participants were younger (median age, 26 versus 34 years P< 0.001), more likely to be non-Caucasian (75 versus 97% P< 0.001), and were less likely to have attended university/college (35 versus 46% P = 0.014). The VP participants reported a higher mean number of male sex partners in the previous year (15 versus 12 P= 0.026) and a higher mean number of regular partners (1.7 versus 0.6 P < 0.001). The VP participants were more likely to report engaging in receptive (92 versus 60% P< 0.001) and insertive (90 versus 69% P < 0.001) anal intercourse with regular partners and receptive anal intercourse with casual partners (62 versus 38% P< 0.001). The VLAS participants were more likely to report never using condoms during insertive and receptive anal intercourse with both regular and casual partners. The VP participants were less likely to report using nitrite inhalants (34 versus 43% P= 0.033), but more likely to report the use of cocaine (30 versus 8% P< 0.001), LSD (21 versus 3% P < 0.001), hetamine (11 versus 1% P< 0.001), heroin (3 versus 0% P= 0.010) and methyldi hetamine (17 versus 10% P= 0.034). The VLAS participants were nine times more likely to report high-risk sexual behavior, after controlling for differences in age, ethnicity, substance use, and method of recruitment between cohort members. After adjustment for differences in demographics, sexual behaviors, and level of substance use, the risk ratio for seroconversion among VLAS participants remained significantly elevated compared with VP participants. These data provide evidence that men who have sex with men who were enrolled in the VP were more sexually active than their VLAS counterparts were 10 years ago as measured by self-reported numbers of regular and casual partners and frequency of anal intercourse with these partners. However, condom use appears to be significantly higher among VP participants, which has contributed to a lower rate of HIV-1 infection.
Publisher: Wiley
Date: 10-2020
DOI: 10.1002/JIA2.25632
Publisher: American Society for Microbiology
Date: 10-2017
DOI: 10.1128/AAC.00954-17
Abstract: Widespread antibiotic use in clinical medicine and the livestock industry has contributed to the global spread of multidrug-resistant (MDR) bacterial pathogens, including Acinetobacter baumannii . We report on a method used to produce a personalized bacteriophage-based therapeutic treatment for a 68-year-old diabetic patient with necrotizing pancreatitis complicated by an MDR A. baumannii infection. Despite multiple antibiotic courses and efforts at percutaneous drainage of a pancreatic pseudocyst, the patient deteriorated over a 4-month period. In the absence of effective antibiotics, two laboratories identified nine different bacteriophages with lytic activity for an A. baumannii isolate from the patient. Administration of these bacteriophages intravenously and percutaneously into the abscess cavities was associated with reversal of the patient's downward clinical trajectory, clearance of the A. baumannii infection, and a return to health. The outcome of this case suggests that the methods described here for the production of bacteriophage therapeutics could be applied to similar cases and that more concerted efforts to investigate the use of therapeutic bacteriophages for MDR bacterial infections are warranted.
Publisher: Elsevier BV
Date: 10-1994
DOI: 10.1016/S0140-6736(94)90631-9
Abstract: We studied the association between socioeconomic status and survival in a prospective study of 364 HIV-infected homosexual men who were recruited during 1982-84. The participants were ided by annual income those earning above Canadian $10,000 (high-income n = 274) and those below $10,000 (low-income n = 90) at recruitment. The latter threshold closely approximated to the poverty level for this population. Low income men were significantly younger than high income men but the groups were similar with respect to baseline CD4 counts, subsequent use of anti-retrovirals and prophylaxis against Pneumocystis carinii pneumonia (PCP), and number of visits attended during follow-up. Subjects were followed for a median of 9.5 years (range 1.8-13.1). By Dec 31, 1993, there were 135 deaths yielding a cumulative mortality rate of mean 45% (SD 4.0) at 11.5 years. Men aged 30 or more at infection had poorer survival than those under 30 (mortality risk ratio 1.56 95% CI 1.09-2.24 p = 0.015), and longer survival was significantly associated with a higher CD4 count at the earliest seropositive visit. The age-adjusted mortality risk ratio for low income men compared with high income men was significantly increased at 1.63 (95% CI 1.11-2.40 p = 0.013). The significant risk of death for low income men persisted despite adjustment for age at infection, CD4 count, use of zidovudine, dideoxyinosine, and dideoxycytidine, use of PCP prophylaxis, and year of infection. We cannot attribute our findings to income loss as a result of more rapid HIV progression because the same effect was present in people who provided income data before seroconversion. Similarly, our findings are not due to differential access to care because the study was done within the context of a universal health care system, and the two income groups received treatments equally. This finding is consistent with the association of lower socioeconomic status with increased morbidity and mortality observed within large populations and in other diseases.
Publisher: Wiley
Date: 09-2007
Publisher: Springer Science and Business Media LLC
Date: 14-04-2021
DOI: 10.1186/S40168-021-01026-9
Abstract: Infectious bacterial diseases exhibiting increasing resistance to antibiotics are a serious global health issue. Bacteriophage therapy is an anti-microbial alternative to treat patients with serious bacterial infections. However, the impacts to the host microbiome in response to clinical use of phage therapy are not well understood. Our paper demonstrates a largely unchanged microbiota profile during 4 weeks of phage therapy when added to systemic antibiotics in a single patient with Staphylococcus aureus device infection. Metabolomic analyses suggest potential indirect cascading ecological impacts to the host (skin) microbiome. We did not detect genomes of the three phages used to treat the patient in metagenomic s les taken from saliva, stool, and skin however, phages were detected using endpoint-PCR in patient serum. Results from our proof-of-principal study supports the use of bacteriophages as a microbiome-sparing approach to treat bacterial infections.
Location: United States of America
No related grants have been discovered for Steffanie Strathdee.