Same-sex practices are stigmatized in much of sub-Saharan Africa. Cross-sectional relationships between discrimination, access to and use of health care services, and HIV knowledge among men who have sex with men (MSM) were assessed in Malawi, Namibia, and Botswana. A survey and HIV screening were used to explore these variables and the prevalence of HIV. Overall, 19% of men screened positive for HIV infection. Ninety-three percent knew HIV is transmitted through anal sex with men, however, only 67% had ever received information of how to prevent this transmission. Few (17%) reported ever disclosing same sex practices to a health professional and 19% reported ever being afraid to seek health care. Men reported ever been denied health care services (5%) and 21% had ever been blackmailed because of their sexuality. Strong associations were observed between experiences of discrimination and fear of seeking health care services. Characterizing the relationship between stigma and health care seeking practices and attitudes can inform the development and implementation of HIV interventions for African MSM.

BACKGROUND Whether parental permission of alcohol and other drug use in a home environment is protective against substance‐related negative outcomes remains controversial. We investigated substance use at home, with or without parental knowledge, and its association with substance‐related consequences. METHODS The sample consisted of 21,207 U.S. students in the 6th to 12th grades surveyed between 2009 and 2017. Substance use patterns and rates of negative outcomes were analyzed by comparing groups of participants who had not used at home, or had used at home with and/or without parental knowledge. RESULTS Adolescents who used substances at home without parental knowledge used alcohol and substances in greater amounts, and tended to have more negative outcomes than those who did not. Students who had not used at home or had used only with parental knowledge tended to have lower levels of use and negative outcomes. CONCLUSIONS Using at home without parental knowledge was a consistent risk factor for substance‐related negative outcomes. These results highlight the importance of screening adolescents for the use of alcohol or drugs in the home without parental knowledge, as well as attempting to prevent substance use in the household.

BackgroundLow levels of serum selenium are associated with increased risk of mortality among HIV+ patients in East Africa. We aim to assess the effect of selenium supplementation on CD4 cell count, HIV viral load, opportunistic infections, and quality of life in HIV-infected patients in Rwanda.Methods and DesignA 24-month, multi-centre, patient and provider-blinded, randomized, placebo-controlled clinical trial involving 300 pre-antiretroviral therapy (ART) HIV-infected patients will be carried out at two sites in Rwanda. Patients ≥ 21 years of age with documented HIV infection, CD4 cell count of 400-650 cells/mm3, and not yet on ART will be recruited. Patients will be randomized at each study site using a randomized block design to receive either the selenium micronutrient supplement or an identically appearing placebo taken once daily. The primary outcome is a composite of time from baseline to reduction of CD4 T lymphocyte count below 350 cells/mm3 (confirmed by two measures at least one week apart), or start of ART, or the emergence of a documented CDC-defined AIDS-defining illness. An intention-to-treat analysis will be conducted using stepwise regression and structural equation modeling.DiscussionMicronutrient interventions that aim to improve CD4 cell count, decrease opportunistic infections, decrease HIV viral load, and ultimately delay initiation of more costly ART may be beneficial, particularly in resource-constrained settings, such as sub-Saharan Africa. Additional trials are needed to determine if micro-supplementation can delay the need for more costly ART among HIV-infected patients. If shown to be effective, selenium supplementation may be of public health importance to HIV-infected populations, particularly in sub-Saharan Africa and other resource-constrained settings.Trial RegistrationNCT01327755

We present a survey of occupational injuries sustained by obstetric and gynaecology trainees in the Oxford Region. There appears to be a pattern of dominant hand and shoulder injury associated with specific obstetric procedures. Individuals with smaller hands seem more prone to injury. Female trainees who reported dominant hand injury wear a small glove. With more women entering a traditionally male dominated specialty occupational injuries in this discipline may be on the increase.