We report results of a community study of syringe exchange that compared the HIV risk behavior of exchange clients with that of nonclients. A prospective cohort of 259 untreated injecting drug users (IDUs) was followed a mean of 10.7 months after baseline. In assessing whether HIV risk behavior at follow-up was associated with study participants' follow-up use of the exchange, we controlled their baseline risk behavior and exchange use as markers of risk-taking tendency in addition to other potential confounders. We also examined whether there was a differential benefit of exchange use for IDUs with versus those without access to other sources of syringes. Both univariate and multivariate analyses revealed a more than twofold decreased odds of HIV risk behavior associated with use of the exchange. In a second multivariate analysis, which examined the interaction of exchange use with access to other sources of syringes, the odds of HIV risk behavior were decreased more than sixfold for IDUs without other sources. We conclude that use of the exchange had a substantial protective effect against HIV risk behavior and may have been especially critical for IDUs without other sources of syringes.

Our data indicate that female condom use supplements male condom use and leads to an increase in protected sex. The results also suggest that attitudinal and communication factors can increase female condom use.

Objectives: Increased risk of morbidity and hospitalization has been observed in children who are HIV-exposed uninfected (HEU) compared with HIV-unexposed uninfected (HUU). Studies in the era of universal maternal antiretroviral treatment (ART) are limited.Design: Prospective cohort. Methods:We investigated hospitalization between 29 days and 12 months of life in a South African cohort of infants born between February 2017 and January 2019 (HEU ¼ 455; HUU ¼ 458). All mothers known with HIV during pregnancy received ART. We reviewed hospital records and classified and graded infectious diagnoses using a standardized tool. We examined factors associated with infectious-cause hospitalization using mixed-effects Poisson regression.Results: Infants HEU vs. HUU had higher all-cause and infectious-cause hospitalization (13 vs. 7%, P ¼ 0.004 and 10 vs. 6%, P ¼ 0.014, respectively). Infectious causes accounted for most hospitalizations (77%). More infants HEU were hospitalized with severe or very severe infections than those HUU (9 vs. 6%; P ¼ 0.031). Mortality (<1%) did not differ between groups. HIV exposure was a significant risk factor for infectious-cause hospitalization [adjusted incidence rate ratios (aIRRs) ¼ 2.8; 95% confidence interval (CI) 1.5-5.4]. Although increased incidence of preterm birth (14 vs. 10%; P < 0.05) and shorter duration of breastfeeding (44 vs. 68% breastfed for !3 months, P < 0.001) among infants HEU vs. HUU contributed to increased hospitalization, they did not account for all the increased risk. Conclusion:Infectious-cause hospitalization incidence was higher among infants HEU vs. HUU, likely partly because of higher incidence of preterm birth and lower breastfeeding rates among infants HEU. The increased infectious disease burden in HEU infants has important implications for health services in sub-Saharan Africa.

This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Objectives: Infants who are HIV exposed but uninfected (HEU) compared with HIV unexposed uninfected (HUU) have an increased risk of adverse birth outcomes, morbidity and hospitalization. In the era of universal maternal antiretroviral treatment, there are few insights into patterns of neonatal morbidity specifically.Design: A prospective cohort study. Methods:We compared neonatal hospitalizations among infants who were HEU (n ¼ 463) vs. HUU (n ¼ 466) born between 2017 and 2019 to a cohort of pregnant women from a large antenatal clinic in South Africa. We examined maternal and infant factors associated with hospitalization using logistic regression.Results: Hospitalization rates were similar between neonates who were HEU and HUU (13 vs. 16%; P ¼ 0.25). Overall, most hospitalizations occurred directly after birth (87%); infection-related causes were identified in 34%. The most common reason for hospitalization unrelated to infection was respiratory distress (25%). Very preterm birth (<32 weeks) (29 vs. 11%; P ¼ 0.01) as well as very low birthweight (<1500 g) (34 vs. 16%; P ¼ 0.02) occurred more frequently among hospitalized neonates who were HEU. Of those hospitalized, risk of intensive care unit (ICU) admission was higher in neonates who were HEU (53%) than HUU (27%) [risk ratio ¼ 2.1; 95% confidence interval (95% CI) 1.3-3.3]. Adjusted for very preterm birth, the risk of ICU admission remained higher among neonates who were HEU (aRR ¼ 1.8; 95% CI 1.1-2.9). Conclusion:Neonates who were HEU (vs. HUU) did not have increased all-cause or infection-related hospitalization. However, very preterm birth, very low birthweight and ICU admission were more likely in hospitalized neonates who were HEU, indicating increased severity of neonatal morbidity.