MSM in Chennai slums are at high risk for HIV. HIV prevention strategies aimed at changing unsafe drug and sexual practices should target the general population of men, with specific attention to areas with high rates of MSM.

Style of child feeding may be an important determinant of child nutrition and health outcomes. Responsive feeding refers to the level and kind of interaction between caregiver and child that lead to a positive feeding experience, adequate dietary intake, and enhanced developmental opportunities. Responsive feeding behaviors may include active physical help and verbalization during feeding, role-playing, persistence, and positive feeding strategies. The aim of this study was to investigate styles of feeding among Vietnamese children 12 or 18 months of age from a rural province in northern Viet Nam. Forty child/ mother pairs were videotaped during two, two-hour feeding episodes. Caregiver and child behaviors were coded at the level of the "intended bite" as observed through the videotape analysis of feeding episodes to assess caregiver behavior and the child's interest and acceptance of food. We found it feasible to use videotape and the modified coding and analysis scheme, originally developed for work in Peru, in Viet Nam. In Viet Nam, caregivers provided physical help to eat nearly all of the time in the younger children, and about 70% of the time among 18 month olds. Caregivers verbalized during only 30% of intended bites, and only half of these verbalizations were responsive in tone or words. Positive caregiver behaviors were significantly associated with higher child's acceptance of food, while non-responsive feeding behaviors were associated with child rejection of food. Future analyses of this data set will evaluate the degree to which an integrated nutrition program positively modified caretaker behaviors. More research is needed to demonstrate the relationships among the promotion of responsive feeding behaviors, acceptance of food, and improved nutrition and health status of children.

IntroductionInjecting drug use is a primary driver of HIV epidemics in many countries. People who inject drugs (PWID) and are HIV infected are often doubly stigmatized and many encounter difficulties reducing risk behaviors. Prevention interventions for HIV-infected PWID that provide enhanced support at the individual, family, and community level to facilitate risk-reduction are needed.Methods455 HIV-infected PWID and 355 of their HIV negative injecting network members living in 32 sub-districts in Thai Nguyen Province were enrolled. We conducted a two-stage randomization: First, sub-districts were randomized to either a community video screening and house-to-house visits or standard of care educational pamphlets. Second, within each sub-district, participants were randomized to receive either enhanced individual level post-test counseling and group support sessions or standard of care HIV testing and counseling. This resulted in four arms: 1) standard of care; 2) community level intervention; 3) individual level intervention; and 4) community plus individual intervention. Follow-up was conducted at 6, 12, 18, and 24 months. Primary outcomes were self-reported HIV injecting and sexual risk behaviors. Secondary outcomes included HIV incidence among HIV negative network members.ResultsFewer participants reported sharing injecting equipment and unprotected sex from baseline to 24 months in all arms (77% to 4% and 24% to 5% respectively). There were no significant differences at the 24-month visit among the 4 arms (Wald = 3.40 (3 df); p = 0.33; Wald = 6.73 (3 df); p = 0.08). There were a total of 4 HIV seroconversions over 24 months with no significant difference between intervention and control arms.DiscussionUnderstanding the mechanisms through which all arms, particularly the control arm, demonstrated both low risk behaviors and low HIV incidence has important implications for policy and prevention programming.Trial RegistrationClinicalTrials.gov NCT01689545

Globally, 30% of new HIV infections outside sub-Saharan Africa involve injecting drug users (IDU) and in many countries, including Vietnam, HIV epidemics are concentrated among IDU. We conducted a randomized controlled trial in Thai Nguyen, Vietnam, to evaluate whether a peer oriented behavioral intervention could reduce injecting and sexual HIV risk behaviors among IDU and their network members. 419 HIV-negative index IDU aged 18 years or older and 516 injecting and sexual network members were enrolled. Each index participant was randomly assigned to receive a series of six small group peer educator-training sessions and three booster sessions in addition to HIV testing and counseling (HTC) (intervention; n = 210) or HTC only (control; n = 209). Follow-up, including HTC, was conducted at 3, 6, 9 and 12 months post-intervention. The proportion of unprotected sex dropped significantly from 49% to 27% (SE (difference) = 3%, p < 0.01) between baseline and the 3-month visit among all index-network member pairs. However, at 12 months, post-intervention, intervention participants had a 14% greater decline in unprotected sex relative to control participants (Wald test = 10.8, df = 4, p = 0.03). This intervention effect is explained by trial participants assigned to the control arm who missed at least one standardized HTC session during follow-up and subsequently reported increased unprotected sex. The proportion of observed needle/syringe sharing dropped significantly between baseline and the 3-month visit (14% vs. 3%, SE (difference) = 2%, p < 0.01) and persisted until 12 months, but there was no difference across trial arms (Wald test = 3.74, df = 3, p = 0.44).