Prevalence of HIV, Sexually Transmitted Infections, and Viral Hepatitis by Urbanicity, Among Men Who Have Sex With Men, Injection Drug Users, and Heterosexuals in the United States

Oster, Alexandra M.; Sternberg, Maya; Nebenzahl, Samara; Broz, Dita; Xu, Fujie; Hariri, Susan; Miles, Isa; Paz–Bailey, Gabriela

doi:10.1097/olq.0000000000000110

Cited by 29 publications

(21 citation statements)

References 7 publications

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“…Furthermore, the study was limited to a single-site, and results may not be generalizable to other populations. However, the temporal trends observed in this report are compatible with previous serological studies [13, 16, 18, 36–38]. …”

Section: Discussionsupporting

confidence: 93%

Parallel declines in HIV and hepatitis C virus prevalence, but not in herpes simplex virus type 2 infection: A 10-year, serial cross-sectional study in an inner-city emergency department

Patel

Laeyendecker

Hsieh

et al. 2016

Journal of Clinical Virology

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Background The Johns Hopkins Hospital Emergency Department (JHHED) has served as an observational window on the HIV epidemic in a socioeconomically depressed, urban population. We previously reported that HIV incidence among JHHED patients is decreasing and that prevalence has declined from 11.4% in 2003 to 5.6% in 2013. Objectives This study sought to observe temporal trends in hepatitis C virus (HCV) and herpes simplex virus type 2 (HSV-2) seroprevalence, which are surrogate markers for parenteral and sexual risk behavior, respectively. Study Design Identity unlinked-serosurveys were conducted over 6–8 weeks in the adult JHHED in 2003, 2007, and 2013. Excess sera from 10,274 patients, previously tested for HIV, were assayed for HSV-2 and HCV antibodies. Results Overall HCV seroprevalence declined steadily from 22.0% in 2003 to 13.8% in 2013 (Ptrend<0.01), and was significant by all gender and race strata. Overall HSV-2 prevalence declined from 55.3% in 2003 to 50.0% in 2013 (Ptrend<0.01), but was non-significant after adjustment for demographics. Among HIV+ individuals <45 years of age, there was a significant decrease in the proportion of individuals with HCV co-infection [without HSV-2] (Ptrend=0.02) from 2003 to 2013, however, there was an increase in individuals with HSV-2 co-infection [without HCV] (Ptrend<0.01). Discussion Little change in age-specific HSV-2 prevalence suggests the decrease in HIV prevalence was likely not associated with changes in sexual risk behavior. In addition to clinical interventions, strategies to address sexual health disparities and continued parenteral harm-reduction efforts are needed to further drive the decline in HIV.

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Section: Discussionsupporting

confidence: 93%

Parallel declines in HIV and hepatitis C virus prevalence, but not in herpes simplex virus type 2 infection: A 10-year, serial cross-sectional study in an inner-city emergency department

Patel

Laeyendecker

Hsieh

et al. 2016

Journal of Clinical Virology

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“…This finding may be due to a generational change in attitudes toward homosexuality, as has been found in population-based data [21], and resultant decreases in bisexual behavior among younger generations of MSM for whom homosexuality is more widely accepted. Moreover, MSM in smaller metropolitan and nonmetropolitan areas and those in the South and Midwest were more likely to link to heterosexual women, which may suggest that they are more likely to engage in bisexual behavior than MSM in large metropolitan areas and MSM in the Northeast and West, respectively; a previous study found that MSM in smaller metropolitan and nonmetropolitan areas were far less likely to identify as gay [22]. …”

Section: Discussionmentioning

confidence: 99%

Using Molecular HIV Surveillance Data to Understand Transmission Between Subpopulations in the United States

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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143

130

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Background Studying HIV transmission networks provides insight into the spread of HIV and opportunities for intervention. We identified transmission dynamics among risk groups and racial/ethnic groups in the United States. Methods For HIV-1 pol sequences reported to the U.S. National HIV Surveillance System during 2001–2012, we calculated pairwise genetic distance, identified linked pairs of sequences (those with distance ≤1.5%), and examined transmission category and race/ethnicity of these potential transmission partners. Results Of 40,950 sequences, 12,910 (32%) linked to ≥1 other sequence. Of men who have sex with men (MSM) who linked to ≥1 sequence, 88% were linked to other MSM and only 4% were linked to heterosexual women. Of heterosexual women for whom we identified potential transmission partners, 29% linked to MSM, 21% to heterosexual men, and 12% to persons who inject drugs. Older and black MSM were more likely to be linked to heterosexual women. Assortative mixing was present for all racial/ethnic groups; 81% of blacks/African Americans linked to other blacks. Conclusions This analysis is the first use of U.S. surveillance data to infer an HIV transmission network. Our data suggest that HIV infections among heterosexual women predominantly originate from MSM, followed by heterosexual men. Although few MSM were linked to women, suggesting that a minority of MSM are involved in transmission with heterosexual women, these transmissions represent a substantial proportion of HIV acquisitions by heterosexual women. Interventions that reduce transmissions involving MSM are likely to also reduce HIV acquisition among other risk groups.

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“…17 Recent estimates among all sexually active men who have sex with men living in a large metropolitan area indicate that the seroprevalence of HSV-2 infection is 24.5%. 25 Homeless and unstably housed women are not currently included as a high-risk population in national guidelines, yet the seroprevalence of HSV-2 infection is more than three times higher. Data presented in this study indicate that revising current guidelines to include women who experience housing instability in screening strategies would target a population with an especially high seroprevalence of infections.…”

Section: Discussionmentioning

confidence: 99%

High Rates of Herpes Simplex Virus Type 2 Infection in Homeless Women: Informing Public Health Strategies

Daniel

CohenJennifer

GrimesBarbara

et al. 2016

Journal of Women's Health

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Background: Homeless and unstably housed women living in an urban setting are at risk for sexually transmitted diseases, yet the seroprevalence and correlates of herpes simplex virus type 2 (HSV-2) specific to impoverished women are poorly understood. Materials and Methods: Between April and October 2010, we conducted a cross-sectional analysis of sociodemographic, structural, and behavioral factors associated with prevalent HSV-2 infection (recent and historical infections) within a community-recruited cohort of homeless and unstably housed women. Logistic regression modeling was used to identify independent sociobehavioral correlates of HSV-2 infection. Results: Among 213 women (114 HIV positive and 99 HIV negative), the median age was 49, 48% were African American, and 63% had completed high school. HSV-2 seroprevalence was 88%, and only 17% of infected women were aware of their infection. In adjusted analysis, odds of HSV-2 infection were significantly higher for those reporting at-risk drinking (adjusted odds ratio [AOR] = 7.04; 95% confidence interval [CI] = 1.59, 67.91), heterosexual orientation (AOR = 4.56; 95% CI = 1.81, 11.69), and for those who were HIV positive (AOR = 3.64; 95% CI = 1.43, 10.30). Odds of HSV-2 infection decreased as current income increased (AOR for each $500 monthly increase = 0.90; 95% CI = 0.78, 0.997). Conclusions: There is an extremely high seroprevalence of HSV-2 infection among homeless and unstably housed women, and most are unaware of their HSV-2 status. Screening all unstably housed women for HSV-2 infection, with additional counseling for sexual risk and alcohol use, may lead to the identification of more infections and be a first step in reducing additional disease transmission.

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Prevalence of HIV, Sexually Transmitted Infections, and Viral Hepatitis by Urbanicity, Among Men Who Have Sex With Men, Injection Drug Users, and Heterosexuals in the United States

Cited by 29 publications

References 7 publications

Parallel declines in HIV and hepatitis C virus prevalence, but not in herpes simplex virus type 2 infection: A 10-year, serial cross-sectional study in an inner-city emergency department

Parallel declines in HIV and hepatitis C virus prevalence, but not in herpes simplex virus type 2 infection: A 10-year, serial cross-sectional study in an inner-city emergency department

Using Molecular HIV Surveillance Data to Understand Transmission Between Subpopulations in the United States

High Rates of Herpes Simplex Virus Type 2 Infection in Homeless Women: Informing Public Health Strategies

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