Browsing by Subject "Circumcision"

Now showing 1 - 7 of 7
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    Continued follow-up of Phambili Phase 2b randomized HIV-1 vaccine trial participants supports increased HIV-1 acquisition among vaccinated men
    (Public Library of Science, 2015) Moodie, Zoe; Metch, Barbara; Bekker, Linda-Gail; Churchyard, Gavin; Nchabeleng, Maphoshane; Mlisana, Koleka; Laher, Fatima; Roux, Surita; Mngadi, Kathryn; Innes, Craig
    BACKGROUND: The Phase 2b double-blinded, randomized Phambili/HVTN 503 trial evaluated safety and efficacy of the MRK Ad5 gag / pol / nef subtype B HIV-1 preventive vaccine vs placebo in sexually active HIV-1 seronegative participants in South Africa. Enrollment and vaccinations stopped and participants were unblinded but continued follow-up when the Step study evaluating the same vaccine in the Americas, Caribbean, and Australia was unblinded for non-efficacy. Final Phambili analyses found more HIV-1 infections amongst vaccine than placebo recipients, impelling the HVTN 503-S recall study. METHODS: HVTN 503-S sought to enroll all 695 HIV-1 uninfected Phambili participants, provide HIV testing, risk reduction counseling, physical examination, risk behavior assessment and treatment assignment recall. After adding HVTN 503-S data, HIV-1 infection hazard ratios (HR vaccine vs. placebo) were estimated by Cox models. RESULTS: Of the 695 eligible, 465 (67%) enrolled with 230 from the vaccine group and 235 from the placebo group. 38% of the 184 Phambili dropouts were enrolled. Enrollment did not differ by treatment group, gender, or baseline HSV-2. With the additional 1286 person years of 503-S follow-up, the estimated HR over Phambili and HVTN 503-S follow-up was 1.52 (95% CI 1.08-2.15, p = 0.02, 82 vaccine/54 placebo infections). The HR was significant for men (HR = 2.75, 95% CI 1.49, 5.06, p = 0.001) but not for women (HR = 1.12, 95% CI 0.73, 1.72, p = 0.62). CONCLUSION: The additional follow-up from HVTN 503-S supported the Phambili finding of increased HIV-1 acquisition among vaccinated men and strengthened the evidence of lack of vaccine effect among women. Trial Registration clinicaltrials.gov NCT00413725 SA National Health Research Database DOH-27-0207-1539
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    HIV prevalence by race co-varies closely with concurrency and number of sex partners in South Africa
    (Public Library of Science, 2013) Kenyon, Chris; Buyze, Jozefien; Colebunders, Robert
    BACKGROUND: HIV prevalence differs by more than an order of magnitude between South Africa's racial groups. Comparing the sexual behaviors and other risk factors for HIV transmission between the different races may shed light on the determinants of South Africa's generalized HIV epidemic. METHODS: Five nationally representative and one city-representative population-based surveys of sexual behavior were used to assess the extent to which various risk factors co-varied with HIV prevalence by race in South Africa. RESULTS: In 2004, the prevalence of HIV was 0.5%, 1%, 3.2% and 19.9% in 15-49 year old whites, Indians, coloureds and blacks respectively. The risk factors which co-varied with HIV prevalence by race in the six surveys were age of sexual debut (in five out of five surveys for men and three out of six surveys for women), age gap (zero surveys in men and three in women), mean number of sex partners in the previous year (five surveys in men and three in women) and concurrent partnerships (five surveys in men and one in women). Condom usage and circumcision were both more prevalent in the high HIV prevalence groups. The reported prevalence of concurrency was 6 to 17 times higher in the black as opposed to the white men in the five surveys. CONCLUSIONS: The differences in sexual behavior in general, and the prevalence of concurrency and the number of sexual partners in particular, offer a plausible and parsimonious cause to explain a part of the differing prevalences of HIV between South Africa's racial groups.
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    HIV prevalence correlates with high-risk sexual behavior in Ethiopia's regions
    (Public Library of Science, 2015) Kenyon, Chris R; Tsoumanis, Achilleas; Schwartz, Ilan Steven
    BACKGROUND: HIV prevalence varies between 0.9 and 6.5% in Ethiopia's eleven regions. Little has been published examining the reasons for this variation. METHODS: We evaluated the relationship between HIV prevalence by region and a range of risk factors in the 2005 and 2011 Ethiopian Demographic Health Surveys. Pearson's correlation was used to assess the relationship between HIV prevalence and each variable. RESULTS: There was a strong association between HIV prevalence and three markers of sexual risk: mean lifetime number of partners (men: r = 0.87; P < 0.001; women: r = 0.60; P = 0.05); reporting sex with a non-married, non-cohabiting partner (men: r = 0.92; P < 0.001, women r = 0.93; P < 0.001); and premarital sex. Condom usage and HIV testing were positively associated with HIV prevalence, while the prevalence of circumcision, polygamy, age at sexual debut and male migration were not associated with HIV prevalence. CONCLUSION: Variation in sexual behavior may contribute to the large variations in HIV prevalence by region in Ethiopia. Population-level interventions to reduce risky sexual behavior in high HIV incidence regions should be considered.
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    Incorrect beliefs about male circumcision and male-to-female HIV transmission risk in South Africa: Implications for prevention
    (Journal of Acquired Immune Deficiency Syndromes, 2015-05-28) Maughan-Brown, Brendan; Venkataramani, Atheendar
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    Male circumcision and sexual risk behaviors may contribute to considerable ethnic disparities in HIV prevalence in Kenya: an ecological analysis
    (Public Library of Science, 2014) Kenyon, Chris Richard; Vu, Lung; Menten, Joris; Maughan-Brown, Brendan
    BACKGROUND: HIV prevalence varies between 0.8 and 20.2% in Kenya's various ethnic groups. The reasons underlying these variations have not been evaluated before. METHODS: We used data from seven national surveys spanning the period 1989 to 2008 to compare the prevalence of a range of risk factors in Kenya's ethnic groups. Spearman's and linear regression were used to assess the relationship between HIV prevalence and each variable by ethnic group. RESULTS: The ethnic groups exhibited significant differences in a number of HIV related risk factors. Although the highest HIV prevalence group (the Luo) had the highest rates of HIV testing (Men 2008 survey: 56.8%, 95% CI 51.0-62.5%) and condom usage at last sex (Men 2008∶28.6%, 95% CI 19.6-37.6%), they had the lowest prevalence of circumcision (20.9%, 95% CI 15.9-26.0) the highest prevalence of sex with a non-married, non-cohabiting partner (Men: 40.2%, 95% CI 33.2-47.1%) and pre-marital sex (Men 2008∶73.9%, 95% CI 67.5-80.3%) and the youngest mean age of debut for women (1989 Survey: 15.7 years old, 95% CI 15.2-16.2). At a provincial level there was an association between the prevalence of HIV and male concurrency (Spearman's rho = 0.79, P = 0.04). Ethnic groups with higher HIV prevalence were more likely to report condom use (Men 2008 survey: R2 = 0.62, P = 0.01) and having been for HIV testing (Men 2008 survey: R2 = 0.47, P = 0.04). CONCLUSION: In addition to differences in male circumcision prevalence, variation in sexual behavior may contribute to the large variations in HIV prevalence in Kenya's ethnic groups. To complement the prevention benefits of the medical male circumcision roll-out in several parts of Kenya, interventions to reduce risky sexual behavior should continue to be promoted.
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    Sutureless adult voluntary male circumcision with topical anesthetic: a randomized field trial of Unicirc, a single-use surgical instrument
    (Public Library of Science, 2016) Shenje, Justin; Millard, Peter S
    Introduction The World Health Organization has solicited rapid and minimally invasive techniques to facilitate scale-up of voluntary medical male circumcision (VMMC). Study design Non-blinded randomized controlled field trial with 2:1 allocation ratio. Participants 75 adult male volunteers. Setting Outpatient primary care clinic. Intervention Open surgical circumcision under local anesthetic with suturing vs. Unicirc disposable instrument under topical anesthetic and wound sealing with cyanoacrylate tissue adhesive. Primary Outcome Intraoperative duration. Secondary Outcomes Intraoperative and postoperative pain; adverse events; time to healing; patient satisfaction; cosmetic result. RESULTS: The intraoperative time was less with the Unicirc technique (median 12 vs. 25 min, p < 0.001). Wound healing and cosmetic results were superior in the Unicirc group. Adverse events were similar in both groups. CONCLUSIONS: VMMC with Unicirc under topical anesthetic and wound sealing with cyanoacrylate tissue adhesive is rapid, heals by primary intention with superior cosmetic results, and is potentially safer and more cost-effective than open surgical VMMC. Trial Registration Clinicaltrials.gov NCT02443792
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    What Do People Actually Learn from Public Health Campaigns? Incorrect Inferences About Male Circumcision and Female HIV Infection Risk Among Men and Women in Malawi
    (AIDS and Behaviour, 2015-05-28) Maughan-Brown, Brendan; Godlonton, Susie; Thornton, Rebecca; Venkataramani, Atheendar