International Journal of STD & AIDS

The COVID-19 pandemic disproportionately affected people of Black ethnicities, however, there are limited data on the post-acute sequelae of COVID-19 infection in these populations, and none in those with HIV.

We conducted a cross-sectional study in people of Black ethnicities with HIV in the UK. Participants were assessed for functional impairment, frailty, respiratory symptoms, anxiety and depression; they were also asked to rate aspects of their physical and mental health on a scale from 1 (poor) to 10 (excellent), both at enrolment and prior to the pandemic. We report associations with COVID-19 history and recovery status.

We enrolled 183 participants between June 2021 and October 2022, 131 (72%) of whom reported COVID-19. A history of COVID-19 was associated with a reduced ability to carry out usual activities (OR 2.54 [1.03–6.21], p = 0.04), an increase in pain, tiredness and breathlessness, and overall decline in physical health. Of those with a history of COVID-19, 111 (85%) reported to have fully recovered. Those who had not fully recovered reported poorer functional status (p < 0.001) and had higher generalised anxiety scores (p = 0.02). Objective measures of physical function were similar in those who reported no COVID-19, COVID-19 with full recovery, and COVID-19 with incomplete recovery.

In this cohort of Black people with HIV, participants with a history of COVID-19 reported a reduced ability to carry out activities of daily living and various other health issues. Although most people reported full recovery from COVID-19, self-reported limitations in functional status and anxiety were common sequelae.

We conducted a global systematic review and meta-analysis of gonorrhoea and chlamydia among men who have sex with men (MSM) from 2000 to 2022.

We searched four databases to identify studies conducted between 1 January 2000 and 19 April 2022 that reported prevalence from aetiological assays. We extracted data, calculated point estimates, corrected and then pooled them using random-effects models. We stratified results by United Nations regions and conducted subgroup analyses established apriori.

172 studies met our inclusion criteria, providing 387 prevalence data points from 57 countries. The overall pooled prevalence for gonorrhoea was 7.2% [95% CI: 6.0 to 8.5; 188 data points; n = 347,253] and for chlamydia was 9.9% (95% CI: 8.8 to 11.0; 190 data points; n = 342,799). For gonorrhoea, pooled prevalence between 2000 and 2010 was 5.0% (95% CI: 3.7 to 6.5; 89 data points; n = 78,557) compared to 9.3% (7.7–11.1; 99 data points; n = 268,696) between 2011 and 2022, p < 0.001. For chlamydia, pooled prevalence between 2000 to 2010 was 6.6% (95% CI: 5.4 to 7.9; 95 data points; n = 91,015) compared to 13.6% (12.0–15.2; 95 data points; n = 251,784) between 2011 and 2022, p < 0.001.

A holistic approach is needed to reduce the curable STIs burden among MSM.

Sexually transmitted and blood-borne infections (STBBIs) disproportionately affect key populations in Canada. For example, recent estimates suggested that the proportion of people living with hepatitis C is the highest among people who use injection drugs and that gay, bisexual and other men who have sex with men represent a high proportion of new cases of infectious syphilis. Understanding what STBBIs test users and potential testers perceive as important aspects of testing will help inform testing initiatives. We aimed to determine aspects of STBBI testing that are important to a diverse range of key populations in Canada.

We conducted qualitative interviews and focus groups with people from key populations (gay, bisexual, and other men who have sex with men; African, Caribbean, or Black individuals; Indigenous individuals; sex workers; people who use substances and injection drugs) and people who do not identify as a key population member. We conducted a thematic analysis.

Two major themes emerged: stigma and inequality, and journey into and through the healthcare system. Within the first theme, participants had diverse perspectives on how aspects of their identity interacted with willingness to seek testing. Within the second theme, participants discussed aspects of testing. Test costs, wait times, and testing accuracy were all viewed as important, but differing perspectives emerged about privacy of testing and receiving results, testing location, and who administers the test.

Participants’ perspectives on STBBI testing and willingness to test were informed by their experiences and aspects of their identity.

Aflatoxins are carcinogenic and immunosuppressive compounds found in Aspergillus-contaminated corn. Kenyan women living with HIV (WLWH) receiving antiretroviral therapy (ART) were studied to examine associations of aflatoxin exposure and HIV immune control.

Sixty WLWH were enrolled; 56 completed the Month-12 visit. Blood samples were collected for aflatoxin, CD4 cell counts and HIV viral load. Logistic regression and linear regression models were fitted to examine factors associated with (1) detectable HIV viral load, and (2) HIV viral load in copies/mL.

All WLWH were receiving ART (mean 9.9 years). Eight women (14.3%) had a detectable HIV viral load (mean 12,439 copies/mL). Aflatoxin B1 was detected in 23 of 56 WLWH (41.7%); 17 of 48 (35.4%) with an undetectable HIV viral load, and 6 of 8 (75.0%) with a detectable HIV viral load (p = 0.053). The mean plasma aflatoxin B1 concentration for all WLWH was 0.0403 pg/μL; 0.0341 pg/μL and 0.0771 pg/μL for WLWH with undetectable or detectable HIV viral loads, respectively (p = 0.039).

Aflatoxin B1 detection is associated with lack of HIV viral load suppression, defined as a detectable HIV viral load, among a cohort of Kenyan WLWH, all receiving ART. Studies are needed to determine the mechanisms involved.

Online postal self-sampling (OPSS) for HIV/STI improves testing access and coverage. We assessed the acceptability, usability, and user experiences of the “Test2Know” (T2K) OPSS platform in Flanders, Belgium, to inform further implementation.

Eligible users completed a risk-assessment to determine infections (HIV, syphilis, chlamydia, gonorrhoea, hepatitis C) and anatomical sites for testing. Self-collected samples were mailed to the laboratory, and results were communicated via the platform. Users completed surveys on acceptability, usability and overall user experience.

Of 131 individuals who received a kit; 98 (74.8%) returned samples. 62.2% were male, 27.6% were men who had exclusively sex with men, and the median age was 29 years. Nearly 43% had never been tested for HIV or did not recall previous testing. 9 (9.2%) tested positive for an STI, all men; 7/9 reported sex exclusively with men, and 2/9 had never tested for HIV. No HIV or HCV infections were detected. Usability and acceptability were 89.2% and 83.3% respectively, nearly 90% would reuse and recommend the platform. However, 45.4% preferred a mixed testing approach due to blood collection challenges.

OPSS is highly acceptable and reaches individuals at risk for STI. Further research should explore sustainable integration into Belgian healthcare.

Pre-exposure prophylaxis (PrEP) is a highly effective intervention to prevent HIV acquisition. Oral PrEP was introduced for men who have sex with men (MSM) in Sindh province of Pakistan in June 2022, yet the uptake remains suboptimal. Here we present an assessment of barriers to PrEP uptake among MSM accessing HIV prevention services in Sindh.

We conducted a cross-sectional survey among MSM clients attending HIV prevention services from community-based organizations in Sindh province. Those who consented to participate were administered a paper-based questionnaire by providers to collect barriers to uptake of PrEP.

We enrolled 742 MSM between November 2023 and May 2024. Among enrolled clients, 149 (20.1%) agreed to initiate PrEP, while 593 (79.9%) refused to initiate PrEP. Among those who refused PrEP, fear of stigma and discrimination at facilities (430, 72.5%) and fear of side effects (416, 70.2%) were the leading reported barriers to PrEP initiation, followed by lack of time to attend the facilities (325, 54.8%), low risk perception (“I have no risk of HIV” [273, 46.0%] and “I am healthy” [265, 44.7%]), difficulty in taking medicine daily (263, 44.4%), transportation issue (229, 38.6%), out of pocket expenses (166, 28.0%), and using condoms during sex (97, 16.4%) as major barriers to PrEP initiation.

The results highlight a need for addressing stigma and discrimination in healthcare settings, raising awareness about HIV risk factors, removing structural barriers to access and offering differentiated client-centered services to remove structural barriers to PrEP uptake.

We sought to determine the prevalence of sickle cell trait (SCT) and apolipoprotein-1 (APOL1) risk variants in people living with HIV (PLWH) in Nigeria, and to establish if SCT and APOL1 high-risk status correlate with estimated glomerular filtration rate (eGFR) and/or prevalent chronic kidney disease (CKD).

Baseline demographic and clinical data were obtained during three cross-sectional visits. CKD was defined as having an eGFR<60 mL/min/1.73 m². We collected urine specimens to determine urine albumin-creatine ratio and blood samples for sickle cell genotyping, APOL1 testing, and for creatinine/cystatin C assessment. The associations between SCT, APOL1 genotype, and eGFR/CKD stages/CKD were investigated using linear/ordinal logistic/logistic regression models, respectively.

Of 2443 participants, 599 (24.5%) had SCT, and 2291 (93.8%) had a low-risk APOL1 genotype (0 or 1 risk variant), while 152 (6.2%) had high-risk genotype (2 allele copies). In total, 108 participants (4.4%) were diagnosed with CKD. In adjusted analyses, SCT was associated with lower eGFR (adjusted mean difference [aMD]= −2.33, 95% CI -4.25, −0.42), but not with worse CKD stages, or increased odds of developing CKD. Participants with the APOL1 high risk genotype were more likely to have lower eGFR (aMD= −5.45, 95% CI -8.87, −2.03), to develop CKD (adjusted odds ratio [aOR] = 1.97, 95% CI: 1.03, 3.75), and to be in worse CKD stages (aOR = 1.60, 95% CI: 1.12, 2.29) than those with the low-risk genotype. There was no evidence of interaction between SCT and APOL1 genotype on eGFR or risk of CKD.

Our findings highlight the multifaceted interplay of genetic factors in the pathogenesis of CKD in PLWH.