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Study Findings

This page lists in chronological order publications concerning Study Findings. 

Explanation of Abbreviations
Terms:  Populations:
HCV - Hepatitis C  PWID/IDU - People who Inject Drugs/Injecting Drug Users
HBV - Hepatitis B  FSW - Female Sex Workers
IPV - Intimate Partner Violence  MSM - Men who have Sex with Men
VCT - Voluntary Counselling and Testing  HRH-  High Risk Heterosexual men 
SRB - Sexual Risk Behavior                        
 STI - Sexually Transmitted Infections         


Keywords Population  Location  Year
HIV and HCV
PWID
 Armenia 2014 
Title
High HIV and HCV and the unmet needs of People who Inject Drugs in Yerevan Armenia
Authors Johnston LG, Grigoryan S, Papoyan A, Grigoryan T, Balayan T, Zohrabyan L
Published in International Journal of Drug Policy. Under review.
Abstract

Despite the low reported HIV prevalence in Armenia, there are numerous reasons to be concerned that the country will experience dramatic increases in HIV, as well as Hepatitis C (HCV), among PWID and consequently to the wider population. In 2010-11 the government of Armenia conducted survey of people who inject drugs (PWID) in an effort to measure HIV and related infections prevalence, risk behaviors and program coverage.

Respondent driven sampling was used to sample 270 men and women, ≥18 years, who injected drugs in the previous three months and lived in Yerevan. Descriptive analysis was conducted with RDSAT v.6.0. Correlates of HIV and HCV infection were conducted using RDSAT-generated survey weights for each infection. 

Most PWID use disposable syringes/needles, 21.2% shared syringes/needles the last time they injected, 43.8% shared injection paraphernalia in the past one month and 70.8% ever injected drugs prepared by someone else. The majority of PWID want help to stop injecting, however only 21% actually sought treatment in the past year. HIV prevalence was 10.9%, HCV antibody was 36.6% and active syphilis 4.1%. Among HIV seropositive PWID, 73.5% were also infected with HCV and 20.6% were also infected with syphilis. HIV infected PWID had higher odds of being female, using condoms, testing for HIV and lower odds of seeking treatment to stop injecting. HCV infection was positively associated with longer injection length, higher injection frequency, sharing injection paraphernalia and being HIV seropositive.

PWID practice risky injection behaviors but are willing to use disposable syringes and are interested in getting help to stop injecting. However, there are numerous barriers to treatment, harm reduction programs and HIV testing and counselling. Limited government initiative and drastic reductions in international funding will likely impact urgently needed HIV prevention and harm reduction services targeting PWID in Armenia.

Download Johnston Yerevan IJDP.pdf
https://www.researchgate.net/publication/260212621




Keywords Population  Location  Year
HIV, Hepatitis B/C and syphilis
MSM
 Dominican Republic 2013 
Title
HIV, Hepatitis B/C and syphilis prevalence and risk behaviors among gay/trans/men who have sex with men, Dominican Republic
Authors Johnston LG, Caballero TV, Dolores Y, Vales HM
Published in International Journal for STD and AIDS. 2013. 24(4):313-321.

Abstract

This study investigated HIV, Hepatitis B (HBV) and C (HCV) and syphilis prevalence and associated behavioral correlates to HIV infection among gay, transsexuals and men who have sex with men (GTMSM) in the Dominican Republic using respondent-driven sampling. Eligible men were aged ≥15 years, reported engaging in anal/oral sex with another man within the past six months and living in one of the four cities sampled. 

GTMSM were recruited in Santo Domingo (n=510), Barahona (n=281), La Altagracia (n=270), and Santiago (n=327). HIV seroprevalence ranged from 5.1% to 7.6%. HBV ranged from 0.6% to 3.5%, HCV from 0.8% to 6.9% and syphilis from 3.5% to 6.9%. GTMSM practice numerous risky sexual behaviors including having multiple sex partners and inconsistent condom use with male and female, including transactional, sex partners. 

Although we found lower HIV prevalence compared to previous studies, the high level of extremely risky sexual behaviors practiced by GTMSM in the Dominican Republic will most likely result in increases in HIV and other infections if action is not taken to scale-up effective prevention programs for this population.

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Keywords Population  Location  Year
HIV, syphilis and sexual risk behaviours MSM  Morocco 2013 
Title
HIV, syphilis and sexual risk behaviours among men who have sex with men in Agadir and Marrakesh, Morocco
Authors Johnston LG, Alami K, El Rhilani MH, Karkouri M, et al.
Published in Sexually Transmitted Infections. April 25, 2013. [Epub ahead of print].
Abstract To collect baseline measurements of HIV and Syphilis prevalence and sexual risk behaviors among men who have sex with men (MSM) in Agadir and Marrakech, Morocco and provide strategic information to improve outreach programs.

Respondent-driven sampling (RDS) was used to recruit males who reported having anal sex with another male in the last six months, aged 18 years and older and having lived in either Agadir or Marrakech for the past six months, regardless of nationality. Data were analysed with the multiplicity estimator using RDS Analysis Tool V.6.0.

323 MSM in Agadir and 346 in Marrakech were recruited into the survey. The median age in Agadir was 21 years and in Marrakech 22. Most MSM reported their sexual orientation as bisexual (67.3% Agadir; 69.8% Marrakech), received money for having sex with numerous commercial partners in the past six months and ever had sex with a female. HIV prevalence was 5.6% in Agadir and 2.8% in Marrakesh; prevalence of syphilis was 7.0% in Agadir and 10.8% in Marrakesh. Among MSM who tested positive for HIV, 31.6% in Agadir and 56.4% in Marrakesh were co-infected with syphilis.

Study findings clearly demonstrate risk and identify and confirm the need to expand programs targeting MSM in the two cities and other regions in Morocco. However, given the current criminalization and discrimination of MSM in Morocco, the most urgent need for long-term and sustainable risk reduction will be through legal reforms and promotion and protection of human rights.
Download Sex Transm Infect-2013-Johnston-sextrans.pdf
https://www.researchgate.net/publication/236339176





Keywords Population  Location  Year
HIV and Hepatitis C associated with injecting drug use FSW Mauritius 2013 
Title
Unexpectedly high HIV and Hepatitis C prevalence among female sex workers in the Republic of Mauritius: Strong association with injecting drug use
 
Authors Johnston LG, Corceal S.
Published in AIDS and Behavior. 2013. 17(2):574-84.
Abstract Female sex workers (FSW) often have a disproportionately high prevalence of HIV infection and they, along with their clients, are considered a core group contributing to the transmission of HIV in many countries.

In 2010, females who reported having vaginal/anal/oral sex in the last six months with a male in exchange for money or kind, aged ≥15 years, and living in Mauritius were recruited into a survey using Respondent Driven Sampling. Consenting females (n=299) completed a behavioral questionnaire and provided venous blood for HIV, HCV and HBV testing.

HIV seroprevalence among FSW was 28.9% and 43.8% were infected with HCV; among HIV seropositive FSW, 88.2% were also infected with HCV. Almost 40% of FSW reported injecting drugs sometime in their lives and 30.5% of all FSW reported doing so in the previous three months. Among those who ever injected drugs, 82.5% did so in the past three months and among those 60% reported injecting drugs at least once a day. Among FSW who ever injected drugs, 17.5% reported sharing a needle at last injection. Regression analyses found injection drug use behaviors to be positively associated with HIV seroprevalence.

These findings indicate that FSW, especially those who inject drugs, are at high risk for HIV and HCV infection and transmission and illustrates the need for gender responsive HIV and injection drug use prevention and treatment models that respond to the unique situations that affect this population.
Download
AIBE Johnston Mauritius FSW.pdf
 https://www.researchgate.net/publication/230592508





Keywords Population  Location  Year
Determinants of HIV infection FSW Moldova 2013 
Title
Determinants of HIV infection among Female Sex Workers in two cities in the Republic of Moldova: The role of injection drug use and sexual risk
Authors Zohrabyan L, Johnston LG, Scutelniciuc O, Iovita A, et al.
Published in AIDS and Behavior. March 29, 2013. [Epub ahead of print].
Abstract Limited data on HIV prevalence and related risks among female sex worker (FSW) exist in the Republic of Moldova.

Using respondent driven sampling methods, 299 females in Chisinau, and 359 females in Balti who reported having vaginal, anal or oral sex in exchange for money in the previous 12 months, ≥16 years, and living in one of the cities in which the survey was conducted for the last 12 months, were recruited into a study in 2009-10.

One fifth of FSW in both cities reported ever injecting drugs and more than 30% reported ever having sexual intercourse with men who inject drugs. Consistent condom use with permanent and casual partners was low in both cities. In Chisnau, 7% and in Balti, 24.7% tested positive for HIV; 18% in Chisinau and 23.7% in Balti had antibodies to Hepatitis C; 9.1% in Chisinau and 8.9% in Balti had antibodies to HBV; and, 8.4% in Chisinau and 6.1% tested positive for Syphilis. FSW who were HIV seropositive in either city were more likely to have ever injected drugs and to be infected with HCV. FSW in Moldova practice several high risk behaviors that put them and others at risk for HIV acquisition and transmission.

The recent funding limitations and waning government initiative which have resulted in a decline in much needed harm reduction services in Moldova need to be reversed.
Download
DeterminantsMoldova.pdf
https://www.researchgate.net/publication/236090599





Keywords Population  Location  Year
Correlates of condom use
MSM
 Moldova 2013 
Title
HIV, Hepatitis and Syphilis Prevalence and Correlates of condom use during anal sex among men who have sex with men in the Republic of Moldova
Authors Zohrabyan L, Johnston LG, et al.
Published in International Journal for STD and AIDS. 2013. 24(5):357-364.
Abstract Limited data on HIV prevalence and behavioral risks among men who have sex with men (MSM) exist in the Republic of Moldova. In Chisinau 188 and in Balti 209 men who reported having anal or oral sex in the last six months with another male, aged >16 years were recruited into a study in 2010 using respondent driven sampling methods.

MSM reported having multiple male and female partners and inconsistent condom use. In Chisinau, 2% of MSM were HIV seropositive, 3.7% had antibodies to Hepatitis C, 5.7% had antibodies to Hepatitis B and 12.1% had Syphilis. In Balti, under 1% of MSM were HIV seropositive, 1.2% had antibodies to Hepatitis C, 3.2% had antibodies to Hepatitis B and 0.5% had Syphilis. MSM who used a condom at last anal sex with a man were less likely to reside in Chisinau, to have occasional sex partners and to have had an HIV test in the last year and more likely to know where to get an HIV test.

Although HIV prevalence was low, MSM practice a number of risky sexual behaviors which may heighten the risk of further HIV transmission in this population and to the wider population. 
Download Correlates of condom use MSM Moldova
https://www.researchgate.net/publication/256086076


   
Keywords Population  Location  Year
HIV, STI and M. genitalium FSW Honduras 2012 
Title
High prevalence of Mycoplasma genitalium among female sex workers in Honduras: implications for the spread of HIV and other sexually transmitted infections
 
 
Authors Johnston LG, Paz Bailey G, Morales-Miranda S, Morgan M, Alvarez B, Monterroso E.
Published in International Journal STD and AIDS. 2012. 2012. 23(1):5-11.
Abstract This study investigates HIV and sexually transmitted infections (STI) and risk factors associated with M. genitalium among female sex workers (FSWs) in four cities in Honduras.

In 2006,795 FSWs from Tegucigalpa, San Pedro Sula, La Ceiba and Comayagua were recruited with respondent-driven sampling and tested for HIV and STIs. HIV infection ranged from no infections in Comayagua to 5.4% in Tegucigalpa. With the exception of Comayagua, more than 20% of FSWs were infected with M. genitalium. M. genitalium in aggregated cities was associated with HIV positivity, being = 30 years old, drinking alcoholic beverages more than one time a week, and always using condoms with regular past month clients.

Compared to a 2001 surveillance study we found lower rates of HIV infection. Interventions for HIV and STI control and prevention among FSWs, including promotion of condom use, are needed.
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  https://www.researchgate.net/publication/221858973




Keywords Population  Location  Year
HIV and Hepatitis C PWID/IDU Mauritius 2011
Title
High HIV and hepatitis C prevalence amongst injecting drug users in Mauritius: Findings from a population size estimation and respondent driven sampling survey
Authors

Johnston LG, Saumtally A, Corceal S, Mahadoo I, Oodally F.

Published in International Journal of Drug Policy. 2011. 22(4):252-8. Epub 2011 Jun 22.
Abstract Mauritius, an Indian Ocean Island nation of approximately 1,000,000 people, has a large number of injecting drug users (IDUs), many of whom are infected with HIV and HCV. Mauritius has been expanding harm reduction and HIV services based in the belief that HIV prevalence among IDUs is somewhere between 30-60% and the IDU population size is around 20,000.

In 2009, the government of Mauritius conducted a survey to estimate of infection prevalence and risk factors and to estimate the population size of IDUs in order to more effectively expand programs. Men and women aged >15 years living in Mauritius and injecting illicit drugs in the past three months were recruited using respondent driven sampling (RDS). Consenting participants were interviewed about HIV-risk behaviors and tested for HIV, syphilis, HCV and HBV. Six multipliers were collected from service data and by the ‘unique object’ method in conjunction with the RDS survey. Proportions were calculated using the RDS analysis tool.

511 IDUs enrolled in the survey; 61.2% reported injecting 2-3 times/day and 29.3% reported past month injection with a previously used needle. Among the 60% of IDUs who reported having sexual intercourse in the past three months, 39.5% did so with ≥2 partners. Almost all IDUs (98.1%) reported inconsistent condom use in the past 12 months. HIV prevalence was 47.4%, HCV 97.3%, HBV 9.0%, and syphilis 2.7%; 99.7% of those infected with HIV were also infected with HCV.

Our population size estimates put the number of IDUs in Mauritius at around 9,500, lower than previous estimates. We observed high rates of HCV and HIV infection among IDUs in Mauritius. The scale up of targeted HCV and HIV prevention, care and treatment services for IDUs should be a high priority.
Download
JohnstonetalMauritiusIJDP.pdf
https://www.researchgate.net/publication/51245264





Keywords Population  Location  Year
HIV
FSW
 Thailand 2013 
Title
Unexpectedly high HIV prevalence among female sex workers in Bangkok, Thailand in a respondent-driven sampling survey
Authors Manopaiboon C, Prybylski D, Subhachaturas W, Tanpradech S, Suksripanich O, Siangphoe U, Johnston LG, et al.
Published in International Journal for STD and AIDS. 2013 Mar 19.
Abstract The pattern of sex work in Thailand has shifted substantially over the last two decades from direct commercial establishments to indirect venues and non-venue-based settings. This respondent-driven sampling survey was conducted in Bangkok in 2007 among female sex workers (FSW) in non-venue-based settings to pilot a new approach to surveillance among this hidden population. Fifteen initial participants recruited 707 consenting participants who completed a behavioural questionnaire, and provided oral fluid for HIV testing, and urine for sexually transmitted infection (STI) testing. Overall HIV prevalence was 20.2% (95% confidence interval [CI] 16.3–24.7). Three-quarters of women were street-based (75.8%, 95% CI 69.9–81.1) who had an especially high HIV prevalence (22.7%, 95% CI 18.2–28.4); about 10 times higher than that found in routine sentinel surveillance among venue-based FSW (2.5%). STI prevalence (Chlamydia trachomatis and Neisseria gonorrhoeae) was 8.7% (95% CI 6.4–10.8) and 1.0% (95% CI 0.2–1.9), respectively. Lower price per sex act and a current STI infection were independently associated with HIV infection (P, 0.05). High HIV prevalence found among FSW participating in the survey, particularly non-venue-based FSW, identifies need for further prevention efforts. In addition, it identifies a higher-risk segment of FSW not reached through routine sentinel surveillance but accessible through this survey method.
Download https://www.researchgate.net/publication/236064680


   

Keywords Population  Location  Year
HIV risk and SRB MSM Tanzania 2011 
Title
HIV risk and the overlap of injecting drug use and high-risk sexual behaviours among men who have sex with men in Zanzibar (Unguja), Tanzania
Authors Johnston LG, Holman A, Dahoma M, Miller LA, Mussa M, Othman AA, Kim E, Kim A, Kendall C, Sabin K.
Published in International Journal of Drug Policy. 2011. 21(6): 485-492.
Abstract Men who have sex with men and inject drugs (MSM-IDU) are particularly vulnerable to HIV infection and have the potential to transmit HIV across multiple populations through their male and female sexual partners and injection drug-using partners.

Respondent-driven sampling was used to recruit men who reported engaging in anal sex with another man in the past three months, aged = 15 years, and living in Unguja, Zanzibar. Participants responded to a face-to-face interview about their HIV and injecting risk behaviors and were tested for HIV, Hepatitis B (HBV) and C (HCV) and syphilis.

Among the 509 MSM who enrolled in the survey, 14% percent (n=66) reported injecting drugs in the past three months among which 66% used heroin, 60% used a needle after someone else had and 68% passed a needle to someone else after using it. MSM-IDU were significantly more likely to have two or more non-paying male receptive sex partners and to have engaged in group sex in the past month, to have symptoms of a sexually transmitted infection in past six months, to have been arrested or beaten in the past 12 months and to be infected with HIV and co-infected with HIV and HCV compared to MSM who did not inject drugs. MSM-IDU were less likely to have used a condom at last sex with a non-paid female partner, to know where to get a confidential HIV test and to have ever been tested for HIV compared to MSM who did not inject drugs.

MSM-IDU, and MSM in general, in Unguja practice multiple high-risk behaviors that put them at risk for blood-borne and sexual transmission of HIV and HCV infection. Targeted interventions for MSM-IDU must account for the overlap of high-risk sexual and drug-using networks and integrate injection drug use and HIV services.
Download
ZanzibarJohnstonMSMIDU2010.pdf
https://www.researchgate.net/publication/45270703




Keywords Population  Location  Year
Correlates of HIV risk PWID/IDU Ukraine 2011 
Title
 Correlates of HIV risk among Injecting Drug Users in sixteen Ukrainian Cities
 
Authors Taran YS, Johnston LG, Pohorilac NB, Saliuk T.
Published in AIDS and Behavior. 2011. 15(1):65-74.
Abstract We present findings from a HIV survey using respondent driven sampling among 3711 injecting drug users (IDUs) in sixteen cities in Ukraine in 2008. Eligible participants were males and females who injected drugs in the past one month, >15 years and lived/worked in their respective interview area. The impact of injecting and sexual risk behaviors on HIV-infection were analyzed using four logistic models.

Overall HIV prevalence was 32%.In the sexual risk model, paying for sex in the past three months and condom use during last sex increased the odds of HIV infection. Being female, having greater than three years of injection drug use, always sharing equipment and using alcohol with drugs in the past month remained significant in all four models.

These findings indicate the urgent need to scale up peer education, needle exchange and methadone substitution programs for IDUs with specific programs targeting the needs of female injectors.
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  https://www.researchgate.net/publication/46580321





Keywords Population  Location  Year
Alcohol and transactional sex HRH South Africa 2011 
Title
“Taking care of business”: Alcohol as currency in transactional sexual relationships among ‘players’ in Cape Town, South Africa
Authors Townsend L, Ragnarsson A, Mathews C, Johnston LG, MiaEkstrom A, Thorson A, Chopra M.
Published in Qualitative Health Research. 2011 21(1):41-50.
Abstract In this article we examine the dynamics of social relationships in which alcohol use and risky sexual behaviors co-occur. As part of a larger biological and behavioral HIV surveillance survey, 20 men who lived in an urban, informal settlement on the outskirts of Cape Town, South Africa participated in in-depth interviews. Interview transcripts were analyzed according to a latent content analysis.

Findings highlight the latent association between alcohol and transactional sex, and enable an in-depth examination of the normative role that alcohol plays in the formation of casual sexual partnerships characterized by exchange. We build on an existing conceptual model that traces the potential pathways by which alcohol use and transactional sex are linked to sexual risk behaviors.

The study findings point to the need for multilevel HIV risk-reduction interventions among men to reduce excessive alcohol use, risky sexual behaviors, and underlying perceptions of ideal masculinity.
Download
ALCOHOL_TSQualHlthRsch.pdf
https://www.researchgate.net/publication/45424035





Keywords Population  Location  Year
HIV/AIDS and IPV HRH South Africa 2011
Title
HIV risk behaviours and their relationship to intimate partner violence (IPV) among men who have multiple female sexual partners in Cape Town, South Africa
Authors Townsend L, Mathews C, Jewkes R, Johnston LG, Chopra M, O’Bra H.
Published in AIDS and Behavior. 2011. 15(1):132-141.
Abstract HIV/AIDS and intimate partner violence (IPV) are growing public health concerns in South Africa. Knowledge about adult men’s perpetration of IPV and links between HIV risk behaviours and IPV is limited. Respondent driven sampling was used to recruit men who have multiple concurrent female sexual partners.

Forty-one percent of the 428 recruited men had perpetrated IPV. Inconsistent condom use was associated with physical IPV; experiencing a symptom of a sexually transmitted infection and engaging in transactional sex were associated with physical and sexual IPV; problem alcohol use was associated with physical, and any IPV, but not sexual IPV; having five or more partners was associated with sexual IPV; perceptions of partners’ infidelity were associated with physical and any IPV.

HIV risk reduction interventions among men, especially those with multiple female sex partners, should incorporate strategies to change the underlying construction of masculinity that combines the anti-social and risky behaviours of IPV perpetration, inconsistent condom use, transactional sex and heavy alcohol consumption.
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 https://www.researchgate.net/publication/41850428





Keywords Population  Location  Year
HIV prevalence and risk behavior MSM Tanzania 2011 
Title
HIV and Related Risk Behavior Among Men Who Have Sex 
with Men in Zanzibar, Tanzania: Results of a Behavioral 
Surveillance Survey
Authors Dahoma M, Johnston LG, Holman A, Miller L, Mussaa M, Othman A, Khatib A, Issa R, Kendall C, Kim A.
Published in AIDS and Behavior. 2011. 15(1):186-92.
Abstract We conducted a respondent driven sampling survey to estimate HIV prevalence and risk behavior among men who have sex with men (MSM) in Unguja, Zanzibar. Men aged >=15 years living in Unguja and reporting anal sex with another man in the past 3 months were asked to complete a questionnaire and provide specimens for biologic testing.

HIV prevalence was 12.3% (95% confidence interval 8.7, 16.3). HIV infection was associated with injecting drugs in the past 3 months, Hepatitis C virus infection and being paid for sex in the past year. Interventions for MSM in Zanzibar are needed and should include linkages to prevention, care and treatment services.
Download
HIVZanzibar.pdf
 https://www.researchgate.net/publication/40484677






Keywords Population  Location  Year
RDS as a new method Street children Albania 2010 
Title
Respondent-driven sampling: A new method for studying street children with findings from Albania
Authors Johnston LG, Thurman TR, Mock N, Nano L, Carcani V.
Published in Vulnerable Children and Youth Studies. 2010. 5(1): 1-11.
Abstract Sampling methods to study street children often rely on convenience approaches. Respondent driven sampling (RDS) is a relatively new methodology for sampling hard-to-reach populations utilizing peer-driven recruitment. It includes both field and analytical procedures to account for non-random recruitment patterns and generates statistically valid samples.

This paper describes RDS and assesses its effectiveness to recruit a diverse sample of street children, defined as children aged 10-17 years who engage in economic activity on the street in Tirana, Albania. This is the first publication on the use of RDS among street children. This paper describes the demographic profile of street children and assesses whether they are sufficiently networked to justify the use of RDS as a sampling approach.

Beginning with ten initial recruits, 293 street children were recruited within nine weeks. The sample included children of various ethnicities and principal work activities as well as those with both a short and long history of street work. Males greatly outnumbered females (93.9% versus 6.1%) and 20.6% of children reported sometimes sleeping away from home. Children had dense social network ties irrespective of whether they slept at home everyday. They also formed social networks related to ethnicity and type of work, but less so with respect to gender. Examination of recruitment patterns revealed important biases that may exist in other methods utilized to study this population. The importance of analytical adjustments applied in RDS is also demonstrated.

RDS could be an important breakthrough for researchers and policymakers, providing a more accurate profile of street children’s characteristics.
Download
AlbaniayouthJohnstonetalVYC2010.pdf
 https://www.researchgate.net/publication/233330744




Keywords Population  Location  Year
VCT and self-perceived risk of HIV HRH South Africa 2010 
Title
The Associations of voluntary counseling and testing acceptance and the perceived likelihood of being HIV-infected among men with multiple sex partners in a South African township
 
Authors Johnston LG, O'Bra H, Chopra M, Mathews C, Townsend L, Sabin K, Tomlinson M, Kendall C.
Published in AIDS and Behavior. 2010. 14 (4): 922-931.
Abstract This paper examines the socio-demographic factors and sexual risk behaviors (condom use, number of sexual partners, STI symptoms) associated with voluntary counselling and testing (VCT) acceptance and self-perceived risk of being HIV-infected among black men with multiple and younger sex partners in a South African township outside of Cape Town.

Using respondent driven sampling, we interviewed 421 men, of whom 409 (97.3%) consented to provide a dried blood spot, 12.3% were HIVinfected (95% confidence intervals [CI.] 8.3, 16.9) and 47.2% (CI. 41.1, 53.6) accepted on site VCT. Twenty six percent (CI. 20.2, 30.7) reported having an HIV test in the past year. Few men perceived themselves as very likely to be infected with HIV (15.6%; CI. 10.4, 20.5). VCT acceptance was significantly associated with being older, married or living with a partner, having higher education, having four to six partners in the past three months and testing HIV positive. Self-perceived likelihood of being HIV infected was significantly associated with low condom use and having seven or more partners in the past three months, and testing HIV positive.

These findings indicate that men correctly understand that engaging in certain HIV risk behaviors increases the likelihood of HIV-infection. However, those who perceive themselves at high risk of having HIV do not seek testing. Further investigation into the psychological and cultural barriers to reducing risky sexual behaviors and accessing VCT and other HIV services is recommended.
Download
VCTSouthAfricaRDSJohnstonetalAIBE2008.pdf
 https://www.researchgate.net/publication/5580943




Keywords Population  Location  Year
Risk factors and Condom use MSM Ukraine 2009 
Title
Risk factors associated with condom use among men who have sex with men in Ukraine
 
Authors Kasianczuk, MG, Johnston LG, Dovbakh, AV, Leszczynski, EB.
Published in Journal of LGBT Health Research. 2009. 5:51-62.
Abstract In 2007, a large scale behavioral surveillance survey (N = 1764) was conducted in 10 Ukrainian cities using chain referral sampling to measure HIV risk behaviors and service utilization among men who have sex with men (MSM). The majority of MSM were 25 years or older, completed secondary school or higher, never married, and currently single.

Just over a third of MSM reported not using a condom at last penetrative sex with a man. In a multivariate regression analysis controlling for several factors MSM had significantly higher odds of using a condom at last penetrative sex with another man if they were younger, had occasional partners in the past 6 months, ever had an HIV test and perceived themselves to be at high risk for HIV and significantly lower odds if they had sexual contact with a main male or with any female partner in the past 6 months and used alcohol in the past month.

This article provides baseline data about MSM’s sexual risk behaviors in Ukraine and discusses the need for essential targeted prevention and intervention programs to help MSM make informed decisions about their sexual behaviors.
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  https://www.researchgate.net/publication/233322695





Keywords Population  Location  Year
Improving survey methods PWID/IDU Serbia and Montenegro 2009 
Title
Improving survey methods in sero-epidemiological studies of injecting drug users: unlinked anonymous and rapid HIV testing in two community settings in Serbia and Montenegro
 
Authors Judd A, Rhodes T, Johnston LG, Platt L, Andjelkovic V, Simic D, Mugosa B, Simic M, Zerjav S, Parry RP, Parry JV.
Published in British Medical Journal. 2009. 9:14 doi:10.1186/1471-2334-9-14.
Abstract Little is known about the prevalence of HIV or HCV in injecting drug users (IDUs) in Serbia and Montenegro. We measured prevalence of antibodies to HIV (anti-HIV) and hepatitis C virus (anti-HCV), and risk factors for anti-HCV, in community-recruited IDUs in Belgrade and Podgorica, and determined the performance of a parallel rapid HIV testing algorithm.

Respondent driven sampling and audio-computer assisted survey interviewing (ACASI) methods were employed. Dried blood spots were collected for unlinked anonymous antibody testing. Belgrade IDUs were offered voluntary confidential rapid HIV testing using a parallel testing algorithm, the performance of which was compared with standard laboratory tests. Predictors of anti-HCV positivity and the diagnostic accuracy of the rapid HIV test algorithm were calculated.

Overall population prevalence of anti-HIV and anti-HCV in IDUs were 3% and 63% respectively in Belgrade (n = 433) and 0% and 22% in Podgorica (n = 328). Around a quarter of IDUs in each city had injected with used needles and syringes in the last four weeks. In both cities anti-HCV positivity was associated with increasing number of years injecting (eg Belgrade adjusted odds ratio (AOR) 5.6 (95% CI 3.2–9.7) and Podgorica AOR 2.5 (1.3–5.1 for >= 10 years v 0–4 years), daily injecting (Belgrade AOR 1.6 (1.0–2.7), Podgorica AOR 2.1 (1.3–5.1)), and having ever shared used needles/syringes (Belgrade AOR 2.3 (1.0–5.4), Podgorica AOR 1.9 (1.4–2.6)). Half (47%) of Belgrade participants accepted rapid HIV testing, and there was complete concordance between rapid test results and subsequent confirmatory laboratory tests (sensitivity 100% (95%CI 59%–100%), specificity 100% (95%CI 98%–100%).

The combination of community recruitment, ACASI, rapid testing and a linked diagnostic accuracy study provide enhanced methods for conducting blood borne virus sero-prevalence studies in IDUs. The relatively high uptake of rapid testing suggests that introducing this method in community settings could increase the number of people tested in high risk populations. The high prevalence of HCV and relatively high prevalence of injecting risk behaviour indicate that further HIV transmission is likely in IDUs in both cities. Urgent scale up of HIV prevention interventions is needed.
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SerbiaJuddetalBMC.pdf
https://www.researchgate.net/publication/23993816






Keywords Population  Location  Year
HIV risk behaviors and prevalence HRH South Africa 2009
Title
Estimating HIV prevalence and Risk Behaviors among High-Risk Heterosexual Men with Multiple Sex Partners: Use of Respondent Driven Sampling
 
Authors Chopra M, Townsend L, Johnston LG, Mathews C, Shaikh N, Tomlinson M, O Bra, H, Kendall C.
Published in J Acquir Immune Defic Syndr. 2009. 51(1):72-7.
Abstract Objective: To collect HIV data from high-risk men who have multiple, younger, female sex partners in a periurban township in South Africa. Design: Unlinked anonymous cross-sectional survey using respondent-driven sampling.

Methods: Survey conducted among men aged 18 years or older who reported having had sex with more than 1 female partner in the previous 3 months (one of whom was either 3 or more years younger than the participant or below the age of 24) and lived in the area of recruitment.

Results: The median age of the 421 recruited men was 28 years (range: 18-62 years). They reported a median of 6 sexual partners (range: 2-39) during the past 3 months, and 51% (confidence interval: 45.0 to 59.6) reported inconsistent condom use with their casual partners. During the 3 months before the survey, 98% of men reported having concurrent sexual relationships. HIV prevalence was 12.3% (confidence interval: 8.3% to 16.9%). Being older than 24 years and not using a condom during the last sexual intercourse with a 1-time sexual partner were significantly associated with HIV infection.

Conclusions: This group of heterosexual urban men practice high levels of risky sexual behavior and are an important group that require more targeted HIV surveillance and prevention interventions.
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HRHSouthAfricaChopraetalJAIDS2009.pdf
  
https://www.researchgate.net/publication/24197595




Keywords Population  Location  Year
STI prevalence and SRB MSM Croatia 2009
Title
Prevalence of sexually transmitted infections and sexual risk behaviors among men who have sex with men in Zagreb, Croatia
Authors Bozicevic I, Dakovic O, Zidovec L, Johnston LG, Stulhofer A, Dominkovic Z, Barak V, Lukas D, Begovac J.
Published in AIDS and Behavior. 2009. 13 (2): 303-309.
Abstract We used respondent-driven sampling among men who have sex with men (MSM) in Zagreb, Croatia in 2006 to investigate the prevalence of HIV, other sexually transmitted infections and sexual behaviours. We recruited 360 MSM. HIV infection was diagnosed in 4.5%. The seroprevalence of antibodies to viral pathogens was: herpes simplex virus type-2, 9.4%; hepatitis A, 14.2%; hepatitis C, 3.0%. Eighty percent of participants were susceptible to HBV infection (HBs antigen negative, and no antibodies to HBs and HBc antigen). Syphilis seroprevalence was 10.6%. Prevalence of Chlamydia and gonorrhoea was 9.0%, and 13.2%, respectively. Results indicate the need for interventions to diagnose, treat and prevent sexually transmitted infections among this population.
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MSMCroatiaBozicevicetalAIBE2009.pdf
 https://www.researchgate.net/publication/226900291


 

Keywords Population  Location  Year

Trauma survivors
  2005 
Title
Clinical Sleep Disorders in a large sample of trauma survivors: An interdisciplinary view of posttraumatic sleep disturbance
Authors Krakow B, Melendrez D, Haynes PL, Warner TD, Sisley B, Johnston LG, et al.
Published in  Journal of Clinical Sleep Medicine. 2005. 42(2):333-345.
Abstract
Study Objectives: To examine the relationship between psychiatric symptoms and self-reported sleep, sleepiness, and nightmare complaints in a convenience sample of 437 trauma survivors. Method: Based on symptom severity reports, individuals were classified as having psychophysiological insomnia (PPI), chronic nightmare disorder (CND), and sleep-disordered breathing (SDB) profiles. Individuals with each symptom profile were compared to individuals without the respective profile on sleep indices, sleepiness-related impairment, and psychiatric distress (anxiety, depression, posttraumatic stress symptoms). Results: Individuals with PPI (76%), CND (79%), SDB (68%), or all three profiles (46%) had significantly worse sleep onset latency, sleep efficiency, total sleep time, sleep-related functional impairment, and psychiatric distress compared to those without each disorder profile. Conclusions: The majority of trauma survivors in this sample suffered from sleep complaints sufficiently severe to warrant independent clinical attention by sleep medicine specialists. Longitudinal studies are necessary to determine whether these disturbances are caused exclusively by PTSD or another sleep disorder comorbid with PTSD.
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Keywords Population  Location  Year

Evacuees
  2004 
Title
Nightmares, insomnia, and sleep-disordered breathing in five evacuees seeking treatment for posttraumatic sleep disturbance
Authors Krakow B, Haynes PL, Warner TD, Santana E, Melendrez D, Johnston LG, et al.
Published in  Journal of Traumatic Stress. 2004. 17(3):257-68.
Abstract Eight months after the Cerro Grande Fire, 78 evacuees seeking treatment for posttraumatic sleep disturbances were assessed for chronic nightmares, psychophysiological insomnia, and sleep-disordered breathing symptoms. Within this sample, 50% of participants were tested objectively for sleep-disordered breathing; 95% of those tested screened positive for sleep-disordered breathing. Multiple regression analyses demonstrated that these three sleep disorders accounted for 37% of the variance in posttraumatic stress symptoms, and each sleep disorder was significantly and independently associated with posttraumatic stress symptoms severity. The only systematic variable associated with posttraumatic stress symptoms of avoidance was sleep-disordered breathing. The findings suggest that three common sleep disorders relate to posttraumatic stress symptoms in a more complex manner than explained by the prevailing psychiatric paradigm, which conceptualizes sleep disturbances in PTSD merely as secondary symptoms of psychiatric distress.
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Keywords Population  Location  Year

Evacuees
  2002 
Title
Sleep dynamic therapy in Cerro Grande fire evacuees with posttraumatic stress symptoms
Authors Krakow B, Melendrez D, Johnston LG, et al.
Published in  Journal of Clinical Psychiatry. 2002. 63(8):673-684.
Abstract Sleep disturbance is common among disaster survivors with posttraumatic stress symptoms but is rarely addressed as a primary therapeutic target. Sleep Dynamic Therapy (SDT), an integrated program of primarily evidence-based, nonpharmacologic sleep medicine therapies coupled with standard clinical sleep medicine instructions, was administered to a large group of fire evacuees to treat posttraumatic insomnia and nightmares and determine effects on posttraumatic stress severity.

The trial was an uncontrolled, prospective pilot study of SDT for 66 adult men and women, 10 months after exposure to the Cerro Grande Fire. SDT was provided to the entire group in 6, weekly, 2-hour sessions. Primary and secondary outcomes included validated scales for insomnia, nightmares, posttraumatic stress, anxiety, and depression, assessed at 2 pretreatment baselines on average 8 weeks apart, weekly during treatment, posttreatment, and 12-week follow-up.

Sixty-nine participants completed both pretreatment assessment, demonstrating small improvement in symptoms prior to starting SDT. Treatment and posttreatment assessments were completed by 66 participants, and 12-week follow-up was completed by 59 participants. From immediate pretreatment (second baseline) to posttreatment, all primary and secondary scales decreased significantly (all p values < .0001) with consistent medium-sized effects (Cohen's d = 0.29 to 1.09), and improvements were maintained at follow-up. Posttraumatic stress disorder subscales demonstrated similar changes: intrusion (d = 0.56), avoidance (d = 0.45), and arousal (d = 0.69). Fifty-three patients improved, 10 worsened, and 3 reported no change in posttraumatic stress.

In an uncontrolled pilot study, chronic sleep symptoms in fire disaster evacuees were treated with SDT, which was associated with substantive and stable improvements in sleep disturbance, posttraumatic stress, anxiety, and depression 12 weeks after initiating treatment.
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Keywords Population  Location  Year

Crime victims
  2001 
Title
Treatment of insomnia and nightmares in crime victims with PTSD
Authors Krakow B, Johnston LG, Melendrez D, et al.
Published in American Journal of Psychiatry. 2001. 158:2043-2047.
Abstract TBA
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Keywords Population  Location  Year

Sexual assault survivors
  2002 
Title
A randomized controlled study of imagery rehearsal for chronic nightmares for sexual assault survivors with PTSD
Authors Krakow B, Hollifield M, Johnston LG, et al.
Published in Journal of the American Medical Association. 2001. 286(5):537-545.
Abstract TBA
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Keywords Population  Location  Year

Sexual assault survivors
  2001 
Title
The relationship of sleep quality and posttraumatic stress to potential sleep disorders in sexual assault survivors with nightmares, insomnia and PTSD
Authors Krakow B, Germain A, Schraeder R, Hollifield M, Koss M, Warner T, Tandberg D, Melendrez D, Johnston LG, et al.
Published in  Journal of Traumatic Stress. 2001. 14:647-665.
Abstract Sleep quality and posttraumatic stress disorder (PTSD) were examined in 151 sexual assault survivors, 77% of whom had previously reported symptoms of sleep-disordered breathing (SDB) or sleep movement disorders (SMD) or both. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Posttraumatic Stress Scale (PSS). High PSQI scores reflected extremely poor sleep quality and correlated with PSS scores. PSQI scores were greater in participants with potential SDB or SMD or both. PSQI or PSS scores coupled with body-mass index and use of antidepressants or anxiolytics predicted potential sleep disorders. The relationship between sleep and posttraumatic stress appears to be more complex than can be explained by the current PTSD paradigm; and, sleep breathing and sleep movement disorders may be associated with this complexity.
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Keywords Population  Location  Year

Crime victims
  2001 
Title
Complex insomnia: insomnia and sleep-disordered breathing in a consecutive series of crime victims with nightmares and posttraumatic stress disorder
Authors Krakow B, Melendrez D, Pedersen B, Johnston LG, et al.
Published in  Biological Psychiatry. 2001. 49:948:953.
Abstract Sleep disturbance in posttraumatic stress disorder is very common. However, no previous posttraumatic stress disorder studies systematically examined sleep breathing disturbances, which might influence nightmares, insomnia, and posttraumatic stress disorder symptoms.

Forty-four consecutive crime victims with nightmares and insomnia underwent standard polysomnography coupled with a nasal pressure transducer to measure airflow limitation diagnostic of obstructive sleep apnea and upper airway resistance syndrome.

Forty of 44 participants tested positive on objective sleep studies based on conservative respiratory disturbance indices of more than 15 events per hour; 22 patients suffered from obstructive sleep apnea and 18 suffered from upper airway resistance syndrome.

In an uncontrolled study, insomnia and sleep-disordered breathing were extremely prevalent in this small and select sample of crime victims. Research is needed to study 1) prevalence of sleep-disordered breathing in other posttraumatic stress disorder populations using appropriate controls and nasal pressure transducers and 2) effects of sleep treatment on posttraumatic stress symptoms in trauma survivors with comorbid obstructive sleep apnea or upper airway resistance syndrome. In the interim, some posttraumatic stress disorder patients may benefit from sleep medicine evaluations.
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Keywords Population  Location  Year

Female sexual assault survivors
  2000 
Title
Potential Sleep Disorders and their relationship to depression and suicidality in female sexual assault survivors with nightmares and posttraumatic stress disorder
Authors Krakow B, Artar A, Warner T, Melendrez D, Johnston LG, et al.
Published in  Journal of Crisis Intervention and Suicide Prevention. 2000. (21):163-170.
Abstract TBA
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