J Acquir Immune Defic Syndr. 2011 Dec 1;58(4):408-16.
Men who have sex with men have a 140-fold higher risk for newly diagnosed HIV and syphilis compared with heterosexual men in New York City.
Bureau of Sexually Transmitted Disease Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA. firstname.lastname@example.org
To describe the population of men who have sex with men (MSM) in New York City, compare their demographics, risk behaviors, and new HIV and primary and secondary (P&S) syphilis rates with those of men who have sex with women (MSW), and examine trends in infection rates among MSM.
Population denominators and demographic and behavioral data were obtained from population-based surveys during 2005-2008. Numbers of new HIV and P&S syphilis diagnoses were extracted from city-wide disease surveillance registries.
We calculated overall, age-specific and race/ethnicity-specific case rates and rate ratios for MSM and MSW and analyzed trends in MSM rates by age and race/ethnicity.
The average prevalence of male same-sex behavior during 2005-2008 (5.0%; 95% CI: 4.5 to 5.6) differed by both age and race/ethnicity (2.3% among non-Hispanic black men; 7.4% among non-Hispanic white men). Compared with MSW, MSM differed significantly on all demographics and reported a higher prevalence of condom use at last sex (62.9% vs. 38.3%) and of past-year HIV testing (53.6% vs. 27.2%) but also more past-year sex partners. MSM HIV and P&S syphilis rates were 2526.9/100,000 and 707.0/100,000, each of which was over 140 times MSW rates. Rates were highest among young and black MSM. Over 4 years, HIV rates more than doubled and P&S syphilis rates increased 6-fold among 18-year-old to 29-year-old MSM.
The substantial population of MSM in New York City is at high risk for acquisition of sexually transmitted infections given high rates of newly diagnosed infections and ongoing risk behaviors. Intensified and innovative efforts to implement and evaluate prevention programs are required.
Rhode Island set to be 10th state to pass same-sex marriage
Wed Apr 24, 2013 7:25pm EDT
(Reuters) – Rhode Island was set to become the 10th U.S. state to extend marriage rights to same-sex couples after the state Senate approved a gay marriage bill on Wednesday, in a major victory for gay rights activists.
The state House had approved a similar measure in January, but the bill will now go back to the House for a new vote because it was amended. Gordon Fox, the speaker of the House, said he will schedule that vote for May 2.
“Pending the final vote by the House of Representatives, Rhode Island will no longer be an outlier in our region,” Governor Lincoln Chafee, an independent, said in a statement.
“We will have the welcome mat out. We will be open for business, and we will once again affirm our legacy as a place that is tolerant and appreciative of diversity.”
Rhode Island, which allows civil unions, is the last New England state without a law allowing gay nuptials, and Wednesday’s vote marks the latest in a string of victories for gay marriage advocates.
Last November, voters in Maine, Maryland and Washington state approved same-sex marriage, while in Minnesota, voters rejected a constitutional amendment that would have defined marriage as a union between a man and a woman.
Meanwhile, the U.S. Supreme Court is considering a legal challenge to a 1996 law that restricts federal recognition of marriage to heterosexual couples.
“It’s clear that if you make the case and talk about why marriage matters, Americans rise to fairness,” said Evan Wolfson, the president of Freedom to Marry.
He noted that the vote also follows votes for gay marriage in France, Uruguay and New Zealand: “The momentum is clear and there are more states and more countries to come until all couples can share in the freedom to marry,” Wolfson said.
Scott Spear, a Rhode Island lawyer affiliated with the National Organization for Marriage, the main national group opposing same-sex marriage, said extending marriage rights to gay couples would “dramatically change the landscape of life” in Rhode Island, and wished the state had brought the issue to the voters in a referendum.
“This is an issue that I believe has been very difficult for people to understand because it’s much more that people are moved simply by emotion than understanding the policy implications,” he said.
Lawmakers in Illinois, Delaware and Minnesota have also taken up same-sex marriage legislation this year. On Tuesday, the Delaware House approved the bill and it now moves onto the state Senate for consideration.
The other six states that have legalized same-sex marriage are: Massachusetts, Connecticut, New York, Vermont, New Hampshire and Iowa.
(Reporting by Edith Honan in New York; Editing by Scott Malone, Leslie Adler, Eric Beech and Lisa Shumaker)
Lancet Infect Dis. 2010 Oct;10(10):682-7. Epub 2010 Sep 9.
Population-based HIV-1 incidence in France, 2003-08: a modelling analysis.
Institut de Veille Sanitaire, Saint-Maurice, France. email@example.com
- Lancet Infect Dis. 2011 Mar;11(3):159.
Routine national incidence testing with enzyme immunoassay for recent HIV-1 infections (EIA-RI) has been done in France since January, 2003. From the reported number of HIV infections diagnosed as recent, and accounting for testing patterns and under-reporting, we aimed to estimate the incidence of HIV infection in France in 2003-08.
We analysed reports from the French National Institute for Public Health Surveillance for patients who were newly diagnosed with HIV between January, 2003, and December, 2008. Missing data were imputed with multiple imputation. Patients were classified with non-recent or recent infection on the basis of an EIA-RI test, which was calibrated with serial measurements from HIV seroconverters from the French ANRS-PRIMO cohort. We used an adapted stratified extrapolation approach to calculate the number of new HIV infections in men who have sex with men (MSM), injecting drug users (IDUs), and heterosexual men and women by nationality. Population sizes were obtained from the national census and national behavioural studies.
After accounting for under-reporting, there were 6480 (95% CI 6190-6780) new diagnoses of HIV infection in France in 2008. We estimate that there were 6940 (6200-7690) new HIV infections in 2008, suggesting an HIV incidence of 17 per 100 000 person-years. In 2008, there were 3550 (3040-4050) new infections in heterosexuals (incidence of 9 per 100 000 person-years), 3320 (2830-3810) in MSM (incidence of 1006 per 100 000 person-years), and 70 (0-190) in IDUs (incidence of 86 per 100 000 person-years). Overall HIV incidence decreased between 2003 and 2008 (p<0·0001), but remained comparatively high and stable in MSM.
In France, HIV transmission disproportionately affects certain risk groups and seems to be out of control in the MSM population. Incidence should be tracked to monitor transmission dynamics in the various population risk groups and to help to target and assess prevention strategies.
French National Institute for Public Health Surveillance (InVS) and French National Agency for Research on AIDS and Viral Hepatitis (ANRS).
Copyright © 2010 Elsevier Ltd. All rights reserved.
[PubMed – indexed for MEDLINE]
Incidence of HIV among men who have sex with men in France
Sean R Hosein a, David P Wilson b
We thank Stéphane Le Vu and colleagues1 for presenting surveillance findings and insightful analyses of data for HIV-1 incidence in France. Incidence is the most important epidemiological measure of the extent of spread of infection in a population, but it is very difficult and costly to calculate. The approach used by Le Vu and colleagues adds substantial value for accurately understanding epidemic trajectories. Importantly, they show a persistent and high incidence of HIV among men who have sex with men (MSM) in France, a situation they describe as “out of control”, whereas HIV incidence has declined in all other major population groups. They also note that this high HIV incidence among MSM is occurring against a background of substantial uptake of highly active antiretroviral therapy (HAART), with which 92% of treated patients achieving a plasma viral load of fewer than 500 copies/mL. Our study in Sydney suggests that the infectiousness of HIV among MSM with HIV has not decreased from
levels that existed before HAART.2 Data from a study in Amsterdam also suggest that HIV incidence has remained relatively high among MSM despite the widespread availability of HAART.3
The treatment as prevention strategy aims to reduce community viral load and assumes that this will reduce HIV transmission at the population level. Ecological studies and limited retrospective analyses suggest that treatment might have a preventative role for heterosexuals and people who inject drugs;4 however, it might be too optimistic to assume that this strategy can be effectively applied to MSM because of higher biological transmission rates and the sexual milieu of MSM. As explained by Le Vu and colleagues, such a milieu includes a high HIV prevalence, together with increased rates of unprotected anal sex with more
partners and increased prevalence of sexually transmitted infections. Thus, merely intensifying a treatment as a prevention strategy for MSM without addressing other co-existing issues at the individual or community level is not going to lead to sustained changes to HIV epidemics.
Intensified research into the experiences of sexually-active MSM, how HIV risk is perceived, and the reasons for taking such risks would usefully complement analyses of incidence for informing effective public health strategies. The findings of Le Vu and colleagues call for well-funded, creative, and thoughtful approaches to improve the sexual health of MSM so that the
devastation of HIV can be remedies
French parliament allows gay marriage despite protests
By Nicholas Vinocur
PARIS | Tue Apr 23, 2013 3:09pm EDT
(Reuters) – France became the 14th country to allow same-sex marriage on Tuesday after parliament approved a new law championed by President Francois Hollande, but it came at a political price amid violent street protests and a rise in homophobic attacks.
Hollande’s “marriage for all” law is one of the biggest social reforms inFrance since his left-wing mentor and predecessor Francois Mitterrand abolished the death penalty in 1981, a move which also split opinion.
Lawmakers in the lower house National Assembly, where Hollande’s Socialists have an absolute majority, passed the bill by 331 votes for and 225 against.
“Many French people will be proud this job is done,” Justice Minister Christiane Taubira told parliament. “Those protesting today will find themselves moved by the joy of the newly-weds.”
Yet the episode has proved costly for an already unpopular president. Critics said Hollande should focus instead on fixing the moribund economywhile opponents of the law have demanded a referendum and protests against it descended into violence.
Opposition conservatives and centrists immediately appealed to the Constitutional Council, the country’s top court, to have it struck down.
The ruling body will now debate whether the law is constitutional. Hollande wants the bill to come into effect by May 25, with the first gay marriages anticipated in June.
The debate has been blamed for a spate of homophobic attacks, including the beating of a 24-year-old in the southern city of Nice on Saturday. Interior Minister Manuel Valls warned this week of “zero tolerance” for such violence.
Socialist and conservative lawmakers had come close to blows more than once during lengthy parliamentary debates on the law, which authorizes adoption and marriage but will not allow gay couples to use medically assisted procreation.
Opponents of the law attempted to unveil a banner in parliament calling for a referendum before being taken away by security.
“You are adding a crisis to a crisis. You are stirring up tensions and are lighting the fuse of homophobia,” Herve Mariton, a member of the opposition UMP party, told lawmakers ahead of the vote.
France, a mainly Catholic country, follows 13 others including Canada, Denmark, Sweden and most recently Uruguay and New Zealand in allowing gay and lesbian couples to tie the knot.
In the United States, Washington D.C. and nine states have legalized same-sex marriage.
Unlike Mitterrand’s abolition of the death penalty, which most French people opposed at the time, polls showed more than half the country backed Hollande’s gay marriage law.
The gay community greeted the news with fanfare, with some rights groups dubbing April 23 the “Day of Love”. But opponents gathered outside parliament for fresh demonstrations.
The leader of the “anti” movement, a feisty female comedian who goes by her stage name Frigide Barjot, has vowed to continue protests that have brought thousands on to the streets beginning on May 5, the first anniversary of Hollande coming to power.
(Reporting by Nicholas Vinocur and Emile Picy; Editing by Catherine Bremer and Mike Collett-White)
Clin Infect Dis. 2010 Sep 15;51(6):725-31.
Rethinking prevention of HIV type 1 infection.
Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA. firstname.lastname@example.org
- Clin Infect Dis. 2010 Oct 15;51(8):995.
Research on the prevention of human immunodeficiency virus (HIV)-1 infection is at a critical juncture. Major methodological challenges to performing prevention trials have emerged, and one after another promising biomedical interventions have failed to reduce the incidence of HIV-1 infection. Nevertheless, there is growing optimism that progress can be achieved in the near term. Mathematical modeling indicates that 2 new strategies, “test and treat” and preexposure prophylaxis, could have a major impact on the incidence of HIV-1 infection. Will our hopes be justified? We review the potential strengths and limitations of these antiretroviral “treatment as prevention” strategies and outline other new options for reducing the incidence of HIV-1 infection in the near term. By maximizing the potential of existing interventions, developing other effective strategies, and combining them in an optimal manner, we have the opportunity to bring the HIV-1 epidemic under control.
quote from article:
“The human immunodeficiency virus (HIV)–1 epidemic remains out of control despite the intense efforts of clinicians, scientists, public health specialists, activists, and others for nearly 3 decades. There have been dramatic gains, particularly in treatment, but for every 2 persons who start antiretroviral therapy (ART), 5 become newly infected . UNAIDS estimates that there were 2.7 million new HIV-1 infections and 2.0 million deaths due to AIDS in 2008. Decreases in some regions were offset by increases in others . In North America, western Europe, and Australia, there is evidence that the epidemic is expanding in the population most affected, men who have sex with men [3–6].”