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Debating Ethics in HIV Research: Gaps between Policy and Practice in Nigeria
 

Title:
Debating Ethics in HIV Research: Gaps between Policy and Practice in Nigeria
Author: Brown B.
Description:
HIV prevention is a critical health issue in Nigeria; a country that has one of the worst HIV epidemic profiles in the world. With 270,000 new infections in 2012, Nigeria is a prime site for HIV prevention research. One effect of the HIV epidemic has been to revolutionalise ethical norms for the conduct of research: it is now considered unethical to design and implement HIV related studies without community engagement. Unfortunately, there is very little commensurate effort in building the capacity of local persons to engage actively with researchers, and there is no existing platform to facilitate dialogue between researchers and communities engaged in research in Nigeria. In an effort to address this gap, we undertook a series of three community dialogues (Phase One) and two community-researcher interface meetings (Phase Two) in Nigeria. This paper aims to give an empirical account of the dialogue from these community engagement processes and provide a resulting critique of the implementation of research ethics practices in Nigeria. It is anticipated that the outputs will: (i) support researchers in designing community-based research protocols; (ii) inform ethics committees of key considerations during research protocol reviews from a community perspective; and (iii) inform policy makers and research sponsors about issues of primary concern to communities with respect to HIV research.
 

International Journal of STD & AIDS, 22-Nov-11
Oral sex practices, oral human papillomavirus and correlations between oral and cervical human papillomavirus prevalence among female sex workers in Lima, Peru

Title:
Oral sex practices, oral human papillomavirus and correlations between oral and cervical human papillomavirus prevalence among female sex workers in Lima, Peru
Date:
22-Nov-11
Publication:
International Journal of STD & AIDS
Author: Brown B.
Description:
Few data exist on oral human papillomavirus (HPV) prevalence in female sex workers (FSWs). Information regarding oral sex practices of 185 Peruvian FSWs, 18-26 years of age, was obtained via survey and compared with HPV testing results of oral rinse samples. Oral HPV prevalence was 14/185 (7.6%); four (28.9%) HPV genotypes were carcinogenic. One hundred and eighty-two participants reported having had oral sex; 95% reported condom use during oral sex with clients and 9.5% with partners. Women who had oral sex more than three times with their partners in the past month were more likely to have oral HPV than women who had oral sex three times or less (P = 0.06). Ten (71.4%) women with oral HPV were HPV-positive at the cervix; conversely 8.3% of women with cervical HPV were HPV-positive in the oral cavity. The prevalence of oral HPV was relatively low, considering the high rates of oral sex practiced by these women.
 

Emerging Infectious Diseases, May-13
Zombies- A Pop Culture Resource for Public Health Awareness

Title:
Zombies- A Pop Culture Resource for Public Health Awareness
Date:
May-13
Publication:
Emerging Infectious Diseases
Author: Brown B.
Description:
Sitting at his laboratory bench, a scientist adds mutation after mutation to a strand of rabies virus RNA, unaware that in a few short days, an outbreak of this very mutation would destroy society as we know it. It could be called "Zombie Rabies," a moniker befitting of the next Hollywood blockbuster- or, in this case, a representation of the debate over whether a zombie apocalypse, manufactured by genetically modifying one or more diseases like rabies, could be more than just fiction. Fear of the unknown has long been a psychological driving force for curiosity, and the concept of a zombie apocalypse has become popular in modern society. This article explores the utility of zombies to capitalize on the benefits of spreading public health awareness through the use of relatable popular culture tools and scientific explanations for fictional phenomena.
 

International Journal of STD & AIDS, 23-Apr-12
Human papillomavirus prevalence, cervical abnormalities and risk factors among female sex workers in Lima, Peru

Title:
Human papillomavirus prevalence, cervical abnormalities and risk factors among female sex workers in Lima, Peru
Date:
23-Apr-12
Publication:
International Journal of STD & AIDS
Author: Brown B.
Description:
Female sex workers (FSWs) are at high risk of human papillomavirus (HPV) infection. Questionnaires were administered to 200 FSWs aged 18-26 years in Lima, Peru, to gather risk behaviours, and cervical swab samples were collected for Pap smears and HPV DNA testing as part of a longitudinal study. Participants reported a median of 120 clients in the past month, and 99.2% reported using condoms with clients. The prevalence of any HPV in cervical samples was 66.8%; 34 (17.1%) participants had prevalent HPV 16 or 18, and 92 (46.2%) had one or more oncogenic types. Fifteen women had abnormal Pap smears, 13 of which were HPV DNA positive. Fewer years since first sex was associated with oncogenic HPV prevalence in a model adjusted for previous sexually transmitted infection (STI) status and condom use with partners (prevalence ratio = 0.77, 95% confidence interval [CI] = 0.60-0.97). Our data confirm the high rates of HPV transmission among FSWs in Peru, highlighting the need for early and effective strategies to prevent cervical cancer.
 

Vaccine - Elsevier, 16-Mar-12
Randomized trial of HPV4 vaccine assessing the response to HPV4 vaccine in two schedules among Peruvian female sex workers

Title:
Randomized trial of HPV4 vaccine assessing the response to HPV4 vaccine in two schedules among Peruvian female sex workers
Date:
16-Mar-12
Publication:
Vaccine - Elsevier
Author: Brown B.
Description:
Two hundred female sex workers (FSWs) in Lima, Peru were randomized to receive HPV4 vaccine in the
standard (0, 2, 6 months) or a modified schedule (0, 3, 6 months). One hundred and eighty four (92%)
participants completed 3 doses of vaccine. Baseline seropositive rates were 58% for HPV6, 22.5% for HPV11,
41.5% for HPV16, and 13% for HPV18. The final geometric mean antibody titer (GMT) following vaccination
was significantly greater for women who were seropositive at baseline compared to seronegative women:
HPV6 (GMT ratio = 2.3, p < 0.01), HPV11 (GMT ratio = 2.7, p < 0.01), HPV16 (GMT ratio = 1.3, p = 0.04), and
HPV18 (GMT ratio = 2.4, p < 0.01). Antibody titers in the modified schedule were not inferior to those in the
standard schedule, suggesting the modified schedule may be paired with required STD visits. Although
all women benefit from vaccination, administration at a younger age and before sexual debut is needed
to achieve maximum protection from vaccine.
 

National Institute of Environmental Health Sciences, 11-Dec-11
Retrospective exposure estimation and predicted versus observed serum perfluorooctanoic acid concentrations for participants in the C8 Health Project

Title:
Retrospective exposure estimation and predicted versus observed serum perfluorooctanoic acid concentrations for participants in the C8 Health Project
Date:
11-Dec-11
Publication:
National Institute of Environmental Health Sciences
Author: Bartell S.M.
Description:
BACKGROUND:
People living or working in eastern Ohio and western West Virginia have been exposed to perfluorooctanoic acid (PFOA) released by DuPont Washington Works facilities.

OBJECTIVES:
Our objective was to estimate historical PFOA exposures and serum concentrations experienced by 45,276 non-occupationally exposed participants in the C8 Health Project who consented to share their residential histories and a 2005-2006 serum PFOA measurement.

METHODS:
We estimated annual PFOA exposure rates for each individual based on predicted calibrated water concentrations and predicted air concentrations using an environmental fate and transport model, individual residential histories, and maps of public water supply networks. We coupled individual exposure estimates with a one-compartment absorption, distribution, metabolism, and excretion (ADME) model to estimate time-dependent serum concentrations.

RESULTS:
For all participants (n = 45,276), predicted and observed median serum concentrations in 2005-2006 are 14.2 and 24.3 ppb, respectively [Spearman's rank correlation coefficient (r(s)) = 0.67]. For participants who provided daily public well water consumption rate and who had the same residence and workplace in one of six municipal water districts for 5 years before the serum sample (n = 1,074), predicted and observed median serum concentrations in 2005-2006 are 32.2 and 40.0 ppb, respectively (r(s) = 0.82).

CONCLUSIONS:
Serum PFOA concentrations predicted by linked exposure and ADME models correlated well with observed 2005-2006 human serum concentrations for C8 Health Project participants. These individualized retrospective exposure and serum estimates are being used in a variety of epidemiologic studies being conducted in this region.
 

Science of the Total Environment - Elsevier, 15-Mar-11
Global burden of disease as a result of indoor air pollution in Shaanxi, Hubei and Zhejiang, China

Title:
Global burden of disease as a result of indoor air pollution in Shaanxi, Hubei and Zhejiang, China
Date:
15-Mar-11
Publication:
Science of the Total Environment - Elsevier
Author: Edwards R.
Description:
Indoor air pollution in developing countries is a major global health problem, yet estimates of the global burden of disease vary widely and are associated with large uncertainty. The World Health Organization uses the fuel based approach to estimate 1.6 million premature deaths globally each year associated with exposure to indoor air pollution, of which 420000 are in China. The fuel based approach uses a ventilation factor to account for differences in indoor air concentrations and exposures in different parts of the world based on regional differences in stove technology. In China this approach assumes that flues eliminate the majority of indoor air pollution, with a ventilation factor of 0.25. To account for historic exposure leading to current disease patterns the ventilation factor was adjusted to 0.5 for adult health endpoints. Measurements in three Chinese provinces, Shaanxi, Hubei and Zhejiang, however, show that high PM(4) concentrations are present in kitchens and living rooms even with stoves with flues as a result of multiple stove and flue use. Comparison of Indian and Chinese indoor air concentrations suggests more appropriate ventilation factors in the range 0.76-1.0 for women and children, and 1.0 for men. Premature mortality in the three provinces using these estimates would be closer to 60600, rather than current estimates of 46000. With the addition of cardiovascular diseases these estimates would increase by 92000. Pollutant based estimates using measured indoor air concentrations and combined with dose-response estimates would imply a burden of disease of 157800 premature deaths including cardiovascular diseases, a tripling of current estimates.
 

Global Environmental Change - Elsevier, Jul-03
Framing environmental change in Africa: cross-scale institutional constraints on progressing from rhetoric to action against vulnerability

Title:
Framing environmental change in Africa: cross-scale institutional constraints on progressing from rhetoric to action against vulnerability
Date:
Jul-03
Publication:
Global Environmental Change - Elsevier
Author: Ogunseitan O.A.
Description:
The reconciliation of national development plans with global priority to mitigate environmental change remains an intractable policy controversy. In Africa, its resolution requires integrating local knowledge into impact assessments without compromising the scientific integrity of the assessment process. This requires better understanding of the communication pathways involved in progressing from frame construction to political action on various environmental issues. The impacts of environmental factors on human health are a common concern in Africa, and it is examined here as a platform for negotiating controversies surrounding the arrogation of global support for local assessments of vulnerability and mitigation. The study focused on the particularities of projected impacts of climate change, and specifically on considerations of the health sector within the context of multivalent international agreements to conduct and use environmental assessments. The analysis addresses limitations of cross-scale communication nodes that are embedded in boundary institutions such as the Country Study Program which is hosted by industrialized nations. The translation of rhetoric into action frames through dynamic vulnerability assessments and critical frame reflection can equally engage indigenous and aided capacity for adapting to environmental change.
 

Science of the Total Environment - Elsevier, 1-May-10
Exposure to polycyclic aromatic hydrocarbons and missed abortion in early pregnancy in a Chinese population

Title:
Exposure to polycyclic aromatic hydrocarbons and missed abortion in early pregnancy in a Chinese population
Date:
1-May-10
Publication:
Science of the Total Environment - Elsevier
Author: Wu J.
Description:
BACKGROUND:
Polycyclic aromatic hydrocarbons (PAHs) are formed during incomplete burning of fossil fuels, wood, and tobacco products. High PAH exposure has been associated with low birth weight, intrauterine growth restriction, and preterm birth, but little is known about its impact on adverse outcomes in early pregnancy such as in-utero fetal death.

OBJECTIVES:
To examine associations between exposure to PAHs and missed abortion in which the embryo has died but a miscarriage has not yet occurred during early pregnancy in a Chinese population in Tianjin.

METHODS:
A case-control study was conducted from April to November, 2007 in Tianjin, China. Cases experienced a missed abortion while controls underwent elective abortions before 14weeks of pregnancy. Eighty-one cases were recruited from four hospitals, with the same number of controls matched on hospital, maternal age (+/-8years), gravidity (1 or >1), and gestational age (+/-30days). Two maternal measures of PAH exposures were obtained based on benzo[a]pyrene (BaP) DNA adducts in 1) aborted tissues and 2) maternal blood (for a subset of subjects). In addition, proxy measures for PAH exposures from different sources were derived from maternal interviews.

RESULTS:
In conditional logistic regression analyses, we estimated more than 4-fold increase in risk of having experienced a missed abortion in women with above the median levels of blood BaP-DNA adducts (adjusted OR=4.27; 95% CI, 1.41-12.99); but no increase with adduct levels in aborted tissues (adjusted OR=0.76; 95% CI, 0.37-1.54). BaP-DNA adduct levels in maternal blood and aborted tissues were poorly correlated (r=-0.12; n=102). Missed abortion risk also was higher among women reporting traffic congestion near the residence, commuting by walking, and performing regular cooking activities during pregnancy.

CONCLUSION:
High levels of maternal PAH exposures may contribute to an increased risk of experiencing a missed abortion during early pregnancy.
 

Transactions of the Royal Society of Tropical Medicine and Hygiene, 10-Oct-10
A network population model of the dynamics and control of African malaria vectors

Title:
A network population model of the dynamics and control of African malaria vectors
Date:
10-Oct-10
Publication:
Transactions of the Royal Society of Tropical Medicine and Hygiene
Author: Yan G.
Description:
A more robust assessment of malaria control through mosquito larval habitat destruction will come from a better understanding of the distribution, productivity and connectivity of breeding sites. The present study examines the significance of vector dispersal ability, larval habitat stability and productivity on the persistence and extinction of a mosquito population inhabiting a dynamic network of breeding sites. We use this novel method of vector modelling to show that when dispersal is limited or vector distribution is patchy, the spread and growth of a mosquito population at the onset of a rainy season is delayed and extinction through larval habitat destruction is more readily achieved. We also determine the impact of two alternative dry-season survival strategies on mosquito dynamics. Simulations suggest that if adult vectors remain dormant throughout the dry season, the stage structure of the population will be synchronized at the onset of the wet season and its growth will be delayed. In contrast, a population that continues to breed throughout the dry season grows more rapidly and is more difficult to control. Our findings have important implications on the development of integrative malaria vector management strategies and on the understanding of dry-season survival mechanisms of African malaria vectors.
 

Public Library of Science, 13-Oct-10
Genome-wide patterns of gene expression during aging in the African malaria vector Anopheles gambiae

Title:
Genome-wide patterns of gene expression during aging in the African malaria vector Anopheles gambiae
Date:
13-Oct-10
Publication:
Public Library of Science
Author: Yan G.
Description:
The primary means of reducing malaria transmission is through reduction in longevity in days of the adult female stage of the Anopheles vector. However, assessing chronological age is limited to crude physiologic methods which categorize the females binomially as either very young (nulliparous) or not very young (parous). Yet the epidemiologically relevant reduction in life span falls within the latter category. Age-grading methods that delineate chronological age, using accurate molecular surrogates based upon gene expression profiles, will allow quantification of the longevity-reducing effects of vector control tools aimed at the adult, female mosquito. In this study, microarray analyses of gene expression profiles in the African malaria vector Anopheles gambiae were conducted during natural senescence of females in laboratory conditions. Results showed that detoxification-related and stress-responsive genes were up-regulated as mosquitoes aged. A total of 276 transcripts had age-dependent expression, independently of blood feeding and egg laying events. Expression of 112 (40.6%) of these transcripts increased or decreased monotonically with increasing chronologic age. Seven candidate genes for practical age assessment were tested by quantitative gene amplification in the An. gambiae G3 strain in a laboratory experiment and the Mbita strain in field enclosures set up in western Kenya under conditions closely resembling natural ones. Results were similar between experiments, indicating that senescence is marked by changes in gene expression and that chronological age can be gauged accurately and repeatedly with this method. These results indicate that the method may be suitable for accurate gauging of the age in days of field-caught, female An. gambiae.
 

BMC Infectious Diseases, 24-Sep-10
A cohort study of Plasmodium falciparum infection dynamics in Western Kenya Highlands

Title:
A cohort study of Plasmodium falciparum infection dynamics in Western Kenya Highlands
Date:
24-Sep-10
Publication:
BMC Infectious Diseases
Author: Yan G.
Description:
BACKGROUND:
The Kenyan highlands were malaria-free before the 1910s, but a series of malaria epidemics have occurred in the highlands of western Kenya since the 1980s. Longitudinal studies of the genetic structure, complexity, infection dynamics, and duration of naturally acquired Plasmodium falciparum infections are needed to facilitate a comprehensive understanding of malaria epidemiology in the complex Kenyan highland eco-epidemiological systems where malaria recently expanded, as well as the evaluation of control measures.

METHODS:
We followed a cohort of 246 children residing in 3 villages at altitudes 1430 - 1580 m in western Kenya. Monthly parasitological surveys were undertaken for one year, yielding 866 P. falciparum isolates that were analyzed using 10 microsatellite markers.

RESULTS:
Infection complexity and genetic diversity were high (HE = 0.787-0.816), with ≥83% of infections harboring more than one parasite clone. Diversity remained high even during the low malaria transmission season. There was no significant difference between levels of genetic diversity and population structure between high and low transmission seasons. Infection turn-over rate was high, with the average infection duration of single parasite genotypes being 1.11 months, and the longest genotype persistence was 3 months.

CONCLUSIONS:
These data demonstrate that despite the relatively recent spread of malaria to the highlands, parasite populations seem to have stabilized with no evidence of bottlenecks between seasons, while the ability of residents to clear or control infections indicates presence of effective anti-plasmodial immune mechanisms.
 

Journal of Immigrant and Minority Health, May-12
Immigrant Health Around the World: Evidence from the World Values Survey

Title:
Immigrant Health Around the World: Evidence from the World Values Survey
Date:
May-12
Publication:
Journal of Immigrant and Minority Health
Author: Noymer A.
Description:
We describe the relationship between immigrant status and self-rated health around the world, both in raw descriptive statistics and in models controlling for individual characteristics. Using the World Values Survey (1981-2005), we analyze data from 32 different countries worldwide. We estimate four regression models per country. The basic model tests mean differences in self-rated health. Additional models add demographic and social class controls. Introduction of control variables (most particularly, age) changes the results dramatically. In the final model, net of controls, only two countries show poorer immigrant health and three countries show better immigrant health. The multivariate regression models net of controls show few differences in health status between immigrants and the native born. The age structure of immigrant populations is an important mediator of differences in health status compared to the native-born population
 

Journal of Global Health Perspectives, 18-Nov-12
Reducing HPV Transmission in the Developing World through Education and Targeted Vaccination

Title:
Reducing HPV Transmission in the Developing World through Education and Targeted Vaccination
Date:
18-Nov-12
Publication:
Journal of Global Health Perspectives
Author: Brown B.
Description:
Human Papillomavirus (HPV) infections account for a significant amount of new cervical cancer cases worldwide. Specifically, the burden of cervical cancer is disproportionately higher in developing countries, such as Peru and India than in developed countries. Due to a lack of economic resources, as well as the high cost of vaccination, developing nations struggle to provide cancer screening and identify cancer precursors. Health care providers worldwide have established unexposed young females as the primary target group for HPV vaccination. Although recent efforts to establish vaccination schedules and provide developing countries with affordable vaccines have been beneficial, they have neglected to incorporate an educational component to the newly vaccinated population on HPV and cervical cancer prevention. The target population must be made aware of the importance for continual routine cervical cancer screenings, safe-sex practices, and of the risk of cervical cancer and HPV infections despite receiving the vaccination. School-based programs and community efforts are essential in ensuring proper education as a supplement for vaccination programs. Furthermore, high-risk groups such as female sex workers (FSW) and men who have sex with men (MSM) are important to identify and consider for vaccination due to their repeated exposure to high-risk activities. With growing worldwide efforts to reduce the increasing rate of chronic HPV infections through vaccination, education on cervical cancer screening and safe-sex must be established.
 

Viruses, Dec-12
The role of human papillomavirus in human immunodeficiency virus acquisition in men who have sex with men: a review of the literature

Title:
The role of human papillomavirus in human immunodeficiency virus acquisition in men who have sex with men: a review of the literature
Date:
Dec-12
Publication:
Viruses
Author: Brown B.
Description:
Human Papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) worldwide. Incidence rates of HPV infection among human immunodeficiency virus (HIV)-infected individuals are well documented and are several-fold higher than among HIV-uninfected individuals. Few studies have demonstrated an increased risk for acquiring HIV infection in those with HPV infection, and this risk seems to be higher when HPV strains are of high-risk oncogenic potential. The estimated prevalence of high-risk oncogenic HPV infection is highest in men who have sex with men (MSM), a particularly vulnerable group with high prevalence rates of HIV infection and other STIs. In this paper, we provide a comprehensive review of the available literature on the role of HPV infection in HIV acquisition. Our review includes data from cross-sectional and longitudinal studies.
 

IRB: Ethics & Human Research, Mar-13
A Global Public Incentive Database for Human Subjects Research

Title:
A Global Public Incentive Database for Human Subjects Research
Date:
Mar-13
Publication:
IRB: Ethics & Human Research
Author: Brown B.
Description:
Ethical review of the use of incentives in recruiting research participants appears haphazard across U.S. institutions, and little is known about comparable practices at institutions outside the United States. Ethics committees and principle investigators alike have few sources of information to consult as reference points for the types and amounts of incentives offered by researchers. This commentary proposes developing a global public incentive database that would serve as an open venue for investigators to voluntarily record the types and amounts of incentives they offered to research participants. The database would have two major categories of ethically salient parameters: features of the index research protocol, and features of the research setting. The existence of the database could eventually support the design and conduct of systematic empirical studies about the use of incentives in human subjects research.
 

PLoS, 14-Mar-13
HPV and Genital Warts among Peruvian Men Who Have Sex with Men and Transgender People: Knowledge, Attitudes and Treatment Experiences

Title:
HPV and Genital Warts among Peruvian Men Who Have Sex with Men and Transgender People: Knowledge, Attitudes and Treatment Experiences
Date:
14-Mar-13
Publication:
PLoS
Author: Brown B.
Description:
BACKGROUND:
Several studies have assessed the epidemiology of HPV infection among MSM, but no qualitative studies have specifically assessed how HPV and genital warts (GW) affect South American men who have sex with men (MSM) and male-to-female transgendered women (TG). This study explored the knowledge, attitudes and experiences of Peruvian MSM and TG regarding HPV and GW.
METHODS:
We performed a qualitative study consisting of fifteen in-depth interviews and three focus groups carried out in Lima, Peru with diverse MSM and TG groups, including sex workers. Resulting data were analyzed by applying a systematic comparative and descriptive content analysis.
RESULTS:
While knowledge of HPV was limited, awareness of GW was common, particularly among TG persons and sex workers. Still, few participants recognized that GW are sexually transmitted, and many had problems differentiating between GW and other STI/anogenital conditions. Stigmatizing experiences were common during sexual encounters with people who had visible GW. Shame, emotional and physical troubles, and embarrassing sexual experiences were reported by individuals with GW. Search for treatment was mediated by peers, but stigma and apparent health services' inability to deal with GW limited the access to effective medical care.
CONCLUSIONS:
In Peru, public health interventions should strengthen services for HPV/GW management and increase accurate knowledge of the transmission, treatment, and sequelae of HPV/GW in MSM and TG populations.
 

HPV Today, 21-Sep-12
High Level Evidence Demonstrates Male Circumcision Reduces HPV Infection

Title:
High Level Evidence Demonstrates Male Circumcision Reduces HPV Infection
Date:
21-Sep-12
Publication:
HPV Today
Author: Brown B.
Description:
Male circumcision (MC) is a simple and safe surgical procedure with multiple medical benefits, including the prevention of balanitis, phimosis (and paraphimosis), urinary tract infections, and penile cancer. More recent evidence demonstrates its protective effects regarding the acquisition of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) and HPV. Indeed, if brought to scale, MC will benefit public health by reducing the transmission of HIV and HPV and thereby the attendant population-level morbidity, mortality, and related healthcare costs.
 

International Journal of STD and AIDS, 25-Jun-13
Reported changes in sexual behaviour and human papillomavirus knowledge in Peruvian female sex workers following participation in a human papillomavirus vaccine trial

Title:
Reported changes in sexual behaviour and human papillomavirus knowledge in Peruvian female sex workers following participation in a human papillomavirus vaccine trial
Date:
25-Jun-13
Publication:
International Journal of STD and AIDS
Author: Brown B.
Description:
Limited data exist on the effect of clinical trial participation on sexual behavioural change. Two hundred female sex workers working in Lima, Peru received human papillomavirus (HPV) vaccine in either the standard (0, 2, 6 months) or modified (0, 3, 6 months) schedule. Participants received comprehensive screening and treatment for sexually transmitted infections (STIs), counselling on safe sex practices, education about HPV and the HPV vaccine, contraceptives (oral and condoms) and family planning at each visit. We assessed vaccine completion rates, change in sexual practices, and changes in HPV knowledge before and after participation in the vaccine trial. There were high rates of vaccine completion, 91 overall. The estimated number of reported new and total clients over a 30-day period decreased significantly (P < 0.001). Knowledge about HPV and HPV-related disease increased among all participants. In addition, all participants listed at least one preventive strategy during the month 7 follow-up survey.
 

BMC Infectious Diseases, 10-Sep-13
Characterizing the syphilis epidemic among men who have sex with men in Lima, Peru to identify new treatment and control strategies

Title:
Characterizing the syphilis epidemic among men who have sex with men in Lima, Peru to identify new treatment and control strategies
Date:
10-Sep-13
Publication:
BMC Infectious Diseases
Author: Brown B.
Description:
Background
Syphilis is an important sexually transmitted infection (STI) with serious public health consequences. Among men who have sex with men (MSM) in Lima, the prevalence and incidence are extraordinarily high. Current syndromic approaches, however, fail to identify asymptomatic cases, and in settings where large proportions of individuals test positive again after treatment, it is frequently difficult to distinguish treatment failure from re-infection. Thus, new approaches are needed to improve treatment strategies and public health control efforts.

Methods/Design
Study participants will undergo baseline testing for syphilis infection along with a behavioral survey covering demographics, sexual behavior, drug and alcohol abuse and health-care seeking behavior. The cohort will be followed for 18 months at three-month intervals. Blood and earlobe scrapings will also be collected for T. pallidum DNA testing, to create molecular markers for subtyping. We will also perform cytokine testing on collected samples in order to create host immunologic profiles associated with recurrence, re-infection, treatment failure and success.

Discussion
Advances in social epidemiology, molecular typing and characterization of host immune responses will offer promise in developing new understandings of syphilis management. We will share our findings with the Peruvian Ministry of Health and other public health organizations, to identify new approaches of case detection and successful treatment.

Keywords:
Syphilis; Peru; Men who have sex with men (MSM); HIV; T. pallidum; Molecular epidemiology; Cytokine; Macrolide resistance
 

LGBT Health, Jan-14
Integration of Screening for Syphilis, Hepatitis C,and Other Sexually Transmitted Infections Screeningwith HIV Testing in a Community-BasedHIV Prevention Program in Miami, Florida

Title:
Integration of Screening for Syphilis, Hepatitis C,and Other Sexually Transmitted Infections Screeningwith HIV Testing in a Community-BasedHIV Prevention Program in Miami, Florida
Date:
Jan-14
Publication:
LGBT Health
Author: Brown B.
Description:
The South Beach AIDS Project (SoBAP) in Miami, Florida, is a nonprofit community-based organization that
recently began offering syphilis, chlamydia and gonorrhea, and hepatitis C screening along with confidential
HIV screening to its clients. We retrospectively reviewed data from SoBAP collected from January 2011 to
June 2012 to describe the prevalence of sexually transmitted infections (STIs) among persons seeking testing
services. Our findings are in line with national data demonstrating that men who have sex with men (MSM)
of color are disproportionately affected by STIs, especially Latino MSM. Integrating HIV, STI, and hepatitis C
screening in community-based testing programs is feasible and an important means to identify infected persons.
 

International Journal of Environmental Research and Public Health, Oct-13
Associations of Meteorology with Adverse Pregnancy Outcomes: A Systematic Review of Preeclampsia, Preterm Birth and Birth Weight

Title:
Associations of Meteorology with Adverse Pregnancy Outcomes: A Systematic Review of Preeclampsia, Preterm Birth and Birth Weight
Date:
Oct-13
Publication:
International Journal of Environmental Research and Public Health
Author: Olivier L.
Description:
The relationships between meteorology and pregnancy outcomes are not well known. This article reviews available evidence on the relationships between seasonality or meteorology and three major pregnancy outcomes: the hypertensive disorders of pregnancy (including preeclampsia, eclampsia and gestational hypertension), gestational length and birth weight. In total 35, 28 and 27 studies were identified for each of these outcomes. The risks of preeclampsia appear higher for women with conception during the warmest months, and delivery in the coldest months of the year. Delivery in the coldest months is also associated with a higher eclampsia risk. Patterns of decreased gestational lengths have been observed for births in winter, as well as summer months. Most analytical studies also report decreases in gestational lengths associated with heat. Birth weights are lower for deliveries occurring in winter and in summer months. Only a limited number of studies have investigated the effects of barometric pressure on gestational length or the effects of temperature and sunshine exposure on birth weight, but these questions appear worth investigating further. Available results should encourage further etiological research aiming at enhancing our understanding of the relationships between meteorology and adverse pregnancy outcomes, ideally via harmonized multicentric studies.
 

The Electronic Journal of Human Sexuality, 29-Jan-14
Revisiting the Condom Riddle: Solutions and Implications

Title:
Revisiting the Condom Riddle: Solutions and Implications
Date:
29-Jan-14
Publication:
The Electronic Journal of Human Sexuality
Author: Brown B.
Description:
The 16th century marked the beginning of the fight against sexually transmitted infections (STIs) with the use of the male condom. However, many puzzling questions and prospective solutions have surfaced over the years in the context of condom use. In 1978, a condom riddle introduced the dilemma of a man having two condoms to use for intercourse with three consecutive women. In this paper, we will discuss the solution proposed to the aforementioned riddle, and examine its public health implications. Moreover, we illustrate the challenges involved in condom use and reduction of STI acquisition.
 

The Open AIDS Journal, 30-Dec-13
Cervical HPV Infection in Female Sex Workers: A Global Perspective

Title:
Cervical HPV Infection in Female Sex Workers: A Global Perspective
Date:
30-Dec-13
Publication:
The Open AIDS Journal
Author: Brown B.
Description:
Approximately 291 million women worldwide are HPV DNA carriers. Studies have indicated that having multiple sexual partners may lead to higher HPV transmission. Thus female sex workers (FSWs) may be at greater risk of infection compared to the general population. Herein we review publications with data on FSW cervical HPV test results. We also examine variations of HPV prevalence and risk behaviors by region. Knowledge of prevalent HPV types in FSWs may lead to improved prevention measures and assist in understanding vaccination in high-risk groups.
 

Understanding STI Risk and Condom Use Patterns by Partner Type Among Female Sex Workers in Peru
 

Title:
Understanding STI Risk and Condom Use Patterns by Partner Type Among Female Sex Workers in Peru
Author: Brown B.
Description:
While brothel-based sex work is regulated by the Peruvian government, there is little data on STI risk factors reported by female sex workers (FSW). This study compared high risk behaviors among 120 Peruvian FSW from government regulated brothels with both clients and non-commercial partners. Our study found that 12% of FSW reported unprotected vaginal sex with clients (compared to 75% with non-commercial partners), and 42% reported unprotected anal sex with clients (compared to 87% with non-commercial partners). Group differences were observed in the expectation to have oral sex (32% for partners vs 60% for clients; p<0.01), and a history of anal sex (65% for partners vs 32% for clients; p<0.01) and both vaginal and anal sex with the same partners (46% for partners vs 25% for clients; p<0.001). These findings suggest that FSW constitute an important bridge population for STI/HIV transmission in Peru.
 

Post-Approval Monitoring and Oversight of U.S.-Initiated Human Subjects Research in Resource-Constrained Countries
 

Title:
Post-Approval Monitoring and Oversight of U.S.-Initiated Human Subjects Research in Resource-Constrained Countries
Author: Brown B.
Description:
Abstract: The history of human subjects research and controversial procedures in relation to it has helped form the field of bioethics. Ethically questionable elements may be identified during research design, research implementation, management at the study site, or actions by a study’s investigator or other staff. Postapproval monitoring (PAM) may prevent violations from ccurring or enable their identification at an early stage. In U.S.-initiated human subjects research taking place in resource-constrained countries with limited development of research regulatory structures, arranging a site visit from a U.S. research ethics committee (REC) becomes difficult, thus creating a potential barrier to regulatory oversight by the parent REC. However, this barrier may be overcome through the use of digital technologies, since much of the world has at least remote access to the Internet. Empirical research is needed to pilot test the use of these technologies for research oversight to ensure the protection of human subjects taking part in research worldwide.
 

HIV self-testing in Nigeria: Public opinions and perspectives
 

Title:
HIV self-testing in Nigeria: Public opinions and perspectives
Author: Brown B.
Description:
Nigeria views the HIV self-test (HIVST) as a possible mechanism to help increase HIV testing uptake and capture otherwise undiagnosed HIV cases. The purpose of this survey was to obtain perspectives of informed members of the Nigerian public on the use of the HIVST. A convenience sample of 1712 researchers, academics, journalists, community advocates, activists and HIV policy-makers and programmers including those working in the development sectors enlisted on the New HIV Vaccine and Microbicide Advocacy Society listserv were sent a brief survey. Respondents were asked to provide a ‘yes’ or ‘no’ response to an enquiry if they support the introduction of HIVST into Nigeria. Reasons for their response were also recorded. Information was collected anonymously with no identifiers. Only 157 (9.2%) provided a response. While the majority (54.8%) supported the introduction of HIVST, a significant number of respondents were concerned about possible risk associated with self-testing, especially suicide and partner violence. Others were concerned about poor linkages to care. Introduction of HIVST would need to be paired with intense media campaigns and education about its use. Once Nigeria commences HIVST, efforts should also focus on approaches to reach people in hard to reach areas of the country.
 

Getting to zero the biomedical way in Africa: outcomes of deliberation at the 2013 Biomedical HIV Prevention Forum in Abuja, Nig
 

Title:
Getting to zero the biomedical way in Africa: outcomes of deliberation at the 2013 Biomedical HIV Prevention Forum in Abuja, Nig
Author: Brown B.
Description:
Abstract
Background: Over the last few decades, biomedical HIV prevention research had engaged multiple African
stakeholders. There have however been few platforms to enable regional stakeholders to engage with one
another. In partnership with the World AIDS Campaign International, the Institute of Public Health of Obafemi
Awolowo University, and the National Agency for the Control of AIDS in Nigeria, the New HIV Vaccine and
Microbicide Advocacy Society hosted a forum on biomedical HIV prevention research in Africa. Stakeholders’
present explored evidences related to biomedical HIV prevention research and development in Africa, and made
recommendations to inform policy, guidelines and future research agenda.
Discussion: The BHPF hosted 342 participants. Topics discussed included the use of antiretrovirals for HIV
prevention, considerations for biomedical HIV prevention among key populations; HIV vaccine development; HIV
cure; community and civil society engagement; and ethical considerations in implementation of biomedical HIV
prevention research. Participants identified challenges for implementation of proven efficacious interventions and
discovery of other new prevention options for Africa. Concerns raised included limited funding by African
governments, lack of cohesive advocacy and policy agenda for biomedical HIV prevention research and
development by Africa, varied ethical practices, and limited support to communities’ capacity to actively engaged
with clinical trial conducts. Participants recommended that the African Government implement the Abuja +12
declaration; the civil society build stronger partnerships with diverse stakeholders, and develop a coherent
advocacy agenda that also enhances community research literacy; and researchers and sponsors of trials on the
African continent establish a process for determining appropriate standards for trial conduct on the continent.
Conclusion: By highlighting key considerations for biomedical HIV prevention research and development in Africa,
the forum has helped identify key advocacy issues that Civil Society can expend efforts on so as to strengthen
support for future biomedical HIV prevention research on the continent.
 

The Ebola outbreak in Western Africa: ethical obligations for care
 

Title:
The Ebola outbreak in Western Africa: ethical obligations for care
Author: Brown B.
Description:
Abstract

The recent wave of the Ebola Virus Disease (EVD) in Western Africa and efforts to control the disease where the health system requires strengthening raises a number of ethical challenges for healthcare workers practicing in these countries. We discuss the implications of weak health systems for controlling EVD and limitations of the ethical obligation to provide care for patients with EVD using Nigeria as a case study. We highlight the right of healthcare workers to protection that should be obligatorily provided by the government. Where the national government cannot meet this obligation, healthcare workers only have a moral and not a professional obligation to provide care to patients with EVD. The national government also has an obligation to adequately compensate healthcare workers that become infected in the course of duty. Institutionalisation of policies that protect healthcare workers are required for effective control of the spread of highly contagious diseases like EVD in a timely manner.
 

Compassionate use of experimental drugs in the Ebola outbreak
 

Title:
Compassionate use of experimental drugs in the Ebola outbreak
Author: Brown B.
Description:
Annette Rid and Ezekiel Emanuel's Viewpoint1 provides a comprehensive overview of ethical considerations in the Ebola outbreak. Their evidence supports randomised allocation and rigorous data collection of any experimental intervention while emphasising health systems strengthening to contain the epidemic. However, they argued against compassionate use of experimental interventions outside clinical trials, an act that could have health benefit.
 

Rape in Nigeria: a silent epidemic among adolescents with implications for HIV infection
 

Title:
Rape in Nigeria: a silent epidemic among adolescents with implications for HIV infection
Author: Brown B.
Description:
Adolescents worldwide often face tremendous sexual violence; a growing problem and a leading reproductive health concern. The prevalence of this violence ranges between 15 and 40% in sub-Saharan Africa, with studies showing rates of sexual coercion and abuse among female adolescents in Nigeria between 11 and 55% (1, 2). Little is known about the impact of rape on adolescents living with HIV (ALHIV), and how their HIV status affects how they cope with this traumatic experience. A recent survey in Nigeria showed 31.4 and 5.7% of sexually active adolescent females and males, respectively, reported forced sex (rape) at sexual initiation (3). The same study showed significantly more reported cases of rape among female ALHIV compared to their HIV-negative peers (p=0.008). Supporting literature from South Africa highlights rape as a risk factor for HIV in women (4). Achunike and Kitause provide vivid accounts of rape in Nigeria and its impact on victims, including physical injuries, fatigue and chronic headaches, and emotional problems, such as suicide attempts, stress disorders, depression, and sexual dysfunction (5, 6). Alcohol and drug abuse were also prominent for victims. In addition, adolescents and youths who have been sexually abused are more likely to have multiple concurrent sex partners, are less likely to report using contraception, and are more likely to report pregnancy
 

A prospective cohort study characterising the role of anogenital warts in HIV acquisition among men who have sex with men: a stu
 

Title:
A prospective cohort study characterising the role of anogenital warts in HIV acquisition among men who have sex with men: a stu
Date:
09/16/14
Author: Brown B.
Description:
Abstract
Introduction The HIV epidemic in Latin America is concentrated among men who have sex with men (MSM) and transgender women (TGW) with transmission predominately occurring during unprotected anal intercourse. This mode of transmission is also responsible for other sexually transmitted infections (STIs) such as herpes simplex, chlamydia and gonorrhoea, human papillomavirus (HPV)/genital warts and syphilis. Studies assessing the prevalence of HIV and HPV among MSM have not addressed the role of genital warts and HPV-related diseases in the acquisition of HIV infection. Community-based testing programmes are a potentially important way to remove barriers including stigma for individuals to learn about their STI status.
 

A multi-level spatial analysis of clinical malaria and subclinical Plasmodium infections in Pailin Province, Cambodia
 

Title:
A multi-level spatial analysis of clinical malaria and subclinical Plasmodium infections in Pailin Province, Cambodia
Author: D. M. Parker
Description:
BACKGROUND:
The malaria burden is decreasing throughout the Greater Mekong Subregion, however transmission persists in some areas. Human movement, subclinical infections and complicated transmission patterns contribute to the persistence of malaria. This research describes the micro-geographical epidemiology of both clinical malaria and subclinical Plasmodium infections in three villages in Western Cambodia.
METHODS:
Three villages in Western Cambodia were selected for the study based on high reported Plasmodium falciparum incidence. A census was conducted at the beginning of the study, including demographic information and travel history. The total population was 1766. Cross-sectional surveys were conducted every three months from June 2013 to June 2014. Plasmodium infections were detected using an ultra-sensitive, high-volume, quantitative polymerase chain reaction (uPCR) technique. Clinical episodes were recorded by village health workers. The geographic coordinates (latitude and longitude) were collected for all houses and all participants were linked to their respective houses using a demographic surveillance system. Written informed consent was obtained from all participants.
RESULTS:
Most clinical episodes and subclinical infections occurred within a single study village. Clinical Plasmodium vivax episodes clustered spatially in each village but only lasted for a month. In one study village subclinical infections clustered in geographic proximity to clusters of clinical episodes. The largest risk factor for clinical P. falciparum episodes was living in a house where another clinical P. falciparum episode occurred (model adjusted odds ratio (AOR): 6.9; CI: 2.3-19. 8). Subclinical infections of both P. vivax and P. falciparumwere associated with clinical episodes of the same species (AOR: 5.8; CI: 1.5-19.7 for P. falciparum and AOR: 14.6; CI: 8.6-25.2 for P. vivax) and self-reported overnight visits to forested areas (AOR = 3.8; CI: 1.8-7. 7 for P. falciparum and AOR = 2.9; CI: 1.7-4.8 for P. vivax).
DISCUSSION:
Spatial clustering within the villages was transient, making the prediction of spatial clusters difficult. Interventions that are dependent on predicting spatial clusters (such as reactive case detection) would only have detected a small proportion of cases unless the entire village was screened within a limited time frame and with a highly sensitive diagnostic test. Subclinical infections may be acquired outside of the village (particularly in forested areas) and may play an important role in transmission.