Summary Background India's 2011 census revealed a growing imbalance between the numbers of girls and boys at ages 0–6 years, which we hypothesise is due to increased prenatal sex determination followed by selective abortion of female foetuses. Methods We examined sex ratios by birth order among 0.25 million births in three rounds of the nationally-representative National Family Health Survey covering the period from 1990 to 2005. We estimated totals of selective female abortion by examining the birth cohorts of children aged 0–6 years in the 1991, 2001 and 2011 censuses. Findings The conditional sex ratio for second order births when the firstborn was a girl fell from 906 per 1000 boys in 1990 (99%CI 798–1013) to 836 in 2005 (99%CI 733–939); an annual decline of 0.5% (p for trend=0·001). Declines were much greater in mothers with 10 or more years of education than in illiterate mothers, and in wealthier households compared to poorer households. In contrast, no significant declines were noted in the sex ratio for second order births if the firstborn was a male, or for firstborns. Between the 2001 and 2011 censuses, more than twice the number of Indian districts (local administrative areas) showed declines in the child sex ratio as districts showing no change or increases. After adjusting for excess mortality rates in girls, the estimated number of selective female abortions rose from 0 to 2.0 million in the 1980s, 1.2 to 4.1 million in the 1990s, and 3.1 to 6.0 in the 2000s. Each 1% decline in child sex ratio at ages 0–6 years implied 1.2 to 3.6 million more selective female abortions. Selective female abortions totalled about 4.2 to 12.1 million from 1980–2010, with a greater rate of increase in the 1990s than in the 2000s. Interpretation Selective abortion of female foetuses, especially for pregnancies following a firstborn girl, has increased substantially in India. Most of India's population now live in states where selective female abortion is common. Funding US National Institutes of Health, Canadian Institute of Health Research, International Development Research Centre, Li Ka Shing Knowledge Institute.
BackgroundHepatitis B (HBV), hepatitis C (HCV) and other sexually transmitted infections (STIs) have been associated with HIV transmission risk and disease progression among gay men and other men who have sex with men (MSM), but the frequency and distribution of STIs in this community in Canada has not been extensively studied.MethodsWe recruited MSM living with and without HIV from a large primary care clinic in Toronto. Participants completed a detailed socio-behavioural questionnaire using ACASI and provided blood for syphilis, HIV, HBV and HCV, herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2), and human cytomegalovirus (CMV) serology, urine for chlamydia and gonorrhea, and a self-collected anal swab for human papillomavirus (HPV) molecular diagnostics. Prevalences were expressed as a proportion and compared using chi-square.Results442 MSM were recruited, 294 living with HIV and 148 without. Active syphilis (11.0% vs. 3.4%), ever HBV (49.4% vs. 19.1%), HCV (10.4% vs. 3.4%), HSV-2 (55.9% vs. 38.2%), CMV (98.3% vs. 80.3%) and high-risk (HR) anal HPV (67.6% vs. 51.7%) infections were significantly more common in men living with HIV. Chlamydia and gonorrhea were infrequent in both groups. Regardless of HIV infection status, age and number of lifetime male sexual partners were associated with HBV infection and lifetime injection drug use with HCV infection.ConclusionsSyphilis and viral infections, including HBV, HCV, HSV-2, CMV, and HR-HPV, were common in this clinic-based population of MSM in Toronto and more frequent among MSM living with HIV. This argues for the implementation of routine screening, vaccine-based prevention, and education programs in this high-risk population.
BackgroundTheory suggests that perceived human immunodeficiency virus (HIV) risk and actual HIV risk behaviour are cyclical whereby engaging in high risk behaviour can increase perceived risk, which initiates precautionary behaviour that reduces actual risk, and with time reduces perceived risk. While current perceived risk may impact future actual risk, it is less clear how previous actual risk shapes current perceived risk. If individuals do not base their current perceived risk on past behaviour, they lose the protective effect of perceived risk motivating precautionary behaviour. Our goal was to determine the impact of actual risk on perceived risk.MethodsSexually active men who have sex with men (MSM) were recruited at the Maple Leaf Medical Clinic in downtown Toronto from September 2010 to June 2012. Participants completed a socio-behavioural questionnaire using an Audio Computer Assisted Self-Interview (ACASI). Actual HIV risk (primary predictor) was constructed by applying principal component analysis (PCA) to eight sexual risk survey questions and comprised three components which reflected sex with casual partners, sex with HIV-positive regular partners and sex with HIV unknown status regular partners. Perceived HIV risk (outcome) was measured by asking participants what the chances were that they would ever get HIV. Multivariable logistic regression was used to measure the association between actual and perceived HIV risk.ResultsOne hundred and fifty HIV-negative MSM were recruited (median age 44.5 years [IQR 37–50 years]). Twenty percent of MSM perceived their HIV risk to be high. The odds of having a high perceived risk was significantly higher in those with high actual HIV risk indicated by low condom use with an HIV-positive regular partner compared to those with low actual HIV risk indicated by high condom use with an HIV-positive regular partner (Odds Ratio (OR) 18.33, 95 % confidence interval (CI) 1.65–203.45). Older age was associated with lower perceived risk but only age 40–49 compared to less than 30 was statistically significant (OR 0.12, 95 % CI 0.016–0.86). The odds of having high perceived risk was significantly associated with men who used poppers in the previous 6 months compared to those who did not use poppers (OR 5.64, 95 % CI 1.20–26.48).ConclusionsPerceived HIV risk increased significantly as condom use with an HIV-positive regular partner decreased. However, perceived HIV risk was not associated with condom use with casual partners or HIV unknown status regular partners, even though these behaviours could be considered risky. The relationship between perceived and actual risk in HIV studies is complex and has implications on how health care workers address the issue of risky sexual behaviour and perceived risk.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2859-6) contains supplementary material, which is available to authorized users.
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