Ecological and individual level analysis of risk factors for HIV infection in four urban populations in sub-Saharan Africa with different levels of HIV infection

Auvert, Bertran; Buvé, Anne; Ferry, Barbara; Caraël, Michel; Morison, Linda; Lagarde, Emmanuel; Nj, Robinson; Kahindo, Maina; Chege, Jane; Rutenberg, Naomi; Musonda, Rosemary; Laourou, M.; Akam, E.

doi:10.1097/00002030-200108004-00003

Cited by 183 publications

(129 citation statements)

References 21 publications

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“…Two articles reported on the same data, and their information was therefore combined in the analysis, and they were treated as one study. 12,13 Information about sample characteristics, setting, study design, variables adjusted for and statistical results were extracted from the study by one reviewer (NK), and a confirmatory data extraction and quality appraisal were carried out by a second reviewer (HS). The quality appraisal was conducted using seven appraisal questions adapted from the graphical appraisal tool for epidemiological studies (GATE).…”

Section: Methodsmentioning

confidence: 99%

Is Early Sexual Debut a Risk Factor for HIV Infection Among Women in Sub‐Saharan Africa? A Systematic Review

Stöckl

Kalra²,

Jacobi

et al. 2012

American J Rep Immunol

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Section: Methodsmentioning

confidence: 99%

Is Early Sexual Debut a Risk Factor for HIV Infection Among Women in Sub‐Saharan Africa? A Systematic Review

Stöckl

Kalra²,

Jacobi

et al. 2012

American J Rep Immunol

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“…[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] There are undoubtedly many more studies of this sort in the grey literature. Six papers are from Uganda, two based on the Masaka cohort 14 22 and four on the Rakai intervention trial subjects.…”

Section: Resultsmentioning

confidence: 99%

“…11 The sound epidemiological reasons for this are not apparent from the indicators themselves and many lay people may not be conversant with these subtleties.…”

Section: Current Indicatorsmentioning

confidence: 99%

A critique of international indicators of sexual risk behaviour

Slaymaker

2004

Sexually Transmitted Infections

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Objectives: To investigate whether the indicators of sexual risk behaviour, defined by UNAIDS for use among members of general populations, have been found as risk factors, to examine how information on sexual behaviour is collected and summarised in order to calculate the indicators, and to look for possible sources of error in the data and in interpretation of those indicators. Methods: The literature on risk factors for HIV infection was reviewed. Indicators were calculated for countries where data were available for two or more points in time.Results: Indicators of sexual behaviour describe behaviours that are relevant to HIV risk and that are amenable to change. These behaviours do not correspond closely to the individual risk factors for HIV infection that have been identified in observational studies. Conclusions: Although potential errors of both measurement and interpretation exist, most of the indicators currently defined can fulfil their purpose, providing they are used with caution. Many of the indicators should not be interpreted in isolation but need supporting information to make sense of trends or differences between groups. Much of this information is provided by other indicators. The source of the data used to calculate the indicator is potentially important and should always be provided with indicator estimates. Some estimate of the accuracy of the estimate, either by means of confidence intervals or the number of respondents, should be given.

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“…39 Fourteen studies provide fair evidence that circumcision is protective against heterosexually acquired HIV infection in men. [40][41][42][43][44][45][46][47][48][49][50][51][52][53] One study with fair evidence found that male circumcision before puberty (specifically before 12 years of age) is more protective than circumcision occurring at a later age. 50 Three large randomized controlled trials provide good evidence of such protection.…”

Section: Hivmentioning

confidence: 99%

Male Circumcision

Blank¹,

Brady²,

Buerk³

et al. 2012

Pediatrics

297

149

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Male circumcision consists of the surgical removal of some, or all, of the foreskin (or prepuce) from the penis. It is one of the most common procedures in the world. In the United States, the procedure is commonly performed during the newborn period. In 2007, the American Academy of Pediatrics (AAP) convened a multidisciplinary workgroup of AAP members and other stakeholders to evaluate the evidence regarding male circumcision and update the AAP’s 1999 recommendations in this area. The Task Force included AAP representatives from specialty areas as well as members of the AAP Board of Directors and liaisons representing the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention. The Task Force members identified selected topics relevant to male circumcision and conducted a critical review of peer-reviewed literature by using the American Heart Association’s template for evidence evaluation. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; furthermore, the benefits of newborn male circumcision justify access to this procedure for families who choose it. Specific benefits from male circumcision were identified for the prevention of urinary tract infections, acquisition of HIV, transmission of some sexually transmitted infections, and penile cancer. Male circumcision does not appear to adversely affect penile sexual function/sensitivity or sexual satisfaction. It is imperative that those providing circumcision are adequately trained and that both sterile techniques and effective pain management are used. Significant acute complications are rare. In general, untrained providers who perform circumcisions have more complications than well-trained providers who perform the procedure, regardless of whether the former are physicians, nurses, or traditional religious providers. Parents are entitled to factually correct, nonbiased information about circumcision and should receive this information from clinicians before conception or early in pregnancy, which is when parents typically make circumcision decisions. Parents should determine what is in the best interest of their child. Physicians who counsel families about this decision should provide assistance by explaining the potential benefits and risks and ensuring that parents understand that circumcision is an elective procedure. The Task Force strongly recommends the creation, revision, and enhancement of educational materials to assist parents of male infants with the care of circumcised and uncircumcised penises. The Task Force also strongly recommends the development of educational materials for providers to enhance practitioners’ competency in discussing circumcision’s benefits and risks with parents. The Task Force made the following recommendations:Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks, and the benefits of newborn male circumcision justify access to this procedure for those families who choose it.Parents are entitled to factually correct, nonbiased information about circumcision that should be provided before conception and early in pregnancy, when parents are most likely to be weighing the option of circumcision of a male child.Physicians counseling families about elective male circumcision should assist parents by explaining, in a nonbiased manner, the potential benefits and risks and by ensuring that they understand the elective nature of the procedure.Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.Parents of newborn boys should be instructed in the care of the penis, regardless of whether the newborn has been circumcised or not.Elective circumcision should be performed only if the infant’s condition is stable and healthy.Male circumcision should be performed by trained and competent practitioners, by using sterile techniques and effective pain management.Analgesia is safe and effective in reducing the procedural pain associated with newborn circumcision; thus, adequate analgesia should be provided whenever newborn circumcision is performed.Nonpharmacologic techniques (eg, positioning, sucrose pacifiers) alone are insufficient to prevent procedural and postprocedural pain and are not recommended as the sole method of analgesia. They should be used only as analgesic adjuncts to improve infant comfort during circumcision.If used, topical creams may cause a higher incidence of skin irritation in low birth weight infants, compared with infants of normal weight; penile nerve block techniques should therefore be chosen for this group of newborns.Key professional organizations (AAP, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Society of Anesthesiologists, the American College of Nurse Midwives, and other midlevel clinicians such as nurse practitioners) should work collaboratively to:Develop standards of trainee proficiency in the performance of anesthetic and procedure techniques, including suturing;Teach the procedure and analgesic techniques during postgraduate training programs;Develop educational materials for clinicians to enhance their own competency in discussing the benefits and risks of circumcision with parents;Offer educational materials to assist parents of male infants with the care of both circumcised and uncircumcised penises.The preventive and public health benefits associated with newborn male circumcision warrant third-party reimbursement of the procedure. The American College of Obstetricians and Gynecologists has endorsed this technical report.

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Ecological and individual level analysis of risk factors for HIV infection in four urban populations in sub-Saharan Africa with different levels of HIV infection

Cited by 183 publications

References 21 publications

Is Early Sexual Debut a Risk Factor for HIV Infection Among Women in Sub‐Saharan Africa? A Systematic Review

Is Early Sexual Debut a Risk Factor for HIV Infection Among Women in Sub‐Saharan Africa? A Systematic Review

A critique of international indicators of sexual risk behaviour

Male Circumcision

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