High prevalent and incident HIV-1 and herpes simplex virus 2 infection among male migrant and non-migrant sugar farm workers in Zambia

Abstract

BackgroundMore insight is needed regarding risk factors for prevalent and incident HIV-1 infection among male farm workers in Sub-Saharan Africa to control the HIV-1 epidemic.MethodsMale farm workers were recruited from a sugar estate in Zambia to participate in a prospective cohort study. Questionnaire data were collected via interview, and testing was conducted for HIV-1, herpes simplex virus type 2 (HSV-2), and syphilis infection at baseline and follow-up between May 2006 and September 2007.ResultsAmong 1062 workers enrolled, HIV-1 prevalence at baseline was 20.7%. Testing HSV-2 seropositive (adjusted odds ratio (AOR) 5.4, 95% CI 3.6 to 8.1), self-reported genital ulcers in the past year (AOR 2.8, 95% CI 1.9 to 4.2), and being widowed (AOR 3.7, 95% CI 2.0 to 6.9) were significantly associated with prevalent HIV-1 infection. The HIV-1 incidence among 731 initially negative participants with at least one follow-up visit was 4.1 per 1000 person-months (95% CI 2.6 to 5.7); seroconversion was independently associated with prevalent HSV-2 infection (adjusted hazard ratio (AHR) 2.4, 95% CI 1.0 to 5.8) and incident HSV-2 infection (AHR 18.0, 95% CI 4.2 to 76.3). HIV-1 prevalence and incidence rates were similar among migrant and non-migrant workers.ConclusionsHIV-1 prevalence and incidence were high, and HSV-2 infection was a risk factor for HIV-1 acquisition. There is an urgent need to expand HIV-1 prevention programmes tailored to farm workers and their communities.

Effect of progestins on immunity: medroxyprogesterone but not norethisterone or levonorgestrel suppresses the function of T cells and pDCs

“…The results of this study, previous studies indicating immunosuppressive properties of DMPA [5, 16–18, 21–27], and multiple epidemiological studies suggesting an association between DMPA use and increased risk of HIV-1 and other infections [5–9, 11, 12, 32–35, 40] constitute strong arguments against the continuous use of high-dose injectable DMPA in women at risk of HIV-1 infection. Importantly, it must be emphasized that, in the settings where no other form of highly effective contraception is available, the overall benefit of the use of DMPA outweighs the potential associated risks as the availability of effective methods of contraception is critical for reducing maternal morbidity and mortality.…”

“…Levonogestrel (LNG) or etonogestrel (ETG)-releasing devices or implants are highly effective and reversible methods of long-term contraception [42–44]. ETG, LNG, and NET are considered for use in HIV-1-endemic areas; however, their safety in regard to the effect on immune system and HIV-1 transmission has not been validated [1, 3, 4, 9, 39, 40, 45]. Identification of contraceptives that do not suppress the protective properties of the immune system is critical for the selection of safe hormonal contraception in areas with high HIV-1 prevalence [4, 36, 37, 40].…”

Syphilis 1855 and HIV-AIDS 2007: Historical reflections on the tendency to blame human anatomy for the action of micro-organisms

“…The medical evidence, however, remains as contested and inconclusive as it always was (Dickson, van Roode, Herbison, & Paul, 2008;Fergusson, Boden, & Horwood, 2006;Ferris et al, 2010;Weiss, Thomas, Munabi, & Hayes, 2006), and the most recent meta-analysis finds no evidence of any significant prophylactic effect (Van Howe, 2013). The jury is still out on whether circumcision will reduce the prevalence of HIV, but there is a shortage of studies confirming the results of the clinical trials (Heffron et al, 2011;Westercamp et al, 2010), and news reports that HIV incidence is unchanged or increasing in programme regions (Gathura, 2014). Other studies find that circumcision could increase male to female transmissions (Wawer et al, 2009), while yet others in developed countries find that circumcision provides no protection at all (El-Sadr, Mayer, & Hodder, 2010;Gust et al, 2010;Rodriguez-Diaz et al, 2012).…”

One size does not fit all: HIV testing preferences differ among high-risk groups in Northern Tanzania

“…The estimated thousands of porters of Mount Kilimanjaro (Peaty, 2012) are predominantly young males who face volatile income cycles and spend extended time away from home. While no HIV prevalence estimates exist for this population, porters share many characteristics with other high-risk groups, such as long-distance truck drivers (Deane, Parkhurst, & Johnston, 2010; Delany-Moretlwe et al, 2013), fishermen (Kiwanuka et al, 2013; Kwena et al, 2010; Smolak, 2014), miners (Clift et al, 2003; Desmond et al, 2005), and migrant farm workers (Heffron et al, 2011). …”