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      The epidemiology of HIV and other sexually transmitted infections in African, Caribbean and Black men in Toronto, Canada

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          Abstract

          Background

          African, Caribbean, and Black (Black) men account for 16.5% of new HIV diagnoses among men in Ontario. There is substantial evidence that sexually transmitted infections (STIs) are associated with increased likelihood of HIV infection; however, little is known regarding the prevalence of HIV/STI co-infections among Black men in Toronto. Progress has been made in understanding factors contributing to racial/ethnic disparities in HIV between among men who have sex with men (MSM). In this study, we investigate within-racial group patterns of HIV/STI infection between Black MSM and Black men who only have sex with women (MSW).

          Methods

          A cross-sectional descriptive epidemiological study was conducted with a non-probability sample of Black men recruited from Toronto, Ontario. Audio Computer Assisted Self-Interviews (ACASI) surveys were used to collect demographic and behavioral data. Biological specimens were collected to screen for HIV and other STIs. Chi-Square tests were used to compare the prevalence of (1) HIV and current STIs between MSM and MSW and (2) current STIs between people living with HIV and people not living with HIV. Logistic regression models were constructed to assess whether or not history of STIs were associated with current HIV infection.

          Results

          The prevalence of HIV (9.2%), syphilis (7.2%), hepatitis B (2.7%), and high-risk anal HPV (8.4%) and penile HPV (21.3%) infections were high in Black men ( N = 487) and were significantly increased in Black MSM compared with MSW; the prevalence of syphilis and high-risk HPV were also increased in men living with HIV. Men with a history of syphilis (OR = 6.48, 95% CI: 2.68,15.71), genital warts (OR = 4.32, 95% CI: 1.79,10.43) or genital ulcers (OR = 21.3, 95% CI: 1.89,239.51) had an increased odds of HIV infection.

          Conclusions

          The HIV/STI prevalence was high among this sample of Black men, although the study design may have led to oversampling of men living with HIV. The associations between STIs and current HIV infection highlight the need for integrated of HIV/STI screening and treatment programs for Black men. Public health strategies are also needed to reduce disproportionate HIV/STI burden among Black MSM—including improving HPV vaccine coverage.

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          Most cited references33

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          Herpes simplex virus 2 infection increases HIV acquisition in men and women: systematic review and meta-analysis of longitudinal studies.

          To estimate the sex-specific effect of herpes simplex virus type 2 (HSV-2) on the acquisition of HIV infection. The increased number of longitudinal studies available since the last meta-analysis was published allows for the calculation of age- and sexual behaviour-adjusted relative risks (RR) separately for men and women. Systematic review and meta-analysis of longitudinal studies. PubMed, Embase and relevant conference abstracts were systematically searched to identify longitudinal studies in which the relative timing of HSV-2 infection and HIV infection could be established. Where necessary, authors were contacted for separate estimates in men and women, adjusted for age and a measure of sexual behaviour. Summary adjusted RR were calculated using random-effects meta-analyses where appropriate. Studies on recent HSV-2 incidence as a risk factor for HIV acquisition were also collated. Of 19 eligible studies identified, 18 adjusted for age and at least one measure of sexual behaviour after author contact. Among these, HSV-2 seropositivity was a statistically significant risk factor for HIV acquisition in general population studies of men [summary adjusted RR, 2.7; 95% confidence interval (CI), 1.9-3.9] and women (RR, 3.1; 95% CI, 1.7-5.6), and among men who have sex with men (RR, 1.7; 95% CI, 1.2-2.4). The effect in high-risk women showed significant heterogeneity, with no overall evidence of an association. Prevalent HSV-2 infection is associated with a three-fold increased risk of HIV acquisition among both men and women in the general population, suggesting that, in areas of high HSV-2 prevalence, a high proportion of HIV is attributable to HSV-2.
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            Setting the stage: host invasion by HIV.

            For more than two decades, HIV has infected millions of people worldwide each year through mucosal transmission. Our knowledge of how HIV secures a foothold at both the molecular and cellular levels has been expanded by recent investigations that have applied new technologies and used improved techniques to isolate ex vivo human tissue and generate in vitro cellular models, as well as more relevant in vivo animal challenge systems. Here, we review the current concepts of the immediate events that follow viral exposure at genital mucosal sites where most documented transmissions occur. Furthermore, we discuss the gaps in our knowledge that are relevant to future studies, which will shape strategies for effective HIV prevention.
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              Epidemiological synergy. Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases.

              Understanding the role of other sexually transmitted diseases (STDs) in the transmission of human immunodeficiency virus (HIV), the role of STDs in progression of HIV disease, and the role of HIV infection in alterations of natural history, diagnosis, or response to therapy of STDs is critical to the development of optimal strategies for HIV control. One hundred sixty-three studies on the interrelationships between HIV infection and other STDs were examined. Of 75 studies on the role of STDs in HIV transmission, the 15 analyses of examination or laboratory evidence of STDs adjusted for sexual behavior showed that both ulcerative and nonulcerative STDs increase the risk of HIV transmission approximately 3- to 5-fold. Due to limited data, the role of STDs in progression of disease remains unclear. Preliminary data from 83 reports on the impact of HIV infection on STDs suggest that, at a community level, HIV infection may increase the prevalence of some STDs (e.g., genital ulcers). If coinfection with HIV prolongs or augments the infectiousness of individuals with STDs, and if the same STDs facilitate transmission of HIV, these infections may greatly amplify one another. This "epidemiological synergy" may be responsible for the explosive growth of the HIV pandemic in some populations. Effective STD control programs will be essential to HIV prevention in these communities.
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                Author and article information

                Contributors
                203-785-5797 , laron.nelson@yale.edu , nelsonla@smh.ca
                wangari@whiwh.com
                whusbands@ohtn.on.ca
                ting.sa@cchmc.org
                nanhua.zhang@cchmc.org
                kushwaha.sameer2@gmail.com
                absalomd@smh.ca
                rupert.kaul@utoronto.ca
                Journal
                BMC Infect Dis
                BMC Infect. Dis
                BMC Infectious Diseases
                BioMed Central (London )
                1471-2334
                29 March 2019
                29 March 2019
                2019
                : 19
                : 294
                Affiliations
                [1 ]ISNI 0000000419368710, GRID grid.47100.32, School of Nursing, , Yale University, ; 400 West Campus Drive, New Haven, CT 06477 USA
                [2 ]GRID grid.415502.7, Centre for Urban Health Solutions, , St. Michael’s Hospital, ; 209 Victoria Street, Toronto, ON M5B 1T8 Canada
                [3 ]GRID grid.439329.6, Women’s Health in Women’s Hands Community Health Centre, ; 2 Carlton Street, Suite 500, Toronto, ON M5B 1J3 Canada
                [4 ]ISNI 0000 0000 8591 010X, GRID grid.423128.e, Ontario HIV Treatment Network, ; 1300 Yonge Street, Suite 600, Toronto, ON M4T 1X3 Canada
                [5 ]ISNI 0000 0000 9025 8099, GRID grid.239573.9, Division of Biostatistics and Epidemiology, , Cincinnati Children’s Hospital Medical Center, ; 3333 Burnet Ave, Cincinnati, OH 45229 USA
                [6 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Faculty of Medicine, , University of Toronto, ; 1 Kings College Circle, Toronto, ON M5S 1A8 Canada
                Author information
                http://orcid.org/0000-0002-2630-602X
                Article
                3925
                10.1186/s12879-019-3925-3
                6441217
                30925906
                2ec53776-5d5e-453e-8b45-55b9dd7ba81e
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 19 April 2017
                : 20 March 2019
                Funding
                Funded by: Canadian Institutes of Health Research (CA)
                Award ID: #HET-85518
                Award Recipient :
                Funded by: Ontario HIV Treatment Network (CA)
                Award ID: Translation and Exchange Grant
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100000060, National Institute of Allergy and Infectious Diseases;
                Award ID: P30 AI078498
                Funded by: FundRef http://dx.doi.org/10.13039/501100000085, Ontario HIV Treatment Network;
                Award ID: AHRC G1066
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Infectious disease & Microbiology
                hiv,sexually transmitted infections,epidemiology,black,health disparities,hiv/sti co-infection,syphilis,black canadian men,black msm,toronto

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