MSc (Med) Population-Based Field Epidemiology, Faculty of Health Sciences, University of the Witwatersrand, 2009 / Background: Sub-Saharan Africa continues to bear the brunt of the global HIV epidemic, with the epicentre located in Southern Africa. Of all the adult and children living with HIV globally in 2006, two-thirds (63%) were in sub-Saharan Africa.1 The epicenter of the HIV/AIDS epidemic in South Africa is located in the KwaZulu Natal province, where HIV incidence and prevalence continue to remain high and this has serious implications for HIV prevention and control programmes. Objectives i. To profile individuals who sero-converted during the period 2003-2007 in order to better target interventions. ii. To estimate the incidence rate for HIV during the period 2003 to 2007. iii. To identify factors associated with HIV infection at individual and household levels in Kwazulu-Natal. Methods This involved analysis data of a dynamic cohort study. The follow-up period was 2003-2007, and the study was a household-based HIV sero-prevalence survey of a population in Kwazulu Natal, South Africa, conducted by the Africa Centre for Health and Population Studies. The cohort comprised females aged 15 to 49 and males 15 to 54 years who participated in the baseline HIV sero-prevalence survey in 2003 and/ or subsequent surveys in 2005, 2006 and 2007. Individuals who participated in at least two surveys and had a negative HIV result on first enrolment were included in the analysis. Selected demographic, socio-economic, behavioural and geographic variables of the participants were obtained from the demographic surveillance system (DSS) database of the Africa Centre Demographic and Information System (ACDIS) for analysis. Profiles of recently HIV sero-converters were based on these variables and descriptive statistics used to compare the differences in sero-conversion between the different strata of each variable. Multiple logistic regression was used to investigate the association between variables of key interest. Results A total of 39, 738 individuals were surveyed for the four annual sero-prevalence surveys conducted from 2003-2007. Of these, 41.5% (n=16,491) were HIV negative on their first enrolment into the study, 11.6% (n=4610) were HIV positive on first enrolment, while 46.9% (n=18,637) had either participated in just one out of the four surveys, or were non-resident at baseline. These two categories of participants as well as those who tested HIV positive on first enrolment were dropped from the analysis. The final sample size used for analysis was 16,491 individuals and comprised 8,425(51.1%) females aged 15-49 years old and 8,066 (48.9%) males aged 15-54 years old. The incidence rate for HIV sero-conversion among the 16, 491 individuals included in the final analysis was 11.5 per 1000PYs during the follow-up period. In other words, 539 individuals sero-converted during 46818.15 person-years (PYs) at risk from 2003-2007. A significant proportion of the new HIV acquisitions (69.8%) occurred in households without any recently or previously infected household member, and women had a significantly greater risk of HIV infection(IR= 16.9 per 1000PYs; 95% CI: 15.33-18.640) compared to men(IR=5.9; 95% CI: 4.95-6.94) in this study area. Conclusion The younger age bracket (24-30 years old) was associated with significantly higher risk of HIV infection compared to the older age category. However, the age group 20-24 years bears the greatest burden of HIV pandemic in this community. Majority of seroconverters were rural dwellers but peri-urban dwellers had the greatest risk of HIV acquisition. The study also showed that attendance of a school or a training facility on a full-time basis during the follow-up period was protective for HIV acquisition compared. Also, attainment of standard 10 to 12 level of education was associated with a greater risk of HIV seroconversion. This can be attributed to the age of individuals at these levels of education and the associated high risk profile of this group. Living in close proximity to primary or secondary roads was also associated with a risk of HIV infection compared to those living far from major roads. This could be due to the ease of mobility and potential exposure multiple sex partners. This may be due to a desire for modern social amenities which requires financial wherewithal, which in turn facilitates transactional sex.

Hepatitis B virus (HBV), the prototype member of the family Hepadnaviridae, is hepatotropic and replicates by reverse transcription. HBV is responsible for the chronic infection of more than 240 million people worldwide, of which 65 million reside in Africa. The nine HBV genotypes (A to I) identified to date, are geographically distributed and exhibit different clinical manifestations and treatment responses. The term occult HBV infection (OBI) refers to a HBV infection in which HBV surface antigen (HBsAg) cannot be detected by conventional serological assays as has been defined by the Taormina expert panel. . HBV and human immune deficiency virus (HIV) are both endemic in many parts of the world and share common transmission routes. Worldwide, 10% of those infected with HIV are also chronically infected with HBV. HIV co-infection has been shown to be a risk factor for the development of OBI in individuals infected with HBV. The aim of this study was to characterize, at the molecular level, HBV from mono-infected and HBV/HIV co-infected individuals in Sudan The objectives of this study were the systematic and comparative analysis of HBV genotype D sequences, available in the public databases; the molecular characterization of HBV from mono-infected Sudanese liver disease patients and from HBV/HIV co-infected Sudanese patients; and the development and testing of bioinformatics tools to explore HBV sequence data generated using ultradeep pyrosequencing (UDPS) and comparison of UDPS results with those obtained from cloning based sequencing (CBS). All available complete genomes of genotype D of HBV from the GenBank database were analyzed. The intra-group divergence of the subgenotypes ranged from 0.8% + 0.5 for subgenotype D6 to 3.0% + 0.3 for subgenotype D8. Phylogenetic analysis of genotype D showed separation into six distinct clusters (subgenotypes D1, D2, D3/D6, D4, D5 and D7/D8), with good bootstrap support. The mean intergroup divergence between subgenotype D3 and subgenotype D6 was 2.6%, falling below the accepted threshold of 4% required to define a subgenotype. This suggests that subgenotypes D3 and D6 are the same subgenotype because they also share signature amino acids. Furthermore, subgenotype D8 is a genotype D/E recombinant, which clusters with subgenotype D7. This analysis provided an update on the classification of the subgenotypes of genotype D of HBV. Although HBsAg seroprevalence in Sudan, a central-African country, is greater than 8%, the only sequencing data for HBV, available prior to our study, was from asymptomatic blood donors, where genotype E predominates, followed by genotype D and subgenotype A2. Ninety-nine HBV-positive liver disease patients were enrolled in our study, including: 15 with hepatocellular carcinoma (HCC), 42 with cirrhosis, 30 asymptomatic carriers, 7 with acute hepatitis and 5 with chronic hepatitis. The surface and basic core promoter/precore (BCP/PC) regions, and the complete genome of HBV were sequenced. Eighty-two percent of the samples from HBV mono-infected liver disease patients were genotyped. Fifty-nine percent were infected with genotype D (74% D1, 10% D2, 3% D3 and 13% D6), 30% with genotype E, 8.5% with genotype A and 2.5% with a genotype D/E recombinant. Patients infected with genotype E had a higher frequency of HBeAg-positivity (29.2%) and higher viral loads compared to patients infected with genotype D. BCP/PC region mutations, including the G1896A mutation, seen in 37% of the HBeAg-negative individuals, could account for the HBeAg-negativity. A total of 358 Sudanese HIV-positive patients were enrolled. HBsAg was detected in 11.7% of the participants, indicating chronic HBV infection. HBV DNA was detected in 26.8% of the participants: 11.7% were HBsAg positive (overt infection) and the remaining 15.1% were HBsAg-negative (OBI). Fifty serum samples from the HBV/HIV DNA-positive co-infected participants were selected for genomic analysis of HBV. Of these, the HBV genotype of 37 was determined. The genotype distribution of HBV isolates from the HBV/HIV co-infected participants did not differ significantly from those from the HBV mono-infected patients: genotype D (46%), E (21.6%), A (18.9%) and a D/E recombinant (13.5%). Compared to the HBV isolates from mono-infected liver disease patients, the frequency of the D/E recombinant and genotype A was higher in HBV/HIV co-infected patients, as was the intragroup divergence of genotype E. No difference in BCP/PC mutations affecting HBeAg expression at the transcriptional and translational levels between genotype D and E was observed. The following mutations could account for the HBsAg-negativity: sM133T, sE164G, sV168G and sS174N. No primary drug resistance mutations were found. Two online bioinformatics tools, the ―Deep Threshold Tool (DDT)‖ and the ―Rosetta Tool‖, were built to analyze data generated from UDPS and CBS of the BCP/PC region of four Sudanese serum samples, infected with either genotype D or E of HBV, from HBeAgpositive and HBeAg negative patients. A total of 10952 reads were generated by UDPS on the 454 GS Junior platform. The Threshold was calculated using DDT based on probability of error of 0.5%. In total, 39 unique mutations were identified by UDPS, of which 25 were nonsynonymous. The ratio of nucleotide substitutions between isolates from HBeAg-negative and HBeAg-positive patients was 3.5:1. From the sequences analyzed, compared to genotype E isolates, genotype D isolates showed greater variation in the X, BCP/PC/C regions. Only 18 of the 39 positions identified by UDPS were detected by CBS. Using the specific criteria, that have been suggested previously, to define genotypes/subgenotypes of HBV, we determined that genotype D has six and not eight subgenotypes. The importance of HBV genotypes in clinical consequences of infection and response to antiviral treatment has led us to characterize HBV genotypes circulating in Sudan. HBV mono-infected patients and HBV/HIV co-infected individuals, were mainly infected with genotype D or E. HBV mono-infected patients, infected with genotype E, had higher HBeAg-positivity and higher viral loads than those infected with genotype D. The ratio of genotype A to non- A, as well as the genotype E intra-group divergence were higher in HBV/HIV co-infected individuals compared to HBV mono-infected individuals. OBI was found in 15.1% HBV/HIV co-infected patients and its clinical relevance remains to be determined. In order to overcome the limitations of Sanger sequencing, which include its high cost and inability to detect minor populations in quasispecies, next generation sequencing techniques have been developed. It was demonstrated that correct analysis of UDPS data required appropriate curation of read data, in order to clean the data and eliminate artefacts and that the appropriate consensus (reference) sequence should be used in order to identify variants correctly. CBS detected fewer than 50% of the substitutions detected by UDPS. This new technology may allow the detection of minor variants between the different genotypes of HBV and provide biomarkers for the prediction of clinical manifestation of HBV and response to antiviral therapy.

Discussion. The epidemic of HIV/STD among MSM is severe, and the prevalence of risk sexual behaviors was at a high level among MSM in China. The risk factors for HIV/STD and factors associated with DAI reported in this study give some insights towards designing relevant prevention programs. The simplicity and feasibility of our effective intervention, enhanced VCT, makes it possible for this to be incorporated into standard VCT procedures. Further translational research is needed to investigate its effectiveness in the real-world setting. / Introduction. Men who have sex with men (MSM) have become the main group for HIV transmission in China in 2009. There have been many epidemiological cross-sectional studies targeting MSM in China in recent years. These provide limited data compared with cohort studies, which can describe the rate at which HIV/STD are spreading in a target population. Moreover, there is a dearth of intervention studies which are theory-based with rigorous research methodology in China. Last but not least, research is needed on sexual behaviors and their determinants, including cognitions from health behavioral theories, event-specific factors, etc. / Objectives. This study investigated the prevalence and incidence of HIV/STD, as well as their associated risk factors among MSM in Nanjing, China. It also explored the prevalence of unprotected anal sex (UAI) and the associated factors, including cognitions from health behavioral theories and event-specific factors. In addition, this is also one of the first studies to examine the efficacy of a randomized control trial (RCT) designed intervention, to use enhanced voluntary counseling and testing (VCT) to reduce UAI among MSM in China. / Results. The RDS-adjusted HIV, syphilis and HCV prevalence were respectively 7.3%, 14.4% and 0.2% at baseline. Of the 397 MSM who were found to be HIV seronegative at baseline, 286 (72.0%) retested at Month 6. HIV, syphilis and HCV incidence were respectively 5.12, 7.58 and 0 per 100 person-years (PY). Recruiting male sex partners mostly at saunas was the risk factor associated with being HIV seropositive at baseline (OR=3.84) and undergoing HIV/syphilis seroconversion at Month 6 (RR=2.351RR=6.72). In the RCT study, participants in the Intervention Group reported significantly less risk than those in the Control Group (UAI with any male sex partners: 48.4% vs. 66.7%;UAI with regular male sex partners: 52.2% vs. 68.9%) at Month 6. Furthermore, Perceived Behavior Control showed a significant association with DAI with both regular (AOR=0.42) and casual partners (AOR=O.73). / Subjects and Methods. A cohort study and randomized control trial were conducted. Out of 416 MSM approached by respondent driven sampling (RDS), 397 HIV negative participants were recruited to the HIV/syphilis/HCV cohort, and they were invited to return for a follow-up visit at Month 6. A subsample from the baseline cohort consisting of 307 MSM, was randomly assigned to either the Intervention Group (enhanced VCT) or the Control Group (standard VCT). Evaluation was conducted at Month 6. Both baseline and Month 6 visits consisted of VCT service and interviewing. Statistical methods such as Chi-square test, logistic regression and Poisson regression were used in this study. / Hao, Chun. / Adviser: Joseph TF Lan. / Source: Dissertation Abstracts International, Volume: 73-04, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 166-179). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendixes I-II also in Chinese.

Background A dramatic increasing trend of HIV prevalence among men who have sex with men (MSM) was observed in China from 2000. Most previous investigations were based on convenience sampling and none of them differentiated money boys (MB) from other MSMs. The objectives of this study was to determine the prevalence of HIV infection and its risk factors among MSMs in Shenzhen, China, using approximate probability sampling methods; and to interpret HIV transmission pattern among MSMs with both phylogenetical and epidemiological information. / Conclusions The prevalence of MV infection in Shenzhen MSMs was similar to the national rate in MSMs. HIV infection and related characteristics in Mf3s and other MSMs were different, indicating that a separate analysis was necessary. TLS could provide information on venue comparisons for venue-based MSMs and RDS could recruit more hidden subjects. Results from this study suggest that venue-specific intervention approaches should be developed and provided to different venues. / Results HIV prevalence was 5.5% among MSMs in Shenzhen. A significantly lower HIV infection was observed in MBs (4.5%) compared with other MSMs (7.0%). The HIV infection rate among MSMs was 5.7% by TLS and 4.6% by RDS, which were not significantly different. Factors related to HIV infection in MSMs included syphilis infection, occupation, sexual orientation, venue for recruitment and hometown HIV prevalence. HIV rate and social-behavioral characteristics were found to vary with venues, with significantly higher rates in family clubs, parks and saunas, than entertainment venue. Molecular phylogenetical analysis showed that genetic clusters were related to receptive anal intercourse, short stay in Shenzhen, early age of first sex, and high hometown HIV prevalence. Venue-specific transmission chains were observed in 60% of the subjects. / Subjects and Methods A total of 2143 MSMs were recruited in Shenzhen from 2008 to 2009, including 1651 persons from time-location sampling (TLS) and 492 from respondent-driven sampling (RDS). A separate recruitment of MBs and other MSMs was applied in TLS surveys and a mixed sample of MSMs was applied in RDS. All subjects were interviewed and had blood tests for HIV and syphilis. HIV positive samples were further used for phylogenetic analysis. / Zhao, Jin / Adviser: Mingliang He. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 161-177). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Tam, Ka Po. / Thesis submitted in: September 2008. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 151-161). / Abstracts in English and Chinese. / Abstract --- p.i / Acknowledgement --- p.vi / Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Human Immunodeficiency Virus --- p.1 / Chapter 1.2 --- Sexual Transmission of HIV --- p.3 / Chapter 1.3 --- HIV Prevalence in MSM Worldwide --- p.5 / Chapter 1.4 --- Risk Factors for Homosexual Men --- p.8 / Chapter 1.4.1 --- Individual Factors --- p.8 / Chapter 1.4.2 --- Societal Factors --- p.12 / Chapter 1.5 --- HIV Prevalence of MSM in Hong Kong --- p.17 / Chapter 2 --- Literature Review --- p.21 / Chapter 2.1 --- The Literature Search --- p.22 / Chapter 2.2 --- Results --- p.25 / Chapter 2.3 --- Reasons to Conduct Social Network Study --- p.26 / Chapter 2.4 --- Review on Methodologies --- p.29 / Chapter 2.4.1 --- Data Source --- p.29 / Chapter 2.4.2 --- Sampling Methods --- p.30 / Chapter 2.5 --- Review on Major Findings --- p.33 / Chapter 2.5.1 --- Individual Characteristics --- p.33 / Chapter 2.5.2 --- Partnerśة Characteristics --- p.34 / Chapter 2.5.3 --- Network Characteristics --- p.38 / Chapter 2.6 --- Critique --- p.40 / Chapter 2.7 --- Implication --- p.46 / Chapter 3 --- Methods --- p.49 / Chapter 3.1 --- Study Design --- p.49 / Chapter 3.1.1 --- Sampling --- p.50 / Chapter 3.1.2 --- Terminology --- p.51 / Chapter 3.2 --- Instruments --- p.56 / Chapter 3.2.1 --- Self-administered Questionnaire --- p.56 / Chapter 3.2.2 --- Demographics --- p.57 / Chapter 3.2.3 --- Setting of Infection --- p.57 / Chapter 3.2.4 --- Partnership Pattern --- p.59 / Chapter 3.2.5 --- Semi-structured Interviewing Guide --- p.61 / Chapter 3.2.6 --- Last Sexual Episode --- p.62 / Chapter 3.2.7 --- Sexual Role --- p.63 / Chapter 3.2.8 --- Partner Selection --- p.63 / Chapter 3.2.9 --- Bem Sex-Role Inventory --- p.64 / Chapter 3.3 --- Data Analysis --- p.66 / Chapter 3.4 --- Ethical Considerations --- p.70 / Chapter 4 --- Results --- p.74 / Chapter 4.1 --- Sampling --- p.74 / Chapter 4.2 --- Characteristics of Respondents --- p.75 / Chapter 4.2.1 --- Demographics --- p.75 / Chapter 4.2.2 --- Settings of Infection --- p.77 / Chapter 4.2.3 --- HIV Test --- p.79 / Chapter 4.3 --- Partnership Pattern --- p.82 / Chapter 4.3.1 --- Partner Types --- p.83 / Chapter 4.3.2 --- Location for Partner Sourcing --- p.84 / Chapter 4.3.3 --- Characteristics of Sex Partners --- p.86 / Chapter 4.3.4 --- Sexual Behavioural Pattern --- p.87 / Chapter 4.3.5 --- The Influence of Partner Types --- p.92 / Chapter 4.3.6 --- Last Sex with Lover(s) and/or Regular Partner(s) --- p.95 / Chapter 4.3.7 --- Sexual Role in Anal Intercourse --- p.98 / Chapter 4.4 --- Networking Pattern --- p.103 / Chapter 4.4.1 --- Individual Network --- p.104 / Chapter 4.4.2 --- Cluster Analysis (with 2-mode correspondence analysis) --- p.108 / Chapter 4.4.3 --- Social Network Analysis --- p.115 / Chapter 5 --- Discussion --- p.122 / Chapter 5.1 --- Possible Existence of 2 Sexual Networks in Hong Kong --- p.123 / Chapter 5.1.1 --- Network Configuration --- p.123 / Chapter 5.1.2 --- Network-related Behaviours --- p.128 / Chapter 5.2 --- Impact of Partnership Pattern on HIV Transmission --- p.129 / Chapter 5.3 --- The Importance of Sexual Role --- p.135 / Chapter 5.4 --- Limitations --- p.136 / Chapter 5.5 --- Implications --- p.141 / Appendices --- p.145 / Chapter A --- Self-administered Questionnaire --- p.145 / Bibliography --- p.151

Thesis (MSc.(Clinical Psychology))--University of Limpopo, 2009. / HIV/AIDS is increasing at a fast rate. Increasing numbers of women worldwide are being infected with HIV, the virus that causes AIDS. Condoms, abstinence and faithfulness have been suggested to prevent the further spread of HIV infection. The present study adopted a qualitative approach to explore the views and attitudes of female church goers towards HIV/AIDS and its preventative measures. The results indicated that they view HIV/AIDS as a fatal disease which cannot be cured by medical means, and it is caused by unprotected sex when an individual engages in sexual intercourse with someone infected with HIV. They all know that condoms are an effective form of prevention. Despite all their knowledge, however, they feel powerless, unsafe, and hopeless regarding effective HIV control and prevention due to their partners’ resistance in respect of condom usage. Church ministers should be more sensitive to the inequalities that exist in marriages and should be careful in their preaching of submission and obedience of women towards men. Church ministers should present their sermons in a way that fosters equalities and the practice of safe sex. Finally, it is also recommended that the younger generation, both males and females should be educated about gender equality during their Sunday school and youth programmes. These programmes should include teachings about gender equality, practice of safe sex, faithfulness and abstinence. Should this be done effectively the new generation could hopefully operate from a different frame of reference as opposed to the current generation whose value systems and norms are outdated and discriminatory.

To obtain more complete mortality data following HIV and AIDS diagnosis in Australia, HIV/AIDS diagnoses between 1980 and 2003 were linked to the National Death Index. Based on 6900 known deaths, and 1455 known non-deaths, sensitivity and specificity of the linkage was estimated to be 82% and 92% respectively. Mortality rates were compared by calendar period, pre-ART (<1990), pre- and early-HAART (1990-1996) and late-HAART (1997-2003). Mortality following AIDS decreased from 590.2/1000 person years pre-ART to 77.4 during the late-HAART period. Mortality following HIV diagnosis prior to AIDS increased from 9.7 to 20.2/1000 person years. The total number living with diagnosed HIV infection in Australia was estimated to have increased from 7873 at the end of 1989 to 12828 in 2003. Risk factors for survival following HIV and AIDS diagnosis were assessed using Cox regression. Age >40 years and certain HIV exposure results were associated with poorer survival following HIV. Predictors of poorer survival following AIDS were age >40 years, females exposed to HIV through receipt of blood, CD4 count <20 and certain AIDS illnesses. Parametric models of survival following HIV and AIDS diagnosis were assessed using likelihood based criteria. Goodness of fit was assessed by comparing observed with model predicted numbers of deaths. Weibull models were found to fit best to both survival following HIV and AIDS. Parametric survival models were used to project deaths after HIV and AIDS across three scenarios of HAART usage. Deaths following HIV were projected to remain low, but to increase from 223 in 2005 to 288, 292 and 282 in 2010 if the HAART usage remains stable at 2005 levels, increases to 70% of all people with diagnosed HIV by 2010 and decreases to 39% of all people with diagnosed HIV respectively. Deaths after AIDS diagnosis were projected to increase unless if HAART usage increases to 100% of AIDS diagnoses by 2010.

"October, 2004" / Bibliography: leaves 118-154. / xii, 154 leaves : ill. (some col.), plates (col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, School of Molecular and Biomedical Sciences, Discipline of Microbiology and Immunology, 2005

Source: Dissertation Abstracts International, Volume: 70-03, Section: B, page: 1574. Adviser: Lu-Yu Hwang. Includes bibliographical references.

Thesis (M. Med. Sc.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 82-86).