It is estimated that 50,000 individuals become newly infected with human immunodeficiency virus (HIV) every year in the United States. HIV is a lentivirus that is primarily spread through sexual contact. If left untreated, this viral infection can lead to decreased CD4+ T cells, increased susceptibility to opportunistic infections, and eventually progression to acquired immunodeficiency syndrome (AIDS) and death. HIV viral loads can be decreased to undetectable levels with the use of combination antiretroviral therapy (cART). In 2012 the Food and Drug Administration approved cART therapy, Truvada (tenofovir/emtricitabine), for safe use as pre-exposure prophylaxis (PrEP). When detectable levels of drug are present in the blood stream of patients, there is up to a 92% relative risk reduction in HIV infection compared to placebo. The implementation of PrEP has the potential to decrease the incidence of new HIV infections in at-risk populations worldwide. Because PrEP treatment is relatively new (2012), there are many barriers to administration to patients. Increased risky sexual behavior, known as risk compensation, is one of the concerns providers cite as a reason against prescribing PrEP. Most publications on PrEP have described randomized controlled trials that focused on safety, efficacy, and to a lesser extent, risk compensation behaviors. Now that Truvada is widely available, researchers are starting to elucidate patients’ sexual habits while using PrEP in the outpatient settings. However, there is a need for more longitudinal research regarding the behaviors of individuals using PrEP, specifically to determine how often risk compensation occurs and under what conditions. This study will initiate a PrEP clinic at Boston Medical Center and run a 3 year, open-label randomized controlled trial of eligible men who have sex with men (MSM) patients, who either start PrEP immediately or are delayed by one year. It is hypothesized that condom usage will decrease among immediate PrEP participants compared to the delayed participants. The study aims to determine if risk compensation occurs in these patients by following condom usage, development of sexually transmitted infections, number of sexual partners, and number/type of sexual encounter. Secondary outcomes will include measurements of medication adherence and number of HIV-seroconverters. These data will be collected through surveys and laboratory testing. The resulting information will help medical professionals better understand the risks and benefits of PrEP and also how to implement it most effectively in the fight to reduce the worldwide HIV burden.

Orientador: Cáris Maroni Nunes / Coorientador: Luzia Helena Queiroz / Banca: Adolorata Aparecida Bianco Carvalho / Banca: Rafael Silva Cipriano / Resumo: A raiva é uma zoonose globalmente distribuída que apresenta alta letalidade, constituindo grande problema em saúde pública. A persistência do vírus da raiva nas populações é mantida devido sua capacidade de se replicar em diversas espécies de mamíferos, incluindo os humanos. O controle da raiva urbana tem se baseado na vacinação de cães e gatos, reservatórios importantes no ciclo urbano, bem como no atendimento de indivíduos após exposição ao vírus da raiva. Adicionalmente, a profilaxia pré-exposição (PrPE) tem sido aplicada em indivíduos que podem ser expostos à infecção, por atividade ocupacional. Objetivando proteger os estudantes ingressantes do Curso de Medicina Veterinária, grupo de risco em potencial para a raiva, a Faculdade de Medicina Veterinária (FMVA) da Unesp, Câmpus Araçatuba, promove anualmente a vacinação em esquema PrPE, seguida de avaliação sorológica, a fim de habituá-los a anualmente verificarem a resposta de anticorpos. Assim, a presente pesquisa teve como objetivo avaliar, por meio de levantamento de dados de PrPE dos arquivos do Serviço de Vigilância Epidemiológica da Secretaria de Saúde da Prefeitura Municipal de Araçatuba, SP, Brasil a adesão à PrPE, a proteção conferida e a dinâmica dos anticorpos (IgG) neutralizantes contra o vírus da raiva, nos estudantes da FMVA durante o período de 2000 a 2017. Foram avaliados 2.404 registros, 86,4% dos quais apresentaram título protetor contra o vírus da raiva (≥0,5UI/mL). A PrPE teve boa adesão pelos estudantes... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Rabies is a globally distributed zoonosis that shows high lethality and is also a major public health problem. Persistence of rabies virus in populations is maintained due to its ability to replicate in several mammals species, including humans. Rabies control has been based on dogs and cats' vaccination, the most important reservoirs in the urban cycle, as well as on the treatment of individuals after exposure to the rabies virus. In addition, pre-exposure prophylaxis (PEPr) has been applied in individuals who might be exposed to infection due to their occupational activities. In order to protect the incoming students of the veterinary medicine course, a group of potential risk for rabies, the School of Veterinary Medicine (FMVA) of Unesp, Araçatuba, SP, Brazil, promotes annual vaccination in a PEPr scheme, followed by a serological evaluation, in order to habituate them to annually check their antibody response. Thus, by analyzing the PEPr data from the archives of the Epidemiological Surveillance Service of the Health Department of Araçatuba, SP, Brazil, during the period from 2000 to 2017, the present study aimed at evaluating the adhesion of the students to the rabies PEPr, the protection conferred by it and the dynamics of the neutralizing IgG antibodies against rabies virus. A total of 2,404 records were evaluated, 86.4% of which presented protective titers against rabies (≥0.5 IU/mL). PEPr had good adhesion by the students, has proved to be effective for generating an... (Complete abstract click electronic access below) / Mestre

This thesis is based on the use of mathematical theories, modelling, and simulations to study the transmission dynamics of HIV/AIDS in the presence of PrEP (pre-exposure prophylaxis) in the MSM (men who have sex with men) population in the United States. A new deterministic model for HIV/AIDS that incorporates PrEP is designed and used to assess the population-level impact of the use of PrEP on the transmission dynamics within an MSM population. Conditions for the effective control (or elimination) and persistence of HIV/AIDS in the MSM population are determined by rigorously analyzing this model. Uncertainty and sensitivity analysis is carried out to determine the effect of the uncertainties in the parameter values on the response variable (the associated reproduction number) and to identify the top-five parameters that have the most effect on the disease transmission dynamics. Numerical simulations show that HIV burden decreases with increasing PrEP coverage. / October 2015

BACKGROUND: Although the total number of new documented HIV diagnoses annually decreased from 2008-2018, the rate of decrease started to slow in 2013, and substantial variation exists across at-risk groups. People who inject drugs (PWID) account for 9% of new diagnoses annually, with increasing incidence in this population starting in 2015. Among PWID, 34% of new HIV diagnoses occurred in individuals who were also classified as men who have sex with men (MSM), indicating that MSM-PWID have elevated HIV risk. Data on MSM-PWID are scarce, and programmatic and advocacy efforts in HIV prevention do not specifically target MSM-PWID, with no CDC-recommended interventions existing for this population. OBJECTIVE: We sought to characterize the complex, intersecting and unique HIV risks faced by MSM-PWID, including perceptions of HIV risk and attitudes toward antiretroviral pre-exposure prophylaxis (PrEP) among MSM-PWID in urban and non-urban areas of Massachusetts and Rhode Island. METHODS: We recruited PWID through community-based organizations (CBOs; e.g. syringe service programs) in 18 urban centers and smaller cities and towns across Massachusetts and Rhode Island. Participants completed semi-structured interviews exploring substance use behaviors and HIV prevention needs. This in-depth analysis focused on describing the experiences and HIV prevention needs and attitudes of nine participants in the sample who reported a sexual orientation other than “heterosexual.” RESULTS: Most participants identified as cisgender, bisexual men. However, the context of their sexual behaviors varied, with some participants only engaging in same-sex behavior during sex work. The relationship between identity and behavior is explored in the context of reported risk behavior. All participants engaged in at least one behavior that increased risk of HIV acquisition, including syringe sharing, inconsistent condom use, and sex work. Participants also described heightened risk when these behaviors overlapped, particularly within contexts of “sex parties” that some individuals described. At the same time, experiences of isolation and exclusion were common in the sample, indicating a potential vulnerability in this population. HIV risk perception varied among participants, but was not consistently aligned with the behaviors described. Many participants did not perceive needing HIV prevention services “yet,” indicating that they did not view their risk to be high enough to warrant prevention services. Alternatively, some described needing to prioritize daily survival and mental health over HIV prevention efforts. Although knowledge of PrEP was low, acceptability of PrEP was high in this sample, and several participants provided specific suggestions for improving the feasibility of PrEP. CONCLUSION: Data from this study illustrate the HIV risks and prevention needs of this at-risk population and highlight mechanisms to engage them in preventative care. Our main findings are (1) participants had low knowledge of PrEP, but were largely enthusiastic after learning about it from interviewers, (2) varying identity related to same-sex behavior among men who have sex with men and inject drugs may play a role in shaping HIV risk and prevention needs, (3) specific healthcare and prevention service needs of this population emerged, including reducing risk at sex parties and improving access to non-stigmatizing mental health services. An in-depth understanding of the ways in which sexual orientation and gender identity shape HIV risk and prevention needs remains crucial in providing treatment and prevention services to MSM-PWID.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Pre-exposure prophylaxis (PrEP) has limited availability across Latin America, though access is increasing. We explored PrEP uptake in Mexico via an online survey completed by Spanish-speaking, Hornet geosocial networking application (GSN app) users without HIV (n = 2020). Most (81.3%) had heard of PrEP, 3.5% were current users, and 34.2% intended to take PrEP within six months. Current PrEP use was associated with PrEP eligibility (aOR 26.07 [95%CI 13.05–52.09], p < 0.001), recent STI testing (aOR 3.79 [95%CI 1.10–13.11], p = 0.035), and recent chemsex (aOR 3.02 [95%CI 1.02–8.93], p = 0.046). Recent STI testing was associated with hearing about PrEP from a doctor (aOR 3.26 [95%CI 1.98–5.36], p < 0.001), and those who lived in large cities were less likely to have learned about PrEP via Hornet (aOR 0.52 [95%CI 0.32–0.85], p = 0.009). Interventions to increase PrEP uptake in Mexico should build upon existing health networks and utilize GSN apps for PrEP information dissemination, particularly in less populated areas. / University of California / Revisión por pares

No description available.

Pre-exposure prophylaxis (PrEP) is an effective tool for preventing human immunodeficiency virus (HIV) acquisition in sexually active at-risk individuals such as men who have sex with men (MSM). The purpose of this study is to examine factors associated with intent to engage in risky sexual behavior among HIV-negative college aged (18-24) MSM who are currently adherent to PrEP or who have expressed interest in the future adoption of PrEP. A multiracial/ethnic sample of 31 men expressing interest in the adoption of PrEP and 6 men currently taking PrEP completed a quantitative survey identifying key themes regarding attitudes towards PrEP and potential behaviors associated with adherence. Themes associated with current adherence to PrEP included protection from HIV infection, the opportunity to engage in sexual activities with a non-condom HIV prevention method, and perceived protection from sexually transmitted infections. Themes associated with potential adoption of PrEP included protection from HIV infection, opportunity to engage in sexual activity with known HIV-positive partners, opportunity to engage in sexual activities with a non-condom HIV prevention method, and perceived protection from sexually transmitted infections. Review found that decreased condom use and increased sexual partners are key themes related to initiation of PrEP, and a decrease in frequency of condom use was indicated among the adherent sample. Other key themes identified include barriers to PrEP implementation and misinformation regarding sexually transmitted infections among the population.

This work examines the surprisingly negative reactions among gay men to the introduction of pre-exposure prophylaxis or PrEP. PrEP refers to a medical regimen where HIV negative people take a drug designed to treat HIV to prevent the transmission of HIV. PrEP has proven to be at least as effective as condoms in preventing HIV transmission (if not more so), but those who take PrEP and engage in more condomless sex (commonly referred to as barebacking) are still viewed by some as dangerous and immoral. Although some scholars have claimed that the negative reactions to PrEP comprise a sex panic (a type of moral panic), I argue that sex panics are those that occur among a general population and this panic is limited to gay men. Drawing on Cathy Cohen’s concept of indigenous panics (2009), I argue that the negative reactions to PrEP among gay men is an intracommunity panic, but not a sex panic among the general population. Given the centrality of the public sphere to moral panics, I support this claim with a qualitative content analysis of 76 mainstream news articles and 294 queer news articles that focus on PrEP or barebacking. I also conducted interviews with 43 gay men regarding their experiences with and attitudes towards PrEP and its users. I found that there was not a general sex panic due to the relative dearth of mainstream articles on PrEP along with its framing as a medical tool rather than a sexual one and the framing of PrEP controversy as an intracommunity issue relevant only to gay men. Queer media produced a similarly medical framing of PrEP which helped limit the extent of the panic. However, moral shocks that set off the panic came from and were targeted against gay men, and queer news media produced a plethora of articles repeating these claims, concerns over increased barebacking, and framings of bareback sex as inherently problematic. Interview data revealed some gay men who embraced the bareback pleasures made possible by PrEP, but others reified the demonization of barebacking, even while claiming they did not intend to do so or glossing over their own barebacking. I argue that the main ways in which this panic was perpetuated are more subtle than other panics in the literature and that this may make the panic harder to resist. I conclude by arguing that the US is on the verge of a widespread sex panic over PrEP and barebacking which could be particularly dangerous given the current vitriolic anti-queer climate.

A Profilaxia Pré-exposição ao HIV (PrEP) é uma nova estratégia de prevenção na qual os indivíduos consomem uma combinação de antirretrovirais diariamente para evitar a aquisição do vírus da AIDS. O objetivo deste estudo foi compreender, a partir da experiência dos usuários de PrEP, a produção do processo de individualização e saúde. Analisou-se o conteúdo de discussões de um grupo de usuários de PrEP, e de pessoas interessadas no assunto, numa rede social virtual com predominância de gays, bissexuais e outros homens que fazem sexo com homens. Os resultados e discussão foram distribuídos em três artigos científicos: o primeiro, discute os conflitos da experiência dos usuários no contexto da sociedade do risco e da individualização. O segundo explora a produção das dimensões do desejo e do prazer sexual - mediados pela PrEP - na vida dos indivíduos. O terceiro, aproxima e discute a experiência dos usuários de PrEP com processos identitários autoproduzidos na individualização contemporânea. As considerações finais, por fim, refletem sobre as implicações às repostas sociais e políticas à epidemia de HIV/AIDS no atual contexto de quimioprofilaxias. / HIV Pre-exposure Prophylaxis (PrEP) is a new prevention strategy in which individuals take a daily combination of antiretrovirals in order to prevent acquiring HIV. This study aimed to understand, grounded in PrEP users\' experiences, the production of the individualization process and health. We conducted a discussion-content-analysis of PrEP users, and of interested persons on the subject, in a digital social network. Gays, bisexuals and other Men who have sex with Men accounted for the majority of the group members. Results and discussion were presented in three scientific articles: the first discusses conflicts from the experience of PrEP users in the context of risk society and individualization. The second explores productions of sexual desire and sexual pleasure - mediated by PrEP - on individuals\' lives. The third approaches and discusses PrEP users experiences and self-produced identity processes in contemporary individualization. Final remarks reflects on the implications for social and political responses to the HIV / AIDS epidemic given the current context of chemoprophylaxis.

A Profilaxia Pré-exposição ao HIV (PrEP) é uma nova estratégia de prevenção na qual os indivíduos consomem uma combinação de antirretrovirais diariamente para evitar a aquisição do vírus da AIDS. O objetivo deste estudo foi compreender, a partir da experiência dos usuários de PrEP, a produção do processo de individualização e saúde. Analisou-se o conteúdo de discussões de um grupo de usuários de PrEP, e de pessoas interessadas no assunto, numa rede social virtual com predominância de gays, bissexuais e outros homens que fazem sexo com homens. Os resultados e discussão foram distribuídos em três artigos científicos: o primeiro, discute os conflitos da experiência dos usuários no contexto da sociedade do risco e da individualização. O segundo explora a produção das dimensões do desejo e do prazer sexual - mediados pela PrEP - na vida dos indivíduos. O terceiro, aproxima e discute a experiência dos usuários de PrEP com processos identitários autoproduzidos na individualização contemporânea. As considerações finais, por fim, refletem sobre as implicações às repostas sociais e políticas à epidemia de HIV/AIDS no atual contexto de quimioprofilaxias. / HIV Pre-exposure Prophylaxis (PrEP) is a new prevention strategy in which individuals take a daily combination of antiretrovirals in order to prevent acquiring HIV. This study aimed to understand, grounded in PrEP users\' experiences, the production of the individualization process and health. We conducted a discussion-content-analysis of PrEP users, and of interested persons on the subject, in a digital social network. Gays, bisexuals and other Men who have sex with Men accounted for the majority of the group members. Results and discussion were presented in three scientific articles: the first discusses conflicts from the experience of PrEP users in the context of risk society and individualization. The second explores productions of sexual desire and sexual pleasure - mediated by PrEP - on individuals\' lives. The third approaches and discusses PrEP users experiences and self-produced identity processes in contemporary individualization. Final remarks reflects on the implications for social and political responses to the HIV / AIDS epidemic given the current context of chemoprophylaxis.