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- A Rede de Rastreio Comunitária: resultadosPublication . Simões, Daniel; Freitas, Rosa; Mendão, Luís; Rocha, Miguel; Paula Meireles; Ana Aguiar; Raquel Lucas; et al.
- Risk of HIV infection in a cohort of men who have sex with men attending CheckpointLX in Lisbon, PortugalPublication . P. Meireles; C. Moreira; Rocha, Miguel; Brito, João; Mendão, Luís; H. Barros; Paula Meireles; et al.
- HIV testing among Portuguese men who have sex with men – results from the European MSM Internet Survey (EMIS)Publication . Carvalho, C; Fuertes, Ricardo; Lucas, R; Martins, A; Campos, MJ; Mendão, Luís; Schmidt, AJ; Barros, HObjectives To describe HIV testing behaviour and context of MSM in Portugal participating in the European MSM Internet Survey (EMIS). Methods Data for the Portuguese sample were extracted and those for 5187 participants were analysed. Multivariate logistic regression models were fitted to quantify the association between participants' characteristics and HIV testing behaviour and context. Results Seventy-two percent of the participants had ever been tested for HIV and among those ever tested, 11% were diagnosed with HIV. Primary care was the most common testing setting for HIV-negative men (37%). Compared to those never tested, men who had ever taken an HIV test had higher educational level (aOR 1.89, 95% CI 1.67-2.14) and identified themselves as gay/homosexual more frequently (aOR 1.94 , 95% CI 1.70-2.20). HIV testing odds significantly increased with the number of sexual partners in the previous 12 months. Those who reported unprotected anal intercourse (UAI) with a partner of unknown or serodiscordant HIV status in the previous 12 months were less likely to report an HIV test (aOR 0.38, 95% CI 0.33–0.44). Among those never tested or who tested negative, 41% and 22% reported UAI with a partner of unknown or serodiscordant status in the previous 12 months, respectively. Among men with diagnosed HIV, 72% were currently on antiretroviral therapy and 58% reported an undetectable viral load. More than one third (38%) of those who had detectable or unknown/undisclosed viral load reported at least one episode of UAI with a partner of unknown or serodiscordant HIV status in the last 12 months. Conclusions Actual interventions should focus on: improving testing uptake and counselling; increasing treatment coverage; achieving and maintaining an undetectable viral load; and intensifying prevention efforts focused on consistent condom use.
- The Lisbon Cohort of men who have sex with menPublication . Meireles, Paula; Lucas, Raquel; Martins, Ana; Carvalho, Ana Cláudia; Fuertes, Ricardo; Brito, João; Campos, Maria José; Mendão, Luís; Barros, HenriquePurpose Newly diagnosed HIV infections among men who have sex with men (MSM) are rising in many European countries. Surveillance tools must be tailored to the current state of the epidemic, and include decentralised prospective monitoring of HIV incidence and behavioural changes in key populations. In this scenario, an open prospective cohort study was assembled—The Lisbon Cohort of MSM—aiming to dynamically monitor the frequency of disease and its predictors. Participants The Lisbon Cohort of MSM is an ongoing observational prospective study conducted at a community-based voluntary HIV counselling and testing centre in Lisbon, Portugal (CheckpointLX). Men testing negative for HIV, aged 18 or over and reporting having had sex with men are invited to follow-up visits every 6 months. At each evaluation, a face-to-face interview using a structured questionnaire is conducted, and HIV and syphilis rapid tests are performed by trained peer counsellors. From April 2011 to February 2014, 3106 MSM were eligible to the cohort of whom 923 (29.7%) did not participate. The remaining 2183 (70.3%) MSM were enrolled and 804 had at least one follow-up evaluation, for a total of 893 person-years of observation. Future plans The study findings will be disseminated in peer-reviewed journals and presented at national and international conferences. The follow-up of this cohort of HIV-negative MSM will be a valuable tool for monitoring HIV incidence in a setting where limited prospective information existed. Moreover, it will allow for a deeper analytical approach to the study of population time trends and individual changes in risk factors that currently shape the HIV epidemic among MSM.
- Incident risk factors as predictors of HIV seroconversion in the Lisbon cohort of men who have sex with men: first results, 2011–2014Publication . Meireles, P; Lucas, R; Carvalho, C; Fuertes, Ricardo; Brito, J; Campos, M J; Mendão, Luís; Barros, HHIV incidence in men who have sex with men (MSM) is increasing in western countries, including Portugal. We aimed to estimate HIV incidence and to assess how individual short-term changes in exposures over time predict seroconversion. We evaluated participants of an open cohort of HIV-negative MSM enrolled after testing at a community-based voluntary HIV counselling and testing centre in Lisbon. At each evaluation a structured questionnaire was completed and HIV status was ascertained using rapid followed by confirmatory testing. Between April 2011 and February 2014, 804 MSM were followed for a total of 893 person-years. Predictors of HIV seroconversion were identified using Poisson generalised linear regression. The overall seroincidence was 2.80/100 person-years (95% confidence interval: 1.89–4.14). Men who seroconverted had a higher mean number of tests per year. Seroconversions were significantly associated with partner disclosure of HIV status during follow-up, newly-adopted unprotected anal intercourse (UAI) with a steady partner and being newly-diagnosed with syphilis during follow-up. Likewise, sexual intercourse with HIV-positive men, having an HIV-positive steady partner at least once during follow-up and persistent UAI with occasional partners were predictors of seroconversion. High HIV incidence in this cohort is likely driven by short-term contextual and behavioural changes during follow-up.
- Risk-taking behaviours and HIV infection among sex workers in Portugal: results from a cross-sectional surveyPublication . Dias, Sónia; Gama, Ana; Fuertes, Ricardo; Mendão, Luís; Barros, HenriqueObjectives Sex workers (SW) are key populations at an increased risk of HIV infection. This study aimed to characterise risk-taking behaviours and assess HIV prevalence among SW in Portugal. Methods A cross-sectional survey was conducted with 1040 SW using a participatory research approach. SW were recruited in sex-work locations and community-based organisation offices. Data were collected through a questionnaire with trained interviewers. An HIV rapid test was performed in 213 respondents. Results Reported HIV prevalence was 8%: 17.6% of man-to-woman transgenders, 7.4% of women and 5% of men. Of SW reportedly living with HIV, 52.2% reported ever injecting drug use. Inconsistent condom use with clients in the last month was higher among male SW (26.5%) and with non-paying partners in the last year was higher among women (71.3%). Among reported HIV-positive SW, the proportions of inconsistent condom use were high. In multivariate regression analysis, reported HIV infection remained significantly higher among transgenders (OR 6.4; 95% CI 1.7 to 24.3), those older (OR 5.1; 95% CI 1.3 to 21.1), working outdoors (OR 5.4; 95% CI 1.9 to 15.6), having ever used psychoactive substances (OR 4.1; 95% CI 2.2 to 7.7) and earning ≤€1000 per month (OR 2.6; 95% CI 1.2 to 5.9). Of those who had an HIV rapid test, 8.9% were reactive; 73.7% were unaware of their seropositivity. Conclusions The HIV infection burden in SW is high. Efforts to promote HIV testing must be sustained in order to reduce undiagnosed infection. The diverse risk profiles of SW must be addressed in targeted HIV interventions. Prevention interventions should be systematically implemented within most-at-risk subgroups of SW.
- Cruising Venues as a Context for HIV Risky Behavior Among Men Who Have Sex With MenPublication . Gama, Ana; Abecasis, Ana; Pingarilho, Marta; Mendão, Luís; Martins, Maria O.; Barros, Henrique; Dias, SóniaWe examined differences in sexual risk behaviors, HIV prevalence, and demographic characteristics between men who have sex with men (MSM) who visit different types of venues to meet sexual partners, and identified correlates of high-risk behaviors. A cross-sectional behavioral survey was conducted with a venue-based sample of 1011 MSM in Portugal. Overall, 36.3 % of MSM usually visit cruising venues to meet sexual partners (63.7 % only visit social gay venues). Cruising venues' visitors reported higher HIV prevalence (14.6 % [95 % CI 11-18 %] vs. 5.5 % [95 % CI 4-7 %]). Visiting cruising venues was more likely among those older, reporting high number of male sexual partners, group sex, and unprotected anal sex with a partner whose HIV status was unknown. Cruising venues play an important role in increasing risk of HIV transmission among MSM who frequent them. Venue-focused behavioral interventions that promote healthy sexual behaviors are needed.
- Health Services Use and HIV Prevalence Among Migrant and National Female Sex Workers in Portugal: Are We Providing the Services Needed?Publication . Dias, Sónia; Gama, Ana; Pingarilho, Marta; Simões, Daniel; Mendão, LuísThis cross-sectional bio-behavioral survey conducted with 853 female sex workers (FSW) aimed to examine differences in use of HIV health services, testing and prevalence among migrant and national FSW. A quarter of undocumented FSW had never used National Health Service (NHS) and 15 % never tested for HIV, significantly more than nationals (p < 0.001 and p = 0.024, respectively). HIV infection was self-reported by 11.9 % of nationals, 1.8 % of documented and 0.8 % of undocumented migrants (p < 0.001). The HIV rapid test was reactive in 13.6 % of undocumented, 8.0 % of nationals and 2.3 % of documented. A higher proportion of migrants were unaware of their positive serostatus compared to nationals. Ever had HIV testing was less likely among undocumented, who never used the NHS and who didn't know where to go if suspected being HIV-infected. Promoting early diagnosis with linkage to care among migrant FSW should be supported, while developing health services better tailored to their needs.
- Acceptability of PrEP among HIV negative Portuguese men who have sex with men that attended 2014 Lisbon pride fairPublication . Rocha, Miguel; José Campos, Maria; Brito, João; Fuertes, Ricardo; Rojas, Jesus; Pinto, Nuno; Mendão, Luís; Esteves, Julio
- Implementation Process and Impacts of a Participatory HIV Research Project with Key PopulationsPublication . Dias, Sónia; Gama, Ana; Simões, Daniel; Mendão, LuísA participatory HIV research project was conducted with sex workers (SW) and men who have sex with men (MSM) to understand epidemiological HIV dynamics and associated sociobehavioural factors among these vulnerable groups. We examine the impact of this project, critically analysing the processes undertaken and focusing on the advantages and the challenges faced. A partnership was built through two Community Advisory Boards (CABs) and a Scientific Commission (SC). Regular meetings, workshops, and focus groups were conducted with CABs, SC, and partners to assess the processes and outcomes of the project implementation. This participatory research produced change processes with impacts at different levels: individuals, community organizations, health professionals, academics, and policy-makers. Advantages of the participatory process were encountered but also challenges, evidencing the dynamic and complex nature of each project's stage. This project showed that participatory research can work as an intervention. Indeed, it triggered a dynamic and interactive process of knowledge coproduction and translation into effective community-oriented health actions and policies. The participatory research reproduced an innovative alliance for HIV prevention and sexual health promotion responsive to local needs and priorities. Further efforts are needed to systematize and evaluate the processes and impacts of participatory health research.