International Journal of STD & AIDS

The primary aim of this study was to determine the frequency of prior herpes zoster and its associated clinical and immunovirological factors, while secondary aims included evaluating varicella-zoster virus serostatus and vaccination rates.

In this multicenter, retrospective, and partially observational study, data from 1,289 people living with HIV between January 2020 and December 2024 were analyzed. Attitudes toward vaccination were also examined.

A history of herpes zoster was identified in 5% of participants (n = 65). Individuals with an herpes zoster history were significantly older than those without (45.5 ± 13.1 vs 38.1 ± 12.9 years; p < 0.001). Herpes zoster history was strongly associated with advanced disease stage at diagnosis (p < 0.001), lower CD4 percentages (p = 0.020), reduced absolute CD4 counts (p < 0.001), and lower CD4/CD8 ratios (p = 0.006) in univariate analysis.Other factors significantly associated with herpes zoster history included prior viremia (p < 0.001), chronic lung disease (p = 0.006), syphilis (p = 0.016), hepatitis B virus coinfection (p < 0.001), malignancy (p < 0.001), and immunomodulatory drug use (p = 0.031). Lack of childhood varicella vaccination was also significantly associated with herpes zoster history (p = 0.003). In multivariable logistic regression analysis, lower CD4 count (aOR 0.992; p = 0.001), history of viremia (aOR 5.74; p = 0.004), malignancy (aOR 8.51; p = 0.007), and hepatitis B virus coinfection (aOR 23.56; p = 0.002) were independently associated with herpes zoster. herpes zoster-related pain was reported in 24 patients (36.9%) and was most frequently treated with non-steroidal anti-inflammatory drugs. Herpes zoster vaccination coverage was notably low, and willingness to be vaccinated remained similarly limited in both groups.

Herpes zoster history among people living with HIV was associated with older age, advanced immunosuppression, viremia, and comorbidities, particularly hepatitis B virus and syphilis. Despite the considerable burden of herpes zoster and its complications, vaccination rates remain low. These findings highlight the need to identify high-risk groups and implement targeted vaccination strategies to reduce herpes zoster-related morbidity among people living with HIV.

Local HIV testing policy is based on clinician assessment of risk factors and HIV indicator conditions, with patient consent required before testing. This project aimed to increase HIV testing among hospital inpatients with community-acquired pneumonia, reduce reliance on clinician judgement, and promote more equitable testing practices.

Adult hospital inpatients (aged ≥16 years) with community-acquired pneumonia discharged between July and November 2024 were included, irrespective of specialty, and assessed for evidence of HIV testing within the preceding 12 months. Weekly HIV testing rates were monitored throughout the project as a series of quality improvement measures were introduced. These included a hospital grand round presentation, safety briefing, targeted education, guideline updates, an electronic community-acquired pneumonia–HIV order set, and educational posters.

A total of 894 hospital inpatients with community-acquired pneumonia were included, of whom 148 (17%) were tested for HIV. Testing rates increased from 4% at baseline to 29% following successive interventions and rose by 3.6% per week over the study period (IRR 1.036, 95% CI 1.01–1.063; p = 0.005). Pathway-embedded interventions produced more sustained improvements than education alone. Male patients were more likely to undergo HIV testing than female patients (19.8% vs 13.0%; χ² (1) = 7.67, p = 0.006), with the greatest disparity observed among patients aged 50–69 years (35.3% vs 8.6%; χ² (1) = 21.7, p < 0.001). Testing rates also differed significantly by age group (p < 0.001), being highest among patients aged 30–49 years and lowest among those aged ≥70 years. All 148 HIV tests were negative.

HIV testing improved significantly following sequential interventions, with pathway-embedded system changes producing more sustainable improvements than education alone. Persistent age- and sex-related disparities suggest clinician risk perception continues to influence HIV testing practices. Low-prevalence settings should consider electronic testing pathways, automated prompts, and the feasibility of opt-out testing approaches.

Selective mass treatment of STIs may lead to a durable reduction in the prevalence of STIs or a temporary reduction associated with an increased probability of antimicrobial resistance emerging.

We searched PubMed and Google Scholar for studies evaluating the impact of mass STI treatment on the long-term prevalence of chlamydia, gonorrhoea, syphilis and chancroid. The primary outcomes were the long term (≥3 months post the intervention) impact of the intervention on prevalence/incidence of the STI and on antimicrobial resistance.

Our search yielded 269 studies, of which 4 met the inclusion criteria. With the exception of the Carletonville study, where this was not assessed, three of the four studies found that intensive STI treatment was associated with a reduced prevalence of the targeted STI during or immediately after the intervention. In all four studies, there was no evidence that the intense treatment had a long-term effect on prevalence. In the only study where this was assessed, the intensive use of penicillin to reduce gonococcal prevalence was associated with the emergence of reduced susceptibility to penicillin in N. gonorrhoeae.

The available evidence suggests that mass treatment of chlamydia, gonorrhoea and syphilis in high prevalence populations is only associated with a temporary reduction in the prevalence of these infections and may select for antimicrobial resistance.

Heterosexual contact is the primary mode of HIV transmission in China and commercial sex is thought to play a crucial role in China’s epidemic. Female sex workers (FSWs) in China tend to be either brothel-based (BSWs) or street-based (SSWs), but few studies have investigated the differences between these important segments of this difficult-to-reach, high-risk population. Our aim was to explore the differences between SSWs and BSWs in terms of socio-demographic characteristics, sexual and risky practices, HIV/STI-related knowledge, health services, HIV/STI prevalence and other aspects.

A cross-sectional survey was conducted in Yunnan Province of China in partnership with a local FSW-friendly non-governmental organization. Face-to-face interviews using a structured questionnaire were conducted to collect data on socio-demographic characteristics, sex work history, sexual behaviours, HIV/STI-related knowledge, HIV testing history, and healthcare services uptake. Blood samples were taken for HIV and syphilis testing, and urine samples for gonorrhea and chlamydia testing. Descriptive statistics were used to evaluate differences between SSWs and BSWs.

A total of 185 BSWs and 129 SSWs were included in the study. SSWs were older and less educated, had more dependents and more clients, lower condom use and accessed fewer healthcare services. Moreover, 37.2% of SSWs and 24.9% of BSWs were found to have HIV/STI infection. Unfortunately, the awareness related to STIs was relatively low in both groups, especially SSWs.

Our study provides evidence that confirms the disproportionately high vulnerability of SSWs to HIV and other STIs, underscoring the urgent need for the Chinese health and public health sectors to prioritize outreach to SSWs. Awareness and educational programs, condom distribution, testing and health check-ups should be included in a comprehensive strategy for HIV/STI prevention in this high-risk population.

South African women have the highest burden of HIV infections globally. We investigated the temporal trends and the impact of key factors associated with HIV diagnosis among a nationally representative cohort of South African women.

Total of 24,657 women who participated in the National HIV, Behaviour and Health Surveys conducted from 2002-to-2017.

Despite decades-long prevention efforts, we observed a significant increase in HIV prevalence over time (22% in 2002 to 21% in 2005-2008 and 29% in 2012-2017). Overall, 46% of the women living with HIV were not aware of their risk of HIV with age-specific disparities. Our findings revealed compelling evidence between HIV seropositivity and high HIV risk-perception (adjusted Odds Ratio (aOR):1.47 to 3.29) which increased overtime and exceeded the other factors. At a population-level, 45% of the HIV diagnoses were exclusively associated with women who believed they were at risk of HIV in 2012-2017. Women who reported using condoms at last sexual act were also at increased risk of HIV infection, with a population attributable risk of 18% (2002) to 21% (2012-2017).

There is an urgent need for culturally, socially, and linguistically appropriate prevention and awareness campaigns with realistic, non-confrontational messages.

This document was produced in accordance with the guidance set out in the BASHH CEG’s document ‘Framework for guideline development and assessment’ published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded.

Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for ‘Identification of problematic recreational drug and alcohol use’ section and ‘Sexual problems and dysfunctions in MSM’ section, searches included PsycINFO.

Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence.

The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication.

The guidelines will be reviewed and revised in five years’ time, 2022.