Studies performed in high-HIV prevalence countries showed a strong epidemiological association be... more Studies performed in high-HIV prevalence countries showed a strong epidemiological association between male circumcision (MC) and the prevention of HIV transmission. We estimated the potential impact of MC on the general heterosexual population in low-HIV prevalence countries. Cross-national comparisons, including data on newly diagnosed HIV cases among heterosexuals living in Israel (where almost all males undergo MC), to similar data from the Netherlands and France (where <10 % of males are circumcised) were performed. National data from HIV registers and Bureaus of Statistics for the period of 2004-2010, global rates, rates by sex, age, and year of HIV-diagnosis were compared. MC and potential biases were examined. Annual rates of new HIV diagnoses per 100,000 were significantly lower in Israel compared to the Netherlands and France (for men: 0.26-0.70, 1.91-2.28, and 2.69-3.47, respectively; for women: 0.10-0.34, 1.10-2.10 and 2.41-3.08, respectively). Similarly, HIV-rates were much lower in Israel when comparing by age groups. Although Gross National Income per capita in 2010 was lower in Israel compared to the Netherlands and France, access to HIV testing and treatment were not different between countries. Also, the number of sexual-partners and condom-use in the general population showed a high similarity between the countries. The lower rate of HIV among heterosexuals in Israel compared to the Netherlands and France might be explained by MC routinely practiced in Israel, since other parameters of influence on HIV transmission were rather similar between the countries. However, recommendation for systematic MC in low HIV prevalence countries requires further investigations.
The worldwide pandemic of human immunodeficiency virus (HIV) casts its shadow on childbirth, espe... more The worldwide pandemic of human immunodeficiency virus (HIV) casts its shadow on childbirth, especially in developing countries, where the estimated rate of vertical transmission is 15%-40%, compared with 15%-25% in developed countries. To date, a total number of 90 children younger than 12 years of age are infected with the virus in Israel, and during the years 2001-2003, an average of 29 mothers living with AIDS gave birth annually. Mother-to-child transmission (MTCT) of HIV can occur during pregnancy, in the intrapartum period or postnatally, through breastfeeding. One third of all the breastfed newborn acquire the infection postnatally. HIV can penetrate through the damaged gastrointestinal mucosa into the newborn blood system. Risk increases during gastrointestinal infections and oral skin lesions. MTCT rate is 3.2 to 100 child years, especially if the mother is infected just before or after labor. Antiretroviral therapy during pregnancy and labor, and throughout the first 6 we...
A survey of winter morbidity revealed a high incidence of childhood influenza. A clinical, virolo... more A survey of winter morbidity revealed a high incidence of childhood influenza. A clinical, virologic and economic survey of childhood influenza morbidity was conducted to characterize this morbidity. Incidence of respiratory disease and influenza-like symptoms was determined among 9,300 children in the Tel Aviv area in the 1997-8 influenza season, and viral cultures performed from nasal swabs. A telephone survey was conducted among the patients' families to determine the family dynamics of the illness and the number of working days lost. Among the study population, 38% had influenza-like symptoms. The highest incidence was among kindergarten and school-age children. Upper respiratory tract infections (URTI) were common in the 0-2 years age group (27.4%). In contrast, 83% of children with influenza-like illness (ILI) were aged 3-15 years (p < 0.01). Of 180 valid viral culture samples, 93 (51%) were positive for influenza, which represents 22% of all children surveyed. Extrapolation to a national level reveals that of approximately two million children in the country, 440,000 would have positive laboratory evidence of influenza infection. In 49 of 52 (90%) families surveyed, the child was the initial patient in the household, and, on average, 66% of family members became ill. The average income lost was NIS 300 per family; at a national level that extrapolates to a loss of NIS 132 million. Influenza-like illness is common among children, particularly in the peak period of influenza activity. As opposed to upper respiratory infections, influenza-like disease is particularly common in the 3-15 year age group (kindergarten and school age). The incidence of children diagnosed with influenza (22%) is much higher than in the general population. Children are the first in the family to become ill and infect other family members. Cost-effectiveness analysis justifies mass childhood influenza immunization.
HIV in Israel started with a subtype-B epidemic among men who have sex with men, followed in the ... more HIV in Israel started with a subtype-B epidemic among men who have sex with men, followed in the 1980s and 1990s by introductions of subtype C from Ethiopia (predominantly acquired by heterosexual transmission) and subtype A from the former Soviet Union (FSU, most often acquired by intravenous drug use). The epidemic matured over the last 15 years without additional large influx of exogenous infections. Between 2005 and 2013 the number of infected men who have sex with men (MSM) increased 2.9-fold, compared to 1.6-fold and 1.3-fold for intravenous drug users (IVDU) and Ethiopian-origin residents. Understanding contemporary spread is essential for effective public health planning. We analyzed demographic and virologic data from 1,427 HIV-infected individuals diagnosed with HIV-I during 1998-2012. HIV phylogenies were reconstructed with maximum-likelihood and Bayesian methods. Subtype-B viruses, but not A or C, demonstrated a striking number of large clusters with common ancestors having posterior probability ≥0.95, including some suggesting presence of transmission networks. Transmitted drug resistance was highest in subtype B (13%). MSM represented a frequent risk factor in cross-ethnic transmission, demonstrated by the presence of Israeli-born with non-B virus infections and FSU immigrants with non-A subtypes. Reconstructed phylogenetic trees demonstrated substantial grouping in subtype B, but not in non-MSM subtype-A or in subtype-C, reflecting differences in transmission dynamics linked to HIV transmission categories. Cross-ethnic spread occurred through multiple independent introductions, with MSM playing a prevalent role in the transmission of the virus. Such data provide a baseline to track epidemic trends and will be useful in informing and quantifying efforts to reduce HIV transmission.
In Israel, as in other industrialized countries, the age of sexual debut among adolescents has de... more In Israel, as in other industrialized countries, the age of sexual debut among adolescents has declined, and the rate of sexually transmitted infections (STI) has risen, but the motivations and attitudes of Israeli adolescents toward carrying condoms have yet to be studied. The aims of this study were to establish the associations (if any) between demographic characteristics and the knowledge held by Jewish Israeli adolescents about HIV transmission, their attitudes toward condom use and sexual experience, and to explore their recommendations to increase condom use. The method used was an analysis of sexual experience and practices, attitudes toward condom carrying and condom use among a national representative sample of Jewish adolescents aged 15-18. Two dichotomized measures were assessed: (i) sexual experience (defined as having had previous consensual oral/vaginal/anal sex); and (ii) the practice of carrying a condom on a regular basis. Of all 410 participants, 14.6% carried condoms, 18.3% had sexual experience, and 70.7% of those used condoms. Those who thought condoms to be protective against HIV, and those who thought they are difficult to wear, were more likely to have sexual experience. The perception of condom use as important, and the perception that condoms are difficult to wear, were predictors of condom carrying. The participants' knowledge of the risk of HIV in vaginal intercourse was deficient. Participants did not consider school sex education to be effective in promoting condom use, and recommended the use of graphic, deterrent personal accounts told by youths to encourage wider use of condoms. Health educators should consider the barriers cited by adolescents and the deterrent techniques they recommend when planning interventions to encourage condom use. Shilo G and Mor Z. Sexual activity and condom use among Israeli adolescents. J Sex Med **;**:**-**.
This study aimed to assess HIV/AIDS point-prevalence among inmates and evaluate costs related to ... more This study aimed to assess HIV/AIDS point-prevalence among inmates and evaluate costs related to universal screening as currently practiced and appraise its necessity. All inmates newly incarcerated in Israel (2003-2010) underwent HIV tests and their medical files were cross-matched the with the national HIV/AIDS registry to who had been newly infected and detected on prison entry. They were classified by key risk-groups. Of 108 866 new inmates during the period, 215 (0.2 per cent) were diagnosed with HIV/AIDS, 44 of those (0.04 per cent) were not aware of their infection. A large majority (94.2 per cent) of the infected inmates were members of a key-risk group: drug-users, homosexuals, or originating from a high-HIV prevalence country. The direct cost of detecting a single HIV-infected inmate who was not previously recorded was [euro ]12 386. The HIV/AIDS-screening process can be improved by interviewing the new inmates and performing targeted HIV-testing for those who are members ...
The worldwide pandemic of human immunodeficiency virus (HIV) casts its shadow on childbirth, espe... more The worldwide pandemic of human immunodeficiency virus (HIV) casts its shadow on childbirth, especially in developing countries, where the estimated rate of vertical transmission is 15%-40%, compared with 15%-25% in developed countries. To date, a total number of 90 children younger than 12 years of age are infected with the virus in Israel, and during the years 2001-2003, an average of 29 mothers living with AIDS gave birth annually. Mother-to-child transmission (MTCT) of HIV can occur during pregnancy, in the intrapartum period or postnatally, through breastfeeding. One third of all the breastfed newborn acquire the infection postnatally. HIV can penetrate through the damaged gastrointestinal mucosa into the newborn blood system. Risk increases during gastrointestinal infections and oral skin lesions. MTCT rate is 3.2 to 100 child years, especially if the mother is infected just before or after labor. Antiretroviral therapy during pregnancy and labor, and throughout the first 6 we...
Fear of AIDS exceeds by far the apprehension concerning any other disease: it is mostly irrationa... more Fear of AIDS exceeds by far the apprehension concerning any other disease: it is mostly irrational, and is driven by a distorted perception of the disease as well as the stigmatization of patients. A major question faced by healthcare systems worldwide concerns the relation between the patients' responsibility to prevent spreading of the virus and the responsibility of the healthcare authorities on this matter. Early HIV detection and treatment, together with proper patients' education, reduce the odds of further infections. Therefore, HIV patients who choose to refrain from partner notification present a significant challenge to the medical staff, as they may rely on human rights and patients' rights principles. This paper deals with dilemmas concerning nonconsensual HIV reporting. The authors advocate a distinction between two types of sexual relationships: whereas in casual relations, both partners share (non-equivalent) responsibility for their safety, in a monogamou...
Background With the increased use of the Internet to seek sex, research has documented its associ... more Background With the increased use of the Internet to seek sex, research has documented its associated sexual risk behaviours, especially among gay and bisexual men. Only a few studies to date have been conducted among adolescent and young men, and these have focussed on behavioural components to do with seeking sex online, without considering the role of same-sex identity formation processes. The current study aimed to identify behavioural and identity formation variables associated with seeking sex online among adolescents and youth. Methods: A web sampling of young Israeli gay and bisexual men aged 12-30 years (n=445) was used to assess their seeking sex online characteristics, mental health, sexual risk behaviours, substance use, same-sex disclosure and acceptance and coping resources. Results: Nearly half of the sample used the Internet to seek sex, which was correlated with substance use and sexual risk behaviour. Young adults seek for sex online more commonly than adolescents....
The Israel Medical Association journal : IMAJ, 2015
Since 2006 more than 60,000 migrants arrived in Israel from the Horn of Africa (HoA: Sudan, Eritr... more Since 2006 more than 60,000 migrants arrived in Israel from the Horn of Africa (HoA: Sudan, Eritrea, Ethiopia). They were detained in prison and screened for tuberculosis (TB) by means of an interview and chest X-ray (CXR). To evaluate the yield of this screening process. This cross-sectional study evaluated the validity of CXR in a random sample of 1087 of the 5335 HoA migrants (20.4%) who arrived in 2009, and assessed its related costs. Sixty-two migrants (5.7%) had CXRs with TB-suspicious findings, and 11 of them were finally diagnosed with TB (17.7% of all TB-suspicious CXRs). TB point-prevalence was 1000 cases per 100,000 migrants (1.0%). As no additional TB cases were diagnosed on arrival, CXR sensitivity, specificity and positive predictive value were 100%, 96.1% and 17.7%, respectively. The interview did not contribute to the detection of migrants with TB. Direct costs related to the detection of single TB cases in prison was 17,970 shekels (US$ 4585), lower than the treatin...
Drawing on resilience theories, this study examined the individual and community factors of Israe... more Drawing on resilience theories, this study examined the individual and community factors of Israeli lesbians, gays, bisexuals, queers, and questioning (LGBQs) that contribute to positive mental health and the degree to which individual and community protective factors mitigate the adverse effect of risk factors for poor mental health. Differences in resilience factors between LGBQ youth and adults were explored. Data were collected on 890 LGBQ youth and adults. Findings emphasize the role of community-level resilience factors in the lives of LGBQs, and that these support systems differ slightly between the two age groups. Among youth, family support was both a strong predictor for well-being and a protective factor for mental distress. Although family support was found as a resilience factor among adults as well, other community-level factors (friends' support, LGBT connectedness and having steady partner) were found as protective factors for poorer mental health. These findings...
Lifestyle may be associated with risk behaviours. This study compares gym exercise and sexual ris... more Lifestyle may be associated with risk behaviours. This study compares gym exercise and sexual risk behaviour between men who have sex with men (MSM) and heterosexual men. The research was based on the assumption that men who become muscular and physically attractive increase their number of sex partners and consequently their risk of HIV or other sexually transmitted infections (STIs). Five gyms in central Tel Aviv, Israel. In 2012, a sample of 182 (48%) MSM and 197 (52%) heterosexual men who train in gyms completed anonymous questionnaires regarding their training, health and sexual behaviours. Participants in this cross-sectional study who exercised more than the median number of anaerobic training hours were defined as performing intensive anaerobic training (IAT), and those who had performed more than one act of unprotected anal/vaginal intercourse in the preceding 6 months with a partner whose HIV status was unknown were defined as high risk. MSM showed a stronger desire to bec...
Research relating to minority stressors generally explores mental health outcomes, with limited f... more Research relating to minority stressors generally explores mental health outcomes, with limited focus on the physical dimension. In addition, minority stress research is conducted mainly in Christian-oriented societies. To address these pitfalls we used Web sampling targeting Israeli participants ages 12 to 30 (N = 952; 28 percent heterosexuals, 78 percent lesbian, gay, and bisexual [LGB] adolescents and young adults) to assess their mental health, physical and sexual risk behaviors, minority stressors, and coping resources. Results indicate that young LGBs had lower levels of mental and physical health than heterosexuals. Among LGB participants, high levels of minority stressors and low levels of coping resources predicted lower levels of mental health, and lower levels of mental health predicted lower levels of physical health. These results emphasize that minority stressors should be recognized as risk factors for poorer mental health, as well as for physical and sexual risk beha...
HIV-testing in Israel for pregnant women (PW) is selective since the year 1998 and recommended if... more HIV-testing in Israel for pregnant women (PW) is selective since the year 1998 and recommended if they or their sex partners (SP] are at high-risk for HIV-infection. HIV-infected PW, citizens and non-citizens alike, are eligible for free HIV-care and treatment. This study describes the current recommendations and HIV epidemiology in Israel. A retrospective study was conducted describing risk groups of HIV-infected PW between the years 1985 and 2010. The source of the data was the National HIV registry. During 25 years of follow-up, 204 vertically HIV-infected children were reported to the Ministry of Health (MoH). Of those, 87 (42.4%) were born in Israel to 83 PW, and the others were born overseas. Of these 87 children, 35 (40.2%) were born to 33 PWwho were unaware of their HIV-infection prior to Labor (31 citizens and 2 non-citizens). Of those, 22 (66.7%) were born in high-prevalence countries, eight (24.3%) were infected from their heterosexual SP, one (3%) used drugs intravenousl...
The HIV/AIDS burden in Israel is increasing. This study aims to describe the nationwide-HIV epide... more The HIV/AIDS burden in Israel is increasing. This study aims to describe the nationwide-HIV epidemiology in the last 30 years and highlight areas of concern in HIV/AIDS control. Descriptive study. The National HIV/AIDS Registry in Israel. All individuals who were reported with HIV/AIDS in Israel. Classification of HIV/AIDS cases by risk groups, calculation of annual trend analysis and estimation of HIV transmission rates by dividing the annual HIV/AIDS-incidence by the prevalence, while the number of newly diagnosed HIV/AIDS cases reported was a proxy of the incidence. From 1981 to 2010, 6579 HIV/AIDS cases were reported in an upward trend from 3.6 new HIV diagnoses/100 000 population in 1986 to 5.6 in 2010. Immigrants from countries of generalised epidemic (ICGE) comprised 2717 (41.3%) of all cases: 2089 (76.9%) were Israeli citizens and 628 (23%) were non-Israeli citizens, mostly migrant workers. The majority (N=2040) of ICGE Israeli citizens were born in Ethiopia. Only 796 (12.1%...
The Israel Medical Association journal : IMAJ, 2012
The increase in human immunodeficiency virus (HIV) among men who have sex with men (MSM) in Israe... more The increase in human immunodeficiency virus (HIV) among men who have sex with men (MSM) in Israel during the last decade raises concerns regarding other sexuallytransmitted diseases (STD) in MSM, which are yet undetermined. To evaluate the STD burden among MSM and heterosexuals visiting the Tel Aviv walk-in STD clinic. Records of all male patients who attended the clinic once were reviewed to identify demographic characteristics, behavioral attributes, and test results. Between 2002 and 2008, 1064 MSM (22%) and 3755 heterosexuals (78%) visited the clinic once. Positivity rates in MSM for HIV, urethral Neisseria gonorrhoea and infectious syphilis were higher than in heterosexuals (2.5%, 2.5%. 0.7% vs. 0.6%, 1.3%, 0.3%, respectively), while urethral Chlamydia trachomatis was higher in heterosexuals than in MSM (2.7% and 1.4%, respectively). MSM tested in our clinic were younger than heterosexuals (P<0.001), more commonly circumcised (P=0.03) and Israeli-born (P<0.001), used sub...
Israel has absorbed labor migrants (LM), mostly originating from developing countries endemic for... more Israel has absorbed labor migrants (LM), mostly originating from developing countries endemic for tuberculosis and AIDS. This trend has increased in the last 4 years, and included LM from the horn of Arica. Public opinion towards LM is ambivalent and is based on incomplete data and prejudice. Those who support LM deportation emphasize the burden of infectious diseases (ID) and raise concerns regarding possible exposure of Israeli citizens. This article will elucidate the process of data monitoring and the risk of ID transmission to the citizens of the hosting country. Of all individuals infected with tuberculosis and AIDS in Israel, 13% and 17% respectively are LM. LM are screened prior to arrival or upon incarceration in Israel Female LM are advised to perform an HIV test during their pregnancy. As a consequence of the active screening, more LM are diagnosed than Israelis, who are not routinely tested. The risk of ID transmission to the citizens of the hosting country is Limited, a...
Studies performed in high-HIV prevalence countries showed a strong epidemiological association be... more Studies performed in high-HIV prevalence countries showed a strong epidemiological association between male circumcision (MC) and the prevention of HIV transmission. We estimated the potential impact of MC on the general heterosexual population in low-HIV prevalence countries. Cross-national comparisons, including data on newly diagnosed HIV cases among heterosexuals living in Israel (where almost all males undergo MC), to similar data from the Netherlands and France (where &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10 % of males are circumcised) were performed. National data from HIV registers and Bureaus of Statistics for the period of 2004-2010, global rates, rates by sex, age, and year of HIV-diagnosis were compared. MC and potential biases were examined. Annual rates of new HIV diagnoses per 100,000 were significantly lower in Israel compared to the Netherlands and France (for men: 0.26-0.70, 1.91-2.28, and 2.69-3.47, respectively; for women: 0.10-0.34, 1.10-2.10 and 2.41-3.08, respectively). Similarly, HIV-rates were much lower in Israel when comparing by age groups. Although Gross National Income per capita in 2010 was lower in Israel compared to the Netherlands and France, access to HIV testing and treatment were not different between countries. Also, the number of sexual-partners and condom-use in the general population showed a high similarity between the countries. The lower rate of HIV among heterosexuals in Israel compared to the Netherlands and France might be explained by MC routinely practiced in Israel, since other parameters of influence on HIV transmission were rather similar between the countries. However, recommendation for systematic MC in low HIV prevalence countries requires further investigations.
The worldwide pandemic of human immunodeficiency virus (HIV) casts its shadow on childbirth, espe... more The worldwide pandemic of human immunodeficiency virus (HIV) casts its shadow on childbirth, especially in developing countries, where the estimated rate of vertical transmission is 15%-40%, compared with 15%-25% in developed countries. To date, a total number of 90 children younger than 12 years of age are infected with the virus in Israel, and during the years 2001-2003, an average of 29 mothers living with AIDS gave birth annually. Mother-to-child transmission (MTCT) of HIV can occur during pregnancy, in the intrapartum period or postnatally, through breastfeeding. One third of all the breastfed newborn acquire the infection postnatally. HIV can penetrate through the damaged gastrointestinal mucosa into the newborn blood system. Risk increases during gastrointestinal infections and oral skin lesions. MTCT rate is 3.2 to 100 child years, especially if the mother is infected just before or after labor. Antiretroviral therapy during pregnancy and labor, and throughout the first 6 we...
A survey of winter morbidity revealed a high incidence of childhood influenza. A clinical, virolo... more A survey of winter morbidity revealed a high incidence of childhood influenza. A clinical, virologic and economic survey of childhood influenza morbidity was conducted to characterize this morbidity. Incidence of respiratory disease and influenza-like symptoms was determined among 9,300 children in the Tel Aviv area in the 1997-8 influenza season, and viral cultures performed from nasal swabs. A telephone survey was conducted among the patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; families to determine the family dynamics of the illness and the number of working days lost. Among the study population, 38% had influenza-like symptoms. The highest incidence was among kindergarten and school-age children. Upper respiratory tract infections (URTI) were common in the 0-2 years age group (27.4%). In contrast, 83% of children with influenza-like illness (ILI) were aged 3-15 years (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Of 180 valid viral culture samples, 93 (51%) were positive for influenza, which represents 22% of all children surveyed. Extrapolation to a national level reveals that of approximately two million children in the country, 440,000 would have positive laboratory evidence of influenza infection. In 49 of 52 (90%) families surveyed, the child was the initial patient in the household, and, on average, 66% of family members became ill. The average income lost was NIS 300 per family; at a national level that extrapolates to a loss of NIS 132 million. Influenza-like illness is common among children, particularly in the peak period of influenza activity. As opposed to upper respiratory infections, influenza-like disease is particularly common in the 3-15 year age group (kindergarten and school age). The incidence of children diagnosed with influenza (22%) is much higher than in the general population. Children are the first in the family to become ill and infect other family members. Cost-effectiveness analysis justifies mass childhood influenza immunization.
HIV in Israel started with a subtype-B epidemic among men who have sex with men, followed in the ... more HIV in Israel started with a subtype-B epidemic among men who have sex with men, followed in the 1980s and 1990s by introductions of subtype C from Ethiopia (predominantly acquired by heterosexual transmission) and subtype A from the former Soviet Union (FSU, most often acquired by intravenous drug use). The epidemic matured over the last 15 years without additional large influx of exogenous infections. Between 2005 and 2013 the number of infected men who have sex with men (MSM) increased 2.9-fold, compared to 1.6-fold and 1.3-fold for intravenous drug users (IVDU) and Ethiopian-origin residents. Understanding contemporary spread is essential for effective public health planning. We analyzed demographic and virologic data from 1,427 HIV-infected individuals diagnosed with HIV-I during 1998-2012. HIV phylogenies were reconstructed with maximum-likelihood and Bayesian methods. Subtype-B viruses, but not A or C, demonstrated a striking number of large clusters with common ancestors having posterior probability ≥0.95, including some suggesting presence of transmission networks. Transmitted drug resistance was highest in subtype B (13%). MSM represented a frequent risk factor in cross-ethnic transmission, demonstrated by the presence of Israeli-born with non-B virus infections and FSU immigrants with non-A subtypes. Reconstructed phylogenetic trees demonstrated substantial grouping in subtype B, but not in non-MSM subtype-A or in subtype-C, reflecting differences in transmission dynamics linked to HIV transmission categories. Cross-ethnic spread occurred through multiple independent introductions, with MSM playing a prevalent role in the transmission of the virus. Such data provide a baseline to track epidemic trends and will be useful in informing and quantifying efforts to reduce HIV transmission.
In Israel, as in other industrialized countries, the age of sexual debut among adolescents has de... more In Israel, as in other industrialized countries, the age of sexual debut among adolescents has declined, and the rate of sexually transmitted infections (STI) has risen, but the motivations and attitudes of Israeli adolescents toward carrying condoms have yet to be studied. The aims of this study were to establish the associations (if any) between demographic characteristics and the knowledge held by Jewish Israeli adolescents about HIV transmission, their attitudes toward condom use and sexual experience, and to explore their recommendations to increase condom use. The method used was an analysis of sexual experience and practices, attitudes toward condom carrying and condom use among a national representative sample of Jewish adolescents aged 15-18. Two dichotomized measures were assessed: (i) sexual experience (defined as having had previous consensual oral/vaginal/anal sex); and (ii) the practice of carrying a condom on a regular basis. Of all 410 participants, 14.6% carried condoms, 18.3% had sexual experience, and 70.7% of those used condoms. Those who thought condoms to be protective against HIV, and those who thought they are difficult to wear, were more likely to have sexual experience. The perception of condom use as important, and the perception that condoms are difficult to wear, were predictors of condom carrying. The participants&amp;amp;amp;amp;#39; knowledge of the risk of HIV in vaginal intercourse was deficient. Participants did not consider school sex education to be effective in promoting condom use, and recommended the use of graphic, deterrent personal accounts told by youths to encourage wider use of condoms. Health educators should consider the barriers cited by adolescents and the deterrent techniques they recommend when planning interventions to encourage condom use. Shilo G and Mor Z. Sexual activity and condom use among Israeli adolescents. J Sex Med **;**:**-**.
This study aimed to assess HIV/AIDS point-prevalence among inmates and evaluate costs related to ... more This study aimed to assess HIV/AIDS point-prevalence among inmates and evaluate costs related to universal screening as currently practiced and appraise its necessity. All inmates newly incarcerated in Israel (2003-2010) underwent HIV tests and their medical files were cross-matched the with the national HIV/AIDS registry to who had been newly infected and detected on prison entry. They were classified by key risk-groups. Of 108 866 new inmates during the period, 215 (0.2 per cent) were diagnosed with HIV/AIDS, 44 of those (0.04 per cent) were not aware of their infection. A large majority (94.2 per cent) of the infected inmates were members of a key-risk group: drug-users, homosexuals, or originating from a high-HIV prevalence country. The direct cost of detecting a single HIV-infected inmate who was not previously recorded was [euro ]12 386. The HIV/AIDS-screening process can be improved by interviewing the new inmates and performing targeted HIV-testing for those who are members ...
The worldwide pandemic of human immunodeficiency virus (HIV) casts its shadow on childbirth, espe... more The worldwide pandemic of human immunodeficiency virus (HIV) casts its shadow on childbirth, especially in developing countries, where the estimated rate of vertical transmission is 15%-40%, compared with 15%-25% in developed countries. To date, a total number of 90 children younger than 12 years of age are infected with the virus in Israel, and during the years 2001-2003, an average of 29 mothers living with AIDS gave birth annually. Mother-to-child transmission (MTCT) of HIV can occur during pregnancy, in the intrapartum period or postnatally, through breastfeeding. One third of all the breastfed newborn acquire the infection postnatally. HIV can penetrate through the damaged gastrointestinal mucosa into the newborn blood system. Risk increases during gastrointestinal infections and oral skin lesions. MTCT rate is 3.2 to 100 child years, especially if the mother is infected just before or after labor. Antiretroviral therapy during pregnancy and labor, and throughout the first 6 we...
Fear of AIDS exceeds by far the apprehension concerning any other disease: it is mostly irrationa... more Fear of AIDS exceeds by far the apprehension concerning any other disease: it is mostly irrational, and is driven by a distorted perception of the disease as well as the stigmatization of patients. A major question faced by healthcare systems worldwide concerns the relation between the patients' responsibility to prevent spreading of the virus and the responsibility of the healthcare authorities on this matter. Early HIV detection and treatment, together with proper patients' education, reduce the odds of further infections. Therefore, HIV patients who choose to refrain from partner notification present a significant challenge to the medical staff, as they may rely on human rights and patients' rights principles. This paper deals with dilemmas concerning nonconsensual HIV reporting. The authors advocate a distinction between two types of sexual relationships: whereas in casual relations, both partners share (non-equivalent) responsibility for their safety, in a monogamou...
Background With the increased use of the Internet to seek sex, research has documented its associ... more Background With the increased use of the Internet to seek sex, research has documented its associated sexual risk behaviours, especially among gay and bisexual men. Only a few studies to date have been conducted among adolescent and young men, and these have focussed on behavioural components to do with seeking sex online, without considering the role of same-sex identity formation processes. The current study aimed to identify behavioural and identity formation variables associated with seeking sex online among adolescents and youth. Methods: A web sampling of young Israeli gay and bisexual men aged 12-30 years (n=445) was used to assess their seeking sex online characteristics, mental health, sexual risk behaviours, substance use, same-sex disclosure and acceptance and coping resources. Results: Nearly half of the sample used the Internet to seek sex, which was correlated with substance use and sexual risk behaviour. Young adults seek for sex online more commonly than adolescents....
The Israel Medical Association journal : IMAJ, 2015
Since 2006 more than 60,000 migrants arrived in Israel from the Horn of Africa (HoA: Sudan, Eritr... more Since 2006 more than 60,000 migrants arrived in Israel from the Horn of Africa (HoA: Sudan, Eritrea, Ethiopia). They were detained in prison and screened for tuberculosis (TB) by means of an interview and chest X-ray (CXR). To evaluate the yield of this screening process. This cross-sectional study evaluated the validity of CXR in a random sample of 1087 of the 5335 HoA migrants (20.4%) who arrived in 2009, and assessed its related costs. Sixty-two migrants (5.7%) had CXRs with TB-suspicious findings, and 11 of them were finally diagnosed with TB (17.7% of all TB-suspicious CXRs). TB point-prevalence was 1000 cases per 100,000 migrants (1.0%). As no additional TB cases were diagnosed on arrival, CXR sensitivity, specificity and positive predictive value were 100%, 96.1% and 17.7%, respectively. The interview did not contribute to the detection of migrants with TB. Direct costs related to the detection of single TB cases in prison was 17,970 shekels (US$ 4585), lower than the treatin...
Drawing on resilience theories, this study examined the individual and community factors of Israe... more Drawing on resilience theories, this study examined the individual and community factors of Israeli lesbians, gays, bisexuals, queers, and questioning (LGBQs) that contribute to positive mental health and the degree to which individual and community protective factors mitigate the adverse effect of risk factors for poor mental health. Differences in resilience factors between LGBQ youth and adults were explored. Data were collected on 890 LGBQ youth and adults. Findings emphasize the role of community-level resilience factors in the lives of LGBQs, and that these support systems differ slightly between the two age groups. Among youth, family support was both a strong predictor for well-being and a protective factor for mental distress. Although family support was found as a resilience factor among adults as well, other community-level factors (friends' support, LGBT connectedness and having steady partner) were found as protective factors for poorer mental health. These findings...
Lifestyle may be associated with risk behaviours. This study compares gym exercise and sexual ris... more Lifestyle may be associated with risk behaviours. This study compares gym exercise and sexual risk behaviour between men who have sex with men (MSM) and heterosexual men. The research was based on the assumption that men who become muscular and physically attractive increase their number of sex partners and consequently their risk of HIV or other sexually transmitted infections (STIs). Five gyms in central Tel Aviv, Israel. In 2012, a sample of 182 (48%) MSM and 197 (52%) heterosexual men who train in gyms completed anonymous questionnaires regarding their training, health and sexual behaviours. Participants in this cross-sectional study who exercised more than the median number of anaerobic training hours were defined as performing intensive anaerobic training (IAT), and those who had performed more than one act of unprotected anal/vaginal intercourse in the preceding 6 months with a partner whose HIV status was unknown were defined as high risk. MSM showed a stronger desire to bec...
Research relating to minority stressors generally explores mental health outcomes, with limited f... more Research relating to minority stressors generally explores mental health outcomes, with limited focus on the physical dimension. In addition, minority stress research is conducted mainly in Christian-oriented societies. To address these pitfalls we used Web sampling targeting Israeli participants ages 12 to 30 (N = 952; 28 percent heterosexuals, 78 percent lesbian, gay, and bisexual [LGB] adolescents and young adults) to assess their mental health, physical and sexual risk behaviors, minority stressors, and coping resources. Results indicate that young LGBs had lower levels of mental and physical health than heterosexuals. Among LGB participants, high levels of minority stressors and low levels of coping resources predicted lower levels of mental health, and lower levels of mental health predicted lower levels of physical health. These results emphasize that minority stressors should be recognized as risk factors for poorer mental health, as well as for physical and sexual risk beha...
HIV-testing in Israel for pregnant women (PW) is selective since the year 1998 and recommended if... more HIV-testing in Israel for pregnant women (PW) is selective since the year 1998 and recommended if they or their sex partners (SP] are at high-risk for HIV-infection. HIV-infected PW, citizens and non-citizens alike, are eligible for free HIV-care and treatment. This study describes the current recommendations and HIV epidemiology in Israel. A retrospective study was conducted describing risk groups of HIV-infected PW between the years 1985 and 2010. The source of the data was the National HIV registry. During 25 years of follow-up, 204 vertically HIV-infected children were reported to the Ministry of Health (MoH). Of those, 87 (42.4%) were born in Israel to 83 PW, and the others were born overseas. Of these 87 children, 35 (40.2%) were born to 33 PWwho were unaware of their HIV-infection prior to Labor (31 citizens and 2 non-citizens). Of those, 22 (66.7%) were born in high-prevalence countries, eight (24.3%) were infected from their heterosexual SP, one (3%) used drugs intravenousl...
The HIV/AIDS burden in Israel is increasing. This study aims to describe the nationwide-HIV epide... more The HIV/AIDS burden in Israel is increasing. This study aims to describe the nationwide-HIV epidemiology in the last 30 years and highlight areas of concern in HIV/AIDS control. Descriptive study. The National HIV/AIDS Registry in Israel. All individuals who were reported with HIV/AIDS in Israel. Classification of HIV/AIDS cases by risk groups, calculation of annual trend analysis and estimation of HIV transmission rates by dividing the annual HIV/AIDS-incidence by the prevalence, while the number of newly diagnosed HIV/AIDS cases reported was a proxy of the incidence. From 1981 to 2010, 6579 HIV/AIDS cases were reported in an upward trend from 3.6 new HIV diagnoses/100 000 population in 1986 to 5.6 in 2010. Immigrants from countries of generalised epidemic (ICGE) comprised 2717 (41.3%) of all cases: 2089 (76.9%) were Israeli citizens and 628 (23%) were non-Israeli citizens, mostly migrant workers. The majority (N=2040) of ICGE Israeli citizens were born in Ethiopia. Only 796 (12.1%...
The Israel Medical Association journal : IMAJ, 2012
The increase in human immunodeficiency virus (HIV) among men who have sex with men (MSM) in Israe... more The increase in human immunodeficiency virus (HIV) among men who have sex with men (MSM) in Israel during the last decade raises concerns regarding other sexuallytransmitted diseases (STD) in MSM, which are yet undetermined. To evaluate the STD burden among MSM and heterosexuals visiting the Tel Aviv walk-in STD clinic. Records of all male patients who attended the clinic once were reviewed to identify demographic characteristics, behavioral attributes, and test results. Between 2002 and 2008, 1064 MSM (22%) and 3755 heterosexuals (78%) visited the clinic once. Positivity rates in MSM for HIV, urethral Neisseria gonorrhoea and infectious syphilis were higher than in heterosexuals (2.5%, 2.5%. 0.7% vs. 0.6%, 1.3%, 0.3%, respectively), while urethral Chlamydia trachomatis was higher in heterosexuals than in MSM (2.7% and 1.4%, respectively). MSM tested in our clinic were younger than heterosexuals (P<0.001), more commonly circumcised (P=0.03) and Israeli-born (P<0.001), used sub...
Israel has absorbed labor migrants (LM), mostly originating from developing countries endemic for... more Israel has absorbed labor migrants (LM), mostly originating from developing countries endemic for tuberculosis and AIDS. This trend has increased in the last 4 years, and included LM from the horn of Arica. Public opinion towards LM is ambivalent and is based on incomplete data and prejudice. Those who support LM deportation emphasize the burden of infectious diseases (ID) and raise concerns regarding possible exposure of Israeli citizens. This article will elucidate the process of data monitoring and the risk of ID transmission to the citizens of the hosting country. Of all individuals infected with tuberculosis and AIDS in Israel, 13% and 17% respectively are LM. LM are screened prior to arrival or upon incarceration in Israel Female LM are advised to perform an HIV test during their pregnancy. As a consequence of the active screening, more LM are diagnosed than Israelis, who are not routinely tested. The risk of ID transmission to the citizens of the hosting country is Limited, a...
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