{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,8]],"date-time":"2025-06-08T19:24:14Z","timestamp":1749410654388,"version":"3.37.3"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T00:00:00Z","timestamp":1614902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"National Institutes of Child Health and Development","award":["R01 HD72659"],"award-info":[{"award-number":["R01 HD72659"]}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01 66767"],"award-info":[{"award-number":["R01 66767"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"name":"AIDS International Training and Research Program Fogarty International Center","award":["D43 TW001042"],"award-info":[{"award-number":["D43 TW001042"]}]},{"DOI":"10.13039\/100008374","name":"Emory Center for AIDS Research","doi-asserted-by":"crossref","award":["P30 AI050409"],"award-info":[{"award-number":["P30 AI050409"]}],"id":[{"id":"10.13039\/100008374","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01 AI51231","R01 AI040951","R01 AI023980","R01 AI64060","R37 AI51231"],"award-info":[{"award-number":["R01 AI51231","R01 AI040951","R01 AI023980","R01 AI64060","R37 AI51231"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>We explored the role of genital abnormalities and hormonal contraception in human immunodeficiency virus (HIV) transmission among heterosexual serodifferent couples in Rwanda.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>From 2002 to 2011, HIV-serodifferent couples who were not using antiretroviral treatment were followed up, and sociodemographic and clinical data were collected, family planning provided, and HIV-negative partners retested. Couples were assessed for genital ulcers; nonulcerative genital sexually transmitted infection (STIs), including gonorrhea, chlamydia, and trichomoniasis; and non-STI vaginal infections, including bacterial vaginosis and candida. Multivariable models evaluated associations between covariates and HIV transmission genetically linked to the index partner.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 877 couples in which the man was HIV positive, 37 linked transmissions occurred. Factors associated with women\u2019s HIV acquisition included genital ulceration in the female partner (adjusted hazard ratio, 14.1) and nonulcerative STI in the male partner (8.6). Among 955 couples in which the woman was HIV positive, 46 linked transmissions occurred. Factors associated with HIV acquisition in men included nonulcerative STI in the female partner (adjusted hazard ratio, 4.4), non-STI vaginal dysbiosis (7.1), and genital ulceration in the male partner (2.6). Hormonal contraception use was not associated with HIV transmission or acquisition.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our findings underscore the need for integrating HIV services with care for genital abnormalities. Barriers (eg, cost of training, demand creation, advocacy, and client education; provider time; and clinic space) to joint HIV\/STI testing need to be considered and addressed.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/infdis\/jiab071","type":"journal-article","created":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T21:41:33Z","timestamp":1612388493000},"page":"81-91","source":"Crossref","is-referenced-by-count":6,"title":["Genital Abnormalities, Hormonal Contraception, and Human Immunodeficiency Virus Transmission Risk in Rwandan Serodifferent Couples"],"prefix":"10.1093","volume":"224","author":[{"given":"Kristin M","family":"Wall","sequence":"first","affiliation":[{"name":"Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"},{"name":"Department of Epidemiology, Rollins School of Public Health, Laney 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Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosine","family":"Ingabire","sequence":"additional","affiliation":[{"name":"Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"},{"name":"Projet San Francisco, Kigali, Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeannine","family":"Mukamuyango","sequence":"additional","affiliation":[{"name":"Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"},{"name":"Projet San Francisco, Kigali, Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Parker","sequence":"additional","affiliation":[{"name":"Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilene","family":"Brill","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matt","family":"Price","sequence":"additional","affiliation":[{"name":"IAVI, New York, New York, USA"},{"name":"Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa B","family":"Haddad","sequence":"additional","affiliation":[{"name":"Center for Biomedical Research, Population Council, New York, New York, 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