This week PLOS Medicine publishes the following new articles:
Erik Volz and colleagues use HIV genetic information from a cohort of men who have sex with men in Detroit, USA, to dissect the timing of onward transmission during HIV infection. In particular, it allowed the researchers to estimate that, in the current HIV epidemic in Detroit, 44.7% of HIV transmissions occur during the first year of infection. These findings may not be generalizable to other cities or to other risk groups. Nevertheless, the findings of this analysis have important implications for HIV control strategies based on the early treatment of newly diagnosed individuals. Because relatively few infected individuals are diagnosed during early HIV infection, when the HIV transmission rate is high, it is unlikely, suggest the researchers, that the ‘‘treatment as prevention’’ strategy will effectively control the spread of HIV unless there are very high rates of HIV testing and treatment. In a related Perspective, Tim Hallett reflects on the influence of early HIV infection on disease epidemic dynamics.
Using thematic analysis, Thomas Kerr and colleagues document the experiences of policing among people who inject drugs (PWID) in Bangkok and examine how interactions with police may affect drug-using behaviors and access to health services. A recent crackdown on PWIDs in 2011 has led to increases in drug-related arrests and compulsory detentions in Thailand. The researchers interviewed 42 PWID from the community in Bangkok, and asked them about their encounters with police during the past three years. Participants reported various police activities, including false accusations, coercion of confessions, excessive use of force, and extortion of money, and were reluctant to report these activities to the authorities. Some PWIDs reported avoiding police by staying indoors, which may limit their access to health services, while others reported changes in their drug-using behavior from street drugs towards misuse of prescribed pharmaceuticals. The study included a small convenience sample of PWID and may not be generalizable outside of Bangkok, however the findings do document reported misconduct in police activities with PWID and highlight the potential for widespread misuse of urine drug testing, was identified as a key tool used by the police, with some police requesting PWID to provide urine samples in public places. In a linked Perspective, Scott Burris and Stephen Koester examine policing activities in other countries and discuss the need for better integration of public health policy with policing activity.
Unni Karunakara and colleagues discuss how Médecins Sans Frontières decided to adopt a data sharing policy for routinely collected clinical and research data in humanitarian settings and its aspirations to create a truly open data set. Public health crises such as the spread of drug-resistant tuberculosis highlight the need for improved sharing of data. For humanitarian organizations, there is a lack of guidance on the practical aspects of making such data available. There are aspirations to create a truly open data set, but the initial aim is to enable data sharing via a managed access procedure so that security, legal, and ethical concerns can be addressed.