bluuebunny/crossref_metadata_2025 huggingface dataset:
O1-S11.03 How many infections are averted by behaviour change after early HIV diagnosis & counselling of MSM? Estimates from a stochastic individual-based model
Authors: White P , Fox J , MacDonald N , Weber J , McClure M , Fidler S , Ward H
Published: July 2011

Background

A recent paper (Fox et al HIV Medicine 2009) reported that MSM in the UK significantly reduced their transmission-risk behaviour following HIV diagnosis and suggested that this could be effective in averting transmission during the highly-infectious primary infection stage. However, cost-effectiveness analysis is required to inform policy-making. To assess the effectiveness of early HIV diagnosis in MSM as a prevention strategy we quantified its potential impact in terms of transmission HIV events averted.

Methods

We developed an individual-based stochastic transmission model to calculate the number of HIV-transmission events expected to occur from a cohort of recently-diagnosed MSM with and without the changes in behaviour that occurred post-diagnosis and counselling. The model incorporates different types of sex-act, patterns of condom use, and distinguishes between regular and casual partners.

Results

In the 12 weeks post-diagnosis, for a large majority of respondents there was a reduction in the expected number of casual partners who would be infected: 76% of participants eliminated risk of onward transmission entirely. However, a small proportion still presented a transmission risk. Overall, reductions in HIV transmission risk behaviour post-diagnosis would have reduced estimated secondary transmission during primary HIV infection (PHI) from been 33 (23–37) to 12 (6–14)—a reduction of 62% (32%–83%). Diagnosis after PHI produces a more modest reduction in transmission by missing the high-infectivity period.

Conclusions

Diagnosis of PHI can produce a large proportionate reduction in HIV-transmission events by reducing transmission-risk behaviour. Due to the high infectivity but short duration of primary infection, even short-term behaviour change can significantly reduce transmission. Later diagnosis is less effective, whilst early diagnosis requires frequent or highly-targeted testing. Whilst further work is required to determine the costs of different testing strategies, our quantification of the number of infections averted is an essential component of an assessment of the cost-effectiveness of strategies to increase early diagnoses of HIV infection.
O1-S11.04 Targeting the use of HIV RNA screening to maximise yield and minimise cost: NYC Health Department STD Clinics, 2008–2010
Authors: Blank S , Borges C , Kowalski A , Sebiyam S , Sweeney M
Published: July 2011

Background

Nucleic acid amplification testing (NAAT) is an important tool for identifying acute HIV infection (AHI), a period of high infectivity when antibody is undetectable. NAAT pooling methods (pNAAT) help contain the costs of screening for AHI. In 2008 NYC STD clinics began routine pNAAT screening for all rapid antibody negative specimens; it was standard of care in all nine clinics by 2009. A pattern of risk factors among AHI cases detected during universal screening suggested the feasibility of using targeted screening to maximise the yield of AHI cases detected while minimising costs of screening.

Methods

Using medical record data, we reviewed cases of AHI diagnosed in nine NYC STD clinics for 2008–2009. From these we developed targeting criteria for AHI screening, and compared yields and costs before and after targeting.was implemented.

Results

Targeted screening began in May 2010 and included the following risk criteria: MSM, females who have had sex with MSM, sex with an injection drug user, exchange sex for money or drugs, shared injection drug works, or recent victim of sexual assault. Prior, 42 696 specimens were screened by pNAAT from June through December 2009, yielding 23 AHI cases (5.4 cases/10 000 specimens). Of these cases, there were 21 males, including 15 who have sex with men (MSM) (71%, 15/21), 1 female, and 1 transgender. The mean age for patients was 30 years; racial/ethnic breakdown was: 57% Black, 39% Hispanic, 13% white, 4% other. Subsequently, 5280 specimens were screened by pNAAT from June through December 2010, representing an 88% decrease in testing compared to the same period during the previous year. A total of 18 AHI cases (34.1/10 000 specimens) were detected; all were MSM. The mean age was 29 years and racial/ethnic breakdown was: 44% Black, 28% Hispanic, 28% white, 5% Asian. Cost data are provided in Abstract O1-S11.04 table 1.

Abstract O1-S11.04 Table 1

Cost effectiveness of targeted AHI screening

UniversalTargetedAverage pooled AHI specimens per month5700770Annual cost of pooled AHI screening$650 000$91 296Annual yield3335Average total cost per month$54 167$7608Average cost per AHI case identified$19 697$2608

Conclusion

AHI screening increases case detection compared to using antibody tests alone. After initial investment in the effort, we were able to cut the cost per case identified by over sevenfold. This approach may make AHI screening more feasible/affordable in settings with patients at very high risk of newly-acquiring HIV.
O1-S11.06 Burden of genital discharge pathogens and associated characteristics of asymptomatic HIV-infected patients in Johannesburg, South Africa
Authors: Lewis D , Chirwa T , Msimang V , Radebe F , Kamb M , Sanne I , Firnhaber C
Published: July 2011

Background

The prevalence of asymptomatic STIs and urethritis/cervicitis pathogen-associated patient characteristics were determined among patients attending a HIV treatment centre in Johannesburg.

Methods

Consenting consecutive HIV-infected patients, asymptomatic for symptoms/signs of genital discharge, were screened over 12 months for gonorrhoea, trichomoniasis, chlamydial andMycoplasma genitaliuminfections using a real-time PCR assay. Bacterial vaginosis (BV) and Candida were detected by microscopy (women only). Serological assays diagnosed syphilis (RPR/TPPA) and herpes simplex type 2 (IgG ELISA) infections. Patients returned at 2 weeks; those with positive results were treated and given contact slips for partners. If available, patients' most recent CD4 (83%) and viral load (VL) (60%) results were recorded. Demographic, clinical and behavioural data were collected by nurse-administered questionnaire. A descriptive analysis was conducted to obtain frequency distributions of patient and STI prevalence data. Associations were investigated using the χ2test at a 5% level of significance. A multiple logistic regression model was fitted to find factors associated with urethritis/cervicitis pathogens.

Results

1109 patients were enrolled (551 men, 558 women). Compared with men, women were younger with a mean age [SD] of 35.0 [7.3] vs 37.9 [7.9] years (p<0.001), reported more STIs in the past year (65.5% vs 56.5%, p=0.002), were less likely to know their partner's HIV status (53.1% vs 62.3%, p=0.007), were more likely to be on HAART (70.4% vs 59.7%, p<0.001) with an undetectable VL (81.0% vs 69.9%, p<0.001) and a higher mean [SD] CD4 count of 346 [203] vs 232 [173] cells/mm3 (p<0.001). Urethritis/cervicitis pathogens were detected in 119/558 (21.3%) women and 90/550 (16.4%) men (p=0.035). BV and Candida were detected in 155 (28.0%) and 101 (18.3%) women, respectively. Detection of urethritis/cervicitis pathogens was associated with recent sexual intercourse with a regular partner (adjusted OR, aOR 1.64, 95% CI 1.08% to 2.48%). Trichomoniasis was associated with female gender (aOR 2.45, 95% CI 1.39% to 4.32%) and sub-optimal condom use with regular partners (aOR 2.04, 95% CI 1.23% to 3.41%).

Conclusions

Urethritis/cervicitis pathogens were highly prevalent among this asymptomatic population. The benefit of introducing such STI screening programmes to improve reproductive health and HIV prevention efforts requires further study.
O2-S1.01 Developmental changes in masculinity, sexual behaviour, and STI risk among adolescent boys
Authors: Ott M , Bell D , Fortenberry J. D
Published: July 2011

Background

Successful STI prevention for younger boys should tap into a cultural understanding of boys' romantic and sexual relationships. However, little data exist. We describe developmental changes in boys' relationships, masculinity, sexual behaviour, and STI risk across adolescence.

Methods

After IRB approval, thirty-three 14–16-year-old boys were recruited from a teen clinic serving high STI prevalence urban areas, and participated in 3 one-hour qualitative interviews, approximately 6–9 months apart. Urine was tested for gonorrhoea, chlamydia and trichomonas using DNA-based tests. Over 80% were retained at each follow-up. Baseline interviews were coded, then each boy's three interviews were read as a group, looking for changes across the interviews in relationship experience, masculine beliefs, sexual communication and decision-making, sexual experiences, and STI prevention.

Results

Mean age was 14.9 years, all were Medicaid-eligible (low income), 90% were African American, and 16/33 were sexually experienced. We observed changes over time in relationships, masculinity, and sexual decision-making. At baseline, boys described girls as having more relationship power, with girls frequently initiating relationships and the decision to have sex. As boys gained experience, they perceived themselves as having more agency, and initiating sex more often. At baseline, we observed low levels of masculine beliefs, with many boys wanting meaningful and emotionally involved relationships, few viewing sex as a conquest, and most worrying about their own relationship and sexual competency. Three trajectories of masculinity emerge. A small number of Players” embodied a subset of masculine beliefs that included sex as a conquest, women as objects, and lack of emotional involvement. “Emotionally distant” was more common; these boys described initially trusting girls, “being burned” by someone they had been close to, and then not investing emotionally so as not to be hurt again. “Caretakers,” also a small minority, emphasised men's role to protect and care for women. Sexual communication, mostly indirect or nonverbal at baseline, became more direct. Despite a baseline interest in sex within relationships, experiences of 1st sex were generally outside of relationships.

Conclusions

For STI prevention programs to have relevance to younger boys, they need to tap into developmental changes in the cultural, relational, and behavioural contexts of sex.
O2-S1.04 Effective ART, viral load and sexual behaviour of HIV positive men who have sex with men: changes from 2000 to 2010
Authors: Wayal S , Cassell J , Copas A , Mercer C , Edwards S , Hart G
Published: July 2011

Background

Early initiation of combination antiretroviral treatment (ART) is being considered as a HIV prevention strategy. Thus, it is important to examine the association between ART, viral load (VL) and the sexual behaviour of HIV+ve patients. We compared the reporting of unprotected anal sex (UAI) in 2010 and 2000 among HIV+ve men who have sex with men (MSM) and its association with VL.

Methods

HIV+ve MSM attending a central London HIV clinic were recruited in cross-sectional surveys in 2000 (411 men) and 2010 (423 men). Data on recent plasma VL (detectable (DVL) or undetectable (UVL)); ART status (treatment naïve or receiving ART); UAI with a boyfriend (main partner) and casual partners in the last 6 and 12 months respectively; boyfriend's HIV status (unknown/negative, or positive) were collected. Nonconcordant UAI (ncUAI) was defined as UAI with unknown/negative HIV status partner(s) and concordant UAI (cUAI) as UAI only with HIV+ve partner(s). Men reporting cUAI and ncUAI were treated as engaging in ncUAI. OR for 2010 compared to 2000 for UAI with casual partners were adjusted for age and DVL/UVL. Analysis for UAI with a boyfriend was adjusted also for boyfriend's HIV status and is restricted to those reporting a boyfriend.

Results

Compared to 2000, 2010 respondents were more likely to be on ART with UVL (76% vs 40%), but less likely to be on ART with DVL (6% vs 32%) or treatment naïve (19% vs 28%), p<0.001. They were older (age ≥45 years: 46% vs 22%, p<0.001), more likely to report an HIV+ve boyfriend (41% vs 25%; p=0.001). An increase in cUAI with a boyfriend (27% vs 14%) remained significant after adjustment, (OR: 2.84, 95% CI: 1.59% to 5.06%; p<0.001). ncUAI with a boyfriend did not change (12% vs 11%; p=0.63). With regards to casual partners, cUAI decreased over time (OR: 0.50, 95% CI: 0.29% to 0.86%; p=0.01) but ncUAI increased (34% vs 17%; OR: 2.79, 95% CI: 1.93% to 4.04%; p<0.001). UVL was not associated with ncUAI with casual partners or boyfriend, but was associated with increased cUAI with casual partners (OR: 1.83, 95% CI: 1.08% to 3.13%; p=0.02).

Conclusions

In comparison with 2000, cUAI with a boyfriend has increased, perhaps due to increased serosorting. In casual partnerships cUAI decreased and ncUAI increased. The latter has implications for onward HIV transmission and needs to be addressed by health promotion programmes. As UVL was not associated with ncUAI, these data do not suggest that early initiation of effective ART will increase HIV transmission.
O2-S1.05 Vulnerability re-assessed: the changing face of sex work in Guntur District, Andhra Pradesh
Authors: Beattie T , Bradley J , Vanta U Devi , Shetty A , Lowndes C M , Alary M
Published: July 2011

Guntur district in Andhra Pradesh, south India, has over 10 000 female sex workers (FSWs), of whom one fifth are estimated to be HIV infected. Following implementation of the Bill & Melinda Gates Foundation funded India AIDS prevention initiative, Avahan, we conducted qualitative studies with FSWs in Guntur district to examine in-depth, perceptions, behaviour and issues pertaining to their vulnerability to HIV infection. Three focus group discussions and 40 in-depth interviews were conducted with 60 FSWs, selected by random sampling. The study found evidence that client solicitation practices are changing in Guntur district, with sex workers now soliciting clients in their homes, often using mobile phones, or at their workplace, rather than in brothels or in public places. In addition, clients are most frequently requesting anal instead of vaginal sex, possibly resulting from recent exposure to pornography. FSWs were frequently unaware that unprotected anal intercourse put them at risk of HIV or other STIs, and the majority reported unprotected anal intercourse with their clients. Older FSWs and HIV-infected FSWs reported living in extreme poverty and were particularly vulnerable, often agreeing to unprotected vaginal and anal intercourse to earn enough money to survive. This, coupled with sharing of clients by home-based FSWs, suggests continued and changing vulnerability in this setting where many FSWs are already HIV infected and where understanding of risk appears deficient. Monitoring the changing sex work environment and adapting programmes accordingly will be crucial if HIV prevention programmes are to continue to reach these target populations effectively.
O2-S1.06 Community responses to an HIV epidemic in South India: knowledge, moral panic and cultural inertia
Authors: Bradley J , Rajaram S , Ramesh BM , Bhattacharjee P , Isac S , Lobo A , Moses S , Blanchard J , Washington R , Alary M
Published: July 2011

Background

Studies have shown that as communities face serious threats to traditional values, such as that posed by HIV, cultural inertia may result, whereby existing trends towards more liberalised views of sexuality are stalled, particularly among the educated and youth. We examined changes in attitudes around HIV in Bagalkot district, south India, between 2003 and 2009.

Methods

General population surveys were conducted in 2003 and 2009, among approximately 6600 randomly sampled men and women in 10 villages and 20 urban blocks. Questions about HIV knowledge, sexuality, gender and condoms were included.

Results

Knowledge of HIV increased from 77% in 2003 to 88% in 2009, and condom awareness increased significantly (37.4%–65.4%). However, in 2009, only 23% of people mentioned condoms spontaneously as a means of preventing transmission (an increase from 8% in 2003). There was an increase in those who thought sex workers should be compulsorily tested for HIV (63.0% vs 73.5%, p=0.01). An increasing number of people agreed that it is wrong to talk about sex" (24.2% vs 29.2%, p=0.05), especially women (21.9% vs 32.4%, p<0.01). There was an increase in those who thought it “wrong to talk about AIDS in a respectable family” (16.4% vs 0.22.1%, p=0.01), largely among urban women, youth and the more educated, and more in 2009 thought it improper for respectable people to discuss condoms (5.5% vs 17.9%, p<0.01). In 2003, 11.8% agreed that “access to condoms promotes promiscuity”, increasing to 29.5% in 2009 (p<0.01). Men, educated people, urbanites and young people under 25 were the most likely to believe this. Sex education was thought to be equally damaging, especially among women and young people, with more agreeing that it promotes sexual activity and promiscuity in 2009 than in 2003 (19.3% vs 30.2%, p<0.01).

Conclusions

Although scapegoats (in the form of sex workers) were increasingly identified by the community, stigma towards those with HIV appeared to have reduced significantly. Despite increased knowledge and positive changes around stigma, fear of change to cultural mores was apparent, with unwillingness to embrace openness and discuss sexuality. Young and educated respondents appeared to be the most regressive thinkers, reflecting a cultural inertia that mirrors studies of other threats to traditional societal values. More effort is required to educate young people about healthy sexuality, openness and safe sex.
O2-S4.03 The cost-effectiveness of human papillomavirus vaccination of females over age 12 years in the USA
Authors: Chesson H , Markowitz L
Published: July 2011

Background

Although the recommended age for Human Papillomavirus (HPV) vaccination of females is 11 to 12 years in the USA, catch-up" vaccination is recommended for females aged 13–26 years who have not been previously vaccinated. The objective of this study was to evaluate the cost-effectiveness of catch-up vaccination strategies for females aged 13–30 years in the USA.

Method

We revised and updated a previously-published, spreadsheet-based model of HPV vaccination to estimate the costs and benefits of female HPV vaccination. The health outcomes we included were: cervical intraepithelial neoplasia, genital warts, recurrent respiratory papillomatosis, and HPV associated cancers (cervical, vaginal, vulvar, anal, oropharyngeal, and penile). We examined the cost-effectiveness of catch-up vaccination for three age groups: ages 13–21 years, ages 21–26 years, and ages 27 to 30 years. We examined a 100-year time horizon. Routine vaccination of 12 year olds was assumed to occur in all 100 years, with coverage set at 20%, 30%, or 75%. The annual probability of receiving catch-up vaccination was 5% for ages 13 to 18 years and 1.25% for ages 19 years and older. The duration of the catch-up vaccination program was varied from 1 to 20 years.

Results

Catch-up vaccination generally became less cost-effective as routine coverage increased and as the duration of the catch-up program increased. When vaccine coverage and the duration of the catch-up program were varied (and all other parameters were set to their base case values), the incremental cost per QALY gained by extending the duration of catch-up vaccination ranged from $5000 to $40 000 for ages 13 to 21, from $50 000 to $85 000 for ages 21 to 26, and was >$140 000 for ages 27 to 30 years. The relatively favourable cost-effectiveness ratios for vaccination of ages 13 to 21 years and the relatively unfavourable cost-effectiveness ratios for vaccination of ages 27 to 30 years were consistent regardless of routine vaccine coverage and the duration of the catch-up vaccine program.

Conclusion

Our preliminary findings support the current recommendations of the Advisory Committee on Immunisation Practices (ACIP) for female vaccination. However, although catch-up vaccination for ages 21 to 26 years might be considered cost-effective now, the cost per QALY gained by catch-up vaccination may increase as time goes by and as vaccine coverage increases.
O1-S02.03 Multiple sex partners and lack of condom use for anal sex are associated with multiple anal HPV infections among men having sex with men: the HIM study
Authors: Nyitray A , Villa L L , Carvalho da Silva R J , Baggio M L , Lu B , Smith D , Abrahamsen M , Papenfuss M , Lazcano-Ponce E , Giuliano A R
Published: July 2011

Background

Human Papillomavirus (HPV) infection is the primary cause of anal cancer. While multiple HPV infections in the anal canal may accelerate disease progression, there are no reports of behavioural factors associated with multiple anal HPV infections among men having sex with men (MSM) and men having sex with women (MSW). We hypothesised that infection with multiple HPV types in the anal canal among MSM was associated with multiple sex partners and lack of condom use for recent anal sex. For comparison, we also assessed the role of multiple partners and condom use among MSW.

Methods

Genotyping for 37 HPV types was conducted on anal canal exfoliated cell specimens from men, ages 18–70, from São Paulo, Brazil; Cuernavaca, Mexico; and Tampa, Florida, USA. Specimens from the pre-enrolment visit of a 4-year prospective study were analysed. Eligibility included no history of genital warts and no current STD diagnosis including HIV. Exfoliated cell samples between the anal verge and the dentate line of the anal canal were obtained with a saline-wetted swab. A total of 193 MSM and 1407 MSW provided evaluable specimens. For multivariable analyses we used Poisson regression with a robust sandwich estimator. Association estimates were adjusted for potential confounders.

Results

Multiple HPV infections were present in the anal canal of 34.7% of MSM and 4.0% of MSW. Prevalence of multiple HPV infections was stable by age group among MSW (p trend=0.65) but declined among MSM (p trend=0.009). After adjustment for potential confounders, ≥2 male anal sex partners in the past 3 months (OR 2.47, 95% CI 1.43% to 4.27% vs 0–1 men) and lack of condom use at last anal sex (OR 1.51, 95% CI 1.07% to 2.12% vs condom use) were associated with detection of multiple anal HPV infections among MSM. Among MSW, ≥2 female sex partners in the past 6 months (OR 1.81, 95% CI 1.02% to 3.21% vs 0–1 women) was associated with detection of multiple anal HPV infections while condom use at last vaginal sex was not associated with infection (no condom use: OR 0.90, 95% CI 0.51% to 1.61% vs condom use).

Conclusions

These data suggest that lowering the number of sex partners may reduce infection with multiple HPV types at the anal canal among MSM and MSW. Additionally, using condoms during anal sex among MSM, even among men with multiple partners, may reduce multiple anal HPV infections at the anal canal. Questions:alan.nyitray@moffitt.org
O2-S4.06 Exploring enema practices among men who have sex with men in the USA: implications for sexual health
Authors: Rosenberger J G. , Herbenick D , Van Der Pol B , Novak D S , Reece M , Fortenberry J D
Published: July 2011

Purpose

Recent literature has suggested that use of hygiene products (ie, douching) by women and men prior to sexual activity, changes the biological makeup of vaginal and anal tissue, potentially affecting risk for HIV/STI acquisition. While men who have sex with men (MSM) continue to be disproportionately impacted by HIV/STI, little information exists about men's lifetime enema behaviours, the situational contexts impacting their use, and attitudes towards use of such products.

Methods

Data were collected via an internet survey from 27 690 18–80 year old MSM. Measures included sociodemographics, recent/lifetime sexual behaviour history, and items related to enema use.

Results

Participants' median age was 39.0 years; ethnicities included white (84.5%), Latino (6.4%), African American (3.5%); and, most (79.9%) identified as homosexual. Over half (54.2%) of men indicated that they were not currently in a romantic relationship and the majority (88.9%) reported having two or more sexual partners in the past year. Most men (64.5%) reported lifetime enema use, with 33.8% reporting use in the past month. Most common reasons for starting enema use were to avoid feces during sex (72.5%) and to feel clean during sex (65.6%). Among enema users, 34.4% reported use of a disposable store bought enema, while 62.5% indicated having used a refillable enema or one that attached to the shower. Men somewhat or strongly agreed that enema use increased comfort with their anus (75.8%), made sex more enjoyable (75.5%), and increased the likelihood of being the receptive partner (75.8%). During the most recent sexual event, enema use was reported both before (37.1%) and after (8.1%) sex, with most (42.0%) reporting use 30 min–1 h prior to sex. Enema use at last sex was more likely to occur among men who were Caucasian (p <0.01), who engaged in anal intercourse (p <0.01), and whose sexual partner was someone they just met (p <0.05).

Conclusions

These data provide one of the first examinations of enema practices among MSM in the US. Findings highlight use of enemas prior to sexual activity as a common behaviour, and one associated with positively enhancing the sexual experience. The acceptability of enema use in this population may provide a vehicle for microbicide or virocide delivery once such compounds are fully developed. Future research should examine the relationship between behavioural practices and biological impacts of enema use in relation to HIV/STI.
O2-S5.02 The association between alcohol use and HIV sexual risk behaviours
Authors: Somji A , Bello B , Delany-Moretlwe S
Published: July 2011

Background

This study aimed to investigate the associations between alcohol use and sexual risk behaviour in migrant men and women living in Johannesburg.

Methods

1465 men and 1008 women living in six hostels and five neighbouring informal settlements respectively were surveyed. Using logistic regression, the association between five measures of alcohol use (current alcohol consumption, frequency of drinking, drunk in the past week, daily alcohol consumption, drinking habit) and five sexual risk behaviours (transactional sex, inconsistent condom use, coercive sex, multiple sexual partners and concurrency) in men and women was assessed.

Results

More men than women reported current alcohol use (42% vs 12%). Among current drinkers, 23% of men and 29% of women reported being drunk in the past week. Consistent condom use was low in both men and women (6%). More men (53%) than women (7%) reported multiple sexual partnerships. In men, frequent drinking (Adjusted OR [AOR] for upper category: 3.1, 95% CI: 1.7% to 5.5%) and being drunk in the past week (AOR: 3.3, 95% CI: 1.8% to 6.0%) were associated with coercive sex. Frequent drinking (AOR for upper category: 1.5, 95% CI: 1.1% to 2.2%) and being drunk (AOR: 2.0, 95% CI 1.4% to 3.0%) was also associated with multiple sexual partnerships. In women, frequent drinking (AOR for upper category: 3.0, 95% CI: 1.0% to 8.9%) and being drunk in the past week (AOR: 3.4, 95% CI: 1.3% to 9.4%) were experiencing coercive sex. Alcohol use did not appear to influence reported condom use.

Conclusions

Alcohol use was associated with several high-risk sexual behaviours in both men and women. Future HIV prevention interventions should focus on the associations between alcohol, partner violence and HIV risk.
O2-S5.03 Sex, drugs and structural interventions: unstable housing associated with increased HIV risk behaviour in a cohort of people on treatment in British Columbia, Canada
Authors: Parashar S , Palmer A , O'Brien N , Chan K , Milan D , Samji H , Montaner J , Hogg R
Published: July 2011

Background

Unstable living conditions may increase risk for HIV exposure and transmission. This analysis examines housing as a structural factor associated with drug and sexual risk behaviours among individuals accessing antiretroviral treatment (ART). We hypothesised that unstable housing is significantly associated with sex exchange and recent injection drug use (IDU).

Methods

The LISA cohort is a cross-sectional study of individuals on ART in British Columbia. Interviewer-administered surveys collect information regarding housing, drug use, utilisation of health services and other clinically relevant socio-demographic factors. Clinical variables, such as CD4 count and viral load, were obtained through longitudinal linkages with the Drug Treatment Program (DTP) at the BC Centre for Excellence in HIV/AIDS. In order to examine the effect of housing status on HIV risk behaviour, multivariate logistic regression was used with three outcomes: sex exchange, unprotected intercourse and recent IDU.

Results

Between 2007 and 2010 approximately 1000 participants were interviewed. The survey was modified part way through the study to stratify sexual behaviour based on partner-type. This analysis is thus restricted to 477 interviews with full information on all outcomes. Median age was 45 (IQR=39–51) and 29.8% (142) were female. After adjusting for potential confounders, unstable housing was significantly associated with a history of exchanging sex for food, money or drugs (Adjusted OR [AOR]=1.92; 95% CI=1.11% to 3.33%) and recent IDU (AOR=2.39; 95% CI=1.41% to 4.03%). Unprotected sexual intercourse with regular partners, casual contacts and clients, was not significantly associated with housing status.

Conclusion

Greater levels of sexual exchange and injection drug use among unstably housed populations are associated with aspects of transient living conditions, as well as the increased need and opportunity for sexual exchanges for food, shelter, drugs and money. Our findings suggest that secure and affordable housing is an important structural intervention that may reduce HIV risk behaviour.
O2-S5.04 Outlier populations: heightened risk for HIV, HCV and HIV/HCV co-infection among solvent-using injection drug users
Authors: Shaw S , Deering K , Jolly A , Wylie J
Published: July 2011

Introduction

Globally, substantial heterogeneity in the prevalence of HIV and other sexually transmitted infections (STIs) among most at-risk populations (MARPs) has been demonstrated. Examining factors related to heterogeneity can inform targeted programming. In Winnipeg, Canada, particularly high risk for HIV and hepatitis C (HCV) has been observed in injection drug users (IDUs) with a history of solvent use (S-IDUs). However, comparisons to other MARPs have been limited. Thus this study examined the association between HIV/STIs and S-IDUs in comparison to IDUs and other MARPs.

Methods

Data were from a 2008 to 2009 cross-sectional study of Winnipeg MARPs (IDUs, sex work- and street-involved individuals); subjects were recruited through respondent-driven sampling (RDS) methods. Adjusted ORs (AORs) from multivariable logistic regression models were estimated, examining the risk of HIV, HCV and HIV/HCV co-infection, and corrected for RDS-chain clustering using generalised estimating equations.

Results

Total sample was 499, of which 13% recently injected drugs (ie, last 6 months), 5% recently inhaled solvents, 6% were recent S-IDUs, and 76% did not inject drugs or inhale solvents. HIV and HCV prevalence among recent S-IDU was 21% and 79%, respectively; HIV/HCV co-infection was 18%. In multivariable models, S-IDUs were at highest risk of HIV (AOR: 3.6, 95% CI: 1.6% to 7.9%; p<0.001), HCV (AOR: 19.3, 95% CI: 6.8% to 58.3%; p<0.001) and HIV/HCV co-infection (AOR: 6.0, 95% CI:2.5% to 14.7%; p<0.001). Comparatively, AORs for IDU-only were 3.3 (95% CI: 1.3% to 7.6%), 3.8 (95% CI: 2.3% to 7.5%) and 4.9 (95% CI: 2.1% to 14.7%). Among lifetime S-IDUs, elevated risk for HIV (AOR: 7.4, 95% CI: 2.3% to 26.2%) and HCV (AOR: 22.7, 95% CI: 11.0% to 47.0%) was observed, but not for HIV/HCV co-infection.

Conclusions

Solvent use occurs among the most marginalised of MARPs, representing unique and complicated drug use trajectories. As the HIV epidemic in Canada becomes increasingly complex, examination of outlier populations such as S-IDU can inform public health by elucidating important pathways by which structural, environmental and individual factors interact to create the highest risk for HIV/STIs and other bloodborne pathogens.
O2-S5.06 Health-seeking behaviours among female sex workers in a community randomised trial in Peru (The Peru-PREVEN Study)
Authors: Kohler P , Campos P E , Buendia C , Carcamo C , Garcia P J , Hughes J , Mejia C , Garnett G , Holmes K
Published: July 2011

Background

This study aims to evaluate health-seeking and HIV/STD preventive behaviours among FSW in mid-sized cities in Peru associated with a community randomised trial intervention and with venue of sex work.

Methods

Through the Peru PREVEN multi-component intervention, mobile team outreach to FSW was conducted in an effort to lower STD rates and increase condom use as well as care-seeking from local Ministry of Health clinics for screening and evaluation of STDs. Relative risks for behavioural outcomes were calculated using multivariate Poisson regression models with robust standard errors and accounting for clustering by city. Analyses were adjusted for city-specific baseline outcomes and by brothel venue, as there were a higher proportion of brothels in intervention cities. A sub-analysis of outcomes associated with brothel venue did not control for baseline but did adjust for age, marital/cohabitation status, alcohol use, geographical region, education and randomisation arm.

Results

4156 FSW were enrolled in 20 cities; 2063 from control and 2093 from intervention cities. The median age at first paid sex was 21 years and the median duration of sex work was 20 months. Sex work was relatively frequent, with a median of 6 days worked in the last week, 4 weeks in the last month and 8 months in the last year. Frequency of sex work increased with age (p<0.001). Twenty-one per cent of FSW were brothel based, 23% street based and 56% were bar or nightclub based. Although proportions of care-seeking behaviours were higher in intervention cities, differences were not statistically significant. In evaluating relationships of venue and health-seeking behaviours, brothel-based FSW reported significantly lower rates of non-condom use with clients (RR=0.18; 95% CI 0.07% to 0.44%), and higher rates of recent health screening exams (RR=1.97; 95%CI 1.58% to 2.45%) and of HIV testing in the last year (RR=1.74; 95% CI 1.45% to 2.09%), compared with FSW who were street or bar-based. Brothel-based FSW also more frequently reported knowledge of STDs (RR=1.07; 95% CI 1.04% to 1.09%) and recognition of STD symptoms in women (RR=1.39; 95%CI 1.22% to 1.59%) and in men (RR=1.32; 95% CI 1.12% to 1.57%).

Conclusions

Sex work venue is significantly associated with the health care-seeking and STD preventive behaviours of sex workers. Interventions to promote STD detection and prevention among FSW should consider structural or regulatory factors related to sex work venue.
O2-S6.01 Non-consensual sex and association with HIV infection among women: a Cohort Study in rural Uganda, 1990–2008
Authors: Birdthistle I , Mayanja B , Maher D , Floyd S , Seeley J , Weiss H
Published: July 2011

Background

Non-consensual sex is associated with HIV infection in Africa, but there is little longitudinal data on this association. We describe reported non-consensual sex among women over two decades in rural southwest Uganda, including associations with incident HIV infection.

Methods

Between 1990 and 2008 in rural southwestern Uganda, consenting individuals in a population cohort who recently seroconverted to HIV were enrolled into a clinical cohort, along with randomly selected HIV-negative controls. Participants were invited to the study clinic every 3 months, and females asked about recent experiences of sex against their will (since their last visit). At enrolment, associations of non-consensual sex with HIV status were analysed using conditional logistic regression. With data from all visits, this association was analysed using logistic regression, with OR adjusted for age and year of interview, allowing for within-woman correlation.

Results

476 women aged 14–81 enrolled and attended 10 475 visits over 19 years. At the time of enrolment, 24% (41/188) of incident HIV and 16% (23/166) of HIV-negative participants reported non-consensual sex in the past year (adjusted OR=0.93, 95% CI 0.47% to 1.82%). Among those who reported recent non-consensual sex (since their last visit) at any visit, most (80/119) did so more than once, including 48% in over half their visits. Using data from all visits, reports of recent non-consensual sex were higher among HIV-positive than HIV-negative participants (22% vs 9%; aOR=2.29, 95% CI=1.03% to 5.09%), with the strongest associations among women aged 14–22, those over 50 years, and married participants.

Conclusions

The study shows high levels of repeated sex against one's will, with many women in this Ugandan population reporting new episodes of non-consensual sex in most or all of their visits. Non-consensual sex was most often reported by the youngest and oldest HIV positive women. Gender-sensitive HIV programmes should address repeated sexual coercion before and subsequent to HIV infection.
LBP-1.04 International validation of AmpliSens NAAT systems manufactured in Russia for diagnosis ofNeisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitaliumandTrichomonas vaginalis
Authors: Domeika M , Savicheva A , Shipitsyna E , Chen C Y , Skov-Jenssen J , Hjelmevoll O , Ballard R , Unemo M
Published: July 2011

Objectives

Data regarding the performance characteristics of STI diagnostic tests used in Eastern Europe are very scarce. The objective of this study was to validate the AmpliSens test systems (Central Research Institute for Epidemiology, Moscow, Russia), compared to internationally acknowledged and validated tests, for genetic detection ofN gonorrhoeae (NG),C trachomatis (CT),M genitalium(MG) andT vaginalis (TV).

Methods

In total, 319 females and 127 males were recruited. For evaluation of the TV tests, additional 33 patients with diagnosed trichomoniasis at dermatovenereological dispensaries (VD) were involved. Conventional AmpliSens PCR assay (cPCR), real-time PCR assay (rtPCR), and a real-time nucleic acid sequence-based amplification assay for detection of NG or CT were evaluated. Furthermore, AmpliSens cPCR and rtPCR for detection of MG or TV were tested. As international reference tests an internationally validated real-timeN gonorrhoeaeporA pseudogene PCR, Cobas Amplicor CT PCR and LightMix 480HT CT PCR, MG rtPCR targeting the MgPa adhesin gene with positive results confirmed by two MG cPCRs targeting the 16S rRNA gene and MgPa gene, and a TV rtPCR targeting a TV specific repeat DNA fragment, respectively, were used.

Results

The overall prevalence of CT infection was 12.6%. The AmpliSens CT NAATs and the reference methods displayed a high level of concordance (97.9%–99.2%). The prevalence of NG was 2.7% and 16% among the urogenital and extragenital samples, respectively. The AmpliSens NG NAATs and the reference method displayed high level of concordance (99.4–100%). The prevalence of MG was 2.5% among females and 9.6% among males. The highest sensitivity (71.4%–100% in different specimens) was exhibited by the AmpliSens rtPCR. All tests had a 100% clinical specificity. The prevalence of TV was 1.2% among the females, and all additional VD patients tested positive. The sensitivity and the specificity of both Russian TV tests validated was 100%.

Conclusion

It seems clear that the biomedical industry in Eastern Europe has the potential for producing reliable reagents and tests kits at affordable prices for genetic diagnosis of STIs. This would open new perspectives for the whole region and could also be cost-effective for some other regions experiencing financial constraints. However, more comprehensive evaluations of regionally manufactured tests should be conducted according to internationally accepted guidelines.
LBP-1.06 Infectious syphilis in New Brunswick: using data for action in a small Canadian province
Authors: Frosst G , Tremblay F W , Allard D
Published: July 2011

Background

New Brunswick (NB) has experienced a resurgence of infectious syphilis with a 10-fold increase in the incidence rate between 2007 and 2010. In response to this increase in cases, an outbreak control team was convened and enhanced surveillance of syphilis was implemented to better understand the epidemiology of infectious syphilis in NB and to inform public health action.

Methods

A standardised enhanced surveillance investigation form was developed to collect detailed information about syphilis cases, their sexual contacts, and risk factors. Since December 2010, all new cases of infectious syphilis reported in NB are followed up by regional Public Health staff using the standardised form, where completed forms are faxed to the provincial office for entry into a central database. Results are disseminated regularly to stakeholders through descriptive epidemiologic reports. Social network analysis (SNA) of cases, contacts, and meeting places for sexual partners (ie, venues) is also occurring to identify routes of transmission and points of intervention.

Results

Fifty-six cases of infectious syphilis have been reported in NB since November 2009, corresponding to annual incidence rates of 5.0 per 100 000 in 2010 and a projected 6.1 per 100 000 in 2011. The majority of cases are located in the small urban centers of Moncton and Fredericton with sporadic cases located in Saint John and rural NB. Ninety-three per cent of cases are male with the highest incidence rate among males aged 20–24 years (58.8 per 100 000 population from November 2009 to April 2011). Five male cases are co-infected with HIV. Eighty-eight per cent of male cases are men who have sex with men, most of whom reported having multiple casual or anonymous sex partners in the months preceding diagnosis. Venues for meeting sex partners include websites, bars, and bathhouses. The epidemiologic reports and SNA informed the first phase of a province-wide social media campaign launched in February 2011. The campaign targets men aged 18–55 years and includes distribution of posters, condom matchbooks, and online advertisements at venues identified by cases.

Conclusions

NB is currently experiencing an outbreak of infectious syphilis. Enhanced surveillance activities, regular epidemiologic reporting, and SNA have informed the development of public health interventions targeting adult males, primarily men who have sex with men in Moncton and Fredericton.
LBP-1.07 Ecology of Human papillomavirus (HPV) infections in the male, studied using Expressed Prostate Secretions (EPS)
Authors: Smelov V , Eklund C , Dillner J
Published: July 2011

Background

In a new era of Human papillomavirus (HPV) vaccination, adequate diagnostics of the viral infection in men becomes more important: the monitoring of the vaccination effect requires evaluating whether vaccine HPV types disappear from and how the prevalence of non-vaccine types is affected in either high-risk groups or general population. Detection methods and anatomical sites for optimal HPV sampling are of high interest among healthcare specialists. Expressed prostate secretion (EPS) obtained during digital rectal examination—a daily routine urological diagnostic procedure—and following massage of the prostate, represents an alternative sampling material for the study of HPV ecology in the male. We present the results from the first study on HPV detection in EPS, as detected using a reference method used at the WHO HPV LabNet global reference laboratory, a multiplex high-throughput genotyping using the Luminex system.

Methods

The EPS samples were from 186 heterosexual men (mean age 32 (range 19–60) years (median sexual life start at 17.6 (9–25) years; 33 (1–500) median life-time sex partners; no concurrent STDs at the time of the study) were collected in a urology outpatient unit in St. Petersburg and tested for the presence of HPV DNA in Stockholm by the Luminex assay.

Results

The results are presented in the Abstract LBP-1.07 table 1. HPV prevalence in the study population was 25.3% for all HPV types with 11.8% for oncogenic types only. High-risk (HR−) HPV 16 and 66 were the most common types 3.7 and 2.7% of men, respectively. Interestingly, untypable HR-HPV types were found in 3.2% of EPS samples. Multiple oncogenic types were found in 22.7% of all HR-HPV+ EPS samples.

Conclusions

EPS can be used for HPV studies in men: additional investigation of EPS may result in better understanding the transmission of HPV infection and to develop strategies for HPV prevention. For the first time, the full range of HPV types in the EPS of men with no STDs was explored.

Abstract LBP-1.07 Table 1

HPV infection prevalence in the prostate (EPS) samples of 186 men

HPV typesLow-risk HPV typesHigh-risk HPV typesUntypable types61142435367707481878991Multi1618313545565866Men, HPV+11211131161515732421156 (3.2%)22 (11.8%)21 (11.3%)47 (25.3%)Total186
LBP-1.10 Misclassification of syphilis cases using a reactive enzyme immunoassay and reactive RPR algorithm alone for diagnosis
Authors: Singh A , Fonseca K , Mukhi S , Gratrix J , Plitt S , Read R , Sutherland K , Zahariadis G , Tyrrell G , Lee B
Published: July 2011

Background

Recent recommendations propose that samples dually reactive by a syphilis enzyme immunoassay (sEIA) and RPR be reported as positive for syphilis without confirmatory testing.

Methods

Samples from 1 September 2007 to 19 March 2011 testing reactive by sEIA and tested by INNO-LIA (IL) were extracted from the Alberta Provincial Laboratory for Public Health's DIAL (Data Integration for Alberta Laboratories), a web based application. Syphilis testing history was reviewed for all patients with a reactive sEIA and reactive RPR and negative (NEG) or indeterminate (IND) result by IL. Syphilis infection was defined by a positive confirmatory test (majority IL; a few TPPA and FTA-ABS). The significance of RPR titres in patients NEG/IND by IL with or without evidence of syphilis infection was analysed using χ2test. Median standard cut-offs (s/co) for the sEIA were compared using the Mann–Whitney U test.

Results

6195 samples from 4695 patients with reactive sEIA were also tested by IL: 15 samples (0.2%) had no reported RPR result, 4232 (48.3%) were non-reactive by RPR, and 1948 (31.4%) samples from 1753 patients were reactive by RPR. 72 (4.1%) of the 1753 patients with reactive RPR had at least one specimen tested NEG/IND by IL (Abstract LBP-1.10 figure 1). 3 of the 72 patients (4.2%) had a serological history of syphilis infection not recognised initially, 15 (20.8%) had no follow-up testing, 23 (31.9%) had a subsequent positive IL, and 31 (43.1%) did not demonstrate syphilis infection on follow-up testing. For the 31 patients with no serological evidence of syphilis infection, 24 remained NEG/IND by IL and seven tested negative by sEIA on follow-up. Overall, 31 patients (1.7%) would have been misclassified as infected based upon an algorithm of dually reactive sEIA and RPR without confirmatory testing. 14.7% of samples that tested negative or IND for IL in confirmed syphilis had RPR titres =1:8 as compared to 20.0% of samples from patients without syphilis on follow-up serology (p=0.5). The median s/co of the screening sEIA for samples from the patients who were infected (4.8, range: 1.0–24.20) differed from the s/co (2.6, range: 1.0–12.4) for those uninfected (p<0.05).

Conclusions

In our experience, 1.7% (31 patients) would have been misclassified as a case of syphilis if a third confirmatory test for syphilis had not been conducted. Additional evaluation of syphilis testing algorithms is warranted before a two test algorithm is widely employed.

Abstract LBP-1.10 Figure 1

Misclassification syphilis cases