bluuebunny/crossref_metadata_2025 huggingface dataset:
P2-S2.05 Mobilising female sex workers to access outreach and medical services: a case study from Solapur district, Maharashtra, South India
Authors: Raghavendra T
Published: July 2011

Background

Solapur in south India is a district to which large numbers of female sex workers (FSWs) migrate from nearby states. The district also holds a number of jatras (religious festivals), in which thousands of people assemble for a short duration of time at a specific location, and where FSWs find a ready market for their services. We are implementing an HIV prevention program in the district among approximately 2525 FSWs, with a view to reducing the transmission of HIV and STIs, and improving their health seeking behaviour.

Methods

Services provided include condom promotion and distribution, and clinic visits for STI detection and treatment. Strategies used for mobilising the community include outreach planning using a peer-educator based approach, development of site-wise social and local hotspot analysis maps, provision of voluntary HIV counselling and testing services in public-private partnerships, and provision of night outreach clinics in brothels. Those FSWs accessing the program are registered with a unique identification number and each outreach contact or clinic visit is recorded using a standard format, with type of service rendered. Peer cards and clinic forms are used to record individual outreach and clinical services provided, and information is entered into a computerised database at local level. The system is web-enabled to avoid double counting, and local implementation units can access information on the provision of services to any particular FSW at multiple clinics across the district.

Results

Over a nine-month period in 2010, 51% (1,298) of the FSWs visited the clinic each month, and 88% (2214) visited the clinic at least once in a quarter. 31% of newly identified FSWs received presumptive STI treatment within 1 month of initial contact. 86% of the women reported condom use at last sex with a commercial sex partner. 1,051 FSWs were tested for HIV, and 4% of them tested positive. 91% of positive FSWs were linked to care services, including assessment for anti-retroviral therapy.

Conclusions

Mobilising the FSW community to utilise clinic services on a regular basis is a challenge, especially in a context of high levels of migration, with frequent turnover. This requires a multi-faceted strategy and effective outreach planning, using micro-plans at local site level. Providing health services close to the community and at convenient times is very important for achieving high levels of coverage.
P2-S2.06 Becoming a sex worker: the nexus between violence, gender disadvantage and poverty
Authors: Shahmanesh M , Wayal S , Cowan F
Published: July 2011

Background

Community mobilisation of female sex workers is integral to India's HIV prevention strategy. Sex workers often become infected by HIV soon after initiation into sex work. The societal factors that propel women into sex work may also inhibit the self-efficacy/agency required to access healthcare and adopt safer sexual behaviour.

Methods

In-depth interviews were conducted with sixteen purposively selected (based on HIV status, ethnicity, age, area, and type of sex work) female sex workers in Goa, India (December 2004–December 2005). We interrogated the life narratives to explore the nexus between the social context/risk environment and self-efficacy/agency.

Results

The narratives showed a dynamic interplay between underlying vulnerabilities, precipitating factors, and the route through which women gain entry into the sex trade: The ubiquitous mitigating theme that emerged was violence in childhood and youth. This ranged from dysfunctional and violent family life, sexual violence, and violence from intimate male partners. The other underlying vulnerabilities that emerged from the narratives were also manifestations of gender disadvantage, namely being unwanted; sexual naïveté and young marriage/sexual initiation; repression of sexuality, desire and entrapment in loveless marriages; and lack of life skills and low self-esteem. The loss of social support through bereavement, abandonment or financial need, were the commonest events that precipitated entry into sex work. Becoming a sex worker was frequently an expression of agency in a context with few other economically viable choices for women. The clearest division in the route into sex work was between traditional caste-based sex workers (devadasi) and those who were either introduced by peers, or sold through a broker; however the underlying and precipitating factors for both routes were remarkably similar. Mostly, initiation was described as a complex process that was mediated through peers.

Conclusion

The interplay between caste, economy, gender, and violence drives the initiation into sex work, which is one of the few viable choices for the women. HIV prevention interventions therefore need to work upstream to impact upon the context within which women enter sex work and downstream to strengthen their agency. The peers who introduce women into sex work are potentially important vehicles to deliver “HIV prevention services and reduce the adverse health outcomes of sex work.”
P2-S2.07 Improving sexually transmitted infections (STI) prevention strategies: factors associated with STIs among female sex workers in India
Authors: Narayanan P , Das A , Gurung A , Parimi P , Rao G , Risbud A
Published: July 2011

Background

Studies among high-risk groups (HRGs) have shown that the presence of STIs is associated with certain demographic and behavioural characteristics as well as exposure to HIV/STI prevention interventions. The objective of this study was to understand the correlates of STIs in female sex workers (FSWs) in India in order to improve STI programming for HRGs.

Methods

During 2008–2009, 417 female sex workers were recruited from three STI clinics in two cities of India as part of an operations research to evaluate the effectiveness of STI prevention service package for sex workers under Avahan, the India AIDS Initiative of the Bill & Melinda Gates Foundation. Behavioural and clinical information along with biological samples were collected. Bivariate analysis of demographic and behavioural characteristics associated with the prevalence of common bacterial STIs-Neisseria gonorrhoeae,Chlamydia trachomatis,Treponema pallidumandTrichomonas vaginalisfrom the baseline data is presented in this paper.

Results

At baseline 49.2% of the participants had a laboratory confirmed diagnosis for at least one of the four bacterial STIs. The significant factors associated with STI prevalence among FSWs were: inability to read or write (OR=2.2, p=0.002); not staying with a sexual partner (OR=1.5, p=0.036); typology of sex work: home-/hotel-based (OR=2.5, p=0.038) vs brothel-based and street-based (OR=3.1, p=0.004) vs brothel-based; regular or occasional consumption of alcohol (OR=1.9, p=0.002); poor knowledge of STI symptoms (OR=1.6, p=0.017); low self-risk perception for acquiring STIs (OR=1.6, p=0.031); less than 2 years in sex work (OR=1.8, p=0.008); no prior exposure to HIV/STI interventions (OR=2.0, p=0.001); and no STI check-ups in the past 6 months (OR=1.5, p=0.029) see Abstract P2-S2.07 Table 1.

Abstract P2-S2.07 Table 1

Factors associated with sexually transmitted infections among female sex workers in India

FactorsOR 95% CIp valueIlliterate (can not read or write)2.2 (1.3 to 3.7)0.002Not staying with a sexual partner1.5 (1.0 to 2.4)0.036Typology Brothel-basedReference Home/hotel-based2.5 (1.0 to 6.7)0.038 Street-based3.1 (1.3 to 7.7)0.004Consume alcohol (regularly or occasionally)1.9 (1.2 to 2.8)0.002Poor knowledge of STI symptoms1.6 (1.1 to 2.4)0.017Low self-risk perception for acquiring STIs1.6 (1.0 to 2.5)0.031New to sex work (less than 2 years)1.8 (1.1 to 2.8)0.008No prior exposure to STI/HIV interventions2.0(1.3 to 3.0)0.001No STI check-ups in past 6 months1.5 (1.0 to 2.3)0.029

Conclusions

HIV/STI prevention programs for FSWs in India need to prioritise services for HRGs who have characteristics associated with STI prevalence. Additionally, awareness activities should promote the importance of regular STI check-ups, recognition and early treatment for STI symptoms.
P2-S2.09 Profile of clients of sex workers developed through imagery used with FSWs in six major Pakistani cities
Authors: Abbas S S
Published: July 2011

Background

Negligible data on clients of FSWs is available in Pakistan. Severe punishments like stoning to death for sex outside marriage etc, has made clients unusually cautious and researchers have shied away in carrying out researches on the clients of sex workers. An innovative psychological method has helped obtain significant information about clients.

Methods

FSWs were asked to recall details about each of their 10 most recent clients through imagery conducted/guided by qualified Clinical Psychologists retrained to work with FSWs. FSWs were steered to remember client's: age, profession, time spent with them, place of risk taking, use of drugs, use of condom, who provided it, resistance if any against the use of condom. 120 FSWs out of 2055 FSWs recruited during recent surveillance round in six big cities of the country (20 FSWs from each city) were randomly selected. Each imagery session lasted 90–120 min. Profile of 1200 Clients was prepared.

Results

56.4% were less than 30 years (youngest: 13 years; oldest 75 years). 67.62% were married. Petty shop keepers, labourers and students constituted 62.18% of the clients and 81.4% of them lived in the same city. 51.84% were regular clients. In 59% of cases FSWs provided their own place for risk taking. Alcohol/Drugs were used in 53.31% cases. 45% of the clients left within 30 min. 52% of the clients bought oral or anal sex for extra money. Condom was used in 57% of the cases but in 58.46% of the cases it was provided by clients themselves. FSWs kept it with them to facilitate the clients. 78% of clients were worried about pregnancies and only 18% of clients worry about STIs. FSWs seldom tried to persuade Clients to use condoms and the most effective way was stated to be the fear of pregnancy.

Conclusions

Clients belong to the same city mostly regular, are inclined to use condom particularly to avoid pregnancy but could be educated to use it to avoid STIs. Client's population is definitely receptive for the use of condoms. Making the FSWs keep a condom on herself is likely to increase the use of condoms.
P2-S2.10 Sex worker collective organization in the absence of NGOs: a qualitative analysis of female sex worker hometown social networks in South China
Authors: Tucker J , Peng H , Wang K , Chang H , Yang L G , Zhang S , Yang B
Published: July 2011

Background

Reducing harm associated with selling and purchasing sex is an important public health priority in China, yet there are few examples of sustainable, successful programs to promote sexual health among female sex workers. Programs focusing on empowering sex workers using a rights-based framework have been effective in India and other regions, but have been challenging to replicate in China. The limited civil society and scope of nongovernmental organizations circumscribe the local capacity of female sex workers to collectively organise, advocate for their rights, and implement STI/HIV prevention programs. The purpose of this study was to examine social networks among low-income female sex workers in South China to determine their potential for sexual health promotion.

Methods

Semi-structured interviews with 34 low-income female sex workers and 28 outreach members were used to examine how social relationships affected condom use and negotiation, STI/HIV testing and health-seeking behaviours, and dealing with violent clients.

Results

These data showed that sex worker's hometown social connections were more powerful than relationships between women selling sex at the same venue in establishing the terms and risk of commercial sex. Female sex workers from the same hometown often migrated to the city with their hometown sisters and these social connections fulfilled many of the functions of non-governmental organizations, including collective mobilisation, condom promotion, violence mitigation, and promotion of health-seeking behaviours. Outreach members observed that sex workers accompanied by their hometown sisters were often more willing to accept STI/HIV testing and trust local sexual health services.

Conclusions

Organising STI/HIV prevention services around an explicitly defined hometown social network may provide a strong foundation for sex worker health programs. Further research on dyadic interpersonal relationships between low-income female sex workers, group dynamics and norm establishment, and the social network characteristics are needed. Hometown social networks may represent a powerful force for organising STI/HIV prevention among low-income sex workers in China and other regions with limited civil society.
P2-S2.11 Focused and early intervention in rural areas can impact on HIV transmission in Southern India
Authors: Washington R , Bhattacharjee P
Published: July 2011

Background

A number of districts in Karnataka, south India have an equal prevalence of HIV in rural and urban areas. A link worker scheme focused on prevention interventions with rural female sex workers, was implemented under the USAID supported Samastha project (2006–2011).

Methods

A rapid rural mapping covering 7700 villages across eight districts helped map 16 043 rural female sex workers clustered in about 1700 villages. Rural female sex workers (RFSW) were defined as women who lived and practiced sex work within the village. Peer educators supervised by outreach link workers identified, educated, directly provided condoms and mobilised RFSW to reach HIV services. STI and counselling and testing services were integrated into Primary Health Centres. An individualised web based management information system tracked outreach and services. Polling booth surveys were used to measure key behavioural outcomes.

Results

By the fourth year of implementation, 14 697 (91.6%) of the estimated RFSW were reached. Monthly contact rates were sustained at 85%, with each RFSW directly receiving a mean of 28.3 condoms per month. Condom use rates rapidly increased to 63% at last sex with any partner and 78% with clients. 81% received STI services and more than 67% had been directly referred and received their HIV status. The proportion reporting with STI symptoms remained stable at around 60%; however, 64% of these were vaginal discharge. Genital ulcer rates decreased from 5.5 to 0.8% and other STI conditions from 6.1 to 1.7%. HIV prevalence among RFSW across districts ranged from 2 to 4%. Overall, HIV prevalence among antenatal women declined from 1.9 to 0.5% (2006–2009) in these districts.

Conclusions

Focused and early interventions can reduce HIV transmission in rural areas and could be impacting even at the population level. It would be important to sustain focused prevention interventions in rural India.
P2-S2.13 A pilot study of the effectiveness of a vaginal washing cessation intervention among Kenyan female sex workers
Authors: Masese L , McClelland R S , Gitau R , Wanje G , Shafi J , Kashonga F , Ndinya-Achola J , Richardson B , Lester R , Kurth A
Published: July 2011

Background

Intravaginal practices have been associated with HIV-1 acquisition. This may be mediated by mucosal disruption, changes in vaginal flora, or inflammatory responses in the genital tract. Reducing vaginal washing could lower women's risk of HIV-1 acquisition. We conducted a prospective study to test the hypothesis that a theory-based intervention would reduce vaginal washing in a cohort of high-risk Kenyan women. We collected pilot data on changes in biological markers that might help to explain the relationship between vaginal washing and HIV-1.

Methods

HIV-1 seronegative women who reported current vaginal washing were recruited from a prospective cohort study of high-risk women in Mombasa, Kenya. A theoretical framework including Information Motivation and Behaviour and Harm Reduction was implemented to encourage participants to reduce or eliminate vaginal washing. At baseline and after 1 month, we evaluated vaginal epithelial lesions by colposcopy, vaginal flora by Nugent's criteria, and vaginal cytokine milieu using ELISA on cervicovaginal lavage specimens.

Results

Twenty-three women were enrolled. The most commonly reported vaginal washing substance was soap and water (N=14, 60.9%). The median frequency of vaginal washing per week was 7 (IQR 0–14). After one week, 21 (91.3%) participants reported cessation of vaginal washing. After 1 month, all participants reported cessation of vaginal washing (p≤0.001 for comparison of baseline to follow-up prevalence). The average number of cervicovaginal epithelial lesions by colposcopy decreased after 1 month compared to baseline (Mean [SD] 0.4 [0.6] vs 0.2 [0.5]; coefficient −0.14; 95% CI −0.29 to 0.01; p=0.08). Although there was no change in the prevalence of BV (OR 1.00, 95% CI 0.42 to 2.38; p=1.00]), these pilot data suggest that the likelihood of detecting Lactobacillus by culture might increase after cessation of vaginal washing (2 [8.8%] vs 6 [26.1%]; OR 3.71, 95% CI 0.73 to 18.76, p=0.11). Most cytokine levels were reduced after cessation of vaginal washing, but in this small, time-limited sample none of these changes were statistically significant.

Conclusions

A theory-based intervention was highly successful in reducing vaginal washing over 1 month. This pilot study suggests the need for future studies with a larger sample size and longer follow-up to determine the effects of vaginal washing cessation on the cervicovaginal epithelium, vaginal flora, and inflammatory markers.
P2-S2.15 Typology of female sex workers and association with HIV risks: evidence from China
Authors: Hong Y , Li X
Published: July 2011

Background

The fast growing heterosexual transmission of HIV in China has drawn global attention. Millions of female sex workers (FSW) play a critical role in the escalating epidemic. Existing studies on FSW in China have typically used venue, income or venue to categorise FSW and none developed a data-driven typology based FSW's HIV risks.

Methods

A cross-sectional survey was administered among 1022 FSW recruited from 60 different types of entertainment establishments or personal service sectors in southwest China. FSW's HIV risk was measured by a composite score of 12 items on condom use, HIV testing, STD infection, drug abuse. We used multiple regression and graphics to illustrate the relationship between the HIV risk and key FSW characteristics including age, working venue, and income.

Results

Unlike previous studies that assumed a linear relationship between HIV risk and age or income, our data revealed that the relationships between HIV risk or income varied by venue. For example, older FSW in clubs or massage parlour reported lower level of HIV risks compared to their counterparts whereas older FSW in saner or KTV reported higher level of HIV risks; but age was not significantly associated with HIV risk for FSW working in hair salons or streets. Income was positively associated with HIV risks; however, the association reversed after the income reached 1500 ¥ ($225). None of the key variables such as age, income, or venue can predict HIV risks singularly; in addition, all three variables need to be integrated to devise the appropriate typology.

Conclusion

Our study suggests that it was too simplistic to categorise FSW HIV risks by a single indicator; the interactions between individual and environmental factors underscored the importance of multiple indicators for typology. Interventions to reduce HIV risks in FSW in China could be more focused and targeted those at highest risks.
P2-S2.21 Traditional devadasi system under transition: boon or bane for HIV prevention programme?
Authors: Gurav K , Cooper E , Junno J , Stein D , Chintada D R , Doddamane M , Moses S
Published: July 2011

Background

One of the key factors attributed to high prevalence of HIV in Northern Karnataka (in India) is socially accepted and widely practiced sex work. Girls from “Devadasi” community enter into sex work through socially accepted way of being dedicated to deity “Yellamma”. Currently, the “Devadasi” system is under transition where, new dedications are not accepted by community leaders. As a result, the social organization of traditional sex work is changing.

Methods

An exploratory research was undertaken in the district of Bagalkot, Karnataka. Ethnographic methods, including participant observation and Focus Group Discussions (FGDs) were used. FGDs were conducted with leaders, sex workers, peer educators, adolescent girls from “Devadasi” community and HIV service providers.

Results

“Daiva” is a committee consisting of key leaders from “Devadasi” community. “Daiva” functions at the local (village) level and make decisions for the welfare of their community. The death of many young “Devadasi” sex workers due to AIDS was reported as a key factor for “Daiva” in stopping girls from entering sex work. Towards this end, “Daiva” has declared that the families who dedicate their daughters will be fined (RS 5000 to 20 000) and be outcasted. Although there seem to be a consensus to the decision of “Daiva”, there are families who still want their daughters to start sex work. The fear of social and financial reprimand is placing new sex workers and their families in a marginalised and potentially illegal position within their village. Meanwhile, it is making new “Devadasi”? sex workers, conceal their identity and also avoid the HIV prevention services offered by peer educators of their own community at the door step.

Conclusion

Changing social organization and conditions of “Devadasi” sex workers increases their intrinsic risk and vulnerability to HIV. Therefore it is important to address the structural changes occurring within the “Devadasi” community and also create an environment for new sex workers to freely access HIV prevention and care services. An innovative intervention model that could negotiate between objectives of “Daiva” and needs of sex workers is required.“
P2-S3.02 Latent class analysis of sexual risk patterns among heterosexually-identified, socially marginalised men in urban, coastal Peru
Authors: Konda K , Celentano D , Kegeles S , Coates T , Caceres C ,   NIMHCollaborative HIV/STD Prevention Trial Group
Published: July 2011

Introduction

We explored patterns of sexual risk behaviour in a population of heterosexually-identified Peruvian men using latent class analysis, a technique that creates classes based on response patterns to questions related to a latent variable. In this study, the latent variable of interest is sexual risk behaviour.

Methods

We used data from the Peru site of the National Institute of Mental Health (NIMH) Collaborative HIV/STD Prevention Trial to investigate patterns of high-risk behaviour among heterosexually-identified men (n=2109). Seven sexual risk behaviours were analysed in latent class analysis to group men into risk classes. These self-reported behaviours included using drugs in the past month, using alcohol or drugs prior to sex, having 3 or more sex partners in the past 6 months, having concurrent sex partnerships, exchanging sex for money, and having a male sex partner in the past 6 months.

Results

Four latent classes of risk were identified, of which two classes had lower probabilities of these risk behaviours and two classes had higher risk classes probabilities of these risk behaviours. Increasing probability of risk behaviours by classes was significantly correlated with increasing reports of unprotected sex (p value for trend test <0.001). HIV/STI prevalence was elevated in all classes and prevalence increased with increasing probability of reporting the risk behaviours, although the differences were not significant. The risk behaviours in two of the latent classes identified were primarily related to alcohol and drug use.

Conclusions

Risk behaviours in this population of heterosexually-identified men vary by latent class; however, given HIV/STI prevalence in each class all require prevention interventions. Interventions should also focus on alcohol and drug use, as these are important risk factors for this population. Future behavioural interventions for the prevention of HIV/STI infection may benefit from this information by tailoring messages to fit the observed patterns risk.
P2-S3.03 Exploring perceptions of the social determinants of STIs in African American communities of the USA
Authors: Friedman A , Forsythe A , Poehlman J , Harris S , Smith J , Uhrig J
Published: July 2011

Background

African Americans (AAs) make up 12% of the US population, yet they account for about half of all reported chlamydia and syphilis cases, and 70% of gonorrhoea cases. Targeted, culturally sensitive interventions are needed to address these disparities. This study sought to explore how AAs perceive STIs in their communities, and what they feel should be done to address the problem.

Methods

Triads (n=31) and individual interviews (n=64) were conducted with sexually active, heterosexual AA adults, ages 18-45, in four communities with high STI incidence. Triads were segmented by age, gender, and urban/rural residence. Interviewers (gender/race-matched) used a semi-structured guide to explore awareness and importance of the STI problem in AA communities, perceptions of contributing factors and high-risk groups, and suggested solutions. Discussions were audio-taped and transcribed. A team of three analysts coded transcripts using QSR NVivo8, based on a codebook developed from identified themes.

Results

A total of 158 adults participated. Overall, STDs were believed or presumed to be very common in AA communities. Many had heard about the disparate STD/HIV rates on the news/TV or in school. Men were more likely to challenge this, reasoning that AAs are heterogeneous and that STIs are more likely influenced by socioeconomic status (SES) than race. Participants identified youth, low SES groups, drug addicts, Sex workers, homosexuals, and men on the down low as highest-risk groups. Promiscuity and a lack of sexual-health education, care for self/others/future, and health-care access were seen as major causes. Other contributing factors were teen pregnancy/family disintegration, gangs, drugs, school dropouts, unemployment, poverty, boredom, hopelessness, male/female ratio, partner concurrency, and the media. Overall, STIs were seen as a relatively low priority. Yet most felt that change is critical and could be promoted through music, mass media, faith-based/community/organizational, electronic and interpersonal channels. Increasing information, education, and healthcare access; and developing parenting, self-esteem boosting, and mentoring programs were suggested.

Conclusions

STDs among AAs are recognised as a likely consequence of many underlying social, structural and community ills, which must be addressed to reduce STD disparities. Traditional STD prevention efforts must be supported by non-traditional social/structural interventions.
P2-S3.04 Condom use among US adults at last sexual intercourse, 1996-2008: an analysis of general social survey (GSS) data
Authors: Warner L , Anderson J , Macaluso M
Published: July 2011

Background

Public health programs have sought to increase the use of condoms among persons at risk for transmitting or acquiring sexually transmitted infection. Although data from national health surveys have indicated increasing trends in condom use among adults since the onset of the HIV epidemic, little is known about recent national trends in usage.

Methods

Questions on condom use at last sexual intercourse were added to the General Social Survey, a nationally representative survey of US adults 18 and older conducted in alternating years, beginning in 1996. Using data from 1996 to 2008, the prevalence of condom use at last intercourse was estimated, and trends and correlates of this measure were evaluated.

Results

Across the 13-year period, condom use was reported by 20.2% of respondents during their most recent intercourse. Use was significantly higher for sex outside ongoing relationships as compared to within relationships, (46.4% vs 18.1%, respectively) and among those with 2 or more past-year sex partners as compared to one partners (44.7% vs 15.6%). A statistically significant increasing 1996–2008 trend in condom use was detected overall, but not for use within partnership type or by number of partners.

Conclusions

Similar to other studies, condom use was more likely to be reported by persons most at risk; however, even among those at increased risk, fewer than half used condoms during most recent sexual intercourse.
P2-S3.05 Association of STI-related stigma and shame to STI testing and partner notification among young black men in San Francisco
Authors: Lippman S , Morris J , Lightfoot M , Philip S
Published: July 2011

Background

Young minority men in the US bear a disproportionate burden of STI, but comprise one of the population groups least likely to access services. STI service utilisation is not only constrained by access to quality care but also potentially impacted by socio-cultural factors, including STI-related stigma and shame, which can undermine efforts to promote testing and treatment. STI-related stigma and shame may also provide a disincentive for young men to participate in partner notification programs, including partner-delivered therapy. We hypothesised that young men who perceive increasing levels of social stigma related to STI would be less likely to seek out STI-related services or notify their sexual partners about STI.

Methods

Between June and July, 2010, 108 African American young men (15—24 years) responded to a brief, self-administered intercept survey on a hand-held device. Recruitment was conducted on the street and in residential areas of a low income urban neighbourhood with elevated STI rates. The survey included socio-demographic questions, an 11 item scale measuring STI-related stigma and shame, and questions regarding STI testing history, preferences for notifying partners, and interest in partner delivered therapy. The association between stigma and shame scores and STI testing and partner notification preferences was evaluated with multivariate logistic regression, adjusting for age and education.

Results

The median (range) STI-stigma score was 12 (5–25) and the shame score was 15 (6–30); higher scores indicate more stigma or shame. Most participants had ever been tested for STI (73%), indicated willingness to personally notify their main partners (72%) or other partners (66%), and said they would deliver STI therapy to a partner (68%). Increasing STI-related stigma was significantly associated with a history of STI testing, such that every SD increase in stigma score was associated with 50% decreased odds of having been tested (OR: 0.5, 95% CI 0.3 to 1.0). Participants with higher levels of stigma and shame were also significantly less likely to be willing to personally notify their partners of STI or to deliver therapy.

Conclusions

STI-related stigma and shame, common in this population, could undermine STI testing, treatment, and partner notification programs. Efforts to expand access to care should be accompanied by efforts to change socio-cultural attitudes and norms around STI testing and treatment.
P2-S3.06 Exploring sexual identity development of African American male college students Age 18–25 at a historically black college and university
Authors: Randolph S , Golin C , Matthews D
Published: July 2011

Among the estimated 56 000 new yearly infections of HIV in the USA, 51% are among African Americans. This demonstrates a disproportionate burden of HIV infection as African Americans make up approximately 12% of the population. One group warranting attention in North Carolina has been African American male college students. Between 2000 and 2003, 11% of new HIV infections among men ages 18–30 were enrolled in college at the time of their diagnosis, with 87% of those college students being African American. Another examination of HIV transmission among men ages 18–30 in North Carolina revealed that 15% of the men reported sexual contact with both men and women in the year prior to their diagnosis, and that these individuals were more likely than men who exclusively have sex with men to be African American and enrolled in college. Sexual identity is a complex and multidimensional construct, many factors of which have yet to be sufficiently explored in the context of the sexual transmission in the HIV epidemic. This is particularly true for heterosexual men and men who have sex with both men and women, as the work that has concerned sexual identity has often ignored these two groups. This neglect may stem from the fact that sexual identity development has often been inappropriately conflated to claiming a minority sexual orientation. As a part of an attempt to more fully understand the role that sexual identity may play in the lives of African American men, we interviewed African American male college students within a historically Black college and university (HBCU) in North Carolina. Our aim was to address a gap in the literature by exploring what shapes sexual identity and its development among African American men. This could potentially lead to future research that could explain sexual behaviour within the context of the HIV epidemic for this population. Interviews were used to assess experiences, attitudes, and beliefs about sexual identity development and sexual activity held by African American male college students. A total of 31 African American male students took part in this investigation that occurred at a HBCU in the central Piedmont region of North Carolina, located in one of the largest cities within the state. Researchers developed interview questions based on The Measure of Sexual Identity Exploration and commitment (MoSIEC) survey instrument. Results from this qualitative exploratory study revealed that the ideas and beliefs about sexuality and sexual identity for African American college males are heavily impacted by their peers and their environment. Males that had influence from an older sibling, cousin, or father about sex reported less sexual partners. Majority of the males reported that it is more acceptable for men to have multiple sex partners, but it is unacceptable for a woman to do the same.
P2-S3.08 Selling sex on the doorstep: development work for the third British National Survey of sexual attitudes and lifestyles (Natsal 3)
Authors: Tanton C , Phelps A , Nicholson S , Mercer C , Sonnenberg P , Datta J , Macdowall W , Erens B , Wellings K , Johnson A
Published: July 2011

Background

The Third British National Survey of Sexual Attitudes & Lifestyles (Natsal 3) builds upon groundbreaking research undertaken for Natsal 1 and Natsal 2 in 1990 and 2000, respectively. Natsal 3 aims to interview 15 000 men and women aged 16–74 years during 2010–2012. However, the first pilot (Pilot 1) for Natsal 3 achieved a response rate of only 38.4%, leading us to explore ways to maximise survey participation.

Methods

Following Pilot 1, we consulted widely with interviewers, survey methodologists and communications experts to improve documents sent to households in advance of the interviewer calling, and the survey branding. This included simplifying the advance letter language and removing specific references to “sex”; developing a more detailed information leaflet to send with the letter; developing a study logo and respondent website. In Pilot 2, households were randomised to be sent the leaflet with the advance letter or to be given it when the interviewer called. We also examined the effect of the token of appreciation on participation rates by randomising households to receive either a £15 or a £30 voucher for participation.

Results

The overall response rate increased to 50.3% (218/434 eligible addresses) in Pilot 2. This did not vary by whether or not households received the information leaflet in advance (50.8% and 49.6%, respectively), but interviewers felt that households sent the leaflet were more informed about the study and they were more confident approaching these households. Interviewers preferred the improved advance letter and some respondents reported that the website was a key factor encouraging them to participate. Pilot 2 response rates differed by token of appreciation (47.1% vs 53.4% for £15 vs £30) but the sample size was too small to conclude that the difference was significant, so randomisation continued during the first wave of fieldwork. Response rates in wave 1 before reissuing were 48.4% vs 50.6% for £15 and £30, respectively (p=0.2).

Conclusions

Despite survey response rates declining generally, Natsal 3 development work has shown that it is possible to attain an adequate response in a population-based survey of sexual behaviour. Careful wording of participant documents, attractive survey branding and a participant website all contributed to increasing response rates. Response rates were slightly higher for the larger token of appreciation but increasing the value was not considered cost-effective.
P2-S3.09 Mobility as predictor of involvemnet in high risk sexual risk behaviour
Authors: Kwena Z , Obuya C
Published: July 2011

Background

Population mobility has long been associated with frequency and variety of sexually transmitted infections including HIV. People's mobility tends to disrupt their traditional social constraints and control of sexual behaviour by giving them opportunity, isolation and the desire for unique experiences. Fishermen being one of the highly mobile populations, we sought to evaluated the extent to their mobility predicts their involvement in high risk sexual behaviour.

Methods

During a Phase I randomised double-blind placebo-controlled cross over trial evaluating the safety and acceptability of ethanol in emollient gel as a topical male microbicide, we collected data on fishermen's socio-economic and demographic characteristics, mobility patterns and sexual practices including extra-marital partnerships. We pre- and post-test counselled for STIs, obtained blood samples for HIV, HSV-2 and syphilis serologies and provided appropriate treatment and referrals. We analysed the data using descriptive statistics and then bivariate and multivariate logistic regression.

Results

Of the 167 fishermen screened, over a half (52%) were mobile defined as travelling and spending at least one night away from home in the month preceding the study). Two-thirds (63%) had active extra-marital relationships with only 5% consistently using condoms in these sexual encounters. During travel, a quarter (24%) drank alcohol and a similar number (25%) had sex with a third (32%) reporting new casual sex partners. At bivariate level, those travelling in the month preceding the study were more likely to be HIV+ (OR 2.08; 95% CI 1.01 to 4.28), have an active extra-marital relationship (OR 3.69; 95% CI 1.57 to 8.68), and have multiple sex partners in the six month preceding the study (OR 2.04; 95% CI 1.06 to 3.95). Mobility among fishermen was independently associated with having an active extra-marital relationship (AOR 3.64; 95% CI 1.11 to 12.00).

Conclusion

Mobile fishermen exhibit high risk sexual behaviour that include extra-marital sex and low condom use. This population is likely to benefit from STI/HIV prevention intervention.
P2-S3.10 HSV-2 serologic testing and psychosocial harm: a systematic review
Authors: Ross K , Wald A , Johnston C
Published: July 2011

Background

Serologic testing for herpes simplex virus type-2 (HSV-2) in persons without a history of genital herpes is currently not recommended partly due to the concern that HSV-2 diagnosis would lead to negative psychosocial sequelae, such as anxiety and depression. We conducted a systematic review to assess the evidence as to whether HSV-2 serologic testing among asymptomatic persons results in persistent negative psychosocial consequences.

Methods

Eight electronic databases and unpublished data sources were searched to identify studies measuring the psychosocial impact of HSV-2 serologic testing in persons without a history of genital herpes. To be included, studies had to test for HSV-2 using an HSV type-specific serologic test and to perform at least one psychosocial assessment of participants after they received HSV serologic results. We compared psychosocial responses in HSV-2 positive persons over time and vsHSV-2 negative persons (when available).

Results

Nine studies satisfied the inclusion criteria. Studies were published from the years 2000–2008 and were conducted in the USA (N=6), Australia (N=2), and the UK (N=1). In total, 1355 participants were included; 596 (44%) participants were HSV-2 positive, and of these 341 (57%) lacked prior history of genital herpes. Participants were recruited from a variety of settings (ie, STD clinics, HMO enrollees, college campuses). Follow-up ranged from immediately after diagnosis to 1 year afterwards. Seven studies reported that HSV-2 diagnosis by serologic test did not have a persistent negative impact on participants' mental health (anxiety, depression, self-esteem) or sexual attitude and satisfaction. Two studies reported a negative impact of testing; one found that 5 HSV-2 seropositive college students had increased distress 3 months post-testing as compared to HSV-2 negatives, and the other found self-reports of sexual undesirability up to one year after diagnosis. A genital herpes diagnosis was perceived as moderately severe for participants prior to testing; however, after HSV-2 testing, the perceived severity of a herpes diagnosis was lower among those testing HSV-2 positive.

Conclusions

Diagnosis of HSV-2 by type-specific serologic testing did not result in long-term psychosocial harm in most asymptomatic persons. Concerns about sustained emotional impact should not deter clinicians from testing individuals without a history of genital herpes for HSV-2.
P2-S3.12 Culture and research: how do you mix them?
Authors: Gesink D , McGilvery P , Tilley T , Saganiuk K
Published: July 2011

Background

Community-based participatory research principles partner community and academics through all stages of the research process. Our purpose is to describe how we have been combining traditional Cree cultural practices (culture) and Western academic research processes (research) to facilitate a restorative research experience.

Methods

Culture and research were given equal emphasis in the structure and content of meetings, governance structure of the project, knowledge exchange activities, project development and ethics. To begin this sexual health project, the Health Director invited academic and government partners to the community. Statistics on rates of sexually transmitted infections were shared with community partners. Since then, emphasis has been placed on face-to-face meetings in the community. Elders and community leadership have attended meetings and provided guidance on research activities. The governance structure was organised so primary decision makers are from the community and are guided by a community working group, cultural advisor and scientific advisor. Knowledge exchange was achieved through mutual participation in traditional Cree cultural activities and research emersion at an academic institution. Key community informants, Elders and research assistants led project development. The local First Nations College provided primary ethical review.

Results

Face-to-face meetings helped build strong, sustainable relationships between community and outside researchers. Knowledge exchange activities, like cultural teachings and research trainings, contributed to mutual respect, understanding and trust between community and outside team members. Participation in community events and traditional ceremonies combined with formal and informal discussions with the community working group, Elders, and key community informants led to the identification of a priority research area of importance to the community. Following community led ways of knowing and doing has led to the development of innovative research methods for data collection. Ethics review held in ceremony provided a supportive, holistic environment from which to proceed with research activities.

Conclusions

Building trust and nurturing the relationship between community and outside research partners has been integral for restoring confidence in the potential benefits of research for this First Nations community.
P2-S4.01 Epidemiological profile and motivations for HIV screening among people attending an anonymous HIV voluntary testing service in Cotonou, Benin
Authors: Zannou D M , Azon-Kouanou A , Alaye O M , Akakpo J , Azon D , Akinocho E , Anagonou-Y S
Published: July 2011

Background

The creation of the only free anonymous HIV voluntary counselling and testing (VCT) center in Cotonou (named SIDAG) is an HIV prevention strategy that allows to reach those who decide, for themselves, to know their HIV status. Knowledge of the epidemiological profile and motivations of these volunteers will help tailoring services offered to them.

Objectives

i) To describe practices at risk for HIV infection among the SIDAG's clientele ii) To analyse the motivations bringing these people for HIV screening; iii) To identify factors associated with HIV infection in this group. MethodsThis cross-sectional survey, carried out from April to June 2010, included all subjects attending SIDAG for HIV anonymous VCT who provided consent for participation. HIV testing was carried out immediately using an algorithm with two rapid tests (Determine and SD Bioline), and results were communicated on site to the participants before they leave.

Results

280 subjects participated in the study (149 men, 53% and 131 women, 47%). Their mean age was 28 years [range: 17–66 years]; 32% were college or university students, 53% had attained a higher educational level and 76% were single. 22% of the subjects had a history of STI. All subjects reported being heterosexual; 274 (98%) had sexual partners (regular partners: 73%; casual partners only: 25%). 27% always used condoms for casual sex. 13% of the men reported sex with sex workers. The main motivations for getting tested were the desire to know their HIV status: 43.6%; exposure to HIV through sexual contact: 20% (unprotected sex, condom failure, prolonged relation with HIV-infected partner); and peer pressure from family or friends: 11.2%. The HIV serology was positive in 6.8% of the 280 tested subjects. Factors associated with seropositivity were: a low education level (p<0.001), current or previous cohabitation with a sexual partner (p<0.01), lack of condom use (p<0.001) and motivation for testing because of clinical suspicion (p<0.001).

Conclusion

Candidates for anonymous HIV VCT in Cotonou are mainly young patients concerned by the risk behaviours they had. Services like SIDAG should be decentralised to serve the greatest number.