bluuebunny/crossref_metadata_2025 huggingface dataset:
P5-S7.08 Assessment of chlamydia testing coverage using HEDIS data: USA, 2009
Authors: Tao G , Hoover K , Romaguera R , Kent C
Published: July 2011

Background

In the USA, chlamydia screening of all sexually active women aged ≤25 years is recommended, but screening rates are low. The Healthcare Effectiveness Data and Information Set (HEDIS) performance measure has tracked the time trend in screening since 2000. It has been found that among sexually active women aged 15–25 years, chlamydia testing rates increased from 25.3% to 41.6% during 2000–2007. While rates have increased, they remain suboptimal, and it is unknown whether testing rates differ significantly between 2007 and 2009 or by the type of health plan.

Methods

The 2009 HEDIS chlamydia testing dataset was analysed to estimate the annual coverage among sexually active women aged 15–25 years who were enrolled in commercial health plans. Sexually active women were defined as those who had a claim or visit for pregnancy, contraception, cervical cancer screening, or STD diagnosis, screening, or treatment. A woman was counted as having a test if she had a claim or healthcare visit for any chlamydia test. Health plan types included in the HEDIS data are health maintenance organisations (HMOs), preferred provider organisation (PPO), point of service (POS), and any combination of HMO, PPO, and POS.

Results

Of 2.4 million sexually active women, 54.5% were enrolled in PPOs, 28.7% in combined HMO/POSs, 13.8% in HMOs, 2.7% in combined HMO/POS/PPOs, and 0.3% in POSs. The overall annual chlamydia testing rate was 44.2% and significantly differed by plan type: 56.1% in HMOs, 45.7% in combined HMO/POSs, 44.6% in POSs, 41.2 in combined HMO/POS/PPOs, and 40.5% in PPOs.

Conclusions

The annual chlamydia testing rate continued to increase between 2007 and 2009 (41.6% to 44.2%). However, the testing rate remains suboptimal, suggesting that additional interventions are needed to further increase testing rates. The highest testing rates were found in HMOs, healthcare settings that have interventions in place to promote provision of recommended healthcare services. The 2010 Affordable Care Act requires insurance plans cover preventive services such as chlamydia screening without patient cost sharing, and has the potential to increase chlamydia screening coverage throughout the US healthcare system. In light of these changes, it is important to continue to monitor chlamydia testing practices and to overcome barriers to testing.
P1-S2.04 Impact of female sex worker turnover on HIV prevalence, incidence and core group intervention impact in Cotonou (Benin)
Authors: Boily M C
Published: July 2011

Background

The influence of turnover of female sex workers (FSW), resulting from different durations spent in sex work or migration patterns remains partly understood but is believed to be an important determinant of HIV/STI spread among FSW and overall populations and intervention impact.

Methods

A deterministic transmission dynamics model, parameterised using serial cross-sectional data, was used to simulate the course of HIV and gonorrhoea (Gc) in FSW/clients and the general population of Cotonou. Different turnover patterns were produced by varying the time spent in sex work (SW duration=lifelong to 1 year) or, equivalently, time spent in the location by migrants (sojourn duration=lifelong, 5, 1 year). Each FSW leaving the local population was replaced by a new FSW with the same risk behaviour and with FSW HIV prevalence, for the SW duration scenarios, set to that of the low risk population and, for the migration scenarios, to 0%, 5% or 50%.

Results

Shortening SW duration (or sojourn duration with initial 0% FSW HIV prevalence) from lifelong to 5- and 1-year delayed and reduced FSW HIV peak prevalence from ∼75% in 1999 to 56% in 2000 and ∼25% in 2020, respectively. The 1-year scenario increased long-term HIV prevalence of the overall female population by twofold, as the rapid turnover reduced the decline in Gc prevalence caused by AIDS differential mortality. With 1-year sojourn duration, local FSW HIV prevalence was mostly determined by the HIV prevalence of new FSW and FSW HIV incidence always exceeded prevalence (Abstract P1-S2.04 figure 1). Sudden increases in turnover of new HIV negative FSW (or sojourn duration=1 year & 0% HIV), in a maturing epidemic (1993), could reduce FSW HIV prevalence by >50% within 2 years but increase HIV incidence, in absence of intervention, compared to no turnover (ie, lifelong duration). The different SW and migration duration patterns did not significantly reduce the general population impact of a FSW targeted condom intervention per se, after controlling for epidemic stages, assuming similar exposure to the intervention by local and new FSW.

Abstract P1-S2.04 Figure 1

Cotonou.

Conclusions

The impact of FSW turnover on HIV is complex but relatively modest if occurring at a slower rate than 0.20 per person-year (ie 1/5 years). Monitoring change in FSW turnover is important to interpret HIV prevalence trends over time, especially following an HIV intervention. Targeted FSW intervention remains effective in presence of rapid turn-over if new FSW can be reached rapidly.
P1-S2.16 What do female sex workers do if they have genital symptoms?
Authors: Lee K , Wong K H
Published: July 2011

Background

Female sex workers (FSW) is an important population in sexually transmitted infection (STI) epidemiology because of their extended partnership pattern that possibly leads to rapid STI spread. Prompt STI diagnosis, treatment and surveillance among FSW is therefore necessary for effective control of STI in the community, and public STI clinics remain the key platform for such. Yet, much is unknown about the pattern of health-seeking behaviour including STI clinic attendance of the FSW.

Methods

A cross-sectional survey of 986 FSWs sampled from one-woman brothels, bars, clubs and streets in Hong Kong were conducted in 2009. Questions on last year attendance at public STI clinics, NGO testing centres, prior 6-month self-reported STI, STI symptoms and the subsequent actions regarding the symptoms were asked. Descriptive analysis was performed to show these frequencies. Self-reported rate among those with or withot symptoms were calculated. Self-reported STI and STI symptoms among those STI clinic and NGO attendees and non-attendees were compared using χ2test.

Results

Overall, 7.8% respondents reported having at least one episode of STI in the last 6 month. About one-third reported either having abnormal vaginal discharge, growth or ulcer in recent 6 months. Strikingly, about two-thirds would either self-medicate or adopt wait and see approach and about one-third attended private doctor or doctor across the border. Altogether less than 5% would attend NGO/STI clinic. Only 26% reported attendance at public STI clinic and 25% in NGO testing centre in the past 1 year. Self-reported STI was reported by 4% of those asymptomatic respondents, and 14% among those reported having any genital symptoms (p<0.05). The self-reported STI rate and STI symptom pattern did not differ significantly between the public STI and NGO attendees and the non-attendees see Abstract P1-S2.16 Figure 1.

Abstract P1-S2.16 Figure 1

Actions subsequent to presence of genital symptoms (vaginal discharge, genital growth or ulcer). SHS, public STI clinic.

Conclusions

STI are three times more commonly reported among FSWs who reported genital complains. However, majority of them would not seek appropriate medical care when symptoms occur indicating that treatment might have been delayed. Self-medication is common and remain a challenge for health promotion in FSW. Although no significant difference is found between clinic attendees and non-attendees on STI symptoms, STI clinic data only captures a fraction of STI burden in FSW.
P1-S2.22 Changes in HIV knowledge & risk behaviours in female sex workers in Rwanda - HIV prevention implications of trend analyses in behavioural surveillance
Authors: Kayitesi C , Hinda R , Gwiza A , Balisanga H , Nsanzimana S , Koleros A , Uwimana J M V , Mwumvaneza M
Published: July 2011

In Rwanda, existing empirical and analytical studies indicate that female commercial sex workers (FCSW) play an important role in the HIV epidemic. It is thus critical to track sexual risk behaviours in this group in order to develop effective prevention programs and services for sex workers. In this context, the Ministry of Health (MOH) of Rwanda and partners conducted two rounds of behavioural surveillance surveys (BSS) among FCSW in 2006 and 2010. We used time-location sampling based on geographic maps of sex work hotspots in Rwanda to recruit a nationally representative sample of 1040 FCSW in 2006 and 1338 FCSW in 2010. At the time of the interview, all FCSW present at the site were asked to participate in the study and administered a quantitative survey instrument after obtaining informed consent. Data were double-entered and analysed using EpiInfo, SPSS and STATA. χ2Tests of significance were performed on key variables. Logistic regression analysis was performed to control for key socio-demographics. Overall, an increase in comprehensive HIV knowledge from 18% in 2006 to 22% in 2010 was observed (p Value<0.0001). However, some misconceptions still persist, with a decline in FCSW who rejected that mosquito bites can transmit HIV from 74% in 2006 to 69% in 2010 (p value <0.0001). The median age of respondents' first paid sexual act remained the same, with a reported median age of 19 years in both surveys. The proportion of FCSW who reported having consistently used condoms in the month prior to the survey rose from 28% in 2006 to 35% in 2010 (p value<0.001). At the same time, the proportion of FCSW who reported having used a condom during their last sexual act with a paying client dropped from 84% in 2006 to 80% in 2010 (p value<0.001). Comparing key indicators from the 2006 and 2010 BSS provides important insights for HIV program planners. Although the comparison indicates that overall HIV knowledge has generally improved in the time between the two surveys, some misconceptions on HIV transmission still persist. Equally, regarding sexual behaviour and practices, although consistent condom use reportedly improved between the two BSS, the overall level of reported use is still relatively low and some important indicators—including condom use at last sex with a paying client—declined. These data further underscore the importance of reaching FCSW with prevention commodities and appropriate HIV education and behaviour change communication messages.
P1-S2.23 Transgender persons in Guatemala - over-exposed and under-protected - the findings of an RDS behavioural survey
Authors: Miller W , Alvarez B , Boyce S , Alvarado A , Barrington C , Paz-Bailey G
Published: July 2011

Background

Male-to-female transgender persons experience the highest HIV prevalence rates of any high risk population in Central America. The purpose of this study is to compare HIV-related risk behaviours, knowledge and exposure to prevention activities among transgender persons and other men who have sex with men (MSM) in Guatemala City.

Methods

From September—to December 2010, we conducted a probability-based survey of MSM, including male-to-female transgender persons who have sex with men, using respondent-driven sampling (RDS) in Guatemala City. Data on sexual and drug use behaviour, knowledge of HIV, attitudes, stigma, access to prevention, care, and treatment services were collected by interviewers using Personal Digital Assistants (PDA). Population proportions and 95% CIs, adjusted for RDS sampling weights, were calculated using the Respondent Driven Sampling Analysis Tool (version 6.0). Crude summary statistics were calculated in SAS (version 9.1).

Results

A total of 509 MSM, including 99 male-to-female transgender persons enrolled in the study. The mean age for transgendered persons was 29.1 vs 28.0 for non-transgender MSM. Education level and socio-economic status were comparable between the two groups. Transgender persons, in comparison to non-transgender MSM, had higher rates of transactional sex (77.6% vs 41.9% in the past year, respectively), drug use (26.7% vs 3.3% cocaine use in the past month) and prior HIV testing (95.7% vs 68.9%, during lifetime). On the other hand, transgender persons have similar levels of forced sex (14.1% vs 6.5% in the past year), exposure to HIV educational activities (74.2% to 67.8% in the past year), access to free condoms (83.9% to 79.6%) and correct knowledge of HIV prevention (54.8% vs 41.7%) see Abstract P1-S2.23 Figure 1. Conclusions—Compared to other MSM, transgender persons in Guatemala City more often receive money for sex and use cocaine and are at disproportionately higher risk for HIV infection. While prevention activities, such as HIV testing, seem to be reaching transgender persons, exposure may not translate into increased protection. Findings emphasise the need for innovative HIV prevention activities to address the many facets and levels of vulnerability and social marginalisation experienced by transgender persons in Guatemala City. Such efforts should extend beyond individual-level outreach and information provision to rigorously evaluated intervention strategies at the social and structural levels.

Abstract P1-S2.23 Figure 1

Behavioural and HIV Prevention Indicators. Non-transgender MSM and Transgender Persons, Guatemala City, 2010.
P1-S2.25 HIV serostatus knowledge, absence of previous testing and sexual behaviours among injecting drug users
Authors: Blouin K , Parent R , Leclerc P , Blanchette C , Alary M , Morissette C , Roy É , Claessens C
Published: July 2011

Background

Few studies have examined the association between HIV status knowledge and sexual behaviours among injection drug users (IDUs). We tested the hypothesis that IDUs who know their HIV positive status will have safer sexual practices than IDUs aware of their HIV negative status or never tested for HIV.

Methods

IDUs who had injected in the past 6 months were recruited in harm reduction programs across the Province of Quebec and Ottawa, Canada. Participants completed a questionnaire including questions on sexual behaviours and provided saliva for HIV antibody testing. For IDUs with multiple participations, the last interview was selected. Data from 2003 to 2009 were analysed. Three groups were compared—IDUs aware of their positive HIV status (n=510), IDUs aware of their HIV negative status (n=2928) and IDUs never tested for HIV (n=427). Proportions were compared using χ2tests.

Results

Male IDUs aware of their positive HIV status were less likely to have had sex in the last month (HIV positive—32.4%, HIV negative—47.2% and never tested—55.0%; p<0.0001, n=2741) and, among those sexually active, more likely to have used a condom at last sexual intercourse (HIV positive—57.4%, HIV negative—43.7% and never tested—51.7%; p<0.005, n=1249). This was not observed for women. In the last 6 months, the proportion of male IDUs who had always used condoms for vaginal or anal sex with their female sex partners was significantly higher in HIV positive than in HIV negative and in those never tested, for regular (54.3%, 22.4% and 33.1%, respectively, p<0.0001, n=1131), casual (77.4%, 54.4% and 51.2%, respectively, p=0.0002, n=933) and partners of whom they are a client (86.7%, 69.7% and 42.1%, respectively, p<0.02, n=123). Women never tested for HIV were less likely than the other groups to use condoms with their regular partners (never tested—4.7%, HIV positive—21.3% and HIV negative—20.2%; p<0.05, n=550) and their client sex partners (never tested—46.2%, HIV positive—82.1% and HIV negative—76.6%; p<0.05, n=259). Women aware of their HIV positive status were more likely to report condom use with their casual sex partners, whereas those never tested were less likely (HIV positive—66.7%, HIV negative—48.0% and never tested—15.8%; p<0.01, n=250).

Conclusions

IDUs aware of their positive HIV serostatus reported more consistent condom use with their various types of sex partners than those aware of their HIV negative status or never tested.
P1-S2.26 Drug and sexual HIV risk among injection drug users - a latent class analysis
Authors: Noor S
Published: July 2011

Background

Injection drug users (IDUs) are at increased risk of HIV infection because they are more likely to engage in high risk injection behaviours (eg, needle sharing) as well as in high risk sexual behaviours (eg, exchange sex). This analysis examines factors associated with HIV risk using a latent class approach.

Methods

Our study includes 523 eligible injection drug users, recruited into the 2009 National HIV Behavioural Surveillance project. Using maximum likelihood we calculated the posterior probability of being in an HIV risk class from nine drug and sexual behaviours. We simultaneously fitted a multinomial regression model to identify socio-demographic factors associated with HIV risk class.

Results

We identified 3 HIV risk classes—high (42%), moderate (25%) and low risk (33%). Compared to the high HIV risk class, homeless IDUs had lower odds to be in the moderate (OR=0.16, 95% CI 0.04 to 0.70) and in low risk HIV class (OR=0.28, 95% CI 0.15 to 0.52). Moreover, IDUs who were arrested in the past 12 month had also lower odds to be in low risk class (OR=0.52, 95% CI 0.32 to 0.86) compared to high HIV risk class.

Conclusions

Our results show that the majority of our IDUs were engaged in high HIV risk behaviours. Though temporality cannot be established due to the cross-sectional study design our findings indicate that homelessness and history of incarceration are associated with HIV risk. Interventions targeting system-level change may help to reduce the burden of HIV among the injection drug user population.
P1-S1.09 Trends in the aetiology of sexually transmitted infections and HIV Coinfections among STI patients attending Alexandra Health Centre, Johannesburg, South Africa (2007–2010)
Authors: Lewis D , Ricketts C , Bhojraj N , de Gita G , Magooa P , Venter I , Mshibe L , Vezi A , Muller E , Radebe F
Published: July 2011

Objectives

To determine trends in the relative prevalence of aetiologies of urethral discharge (UDS), vaginal discharge (VDS) and genital ulcer (GUS) syndromes, and in the seroprevalence of syphilis, HSV-2 and HIV.

Methods

Consecutive male (UDS/GUS) and female (VDS/GUS) patients were enrolled at Alexandra Health Centre, Johannesburg from January to April each year during 2007–2010. Urethral swabs (UDS), endocervical swabs/vaginal smears (VDS), genital ulcer swabs/smears (GUS) and sera (all) were collected with written informed consent. Real-time PCR assays were used to detectNeisseria gonorrhoeae(NG),Chlamydia trachomatis(CT),Trichomonas vaginalis(TV) andMycoplasma genitalium(MG) from UDS/VDS swabs, and herpes simplex virus (HSV),Treponema pallidum(TP)Haemophilus ducreyi(HD) andChlamydia trachomatisL1-3 (LGV) from ulcer swabs. Slides were stained for bacterial vaginosis/candidiasis (BV/CA, VDS) and granuloma inguinale (GI, GUS). Sera were tested for syphilis (rapid plasmin reagin, RPR; Omega Diagnostics), for HSV-2 (HerpeSelect IgG; Focus Diagnostics) and for HIV (Determine; Abbott Laboratories). χ2for linear trend analyses were undertaken with summary data (Prism v.2, GraphPad Software).

Results

928 UDS, 805 VDS and 455 GUS patients were recruited overall. Trends in the relative prevalence of most syndrome aetiologies were non-significant between 2007 and 2011—NG (UDS, 71%–79%; VDS 11%–17%), CT (UDS, 20%–25%; VDS, 27%–37%), MG (UDS, 10%–13%; VDS, 11%–14%), BV (VDS, 30%–36%), CA (VDS, 26%–31%), HSV (GUS, 53%–75%), TP (GUS, 4%–7%), HD (GUS, 0%–2%), LGV (0%–2%). There were no cases of GI. There was, however, significant decreasing trends for TV detection among UDS (4%–13%, p=0.003) and VDS (19%–34%, p=0.001) patients. Serologically, VDS patients had a decreasing trend in RPR seropositivity (1–8%, p<0.001) and, importantly, HIV coinfections decreased among both UDS (29%–39%, p=0.011) and GUS (60%–75%, p=0.032) patients. Non-significant variations in seropositivity were observed for RPR tests among UDS (1%–3%) and GUS (4%–11%) patients, for HSV-2 among all groups (UDS, 50%–60%; VDS, 74%–84%; GUS, 81%–87%), and for HIV among VDS (48%–59%) patients.

Conclusions

These data suggest significant decreases in the prevalence of HIV coinfection in UDS/GUS patients and of trichomoniasis as a cause of UDS/VDS. Though the HIV trends are encouraging for men, the lack of a similar trend for women with VDS is of public health concern.
P1-S2.34 STI-Surveillance within AIDS Reference Centres in Belgium - high consistent STI incidence among HIV-positive Men having Sex with Men, 2008–2009
Authors: Verbrugge R , Van Beckhoven D , Sasse A
Published: July 2011

Background

The observation of STI in HIV-patients has triggered a STI-Surveillance in AIDS Reference Centres (ARC). The aim of this surveillance is to identify STI emerging in HIV-patients, to analyse STI-trends in this group and to describe patient characteristics.

Methods

There are nine ARC in Belgium. The ARC are specialised in HIV-patient care, STI-consultation and treatment. Since April 2007, seven ARC participate in the surveillance. STI included are limited toChlamydia, gonorrhoea, syphilis,Lymphogranuloma Venerum(LGV), hepatitis B (HBV) and hepatitis C (HCV) among men having sex with men (MSM).

Results

In 2008, 6962 HIV-patients (36.8% women; 63.2% men) were followed and 7454 patients (35.7% women; 63.9% men) in 2009. The HIV-population under follow-up increased by 7.1% (8.3% in men; 4.7% in women). In 2008 as well as in 2009, 279 STI were reported among the HIV-patients. It concerns 250 men and two women in 2008 and 251 men and two women in 2009; 242 were MSM in 2008 and 244 in 2009 (96%). The finding observed in 2009, with 5.3% HIV-infected men presenting an STI vs 5.7% in 2008 prevails a lower incidence of STI. This decrease is not statistically significant (χ2=0.76, a=0.38). In 2008 as well as in 2009, 13 patients were diagnosed with more than 1 STI (4.6% of the STI patients) The most frequent STI was syphilis, with 171 cases (61% of STI diagnosis) in 2008 and 160 cases (59%) in 2009, of whom one woman; respectively 94% and 95% of the men were MSM. Chlamydia has been found in 30 men and two women in 2008 and in 28 men and one woman in 2009. LGV was confirmed in 12 men in 2008 and in 15 in 2009. Gonorrhoea was found in 29 men in 2008 and 32 in 2009. HBV and HCV were respectively diagnosed in 2 and 14 men in 2008 and in 7 and 17 men in 2009. All men reported with Chlamydia, LGV, gonorrhoea, HBV and HCV were MSM. 64% (2008) and 75 % (2009) of the homosexual men with STI mentioned having multiple partners.

Conclusions

The surveillance in 2008 and 2009 confirms an STI-problem among HIV-infected MSM. These results highlight unsafe sex behaviour among MSM, also reflected by the high proportion of MSM reporting multiple partners. HIV-positive MSM are particularly vulnerable for syphilis. The incidence of LGV and HCV among HIV-positive men should be followed closely and an adaptation of the international screening policy for LGV and HCV is needed. Chlamydia patients belonging to high risk groups should be tested for the LGV variant.
P1-S2.35 Increased HIV and primary and secondary syphilis diagnoses among young men who have sex with men, 2004–2008
Authors: Torrone E , Bertolli J , Li J , Sweeney P , Jeffries W , Peterman IVT
Published: July 2011

Background

National surveillance data document increases in HIV and syphilis diagnoses in young black men who have sex with men (MSM), but trends could be driven by increases in a few large areas. We assessed the extent to which metropolitan areas of varying population sizes have reported increases in HIV diagnoses among MSM and in syphilis diagnoses among men.

Methods

We examined trends in HIV and primary and secondary syphilis case report data in metropolitan areas with greater than 500 000 people, at least 500 black men aged 13–24 years, and with mature HIV reporting systems as of 2004 (n=73). We compared the average number of case reports in 2004–2005 and 2007–2008 and examined differences by age at diagnosis (13–24 years, 25–29 years, ≥30 years), race/ethnicity (white, black, and Hispanic), and area population size (500 000–999 999, 1 000 000–2 499 999, and ≥2 500 000 persons).

Results

Among MSM aged 13–24 years, observed increases in HIV diagnoses were larger among blacks (average percent increase=68.7%) compared with Hispanics (36.7%) and whites (41.7%). Increases in HIV diagnoses were observed in more areas for black MSM aged 13–24 years (85% of areas) than for Hispanic MSM aged 13–24 years (62% of areas), or white MSM aged 13–24 years (58% of areas), or older MSM of any race/ethnicity (range—44%–62% of areas). (Abstract P1-S2.35 figure 1) Among men aged 13–24 years, primary and secondary syphilis diagnoses increased on average 203.5% among blacks, 99.7% among Hispanics, and 43.7% among whites, and increases were observed in more areas for blacks (70% of areas) than for Hispanics (44% of areas) or whites (59% of areas). (Abstract P1-S2.35 figure 1) The majority of areas (63%) had increases in both HIV and syphilis in black men aged 13–24 years. Across area size strata, the youngest group of black men had the highest average percent increase in diagnoses of HIV and syphilis as well as the highest percentage of areas with increases in diagnoses.

Abstract P1-S2.35 Figure 1

Change in average diagnoses of HIV among men who have sex with men and primary and secondary syphilis among men comparing 2004–2005 with 2007–2008, by age and race/ethnicity - selected areas (n=73). Increased HIV and Primary and Secondary Syphilis Diagnoses among Young Men Who Have Sex with Men, 2004–2008.

Conclusions

HIV and syphilis diagnoses have increased among young black men in almost all areas, suggesting that national trends are not driven by increases in a few large areas. Findings highlight the need for improved prevention efforts for young MSM, particularly young black MSM.
P1-S2.36 Prevalence and risk factors of HSV-2 infection among men who have sex with men in China
Authors: Chen S , Yin Y P , Wang H C , Wei W H , Wang A L , Han Y , Peng R R , Chen X S , Wang B X
Published: July 2011

Background

HIV prevalence among MSM is high, and epidemiological surveys have confirmed that HSV-2 infection can increase the risk of HIV infection and that HIV seroconversion is closely related to HSV-2 infection. In spite of high prevalence of HIV in MSM and strong association between HSV-2 infection and HIV seropositivity, there have been few studies about the prevalence of HSV-2 among MSM in China. To prevent the spread of HIV among this high risk population, there is an urgent need to investigate the HSV-2 prevalence and potential demographic and behavioural risk factors among MSM in China.

Methods

A total of 1462 men who have sex with men were randomly selected from three regions (Changzhou, Guangzhou and Shenzhen) in China. Sera were tested to estimate the prevalence of HSV-2 (ELISA for the detection of HSV-2 type specific IgG) and HIV (ELISA for screening and WB for confirmation), while univariate and multivariate logistic regression analyses were used to estimate the degree of association between HSV-2 infection and potential demographic and behavioural risk factors. Results—The prevalence of HSV-2 antibodies was 16.0% (234 out of 1462). Factors independently associated with higher prevalence of HSV-2 antibodies were—age, educational level, exchange of sex for money and HIV status (see Abstract P1-S2.36 table 1).

Abstract P1-S2.36 Table 1

Multivariate analysis of risk factors associated with HSV-2 seropositivity among 1462 MSM in China

CharacteristicAOR (95% CI)p ValueAge ≤301 >301.988 (1.426 to 2.771)<0.05Educational level 0–9 yr2.247 9–12 yr1.479 (1.520 to 3.321)<0.05 >12 yr1 (1.020-2.144)<0.05Exchange of sex for money Sometimes1 Never0.583 (0.407 to 0.835)<0.05HIV status Positive2.763 Negative1 (1.850 to 4.128)<0.05

Conclusions

The high prevalence of HSV-2 among MSM and strong association between HSV-2 infection and HIV seropositivity suggests the urgent need for intervention to prevent HSV-2 and HIV infections in high-risk MSM in China.
P1-S2.37 Incidence of urethral discharge syndrome among men who have sex with men and associated risk factors in India; a cohort analysis of clinic attendees
Authors: Gurung A , Das A , Naryanan Prakash , Neilson G , Morineau Guy , George Bitra
Published: July 2011

Background

Monitoring data from a cohort of men who have sex with men (MSM) attending 421 clinics located in six states of India from January 2004 to December 2009 were studied. These clinics were supported by Avahan (the India AIDS initiative of the Bill & Melinda Gates Foundation) and provided services for sexually transmitted infections (STIs) including presumptive treatment for gonorrhoea and chlamydia; risk reduction counselling, treatment of STI syndromes and regular STI check-ups.

Methods

Individual tracking data from the clinical forms were collected, merged and cleaned. Observed episodes of urethral discharge (UD) were counted as incident cases when clinical record prior to the episode reported no UD or if the patients had received the clinics' standard single dose directly observed treatment. The mid-point between visits was considered as the time of incident UD. Cox proportional hazard models were used to assess associations between incidence of UD and reported behaviours.

Results

A total of 82 690 MSM made 508 469 visits to the clinics, constituting a cohort of 88 458 person-years (median duration of follow-up 0.86 years; maximum, 5.9 years). 7292 cases of UD were considered as incident giving an incidence rate (IR) of 8.2 per 100 person years (PYs). The IR decreased from 82.7 per 100 PYs in 2005 to 2.8 per 100 PYs in 2009; the first year of follow-up having the highest incidence (HR =1.5, p<0.001). Factors influencing the risk of UD were—number of years in commercial sex; the first year being the most risky, (HR=4.3, p<0.001); having more than ten clients per week (HR=1.6, p<0.001); not using condoms at last sex (HR=2.3, p<0.001); self-reported sexual identity of a penetrative role in anal sex (HR=1.4, p<0.001), and not receiving treatment in the first three clinic visits, (HR=2.8, p<0.001). Increasing frequency of clinic visits per year had a protective role (HR=0.9, p<0.001). MSM visiting the clinics more than five times a year had an IR below 1 per 100 PY. While one-time presumptive treatment increased the risk of UD (HR=3.2, p<0.001), there were no episodes of UD when the treatment was given at more than one consecutive visit.

Conclusion

Urethral discharge syndrome among MSM shows a decline and could be a good proxy to include in future STI surveillance in resource-constrained scenarios. An analysis of MSM risk behaviour in India can help in risk profiling for targeted interventions.
P1-S2.42 STI prevalence and condom use in men who have sex with men attending STI Services, Honduras 2010
Authors: Tinajeros F , Artiles N , Farach N , Castro L , Maradiaga V , Sevilla A , Mendoza S , Urquia M , Galindo H , Paz-Bailey G
Published: July 2011

Background

Men who have sex with men and the transgender population have the highest prevalence of HIV in Honduras. Specialised services for MSM were established at three public clinics in San Pedro Sula, La Ceiba and Tegucigalpa, with the objective of improving STI management and access to HIV testing and counselling among MSM and transgender populations. STI and HIV testing and management were strengthened at three STI clinics in early 2010. Health workers were trained on HIV/STI services, including counselling and reducing stigma and discrimination.

Methods

Discussions with MSM organizations were carried out to determine the type of clinical and counselling services as well as a referral strategy for MSM. A standardised form was designed and implemented to collect key clinical, laboratory and behavioural indicators and entered into an electronic system in Epi-Info. The diagnostic tests offered at no charge were—rapid test and ELISA for HIV, PACE II forChlamydia trachomatisandNeisseria gonorrhoeae, and RPR with TPPA for syphilis. All men attending the clinics in 2010 were included in this analysis.

Results

Between January and December 2010, 227 MSM received STI services in the VICITS clinics in Tegucigalpa, San Pedro Sula and La Ceiba. Patients' mean age was 27.4 years. Overall 60.8% (135/222) reported alcohol use and 34.7% (76/219) reported drug use during the last year. An STI in the previous 12 months was reported by 37.6% (83/221) and 13.6% (30/219) reported engaging in sex work. Out of those patients who reported engaging in sex work, 86.5% (94/109) used a condom during their most recent sexual encounter, 88.3% (147/166) reported using a condom with casual partners and 64.5% (74/115) with stable partners. Overall, 12.3% (10/81) were infected with HIV, 10.3% (13/126) had a confirmed syphilis infection, 3.6% (5/138) were infected with chlamydia and gonorrhoea.

Conclusions

Results from the first year of STI clinics for MSM evidence high HIV and syphilis prevalence rates. Behaviour change interventions targeting this community should focus on increasing condom use. Efforts should be made to increase the number of MSM attending specialised services.
O1-S01.01 Chlamydia trends in the USA: results from multiple data sources
Authors: Satterwhite C , Weinstock H , Datta D
Published: July 2011

Background

Chlamydia is the most commonly reported notifiable disease in the US, with over 1.2 million cases reported in 2009 (409.2 per 100 000 population). While rates based on case reports have been climbing steadily over the past 20 years (155% increase), interpretation of trends is difficult due to better disease detection, reporting, and screening coverage among sexually active women aged 15–24 years. Prevalence data from other sources may be more reflective of national morbidity trends.

Methods

Chlamydia trends were analysed using data from three alternative sources. Using data from the National Health and Nutrition Examination Survey (NHANES), chlamydia prevalence from 1999 to 2006 was assessed in a nationally representative sample of the US population aged 14–39. Using data from the Infertility Prevention Project (IPP), two analyses of chlamydia positivity trends in different populations were conducted. The first analysis modelled trends among women aged 15–24 years tested in family planning clinics from 2004 to 2008; the second evaluated women aged 15–24 years who were tested in prenatal clinics from 2004 to 2009. Finally, data collected through the National Job Training Program (NJTP) on trends from 2003 to 2007 among high-risk men and women aged 16–24 years, were modelled. Models (IPP and NJTP analyses) controlled for age, race, geography, and test technology.

Results

Based on analyses of data from each of these populations, chlamydia prevalence trends were flat or decreasing. In NHANES, prevalence declined 48% (95% CI: 23% to 72%), from 2.6% (95% CI: 1.9% to 3.5%) in 1999–2000 to 1.4% (95% CI: 0.9% to 2.0%) in 2005–2006. In IPP prenatal clinics, chlamydia positivity also decreased; the adjusted odds of having a positive chlamydia test declined by 35% from 2004 to 2009. Likewise, in the NJTP, the odds of a positive test decreased by 19% in women and 8% in men from 2003 to 2007. In IPP family planning clinics, positivity neither increased nor decreased from 2004 to 2008.

Conclusions

Although rates of chlamydia based on case reports are increasing, analyses of prevalence data suggest that the overall prevalence of chlamydia may be decreasing. Reported chlamydia case rates are likely reflections of policy and programmatic changes and do not accurately reflect morbidity trends.
O2-S6.04 An exploratory survey of male sex workers and HIV risk in an urban area of Southwest China
Authors: Yu B N , Wang X A , Yu F , Wang J , Blanchard J
Published: July 2011

Background

Little knowledge is available on risk behaviours of HIV and basic demographic characteristics in male sex workers (MSW) in the population of men who have sex with men (MSM) in China. The objective of this study is to explore the risk to HIV/STI of MSW in southwest China through a convenience sample of an HIV surveillance survey of MSM.

Method

Those who self-reported had been paid for sex or “engaging in money exchange for sex” were identified as MSW or “Money Boys”. Data of the past five cycles (2004–2008) of an HIV surveillance survey were included in this study. Descriptive statistics were employed to describe demographics, sex practices, and HIV prevalence in these male sex workers.

Results

A total of 117 men self-identified as MSW in five consecutive cross-sectional surveys (2004 n=54, 2005 n=39, 2006 n=45, 2007 n=34, and 2008 n=45). The median age of participants ranged from 25 to 27 years. In the 6 months prior to the survey, the median number of male sex partners ranged from 4 to 11; the median of number of female sex partners ranged from 0 to 2; over 90% (89%–98%) of MSW reported anal sex and 26% of them engaged in group sex; but proportions who reported always using condoms for anal sex were less than 60% (ranged from 28% to 60%). HIV screening positive rate was 9% in both 2007 and 2008 see Abstract O2-S6.04 table 1. HIV positive rate is associated with the number of male sex partners and condom use frequency in both 2007 and 2008.

Abstract O2-S6.04 Table 1

Demographic characteristics of men who provided sex services for money in 2008 survey

Income US $/monthNo income9% <$1459% $145–28529% $285–43020% $430–57013% >$57020%Education Primary education13% Junior high13% High school47% University27%1st sex partner Male53% Female44%Place for soliciting sex partners Bar, dance-hall, tea house, club31% Bath-house, massage parlour7% Public place: park, toilet etc.20% Internet38% Other4%Sex orientation Gay40% Heterosexual11% Bi-sexual40% Not sure9%Last 6 months sex with men98%Last 6 month sex with women40%Group sex activity27%

Conclusion

MSW have been emerging in the sex trade industry in China. Behavioural risk factors and high prevalence of HIV in the MSW survey sample signalled a need for further understanding of this special population. Effective public health intervention strategy and programs are in urgent demand.
O2-S6.05 Sexual violence against men who have sex with men and transgenders (MSM-T) in southern India
Authors: Shaw S , Lorway R , Deering K , Mohan H L , Bhattacharjee P , Isac S , Ramesh B M , Washington R , Reza-Paul S , Moses S , Blanchard J
Published: July 2011

Introduction

Sexual violence (SV) has been associated globally with vulnerability to HIV and other sexually transmitted infections (STIs) in marginalised populations. There is little information on SV among men who have sex with men and transgendered individuals (MSM-T) in South Asia. Societal sanctions resulting in stigma and discrimination may place MSM-T at especially high risk for both SV and HIV/STIs. We investigated factors associated with SV among MSM-T, and the relationship between health care utilisation patterns and reported SV.

Methods

Data were obtained from cross-sectional surveys in four districts in Karnataka state, south India. Bivariate and multivariable logistic regression models were constructed to examine factors related to SV. Multivariable negative binomial regression models examined the association between physician visits and SV. Normalised weights were used to account for a complex sampling design.

Results

The total sample size was 543. The prevalence of SV in the past year was 18%, with a range by district of 12%–31%. HIV prevalence among those reporting SV was 20%, compared to 12% among those not reporting SV. In a multivariable model, among those reporting sex work involvement, having anal sex with five or more casual sex partners in the past week was associated with SV (AOR: 4.1; 95% CI: 1.2% to 14.3%, p=0.03). Of those not reporting sex work, feminised sexual identities (AOR: 6.10; 95% CI: 1.3% to 28.8%, p=0.03) and younger age (AOR: 0.9; 95% CI: 0.9% to 1.0%, p=0.002) were associated with SV. There was no significant association between numbers of partners and SV among those not reporting sex work. Increased physician visits among those reporting SV was reported only for those involved in sex work (AOR: 1.7; 95% CI: 1.1% to 2.7%, p=0.01).

Conclusions

There was a trend towards higher HIV prevalence overall among MSM-T reporting sexual violence, as well higher HIV prevalence among important sub-groups experiencing SV. These findings highlight the importance of integrating programs to address sexual violence into STI/HIV prevention programs among MSM-T, and of understanding that there is considerable contextual heterogeneity in vulnerability to violence in this population. The demonstrated higher rates of physician utilisation by male sex workers who report sexual violence suggests an important point of contact for a population which may otherwise be quite hidden.
O2-S6.06 Sexual practices of transgender community in Pakistan
Authors: Ahmad Z
Published: July 2011

Issue

Pakistan, the second most populous Muslim nation in the world, has started to finally experience and confront the HIV/AIDS epidemic. The country had been relatively safe from any indigenous HIV cases for around two decades, with most of the infections being attributable to deported HIV positive migrants from the Gulf States. However, the virus finally seems to have found a home-base, as evidenced by the recent HIV outbreaks among the injection drug user community. Extremely high-risk behaviour has also been documented among Hijras (sex workers) and long-distance truck drivers. The weak government response coupled with the extremely distressing social demographics of this South-Asian republic also helps to compound the problem. The time is ripe now to prepare in advance, to take the appropriate measures to curtail further spread of the disease. If this opportunity is not utilised right now, little if at all could be done later. Objective: To assess risk behaviours including number and type of sex partners, condom use, knowledge of STIs and HIV/AIDS among hijras (eunuch) of Lahore, Pakistan.

Methods

Two hundred hijras were recruited through Respondent Driven Sampling and interviewed by a team of experienced interviewers. Lessons Learnt: The mean age of the respondents was 29.2±6.3 years (Range 18–55). More than two third (68.5%) were illiterate; 23% were married. Among married, 89% were married to women and had 1 to 7 children. Sixty per cent had taken some hard drug (Cocaine, Heroin, Morphine and Amphetamine) during the last 12 months and 3% had injected drugs. Eight per cent had sex with a woman during the last year. During the last 1 week, 82% respondents had 1–21 new clients and 69.5% never used condom; 21.5% had oral sex with new clients. During the same period, 72% respondents had 1–12 regular clients and 71.5% of them never used condom while 7% respondents had 1–5 non-paying partners. During the last 1 month, five hijras had paid women to have vaginal sex. Nineteen hijras paid another man to have sex with them. Only 27.1% were not aware of any symptom of sexually transmitted Infections. Majority of the hijras (81.5%) were familiar with HIV/AIDS. However knowledge about its mode of transmission was faulty.

Conclusion

Due to low level of accurate knowledge regarding STI/HIV and pernicious risk behaviours, hijras may become a potent source of HIV transmission, if necessary remedial measures are not taken.
O3-S1.04 Performance characteristics of bioplex 2200 syphilis IgG and Liaison Treponema automated assays for detection of antibodies toTreponema pallidum
Authors: Fakile Y , Kikkert S , Ballard R , Cox D
Published: July 2011

Background

Serological testing continues to be a crucial tool for syphilis diagnosis and control. The commonly accepted syphilis screening algorithm is screening with non-treponemal tests such as RPR or VDRL, and confirming with treponemal tests such as TP-PA. Recently, automation has been introduced whereby serological screening using treponemal tests has resulted in reduced labour time and removal of the subjectivity associated with the traditional testing algorithm. The objective of this study was to compare the performance characteristics of two FDA approved automated tests, the BioRad BioPlex 2200 Syphilis IgG and the DiaSorin LIAISON treponemal assays, with known predicate tests. The BioPlex 2200 syphilis IgG is a multiplex test that utilises three analytes (15-, 17-, & 47-kDa) to detect specific IgG antibodies, whereas the LIASION treponemal assay uses only one analyte (17 kDa) in a single step sandwich method to detect both syphilis IgG and IgM antibodies.

Methods

A total of 1086 commercially obtained sera tested in this study consisted of: 430 from pregnant women, 409 from HIV positive individuals, and 111 from known syphilis patients of various disease stages. Characterised syphilis samples (n=140) were also obtained from the CDC serum repository. All samples were screened by the Bioplex IgG, Liaison, RPR and TP-PA tests. Any indeterminate results were repeated at least once.

Results

Of the 1086 samples tested, the syphilis reactivities were the following: 551 (50.7%) by BioPlex IgG, 528 (48.6%) by LIAISON, and 509 (46.9%) by TP-PA. The sensitivity and specificity when compared to TP-PA for LIASION was 98.8% and 90.5% respectively. The BioPlex IgG sensitivity and specificity when compared to TP-PA was 85.1% and 80% respectively. Overall, 443 (40.8%) samples were found to be reactive and 450 (41.4%) non reactive to both LIAISON and BioPlex IgG. All three tests agreed on 877 (81%) samples. On the 209 discordant samples TP-PA agreed with LIAISON 85.2% (n=178), BioPlex 7.2% (n=15), but disagreed with both tests 7.7% (n=16).

Conclusion

Both tests have high throughput, walk-away capability, and would be useful in low prevalence settings. There was good agreement between the LIAISON and the BioPlex IgG in 893 (82%) samples (Cohen's κ=0.64). The LIAISON had higher sensitivity most likely due to its detection of both IgG and IgM, while the BioPlex detected only IgG antibodies. Both tests show significant promise in the future of syphilis serology.