bluuebunny/crossref_metadata_2025 huggingface dataset:
P1-S5.21 Self-esteem and STI/HIV prevalence among residents of a Tanzanian sugar plantation
Authors: Rice C , Turner A N , Norris A , Mtweve S
Published: July 2011

Background

Sexually transmitted infections (STIs), including HIV, lead to significant reproductive morbidities worldwide. The association between risky sexual behaviours and increased STI/HIV prevalence has been well-documented. In addition, low self-esteem appears to lead to higher-risk sexual behaviours. However, the direct association between self-esteem and STI/HIV has not been well studied. We aimed to examine whether self-esteem directly affects STI/HIV prevalence, after adjusting for risky sexual behaviour.

Methods

We conducted a secondary analysis of a cross-sectional study of sugar plantation residents in Tanzania. The 2004 study included a self-administered survey with self-esteem assessment and testing for syphilis, herpes simplex virus type 2 (HSV-2) and HIV. We restricted our analysis to individuals with valid STI/HIV results and complete self-esteem data. Through principal component analysis, the 8-item self-esteem scale was reduced to a single variable. This variable was further categorised as low, medium, and high self-esteem and was the primary exposure variable in a multivariable log binomial model with a combined outcome representing any prevalent STI/HIV (syphilis, HSV-2, or HIV).

Results

From the full study sample of 556 residents, 431 (78%) individuals had both complete STI/HIV data and self-esteem assessment and were included in the analysis. The analysis population was 51% male and 49% female. Nearly 60% (n=254) had at least one STI/HIV. We observed no significant heterogeneity by gender in the effect of self-esteem on STI/HIV prevalence. Gender, transactional sex and alcohol use were retained as confounders in the final model; no other demographic or behavioural variables met our a priori statistical criteria for confounding. The adjusted prevalence ratios (PR) for STI/HIV for individuals with low self-esteem compared to those with medium self-esteem and high self-esteem were 0.95 (95% CI 0.80 to 1.13) and 0.92 (95% CI 0.67 to 1.27), respectively.

Conclusion

Self-esteem was not independently associated with STI/HIV prevalence in plantation residents in Tanzania. Our findings suggest that the role of self-esteem in reproductive health may be limited to its association with increased sexual risk behaviour, which subsequently affects STI/HIV prevalence. Interventions aimed at improving self-esteem may only be appropriate if they reduce likelihood of participation in risky behaviours.
P1-S1.02 Assessing heterogeneity in the incidence of chlamydia and gonorrhoea in an urban Canadian setting—a population-based analysis
Authors: Shaw S , Whitlock M , Nowicki D , Plourde P , Mahmud S
Published: July 2011

Introduction

A combination of increased testing and improved testing modalities has contributed to substantially higher incidences of chlamydia (CT) and gonorrhoea (GC) infections globally. Previous studies have noted the differing epidemiological profiles of CT and GC, resulting in different public health prevention and intervention strategies. Using a population-based perspective, this study describes recent trends, and assesses inequalities in the geographic distribution of CT and GC in a Canadian city.

Methods

Analyses included all laboratory-confirmed cases of CT and GC among residents of the Winnipeg Health Region from 1996 to 2008. Annual CT and GC incidence rates were directly age-standardised to the 2000 Winnipeg Health Region population. Adjusted rate ratios (ARR) for the effect of age and gender, and 95% 95% CI, were estimated by negative binomial regression models. Generalised estimating equations (GEE) were used to correct for clustering within neighbourhood areas (n=25). Inequalities in the neighbourhood area distribution of annual CT and GC rates were measured by the Gini coefficient, with 95% CI estimated by bootstrapped samples. For regression and Gini analyses, cases were grouped into 10–19, 20–29 and 30+ age groups.

Results

The age-adjusted incidence of CT increased from 198/100 000 in 1996 to 513/100 000 in 2008. During this same time period, GC increased from 62/100 000 to 89/100 000, with a peak of 133/100 000 in 2006. For females, and compared to those aged 30 or over, equally high rates of CT were observed in those 10–19 (ARR 24.2; 95% CI 18.7 to 31.4, p<0.0001) and 20–29 years (ARR 24.4; 95% CI 18.8–31.7, p<0.0001). For males, differences in rates were observed in those aged 10–19 (ARR 5.3; 95% CI 4.1 to 6.9, p<0.0001) and 20–29 (ARR 10.5; 95% CI 8.2 to 13.5, p<0.0001) years. A similar pattern was detected for GC infections. Inequality by neighbourhood area, as measured by Gini coefficients decreased over time for CT infections, regardless of age group. For GC infections, increases were observed in those 30 years or older, for both males and females.

Conclusion

Since 1996, the distribution of CT incidence is suggestive of a generalised spread; while for GC the distribution has narrowed in those aged 30 or over, suggestive of concentration among core populations within this age group. CT and GC continue to display differing and dynamic epidemiological profiles.
P1-S1.20 Seroprevalence of herpes simplex virus type I and II infections in Russian Federation
Authors: Khryanin A , Reshetnikov O , Kandrushina M
Published: July 2011

Background

Herpes simplex virus type 2 (HSV-2) is a common sexually transmitted infection worldwide, and its prevalence has increased significantly over the last 2 decades in many developed countries. The prevalence rates of HSV-2 infection differ between populations; however, HSV-2 seropositivity is uniformly higher in women than in men and increases with age. However, HSV-1 has been recently identified as a genital infection.

Objectives

Aim of the present study was to evaluate the seroprevalence of HSV-1, and HSV-2 infections among various population groups in Siberia, Russia.

Methods

A sample of 1014 persons aged 14–64 years (47% males) were randomly selected from the general population in urban Novosibirsk (predominantly Caucasians) and rural regions of Tyva and Altai Republic (predominantly persons of Asian origin). The study includes data obtained in 1994–2005. The current investigation was performed as an optional fragment of international WHO MONICA study, and HAPIEE study (Wellcome Trust Fund 064947/Z/01/Z and 081081/Z/06/Z). Sera were tested for IgG antibodies to HSV infections with type-specific ELISA (VectoHSV-1 IgG, VectoHSV-2 IgG, Vector-Best, Novosibirsk, Russia).

Results

The overall prevalence of HSV-2 positivity was 21% being higher in females (26.4%) compared to males (17.0%, p=0.01). Seroprevalence rates increased with age from 0% at 14–17 years to 22.8% at 55–64 years in males and from 1.8% at 14–17 years to 31.6% at 55–64 years in females. Neither difference was observed between urban and rural population, nor in surveyed persons of Caucasian and Asian origin. Ten-year trend showed a decrease in the frequency of HSV-2 detection equally in different populations by 20%. HSV-1 seroprevalence was uniformly high in each population group (99–100%). In conclusion, HSV-2 is common in Russia with the prevalence rates close to USA and Scandinavian countries. The sex and age distribution of the infection in Russia is similar to other populations. In Siberia, ethnicity and standard of living do not influence HSV-2 prevalence. However, HSV-1 infection rates may influence HSV-2 infection distribution by cross-reactive immunity patterns.
P1-S5.24 Prevalence ofChlamydia trachomatisamong women infected by HIV attending the institute of tropical medicine in Amazonas, Brazil
Authors: Miranda A , Silva L , Sardinha F , Talhari S
Published: July 2011

Background

Chlamydia trachomatis(CT) is one of the world's most frequent sexually transmitted infections (STI), having great impact on sexual and reproductive health.

Objectives

To describe clinical profile of and the prevalence of CT infection in HIV women attending the Institute of Tropical Medicine in Manaus, Amazonas, Brazil Methods: A cross-sectional study performed among women attending the AIDS clinic from March to December 2010. They were invited to take pat in the study and answered an interview including demographic, behavioural and clinical data. They underwent in a gynaecological examination where it was collect a cervical sample for diagnosing CT by hybrid capture.

Results

A total of 330 women were included in the study. Median age was 32 (IQR (IQR): 27; 38) years and median of schooling 9 (IQR: 4; 11) years. Prevalence rate of CT was 4.5% (95% CI 2.3%—to 6.7%). Median of first sexual intercourse was 16 (IQR: 14; 17) years and 53.9% were married or reported a stable partner. A total of 70.9% reported regular use of condoms in the last year. Risk factors reported were: injecting drug use (1.2%), no-injecting drugs (15.2%), previous STI (32.4%), commercial sex workers (16.4%), more than one partners in the last year (12.7%) and in life (94.5%). Regarding clinical symptoms, 51.1% reported chronic pelvic pain, 55.2% vaginal discharge, 23.0% dysuria and 10.0% genital bleeding. CD4 counts were more than 500 cells/mm3in 21.8% and viral load were less than 100 copies/mm3in 55.2%. In the final model of logistic regression the only variable remained was having more than one partner in life.

Conclusions

Health programmes need to pay attention to the need to screen for easily curable sexually transmitted infections, such as Chlamydia trachomatis, in populations that are more vulnerable and at greater risk, as women living with HIV.
P1-S5.30 Relationship between syphilis and HIV: lessons from a Nigerian surveillance survey
Authors: Adeyemi A , Oyediran K , Azeez A , Kawu I , Fakunle O
Published: July 2011

Background

Sexually transmitted infections (STI) including syphilis are associated with risks of acquiring HIV infection. Behaviours that increase STI also play important role in increasing the risk of HIV. Transport workers are highly mobile population often predisposed to STI including HIV due to the nature of their business. Similarly, they are potential bridge population between female sex workers and the general population. This study assesses relationship between syphilis and HIV among transport workers in Nigeria.

Methods

Secondary data analysis of a survey conducted in 2007 among 2233 transport workers in six Nigerian states. Time location sampling was employed. The relationship between HIV and syphilis was evaluated using multivariate logistic regressions while controlling for confounding factors such as demographic, knowledge and behavioural variables.

Results

Median age was 33 years with age range: 18–49 years and all participants were male. Syphilis prevalence among transport workers was 1.6%. State-level prevalence of syphilis was: 4.2% in Anambra, 1.1% in Cross Rivers, 0.7% in Edo state, 1.8% in FCT, 0.8% in Kano and 1.9% in Lagos. HIV prevalence was 3.8% with the highest prevalence (6%) in Cross Rivers and the lowest (1.6%) in Kano. Also, 33.5% had genital discharge; 14.5% had genital ulcers/sores; 12.2% used marijuana; 25.0% were away from home for >1 month; 55.5% had secondary education and 67.2% had ever been married. Only 17.3% used condom in the last sex with non-regular partner; 31.0% had sex with a girlfriend in the past 12 months and 4.3% paid for sex in the last 12 months. Syphilis was not associated with HIV infection OR=1.54 95% CI 0.90 to 2.65. However, risks for HIV infection included being away from home for >1 month OR=1.8 95% CI 1.4 to 2.3; sex without condom in the last 12 months OR=1.5 95% CI 1.2 to 1.9; sex with female sex workers OR 1.7 95% CI 1.2 to 2.2 while secondary education was protective with OR: 0.6 95% CI 0.4 to 0.8.

Conclusions

More researches are needed to investigate the relationship between syphilis and HIV in Nigeria as little evidence is available from the national survey. These findings have implication of promoting secondary education and condom uptake in non-marital relationships among transport workers in Nigeria.
P1-S5.31 Coinfection and concurrent sexually transmitted infections (STIs) in sexual partnerships: potential impact of partner notification and treatment in STD control
Authors: Canchihuaman F , Hawes S , Holmes K , Garcia P , Carcamo C
Published: July 2011

Background

Partner notification and treatment has the potential to be one of the most important strategies in the control of STIs. However, studies indicate that this approach is not often used. Additionally, there is not much information about STIs among sexual partnerships.

Objectives

To determine the prevalence of several STIs in sexual partnerships and to estimate the potential utility of partner treatment.

Methods

We enrolled males and females 18–29 years of age from a random household sample in 24 cities in Peru and enrolled same-residence sex partners of the participants. Participants and partners responded to demographic and sexual behaviour questionnaires and provided biological samples tested forNeisseria gonorrhoeae,Chlamydia trachomatis, andTrichomonas vaginalis, syphilis, HSV-2 and HIV.

Results

Of 2302 couples enrolled, 2163 couples had laboratory results available for either CT or TV and 1696 couples for either HIV, HSV-2 or early syphilis. CT, TV, early syphilis, HSV-2, and HIV were found in 7.1%, 4.4%, 1.2%, 24.8%, and 0.2% of couples, respectively. Among couples in which at least one subject was affected by a specific STIs, both partners had CT in 53 (39.3%) couples, TV in 22 (25.0%) couples, early syphilis in 3 (14.3%) couples, HSV-2 in 215 (51.1%) couples, and HIV in 2 (66.7%). Of couples affected by CT, 18/131(13.7%) had TV; 1/109 (1.3%) had early syphilis; 41/109 (41.6%) had HSV-2; and no one had HIV. Among females affected only by CT, 52.3% of partners had CT and 2.6% had TV; and among those only affected by TV, 13.7% of partners had CT and 26.2% had TV. Among males affected only by CT, 68.8% of partners had CT and 14.3% had TV; and among those affected only by TV, 11.5% of partners had CT and 84.6% had TV.

Conclusions

A relatively high proportion of males and females affected by an STI had the same infection than their partners and not an infrequent number had different infections. Strategies to increase utilisation of partner notification and treatment may help STI control. Further review of partner treatment guidelines needs to be performed.
P1-S1.21 Incidence rate of Herpes Simplex Virus type 2 (HSV-2) in the USA, 1988–2008
Authors: Gerver S
Published: July 2011

Background

HSV-2 infection remains a major public health problem in the USA, where the prevalence is 16.2% in persons aged 14–49. In this report, we provide national estimates of new HSV-2 infections in the USA and examine trends in incidence over the past 2 decades.

Methods

A simple catalytic model was used to estimate HSV-2 force of infection (FOI), defined as the incidence of HSV-2 in the susceptible population, from National Health and Nutrition Examination Surveys (NHANES) in the USA from 1988 to 2008. HSV-2 serology was included in the nationally representative surveys during 1988–1994 (NHANES III) and in continuous NHANES from 1999 to 2008. Incidence rates and trends over time were estimated by age, sex and race/ethnic group for non-Hispanic whites, non-Hispanic blacks, and Mexican-Americans.

Results

HSV-2 FOI rates were highest in non-Hispanic blacks and lowest in non-Hispanic whites, with the FOI among 25-year-old non-Hispanic black women more than 13 times greater than white men of the same age. Rates were highest between ages 25 and 35 years for all sex-race/ethnicity groups (peak in non-Hispanic white and black women aged 25 years, in non-Hispanic white and black men aged 35 years and in Mexican-American women in their early-30s) except for Mexican-American men, for whom there was less variation in FOI by age. Over the last 20 years, age-adjusted FOI rates were stable for the sex-race/ethnicity groups examined except for non-Hispanic white and Mexican-American women, in which there were decreases after 2002 and 2001, respectively. FOI rates were lower in men than women among non-Hispanic blacks and Mexican-Americans, and in non-Hispanic whites prior to 2002. Overall, the estimated number of new HSV-2 infections in 2007–2008, among these three groups, aged 14–49 years, was in excess of 750 000, with 48% (∼360 000) occurring in women and 52% (∼392 000) in men. Nearly half (45%) of all infections occurred in persons under 25 years old (34% and 57% of infections in men and women, respectively).

Conclusion

Risk of HSV-2 infection varies substantially across the US adult population, with the highest risk among non-Hispanic black men and women. Information on the detailed distribution of new infections can help improve the efficiency of interventions. In addition, although we found evidence for substantial reductions in the risk of HSV-2 among some race/ethnicity groups, FOI in groups with the highest rates has not changed in 20 years.
P1-S5.33 Timing of incident STI relative to sex partner change in young women
Authors: Ott M , Harezlak J , Ofner S , Fortenberry J D
Published: July 2011

Objectives

Partner concurrency is associated with STI acquisition, even when partners are sequential (ie, serial monogamy). However, little is known about the timing of STI relative to partner change. This is due, in part, to lack of documentation of STI before and after partner change. Using prospective behavioural and STI screening data, we compared the proportion of an STI occurring before and after partner change within a 12-week period.

Methods

As part of a larger study of risk and protective factors for STI in a mid-sized US city, young women provided weekly vaginal swabs and completed daily diaries of sexual behaviours for a 12-week period twice a year for up to 8 years. Vaginal swabs were tested for chlamydia (CT), gonorrhoea (NG) and trichomonas (TV) using amplified DNA-based tests. We limited analysis to the 12-week periods in which young women reported one sex partner change (ie, 2 sequential partners, no overlap). STIs with partner 1 were defined as those diagnosed before 1st sex with partner 2; STIs with partner 2 occurred after 1st sex with partner 2. Published data shows a higher odds of infection after a partner change (compared to no change) with the ORs ranging from 2.0 to over 4.0. We used a non-equivalency test to identify the odds for not detecting differences in STI acquired with partner 1 vs partner 2. If there is a difference between rates for partner 1 and partner 2, it will not be higher than the upper bound of the CI.

Results

Ninety-two women provided 111 12-week periods with one partner change. Mean age was 17.8 years; 94% were African American. Rates of STI were high for both Partner 1 and Partner 2 (see Abstract P1-S5.33 table 1). For CT, TV, and any STI, the upper bound of the 95% CI was lower previously reported rates. We have 95% confidence that the OR for infection with partner 2 vs partner one is not greater than 1.83 for CT, 1.47 for TV, and 1.68 for any STI. In contrast, the true OR for GC may fall within or higher than previously reported. We have 95% confidence that the OR for GC infection with partner 2 vs partner 1 is between 0 and 9.7.

Abstract P1-S5.33 Table 1

Partner 1 n (%)Partner 2 n (%)95% CI for OR*CT11 (9.9%)10 (9.0%)0 to 1.83GC3 (2.7%)9 (8.1%)0 to 9.70TV8 (7.2%)5 (4.5%)0 to 1.47Any STI21 (18.9%)19 (17.1%)0 to 1.68*

One-sided OR.

Conclusion

Many young women already have an STI when a partner change occurs. These data suggest that the relationship contexts of partner change–in addition to the risk characteristics of a new partner–are also relevant to the epidemiology of STI in a specific common form of partner concurrency (ie, serial monogamy).
P1-S5.35 Multiple concurrent sexual partnerships among adolescents in Tanzania and South Africa: a comparison between areas with contrasting level of HIV magnitude
Authors: Mmbaga E , Helleve A , Leyna G , Masatu M , Onya H , Klepp K I
Published: July 2011

Background

Modelling and empirical evidence suggest that population differences in the practice of concurrent sexual partnership could be the most important explanation of the observed heterogeneity in HIV epidemic in sub-Saharan Africa. Biomedical and some behavioural evidence have not sufficiently explained the variation. This study aimed at comparing the rate of concurrent sexual partnerships among adolescents in Arusha, Tanzania and Polokwane, South Africa, two areas with contrasting level of HIV magnitude.

Methods

A baseline cross-sectional study involving junior secondary school adolescents in Arusha, Tanzania and Polokwane South Africa was conducted in 2010 as part of the school-based Health Intervention project (LASH). Adolescents from 12 randomly selected schools from each country were interviewed regarding their socio-demographic characteristics, sexual behaviours and substance use. Data were entered and analysed using SPSS statistical package.

Results

A total of 2408 adolescents from Arusha and 1649 from Polokwane participated in the study. Adolescent interviewed in Arusha were significantly older than their Polokwane counterpart (Mean age (SD) 19.3(0.5) and 15.5(0.7), respectively, p<0.001). The overall prevalence's of reported multiple concurrent sexual partnerships were 9.2% in Arusha and 25.2% in Polokwane (OR, 3.7, 95% CI 3.0 to 4.7. Both males and Females adolescents from Polokwane were significantly more likely to report concurrent sexual partnerships than those from Arusha (p<0.001). Moreover, adolescents from Polokwane reported practice of other HIV risk behaviours as compared to those in Arusha (p<0.001). History of sexual experience (vaginal, oral, anal), ever use of condom and substance use were independent predictors of multiple concurrent sexual partnerships in both sites.

Conclusions

High practice of multiple concurrent sexual partnerships among adolescent living in high HIV prevalent area as compared to those in low prevalence area indicate that concurrent partnership could be the most important explanation of the observed heterogenic HIV transmission in sub-Saharan Africa. Being sexually active and substance use predict practice of concurrent sexual partnerships among adolescents. Delaying sexual debut and addressing substance use among adolescents may have a significant impact on HIV epidemic.
P1-S5.36 Concurrency among women <25 years of age screened in family planning and reproductive health clinics in US Public Health Service Region X, January 2009–June 2010
Authors: Nakatsukasa-Ono W , Fine D
Published: July 2011

Background

To better understand the dynamics of STIs and HIV, researchers are increasingly examining the determinants and consequences of sexual networks. In January 2009, the Infertility Prevention Project (IPP) in US Public Health Service Region X-one of 10 regional projects funded by the Centers for Disease Control and Prevention (CDC)-began collecting a new network sexual risk behaviour for IPP chlamydia (CT) tests. The Region X IPP decided to collect sex partner (SP) concurrency based on the literature, research conducted in California, CDC input and regional interest.

Methods

CT positivity (CT+) was calculated by demographics, sexual risk behaviours, SP concurrency and clinical findings for 94,433 tests among women <25 years of age screened in Region X IPP family planning and reproductive health (FP/RH) clinics from January 2009 to June 2010. Univariate and multivariate analyses were conducted.

Results

Of the 94 433 tests, 62% were age 20–24, and 72% were non-Hispanic white. 14% of clients reported their SPs definitely, 41% reported “possibly” and 38% reported it was “unlikely” their SPs had concurrent SPs in the last 12 months. CT+ ranged from 7.6% among clients reporting their SPs “definitely” had concurrent SPs to 5.2% among those reporting it was “unlikely.” Clients reporting their SPs “definitely” or “possibly” had concurrent SPs were more likely to report other sexual risk behaviours and have clinical findings on examination. Significant (p<0.001) factors for CT+ included SP concurrency (definitely: AOR=1.20; possibly: AOR=1.25); age (15–19 years: AOR=1.34); race/ethnicity (Black: AOR=1.55; American Indian/Alaska Native: OR=1.60; Native Hawaiian/Other Pacific Islander: AOR=1.92); CT infection in the last 12 months (AOR=2.06); new SP (AOR=1.43), multiple SPs (AOR=1.48), symptomatic SP (AOR=4.07) in past 60 days; clinical findings (cervicitis or PID diagnoses; AOR=2.22).

Conclusions

It is feasible to collect SP concurrency with female clients in the context of a clinic visit. SP concurrency was a significant predictor of CT+ beyond other risk factors. Results for clients who reported their SPs “possibly” had concurrent SPs may reflect clients being less knowledgeable about their SPs' sexual behaviours. Findings confirm the importance of assessing network characteristics such as SP concurrency, the need to incorporate SP concurrency in risk reduction counselling, and the potential to use this measure in empirically based screening decisions.
P1-S5.39 Triple jeopardy? Sexual networks of syphilis & HIV infection among heterosexuals, MSM, and bisexual men in North Carolina
Authors: Doherty I , Pasquale D , Liebman A , Adimora A , Leone P
Published: July 2011

Background

The velocity of STI spread depends in part on the formation of sexual partnerships and the structure of sexual networks. Dual outbreaks of HIV and syphilis have persisted in NC since 2001 among young black men who have sex with men (MSM). During 2007–2009, the incidence rate of early stage syphilis increased 600% in County X from 9/100 000 to 57/100 000; the outbreak involved MSM, bisexual men (MSMW), heterosexual men (MSW), and women. We sought to determine if bisexual men bridged MSMs and heterosexuals to facilitate syphilis and HIV spread in both populations.

Methods

We abstracted public health department charts in County “X” for early stage syphilis cases and HIV for black men ages 15–30 during 2006–2009. We documented each sexual and social tie, permitting sociometric analysis.

Results

Of the 532 cases with syphilis, HIV, or both infections, 69% were male. The per cent of males declined with age from 24% to 18% to 13% for ages 21–25, 26–30, and 31–35 respectively, whereas women in each age group were equally distributed between 16% and 18%. Women, MSW, and MSM, accounted for 31%, 32% and 30% respectively of cases; 7% were bisexual men. Though most heterosexuals had only syphilis, 16% were HIV+ and 38% of them were coinfected. Among 196 bisexual and MSM, 73% were HIV+; of these, half were coinfected. On the basis of timing of HIV and syphilis diagnoses and syphilis stage, an estimated 33% of HIV+ men may have serosorted. Unlike other MSM populations, these cases did not use methamphetamine; 35% reported marijuana use. Crack cocaine use was reported for 16% of MSW and 33% of women. A total of 2099 individuals (cases, uninfected contacts, and anonymous partners) made up the network divided into 293 components. The largest component of 261 people (Abstract P1-S5.39 figure 1) was predominantly MSM including 10 of the 36 MSMW. None of MSMWs' female partners had other partners, suggesting that onward transmission did not occur. Heterosexuals, engaging in transactional sex, comprised the second largest component involving at least 135 individuals; all cases were syphilis-infected.

Abstract P1-S5.39 Figure 1

Infection Status.

Conclusions

Contemporaneous syphilis and HIV epidemics persist among MSM; neither serosorting nor methamphetamine use fuels spread. Heterosexuals experienced a syphilis outbreak driven in part by transactional sex and crack cocaine use. Bisexual men did not bridge the populations. Frequent dual screening among MSM is critical to impede further transmission of both STIs.
P1-S1.22 HSV-2 prevalence across a pastoral landscape: transmission and transition among the Himba and Tjimba populations
Authors: Hazel A , Foxman B , Low B
Published: July 2011

Background

Sexual partnerships take multiple forms among the Himba and Tjimba people living in Northwestern Namibia, including polygynous and monogamous marriage, and long- and short-term extra-marital partnerships. We hypothesised that HSV-2 prevalence would be higher in regions that are connected to local urban areas, because these should be sites of more frequent anonymous partner exchange.

Methods

In 2009, we surveyed 30 villages, obtaining HSV-2 status (using the BioKit Rapid Test for HSV-2) and demographics, home village, recent travel patterns and sex partnerships (n=446). We estimated prevalence (a) for the entire population (b) for all women and men and c) for individual villages. Logistic regression models were fit to test the correlation between risk of infection and travel patterns.

Results

Overall HSV-2 prevalence was 36.5%, with higher rates among women (50.5%) than men (23.3%). In contrast to expectation, the highest HSV-2 prevalences were found in some of the most remote regions. To explore this further, we built a network model that superimposes travel patterns onto sex partnership data. Using this model, we observed that older travel corridors (eg, travel from home village to extended-family associated villages) were more associated with higher HSV-2 transmission than newer corridors (eg, travel to local cities to hang out). Ethnographic interviews suggest that differences in the nature of relationships that occur in urban areas (eg, lower contact frequency, higher condom use) may explain the difference between observed and predicted.

Conclusions

In this population cultural and economic transitions that lead to more travel into urban areas were not associated with increase in HSV2 prevalence, probably because these relationships are deemed more risky. Shifting attitudes about sex and sex partnerships are likely to affect future STD transmission in this population.
P1-S5.42 Prevalence of transitional and embedded concurrency within a prospective cohort of urban adolescent females
Authors: Matson P , Chung S E , Fortenberry J D , Ellen J
Published: July 2011

Background

Studies have found that concurrent sexual partnerships, as opposed to cumulative number of sex partners or serially monogamous partnerships play a pivotal role in rates of STI transmission. Different patterns of concurrency have different consequences to STI transmission as these patterns result in diverse network structures from within which to disseminate disease. Our objective was to determine the prevalence and types of concurrent partnerships within a prospective cohort of urban adolescent females.

Methods

A cohort of adolescent females (N=63), aged 16–19 at baseline, were recruited from health clinics and community venues in Baltimore, MD and completed daily diaries about each current sex partner on a Palm Smartphone continuously for up to 18 months. As data collection is ongoing, relationships that were at least 8 weeks long were selected for this analysis. Partner names were confirmed by participants at regular intervals to ensure the same partner was followed over time. Sex partners were considered concurrent if they were named by the participant in the same week. Concurrent partners were categorised as either embedded or transitional relative to each relationship. A side partner was categorised as embedded if the week(s) that partner was named were completely contained within the weeks of the relationship. A side partner was categorised as transitional if weeks that the partner was named either preceded or persisted beyond the relationship or if the partner was only named in a single week within the first or last 4 weeks of the relationship.

Results

Fifty-five participants had a relationship of at least 8 weeks duration, of these 55 relationships 28 (51%) had a concurrent partner within the relationship, with a mean (SD) of 2.7 (2.6) concurrent partners. Of the 28 relationships that contained concurrency, transitional concurrency was most prevalent (43%), followed by both transitional and embedded (39%), and embedded only (18%). Among relationships with concurrency, 25% had a gap of >4 weeks within the relationship, as a result partners initially classified as transitional subsequently became embedded. There was no difference in relationship duration for those with and without concurrency.

Conclusions

Transitional concurrency may reflect adolescents' intentions of serial monogamy. Future data collection is needed to gain an improved understanding of adolescents' motivations for concurrent sexual partnerships.
P1-S6.01 Controlling the heterosexual HIV epidemic in low-prevalence domains
Authors: Lehman C , Keen A , Kerr B
Published: July 2011

Background

HIV/AIDS has a manifest ability to swell to epidemic proportions and debilitate entire societies. Currently, the disease remains below the level of a generalised epidemic1 in the USA and many other developed nations. Yet the number of reported HIV infections continues to expand steadily.2 The same strains of virus affect all humans, but their ecology and epidemiology are markedly different in opposite-sex vs same-sex communities. Variance terms in the transmission equations of opposite-sex communities are reduced in same-sex communities, changing the dynamics of the disease and the interventions that could successfully control it.

Methods and Results

We apply mathematical disease models of minimal complexity and higher complexity equation-free network models to show how (1) purely epidemiological forces are sufficient to explain the rapid spread of the virus through male same-sex communities, independent of usual assumptions of more dangerous or careless sexual practices in those communities3, (2) the expansion tendencies of HIV can be counteracted in national testing and treatment programs aimed at breaking the spread of infection, and (3) simple behavioural changes resulting from increased awareness of infection through increased testing4 can conceivably bring the infection under control in the heterosexual community, even without universal voluntary testing.5

Conclusions

Much world effort properly is being focused where the disease is rampant, as in opposite-sex communities in many African nations6 as well as male same-sex communities everywhere.7 Critical attention must be continued in these sensitive populations, but attention throughout the general population is called for as an additional pre-emptive measure. Our results illustrate how expanded efforts in low-prevalence heterosexual communities throughout the developed world could moderate the expanding infection there, arrest it before it reaches run-away levels, and conceivably cause it to decline and eventually vanish from the general population.
P1-S6.04 Education and lifetime risk of HIV infection in Manicaland, Zimbabwe
Authors: Robertson L , Mushati P , Eaton J , Schumacher C , Gregson S , Nyamukapa C
Published: July 2011

Background

There is evidence that attendance at school is protective against HIV among young people in South Africa. Further work is required to investigate the effect of education on the life-time risk of HIV in sub-Saharan Africa. In this paper, we have examined the association between education and HIV infection/sexual risk behaviour among men and women of different ages in Zimbabwe.

Methods

The effects of education level (none or primary only; secondary or higher) on prevalent HIV infection and sexual risk behaviours among young people of school age (15–21 years) and older adults (22–54 years) were investigated using data from four rounds of an open cohort study collected between 1999 and 2008 in Manicaland, Eastern Zimbabwe. Multivariate regression models were used to investigate the independent effects of education, marriage and wealth.

Results

School-aged men, interviewed in 1999/2000, with secondary or higher education had significantly reduced risk of HIV infection compared to those with none or primary education only (adjusted OR=0.35; p=0.011). For older men, the effect of education level was not significantly associated with HIV risk (adjusted OR=1.17; p=0.125). For those interviewed in 2006/2008, education level was not found to be independently associated with HIV infection among school-aged or older men. At both time points, marital status and living in a town were independent risk factors for HIV among older men. Among women interviewed in 1999/2000, adjusted models indicate that a higher level of education had a significant protective effect for school-aged (adjusted OR=0.64; p=0.023) and older (adjusted OR=0.80; p=0.017) women. For those interviewed in 2006/2008, a higher level of education level was protective among school-aged (adjusted OR=0.56; p=0.040) but not older (adjusted OR=0.99; p=0.940) women. Marital status was an independent risk factors for HIV infection fort women of all ages.

Conclusions

There is evidence that secondary or higher education is protective against HIV infection among school-aged people in Zimbabwe, particularly women. Among older men, education does not appear to be protective against HIV. In 1999/2000, secondary or higher education was protective against HIV among older women. However, in 2006/2008, this protective effect was reduced. Further work to calculate the lifetime cumulative risk of HIV infection by education level, in this population, will be conducted.
P1-S6.08 A multifaceted intervention to increase chlamydia testing in Australian general practice
Authors: Hocking J , Poznanski S , Vaisey A , Walker J , Wood A , Lewis D , Guy R , Temple-Smith M
Published: July 2011

Background

The Australian Government has funded the Australian Chlamydia Control Effectiveness Pilot (ACCEPt), a randomised controlled trial of a chlamydia testing intervention to assess the feasibility, acceptability and cost-effectiveness of chlamydia testing in general practice clinics. There are well documented barriers to increased chlamydia testing in general practice including time, cost, and clinicians' knowledge and awareness of chlamydia. If an intervention is to successfully increase chlamydia testing, it must minimise these barriers and take the uniqueness of each general practice into consideration. This paper describes the chlamydia testing intervention being implemented in ACCEPt.

Methods

Clinics in the intervention group are being provided with a multifaceted evidence-based intervention designed to increase annual chlamydia testing for sexually active 16–29 year olds. The intervention includes: a computer alert prompting GPs to test; incentive payments for GPs and practice nurses to conduct testing; an annual recall system involving SMS, phone or mail reminders; a comprehensive education pack; and regular feedback on testing performance. The intervention will be in place for up to 4 years, and will be tailored to the resources and needs of each clinic. Prior to implementation, clinic staff are engaged and given the opportunity to identify methods for improving chlamydia testing within their clinic, using an evidence-based practice assessment tool.

Results

To date, 69 clinics in 24 areas have been recruited across three Australian states. Four of these areas (9 clinics) have been randomised: two areas (7 clinics) are in the intervention group, and two areas (2 clinics) in the control group. The intervention has been customised to each clinic with two thirds of clinics receiving the computer alert, 4 clinics using SMS reminders for recall, others using a mail recall and some using practice nurses to initiate chlamydia testing. Where possible, doctors and practice nurses have been given one on one education and training about chlamydia and pelvic inflammatory disease.

Conclusions

Given that each Australian general practice is unique, it is vital that the intervention is tailored to individual clinic needs to achieve sustainable system changes. This enables maximum staff engagement to ensure the effective uptake of increased chlamydia screening in the Australian general practice setting.
P1-S6.15 Characteristics and predictors of women seeking rescreening for stis after using the http://www.iwantthekit.org program: were they infected or uninfected?
Authors: Gaydos C , Hsieh Y H , Barnes M , Jett-Goheen M , Quinn N , Agreda P , Whittle P , Hogan T
Published: July 2011

Background

CDC recommends rescreening women who are infected with chlamydia (CT) and gonorrhoea (GC) in 3 months. The iwantthekit (IWTK) Internet screening program offered an opportunity to study women who seek rescreening, and determine reported infected status at the previous screening. Mailed IWTK home-collected vaginal swabs are tested for CT, GC, and trichomonas (TV) by NAATs.

Methods

Characteristics (demographics, risk behaviours, use perceptions) of repeat users were determined from questionnaires. Predictors of repeat users were measured in a matched case-control study by conditional logistic regression analysis. A case (N=304) was defined as reporting having ever used IWTK before. A control was a user who reported never using the program earlier. Two controls (N=608) were systematically sampled for each case by matching date of use of IWTK of the case within 3 months.

Results

From 2007 to 2010, 17% of 1747 women who used IWTK for STI testing indicated they had used IWTK previously. Of these, 45% used it >2 times. Mean age was 24.7±5.7 yr; most were African American (69%); single (87%); 57% had 2–4 sexual partners previous yr; 44% had new partners in last 3 months; 32% were currently having sex >1 person; 16% practiced anal sex in the last 3 months; 13% never used condoms; 77% had been treated for an STI; (5 HIV+). In multivariate analysis, repeat IWTK users were more likely to be ≥20 yr. (OR=2.10, 95% CI 1.30 to 3.38) and reside in Maryland (OR=2.03, 95% CI 1.31 to 3.13). They were more likely to have had a pelvic exam in past yr (OR=2.03, 95% CI 1.36 to 3.05); be treated for an STI (OR=2.32, 95% CI 1.57 to 3.44); to perceive internet screening as confidential (OR=1.98, 95% CI 1.32 to 2.97); report results from self-administrated swabs as accurate (OR=2.49, 95% CI 1.61 to 3.87); be less likely to drink alcohol before sex (OR=0.63, 95% CI 0.44 to 0.91); and to never use condoms with vaginal sex (OR=0.43, 95% CI 0.27 to 0.69). Of repeat users, 84.2% reported having a negative prior test and 48/304 (15.8%) reported last test positive; 27 had CT; 24 had TV; 3 had GC; 6 were mixed infections. At present test, 40 (13.2%) were positive: 14 had CT, 2 had GC, 28 had TV; 4 were mixed infections. Previous TV was associated with current TV positivity (p<0.05).

Conclusions

IWTK attracted many previous participants who practiced high-risk sexual behaviours to use IWTK for repeat STI testing. IWTK may offer an alternate approach for rescreening previously infected women.
P1-S6.18 Characteristics of men who seek rescreening for STIs after once using the http://www.iwantthekit.org screening program
Authors: Hsieh Y H , Barnes M , Jett-Goheen M , Quinn N , Agreda P , Whittle P , Hogan T , Gaydos C
Published: July 2011

Background

The iwantthekit (IWTK) Internet screening program offered an opportunity to study characteristics of men who seek rescreening, as well as determine reported infected status at the previous screening.

Methods

We determined characteristics of male repeat users from questionnaires. Predictors of repeat users were identified in a matched case-control study by conditional logistic regression analysis. A case was defined as reporting ever having used IWTK before. A control was a user who reported never using the program before. Two controls were systematically sampled for each case by matching the date of use IWTK of the case within 3 months.

Results

During 2007–2010, 115 (14%) of 852 men who used IWTK for STI testing, indicated that they had used IWTK previously. Among them, 43% used it >2 times. Mean age was 25.8 yr ±8.5 yr, and 90% were currently sexually active. 17% reported having sex with a male; 35% had >5 partners in the past yr; 58% had new partners in last 3 months; 49% currently were having sex >1 person. 63% had been treated for an STI: chlamydia (CT)(74%), trichomonas (TV)(42%) and gonorrhoea (GC)(23%); 6 reported being treated for HIV. By matching time of enrolment, 230 controls were selected. In the multivariate analysis, repeat IWTK users were more likely to be <30 years (OR=2.04, 95% CI 1.04 to 4.02), have health insurance (OR=2.01, 95% CI 1.10 to 3.69), reported ever being tested for an STI (OR=2.01, 95% CI 1.02 to 3.97), ever been treated for an STI (OR=2.20, 95% CI 1.14 to 4.23), particularly TV (OR=5.16, 95% CI 1.80 to 14.81), and less likely to have penile discharge currently (OR=0.24, 95% CI 0.08 to 0.76). Of male repeaters, 80.9% reported previous test results from IWTK as negative and 22/115 (19.1%) reported previous result positive–11 had CT, 4 had GC, 8 had TV; 2 of these were mixed infections. At present test, 24 tested positive–19 had CT, 3 had GC, 5 had TV; 3 were mixed infections. Reported CT positivity in last test was associated with current CT test positivity (p<0.05).

Conclusions

The Internet screening program IWTK attracted a number of previous male users of IWTK, who practiced high-risk sexual behaviours, to use the program for repeat STI testing. IWTK provided an alternate approach for rescreening previously infected men as well as men reporting high-risk behaviours.
P1-S6.19 Comparing two methods of estimating chlamydia screening coverage in an urban neighbourhood, 2009
Authors: Nelson M , Pathela P , Blank S , Schillinger J
Published: July 2011

Background

CDC recommends sexually active females aged <26 be screened annually forChlamydia trachomatis(Ct). Only Ct cases are reported to local health departments. Screening coverage estimates, defined as the proportion of the sexually active population tested for Ct, are not routinely available. Without such measures it is difficult to interpret increases in Ct case reports.

Methods

We compared 2 approaches to estimating screening coverage in the New York City neighbourhood of Central Brooklyn (CB) in 2009: The “indirect method” used public health surveillance data, and “back calculated” to get the number of sexually active females that must have been screened to yield the number of reported Ct cases in CB females aged 15–19 and 20–25 years. Data inputs included: reported number of females with ≥1 Ct case in 2009 (730 cases aged 15–19, 619 cases aged 20–25) population estimates (12 772 aged 15–19, 14 024 aged 20–25), proportion ever had sex (35% aged 15–19), proportion sexually active in last 12 months (76% aged 20–25), and Ct positivity (20% aged 15–19, 8% aged 20–25). The “direct method” used electronic health record (EHR) data from 8 primary care provider practices in CB and adjoining zip codes using a common EHR for >1 year. EHR data were analysed to determine: numbers of unduplicated female clients aged 15–19 and 20–25, proportion sexually active, and number of sexually active females screened for Ct. The sexually active population was measured in 2 ways; group 1 was defined as females that reported ever having sex (18% (246/1340) aged 15–19 and 12% (302/2419) aged 20–25). Group 2 was defined as females meeting >1 of: reported ever having sex; ever prescribed an oral contraceptive by the practice; ever had an STD; ever diagnosed with STD by the practice; ever pap ordered by the practice (38% (514/1340) aged 15–19 and 38% (910/2419) aged 20–25).

Results

See Abstract P1-S6.19 table 1.

Abstract P1-S6.19 Table 1

Estimated Chlamydia Screening Coverage for Central Brooklyn Females by Method and Age Group, 2009

MethodAge groupFemale populationPercent sexually activeNumber Ct testedEstimated screening coverageIndirect15–1912 77235% (4406)363282%20–2514 02476% (10 630)823477%EHR Group 115–19134018% (246)16768%20–25241912% (302)17859% Group 215–19134038% (514)31561%20–25241938% (910)51857%

Conclusion

The indirect approach yielded a higher Ct screening coverage estimate than the direct approach. By both methods, screening coverage was higher in the 15–19 age group than the 20–25 age group. For the direct approach, definitions of sexually active women affected measures of screening coverage, particularly for 15–19 year olds. The indirect method can be easily replicated, with limited resources. The direct method requires more resources and is contingent on consistent and accurate provider documentation of sexual activity.