bluuebunny/crossref_metadata_2025 huggingface dataset:
P2-S2.18 Are we doing enough to cover risk of STI/HIV transmission from the lovers “of female sex workers (FSWs)?”
Authors: Doddamane M , Bhattacharjee P , Rao D
Published: July 2011

Background

Condoms use among Female sex workers with paid clients found to have increased rapidly in three years from 58% to 76% (IBBA data) due to scale up of interventions among them. However condom use with lovers still remains low at 33% (IBBA 2008). PBS 2009 shows 50% of the sex workers have lovers. Programmatically it has been challenging to design and implement programme to reach out to Lovers and to provide them services consistently. To understand the Lovers and the risk factor associated with them we conducted Focused Group Discussion (FGDs).

Method

14 Separate FGDs were conducted with both the FSWs and their Lovers in seven districts of Karnataka. A structured tool guided the Facilitators of the FGD. Each FGD was documented by a Recorder.

Results

Three fourths of the FSWs had more than one lover at any given point of time. One fourth of the lovers had physical relationship with other FSWS or women other than wife. Half of the FSWs especially the urban based changed lovers in less than a year. Majority of the lovers knew that their partner is a sex worker. Key barriers for Lovers to use condoms with the sex workers were: 1. Faith and trust with FSWs (almost half of the respondents) 2. Condoms don't give pleasure (one third of the respondents). The barriers stated by the FSWs were: 1. Faith and trust in the lover because they are like husbands (one third of the respondents) 2. Did not want to make the lover suspicious (one fourth of the respondents) One fourth of the sex workers responded experiencing harassment from the lovers especially for money. Only one third of the lovers had correct information about HIV (modes of transmission) and negligible number of lovers accessed STI services.

Conclusion

Evidence shows that there is clear need to intervene with Lovers of female sex workers to improve condom use among them. The interventions have to address not only gaps in information, condom use, access to service, but also the perception of faith and trust.
P2-S2.22 Innovations to attract young female sex workers to access STI services in drop in centres (DIC): a case study from Bangalore, South India
Authors: Michael E , Murugan S K , Viswanatha L , Pushpalatha R
Published: July 2011

Background

Young female sex workers pose a challenge in accessing continuous services in prevention program. Being young, relatively active and new to sex work increases their vulnerability drastically but also attract more clients. As young sex workers they often do not access services provided in the drop in centre due to several factors including self stigma, lack of Peer interaction, and less awareness about services in the DIC.

Method

Community consultations were done initially to know the barriers to accessing services in the DIC. As physical appearance goes a long way in determining how an individual is perceived by oneself and others around, introducing sessions on beauty and healthcare by a trained beautician, was felt suitable in attracting sex workers to the Drop in Centre. A beautician was hired and oriented towards the program. The primary focus of the sessions was to showcase and teach the sex workers basic skills in dressing well and looking good using quick and cost-effective ways. Apart from this the beautician also provided few beauty services which was accessed by the sex workers. These services were charged nominally so that the amount was used to replenish the cosmetics and makeup materials. Other crucial aspects of health, such as cleanliness, hygiene and prevention of STI, female condom demonstration and distribution were covered during counselling session and one to one interactions. This innovative approach aimed towards increasing uptake and access of services proved cost effective and was received well by the most vulnerable, young sex workers, attracting them to the DIC.

Results

As a result of introducing these sessions in the DIC 25 young sex workers were accessing services from the drop in centre every week. There was a steady increase in testing for STI in the introductory months itself. A peer network among the young sex workers was initiated and this helped the project to ensure that access to STI services were regular by this community. This innovative approach acted as a catalyst to improve the self-esteem of sex workers and ensured access to services there by reducing their vulnerability.

Conclusion

It is imperative for prevention programs to evolve and find newer and innovative methods to address the changing needs of vulnerable communities like the female sex workers. This strategy has proved to attract young sex workers there by effectively providing them STI and other services within the program.
P2-S3.01 STI risk among persons attending burning man in 2010
Authors: Marcus J L , Bernstein K T , Philip S S
Published: July 2011

Background

Burning Man is a week-long event held annually over Labour Day in the Nevada desert, with over 50 000 attendees in 2010. We aimed to assess the potential for STI transmission among San Francisco attendees and the availability and acceptability of safer-sex services at Burning Man.

Methods

We conducted a survey among a convenience sample of persons who attended Burning Man in 2010. An online questionnaire on demographics, sexual practices, and safer-sex services at Burning Man was created on SurveyMonkey and advertised on two email lists, one for all attendees and one for those living in San Francisco. Attendees were invited to participate anonymously from 1 week through 6 weeks after the event. We conducted a descriptive analysis of the responses.

Results

Of the 1477 persons who completed the survey during 10 September–22 October 2010, most were heterosexual men (45.1%), heterosexual women (30.0%), or men who have sex with men (12.4%); of white race/ethnicity (86.5%); and from 25 to 44 years of age (62.5%). The majority (70.6%) had attended the event in prior years, and 17.8% resided in San Francisco. Over one quarter (28.5%) had been previously diagnosed with an STI. Of the 69.8% who reported having oral, vaginal, or anal sex at Burning Man, almost half (43.5%) reported sex with new partners. Although most attendees (86.3%) noticed that condoms were available at the event, nearly one quarter (23.0%) of respondents with new partners had intercourse without a condom, of whom two thirds (64.9%) did not plan to test for STIs during the month after the event. Of those planning to test, 49.3% planned to test with a private doctor, 23.9% at a community clinic, and 19.7% at an STI clinic. Only 2.6% of attendees reported that STI testing was available at the event; 41.3% said they would use the service if it were available.

Conclusions

Although some safer-sex services were available at Burning Man in 2010, attendees reported unprotected intercourse with new partners during the event, a behaviour that confers high risk for STI acquisition. Large gatherings such as Burning Man might present opportunities for rapid STI transmission among geographically diverse sexual networks. Local health jurisdictions, both in the host location and those in which event attendees reside, should consider further assessment of STI transmission and prevention at Burning Man and similar events.
P2-S3.07 Responding to problems of sexual violence and vulnerability to HIV/AIDS within crisis and unstable situations: a case study of Kenya's post-election violence
Authors: Musyoka C , Mwendwa A , Kyalo N
Published: July 2011

Introduction and Background

Sexual violence and the risk of HIV transmission are clearly linked through multiple pathways underpinned by gender inequalities and poverty like increased genital injury, anal rape, multiple perpetrators and ejaculation all common in sexual violence. It is important therefore to understand and recognise these links between sexual violence and HIV/AIDS as the basis for developing strategies to address the complex interactions at individual, communal and institutional levels.

Objectives

Based on the Kenya's post-election violence of 2008, this study aimed to capture and understand the complex and multiple factors that interact to influence vulnerability to HIV and AIDS. Its holistic framework proposed a macro level model for understanding the risks factors for STIs, and HIV/AIDS transmission within the context of sexual violence. Its main objective was to explore and identify bio-medical and epidemiological factors that act as conduits for the transmission of HIV/AIDS and other STIs within crisis and unstable settings.

Methodology and Results

It uses a multi-disciplinary approach that simultaneously embraces gender, poverty and biomedical analytical lenses to identify and strategically address emerging links between violence and HIV/AIDS. Interviews and VCT were administered to both multistage cluster and purposively-random sampled sexual violence victims in Kenya—A multiple logistic regression model controlling age, condom use (if any), and biological influences like the routes of exposure—whether vagino-penile or anal-penile—and sex of both victims and assailants was adopted. Overall prevalence for HIV, syphilis and gonorrhoea shot up: 2.3%, 1.1%, and 3.1% respectively among men. For women: 2.7%, 1.9%, and 4.2.0% respectively.

Conclusion and Recommendations

Sexual violence diminishes people's social capital in terms of social networks, norms, and traditions that could prove to be conducive to the spread of the HIV. We recommend early diagnosis to allow treatment of sexual violence survivors. Post Exposure Prophylaxis (PEP), to address exposure to HIV as a result of sexual violence, emergency contraception and VCT should form the backbone for intervention in order to address the menace of HIV/AIDS. Anti-retroviral regimens dramatically improve rates of mortality and morbidity, prolong lives, improve quality of life, revitalise communities and transform perceptions of HIV/AIDS from a plague to a manageable, chronic illness.
P1-S1.33 Timing of progression ofChlamydia trachomatisinfection to pelvic inflammatory disease - a Mathematical Modelling Study
Authors: Herzog S A , Althaus C L , Heijne J C M , Oakeshott P , Kerry S , Hay P
Published: July 2011

Background

Screening programmes aim to detect and treat asymptomaticChlamydia trachomatis(chlamydia) infections to prevent ongoing transmission and reduce the incidence of pelvic inflammatory disease (PID). The timing of development of PID after chlamydia infection might affect the potential impact of screening to interrupt ascending infection. We used mathematical models to study three hypothetical processes for the timing of progression from chlamydia infection to PID and determine which was most consistent with empirical data.

Methods

We used data from the Prevention of Pelvic Infection (POPI) randomised controlled trial (RCT) that was designed to examine the effect of chlamydia screening on PID incidence over a follow-up period of 1 year. We developed a compartmental model that simulates the RCT results in a Susceptible-Infected-Susceptible framework and tracks the number of PID episodes in the screened and control groups. The model is fitted to the incidence of 1.9% in the absence of screening (POPI control group) and predicts PID rates when screening is implemented. The hypothesised processes were—PID develops at the beginning of an infection with chlamydia; PID can develop throughout the course of a chlamydia infection at a constant rate; and PID happens at the end of chlamydia infection before spontaneous clearance. We predicted the incidence of PID with each process and compared these with the observed cumulative incidence of 1.3% (95% CI 0.7 to 2.1%) in the POPI screened group. We took into account baseline chlamydia prevalence, screening uptake during the RCT, duration of infection and treatment failure.

Results

The mathematical models suggested that the process by which PID develops during the course of a chlamydia infection was closest to the observed cumulative incidence in the screened group, but the process with PID at the end of chlamydia infection was also compatible with the empirical data. The process where PID develops at the very beginning of a chlamydia infection predicted a higher incidence of PID in the screened than the control group. Our model also allowed us to estimate the proportion of chlamydia infections that develops PID and the reduction in PID incidence due to long-term screening.

Conclusion

This study suggests that the development of PID can happen during or, possibly, at the end of a chlamydia infection. This implies that screening for chlamydia might have a direct effect on PID prevention by interrupting ascending infection.
P2-S3.11 STI-related risk behaviours and STI disparity between residents of Baltimore City and other urban cities in the USA
Authors: Villarroel M , Rogers S , Turner C
Published: July 2011

Background

Baltimore City, Maryland, has experienced rates of STDs that are consistently higher than the national average. National surveillance data indicate that in 2000 the rates of gonorrhoea and Chlamydia in Baltimore City were 3.3 and 6.7 times higher than the overall US rate. Among US cities with greater than 200 000 people, Baltimore City ranked among the top four for Chlamydia and gonorrhoea infection rates.

Objective

To compare reports of diagnoses of gonorrhoea and Chlamydia among adults residing in Baltimore City to those in other central cities of the US and to assess whether a higher prevalence of sexual and substance use behaviours in Baltimore may account for infection disparity.

Methods

We utilised data collected from a cross-sectional probability telephone survey of the USA (N=1,543) and Baltimore City (N=744) adults aged 18–45 years old in 1999–2000. Respondents were asked about a wide range of STI-related risk behaviours and STI history. Bivariate analysis assessed differences in the prevalence of self-reported history of gonorrhoea and chlamydia, substance use, and sexual risk behaviours among residents of Baltimore City and other central cities of the USA Multivariate logistic regression models measured heterogeneity in self-reported history of gonorrhoea and chlamydia by location of residence, substance use and sexual history, adjusting for race and age.

Results

Lifetime prevalence of gonorrhoea and chlamydia was 18.2% (95% CI 14.8% to 22.1%) among Baltimore residents and 9.8% (95% CI 7.3% to 13%) among residents of other central cities (p<0.001). In bivariate analysis, Baltimore residents were no more likely to report a history of cocaine or injection drug use than residents of other urban areas (p=0.774). However, Baltimore residents were more likely to report having six or more lifetime sexual partners (49.1% vs 40.7%, Prev. Ratio 1.21 (95% CI 1.2 to 1.24)), multiple partners in the past year (24.3% vs 16.9%, Prev. Ratio 1.4 (95% CI 1.4 to 1.5)), and a history of paid sex (17.8% vs 8.7%, Prev. Ratio 2.0 (95% CI 1.8 to 2.3)).

Conclusion

The higher prevalence of sexual risk behaviours among Baltimore adults is likely to accelerate STI transmission and contribute to the higher incidence of STIs in Baltimore.
P2-S3.13 Effective HIV and AIDS prevention: is factors affecting the spread important?
Authors: Bankole M , Bankole M , Adebowale A , Iboma G , Olonire O
Published: July 2011

Background

There is no doubt that the last two decades had witnessed a rising trend in the Global efforts at combating HIV and AIDs, more especially through the various treatment measures. However, though a lot had been achieved in the treatment of infected persons, the long and short term side effects of the drugs; patient drug adherence and follow-up issues are often problematic. Therefore, the most appropriate way to address the menace will be rigorous efforts geared towards adopting simple and effective prevention methods the world over. In developing countries such as found in Africa, including Nigeria, there are many factors militating against achieving a good success in reducing the spread of HIV and AIDs. The identified factors include: culture and tradition of the people, peer group influence, large family burden (Economy), marriage and religion. Hence, this work was undertaken to identify the most common factors contributing to the spread of HIV and AIDS in order to adopt adequate, practical and preventive solutions to tackle the identified factors in Lagos, Nigeria.

Method

Questionnaires were distributed to 500 people in different locations in Lagos State, including one tertiary institution, 50 hair dressing and barbing salons, five community groups, 50 patent medicine dealers' shops, National Union of Road Transport Workers and ten randomly selected secondary schools in the five geographical zones in Lagos State between October 2009 and May 2010.

Result

Out of the 500 people given questionnaires, only 350 (70%) responded. Out of the 350 respondents, 315 (90%) of them have had sex at one time or another, of which a highly significant (p>0.05) 157 (49.8%) people have had unprotected sex in the past. Of this group, 70 (44.6%) were sex with multiple partners while 87 (55.4%) were sex with single partners. Fifty (31.9%) people in this group adduced their reason for unprotected sex to marriage obligation, 20 (12.7%) to religion, 30 (19.1%) to culture and tradition, 40 (25.5%) to peer influence while 37 (23.6%) were due to economic reasons.

Conclusion

There is a large pool of people who are still engaged in unprotected sex especially with multiple sexual partners in Lagos, Nigeria. The reasons include social, economic, religious, marital and religious factors. Hence a lot more concerted effort is needed by the Government, private organizations, religious and traditional leaders to educate and enlighten people on the need for protected sex, especially people with multiple sexual partners in order to reduce the spread of STIs including HIV and AIDS in our communities in Lagos, Nigeria.
P2-S4.05 Acceptability of medical male circumcision among men attending an HIV voluntary counselling and testing center in Mysore, India
Authors: Madhivanan P , Krupp K , Srinivas V , Klausner J
Published: July 2011

Background

There is currently limited information on the acceptability of medical male circumcision (MMC) in India. This study investigated the acceptability of MMC as a HIV prevention strategy among attendees of an HIV voluntary counselling and testing center (VCT) in Mysore, India.

Methods

A cross-sectional survey was conducted among a consecutive sample of 300 men attending the VCT in Mysore, India, between April and August 2009. After obtaining the informed consent in Kannada, an interviewer administered survey collected demographic, sexual risk behaviour, perceived risk and acceptability of MMC information.

Results

Most participants were Hindus (98.2%); 1.5% were Muslims, and 0.3% belonged to other religions. Fifty-three per cent of respondents had less than 7 years of schooling, 27.5% had 8–10 years, 3.0 % had attended high school and 16.0% had more than 12 years. Of participants, 71% were married and 45% made less than 4000 INR per month. About 244(73.9%) said that they had heard of MMC. On being informed about the risks and benefits of male circumcision, 97.9% said that other men should consider MMC to reduce the risk of contracting HIV/STDs. When asked if they would consider being circumcised safely in a hospital or clinic with little/no pain and at low/no cost, only a third (32.1%) said they would consider circumcision. The most important barriers to MMC reported by participants included MMC not being their cultural tradition (90%), fear of stigma and rejection by friends and family (74.8%) and pain (76.7%).

Conclusions

While MMC has been shown to be protective against heterosexual acquisition of HIV, little is known about whether it could be implemented in this primarily non-circumcising country. While this study found relatively low acceptability for MMC among VCT clinic attendees, more research on MMC acceptability among other populations, particularly those at high risk for HIV, is warranted.
P2-S5.01 A qualitative study of barriers to consistent condom use among HIV-1 serodiscordant couples in Kenya
Authors: Ngure K , Mugo N , Celum C , Baeten J , Morris M , Olungah O , Olenja J , Tamooh H , Shell-Duncan B
Published: July 2011

Background

Consistent condom use reduces HIV-1 risk and is important for HIV-1 serodiscordant couples (where one partner is HIV-1-infected and the other is HIV-1-uninfected). This study explored barriers to consistent condom use among heterosexual HIV-1 serodiscordant couples.

Methods

This qualitative study used 28 in-depth interviews and 9 focus group discussions. The participants were purposively-selected heterosexual HIV-1 serodiscordant couples from Thika and Nairobi districts in Kenya.

Results

A majority of HIV-1 serodiscordant couples reported challenges in consistent condom use. The main barriers to consistent condom use included male partners' reluctance to use condoms regardless of HIV-1 status, female partners' inability to negotiate condom use, poor knowledge of condom use leading to condom breakage, misconceptions about HIV-1 serodiscordance, challenges in disclosing HIV-1 positive results to new sexual partners, desire for conception, and reduced sexual pleasure reported by both male and female partners. Condom use was cited as one of the main challenges of living with HIV-1 serodiscordance.

Conclusions

Serodiscordant couples face multiple challenges in using condoms for HIV-1 prevention, and need couples-centred counselling to address barriers to consistent condom use. Specific areas of focus should include provision of information about the substantial risk of HIV-1 transmission within serodiscordant partnerships, development of skills for women to effectively negotiate condom use, disclosure of HIV-1 serostatus to new sexual partners, and strategies for conception that minimise risk of HIV-1 transmission.
P2-S5.02 Confined outreach clinics: increasing utilisation of HIV/STI clinic services by IDUs in hard to reach rural settings: an example from North-East India
Authors: Sono C Z , Lalawmpuii M
Published: July 2011

Issue

Clinics in fixed locations have limited effectiveness in HIV/STI prevention programs among injecting drug users (IDUs) in North-East India. Mountainous terrain and poor roads make physical accessibility difficult, and designated IDU clinics are often stigmatised by the general community, reducing acceptability among IDUs.

Setting

Nagaland state in Northeast India has a porous border with Myanmar and is characterised by difficult terrain, poor infrastructure, and a conservative religious climate generally intolerant of IDUs. HIV and STI prevalence rates among IDUs are among the highest in India. HIV prevalence is 1.8% (2008), while syphilis prevalence is as high as 17% (2009) and chlamydia as high as 13% (2009) in some districts.

Project

Project ORCHID, funded by Avahan India, has been implementing HIV/STI targeted interventions among IDUs in Nagaland since 2004. In response to the high prevalence of STIs and the clinic access challenges facing IDUs, an outreach clinic service known as the Confined Outreach Clinic (COC) was developed. The COCs are conducted by trained clinical staff and outreach teams in locations convenient to the IDUs. Timing and locations for the clinics are chosen by the IDU community in consultation with the outreach teams to ensure maximum acceptability and attendance. Clinical services follow standardised national guidelines. They provide STI treatment as well as HIV/STI prevention and referral services. To maximise acceptability, some general medical services are also provided.

Outcomes

Clinic visits more than doubled after introduction of this model, from 1734 (July–December 2009) to 4347 (January–June 2010), while the number of individuals accessing the clinic increased by 68%. The COC model therefore not only increased population coverage but also the number of repeat clinic visits within the reporting period. COCs are a low cost and highly acceptable model of service delivery for IDUs, effective in improving poor service uptake.
P2-S5.04 Behavioural risks and HIV/AIDS knowledge in adolescent street children and their health implications
Authors: Naseem F , Ahmad R , Rashid A
Published: July 2011

Background

In Pakistan social and ethical bindings are major constraints to launch effective awareness campaign or vaccination trial against HIV transmission. Lack of awareness coupled with high risk behaviour could result in AIDS epidemic among adolescents and street children as in these groups coercive and transactional sex is common. We aimed to examine adolescent's behavioural risks and their knowledge about HIV/AIDS. Sources of information regarding HIV/AIDS were analysed for risk behaviour in relation to social factors.

Methods

Cross-sectional study was conducted in rural and urban areas of Rawalpindi to gather information from street children (n=148, mean age 17 years). Multivariate analysis was performed to see effect of residential site and gender on AIDS concepts.

Results

Among surveyed population, 14% had heard of HIV vaccine and 50% believe HIV vaccine could develop infection. About 33% ever had sex and 10% revealed >1 partner per year. 5% had knowledge about HIV status of partner see Abstract P2-S5.04 Table 1. A high degree of risky behaviour activities correlated with those children who lived in rural areas. Urban area street children were found to explore more sources to grasp HIV information. We found limited availability of documented information to compare the present observations.

Abstract P2-S5.04 Table 1

Multivariate ANOVA for HIV/AIDS knowledge

Main effectInteractionSiteGenderSite × GenderMANOVA test (Pillais F value)2.174.451.43HIV/AIDS transmission route<1<1<1Discussion about HIV/AIDS1.22.211.53Behavior risks<1<12.25

Conclusions

Both the adolescents and street children with poor knowledge about HIV are involved in risky behaviour. Our study propelled the need to consolidate, where relevant, community mobilisation for HIV prevention research throughout the country. Moreover, cross-country documentation must be improved for wider sharing of knowledge. A planned approach with educational sessions seems imperative for developing an effective sexual health safety program.
P2-S5.06 Behavioural interventions for reducing HIV infection in workers in occupational settings, a Cochrane systematic review
Authors: Ojo O , Verbeek J , Rasanen K , Heikkinen J , Isotalo L , Mngoma N , Ruotsaalainen E
Published: July 2011

Background

HIV in the workforce has a negative impact on economic growth and development of affected countries. The workplace provides an important avenue to prevent HIV by providing easy access to workers who might have similar high risk sexual behaviour because of the nature of their work. Objective of this systematic review is to evaluate the effect of behavioural interventions on high risk sexual behaviour to prevent HIV among workers.

Methods

We searched electronic databases to locate studies. Only randomised control studies in occupational settings or among workers identified as high risk groups were included. The outcome measures were: indicators of high risk sexual behaviours, uptake of Voluntary Counselling and Testing (VCT), and incident cases of HIV. We excluded health workers, sex workers, injection drug users and Men who have sex with men because these are already in other reviews.

Results

We included 4 studies but we had incomplete data from one. All the studies were from developing countries in Asia and Africa with a total of 7994 participants. We grouped the studies in the following comparisons: Uptake of VCT was increased when provided in workplace compared to voucher for testing only, RR=14.0 (95% CI 11.8 to 16.7), HIV incidence was not reduced, RR=1.4 (95% CI 0.7 to 2.7). Education caused a non-significant decrease in sex with extra partner RR=0.7 (95% CI 0.3 to 1.8) and unprotected sex, RR=0.9 (95% CI 0.5 to 1.4). More intensive Information, motivation and behavioural (IMB) skills training increased the use of condom, RR=2.8 (95% CI 1.6 to 4.1) and decreased sex with commercial sex workers, RR=0.8 (95% CI 0.80 to 0.96) in a very high risk group of truck drivers.

Conclusion

VCT might not be effective in reducing HIV incidence in workplace intervention, and delivering voluntary counselling and testing on-site at workplace increases the uptake of VCT. However, education, and Information, motivation and behavioural (IMB) skills training might be worthwhile in reducing risky sexual behaviour and increasing condom use, especially when delivered with high intensity in the workplace.
P2-S5.07 Cost of the Avahan HIV prevention programme for high risk groups: results from 23 districts from four southern states in India
Authors: Chandrashekar S , Vassall A , Reddy B , Shetty G , Alary M , Vickerman P
Published: July 2011

Background

It is estimated that 2.27 million people are living with HIV or AIDS in India. The epidemic is concentrated and predominately driven by marginalised groups. The Avahan Programme in India is one of the largest HIV prevention programmes targeted at high risk populations within a single country in the world. It provides grants to state lead partners (SLPs), who in turn provide grants to non-government organsiations (NGOs) at the district level to deliver multi-component interventions (including peer outreach, STI services, and structural interventions). This study presents the costs of implementing these interventions to female sex workers, men who have sex with men and transgender from 23 districts in the four Southern states of India over 4 years.

Methods

Financial and economic costs were prospectively collected. Costs by input and activity, unit costs of interventions between 2004 and 2008 were analysed. Economic costs are presented in US $ 2008 using 3% discount rate.

Results

The total economic cost of the intervention over 4 years for 23 districts was US$ 27 341 121(range per district US$307 597–US$3 147 790) for an estimated target population of 93 345. In year 4, the average annual economic cost per estimated population at the NGO level across the 23 districts was US$70 (US$30–174). The average annual financial cost at current prices was US$59. Over the four years, at the NGO level, capital costs accounted for 10% of total costs. The main recurrent costs were personnel costs (46%) and the materials and supplies for sexually transmitted infections (STI) services (13%). Examining both SLP and NGO costs, programme management, information and grant management costs activities accounted for 27% of total cost; followed by capacity building (20%), STI services (19%), peer outreach (including behaviour change communication, condom provision) (16%) and structural interventions (11%). The proportion of cost that was spent on direct services such as peer outreach and STI services increased as the programme scaled up. Costs for structural activities also increased from 5% in year 1 to 11% by year 4.

Conclusions

Assessing costs over the life of the project helps to identify how costs vary with the changing needs and strategies of the programme. We will conduct further analysis to examine which factors most influence costs (local price/wages, programme intensity, community involvement etc). This cost data can assist the realistic planning of large scale long term HIV prevention programmes in the future.
P2-S6.01 Social, behavioural characteristics, and seroprevalence of HIV infection among men who have sex with men (MSM): about 92 cases collected in a community medical center named Centre Oasis “of Association African SolidaritÉ (AAS), Ouagadougou, Burkina Faso”
Authors: Elias Dah Ter Tiero , Koala T S
Published: July 2011

Background

Like many African countries, the issue of sex between men in Burkina Faso remains taboo and is often the cause of social exclusion. Our objective in this study was to determine social and behavioural characteristics and seroprevalence of HIV infection among MSM in Ouagadougou.

Methods

A questionnaire (closed questions) written by the medical team at Centre Oasis" was submitted to the MSM. Our sample of 92 consisted of MSM who frequented the center and some who did not. Data were collected by medical staff and peer educators. They were: -Social, -Behavioural, -The results of HIV serology.

Results

The average age of MSM surveyed was 28.6 years with extremes of 18 and 56 years. MSM were predominantly students with a proportion of 34.8%. 21.7% were traders, 2.2% were unemployed. More than half of respondents were single (54.8%). 22.8% were living with a common-law wife, and 20.7% were legally married. 78.3% of MSM had had sex with a woman. 2 / 3 of all MSM (65.2%) were bisexual. In 90.2% of cases, the MSM used condoms two out of three times during sexual intercourse0.77.2% of MSM used water-based gels two out of three times during sexual intercourse. The majority of MSM (82, 6%) had more than one sexual partner. In 82.1%, none of the MSM had discussed their situation with their family for fear of being rejected. Of 55 MSM who had had an HIV test, 8 had been diagnosed positive for HIV giving a prevalence of 14.5%.

Conclusion

In our study, it appears that the MSM community in Ouagadougou is highly vulnerable given the high rate of HIV seroprevalence and its marginalisation. Targeted interventions for the recognition ofsupport are needed to help sustain the achievements of the national fight against HIV.
P2-S6.06 Prevalence, incidence and predictors of sexual assault in the community-based HIM cohort of Sydney homosexual men
Authors: Templeton D , Jin F , Prestage G , Poynten M
Published: July 2011

Background

Sexual assault (SA) is commonly reported in cross-sectional studies of men who have sex with men (MSM) worldwide, but there are few community-based longitudinal data.

Methods

Participants in the Health in Men (HIM) cohort study reported lifetime history of SA at baseline and annual experience of SA at each interview. Predictors and outcomes of lifetime and incident SA were assessed using logistic and Cox regression analyses, respectively.

Results

At study entry 319 of 1427 participants (22.5%, 95% CI 20.4 to 24.8%) reported past SA. Independent demographic predictors of past SA were being on pension or benefits (p<0.001), Asian v Anglo ethnicity (OR=0.37, p=0.015) and Indigenous vs non-Indigenous ethnicity (OR 3.79, p=0.024). Those reporting past SA had more lifetime male sexual partners (p<0.001) and more often reported past gonorrhoea infection (p=0.010). Past SA was associated with cigarette smoking (p<0.001), marijuana use (p<0.001), amyl nitrate use (p=0.034) but not use of alcohol or other recreational drugs. During 7392.7 person years of follow-up 55 incident SA were reported (incidence 0.74 per 100PY, 95% CI 0.57 to 0.97). Incidence was significantly higher among those with lower incomes (p=0.015) and those who reported a past history of SA at baseline (HR 2.61, p=0.009). In the previous 6 months, those suffering incident SA had more male sexual partners (p=0.056), more unprotected receptive anal sex with casual partners (p=0.004), but were no more likely to acquire HIV (p=0.313). There was no association of incident SA with current sex work, smoking, alcohol or other recreational drug use. After adjustment for age both past and incident SA were predictors of current erectile dysfunction (p<0.001 & p=0.005, respectively), low libido (p=0.050 & p=0.028, respectively) and other problems affecting sexual satisfaction (both p<0.001). Lifetime and incident SA were both also associated with a range of adverse psychological correlates.

Conclusions

As far as we are aware, these are the first prospective data to examine sexual violence among MSM. A number of demographic and behavioural correlates suggest socioeconomic disadvantage and potentially heightened STI/HIV risk in these MSM victims. There was a strong association of SA with adverse markers of psychological and psychosexual health. Routine enquiry regarding SA experience of MSM should occur in sexual health clinics due to its association with a broad range of adverse sexual health outcomes.
P2-S6.07 Intentional viral sorting as a frequently practiced HIV risk reduction strategy among HIV-positive MSM with HIV discordant and concordant partners
Authors: Davidovich U , Van den Boom W , Witlox R , Stolte I
Published: July 2011

Background

Viral sorting is a risk reduction strategy based on the perception that an undetectable viral load reduces HIV transmission risk during unprotected anal intercourse (UAI) with casual partners. We examined how frequently HIV-positive men who have sex with men (MSM) practice intentional viral sorting with HIV-positive and HIV-negative or unknown casual sex partners and sex buddies.

Methods

We included 177 HIV-positive MSM who completed a questionnaire regarding UAI and viral sorting practice. Viral sorting was defined as intentionally engaging in UAI on the condition that both the participant and the HIV-positive partner had an undetectable viral load, or the participant himself had an undetectable viral load with an HIV-negative/unknown casual partner. We examined whether men ever practiced intentional viral sorting since HIV diagnosis, and how often UAI with a last casual partner was the result of viral sorting. We distinguished two casual partner types: the casual sex partner (met by chance and had sex with”) and the sex buddy (“contacted on a regular basis for sex but not considered a steady partner”).

Results

Of the 177 participants, 68% (120/177) ever had UAI since HIV diagnosis. Of those, 44% (53/120) ever practiced viral sorting with an HIV-positive partner and 38% (46/120) with an HIV-negative/unknown partner. Of all participants, 41% (73/177) had UAI with a last casual partner. Among men who had UAI with a last HIV-positive casual partner (n=35), proportions of viral sorting practice with a casual sex partner and a sex buddy were, respectively, 20% (3/15) and 58% (11/20), p<0.05. Among men who had UAI with an HIV-negative/unknown casual partner (n=38), proportions of viral sorting with a casual sex partner and a sex buddy were, respectively, 57% (16/28) and 40% (4/10), p=0.47.

Conclusions

Our data suggest that viral sorting as an intentionally practiced HIV risk reduction strategy is applied relatively frequently among HIV-positive MSM with all partner types. The highest proportions were reported with HIV-positive sex buddies and HIV-negative/unknown casual sex partners. Since viral sorting is being extensively applied by MSM and most of the available data on viral load and HIV transmission risk is derived from studies on heterosexuals, future investigation should provide clear-cut indications on the effectiveness of viral sorting in lowering HIV transmission among MSM.
P1-S1.36 Prevalence ofNeisseria gonorrhoeaeinfections among men and women entering the National Job Training Program-USA, 2004–2009
Authors: Bradley H , Satterwhite C
Published: July 2011

Background

National notifiable disease data indicate that 99 of every 100 000 persons in the USA were infected with gonorrhoea in 2009, the lowest recorded gonorrhoea rate in US history. However, the extent to which declining case reports signify a reduction in prevalence is unknown. In order to better understand national gonorrhoea trends, we examined prevalence over time among men and women entering the National Job Training Program (NJTP).

Methods

Gonorrhoea prevalence was estimated among 16–24-year-old men and women entering the NJTP in 48 states and the District of Columbia from 2004–2009. To approximate gonorrhoea screening, only data from the 105 (85% of all 123) centers that performed gonorrhoea testing on at least 50% of the population were included. Conditional logistic regression was used to assess the probability of testing positive for gonorrhoea over time, adjusted for variables associated with gonorrhoea risk.

Results

95 184 men and 91 697 women were screened for gonorrhoea upon entry to the NJTP from 2004 to 2009. For women, gonorrhoea prevalence increased from 2004 (2.6%) to 2006 (2.9%), then decreased steadily through 2009 (1.8%). For men, prevalence increased from 2004 (1.3%) to 2005 (1.6%), then decreased through 2009 (0.9%). Gonorrhoea prevalence among black women decreased from 3.6% in 2004 to 2.5% in 2009 and was 2–4 times higher than prevalence among white women during the study period. Likewise, prevalence among black men decreased from 2.0% to 1.5% and was 8–22 times higher than prevalence among white men. After adjusting for age, race, region, and test technology, the odds of a woman testing positive for gonorrhoea decreased by 50% from 2004 to 2009. Similarly, the odds of a man testing positive for gonorrhoea decreased by 40% during the study period see Abstract P1-S1.36 Figure 1.

Abstract P1-S1.36 Figure 1

Gonorrhoea prevalence among men and women screened for gonorrhoea at entry to the National Job Training Program—USA, 2004–2009.

Conclusions

Declining trends in gonorrhoea infection among NJTP entrants are similar to those observed in gonorrhoea case report data, suggesting that the decrease in case reports is due to a decrease in prevalence. Both data sources also demonstrate continuing racial disparities in gonorrhoea infection between blacks and whites. Interventions to reduce gonorrhoea infections should be developed to reach populations with a disproportionate risk.
P2-S6.09 Factors associated with HIV sexual risk management among HIV-negative men who have sex with men living in Quebec and who use internet to find sexual partners
Authors: Drouin M C , Léobon A , Frigault L R , Lévy J J
Published: July 2011

Background

This presentation has 2 primary objectives. First, to describe sociodemographic, psychosocial, sociosexual, environnemental and health predictors of a HIV seroconversion risk behaviour, unprotected anal intercourse with HIV-positive or HIV-unknown casual partners (UAI(+/?)), among HIV-negative MSM who live in Quebec and use Internet to find sexual partners. Second, to analyse factors associated to those predictors.

Method

We use data from Net Gay Baromètre 2008, a online quantitative survey which took place on Quebec’ dating websites from December 2007 to May 2008. 3718 MSM participated in this survey of whom 1794 were HIV-negative. Bivariate analysis (χ2; t test) and hierarchical regression were performed with SPSS v0.16.0 for Macintosch.

Results

14.7% of HIV-negative respondents have declared an UAI(+/?) in the past 12 months. Multivariate analysis show that homosexual identity, number of casual partners, marginal sexual practices, drug use, engagement in a couple relationship and history of a STI in the past 12 months were significant predictors associated with UAI(+/?) among those respondents. Bivariate analysis show that those predictors were more often declared among respondents who live in Montreal region, are seeking sensations, are seeking partners in sex venues and are regularly seeking partners on dating websites.

Conclusions

This group of predictors and associated factors shows various sexual scenarios. Those sexual scenarios seem to be more frequent in certain spaces like Internet, which influence the management of sexual risks. Initiatives to prevent HIV seroconversion adapted to the reality of MSM who live in Quebec and use Internet to find sexual partners are proposed.
P2-S6.10 Risks and attributable fractions for HIV infection among MSM at a LGBT Health Center: Chicago, 2010
Authors: Hotton A , Gratzer B , Estrich C , Mehta S D
Published: July 2011

Background

Continued increases in HIV among men who have sex with men (MSM) underscore the need for intervention strategies that target those at highest risk of infection.

Methods

January–December 2010, we collected information on demographic and behavioural risks in the past 12 months from MSM seeking anonymous HIV testing. We examined risks for HIV infection and calculated population attributable fractions (PAFs) to identify relative contributions of exposures to overall infection.

Results

Overall, 81 (2.7%) newly diagnosed infections were identified among 3045 men. Men were median age 31, 64% white, 9% black, 17% Hispanic, and 10% other race/ethnicity. 14% had been diagnosed with an STI in the past year. Among clients for whom behavioural data were available (98%), black race, STI history, receptive anal intercourse (RAI), not always using condoms for RAI, ≥3 partners for RAI, methamphetamine use, sex with an HIV positive partner, and sex with a partner of unknown serostatus were associated with an increased odds of HIV infection in univariate analysis. The univariate association between methamphetamine use and HIV infection was partially mediated by sexual risk behaviour. In multivariable logistic regression, black race (OR, 1.7; 95% CI 1.2 to 2.4), STI history (OR, 2.0; 95% CI 1.1 to 3.6), not always using condoms for RAI (OR, 2.6; 95% CI 1.5 to 4.6), and RAI with ≥3 partners (OR, 2.2; 95% CI 1.3 to 3.9) were significantly associated with HIV infection. Adjusted PAFs were 13.7% (95% CI −1.4 to −26.6) for STI history; 36.7% (95% CI 12.2 to 54.4) for not always using condoms for RAI; and 28.8% (95% CI 5.5 to 46.3) for ≥3 RAI partners. The total combined PAF for these factors adjusted for race/ethnicity was 58.8% (95% CI 28.5 to 72.0). While 81% of HIV-infected men reported at least one risk factor and 11% reported all three, overall, 51% of men screened had at least one of these factors: STI history (14%); not always using condoms for RAI (32%); and ≥3 RAI partners (27%).

Conclusions

STI history, inconsistent condom use, and ≥ 3 sex partners for RAI accounted for 59% of new HIV infections, but were present in half those tested. While we identified behaviours for intervention content, we did not identify sub-groups to target. Interventions that address condom use efficacy and reducing numbers of partners for RAI, including the effect of substance use on sexual decision making, should be considered for men reporting these risks.