bluuebunny/crossref_metadata_2025 huggingface dataset:
Promoting condom-only brothels through solidarity and support for brothel managers
Authors: Sakondhavat Chuanchom , Werawatanakul Yuthapong , Bennett Anthony , Kuchaisit Chusri , Suntharapa Sugree
Published: October 2002

Brothel workers in Thailand are at high risk of HIV infection but they alone do not have adequate bargaining power to insist on condom use with all clients. Brothel managers, on the other hand, are a source of influence over both clients and their workers and can promote universal condom use in their establishments. To test whether brothel managers in Khon Kaen City would adopt and successfully implement a condom-only policy in their establishments, all 24 brothel managers in Khon Kaen City attended a meeting on the dangers of HIV and benefits of an all-condom policy. Ideas on how to implement the policy were discussed. Follow-up visits were made once a month to brothels to resupply condoms, provide reinforcement and to collect data. All brothel managers approved of the condom-only in principle and are now implementing the policy. Results of the evaluation of condom use and degree of solidarity in these 24 brothels are available for the AIDS prevention programme. However, a condom-only policy in brothels can only succeed if managers and brothel workers show solidarity in rejecting all noncondom using clients. Laws to promote condom use may not be needed if brothels are given the opportunity to implement a condom-only policy using their own resourcefulness and determination.
Sex, thrush and bacterial vaginosis
Authors: Hay P E , Ugwumadu A , Chowns J
Published: October 2002

Summary: Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women of childbearing age. In some women it shows a relapsing and remitting course with apparently spontaneous onset and resolution. There are intermediate patterns of vaginal flora in which lactobacilli and other species co-exist. We asked women with recurrent BV to prepare vaginal smears daily, and to record symptoms, time of menstruation, sexual activity and use of douches or medication. We Gram-stained the smears and assigned a Nugent score for BV, and noted the presence of candida, pus cells, sperm and blood. Eighteen women collected daily vaginal smears for up to 10 months. Forty months of slides were collected in total. Bacterial vaginosis arose spontaneously on 23 occasions. We saw candida arise 11 times. Bacterial vaginosis appeared after candida on 9 of these 11 episodes. We saw BV regress spontaneously 13 times. Nine of these resolutions occurred within 48 h of unprotected sexual intercourse: BV only arose on one occasion within 48 h of unprotected intercourse. The intermediate pattern was seen for up to 10 days, and occurred as BV began or resolved in some women, and sometimes resolved without developing into BV. Bacterial vaginosis arose most often in the first 7 days of a menstrual cycle, and resolved spontaneously most often in mid-cycle. In women with recurrent BV, BV arises most often around the time of menstruation and resolves spontaneously in mid-cycle. Recurrences often follow an episode of candidiasis, and BV often regresses after unprotected sexual intercourse.
Physician concurrence with primary care guidelines for persons with HIV disease
Authors: Heath Katherine , Hogg Robert S , Singer Joel , Schechter Martin T , O'Shaughnessy Michael V , Montaner Julio S G
Published: October 2002

Summary: An anonymous questionnaire was mailed to 3 groups of physicians in British Columbia: 659 registrants of a province-wide human immunodeficiency virus (HIV) drug treatment programme (Group 1); 765 who had had a patient test positive for HIV (Group 2); and a random sample of 484 (Group 3). Questionnaires provided data about: physician's demographic and personal characteristics; HIVrelated patient care experience; and 12 knowledge-based items. Responses were received from 65% of Group 1, 68% of Group 2 and 70% of Group 3, with complete information received from 38% of Group 1 and 50% of Groups 2 and 3. Summary knowledge scores were computed by comparing physician responses to recommendations of contemporary guidelines. Regression techniques identified associations between physician characteristics and knowledge scores. Multivariate analysis revealed an inverse relationship between knowledge and physician age in < all groups (all P 0.01). Increased knowledge was associated with the number of currently active HIV-positive patients in Groups 1 and 2 (all P 0.001), and lack of specialization in Groups 2 and 3 (both P 0.001). < <
Confirmatory serological testing of blood donors positive on TPHA screening in Singapore
Authors: Wong S S , Teo D L T , Chan R K W
Published: October 2002

Summary: Seventy-two blood donors who were tested positive by the Singapore Blood Transfusion Service (SBTS) for Treponema pallidum haemagglutination (TPHA) test, were evaluated at the Department of Sexually Transmitted Diseases Clinic (DSC) between November 1994 to December 1996. All underwent syphilis serological testing, including rapid plasma reagin test (RPR), TPHA test and fluorescent treponemal antibody-absorption (FTA-Abs) test. All except one (98.6%) were confirmed TPHA positive by the DSC. Of the 71 TPHA-confirmed-positive donors, 53 (74.6%) were subsequently tested positive for FTA-Abs and 18 (25.4%) were tested negative for FTA-Abs. Twenty-two (31%) of the 71 TPHA-positive blood donors had reactive RPR and 49 (69%) had non-reactive RPR. Of the 22 TPHA-positive donors who had reactive RPR, 19 (86%) had positive FTA-Abs (13 late latent syphilis, 4 serological scar, one late congenital syphilis, one secondary syphilis), and 3 (14%) had negative FTA-Abs (all late latent syphilis). Of the 49 TPHA-positive donors who had non-reactive RPR, 34 (69%) had positive FTA-Abs (24 late latent syphilis, 9 serological scar, one late congenital syphilis) and 15 (31%) had negative FTA-Abs (12 late latent syphilis, 2 serological scar, one false-positive TPHA). Only one TPHA-positive donor referred by the SBTS subsequently turned out to have negative syphilis serology at the DSC. Overall, 68 (95.8%) TPHApositive donors who had a past history of sexual exposure were managed as treated or untreated syphilis, regardless of their RPR or FTA-Abs results. However, FTAAbs was found to be useful in the management of 3 (4.2%) TPHA-positive blood donors in the absence of a history of sexual exposures.
The Internet and medicine: related sites including HIV/AIDS
Authors: Brettle R P
Published: October 2002

Summary: Whilst interest in the Internet is increasing there has been very little information to date on health-related resources. This review provides a personal selection of some initial sites together with brief descriptions of their contents in the areas of general medicine, infectious diseases, travel-related medicine and HIV/AIDS.
Anogenital warts in prepubertal children: pathogenesis, HPV typing and management
Authors: Armstrong D K B , Handley J M
Published: October 2002

Summary: The incidence of anogenital warts in prepubertal children is increasing. Modes of transmission of human papillomavirus to the anogenital area include perinatal, autoinoculation and heteroinoculation, sexual abuse and possibly indirect transmission via fomites. It was previously thought that childhood sexual abuse was the most common mode of transmission and human papillomavirus types 6 and 11 were most often detected. More recent studies, however, would suggest that perinatal infection and autoinoculation or heteroinoculation may be much more prevalent than originally thought. It has been increasingly reported that human papillomavirus type 2 is present in a significant proportion of cases. Assessment of children should be multidisciplinary and sexual abuse should be considered in every case. Treatment modalities, although similar to adult disease, are particularly dependent on individual factors. In view of the as yet unknown risk of subsequent anogenital neoplasia it is recommended that individuals should have regular follow-up on a long-term basis.
Demographic data on prostitutes from Bulgaria- a recruitment country for international (migratory) prostitutes
Authors: Tchoudomirova Krasimira , Domeika Marius , Mardh Per-Anders
Published: October 2002

Summary: The study was aimed at investigating the conditions and circumstances for the recruitment of prostitutes, as well as their reproductive history, working conditions, knowledge of and attitudes to sexually transmitted diseases (STDs), and use of prophylactic antibiotic therapy of these diseases. Two hundred prostitutes were investigated by in-depth interviews at STD clinics, private practices and hotels. Of the 200 prostitutes, 8 (4%) were less than 15 years old and 32 (16%) more than 25 years old. Most of the women came from rural villages. Half of them were gypsies. Most had a boyfriend (often the pimp). One-quarter had been or were on their way abroad to prostitute. Half were migrating within Bulgaria to prostitute. They claimed a high rate of condom use with customers, but seldom with their pimps or boyfriends. About one-tenth used antibiotics prophylactically. They had knowledge of classical STDs and HIV/AIDS but only in exceptional cases had they heard about chlamydial and human papillomavirus infections. They often cohabited with a female friend also often practising prostitution. It was concluded that recruitment is often easy as the prostitute can earn more from only one contact with a customer than their parents earn from work in a month. Symptoms suggestive of STD were very common in the prostitutes, i.e. in 43%. Bulgaria is a recruitment area for international prostitutes.
Anonymous HIV surveillance with risk-factor elicitation: at Perth (for men) and Cornton Vale (for women) Prisons in Scotland
Authors: Gore Sheila M. , Bird Graham A. , Burns Sheila , Ross Amanda J. , Goldberg David
Published: October 2002

Summary: 434 male and 145 female prisoners were available to participate in crosssectional, voluntary anonymous HIV surveillance (using saliva samples) with linked self-completion questionnaire at HMP (Her Majesty's Prison) Perth on 17 May and at HMP Cornton Vale on 18 May 1995. Three hundred and four men (70%) and 136 women (94%) completed a risk-factor questionnaire and 304 and 135 samples were received for HIV antibody testing. Two hundred and eighty-two and 132 questionnaires passed logical checks. Six saliva samples from Perth (all injectors) out of 304 and none from Cornton Vale out of 134 tested were HIV antibody positive. Four were presumptively from known HIV-infected male inmates; the other 2 were local men, under 26 years, who began injecting in 1989-91, and both reported having had a recent HIV test. Overall HIV prevalence was estimated at 2% compared to a known prevalence of 1.4% (6/434), giving a 1.5 ratio of overall: disclosed HIV prevalence at HMP Perth. HIV prevalence was estimated at 7% (6/82) for injector-participants and 14% (5/35) for local injector participants. At Cornton Vale, where both known HIV-infected inmates abstained, overall and disclosed HIV prevalence were equal at 1.4%. At Perth Prison, 29% of prisoners had injected drugs (82/278); 85% of injector-inmates reported having injected inside (some) prison and 31% (25/80) had started to inject while inside, 7 during their present sentence. Of all 21 injector-inmates who first injected after 1991, 10 hadstarted to inject inside, including one of 69 male inmateswho had never been inside before. The corresponding figures for Cornton Vale, where 46% of inmates were injectors (58/132), were that 57% of injector-inmates had injected inside (32/56) but only one woman, for whom this was not her first sentence, had started to inject inside. Twenty-eight per cent of male prisoners (78/277) and 57% of male injector-inmates (47/82) had had a personal HIV test since January 1993, as had 35% of female prisoners (43/124) and 57% of female injector-inmates (30/53). A much higher proportion of Glasgow's female prisoners (64%: 38/60) were injectors than of women prisoners from the Edinburgh, Dundee and Fife area (21%: 5/26) or from elsewhere (34%: 15/45). Rape was reported by 23% of women (30/130). Women who had been raped had a more polarized distribution of male sexual partners (none to 2 plus) in the year before sentencing than other women and were more likely to report anal sex (11/30 vs 11/100, P< 0.001). Prostitution had been engaged in by 19% of female injector-inmates (11/57) and was acknowledged by one other woman. However, only 5% of women (6/130) reported ever having been treated for an STD.
Syphilis in injecting drug users: clues for high-risk sexual behaviour in female IDUs
Authors: Muga Roberto , Roca Josep , Tor Jordi , Pigem Carme , Rodriguez Rosa , Manuel Egea Jose , Vlahov David , Munoz Alvaro
Published: October 2002

The objective was to measure the gender-specific differences for syphilis and for the sexual transmission of human immunodeficiency virus (HIV) in a crosssectional analysis of injecting drug users (IDUs) admitted to detoxification between February 1987 and January 1990. HIV was determined by enzyme-linked immunosorbent assay (ELISA) and confirmed with Western blot. For syphilis reactive samples to a rapid plasma reagent (RPR) were confirmed with treponemal tests (FTA-ABS or MHA-TP). Of the 386 heterosexual IDUs, 68% were HIV-positive and 4.7% had serologic syphilis (RPR and FTA-ABS or MHA-TP positive). Syphilis was higher in women (12%) than in men (3%), and women reported a significantly (P< 0.001) higher number of sex partners. Men had an IDU as a sex partner more often than women did (P=0.001). Serologic syphilis in women was associated with having had more than one sexual partner in the previous year (P=0.028) but this association was not present in men. HIV infection was not associated with syphilis in male IDUs. However, HIV was present in all women with syphilis that reported more than one partner.
Levels of dangerousness: an analysis of Irish dentists' clinical responses to HIV-seropositive patients
Authors: Gibson B J , Freeman R E , McCartan B E
Published: October 2002

Work conducted in the mid-1980s suggested that dentists in the Republic of Ireland felt uncomfortable about treating patients who were HIV-seropositive. It seemed that with greater understanding of the behaviour of the virus, dentists' attitudes would be modified accordingly. The aim of this study was to assess the reactions of Irish dentists to the treatment of HIV-positive patients. All dentists currently on the register were sent a questionnaire to assess their knowledge, attitudes and clinical behaviours. Over 60% of dentists responded. The study highlights dentists' responses to HIV infection suggesting that they are fearful of the virus. They perceive HIV as dangerous to themselves, their other patients and their practice. The findings indicate that attitudes relating to dangerousness remain a significant obstacle in the treatment of this patient group.
Phase II trial of 13- cis -retinoic acid for poor risk HIV-associated Kaposi's sarcoma
Authors: Bower M , Fife K , Landau D , Gracie F , Phillips R H , Gazzard B G
Published: October 2002

Fifteen men with HIV-associated Kaposi's sarcoma (KS) and poor risk disease according to the TIS staging were enrolled in a phase II trial of oral 13- cis retinoic acid. The median CD4 cell count was 95 cells/ l (range 7-260) and 6 had prior AIDS-defining opportunistic infections. One patient was withdrawn on account of cutaneous toxicity. Evaluation was by AIDS Clinical Trials Group (ACTG)1 defined assessment. One patient achieved a partial response and remains on treatment in partial remission. Thus the overall response rate is 7% (95% confidence interval 0-23%). A further 5 patients had stable disease (38%: 95% confidence interval 7-64%). The overall low activity, considerable toxicity and limited cosmetic benefit even in responding patients limits the value of this approach in KS. However, this treatment strategy may be more rewarding in early good risk KS. u
Anal cytological abnormalities in HIV-infected homosexual men
Authors: Sayers S J , McMillian A , Mcgoogan E
Published: October 2002

Summary: This study aimed to examine the prevalence of anal cytological abnormalities in groups of HIV-infected and non-infected homosexual men, and to monitor changes with time. Dyskaryosis suggestive of anal intraepithelial neoplasia (AIN) was noted in 24 (30%) of the 80 satisfactory anal smears from 66 HIV-seropositive homosexual men; such changes were found in only 7 (4.7%) of the 149 satisfactory smears from 181 HIV-seronegative homosexual men ( P 0.005), and in none of 34 satisfactory preparations from 51 HIV-seronegative heterosexual men. In the follow-up of 20 HIV-seropositive men, the severity of the cytological abnormalities found in 2 men increased, with the most recent smear showing changes suggestive of AIN III; one of these men subsequently developed anal cancer. Smears from 4 men showed apparent regression in the degree of dyskaryosis. Although the numbers of patients studied were small, there appeared to be a trend towards a more severe degree of dyskaryosis in those men with increasing immunodeficiency. There was no significant difference in the detection of human papillomavirus types 6b, 11, 16 and 18 between HIV-infected and noninfected men. <
Testosterone therapy for clinical symptoms of hypogonadism in eugonadal men with AIDS
Authors: Rabkin G J Wagner J G
Published: October 2002

Summary: We conducted a small exploratory study to assess whether testosterone therapy is an effective treatment for clinical symptoms characteristic of hypogonadism in eugonadal men with AIDS. Treatment consisted of 12 weeks of bi-weekly intramuscular injections of testosterone cypionate. Twenty-three men enrolled in the study; mean age was 37 and 44% were ethnic minorities. All had an AIDS diagnosis and the mean CD4 cell count was 150 cells/mm 3. All baseline serum testosterone levels were within the laboratory reference range and above 500 ng/dl. Diminished libido was an inclusion criterion, plus each patient had at least one additional symptom (low mood, low energy, loss of appetite and/or weight). Nineteen men completed the trial and a majority of patients responded with regard to libido (89%), mood (67%), energy (71%), and appetite (67%) as rated by the Clinical Global Impressions Scale. With the exception of appetite, self and clinician rated measures showed significant improvement in all symptom domains. Among the 14 study completers with significant weight loss, the average weight gain was 2.3 kg, with a 1.8 kg increase in body cell mass and no change in body fat. These results suggest that testosterone is as effective in treating these symptoms in eugonadal men with AIDS as we have found in our research with hypogonadal HIV+men.
The management of chlamydial infection: setting standards at a regional level
Authors: Sonnex Chris , Williams Olwen
Published: October 2002

Between 1993 and 1997, clinicians from 9 departments of genitourinary medicine (GUM) and one department of sexual health in East Anglia met to audit the process of contact tracing in chlamydial infection. After defining the target group, standards were set for discussion of the diagnosis with the index patient, appropriate treatment of the condition and documented notification of partners. Data were collected for all patients with confirmed chlamydial infection during the periods January to March 1995 and 1996. Considering the combined data for both years, overall 97% of patients were informed of the diagnosis and 100% received appropriate treatment. Notification of partners was addressed at the initial consultation in 99% of cases and again at follow-up in 87%. Where contacts were traceable, there was confirmation that assessment had occurred in 65%, and the index cases reported that 66% had undergone assessment. The achievements and also the problems associated with this audit are discussed.
Sexual functioning in ambulatory men with HIV/AIDS
Authors: Newshan Gayle , Taylor Brian , Gold Richard
Published: October 2002

Sexual functioning is often neglected in the care of HIV-infected patients. Little information exists about the relationship between hormonal factors, psychological factors, medication, HIV disease stage and sexual functioning among persons with HIV disease. In this study, 50 HIV+ men completed the Derogatis Sexual Functioning Inventory (DSFI), and had serum hormonal assays drawn (testosterone, thyroid function test, leuteinizing hormone, prolactin and oestradiol). Although all the subjects reported some degree of sexual dysfunction, persons with symptomatic HIV/AIDS reported more negative mood, lower sexual satisfaction scores and worse body image than persons with asymptomatic HIV. Persons with asymptomatic HIV also tended to have normal testosterone levels compared with persons with symptomatic HIV/AIDS. No relationship was found between medications and low testosterone, although numbers were small. These results suggest that sexual dysfunction is prevalent among persons with HIV disease, is more common as patients become symptomatic and progress to AIDS and that both physiological (low testosterone) and psychological issues play a role.
A general practitioner STD training programme: meeting education and service provision needs
Authors: Wray L , Barrie S C
Published: October 2002

This paper discusses the development, implementation and evaluation of a training programme in sexually transmitted diseases (STDs) for general practitioners (GPs) belonging to the Divisions of General Practice in the Sydney metropolitan area. The aims of the project were to involve GPs in the management of STDs, sexual health issues and the prevention of human immunodeficiency virus (HIV) infection and to ensure a consistent and high quality of care in the management of STDs and HIV. The strategy used was a two-stage programme consisting of a series of 3 educational modules (total 15 h) and an intensive clinical training programme for selected GPs for 12 times 4 h clinical sessions. Needs assessment of the participating GPs was conducted to ensure that the content of the theory modules was appropriate. Evaluation of the modules was conducted to examine both perceived quality of the actual presentations and changes in knowledge or skills as a result of participation in the project.
Prevalence of HSV-2 antibodies among STD clinic patients in Tanzania
Authors: Langeland N , Haarr L , Mhalu F
Published: October 2002

Summary: Patients attending a referral sexually transmissible diseases clinic at Muhimbili Medical Centre in Dar-es-Salaam during the period 1989 to 1993 were examined for herpes simplex virus type 2 (HSV-2) antibodies. An ELISA technique, using glycoprotein G of HSV-2 as antigen, was used to test 294 patients' sera. Of these, 126 sera were HSV-2 positive, while 168 were negative, yielding an overall HSV-2 prevalence of 42.9%. Sixty-three per cent of the women and 35.5% of the men were HSV-2 positive. Seropositivity rose from 8.7% in the youngest men to 61.5% in the oldest male age group, while even the youngest women aged 20 or less had an HSV-2 prevalence of 55.6%. There was a significant positive association between HIV and HSV-2 seropositivity ( P =0.0006), most pronounced among the youngest women. There was no over-representation of HSV-2 positivity among patients with genital ulcer disease, indicating that other causes of this disease could be more common than HSV-2 in Tanzania.
Gender-related correlates and predictors of consistent condom use among young adult African-American women: a prospective analysis
Authors: Wingood G M , Diclemente R J
Published: October 2002

The present study examined the correlates of consistent condom use among African-American women and prospectively evaluated the stability of these significant variables to predict consistent condom use at 3-month follow-up. A sample of 128 African-American women, 18-29 years of age completed a baseline interview and 3 months later completed a similar follow-up interview ( n =100). Compared to women who were inconsistent condom users, women who were consistent condom users were more likely to: have high assertive communication skills (OR=13), desire not becoming pregnant (OR=8.6), have high sexual selfcontrol over condom use (OR=7.6), perceive having control over their partners' use of condoms (OR=6.6), be younger (OR=5.8), and report having a partner that was not committed to the relationship (OR=3.3). Prospective analyses identified baseline level of condom use as the best predictor of condom use at 3-month follow-up. Women who were consistent condom users at baseline were 6.3 times as likely to be consistent condom users at 3-month follow-up. In conclusion, HIV prevention programmes for women need to be gender specific and need to be implemented before high-risk behaviours are established and may be more difficult to modify.
Examining self-justifications for unsafe sex as a technique of AIDS education: the importance of personal relevance
Authors: Gold Ron S , Rosenthal Doreen A
Published: October 2002

Summary: In an earlier study, we found that sexual risk-taking in gay men was reduced by getting them to evaluate the self-justifications for having unsafe sex which they had used on a specific occasion when they 'slipped up' (broke their safe sex rules by having unprotected anal intercourse). This study investigated whether the earlier finding occurred simply because recalling vividly a specific encounter in which a slip-up took place brought the men's risk-taking home to them very strongly and whether the intervention would still work if translated into posters suitable for the mass media. Gay men (n =92) who had slipped up kept diaries of their sexual behaviour for 16 weeks. After 4 weeks, they were allocated to one of 3 conditions: Specific Encounter (detailed reconstruction of a slip-up, but without any questions about self-justifications); Posters (examination of posters, specially designed for the study, that focused on self-justifications); and Control (no intervention). All 3 groups slipped up to the same extent in the post-intervention period. The results for the Specific Encounter group indicate that the earlier finding is not attributable to the alternative explanation above, while those for the Posters group suggest the importance of ensuring personal 'ownership' of the self-justifications presented. Implications for AIDS education are discussed.
Reasons for HIV antibody testing: plus ca change?
Authors: Chippindale Sarah , French Patrick , Miller David
Published: October 2002

Patient records in a central London genitourinary medicine (GUM) clinic relating to HIV testing were examined and compared for the 3 months immediately before and after World AIDS Day (WAD) in 1994, according to gender and sexual orientation, and the reasons given for testing. Additionally, patient-identified risk was compared with counsellor-identified risk in each case in 1994. Findings were compared with data from the initial HIV awareness campaign in 1986-87. In the 1994 study period, there were no significant differences in overall numbers attending or gender of test-seekers before and after WAD, or proportions of heterosexual, bisexual and gay test-seekers across the time periods. Within each of these groups, gay test seekers were significantly more likely to be HIV positive than heterosexuals, although there were no differences in numbers found positive in each group before and after WAD. Thirty-five per cent (n =268) reported a history of safer sex only, 32% (n =247) said 'sometimes', and 33% (n =249) said 'no'. Overall, the main reasons given for HIV test-seeking included having part of a sexual health screen, having episodes of unprotected sex and/or casual partners, concern over partner's status/monogamy, and intravenous drug user (IDU) contact. Reasons for testing in 1994 reflected greater awareness of HIV transmission compared to 1986- 87, although only one-third of those tested reported a history of safer sex.
Antenatal HIV prevalence in Yaounde, Cameroon
Authors: Keou F X Mbopi , Mauclere P , Andela A , Tetanye E , Leke R , Chaouat G , Sinoussi F Barre , Martin P , Belec L
Published: October 2002

Summary: From June 1994 to July 1996, 4100 pregnant women living in Yaounde, Cameroon, were tested for human immunodeficiency virus type 1 HIV 1 and syphilis. The HIV seroprevalence was 4.2 95 confidence interval CI : 3.6- 4.8 , and that of antibodies to Treponema pallidum was 17.4 95 CI: 16.3- 18.6 HIV infection was twice as common in women with positive syphilis serology 7.2 vs 3.6 . Over the study period, the antenatal seroprevalence of syphilis remained stable, while there was an increase in the HIV seroprevalence rate. There was an increase in HIV seropositivity in women uninfected with syphilis between 1994 1995 and 1995 1996 from 2.9 to 4.3 . By the end of the study, HIV infection was no commoner in women with negative compared with positive syphilis serology. It is therefore postulated that HIV infection in Yaounde has entered the general, sexually active female population. We suggest that manage ment of pregnant women in Cameroon should include routine screening for both HIV infection and other sexually transmitted diseases STDs .
Health risk profile of prostitutes in Dublin
Authors: Mcdonnell R J , Mcdonnell P M , Neill M O , Mulcahy F
Published: October 2002

This study examined the health risk profile of prostitutes in Dublin. Clinical records of all 150 new prostitutes who attended a drop in clinic for prostitutes in Dublin city during the period 1991-1997 were reviewed. Variables examined included: age, use of injectable drugs, human immunodeficiency virus HIV status, hepatitis B and C status, presence of sexually transmitted disease STD , cervical cytology. Results showed the mean age of the women was 32 years. Among those tested, 2.5 were HIV positive, 5 were hepatitis B positive, 8 were hepatitis C positive and 25 had an STD. Almost 8 were injecting drug users IDU with higher prevalences of HIV, hepatitis B and C compared with non IDU < P 0.001 . The clinic has been successful in providing a health care facility for the specific health needs of this patient cohort.
HIV infection and asymptomatic sexually transmitted infections in a rural South African community
Authors: Colvin M , Karim S S Abdool , Connolly C , Hoosen A A , Ntuli N
Published: October 2002

The objective was to determine the prevalence of HIV and other sexually transmitted infections STIs in a rural community. A population based survey of adults in 110 homesteads was conducted in 1995. A questionnaire on demographics, sexual practices and history of STDs was administered. Neisseria gonorrhoeae and Chlamydia trachomatis infections were detected using ligase chain reaction LCR assay of urine. The seroprevalence of syphilis rapid plasma reagin RPR and Treponema pallidum haemagglutination assay TPHA and HIV infection ELISA was determined. Among 259 subjects the prevalence of HIV was 10.5 , N. gonorrhoeae 4.5 , C. trachomatis 6.1 and active syphilis 8.8 . All infections were asymptomatic. Forty per cent of sexually active men had more than one concurrent sexual partner. Only 14 of subjects had ever used condoms. The STI epidemic is being promoted by high levels of asymptomatic infections, high partner concurrency and low condom use.
Clinical and in situ cellular responses to Haemophilus ducreyi in the presence or absence of HIV infection
Authors: King Roy , Choudhri Shurjeel H , Nasio James , Gough James , Nagelkerke Nico J D , Plummer Francis A , Ndinya Jackoniah O , Ronald Achola Allan R
Published: October 2002

We aimed to determine if the clinical and histological features of chancroid are altered by HIV infection. Male patients presenting to the Nairobi special treatment clinic with a clinical diagnosis of chancroid were eligible for the study. A detailed history, physical examination, swabs for Haemophilus ducreyi culture and blood for HIV serology, syphilis serology and CD4 counts were obtained from all patients. Punch biopsies from an ulcer were obtained from 10 patients and either fixed in 10 formalin or snap frozen in Optimum Cutting Temperature OCT medium compound at 70 C. Patients were treated with erythromycin and followed for 3 weeks. Chi square and Student s t test were used to determine if the clinical and laboratory features of chancroid differed between HIV seropositive and seronegative individuals. Cox regression survival analysis was used to determine if HIV infection altered cure rates of chancroid at 21 days. Immunohistochemical staining was performed using lymphocytic and macrophage markers and tissue sections were analysed by 2 pathologists in a blinded manner. Between February and November 1994, 109 HIV seropositive and 211 HIV seronegative individuals were enrolled in the study. HIV patients had ulcers of longer duration than HIV seronegative patients P =0.03 . Although cure rates were similar at 3 weeks, HIV patients had lower cure rates at 1 week 23 v 54 , P =0.002 . A dense interstitial and perivascular inflammatory infiltrate extending from the reticular to deep dermis was present in all biopsies. This consisted of equal amounts of CD4 and CD8 T lymphocytes as well as macrophages. The histological and immunohistochemical picture was identical for HIV positive and negative patients. HIV infection slows the healing rates of chancroid ulcers despite appropriate antibiotic therapy. This clinical difference cannot be attributed to an altered histopathological response to HIV infection. Additional studies are needed to elucidate the mechanisms responsible for this finding.
Transsexual Orientation in HIV Risk Behaviours in an Adult Male Prison
Authors: Stephens Torrance , Cozza Scott , Braithwaite Ronald L
Published: October 2002

The present study examined the consequences of being a self-reported transsexual male and HIV risk behaviours in a state penal system. The specific research question was whether or not sexual orientation of inmates influences the level to which they evidence HIV risk behaviours. A total of 153 participants volunteered to participate in the study of which 31 described themselves as being transsexual. Based on risk ratios and using transsexual inmates (TIs) as the reference group, they were 13.7 times more likely to have a main sex partner while in prison [95% CI=5.28, 35.58]. Moreover, TIs were 5.8 times more likely than non-transsexual inmates (NTIs) to report having more than one sex partner while in prison [95% CI=2.18, 15.54]. It is obvious from these findings that TIs require more preventive support than their NTI confederates. In addition to TIs being protected from assault and battery by NTIs, they need social support and carefully developed preventive informational materials.
Delay in Symptom Presentation among a Sample of Older GUM Clinic Attenders
Authors: Gott C Merryn , Rogstad Karen E , Riley Vincent , Ahmed-Jushuf Imtyaz
Published: October 2002

Prior research undertaken with predominantly youthful populations has established that delay between symptom recognition and health-care presentation is a common feature of sexually transmitted infection (STI) related illness behaviour1-4. However, it is not known whether similar behaviours are exhibited by older populations with genitourinary symptoms. The present analyses therefore aim to clarify this issue by focusing upon (1) extent of delay behaviour, (2) reasons for delay behaviour and (3) variables predicting delay behaviour among a sample of genitourinary medicine (GUM) clinic attenders aged over 50 years.

A self-administered questionnaire study linked to patient note data was undertaken within 3 GUM clinics in the Trent region between January 1997 and March 1998 (Sheffield, Nottingham and Leicester).

Of 121 symptomatic older attenders with suspected STI, 43.8% (n=53) waited over 2 weeks between symptom recognition and clinic attendance. Reasons given for delay included wanting to ‘wait and see’ if symptoms improved and being embarrassed or afraid to attend clinic. A logistic regression analysis identified that delay behaviour was predicted by history of HIV testing.

Comparisons with previous research undertaken in this field indicate that levels of delay behaviour reported by this older sample are higher than those exhibited by youthful populations with genitourinary symptoms. This finding has significant implications for health-care professionals working both within a GUM setting, and with older people, especially when viewed in the context of an ageing population.
Sexually Transmitted Diseases in Lithuania: Some Epidemiological and Social Aspects
Authors: Lapinskaitè Genovaitè S , Bingham J S
Published: October 2002

With political, economical and social changes in Lithuania following the break-up of the Soviet Union, the health-care system has changed. The old Soviet system has been abandoned and it has taken time to re-establish a system under the new government. Resources are limited in most aspects of health care, including sexually transmitted infections (STIs). This has, also limited the development of education packages on STIs which are so important when trying to combat the spread of HIV infection. Notifications of syphilis, in Lithuania, have increased 52 fold between 1990 and 1996 although, since then, the incidence has started to decrease. Syphilis has been more reliably notified than other STIs and serves as the most reliable indicator of STI trends.
Monitoring Cytomegalovirus Retinitis Prevalence in an HIV-Seropositive Cohort: The Assessment of Improvements Observed following the Introduction of Highly Active Antiretroviral Triple Therapy
Authors: Hutchinson Sacha , Courtney Richeal , Mulcahy Fiona , O'connor Martin , Mcophth Susan Mullaney , Kilbride Ronan
Published: October 2002

This paper concerns the ophthalmic assessment of patients with acquired immunodeficiency syndrome (AIDS) for a number of eye conditions and in particular cytomegalovirus (CMV) retinitis. CMV has been the most common opportunistic infection associated with AIDS and the leading cause of blindness among AIDS patients. There have been early indications of a widespread fall in CMV prevalence internationally following the introduction of a new highly active antiretroviral triple (HAART) therapy. Our study sought to assess the position for Ireland. Our cohort was the entire population of stage IV AIDS patients attending the country's leading referral centre. The total number of patients examined was 167 and the period of examination was 1 May 1995 to 30 April 1997. HAART was introduced in March 1996, so the data permitted a ‘before and after’ comparison of various clinical findings. The incidence of new CMV cases was found to be 4 among the 102 patients examined in the first 12-month period and one among 107 patients examined in the second 12-month period. There were accompanying declines in HIV-related non-infectious retinal vasculopathy (HIVR), keratitis and other conditions. The findings are promising, but we argue that caution is needed in assessing long-term trends. In the paper we discuss a number of methodological issues in the collection and analysis of the clinical data and in the interpretation of results.
Evaluation of Self-Taken Samples for the Presence of Genital Chlamydia Trachomatis Infection in Women using the Ligase Chain Reaction Assay
Authors: Carder C , Robinson A J , Broughton C , Stephenson J M , Ridgway G L
Published: October 2002

The aim of this study was to evaluate the sensitivity and acceptability of self-taken vulval-introital (VI) samples, first-catch urine (FCU) samples and clinician-obtained cervical samples for the presence of genital Chlamydia trachomatis infections in women using the ligase chain reaction (LCR) assay. One hundred and four patients were enrolled, of whom 54 patients had chlamydial DNA in at least one of the samples tested. The sensitivity of the cervical sample was 96.3%, vulval-introital sample in LCR buffer 92.6%, vulval-introital swab collected dry 88.9%, FCU stored at +2–8°C 81.5%, FCU stored at room temperature 77.8% and FCU stored with 2% w/v boric acid at room temperature 87.0%.

Self-taken vulval-introital LCR samples were shown to be an acceptable alternative to a clinician-obtained LCR sample. The addition of boric acid may overcome the need for a continuous cold chain for FCU samples.
Intestinal Protozoa in Homosexual Men in Edinburgh
Authors: Pakianathan M R , Mcmillan A
Published: October 2002

Our objective was to determine the prevalence of intestinal protozoa in homosexual men attending a sexually transmitted diseases (STD) clinic, to compare it with the prevalence in a previous study from the same clinic, and to examine the relationship, if any, between the presence of protozoa and sexual practices.

Men who consecutively attended the clinic and who gave a history of having had recent sexual contact with another male were invited to provide a stool sample for protozoological examination. Diarrhoeal samples were examined by direct microscopy for trophozoites and cysts and, after staining, for Cryptosporidium spp. In all cases, a modified formol–ether method was used to concentrate protozoal cysts before microscopy.

One hundred and seventy-five of the 257 men invited to participate in the study provided a stool sample. At least one species of protozoan was found in 99 (57%) men. Giardia intestinalis was identified in only 5 (3%) men. Blastocystis hominis was found in 46 (26%) men, but the presence of this protozoan was not associated with diarrhoea. Other than the prevalence of Entamoeba dispar/histolytica and G. intestinalis, which remained unchanged, the proportion of men who harboured the non-pathogenic protozoa was significantly increased from 1981/82. A correlation between oral-anal sex or peno-insertive or peno-receptive anal intercourse and the prevalence of protozoa was not found. There was also no correlation between the number of species of protozoa carried and these sexual practices. The presence of protozoa was not associated with a history of foreign travel or sexual contact with a man who had recently travelled outside the UK.

The study showed that, although the prevalence of infection is low, giardiasis is still transmissible amongst homosexual men. A correlation between individual sexual practices and the prevalence of intestinal protozoa was not found.
Usefulness of Information from the Unlinked Anonymous Prevalence Monitoring Programme for HIV in England and Wales: Survey of Planners of HIV/AIDS Services
Authors: Kessel A S , Watts C J
Published: October 2002

The aim of this study was to evaluate whether information from the Unlinked Anonymous Prevalence Monitoring Programme for HIV in England and Wales is useful to planners of HIV/AIDS services. The study involved 2 stages: examination of 1997 AIDS Control Act Reports for England and Wales, and a telephone questionnaire survey of local planners of HIV/AIDS services.

Forty-eight out of 55 health authorities (87.3%) found information from the programme to be useful in general; 37/55 (67.3%) found the information useful for targeting of health promotion; 35/55 (63.6%) found the information useful for assessing the effectiveness of preventive measures aimed at reducing the spread of HIV; and 28/55 (50.9%) found the information useful for planning of medical or social services. If information from the programme was no longer available, 36/55 (65.5%) said it would make some difference to local planning, although 12/55 (21.8%) said it would make no difference. Local planners were generally supportive of the programme, and complaints were mostly directed at funding and timeliness of the reports.
HIV-Infected Workers Deported from the Gulf States: Impact on Southern Pakistan
Authors: Shah S A , Khan O A , Kristensen S , Vermund S H
Published: October 2002

HIV prevalence is still very low in Pakistan, but its south Asian location and subgroups with recognized lifestyle risk factors suggest that Pakistan will experience expanded diffusion of HIV. We report the frequency of HIV infections identified by the AIDS Control Programme on the Sindh province of Pakistan. Most HIV-positive cases currently reported to the Sindh AIDS Control Programme are found among Pakistani workers deported from the Gulf States and among foreigners. The 58 returned workers with HIV represent 61 to 86% of reported cases in any given year during the 1996–1998 period. Five wives of returning workers have been identified with HIV. Expatriate workers in the Gulf States are tested for HIV routinely, unlike other subgroups in Pakistan. Considering the risk of HIV/AIDS due to regular introduction of HIV from returned workers, and the limited awareness surrounding sexual health and HIV/STD transmission issues in Pakistan, intervention programmes targeted at overseas workers need to be implemented to control the expansion of the HIV epidemic in Pakistan.
HIV prevention and the positive population
Authors: King-Spooner S
Published: October 2002

Efforts to prevent the spread of HIV have, to an overwhelming degree, addressed themselves to the HIV-negative rather than to the positive population. But it makes sense to direct more preventive work towards positive individuals, for 3 reasons. First, because changes in the behaviour of positive people have a disproportionately greater effect on the spread of the epidemic- so positivetargeted interventions are potentially more cost-effective, and in many cases enormously so. Second, positive individuals already show a degree of preventive altruism that generally outweighs the self-protective efforts of those who are negative. And third, there is reason to believe that this preventive altruism can be strengthened by appropriate interventions. Some of the practical implications of a shift to greater positive targeting, involving both novel interventions and modified familiar ones, can be sketched out.
Behavioural risk factors for HIV/AIDS in a low-HIV prevalence Muslim nation: Bangladesh
Authors: Gibney L , Choudhury P , Khawaja Z , Sarker M , Vermund S H
Published: October 2002

A review of published and unpublished data indicates the prevalence of high-risk behaviours for HIV transmission in segments of the Bangladeshi population. These include casual unprotected sex, heterosexual as well as between males, prior to and after marriage. Intravenous drug use (IVDU) exists though illicit drugs are more commonly inhaled. There is a fear, however, that inhalers may turn to injecting drugs, as is common in neighbouring countries. The lack of public awareness of HIV/AIDS, and misconceptions about the disease, may contribute to continued high-risk behaviours by segments of the population and, thus, to the spread of HIV. Bangladesh's proximity to India and Myanmar (countries with high HIV endemicity and a rapidly growing number of cases) increases fears of an epidemic in Bangladesh. This proximity will only be a risk factor, however, if highrisk contacts occur between nationals of these countries.