bluuebunny/crossref_metadata_2025 huggingface dataset:
P2-S4.02 Don't look at your patients, look at their partners: Characteristics of sexual partnerships reported by people attending GUM clinics in England
Authors: Mercer C H , Aicken C R H , Low N , Estcourt C S , White P J , Keane F , Brook G , Rait G , Cassell J A
Published: July 2011

Background

Partnership characteristics, for example, their length, timing, and whether or not condoms are used, may be more important for assessing STI transmission risk than partnership numbers. However, data routinely collected by GUM clinics in the UK are limited in terms of such measures of partnership risk. We sought to measure this in a high-risk population and consider the implications for STI transmission and partner notification (PN).

Methods

Cross-sectional survey of 2203 people attending 4 sociodemographically and geographically contrasting GUM clinics in England in 2009. Attendees completed a questionnaire that was linked to their clinical records for data on acute STI diagnoses. Questions asked about their three most recent partnerships in the 3 months prior to attending GUM and the total number of partners in this period. We used a novel statistical approach to weight the data to represent the partnerships for which these questions were not asked. This enables us to describe the population of partnerships reported by GUM attendees, rather than the population of attendees.

Results

Most patients had few partners: median: 1 partner, IQRs: 1–3 (men) and 1–2 (women). However, the 1941 attendees reporting partners reported a total of 3576 partners: 1953 by 846 men, 1623 by 1095 women. Men's partnerships were shorter than women's: 73% vs 54% (p<0.01) were <3 months “old” (49% vs 27%, respectively, were one-off encounters), and were more likely to be considered as ended: 64% vs 41%, respectively, p<0.01, see Abstract P2-S4.02 figure 1 Inconsistent condom use was high, especially in women's partnerships: 81% vs 65% among men's partnerships, p=0.002. Men (but not women) were more likely to have acute STIs diagnosed if they had never used condoms with their partners than if they had at least once: 33% vs 27%, p=0.001. 24% of men vs 14% of women had recent concurrent partnerships based on the dates of their 3 most recent partners (p<0.01), but this was not associated with having acute STI diagnoses.

Abstract P2-S4.02 Figure 1

Distribution of partnership length by partnership status and gender of GUM clinic attendee.

Conclusions

Despite low median partner numbers, GUM attendees have a large population of partnerships, of which only a small minority involve consistent condom use, thus the potential for STI transmission is high. These partnerships are often casual in nature being short in duration and unlikely to be ongoing. Research is needed to develop and test alternative methods for reaching such partners to ensure that PN achieves both individual and public health benefit.
P2-S4.03 Prevalence and risk factors forChlamydia trachomatisinfection among female medical students and women attending family planning clinics in Northern Italy
Authors: Biglino A , Montrucchio G , Moglia R , Concialdi E , Bolla C , Tramontano M , Ferrero D V
Published: July 2011

Background

Prevalence and risk data concerningChlamydia trachomatisCT in Italy is scare. We present a study of the prevalence and predictive risk factors for CT infection by comparing two different female populations at risk because of age (18–26) but with different socio-cultural backgrounds.

Methods

An anonymous questionnaire concerning sexual behaviour was given to 493 female medical students aged 18–26 at the University of Torino and to women aged 18-26 attending three Family Planning Clinics (FPC) in Asti, Italy. A first-catch urine sample was collected into a liquid transport medium (UPT, Becton Dickinson) from each subject who completed the questionnaire. Nucleic acid amplification testing for CT was performed using the BD ProbeTec ET assay. Age and behavioural characteristics were compared.

Results

6 women of 493 medical students tested (1.22%) were positive for CT, while 11 of 262 women attending FPC had a positive CT result (4.2%) (χ2=5.7; p=0.017). Different behaviours between the female medical students and the FPC population respectively for non-barrier contraceptive methods were: (34% vs 59%); age <18 at first intercourse (40% vs 60%); more than 1 partner during last year (16% vs 20%), or the last 5 years (2% vs 56%). Risk of infection was associated with >4 partners during the last 5 years both in medical students and to a lesser extent in women attending FPC (OR 10.7; CI 2 to 49 and, respectively (OR 3.7; CI 1.2 to 12). Age at first intercourse was also a factor. Women in FPC whose age was <18 at first intercourse were at higher risk of CT (OR 7.6; CI 1.1 to 30) than the female medical students (OR 1.5; CI 0.3 to 8). Logistic regression confirmed that >4 partners during the last 5 years in both groups (Wald 7.3; p<0.01 [students]; 3.7 p<0.05 [FPC subjects]) and an age <18 at first intercourse only in FPC subjects (Wald 3.5; p<0.06) were independent predictors of infection.

Conclusions

Female medical students showed a significantly lower prevalence of CT compared to the female population of same age but different socioeconomic background. The number of partners in the last 5 years and age at first intercourse were the factors regarding this difference. Awareness and the level of knowledge, possibly dependent on cultural factors, seem to reduce the prevalence. The importance of targeted CT screening programs to groups at greatest risk, while promoting widespread educational efforts and awareness of risk among general population is apparent.
P2-S4.04 Motivational interviewing is effective for reducing high risk sexual behaviour
Authors: Boman J , Lindqvist H , Brandell-Eklund A , Forsberg L , Nylander E
Published: July 2011

Background

Motivational interviewing (MI) can be effective for behaviour change even when tailored to brief encounters. MI is focused on resolving the ambivalence that might prevent change. We have developed and evaluated simple tools to facilitate MI based counselling for reducing high risk sexual behaviour.

Method

Patients attending a drop-in STI services reception were offered 20–30 min of MI-based risk-reducing counselling. Out of 110 eligible patients (56 men and 54 women) who had had at least 4 sexual partners during the previous year, 72 patients aged 17–34 years (mean 24.8) participated. A structured manual was developed containing 14 questions, the first 5 of which were aimed at developing and amplifying the patient's motivation to reduce risky behaviour. We discussed with the patients their own perception of STI risks and the importance of not becoming infected, not infecting sexual partners and avoiding pregnancy. At the end of the session, patients were asked to assess their future commitment to changing risky sexual behaviour and a plan for accomplishing this change was drawn up. To ensure treatment fidelity, MI skill was assessed using the Motivational Interviewing Treatment Integrity Coding System (MITI 3.0).

Results

At baseline, 4 of 32 men (12.5 %) and 6 of 40 women (15 %) had a genital CT infection. After intervention, the incidence of CT was 6 % in men and 0 % in women in the following12 months. Of those CT-infected at start, none was re-infected within the next year. At baseline, men reported on average 8 (4-35) partners in the previous12 months and women 6 (4–17). On a scale from 0 to 10 men rated their STI-risk in the previous year as 5.5 (1–10) and women as 6.3 (2–10). The corresponding rating for pregnancy risk was 2.7 (0–8.5) for men and 3.3 (0–9) for women. Men rated the importance of not becoming infected as 8.5 (5–10) and women as 9.5 (5–10). The importance of not infecting a sexual partner was rated as 9.2 (2.5–10) in men and 9.6 (6–10) in women. The importance of avoiding pregnancy was rated as 9.2 (5–10) in men and 9.5 (2–10) in women. The ability to reduce sexual risks was judged as 8.4 (5–10) in men and 8.6 (3.5–10) in women. At the end of the session, patients' commitment to reducing STI risks was 9.1 (6–10) for men and 9.3 (8–10) for women.

Conclusion

Brief MI-based single-session counselling aimed at assessing personal risks, resolving ambivalence, developing risk-reduction strategies and implementing safer sex behaviours is effective in the reduction of high-risk sexual practices and CT incidence.
P2-S4.06 Knowledge of HSV-2 serostatus in asymptomatic adults may result in change in sexual behaviour and possible risk reduction
Authors: Cuyugan M G , Mulugeta W , Thabolingam-Haridas M , Wilson T , Augenbraun M , Elsassy T , Cerniglia B
Published: July 2011

Background

HSV-2 is the main cause of genital ulcer disease worldwide. It is frequently under- recognised because it is often clinically silent. Serologic testing for HSV antibody reliably identifies individuals infected with HSV-2. There is little literature investigating whether serologic screening of asymptomatic patients changes sexual behaviour and risk reduction.

Methods

Patients >18 yrs old who came to an urban STD clinic in Brooklyn with no previous history of HSV or HIV, no genital ulcer at initial visit, and sexually active in the preceding 3–6 months were administered a questionnaire. HSV1/2 IgG testing using HerpesSelect (Becton Dickinson and Company in Sparks MD) was used and patients were told about the results after 1 week. Participants were educated regarding natural history of HSV and asked to come back after 3 months to complete a follow-up questionnaire. Changes in sexual behaviour including number of sexual partner, condom use and psychological stress were the primary outcome of interest of this study.

Results

A total of 193 eligible participants were included for analysis and follow-up is available for 101(51%). There was no significant difference among baseline characteristics (age, gender, no. of sexual partners) among participants. Majority of participants were heterosexuals (95.8%) and black immigrants (92.3%). The seroprevalence of HSV2 IgG was 35%. More women were HSV + (67%) and more HSV + participants reported having non-steady partners (p 0.027). When analysing change (from baseline to follow-up), there was a significant decrease in number of non-steady partners among HSV + and HSV—participants (p 0.004 and p 0.0049 respectively). There was no statistically significant difference in the frequency of condom use between HSV + and HSV—participants (p=0.448 and p=0.91). Discussion: There was a significant decrease in the number of non-steady partners after knowing HSV status among both HSV+ and HSV- participants but no change in frequency of condom use. This finding is important because this suggests that knowledge of HSV status may impact sexual behaviour that can potentially reduce risk of transmission. However, both groups had a significant change in the number of non-steady partners regardless of HSV results, which may suggest that being tested for HSV-2 is enough to alter certain risky sexual behaviours. This can be potentially useful to patients visiting STD clinics for screening.
P2-S4.08 Patterns and correlates of condom use at last sex episode in a population presenting for voluntary HIV counselling and testing in Soweto, Johannesburg
Authors: Nshimiyimana T , Thandekile E , Katz I , Martinson N , Gray G , de Bruyn G
Published: July 2011

Background

Promotion of condom use remains an important public health intervention to prevent HIV transmission and acquisition. Routine data from voluntary counselling and testing (VCT) can inform evaluation of prevention efforts that emphasise condom use. This study uses a Johannesburg township VCT data to characterise the correlates of condom use at the sexual episode that preceded VCT visit.

Methods

This retrospective analysis uses a service level data on 2829 individuals seeking VCT at a Soweto-based testing center between 2008 and 2010. Multivariate models were used to compare the correlates of condom use with clients' HIV-1 serostatus.

Results

Women were 1800 (63.6%) with a mean age of 32 while men were 1029 (36.4%) with a mean age of 35. Out of 1,862 clients reporting sexual intercourse within the month that preceded VCT visit, 27.8% were HIV-1 infected. Among 1,916 HIV-1 seronegative clients, 51.8% reported not using condom at last sexual episode compared to 44% among 911 clients in the HIV-1 seropositive subgroup. HIV-1 seropositive clients reporting not having a sex partner but who described their most recent sexual episode as casual were less likely to have used a condom during that sex act compared to those who reported having their last sex with their regular partners (Adjusted Odd Ratios [AOR], 0.4; 95% CI, 0.2 to 0.6). This difference was not observed in the HIV-1 seronegative subset. In the HIV-1 seropositive subgroup, those reporting previous exposure to VCT were more likely to have used a condom during the sex episode that preceded their VCT visit compared to those reporting it was their first encounter with VCT (AOR, 2.6; 95% CI 1.6 to 4.3). However, the effect of previous exposure to VCT on condom use was not significant in the HIV-1 seronegative subset. For both the HIV-1 seronegative and seropositive subsets, condom use likelihood was higher among men compared to women (AOR, 1.6; 95% CI 1.2 to 2.0 and AOR 1.7; 95% CI 1.1 to 2.7), respectively.

Conclusion

The findings underline a need for distinguishing HIV risk reduction counselling targeted at the HIV-1 infected from those aimed at the HIV-1 uninfected, especially in Soweto context.
P2-S4.10 Characteristics associated with condom breakage/slippage or partial use during vaginal sex with main and non-main partners: findings from the Safe City Project Study
Authors: D'Anna L , Margolis A , Warner L , Korosteleva O , O'Donnell L , Rietmeijer C , Klausner J , Malotte C K
Published: July 2011

Background

Condom use problems including breakage, slippage, or partial use (delayed application or early removal) jeopardise condom effectiveness. Our research aims were to: 1) assess the prevalence of condom use problems among urban US STD clinic users; 2) identify participant and partner characteristics and Behaviours associated with condom use problems; and 3) examine how these characteristics are associated with the odds of experiencing condom breakage/slippage or partial use during vaginal sex.

Methods

Patients (n=1609) attending STD clinics in 3 cities (Denver, Long Beach, and San Francisco) between June 2004 and May 2005 were enrolled in a study evaluating the behavioural effects of a video-based waiting room intervention modelling couples overcoming barriers to safer sexual behaviours. Two surveys were conducted (baseline and 3-months) measuring behaviours during the previous 3 months. Bivariate analysis using χ2and multivariable analysis using logistic regression were conducted.

Results

At baseline, 767 men and women (median age=26 years) reported using a condom at least once during vaginal sex with their most recent partner (64.4% main and 35.5% non-main) in the preceding 3 months. A majority did not use condoms consistently (62.3%). Among 100% condom users, 152 (52.6%) reported no errors, while 137 (47.4%) experienced errors (56 breakage, 49 partial use, and 32 both errors). Among all users, the per-condom use rates of breakage/slippage, but not partial use, varied significantly by partner type (5.96% main and 9.35% non-main). Multivariable analysis revealed the following characteristics associated with increased odds for condom breakage/slippage: African American race (OR=2.0; CI 1.3 to 3.1), Latino ethnicity (OR=2.0; CI 1.3 to 3.1), drunk/high during sex (OR=1.5; CI 1.1 to 2.1), STI among recent sex partner (OR=1.7; CI 1.2 to 2.3); and main partner status (OR=1.8; CI 1.3 to 2.6); and for partial use: female gender (OR=1.4; CI 1.0 to 1.9), drunk/ high during sex (OR=1.5; CI 1.1 to 2.0), and main partner status (OR=1.4; CI 1.0 to 2.0).

Conclusions

In this population of condom users at high risk for STI/HIV, inconsistent condom use and consistent condom use with errors were reported frequently. These results suggest that clinicians should not assume that patients use condoms correctly, and that patients may benefit from condom use counselling tailored to individual and partnership characteristics and behaviours.
P2-S5.03 Hyperfeminine and vulnerable: gender identities and HIV/AIDS in transgender women in BogotÁ, Colombia
Authors: Estrada-Montoya J H , García-Becerra A
Published: July 2011

Background

Studies in current literature show high HIV prevalence rates in transgender women all around the world. Transgender women face very high-levels of marginalisation, violence, stigma and discrimination, which in turn affect their access to housing, employment, healthcare and put them in a high risk of STD. These characteristics are shared with sex workers, injecting drug users and men who have sex with men. However, gender identity has led to a particular combination of vulnerabilities, ultimately resulting in a much higher risk of HIV infection among the male-to-female transgender population as mentioned above.

Methods

We conducted an exploratory descriptive study and collected data with surveys, in-depth interviews, focus groups and ethnographic strategies with 18 transgender women. The collected information was analysed, taking into account the following dimensions of interpretation: 1-Love, erotic, and sexual relations. 2- Gender and sexual identities. 3-Sexual behaviour and practices. 4-Self-care, HIV-risk perception and life goals.

Results

Transgender women believed that they needed to perform an overtly feminine identity (hyperfeminine). They think this performance involves taking sexual risks assigned traditionally by the social space such as street prostitution. In this role transgender women's negotiation power is significantly reduced. Many transgender women assumed and accepted this gender disparity social structure that increased their vulnerability to STI/HIV.

Conclusions

This research intended to identify the most significant ways in which sexuality is represented and imagined within the culture of transgender women in Colombia. Special emphasis was placed on discovering transgender women's logics, or thinking processes, which are capable of perpetuating their high vulnerability to HIV/AIDS. Transgender women in Colombia construct their gender identities within contexts of stigmatisation, social marginalisation, and multiple symbolic and physical forms of violence. Our work critiques approaches based on androcentrism that perceive gender identities as essential and fixed, and assume sexual binaries that oppress the lived experience of human bodies. We propose a peer-led educational strategy focused on the deconstruction and reconstruction of gender identities and interventions with transgender women that reduce stigma through enhancing autonomy, joy, and self-care. We argue that these are the central elements for a “life with quality” in which equal citizenship can be exercised.
P1-S1.35 Declining positivity among 15–24-year-olds screened for chlamydia in England - a sign of falling prevalence or a symptom of changing uptake?
Authors: Woodhall S C , Mercer C H , Soldan K
Published: July 2011

Background

The number of tests performed as part of the National Chlamydia Screening Programme (NCSP) has increased since the start of the programme in 2003 and the positivity has declined. We explored the extent to which available data can be used to adjust for changes in who is being screened in order to estimate any changes in the population prevalence up to 2010.

Methods

Analyses of positivity trends were conducted using available data for opportunistic asymptomatic tests (screens) from the NCSP national dataset for 2005 to 2010 from areas that implemented screening throughout this time period. Age, sex, ethnicity, sexual behaviour, regional and venue of screen weights for the English population of 15–24-year-olds were derived (from national sources where available) and applied to the dataset.

Results

From 2005 to 2010 there was an increase in screens among men. There were no major changes in characteristics known to be associated with infection (year of age, sexual behavioural variables). Available data on sexual behavioural variables and ethnicity decreased over time. There were some changes in venue use over time. Weighting for 5-year age group, sex, <2 sexual partners in past 12 months, ethnicity and region lowered positivity in each year but slightly increased the decline in positivity from an average decline of 13% per year (from 11% in 2005 to 6% in 2010) to an average of 14% per year (from 10% to 4%). Additional standardisation by screening venue did not reduce the overall observed decline in positivity during this period. Differences in positivity between venues remained, but were slightly reduced, after weighting for differences in known characteristics of screened clients.

Conclusions

The observed decline in positivity over time among screens was not accounted for by weighting for known characteristics of those screened or changes in testing venues. Together with the consistency of declining positivity in all sub-categories this suggests that a true decline in population prevalence may have occurred. Further analyses of the potential effects of data limitations and using regression techniques with additional variables (eg, deprivation) are in progress to better understand the relationship between screen positivity and population prevalence at different levels of screening uptake in England.
P2-S5.08 Knowledge about STD transmission and clinical characteristics among conscripts in Brazil, 2007
Authors: Ribeiro D , Pinto V M , Espinosa A , Rezende E , Pereira G , Barbosa M
Published: July 2011

Our goal was to describe knowledge of military conscripts related to STDs. A self-applied questionnaire with demographic characteristics and STD clinics; knowledge of transmission modes and preferred access to information about STDs was applied. Variables associated with outcome were: being 19–20 years [OR 1.2 (95% CI 1.18 to 1.32)]; STD transmission by eating contaminated food [OR 2.2 (95% CI 1.96 to 2.55)], for bathing in rivers / beaches [OR 1.5 (95% CI 1.27 to 1.88)]; by mosquitoes [OR 1.5 (95% CI 1.38 to 1.65)], and for having sexual intercourse ≤14 years [OR 1.4 (95% CI 1.33 to 1.55)]. The variables were negatively associated: being white [OR 0.9 (95% CI 0.82 to 0.91)], namely the transmission by sharing syringes and needles [OR 0.7 (95% CI 0.62—to 0.78)], by transmission from mother to child during childbirth and breastfeeding [OR 0.6 (95% CI 0.58 to 0.69)], using a condom at last sex [OR 0.8 (95% CI 0.71 to 0.85)]; MSM [OR 0.7 (95% CI 0.60 to 0.92) and know that sex without condom use increases the risk of transmission [OR 0, 4 (95% CI 0.37 to 0.51)]. STD education programs must be dynamic and comprehensive, involving teens, their parents and educators, once isolated knowledge about modes of transmission of STD is not enough to help protect.
P2-S5.09 Transgenders and HIV: a literature review of HIV risk behaviours and prevalence rates
Authors: Butt S , Mena L , Muzny C
Published: July 2011

Background

Transgenders (TG) are a marginalised population that has been greatly impacted by the HIV/AIDS epidemic. The objective of this study is to review the current literature citing risk factors and prevalence rates for HIV infection among male to female (MTF) and female to male (FTM) TG in the USA.

Methods

A review of the original research articles published from 1981 to 2010 was performed through a Pubmed search using the terms “HIV risk” and “Transgender”.

Results

Thirty-five articles were identified, with MTF described in thirty-three and FTM described in nine. Collectively all racial groups were represented. The majority of research was done in large urban cities in the Southwest, Midwest, and Northeast. Most studies relied on self-report of HIV infection; and only six studies tested participants for HIV. The prevalence rates of HIV infection ranged from 2.2% to 68.0%. Unprotected receptive anal intercourse (URAI), commercial sex work (CSW), and African American (AA) race were the most frequent HIV risk factors identified. Homelessness and financial instability were frequent among adolescents. When compared to men who have sex with men (MSM) and heterosexual females, MTF are more likely to have URAI with multiple sexual partners. Among MTF participants, AA and Hispanics were more likely to participate in CSW than Caucasians. Self reported prevalence of HIV was low in FTM population (0–2%), except in one study which tested for HIV and found similar HIV prevalence in both FTM (10%) and MTF (10%); risk factors associated with HIV infection in this study were unprotected sex with a partner of unknown HIV status and location in an urban metropolitan area.

Conclusions

HIV rates among TG are high, especially among AA and Hispanics. Majority of MTF participate in high risk sexual activities. Geographically and ethnically diverse studies including MTF and FTM are needed to test HIV prevalence and associated risk factors in TG population.
P2-S5.10 Sexual behaviours among injecting drug users (IDUs) in North-East India
Authors: Mishra R K
Published: July 2011

Background

The North-East Indian states of Nagaland and Manipur have among the highest HIV prevalence in India, fuelled by an epidemic of injecting drug use. In 2008, the HIV prevalence among IDUs in Manipur was 28.65% and in Nagaland was 3.16% in 2008 as per National Surveillance data. Proximity to Myanmar, high unemployment and ongoing violent insurgencies serve to exacerbate the problem. Project ORCHID, an initiative funded by the Bill and Melinda Gates Foundation, has been running HIV prevention programs with high risk groups through local NGOs in these two states since 2004. Methodology: To evaluate risk behaviours among the IDU communities served by Project ORCHID, polling booth surveys (PBS) were conducted in all 26 intervention sites across both states in 2010. Participants were purposively selected from a broad geographical area, and asked to anonymously answer questions through a ballot box.

Results

In total, 558 IDUs in Manipur and 440 IDUs in Nagaland were sampled for the PBS. They reported high rates of access to needles/syringes from ORCHID projects (82% in Manipur and 96% in Nagaland). In both states, three-quarters had injected in the previous week. Among these, the mean weekly injection frequency was 11 times in Manipur and 5 in Nagaland. The proportion of injecting episodes using a clean needle/syringe was 77% in Manipur and 94% in Nagaland. Needle sharing in the previous month was reported by 38% in Manipur and 25% in Nagaland. Manipur had less IDUs who had been sexually active in the previous week (46% vs 71% in Nagaland) but consistent condom use was lower in Manipur than Nagaland (30% vs 76%).

Conclusion

Higher rates of risky injecting and sexual behaviour were found in Manipur IDUs, which together with the much higher injection frequency and HIV prevalence of 28.65% underlines the need for continued behaviour change communication. Low injecting rates and moderate to high sexual activity among Nagaland IDUs indicates communication strategies should shift towards sexual risk behaviours. The 3rd PBS is underway and will enable to see how behaviours are changing over time.
P2-S6.02 Use of a computer alert increases detection of early, asymptomatic syphilis among higher risk men who have sex with men
Authors: Bissessor M , Fairley C , Leslie D , Chen M
Published: July 2011

Background

More frequent screening of higher risk men who have sex with men (MSM) for syphilis could reduce the transmission and prevalence of syphilis. This study assessed the impact of a computer alert on the rate of syphilis testing and diagnoses among higher risk MSM.

Methods

In October 2008, a computer alert was introduced at the Melbourne Sexual Health Centre. This alert appeared during consultations for MSM who reported more than 10 male partners in the prior 12 months, reminding clinicians to test such higher risk men 3 monthly for syphilis. Syphilis testing rates and diagnoses among MSM were determined for the 12 months before and the 12 months after the introduction of the alert.

Results

The proportion of MSM who were identified as being higher risk who were tested for syphilis in the two time periods increased from 77 % (1559/2017) to 89% (1282/1445) (p<0.001). The proportion of higher risk men diagnosed with early syphilis and who were asymptomatic for syphilis was 16% (5/31) and 53% (31/58) respectively (p=0.001). By contrast, there was no significant increase in the proportion of MSM who were identified as being lower risk who were tested for syphilis: 65% (1228/1885) and 68% (1667/2448) (p=0.4). Nor was there a significant increase in the proportion of lower risk men diagnosed with early syphilis who were asymptomatic: 10% (1/10) and 19% (3/16) respectively (p=0.6).

Conclusion

The use of a computer alert was associated with increased syphilis testing of higher risk MSM attending a clinical service as well as increased detection of early, asymptomatic syphilis.
P2-S6.04 Needs assessment on STI prevention services among men who have sex with men with HIV in Guatemala City, 2010
Authors: Farach N , Boyce S , Barrington C , Galindo C , Paz-Bailey G
Published: July 2011

Background

STI prevention and support services for MSM living with HIV in Guatemala are limited. The aim of this study was to collect information on STI risk among MSM living with HIV to inform the development of integrated prevention and care services for this population.

Methods

As part of a qualitative study with MSM in Guatemala City, nine MSM living with HIV were purposely selected and interviewed in March 2010. Interviews addressed STI-related risk behaviours, experiences with HIV/STI services, social network characteristics and life after HIV diagnosis. Participants were recruited through referral from NGO representatives, key informants, clinic staff and other participants. In-depth interviews were recorded and transcribed and field notes were incorporated into the transcriptions. After multiple readings of the transcripts, key themes were identified and a codebook was developed. Codes were applied using the qualitative software Atlas.ti. Data was further analysed using analytic memos and discussions with research team.

Results

Despite reporting HIV-related risk behaviours, including multiple, concurrent sexual partners, inconsistent condom use, and alcohol and drug use, most participants did not report an STI infection after their HIV diagnosis. Attitudes towards current HIV/AIDS treatment services tended to be favourable, especially among those who compared them to earlier treatment experiences, and participants described preferences for a one-stop venue for sexual health services. Participants were generally not familiar with STI services and identified several barriers to access including insufficient information on STI, lack of confidentiality and fear of stigma and discrimination from health workers. Many participants experienced a double burden of family rejection, first for their sexual orientation and then for their HIV diagnosis. In response to this alienation, participants created alternative networks of social support, frequently with other MSM or people with HIV, which provide moral support and motivation for treatment adherence.

Conclusions

STI prevention, diagnosis and treatment services among MSM with HIV in Guatemala should be strengthened. Prevention interventions should contemplate using social support networks as an additional communication channel for STI prevention and antiretroviral adherence messages. Confidential STI prevention, diagnosis and treatment services should be integrated into existing HIV/AIDS services.
P2-S6.05 Exploring dynamics around female condom use for anal sex among MSM
Authors: Kokku S B , Tucker S , Punyam S
Published: July 2011

Background

Studies around the world have reported about the use of female condom (FC) for anal sex by men who have sex with men (MSM). No studies have been conducted in India about FC use for anal sex. This study was designed to know the reasons, perceived benefits, concerns and other issues around FC use in Andhra Pradesh where India HIV/AIDS Alliance implementing a HIV prevention program.

Methods

A qualitative study was carried out among MSM at three sites, selected using purposeful sampling method. Total eight Focus Group Discussions (FGDs) with 83 participants and 18 in-depth interviews (IDI) were conducted. IDI respondents were selected by purposeful sampling method from the self-reported FC users. A structured questionnaire was used for the study.

Results

In two sites, 18 out of 53 respondents (34%) reported using FC while none of the respondents at the third site had heard of using FC for anal sex. The practice is mainly due to peer influence within the local sexual networks. The decision to use FC is made by the recipient partner who is influenced by various factors like difficult partners/clients who don't like to wear male condom and in anticipation of having sex with more than one partner or group sex etc. A few MSM (11%) are using single condom with multiple clients. The perceived benefits with FC use include sense of security, having control, client satisfaction hence better income, and they can use a single condom for multiple encounters with multiple partners. Participants reported frequent problems with FC use, particularly rectal bleeding (100%), discomfort (72%) and slippage (28%). Despite bleeding from anus on first time use, majority (83%) of them said they will continue to use FC. One of the myths observed during the FGDs is the use of spit with mud as lubricant which was attributed to better satisfaction due to the presence of finer granules in the mud.

Conclusions

The study clearly shows that despite frequent problems with FC use, considerable number of MSM (83%) prefer to continue using FC. Therefore the need for modifying condom design, conducting training, and research on safety outcomes becomes absolutely imperative. IEC (Information, Education & Communication) materials need to be designed to spread the message on proper use and disposal of FC, and also to address the use of single condom with multiple partners. Using of mud with spit as lubricant needs to be explored further to better understand its consequences.
P2-S6.08 Examining risk in high risk “populations: measuring sexual behaviour among men who have sex with men”
Authors: Rosenberger J G , Reece M , Novak D S , Herbenick D , Fortenberry J D , Van Der Pol B
Published: July 2011

Purpose

Due to the disproportionate impact of HIV and other sexually transmitted infections (STIs) on men who have sex with men (MSM), men who indicate same gendered sexual interactions are categorised as a priority population and often perceived as high-risk”. While acknowledging the potential for increased risk among certain populations is important for disease prevention and transmission efforts, this approach broadly labels men based on a limited behavioural profile without consideration for the contextual factors of a given sexual event that influence potential disease exposure. This study sought to assess sexual behaviour among MSM in the USA during their most recent sexual event and identify factors associated with decreased risk for HIV/STI.

Methods

Data were collected via an internet survey from 27,690 18–80-year old MSM. Measures included sociodemographics, recent/lifetime sexual behaviour history, and sexual experience items.

Results

Participants' median age was 39.0 years, ethnicities included white (84.5%), Latino (6.4%), African American (3.5%), and most (79.9%) identified as homosexual. Most participants reported a sexual event within the past month (86.1%), with the majority indicating their most recent event in the past 7 days (60.1%). While most men reported not engaging in insertive (35.2%) or receptive (37.0%) anal intercourse, of those who did, 46.1% used a condom and almost none reported ejaculation occurring in their or their partner's anus, 2.7% and 2.5% respectively. Among men (24.5%) who described their sexual partner as a boyfriend or spouse, nearly half reported they and their partner had not had other sexual partners during the past 6 months (44.7%), and the majority had been tested for STIs (61.6%) and HIV (64.8%).

Conclusions

These data provide a large scale assessment of sexual behaviour during the most recent sexual event among MSM in the USA. Findings from this study highlight diversity in behaviours and demonstrate varying degrees of potential risk for HIV and other STIs, regardless of gender. Future prevention efforts should consider contextual components of sexual events, including partner type, HIV and STI testing patterns, and semen exposure, to more accurately develop custom risk reduction strategies.
P2-S6.12 Sexual debut and sexual health: Is early age of first anal intercourse associated with heightened HIV vulnerability among gay men?
Authors: Lyons A , Pitts M , Grierson J , Smith A , McNally S , Couch M
Published: July 2011

Background

To explore the long-term sexual health implications for gay men having first anal intercourse (FAI) at an early age.

Methods

A nationwide online survey was conducted among 854 Australian gay men born between 1944 and 1993 (16–65 years).

Results

Age at FAI dropped sharply from a median of 35 years among men born 1944–1953 to 18 years among men born 1984–1993. At their most recent sexual encounter, men who reported FAI at age 16 years or younger were more than twice as likely to have had receptive anal intercourse or reciprocal anal intercourse (both insertive and receptive in the same sexual encounter), and were almost twice as likely to report having more than 10 sexual partners in the past year. These men were also nearly twice as likely to have become HIV-positive since their sexual debut and were several times as likely to report having had a hepatitis A or C diagnosis. Additional features of the sexual health and behaviour of gay men who report early FAI will be presented that further demonstrate a need to pay close attention to age at FAI.

Conclusions

Gay men who report early FAI are at higher risk of HIV than those who report later FAI, and are more likely to have recently engaged in risky sexual behaviour. Discussion will focus on explaining these patterns and why health service providers need to pay attention to age at FAI.
P2-S6.15 Investigating the critical programme components of HIV prevention programme among MSM-Ts in Bangalore, Karnataka
Authors: Prakash R , Isac S , Ramesh B M , Moses S , Washington R , Bhattacharjee P , Shetty B , Kumar S
Published: July 2011

Background

A number of studies in the context of HIV/STI epidemic and related vulnerability have focused on the risk reduction of HIV/STI prevalence and condom use among female sex workers (FSWs). However, such studies focusing the men having sex with men (MSM) and transgender remains limited. Since the risk reduction of HIV/STI vulnerability among MSM-T are equally important, a systematic study is required to identify the critical programme indicators which increases the condom use and reduces HIV/STI prevalence among MSM-Ts.

Methods

Two rounds of IBBA data collected from the urban parts of the Bangalore district are used. Bi-variate analysis is used to cross-classify the outcome measures by those who are exposed to the programme than those who are not, whereas the application of binary logistic regression analysis is done to get the adjusted effect of programme indicators on condom related outcomes (condom breakage in past 1 month, zero unprotected sex acts with commercial clients in past 1 month, condom use at last sex with occasional clients/repeat partner/regular partner) and HIV/STI prevalence.

Results

The sample includes 1432 MSM-T of which 56% belonged to the baseline while remaining to the follow-up survey. The mean age at sexual debut was lower and weekly client volume was higher among the MSM-Ts interviewed in the first round of survey which has shown a significant shift in positive direction in the second round of the survey. In context of programme exposure, higher percentage of MSM-T (about 75% vs 70%) reported project STI clinic visit, visit to DIC (68% vs 14%) than the baseline survey whereas the peer contact remained around 85% in both the rounds. The increased level of clinic/DIC visit found to be positively associated with higher proportion zero unprotected sex with commercial clients, consistent condom use with commercial clients/ repeat partner and with the regular partners in follow-up survey. The crude and adjusted OR shows a significantly less chances of HIV/STI among those who were contacted by peer (OR=0.78, 95% CI 0.67 to 0.99) and visited to clinic (0.82, 95% CI 0.79 to 0.96) compared to their respective counterparts after adjusting the effects of other confounders in the two rounds of the survey. The prevalence was significantly lower among those MSM-T who used condom with different type of partners at different occasions.

Conclusions

The extent of peer-led outreach remain more or less over the period of time, however, a significant improvement in clinic/DIC visit found as the critical component in reducing the HIV/STI prevalence through increased means of condom use with different types of partners.
P1-S1.37 Prevalence of and risk behaviours forNeisseria gonorrhoeaein parturient women aged 15–24 in Brazil
Authors: Miranda A , Pinto V , Szwarcwald C , Baroni C , Stringari L , Inocencio L
Published: July 2011

Background

Neisseria gonorrhoeae(NG) is a sexually transmitted infection having repercussions on reproductive health and impact on the fetus. Our goal was to estimate the prevalence of and risk factors for NG in young parturient women in Brazil.

Methods

A national cross-sectional study among parturient women, aged 15–24, attending Brazilian public hospitals was performed in 2009. Participants answered a questionnaire including demographic, behavioural and clinical data. A sample of urine was collected and screened for NG andChlamydia trachomatis(CT), using PCR.

Results

A total of 2400 women were selected and 2071 (86.3%) participated in the study. Mean age was 20.2 years (SD 2.7). A total of 59.1% had up to 8 years of schooling and 93.3% reported an income under US$ 500. Ninety-five per cent attended antenatal care. Prevalence of NG was 1.0% (95% CI 0.6% to 1.4%) and 4% of women infected with NG also had CT infection. First sexual intercourse was reported under 15-years old by 32.8%; 5% reported previous STI; 0.8% were commercial sex workers and 6.0% used illicit drugs. NG associated factors in the final logistic model were—being single [OR=3.2 (95% CI 1.27 to 8.01)]; having more than one sexual partner in lifetime [OR=1.6(95% CI 1.13 to 2.26)]; and CT infection [OR=7.7(95% CI 2.99 to 19.91)].

Conclusions

Although this study shows a low prevalence of NG infection among young pregnant women in Brazil, they presented STI risk factors that justify include STI counselling for this population.
P2-S7.03 Pregnancy and contraceptive experiences of women living with HIV in Mexico
Authors: van Dijk M , Wilson K , Contreras X , Ettenger A , Fukuda H D , García S
Published: July 2011

Background

In Mexico new HIV infections are occurring increasingly in women, but little is known about the experiences of women with HIV/AIDS seeking sexual and reproductive healthcare.

Methods

In four states we conducted in-depth interviews with HIV-positive women who were pregnant or had been pregnant within the last 5 years. Participants were recruited through hospitals and clinics providing HIV care and through NGOs providing health and social services for people living with HIV.

Results

Participants reported that the information and care they received were inadequate and influenced more by their providers' personal opinions than by their own fertility desires. They experienced provider discrimination and pressure to use particular contraceptive methods. HIV specialists and OB/GYNS differed significantly in practice, with HIV specialists focusing on prevention and condom use while OB/GYNS focused on long-acting or permanent methods of contraception. Due to gaps in contraceptive counselling and options many women had unplanned pregnancies while others resorted to sterilisation or abstinence. Furthermore, few women received adequate prenatal HIV care and counselling on pregnancy options.

Conclusions

The health sector seems to focus narrowly on disease prevention and treatment lacking a holistic approach to women's wellbeing. The experiences of women living with HIV/AIDS reveal discrepancies between policy and practice in Mexico as manifested in gaps and inconsistency in healthcare services and even failures to respect patient confidentiality and human rights. The health sector should improve the integration of HIV and sexual and reproductive healthcare through cross-training HIV specialists and OB/GYNS, and by continued sensitisation of all providers on the topic.
P2-S8.03 Did you hear about the 2010 STD treatment guidelines? Re-strategizing how we e-Communicate about STD guidance
Authors: Habel M A , Richman L , Haecker S , Verma R , Meneghetti A , Kachur R , Collins B , Barnes R , Thompson N , Workowski K
Published: July 2011

Background

The 2010 STD Treatment Guidelines advise physicians and other health-care providers on the most effective diagnostic evaluation, treatment regimens, prevention and vaccination strategies for STDs. CDC revises the Guidelines approximately every 4 years, using a scientific, evidence-based process. Previous communication efforts around the Guidelines have lacked structured promotion and evaluation strategies. 2010 communication efforts strove to improve dissemination of this important resource in the public and private sector using traditional and novel communication technologies.

Methods

The Guidelines were released online in the MMWR on 16 December 2010. A communication plan was devised involving an email distribution campaign, development of interactive elements such as webinars, podcasts, social media (Twitter), and mobile promotional efforts through a partnership with Epocrates. Click-through rates and web metrics were tracked using SiteCatalyst and tracking codes.

Results

45 days post-launch, the 2010 Treatment Guidelines web page was viewed 107 174 times and downloaded 47,715 times making it the second most popular download on CDC's website. An email campaign targeting more than 54,000 individuals resulted in click-through rates well above worldwide government industry standard (3.3%); ranging from 10% to 878% suggesting that emails were forwarded or the site was bookmarked. A January 13 live webinar resulted in 3200 registrations, 827 CMEs, and 742 evaluations. A podcast featured on Medscape was viewed 12 296 times within 30 days; traffic was 3 times that of a June Chlamydia podcast. Preliminary Twitter data show that tweets were clicked on or retweeted at least 50 times during a 4-day period. A Dec 21 Epocrates DocAlert was delivered to 80 795 devices in the first 10 days, 272 857 devices by week 6, and targeted to primary care, OB/Gyn, ID, ER, urologists, etc.; 22% of responders requested detailed information and links via email or via iPhone/Android on device.

Conclusions

Data suggest (see Abstract P2-S8.03 Figure 1) that promotion efforts were highly successful as page view spikes coincided with email and mobile campaign pushes. Campaign tracking codes and web metrics are a simple way to evaluate health communication efforts and can offer insight on how well target audiences are being reached. Likewise, public health communicators should consider mutually beneficial partnerships with organizations that can reach providers in the private sector.

Abstract P2-S8.03 Figure 1

Number of page views to the STD Treatment Guidelines Homepage from 16 December 2010 to 30 January 2011.