bluuebunny/crossref_metadata_2025_split huggingface dataset:
S11.2 Sex in the United States in the New Millennium: Temporal Trends Among Men and Women Aged 15–44 Years
Authors: Leichliter J S , Haderxhanaj L T , Chesson H W , Aral S O 
Published: July 2013

BackgroundExamining national trends in sexual behaviour can aid in the understanding of STD trends. We examined trends in sexual behaviour, focusing on sub-populations most impacted by STDs in the US.MethodsWe used data from the 2002 and 2006–10 National Survey of Family Growth (NSFG), a multi-stage survey nationally representative of men and women aged 15–44 years living in the United States (US). The sample sizes and response rates for the surveys were 12, 571 (79%) in 2002 and 22,682 (77%) in 2006–10. Sexual behaviours included in this analysis were predominantly from audio computer assisted self-interview and were compared by several demographics, separately by sex. Data were weighted to represent the US population and data analyses accounted for the multi-staged sampling procedures used by NSFG.ResultsSexual behaviours with opposite- and same-sex partners were frequently similar in 2002 and 2006–10. Of women who ever had vaginal sex, there was no change in the average number of partners in the past 12 months (1.21 in 2002, 1.11 in 2006–10); however there was a slight decrease over time for Hispanic and black women and a slight increase among women in the non-Hispanic other category. Findings for men were similar except for a slight increase in partners among white men. Overall, HIV-related risk with opposite-sex partners decreased from 2002 to 2006–10. Specifically, exchanging sex for money or drugs significantly decreased among women (2.0% to 0.7%, p < 0.05) and men (2.6% to 1.3%, p < 0.05). Finally, the average number of male partners decreased among sexually active men who have sex with men (MSM) from 2.9 in 2002 to 2.3 in 2006–10 (p < 0.05). Specific HIV risk also declined among MSM.ConclusionPreliminary findings suggest that behaviours have not changed much during this time; however, we did identify shifts in behaviours among sub-populations.
S11.3 Switzerland: National Trends in Sexual Behaviour in the Context of HIV/STI Behavioural Surveillance 1987–2012
Authors: Dubois-Arber F , Jeannin A , Lociciro S , Bize R , Spencer B , Gervasoni J 
Published: July 2013

BackgroundNational trends in sexual behaviour have been assessed mainly in the context of the HIV related behavioural surveillance system set up in Switzerland between 1987 and 1992.MethodsSeveral populations are included in the system. Repeated surveys have been regularly conducted among the general population and youth, men having sex with other men (MSM), injecting drug users (IDU). Data on sexual behaviour are regularly recorded among people living with HIV/Aids (PLWHA) included in the Swiss HIV Cohort.ResultsThe main trends observed are :In young adults (aged 18–20):a steady increase in the proportion of sexually active at age 17a stable median number of partners with a recent increase in the proportion of multipartners;a high and stable level of condom use among multipartners.Among MSM:an increase in the number of partners and a steady increase in unprotected anal intercourse since 1997, after a period of decreasing trends.Among IDU:a low and stable use of condoms with stable partners;a high and stable use of condoms with occasional and paying partners (only among women) with a possible recent decreasing trend.Among PLWHA: a high use of condoms with all types of partners with a recent decrease.ConclusionsThe behavioural surveillance system in place allowed to assess various trends in sexual behaviour in several populations such as: long term trends regarding sexual debut, stable trends and recent changes regarding different indicators of sexual activity in the general population, IDU and PLWHA, inversion of trends in sexual activity and condom use among MSM.
S13.1 Current and Future Challenges in Gay Men’s Health
Authors: Hart G J 
Published: July 2013

Epidemics of HIV in men who have sex with men (MSM) were first recognised in the early 1980s. Since the introduction of antiretroviral treatment (ART) in the mid-1990s incidence of HIV has not, despite expectations, reduced significantly in many countries. Indeed, the numbers of new diagnoses has increased in some European countries, the USA and Australia. In the UK, for example, over 3000 MSM were diagnosed with HIV in 2010, the highest number since the beginning of the epidemic. As a consequence, the prevalence of HIV is increasing and, for gay communities, a growing number of men are now living with HIV.Although incidence of sexually transmitted infections (STIs) in MSM fell dramatically in the early years of AIDS, post-ART we have seen a return in some jurisdictions to pre-AIDS incident STIs, and the emergence of new sexually transmitted pathogens.This paper will focus on behavioural and epidemiological research in the era of ART, with particular reference to the continuing transmission of HIV. It will review current risk factors for HIV infection in negative MSM, sexual risk behaviour and risk reduction interventions among HIV positive MSM, and the emergence and re-emergence of new and established STIs. It will conclude with current challenges to the prevention of HIV and STIs in MSM, and prospects for the future.
S13.2 Evidence-Based Targeted Review of HIV and STI Prevention Interventions Among MSM
Authors: Thorson A , Strömdahl S , Sabido M , Pharris A 
Published: July 2013

BackgroundIn Europe, men who have sex with men (MSM) are disproportionately affected by STI/HIV. Sex between men is the predominant mode of HIV and syphilis transmission and contributes to a third of gonorrhoea cases in 2011. The main goal of this evidence-based review was to gather and critically appraise the scientific evidence for and to inform European guidance on a comprehensive approach for HIV, STI and hepatitis prevention among MSM.MethodsRelevant data bases were searched for publications related to disease prevention and health promotion among MSM. All kinds of reviews were included but gave presence to systematic reviews, when no reviews were found individual studies were included. A critical appraisal of the quality of each study was performed before inclusion in the targeted review. The Highest Attainable Standard of Evidence (HASTE) was used for grading as the basis for recommendations as HASTE was specifically developed to evaluate evidence regarding HIV/STI interventions among key populations. HASTE takes into account three categories with equal weight: efficacy data; implementation science data; biological and public health plausibility.ResultsSeven interventions were identified to be strongly recommended for prevention of HIV, STI and/or hepatitis, and 15 interventions for probable or possible recommendation. Consistent condom use, HIV treatment as prevention, peer outreach and support groups for men testing HIV negative as well as for HIV positive men, together with HSV-2 suppression therapy with acyclovir to prevent genital ulcer disease and hepatitis B vaccination, were all strongly recommended according to the HASTE grading.ConclusionsIn general, studies of acceptable quality from the European context were few and made the assessment of context-specific effectiveness difficult. Additionally, effectiveness studies looking into real-life effectiveness of biomedical interventions were very few. Future research would be able to contribute with more information from the specific European settings including (cost-) effectiveness studies.
S13.3 The Status of HIV Prevention Among MSM: An Overview of the European Response
Authors: Sfetcu O , Noori T , Spiteri G , Pharris A , Laar M van de 
Published: July 2013

IntroductionMSM in the European Union and European Economic Area (EU/EEA) are disproportionately affected by STI: 39% of all HIV diagnoses, 33% of gonorrhoea and 55% of syphilis cases were reported among MSM in 2011.MethodsAnalyses of surveillance data and information from countries responses for Dublin Declaration monitoring were combined with a review of existing national prevention intervention programmes targeted at MSM. Characteristics of 118 prevention interventions studies were included in the repository.ResultsOutbreaks of syphilis, hepatitis C and lymphogranuloma venereum and increasing trends of gonorrhoea and HIV among MSM, observed between 1995–2011, were reported to be associated with high levels of risk behaviour, sexual networking and socio-economic and cultural factors. The national responses included: strenghtening of surveillance, prevention and care; enhanced partner notification; and development of a range of prevention intervention programmes. The majority of prevention interventions used media campaigns, education and counselling followed by harm reduction strategies like condom distribution and HIV/STI testing alone or combined with other activities. Nearly half of the behavioural interventions studies reported proper outcome evaluation.In 2012, HIV/STI prevention programmes targeted to MSM were implemented in 22/30 EU/EEA countries, with non-governmental organisations playing a key role in programme implementation through campaigns, outreach work, information provision and condom distribution. Reported coverage of HIV prevention programmes for MSM ranged from 43% to 76% across countries. Rates of HIV testing among MSM during the last 12 month ranged from 12% to 74% and rates of condom use at last anal intercourse from 42% to 64%.ConclusionDiversity across EU/EEA in the design and implementation of prevention intervention strategies reflects various characteristics of MSM populations and the changing epidemiology of STI/HIV. A common need exists for improving the effectiveness of prevention intervention programmes, for targeting young, migrant and ethnic-minority MSM and for ensuring adequate funding.
S13.4 What Do Gay Men Need? - Challenges Regarding Comprehensive Approaches in HIV-Prevention Interventions from a National Perspective
Authors: Sander D 
Published: July 2013

Regarding empirical evidence gay men are facing several health problems which can arise from the mastering of living in homo-negative environment. We can e.g. find high levels of substance use, mental health problems, and risky behaviour.The presentation will raise the question on how these different and interacting health matters work together and how they can be tackled in campaigns focused on gay men and other MSM. What is the experience of the national German campaign “I KNOW WHAT I'M DOING”; what can be done in future work from the MSM community perspective; who are the necessary co-operative partners, what has to be requested from different policy sectors?
S14.2 The CISNE Project: Implementation of POCT For Syphilis and HIV in Antenatal Care and Reproductive Health Services in Peru
Authors: Garcia P , Peeling R , Mabey D , Holmes K , team C 
Published: July 2013

BackgroundCongenital syphilis and syphilis in pregnancy in Peru persist as important public health issues, and improvement of screening/treatment for pregnant women remains challenging. Rapid syphilis testing (RST) allows simple and immediate diagnosis and treatment at a single clinic visit and could increase screening and treatment coverage reducing the incidence of stillbirth and congenital syphilis and generate in the long term a sustainable cost effective intervention.MethodsWe tested the feasibility, performance, impact and cost-effectiveness of implementing RST in an underserved urban area at a biggest maternity hospital in Peru and a network of 16 peripheral health centres offering prenatal care in a periurban poor area in Callao-Ventanilla, Peru. RST (integrated with HIV rapid test: the “two for one”) were offered at the first prenatal visit (ANC), at delivery and within miscarriage/abortion services.ResultsData from the baseline pre-implementation evaluation revealed limited coverage of screening and treatment services for maternal syphilis and a complex and inefficient system for ANC. RST was started in January 2010. Overall success of implementation was measured by rates of maternal syphilis screening and treatment coverage, partner treatment, and acceptability of RST among providers and patients. We also performed a cost-effectiveness analysis of RST against the Rapid Plasma Reagin (RPR). Attention was paid to the process of dissemination and transfer activities to the Ministry of Health of Peru, through the involvement of both the National Program of STIs and HIV and the Reproductive Health Program. National guidelines have been modified, and recommend the use of both tests, RST and rapid HIV testing in the screening of pregnant women.ConclusionsRST implementation was feasible, successful, acceptable and cost effective. Its introduction catalysed improvements in the quality of care, and by the end of the project it has been introduced in the country as a National policy.
S14.3 Explaining Inaction: The Politics of Congenital Syphilis and the Global Health Agenda
Authors: Bump J , Salisbury N 
Published: July 2013

BackgroundIf disease burden were directly correlated with priority on the global health agenda, then congenital syphilis would have a high position. But even though congenital syphilis adversely affects around 650,000 pregnancies and newborns annually and is relatively simple to diagnose and treat, it is largely absent from high-level discussions of reproductive and child health and is not a major programmatic focus at prominent global health organisations. We sought to examine explanations for the low prioritisation of congenital syphilis and use our findings to inform framing strategies to improve the placement of congenital syphilis on the global health agenda.MethodsFirst, we reviewed published literature on congenital syphilis to construct a basic narrative, identify trends, and identify important stakeholders. Second, we conducted semi-structured interviews with stakeholders involved with or important to congenital syphilis control to understand the prioritisation of congenital syphilis and attempts to promote it. Third, we surveyed influential representatives of global health institutions to assess their perspectives on the position of congenital syphilis on the global health agenda. Finally, we analysed the data to track changes in priority given to congenital syphilis over time. We then developed political strategies based on these data.ResultsBased on our literature review and key informant interviews, we develop framing strategies, identify potential political allies, and suggest pathways advocates can use to increase the prominence of congenital syphilis on the global health agenda.ConclusionsAlthough it is an important cause of stillbirth and neonatal death, congenital syphilis is largely invisible on the global health agenda. Past efforts to raise awareness have had limited impact. Future efforts toward elimination of congenital syphilis could benefit greatly from increased attention to framing strategies and alliances with related issues in global health.
S14.4 Monitoring the Finish-Line: Integrated Global Criteria and Processes For Validation of EMTCT of Syphilis and HIV
Authors: Newman L , Hayashi C 
Published: July 2013

BackgroundThe global community is committed to elimination of mother-to-child transmission (EMTCT) of HIV and syphilis as public health problems. International and regional goals have been set, and countries are scaling up programmes towards EMTCT. Regional initiatives in the Americas, Asia-Pacific, and Africa have approached control of MTCT of HIV and syphilis as an integrated process. Prior to this work, there were no internationally standardised processes and criteria to validate EMTCT of HIV or syphilis.MethodsAs the global community prepares to assess progress towards global health goals in 2015 and beyond, standardised processes and criteria are needed to assess and validate EMTCT of HIV and syphilis across widely varying epidemiologic and programmatic contexts. This presentation will review the process for development of minimum global processes and criteria, provide a description of global validation targets and indicators, explain validation procedures, including maintenance of validation status, and describe next steps at the global, regional, and national levels.ResultsThese guidelines are intended for use by national, regional, and global validation committees; national AIDS, sexually transmitted infection, maternal, and child health programme managers; monitoring and evaluation (M&E) officers; policy-makers; and international partners. Currently there are at least 4 regions moving forward with establishment of regional processes for validation, and several countries have expressed interest in applying for validation of EMTCT of HIV and/or syphilis.ConclusionsAs experience is gained through establishment of global and regional validation processes, additional guidance and tools will be developed to complement these initial minimum global standards. Although it is recognised that not all countries are able to meet these criteria at this time, these criteria can also serve as aspirational targets for countries for 2015 and beyond and an opportunity to improve programmes and monitoring systems, reduce disparities within countries, and highlight models of success.
S14.5 Piloting Methods For Validation of Elimination of MTCT of HIV and Syphilis in St. Lucia and Chile
Authors: Hoover K W , Caffe S , Alonso M , Kamb M 
Published: July 2013

IntroductionIn 2010, the Pan American Health Organization (PAHO) member countries approved the Strategy and Plan of Action for Elimination of Mother-to-Child Transmission (MTCT) of HIV and Congenital Syphilis, with the goal of elimination by 2015. Elimination targets are MTCT of syphilis of ≤ 0.5 cases per 1,000 live births; MTCT of HIV of ≤ 0.3 cases per 1,000 live births; and transmission of HIV from HV-infected mothers to their infants of ≤ 2%. PAHO has supported Latin American and Caribbean countries to achieve these goals, by developing several technical resources, a system for reporting indicators of elimination, and methodology for validating elimination.MethodsIn 2012, we piloted validation methodology in St. Lucia and Chile, countries with robust elimination programmes. Teams of external experts travelled to each country to assess the national surveillance system and verify reported data; the national laboratory system; and programmatic aspects important for achieving and sustaining elimination. The assessment included review of databases and reports, triangulation and re-calculation of data, mapping of health services delivery, interviews with national and regional stakeholders, and visits to service delivery sites.ResultsThe validation methodology was able to identify national strengths and challenges in surveillance, health services, laboratory, and programme. It also was able to demonstrate sub-national variances and inequities in achieving and maintaining elimination targets, and barriers to health services access in underserved populations. Data verification and triangulation led to re-calculation of some indicators, but others could not be calculated due to data gaps.ConclusionThe validation methodology is useful for assessing progress in elimination of MTCT of HIV and syphilis, but also as a tool for countries to review their programmatic actitivies to identify opportunities for accelerating achievement of elimination. Challenges in re-calculation of indicators emphasise the importance of comprehensive information systems that collect data necessary to verify elimination.
S16.1 Recurrent and Persistent Urethritis in Men - a Structured Evidence Based Approach to Management
Authors: Horner P 
Published: July 2013

This occurs in 10–20% of men treated for acute NGU. Its aetiology is multifactorial, an infectious agent being identified in < 50% cases.Mycoplasma genitaliumhas been identified in 20–40% andChlamydia trachomatisin up to 20%.Ureaplasma urealyticummay also play a role.Trichomonas vaginalisis identified in up to 10% in populations where it is endemic.Until recently azithromycin 1grm and doxycycline 100 mgs bd 7days were considered equally effective in treating men with acute NGU. However this is not the case. The microbiological failure rate of azithromycin 1 grm is 13 – 30% forM. genitaliumand associated with 23S rRNA gene macrolide antimicrobial resistance mutations, which it can induce. This has also been demonstrated to occur women. A prolonged course of azithromycin for 5 days appears to be effective but not always, possibly because of prior macrolide resistance. Up to 20% of men with Chlamydia will also fail azithromycin 1grm but do not develop antimicrobial resistance mutations. Doxycycline 100 mgs bd 7 days has a failure rate > 50% withM. genitaliumbut probably < 5% with Chlamydia. It does not induce antimicrobial resistance mutations. Ofloxacin is probably effective against Chlamydia but has a high failure rate (∼50%) againstM. genitaliumand may result in quinolone antimicrobial resistance mutations. Moxifloxacin is effective against both micro-organisms.Any treatment of recurrent/persistent NGU should coverM. genitaliumandT. vaginalis.As there is a significant risk of macrolide and quinolone resistance developing inM. genitalium, an infection for which there is no commercial test, the most sensible strategy would be to use doxyccline 100mgs bd 7dys as first line treatment and when using azithromycin to restrict prescribing to a five day course for both index cases and partners. The use of quinolones should be limited to moxifloxacin in those who fail azithromycin 5dys treatment.
S16.4 Lymphogranuloma Venereum in Men Who Have Sex with Men. An Ongoing Epidemic Since 10 Years, But Still Not Tackled
Authors: Vries H J C De 
Published: July 2013

LGV is endemic in large parts of the tropics. Since 2003 anorectal LGV is also endemic among Men who have Sex with Men (MSM) throughout the industrialised world. Currently we see an increase in de incidence of LGV cases among MSM in Amsterdam. Occasional cases of heterosexual LGV are usually imported from endemic countries.LGV is caused by Chlamydia trachomatis (Ct) biovar L. Compared to non-L biovar infections, LGV has a completely different clinical picture characterised by an invasive, lymph destructive and fibrosing inflammatory reaction. The majority of MSM with LGV are HIV co-infected (up to to 85%), and a considerable portion is hepatitis C co-infected.LGV requires extensive treatment in contrast to non-L Ct infections, thus correct biovar identification is clinically relevant. Routinely LGV is excluded in Ct positive anal, ulcer, and bubo samples. Urethral LGV is not screened routinely. The vast majority of reported LGV cases comprise anorectal infections. Infections residing at other locations than the rectum could form an undiagnosed and undertreated reservoir contributing to ongoing LGV transmission. We recently found concurrent urethral LGV infections in 2.1% of MSM with anorectal LGV. Moreover, 6.8% of the partners of anorectal LGV cases had a urethral LGV infection. This shows that urethral LGV is common, probably key in transmission, and missed in current routine LGV screening algorithms.In European MSM the majority of LGV infections is caused by biovar L2b (Amsterdam variant). Based on clonal relatedness of prevalent LGV strains, there is evidence that the LGV epidemic among MSM prevailed already in the United States in the 1980s and was introduced into Europe by the end of the last century via the highly internationalised network of sexual contacts among MSM. A new LGV variant was unveiled and designated L2c.