bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5-S1.02 Sexual risk behaviours and mental health concerns among HIV-infected MSM
Authors: Safran M , Guoyu T , Butler M , Hoover K 
Published: July 2011

BackgroundSome HIV-infected MSM are at risk for acquisition and transmission of STDs because of ongoing high risk sexual behaviours. HIV-infected MSM also can experience psychosocial stressors and related mental health issues. We assessed the association between STD risk behaviours and the desire to discuss mental health issues, as reported by HIV-infected MSM currently receiving care in HIV clinics.MethodsIn 2007, 426 HIV-infected MSM receiving care in eight urban HIV clinics were randomly selected to complete a survey that queried them about risk behaviours and health concerns. We estimated the percentages who answered that they wanted to discuss their mental health with their clinicians, by sexual behaviour and substance use in the past year. Differences in percentages of patients were considered statistically significant if the two tailed p value was ≤0.05 using a χ2test.Results90% of patients had initiated care for their HIV infection more than a year ago. In the year preceding the survey, 74% had multiple sexual partners, 75% engaged in anal intercourse, 48% had at least one HIV-uninfected partner, and 82% used illegal psychoactive drugs. Among those who reported anal intercourse, 39% did not use a condom during the most recent episode. Among patients, 70% wanted to talk with their clinicians about how they felt mentally or emotionally. Patients who engaged in unprotected receptive anal sex were more likely to want such a conversation than those who did not engage in unprotected receptive anal sex (80% vs 62%, p<0.01); those who engaged in unprotected insertive anal sex were also more likely to want a discussion (81% vs 63%, p<0.01).ConclusionsAlthough the vast majority of these patients had been in treatment for more than a year, a large percentage of patients engaged in substance abuse and sexual behaviours that increase their risk of HIV transmission, and STD transmission and acquisition. Such patients were more likely to want to discuss their mental health concerns than those who did not engage in these behaviours. These findings underscore the importance of interventions to decrease risky sexual behaviour and to promote clinical assessment of mental health needs for this patient population. A mental health assessment can identify patients who might need greater psychosocial support or referral for treatment of substance abuse and underlying mental illness.
P5-S1.03 HIV status disclosure in family and determinants of stigmatisation in a conservative society
Authors: Rashid A , Adnan M 
Published: July 2011

BackgroundNational AIDS control of Pakistan and its development partner Canadian Government CIDA is seeking for effective AIDS surveillance. However, prevailing illiteracy and conservative societal norms are challenging factors in preventing HIV spread. Factors which lead to behavioural changes among people if they have been told of their HIV positive status are complicated and directly related to self-esteem and personal liberation.MethodsWe evaluated this complex phenomenon with an aim to identify factors that prevent a person to disclose his/her HIV status to family members. Effort was also made to characterise determinants of prevailing stigma at society level for HIV positive and PLHA. Self structured questionnaire with binary and multiple response items was used for data collection. Multivariate logistic regression was used to identify significant predictors of stigma at family and societal level.ResultsA total of 412 subjects (178 females and 234 males) were included in the study. Family level anticipated stigma items that were significantly associated with HIV test refusal were family perception, life partner perception, family break-up and neglect by family. Social indicators for prevalent stigmatisation were losing job and livelihood, bad treatment by the healthcare worker and difficulty in finding marital partner of choice (Abstract P5-S1.03 table 1).Abstract P5-S1.03 Table 1Association of HIV stigma with test refusal at personal level as predictors of family and social stigmatisationDependent variableAdjusted OR for HIV test refusal95% CIp ValueFamily level stigma indicators Life partner perception2.150.92 to 3.64<0.001 Family perception1.421.12 to 2.85<0.01 Family break-up1.161.02 to 2.88<0.05 Neglect by family1.831.32 to 2.41<0.01Social stigma indicators Losing job1.721.22 to 3.74<0.01 Livelihood loss1.050.29 to 0.65<0.001 Health worker treatment1.221.23 to 4.67<0.05 Marital life entry fallout2.410.39 to 2.16<0.05ConclusionsThe study concludes that prevailing stigma is the major hindrance for running effective AIDS surveillance program. Clinical programs to prevent HIV infection must be integrated with psychiatric care service as a policy to improve awareness and peoples' willingness for HIV testing.
P5-S2.01 Survey on knowledge, attitude and practices on male circumcision in Rwanda
Authors: Mbabazi J 
Published: July 2011

BackgroundWHO/Joint United Nations Program on AIDS (UNAIDS) has recommended adult male circumcision (AMC) for the prevention of heterosexually acquired HIV infection in men from communities where HIV is hyper endemic and AMC prevalence is low. The aim of this study was to provide evidences on knowledge and attitudes of non-circumcised men with regard to MC, and to determine the willingness to be circumcised among Rwandan men aged 15–59 years.MethodsThis cross sectional study was part of a large survey conducted in Rwanda in January 2010 by the Ministry of Health, to assess knowledge, attitudes and practices regarding MC in the general population (KAP). The data were collected independent of religions and participants were recruited from all of the five provinces of Rwanda and 29 out of 30 districts were covered The data were collected using quantitative technique and a structured questionnaire written in Kinyarwanda was administered and completed by 1098 men.FindingsThe study findings showed that the prevalence of circumcision is 16.5% (95% CI 14.3 to 18.7%) in the study population. This proportion is the highest in the City of Kigali (52.5%) and in the Western Province (25.9%). The district of Rusizi in the western Province has the highest rate of circumcised men in our study, compared to other districts (71%). Among 63.3% of circumcised men, the procedure was performed by a healthcare provider. An estimated 50.2% of uncircumcised men would consider being circumcised and 78.5% would support circumcision for their sons and uptake will steadily increase if services are provided. The main reason would be to prevent them to be infected with STIs (including HIV) and Hygiene. The major reasons preventing uncircumcised men to circumcise is being too old for that procedure, the fear of pain and not becoming sexually promiscuous.ConclusionThis study demonstrates that male circumcision prevalence in Rwanda remains low although MC is a known and acceptable practice among the study participants. The major barriers to MC acceptability can be removed by effective interventions like education and social mobilisation. Interventions should also target women as they can play a key role in the decision making process about circumcision within their couples and families.
P5-S3.01 Developing a multi-pronged quality improvement (QI) strategy to increaseChlamydia trachomatis(CT) retesting rates: building a framework for success
Authors: Howard H , Barandas A , Creegan L , Bauer H , Chow J , Park I , Bolan G 
Published: July 2011

BackgroundCT reinfection is common and linked with adverse reproductive sequelae. Despite strengthened national recommendations and clinician education efforts in California (CA), retesting rates remain low. Our objective was to use a systematic QI approach (assess, intervene, assure, evaluate) to build an effective, feasible, multi-pronged strategy for increasing CT retesting rates in the CA family planning (FP) setting.MethodsWe assessed underlying barriers to retesting using two data sources: (1) clinical encounter data from a CA FP program screening 1 million low-income women for CT annually was analysed to determine clinic return and retesting rates among female CT patients 1–6 months post-treatment; and (2) a survey of FP clinicians was used to identify retesting knowledge, attitudes, and practices. A pilot strategy designed from these findings was refined after iterative sessions with key clinic staff and evaluation of existing protocols and electronic systems at select sites.ResultsClaims data analyses revealed that while 60% of female CT patients returned to clinic 1–6 months post-treatment, only half were retested. Missed opportunities for retesting were associated with limited visits such as pregnancy tests and birth control refills. Clinician survey results showed that 79% did not prioritise CT retesting, only 33% utilised active retesting strategies, and 73% attributed low retesting rates to low patient return rates. A 4-pronged strategy was implemented: (1) to promote retesting as a high priority, medical directors were shown clinic data demonstrating high reinfection rates, high patient return rates, and low retesting rates; (2) clinic systems-level interventions were introduced (chart prompts, clinic practice tools, express STD screening visits); (3) all levels of clinic staff were trained to provide comprehensive counselling to CT-positive patients on reinfection, partner treatment, and practical ways to remember to retest; and (4) patient education materials were revised to improve readability and reinforce messaging. A detailed checklist was developed as a quality assurance tool to facilitate implementation of each intervention and ensure that any operational loopholes were closed. A plan for evaluating the strategy through future monitoring of retesting rates was developed.ConclusionsBy employing a systematic QI approach we were able to tailor specific interventions to address multiple underlying causes of low CT retesting rates.
P5-S3.03 Individual tracking among high risk groups for STI management in India: an analysis of 400 000 high risk groups followed from 2004 to 2009
Authors: Gurung A , Narayanan P , Mugundu P , Ranjan M , Kumar R , Prabhakar P , Das A 
Published: July 2011

BackgroundAvahan, the India AIDS Initiative of the Bill & Melinda Gates Foundation implemented a large HIV prevention program across six high HIV prevalence states among high risk groups (HRG) consisting of female sex workers (FSW), high risk men who have sex with men (HR-MSM), transgender (TG) and injecting drug users (IDU) in India.MethodsThe Avahan monitoring system included individual tracking data pertaining to registration, outreach and clinical services among HRG. All clinic visits were recorded using unique identification numbers, and visits by each clinic attendee were tracked from January 2004 to December 2009. Each clinic visit was recorded using a pre-defined clinical encounter form (CEF).ResultsA total of 439 000 individuals (including 331 616 FSW, 10 280 IDU, 82 246 H- MSM, and 7330 TG) visited the clinics with a total of 2 716 391 visits. Individuals made an average of 6.2 visits to the clinics during the study period. The number of visits per person increased annually from 1.2 in 2005 to 8.3 in 2009. The proportion of attendees visiting clinics more than four times a year increased from 4% in 2005 to 26% in 2009 (p<0.001). The proportion of syndromes diagnosed among FSW decreased from 39% in 2005 to 11% in 2009 (p<0.001) while the proportion of syndromes diagnosed among HR-MSM decreased from 11.6% to 3.5 % (p<0.001). The proportion of attendees seeking regular STI check-ups increased from 12% to 48% (p<0.001). The proportion of HRG accessing clinics within 2 days of the onset of STI-related symptoms and acceptability of speculum and proctoscope examination increased significantly (p<0.001) see Abstract P5-S3.03 figure 1.ConclusionsThe project demonstrated that acceptable and accessible services with marginalised and often difficult-to-reach populations can be brought to a very large scale using standardised approaches. The paper presents the utilisation of these services, improved health seeking behaviour and reduced STI syndromes among the HRG.Abstract P5-S3.03 Figure 1Decreasing trends of STI syndromes in the Avahan clinics Jan 2005 to June 2009.
P5-S3.04 Continued decline in genital warts 3 years after introduction of quadrivalent Human papillomavirus (HPV) vaccination program
Authors: Read T , Hocking J , Gurrin L , Chen M , Donovan B , Bradshaw C , Fairley C 
Published: July 2011

BackgroundVaccination of girls and young women aged 12–26, for HPV genotypes 6, 11, 16 and 18, commenced in Australia in 2007. Vaccine uptake is estimated to be 70%.MethodsDiagnoses for all new patients were recorded and the proportion of patients diagnosed with warts was calculated for exclusively homosexual (MSM) and heterosexual men (MSW) and, for women according to their eligibility for vaccination. Women aged ≥27 years in 2007 were too old for the vaccine program. Changes in these proportions are reported from 2004 to the end of 2010 (to be updated to 30 June 2011).Results53 088 new patients were seen from 2004 to the end of 2010 and 5191 were diagnosed with warts. The proportion of patients diagnosed with warts fell from 11.2% (95% CI 9.8 to 12.8%) in the third quarter of 2007 to 7.3% (95% CI 6.2 to 8.4%) in the final quarter of 2010. Women aged <27 years in 2007 experienced the greatest quarterly reduction (OR per quarter (OR) 0.93, p<0.001) to a proportion of 3.8% seen with warts in the 4th quarter of 2010. There was no significant change in women ≥27 years (OR 1.0, p=0.9) or in homosexual men (OR 0.99, p=0.54) and a small reduction in heterosexual men (OR 0.98, p=0.005). The proportion of younger women diagnosed with warts is continuing to fall, compared to other groups and to the proportions diagnosed with first episode genital herpes (Abstract P5-S3.04 figure 1).Abstract P5-S3.04 Figure 1Presentations with Warts Quarters 2004 to end 2010.ConclusionsThe substantial decline in genital warts continues in young Australian women, 3 years after the roll-out of the HPV vaccination program. Heterosexual men are experiencing a smaller, but significant decline.
P5-S4.07 SMS reminders increase re-testing for repeat chlamydial infection in heterosexuals at a sexual health clinic
Authors: Guy R , Wand H , Read P , Kenigsberg A , Knight V , McNulty A 
Published: July 2011

BackgroundRepeat infection withChlamydia trachomatisfollowing treatment is common. If left untreated it can lead to onward transmission and in females it increases the risk of pelvic inflammatory disease by fourfold. In late 2008, Sydney Sexual Health Centre implemented a reminder system using short message service (SMS) to improve re-testing rates following treatment of chlamydial infection. Clinicians were advised to set up SMS reminders to be sent out at 3 months after the visit.MethodsWe evaluated the impact of this system in its first year of operation using a controlled observation design. Using logistic regression we assessed the association between a SMS reminder and re-testing within 1–4 months of chlamydia infection in Jan–August 2009 among all heterosexuals. The comparison group was heterosexuals diagnosed with chlamydia who received a brief recommendation to re-test in the same time period.ResultsThere were 230 heterosexuals diagnosed with chlamydial infection in the study period; 128 females (median age=24 years) and 112 males (median age=26 years). Of these, 47% were sent a SMS reminder (SMS group), and 53% received a brief recommendation (comparison group). The re-testing rate within 1–4 months of chlamydial infection was 58% in the SMS group, compared to 42% in the comparison group, OR=1.9, 95% CI 1.1 to 3.2, p=0=002. In females, the chlamydia re-testing rate within 1–4 months of chlamydial infection was 57% in the SMS group, compared to 40% in the comparison group, OR=2.0, 95% CI 1.0 to 4.0, p=0.05. In males, the chlamydia re-testing rate within 1–4 months of chlamydial infection was 59% in the SMS group, compared to 45% in the comparison group, OR=1.7, 95% CI 0.8 to 3.8, p=0.165.ConclusionThis low cost system substantially increased re-testing rates after chlamydia infection in heterosexuals at a large sexual health clinic. The clinic now plans to implement electronic prompts to remind clinicians to offer SMS reminders to all patients diagnosed with chlamydia.
P1-S1.55 Higher seroprevalence is associated with HPV infections of mucosal epithelium and infections at multiple sites in men
Authors: Lu B , Viscidi R , Wu Y , Nyitray A , Villa L , Lazcano-Ponce E , Silva R J Carvalho , Baggio M L , Quiterio M , Salmerón J , Smith D , Abrahamsen M , Papenfuss M , Giuliano A 
Published: July 2011

BackgroundPreviously we observed elevated HPV seroprevalence in men who had sex with men (MSM) and men who had sex with men and women (MSMW) compared to men who had sex with women (MSW). We hypothesise that the higher seroprevalence is associated with HPV infection at multiple anatomic sites, and the presence of mucosal epithelium infection as opposed to keratinised epithelium infection. We assessed associations between HPV seropositivity and prevalent HPV infection at anal canal and external genitalia in men to test the hypothesis.MethodsEnrolment data for 1663 men, including 1474 MSW, 83 MSM and 106 MSMW, were analysed. HPV L1 VLP-based ELISA was used for serum antibody testing and Linear Array for HPV DNA testing. Associations were estimated for HPV 6 and 16, respectively, using logistic regression. MSM and MSMW were combined to form the group MSM.ResultsOverall HPV 6 and 16 seroprevalence was 9.9% and 14.1%. HPV 6 and 16 DNA was present in 2.2% and 2.7% of anal samples, and 6.4% and 7.3% of genital samples. Seroprevalence of HPV 6 and 16 was significantly higher in MSM compared to MSW (32.8 vs 6.9%; 34.4 vs 11.5%). Similarly, HPV 6 and 16 DNA was more frequently detected in anal samples (9.5 vs 1.2%; 9.0 vs 1.8%) and genital samples (7.4 vs 6.2%; 9.0 vs 7.1%) of MSM than MSW. Men with simultaneous anal and genital HPV infection (AOR—9.20 and 6.79) or anal HPV infection alone (AOR—19.93 and 3.19) were significantly more likely to be HPV 6 and 16 seropositive. There was no association of seropositivity with prevalent genital HPV 6 or 16 infection. Strong positive associations were detected in MSW and MSM who were anal HPV 6 positive, regardless of coinfection with genital HPV 6. In contrast, no association was observed among MSW with anal HPV 16, with or without genital coinfection. However, significant associations were observed in MSM with anal HPV 16 (with coinfection—AOR, 10.94, 95% CI, 1.18 to 101.68; without—AOR, 4.96, 95% CI, 1.40 to 17.57).ConclusionWe found type-specific associations of HPV 6 and 16 seropositivity with prevalent anal HPV infection, but not with prevalent genital HPV infection alone. Anal HPV 6 infection was associated with seropositivity in both MSW and MSM, while anal HPV 16 infection was only associated with seropositivity in MSM. Our data suggest that, in men, anal HPV infection may be more efficient than genital HPV infection in inducing immune responses. This may have relevance for protective immunity or the lack thereof, conferred by natural infection.
P5-S5.02 Outcomes following the introduction of HIV partner notification guidelines in Edmonton, Canada
Authors: Bergman J , Brandley J , Gratrix J , Ross K , Paradis K , Parker P , Anderson B , Houston S , Singh A 
Published: July 2011

BackgroundIn April 2010, the HIV Partner Notification Guidelines were implemented in Edmonton, Alberta, Canada. Prior to this, partner notification of newly diagnosed HIV cases was conducted inconsistently.MethodsAll individuals newly diagnosed with HIV in the Alberta Health Services- Edmonton zone were interviewed by a partner notification nurse (PNN) for sexual and needle sharing partners, and perinatal contacts under Alberta's Public Health Act. PNNs attempted to locate named contacts to ensure timely counselling, testing, and follow-up care. The number of contacts in the year preceding the diagnosis and information required to locate each contact was recorded for each case. Additional information included whether they were located, tested, and their test results; all information was entered into a Notifiable Disease Reporting database. A descriptive analysis was performed on the characteristics and outcomes of data collected between 5 April and 31 December 2010.ResultsThere were 50 newly diagnosed HIV cases during this time period. The majority (n=33; 66%) of the cases were male and the overall median age was 39 years (IQR 32–48). Male cases were more likely to be Caucasian (n=21; 63.6%) while female cases were more likely to be Aboriginal (n=8; 47.1%, p=0.001). The primary mode of transmission among male cases was MSM (n=18; 54.5%) and among female cases was heterosexual transmission (n=10; 58.8%). A total of 92 contacts were provided by 36 (72%) of the HIV cases, with an average of 2.6 (range 1–14) contacts per case. The majority (97.8%; n=90) of contacts were exposed through sex with an additional 5 (5.4%) contacts being exposed through needle sharing during drug use. Of the 92 named contacts, 17.4% (n=16) were found to be previously positive for HIV, 16.3% (n=15) resided outside of Edmonton, and the remaining 66.3% (n=61) were followed up by local PNNs. At the time of analysis, 75.4% (n=45) of the contacts were located and of those located, 82.6% (n=38) were tested resulting in four new cases of HIV.ConclusionsHIV partner notification efforts resulted in the majority of contacts being located and tested for HIV, with four new cases of HIV identified. Nearly one-quarter (n=20; 21.7%) of the total contacts were HIV positive, suggesting a need for ongoing prevention and risk reduction strategies for individuals living with HIV and their partners.
P5-S5.04 Provider and contract referral for bacterial STIs: two sides of the same coin?
Authors: Cassell J , Estcourt C , Symonds M , Richens J , Rait G , Lanza S , Dodds J , Smith H 
Published: July 2011

BackgroundDuring the pilot of an RCT of provider, contract and patient referral, for a 66 practice RCT of partner notification in UK primary care, it emerged that there is uncertainty about real life clinical practice. Our objectives are to describe how health advisers negotiate provider, contract and patient partner notification in clinical practice. To determine the feasibility of comparing both provider and contract referral separately against patient referral.MethodsWe recruited 10 health advisers from contrasting settings to attend a 1-day workshop led by partner notification specialists and researchers. They participated in focus group discussions, observations of practice, role play with each other and with actors. They and the actors then contributed to further focus groups reflecting on their observations and experiences, and advising on feasible strategies for delivering standard partner notification interventions in the RCT context. All discussions were recorded for qualitative analysis.ResultsAll health advisers practised provider referral, but the extent was variable. Contract referral as defined in the UK (a time period is explicitly agreed for the patient to notify, after which provider notification is initiated) is practised for HIV, other bloodborne viruses and sometimes syphilis. However for common bacterial STIs, a patient's choice of provider referral often emerges over multiple consultations, and provider referral is not a distinct intervention from contract referral. Health advisers saw their role as helping patients find solutions to partner notification, rather than applying specific interventions.ConclusionsProvider and contract referral are not sufficiently distinct to be compared with each other in a trial setting for chlamydia and gonorrhoea. However contract referral does have an important role in management of partner notification for bloodborne viruses.