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Given the opportunity, would women be more likely to take specimens for sexually‐transmitted‐infection (STI) testing in the comfort and privacy of their own home, or go to a clinic? Jones and colleagues examined this question in a randomised trial involving 626 women in Gugulethu, South Africa. The difference between the groups was rather modest; 47% of those with the home kit returned a complete set of specimens, compared with 42% of those who went to the clinic (an additional 14% of mailed specimen sets were not received or were incomplete). Effective initiatives for detecting and treating STIs in this population are certainly needed, as 22% of women had chlamydia, 10% had trichomonas and 8% had gonorrhoea.
See p 552
Two surveys, from China and Peru, show the global popularity of the internet for men who have sex with men (MSM). In both settings about 80% of men had used the internet to seek sexual partners. Zhang et al found that gay Chinese internet surfers were young and well‐educated, but those who also went to traditional gay venues were less well educated, had more sexual partners and were more likely to pay for or be paid for sex than those staying in the virtual world. Blas et al found that including an offer of free testing for HIV and syphilis attracted more visitors to their survey. They aim to use this incentive to develop internet‐preventive interventions for MSM. Both studies collected more than 1000 responses in 3months. More detailed comparisons are, unfortunately, not possible because the questions used in the two studies were too different.
See p 567 and 571
Point‐of‐care tests, providing rapid and accurate diagnosis for STIs, are a hot topic. Romoren and colleagues used decision analysis to find out what the benefits might be in pregnant women compared with a syndromic approach, using empirical data from Botswana where possible. In almost all scenarios examined, point‐of‐care tests achieved a higher cure rate than syndromic management, but at higher cost. The lowest incremental costs per case cured were when the sensitivity of the test was 75% or higher, and screening was limited to teenagers. Uncertainties in the estimates for parameters such as the rate of partner treatment and the incidence of neonatal complications strengthen the argument for large field studies of effectiveness of point‐of‐care tests.
See p 558
In an age of widespread international travel, who is at risk of STIs and HIV through overseas sexual encounters? Mercer and colleagues analysed data from a large probability survey of 12110 British residents. A substantial minority of men and women reported a new sexual partner while overseas in the past 5years, and this was commonest among young men (23%) and women (17%). People reporting new partners abroad were more likely to report high numbers of partners and STI diagnoses, suggesting that sexual health promotion for travellers should be given greater emphasis.
See p 517
In a systematic review of condom promotion intervention studies, Foss and colleagues explored the effect of interventions on condom use. Two thirds of studies reported increased condom use, with the most robust evidence for condom use in higher‐risk settings such as sex work. Evidence for increased use in long‐term relationships, in the absence of known HIV infection, remains weak.
See p 510
The Avahan Initiative is a large‐scale HIV prevention programme in which high‐risk groups in six southern Indian states are being targeted. The evaluation of this initiative will require synthesis of biological and behavioural data with transmission dynamic modelling. Boily and colleagues describe and discuss the merits of a novel‐integrated‐mathematical framework they propose to use for this purpose.
See p 582