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1.  Condom use problems during anal sex among men who have sex with men (MSM): findings from the Safe in the City Study 
AIDS Care  2012;24(8):1028-1038.
Our research aims were to: 1) assess the prevalence of two condom use problems: breakage or slippage and partial use (delayed application or early removal) among men who have sex with men (MSM) seeking services in urban U.S. STD clinics; and 2) examine the association between these condom use problems and participant, partner and partnership characteristics. Analysis is restricted to HIV-negative MSM who reported having anal sex at least once in the preceding 3 months and who completed both the baseline and 3-month follow-up assessments. Two models were fitted using the GEE approach. A total of 263 MSM (median age=32 years) reported 990 partnerships. Partnerships with no condom use 422 (42.6%) were excluded. Thus, 207 MSM and 568 partnerships were included. Among condom users, 100% use was reported within 454 partnerships (79.9%) and <100% within 114 (20.1%), and 21(3.7%) reported both condom use problems, 25 (4.4%) reported only breakage, 67 (11.8%) reported only partial use, and 455 (80.1%) reported no errors. The breakage or slippage and partial use rates per condom used were 3.4% and 11.2%, respectively. A significantly higher rate of breakage or slippage occurred among non-main partnerships. Characteristics associated with increased odds for condom breakage or slippage were: lower education level (OR=2.78; CI: 1.1-7.5), non-main partner status (OR=4.1; CI: 1.5-11.7), and drunk or high during sex (OR=2.0; CI: 1.1-3.8), and for partial use: lower education level (OR=2.6; CI: 1.0-6.6), perceived partner STI risk (OR=2.4; CI:1.3-4.2), and inconsistent condom use (OR=3.7; CI:2.0-6.6). A high percentage of MSM partnerships reported no condom use and among condom users, a sizable proportion did not use them consistently or correctly. MSM may benefit from interventions designed to increase proficiency for condom use with a particular focus on the behaviors of inconsistent and partial condom use.
doi:10.1080/09540121.2012.668285
PMCID: PMC3389178  PMID: 22519680
2.  PREVALENCE AND CORRELATES OF BACTERIAL VAGINOSIS AMONG YOUNG WOMEN OF REPRODUCTIVE AGE IN MYSORE, INDIA 
Purpose
Bacterial vaginosis (BV) is the most common cause of abnormal vaginal discharge among women of childbearing age and is associated with STI/HIV and adverse birth outcomes. The objective of this study was to determine the prevalence and correlates of BV among young women of reproductive age in Mysore, India.
Methods
Between October 2005 and December 2006, 898 sexually active women of 15–30 years of age were enrolled from two reproductive health clinics in Mysore. The women underwent an interview followed by physical examination, HSV-2 serologic testing, endocervical culture for Neisseria gonorrhoeae, and vaginal swabs for diagnosis of BV, Trichomonas vaginalis infection and candidiasis. Statistical analyses included conventional descriptive statistics and multivariable analysis using logistic regression.
Results
Of the 898 women, 391 (43.5%) were diagnosed with ≥1 endogenous reproductive tract infection and 157 (17.4%) with ≥1 sexually transmitted infection. Only 863 women had Gram-stained vaginal smears available, out of which 165 (19.1, 95% confidence interval [CI]: 16.3%–22.2%) were found to have BV and 133 (15.4, 95% CI: 12.9%–18.3%) were in the ‘intermediate’ stage. BV was related to concurrent infections with T. vaginalis (odds ratio [OR] = 4.07, 95% CI: 2.45–6.72) and HSV-2 seropositivity (OR = 2.22, 95% CI: 1.39–3.53).
Conclusions
In this population, the prevalence of BV at 19% was relatively low. Coinfection with T. vaginalis, however, was common. BV was independently associated with concurrent T. vaginalis infection and partner’s alcohol use. Muslim women had reduced odds of BV as compared to non-Muslim women. Further research is needed to understand the role of T. vaginalis infection in the pathogenesis of BV and the sociocultural context surrounding the condition in India.
PMCID: PMC3625939  PMID: 18445948
Bacterial vaginosis; correlates; epidemiology; India; prevalence; sexually transmitted infections
3.  Risk Factors for the Spread of HIV and Other Sexually Transmitted Infections Among HIV-infected Men Who Have Sex with Men in Lima, Peru 
Sexually transmitted infections  2008;84(6):449-454.
Objectives
To assess the prevalence of sexually transmitted infections (STIs), frequency of sexual risk behaviors, and relationship between knowledge of HIV infection status and sexual risk behavior among HIV-infected men who have sex with men (MSM) attending an STI clinic in Peru.
Methods
We recruited a convenience sample of 559 MSM from a municipal STI clinic in Lima, Peru. Participants completed a survey and provided blood for HIV, Syphilis, and HSV-2 antibody testing, and urine for gonorrhea and chlamydia nucleic acid testing.
Results
Among 124 HIV-infected MSM, 72.6% were aware of their HIV-infected status. Active syphilis (RPR≥1:8) was diagnosed in 21.0% of HIV-infected participants, HSV-2 in 79.8%, urethral gonorrhea in 1.6%, and chlamydia in 1.6%. Among 41 participants reporting insertive anal intercourse with their last sex partner, 34.2% did not use a condom. Of 86 participants reporting receptive anal intercourse, 25.6% did not use a condom. At least one episode of insertive unprotected anal intercourse (UAI) with an HIV-uninfected partner during the previous six months was reported by 33.6% (35/104) of participants, and receptive UAI with an HIV-uninfected partner by 44.6% (45/101). No difference in frequency of UAI, with HIV-uninfected or HIV-infected partners, was observed between men who knew their serostatus compared with those who were previously undiagnosed (all p-values >0.05).
Conclusions
HIV-infected MSM in Peru engaged in high-risk behaviors for spreading HIV and STIs. Knowledge of HIV-infected status was not associated with a decreased frequency of unprotected anal intercourse. Additional efforts to reduce risk behavior after the diagnosis of HIV infection are necessary.
doi:10.1136/sti.2008.031310
PMCID: PMC2613035  PMID: 19028945
MSM; Peru; HIV; Secondary prevention; Prevention for positives

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