Repeat infections with Trichomonas vaginalis (TV) among human immunodeficiency virus (HIV)-infected women are common and may increase the risk of HIV transmission. Patient delivered partner treatment (PDPT) has been shown to reduce repeat infections of other sexually transmitted diseases. The purpose of this study was to evaluate adherence to PDPT and possible causes of repeat TV infection among HIV-infected women.
A multicentered cohort study was conducted in 3 US cities. Women coinfected with HIV and TV were treated with metro-nidazole and given treatment to deliver to all reported sex partners. A test-of-cure visit was conducted 6 to 12 days post index treatment completion and behavioral data were collected.
Of 252 women (mean age = 40 years, s.d. 9.1) enrolled, 92.5% were black, 26.2% had CD4 cell counts <200/mm3, 34.1% had plasma viral loads >10,000 copies, 58.3% were taking antiretrovial therapy, and 15.1% had multiple partners. Of the 183 women with partners at baseline, 75.4% provided PDPT to all partners and 61.7% reported they were sure all of their partners took the medication. Factors associated with not giving medications to all partner(s) were multiple sex partners, being single, and having at least one partner unaware of the index woman’s HIV status. At test-of-cure, 10.3% were TV-positive and 16.7% reported having sex since baseline. Of the 24 repeat infections, 21 (87.5%) reported adherence to medication and no sexual exposure.
HIV-infected women with TV reported high adherence to PDPT, and treatment failure was the most common probable cause of repeat infection.
Youth with alcohol or marijuana dependence or disorders (substance use disorders [SUDs]) are at increased risk of acquiring sexually transmitted diseases (STDs). Sexual partner characteristics may explain the relationship between SUD and STD.
Clinical criteria for SUD, clinical STD diagnosis, and sexual partner characteristics were assessed among 15- to 24-year-old STD clinic attendees between 1999 and 2002 (n = 412). We used exact logistic regression and path analysis to examine the mediation effect of sexual partner characteristics (age discordance, incarceration, STD diagnosis, other partners, perceived alcohol problem, perceived marijuana problem, and a calculated composite measure) on the relationship between SUD and STD, adjusting for important demographics and condom use.
We found evidence of mediation by partner characteristics on the relationship between SUD and STD. For the logistic regression analysis, adding the partner characteristic composite reduced the strength of the association between SUD and STD from a statistically significant odds ratio of 1.7 (95% confidence interval = 1.0–2.7) to a statistically nonsignificant odds ratio of 1.5 (95% confidence interval = 0.9–2.5). In the path analysis, adding the partner characteristic composite reduced the significant direct effect of SUD on STD (β = 0.5, P = 0.04) to statistically nonsignificant effect (β = 0.1, P = 0.2). We estimated that 31% of the total effect of SUD on STD was attributable to the indirect path through the composite partner characteristic measure.
Even when controlling for demographics and condom use, partner characteristics partially explained the association between SUD and STD.
Hormonal contraception use by women may increase the risk of acquiring certain sexually transmitted infections. We explored the effect of hormonal contraceptive use, specifically oral contraception (OC), and depot-medroxyprogesterone acetate (DMPA) on Trichomonas vaginalis infections in women.
We examined data from a prospective case–control study of women with trichomoniasis and noninfected female patients recruited from 3 public sexually transmitted disease clinics. Women with positive wet mount microscopy or T. vaginalis culture results were classified as having trichomoniasis. Participants underwent physical examinations, sexually transmitted infections testing and completed questionnaires which included information about demographics, sexual behavior, douching and contraceptive use. We assessed the association between hormonal contraceptives and trichomoniasis using bivariable and multivariable analysis and estimated exposure odds ratios (ORs) and adjusted odds ratios (aORs) with 95% confidence intervals (CIs).
We identified 427 women with trichomoniasis and 144 uninfected women who had information reported about contraception use. Compared with nonhormonal contraceptive use, OC use was negatively associated with trichomoniasis in bivariable analysis (OR: 0.5; 95% CI: 0.3–0.8). This association was no longer statistically significant after adjusting for demographic variables, douching and condom use (aOR: 0.9; 95% CI: 0.5–1.6). Use of DMPA, compared with nonhormonal contraceptive use, was not associated with trichomoniasis in bivariable or multivariable analyses (OR: 1.0, 95% CI: 0.5–2.1; aOR = 1.4, 95% CI: 0.6–3.4, respectively).
Although OC use appeared to have a protective effect in the bivariable analysis, the hormonal contraceptives OC and DMPA were not associated with T. vaginalis infection after adjustment for other factors.
Prostate-specific antigen (PSA) is a valid biomarker of semen exposure in women and has been used to assess reliability of self-reported sexual behavior as well as serve as a proxy measure for condom efficacy. Quantitative PSA tests are expensive and require specialized equipment. A simple, rapid, and inexpensive test for PSA would facilitate semen biomarker evaluation in a variety of research settings. This study evaluated the performance of a rapid PSA test compared with a quantitative assay to identify semen in vaginal swab specimens.
We tested 581 vaginal swabs collected from 492 women participating in 2 separate research studies in Bangladesh and Zimbabwe. PSA in vaginal secretions was detected using the quantitative IMx (Abbott Laboratories) assay and the ABAcard p30 (Abacus Diagnostics) rapid immunochromatographic strip test.
The ABAcard test was 100% sensitive (95% confidence interval [CI], 98%–100%) and 96% specific (95% CI, 93%–97%) compared with the quantitative test in detecting >1.0 ng PSA/mL vaginal swab eluate. Rapid PSA results were semiquantitative and correlated well with PSA concentrations (κ = 0.88; 95% CI, 0.85–0.90).
Rapid PSA detection requires no instrumentation and can be performed easily and economically. Having rapid PSA results available immediately following interview provides opportunities to explore discrepancies between the objective marker of recent semen exposure and self-reported behaviors.
Men who have sex with men (MSM) are the largest HIV risk-group in the United States. Sexual concurrency may contribute to high HIV incidence, or to racial/ethnic HIV disparities among MSM. Limited information is available on concurrency and racial/ethnic differences among MSM, or on the extent to which MSM engage in concurrent unprotected anal intercourse (UAI).
Data are from baseline responses in a prospective online study of MSM aged ≥ 18 years, having ≥ 1 male sex partner in the past 12 months, and recruited from social networking websites. Pair-wise sexual concurrency and UAI in the previous 6 months among up to 5 recent partners was measured, using an interactive questionnaire. Period prevalences of concurrency and concurrent UAI were computed and compared across racial/ethnic groups at the individual and triad (a respondent and 2 sex partners) levels.
2,940 MSM reported on 8,911 partnerships; 45% indicated concurrent partnerships and 16% indicated concurrent UAI in the previous 6 months. Respondents were more likely to have UAI with two partners when they were concurrent, compared to serially monogamous (OR [95% CI] = 1.93 [1.75, 2.14]). No significant differences in levels of individual concurrency or concurrency among triads were found between non-Hispanic white, non-Hispanic black, and Hispanic men.
Concurrency and concurrent UAI in the previous 6 months was common. Although there were no differences by race/ethnicity, the high levels of concurrency and concurrent UAI may be catalyzing the transmission of HIV among MSM in general.
Concurrency; MSM; sexual networks; UAI; racial disparities
Patient-initiated notification is a commonly used practice for notifying sex partners of possible exposure to a sexually transmitted infection (STI), yet 46% to 75% of partners are never treated. The Contraceptive CHOICE Project (CHOICE) is a longitudinal cohort study of women that provides no-cost contraception, STI testing, treatment to participants, and free partner treatment. Our objective was to evaluate characteristics of women who tested positive for chlamydia, gonorrhea, or trichomoniasis, and their association with successful partner treatment.
We analyzed baseline survey and STI testing, notification, and treatment data from the first 5,087 participants enrolled in CHOICE. We considered “treated partners” to be men who received antibiotic treatment at the study clinic or by a prescription through the study. Independent predictors of successful partner treatment were identified using univariate analysis and multivariable analysis using Poisson regression with robust error variance.
Forty-four percent of male partners were successfully treated. Women whose partners were less likely to obtain treatment were black (RRadj=0.6; 95% CI: 0.5–0.8) or reported some concern about future STI with the partner (RRadj=0.6; 95% CI: 0.4, 0.8). Women whose partners were more likely to receive treatment were living with their partner (RRadj=1.4; 95% CI: 1.1–1.8) or reported recent inconsistent condom use (RRadj=1.5; 95% CI: 1.1–2.1).
The male partner treatment rate resulting from female patient-initiated partner notification in our study was low. Our findings highlight the need to develop novel notification interventions that yield higher partner treatment rates and consider patient-specific factors, such as race and relationship status.
partner notification; sexually transmitted infections; treatment
Migrant sex workers are known to be vulnerable to HIV. There is substantial female sex worker (FSW) mobility between the borders of Maharashtra and Karnataka, but little programming emphasis on migrant FSWs in India. We sought to understand the individual/cultural, structural and contextual determinants of migration among FSWs from Karnataka.
A cross sectional face-to-face interview of 1567FSWs from 142 villages in 3 districts of northern Karnataka, India was conducted from January–June 2008. Villages having 10+FSWs, a large number of whom were migrant, were selected following mapping of FSWs. Multinomial logistic regression was conducted to identify characteristics associated with migrant (travelled for ≥2weeks outside the district past year) and mobile (travelled for <2weeks outside the district past year) FSWs; adjusting for age and district.
Compared to non-migrants, migrant FSWs were more likely to be brothel than street-based (AOR 5.7; 95%CI 1.6–20.0), have higher income from sex work (AOR 42.2; 12.6–142.1), speak >2languages (AOR 5.6%; 2.6–12.0), have more clients (AORper client 2.9; 1.2–7.2) and have more sex acts/day (AORper sex act 3.5; 1.3–9.3). Mobile FSWs had higher income from sex work (AOR=13.2; 3.9–44.6) relative to non-migrants, but not as strongly as for migrant FSWs.
Out-migration of FSWs in Karnataka was strongly tied to sex work characteristics; thus, the structure inherent in sex work should be capitalized on when developing HIV preventive interventions. The important role of FSWs in HIV epidemics, coupled with the potential for rapid spread of HIV with migration, requires the most effective interventions possible for mobile and migrant FSWs.
Migration; HIV; India; Female sex worker
Among adolescents, partner changes are associated with STIs, but little is known about timing. Using daily diaries and weekly STI tests, we describe whether infections occur before or after partner change during periods when young woman changes partners once. Results showed infections occurring both before and after partner changes.
Adolescent; Sexual Behavior; Concurrency; Sexual Relationships; Sexually Transmitted Infection; Gonorrhea; Chlamydia; Trichomonas; incidence; Female
This study prospectively assessed and compared the incidence of condom use errors/problems among clinic patients testing positive for one or more of 3 STDs and those testing negative. The study also identified event-level condom use errors associated with condom breakage and slippage during sex.
Enrolled clinic patients (N=928) were tested for 3 STDs, then patients electronically recorded sexual intercourse and condom use behaviors daily for up to 6 months. Data were available on condom use errors and problems for the more than 10,000 sex events involving condoms. Assessed errors/problems were: 1) not using a new condom, 2) allowing condoms to contact sharp objects, 3) not using condoms from start to finish of sex, 4) condoms drying out, 5) erection loss during condom use, 6) breakage, 7) slippage during sex, and 8) slippage after sex. Because the event-level measures were correlated within individual, Generalized Estimation Equation (GEE) models were used for analyses.
All eight forms of errors/problems with condom use occurred, with varying levels of frequency, without significant differences by baseline STD status for either men or women. Condom breakage was associated with contact with sharp objects (P< .0001) and drying out (P< .0001). Slippage during sex was associated with erection loss (P<.0001) and drying out (P<.0001).
Subsequent to STD evaluation, much of the sex occurring with the use of a condom may not confer adequate protection. Problems found to be associated with condom breakage and slippage are potentially amenable to counseling interventions.
Condoms; men; women; sexually transmitted infections; sexual behavior
Some vaginal bacterial communities are thought to prevent infection by sexually transmitted organisms. Prior work demonstrated that the vaginal microbiota of reproductive-age women cluster into five types of bacterial communities; 4 dominated by Lactobacillus species (L. iners, L. crispatus, L. gasseri, L. jensenii), and one (termed community state type (CST) IV) lacking significant numbers of lactobacilli and characterized by higher proportions of Atopobium, Prevotella, Parvimonas, Sneathia, Gardnerella, Mobiluncus, and other taxa. We sought to evaluate the relationship between vaginal bacterial composition and Trichomonas vaginalis.
Self-collected vaginal swabs were obtained cross-sectionally from 394 women equally representing four ethnic/racial groups. T. vaginalis screening was performed using PCR targeting the 18S rRNA and β-tubulin genes. Vaginal bacterial composition was characterized by pyrosequencing of barcoded 16S rRNA genes. A panel of eleven microsatellite markers was used to genotype T. vaginalis. The association between vaginal microbiota and T. vaginalis was evaluated by exact logistic regression.
T. vaginalis was detected in 2.8% of participants (11/394). Of the eleven T. vaginalis-positive cases, eight (72%) were categorized as CST-IV, two (18%) as communities dominated by L. iners and one (9%) as L. crispatus-dominated (p-value:0.05). CST-IV microbiota were associated with an 8-fold increased odds of detecting T. vaginalis compared to women in the L. crispatus-dominated state (OR:8.26, 95% CI:1.07–372.65). Seven of the 11 T. vaginalis isolates were assigned to two genotypes.
T. vaginalis was associated with vaginal microbiota consisting of low proportions of lactobacilli and high proportions of Mycoplasma, Parvimonas, Sneathia, and other anaerobes.
Trichomonas vaginalis; vaginal microbiota
Male clients of female sex workers (FSWs) serve as a potential bridge of HIV to the general population. Little is known about the characteristics and risk factors for HIV infection among male clients patronizing FSWs in Hekou County, Yunnan Province in southern China bordering with Vietnam.
Male clients were recruited through outreach of study staff, referrals by Vietnamese FSWs, their bosses, and snowball sampling. Each participant completed a questionnaire survey and donated a blood specimen to test for HIV, herpes simplex virus type 2 (HSV-2), and syphilis. Logistic regression models were fitted to identify factors associated with HIV infection.
Among 306 participants, 28 (9.2%) were HIV positive, 81 (26.5%) were HSV-2 positive, and none were infected with syphilis. Approximately half (n=149, 49.2%) reported always using condoms with sex workers in the past year; 36 (11.8%) reported a history of injection drug use (IDU). Compared to HIV negative men, HIV positive men were more likely to have a history of IDU (64.3% vs. 6.5%) and be co-infected with HSV-2 (50.0% vs. 24.1%).
IDU was the most salient risk factor for HIV infection in this study, which suggests that male clients may acquire HIV from routes other than commercial sex, but the significance of HSV-2 infection indicates that sexual transmission is also of concern. HIV prevention intervention programs for this often ignored and hard-to-reach risk group should be two-pronged, addressing both drug use and commercial sex.
HIV; HSV-2; injection drug use; male clients; female sex workers; China
Trichomonas vaginalis (TV) and bacterial vaginosis (BV) were examined among human immunodeficiency virus+ women. The prevalence rates were 28.0% for TV, 51.4% for BV, and 17.5% for TV/BV co-infection. Among human immunodeficiency virus+/TV+ women, the rate of BV was 61.0%. Research is needed to examine how BV affects the clinical course and treatment of T. vaginalis.
Anal cancer is one of the most common cancers affecting human immunodeficiency virus (HIV)-infected male patients. Currently, there is no consensus on post-treatment surveillance of HIV-infected men who have sex with men (MSM) who have been treated for high-grade intraepithelial neoplasia (HGAIN), the likely precursor to anal cancer.
To assess the cost-effectiveness of a range of strategies for anal cancer surveillance in HIV-infected MSM previously treated for HGAIN.
We developed a Markov model to project quality-adjusted life expectancy (QALE), lifetime costs, and the incremental cost-effectiveness ratios (ICER) of five strategies using high resolution anoscopy (HRA) and/or anal cytology testing after treatment.
Performing HRA alone at 6- and 12-month visits was associated with a cost-effectiveness ratio of $4,446 per QALY gained. In comparison, combined HRA and anal cytology at both visits provided the greater health benefit at a cost of $ 17,373 per QALY gained. Our results were robust over a number of scenarios and assumptions, including patients’ level of immunosuppression. Results were most sensitive to test characteristics and cost, and progression rates of normal to HGAIN and HGAIN to cancer.
Our results suggest that combined HRA and anal cytology at 6 and 12 months may be a cost-effective surveillance strategy following treatment of HGAIN in HIV-infected MSM.
HIV/AIDS; HPV; men who have sex with men; treatment; cost-effectiveness; anal cancer
Vaginal HIV-1 shedding has been associated with Trichomonas vaginalis (TV) infection and could play a role in HIV transmission. The purpose of the study was to examine if effective TV treatment reduces the presence of vaginal HIV-1 RNA.
TV+ women attending an HIV outpatient clinic in New Orleans, LA, who resolved infection (n = 58) and TV-negative controls (n = 92), matched on antiretroviral therapy (ART) were examined and interviewed at baseline, 1, and 3 months. TV status was tested by culture and the amount of cell free HIV-1 RNA in the vaginal fluids was determined by the Amplicor HIV-1 Monitor ultrasensitive assay.
Most women (81.3%) were black and the mean age was 37.5 (SD 8.7). At baseline, 46.0% had plasma HIV-1 RNA ≥10,000 copies/mL, 26.4% had CD4<200 cells/μL, 54.7% were taking ART, and only 26.0% had detectable HIV-1 RNA in their vaginal fluids. TV-positive women who were effectively treated for TV were less likely to shed HIV vaginally at 3-months post-treatment compared to baseline (R.R. 0.34, 95% CI: 0.12–0.92, P = 0.03), whereas there was no change for TV-negative women.
This study provides additional support that reducing TV infection among HIV-positive women may have an impact on the prevention of HIV transmission. Reasons for the delayed treatment effect and the effect on cervical shedding need further investigation.
The prevalence of Trichomonas vaginalis is higher among incarcerated women than in the general community. We sought to determine whether a history of incarceration itself was independently associated with trichomoniasis.
The HIV Epidemiology Research Study (HERS) is a prospective cohort study of 871 HIV-seropositive and 439 high-risk seronegative women in 4 urban centers (Bronx, NY; Detroit, MI; Providence, RI; Baltimore, MD). All participants enrolled between April 1993 and January 1995, with interviews and physical exams conducted at baseline and at follow-up visits every 6 months up to 7 years.
Of 1310 subjects, 427 (33%) reported being incarcerated on at least one occasion. In addition, 724 (55%) were found to have an STI on at least one occasion during the study; baseline rates were 21% for T. vaginalis, 4.3% for C. trachomatis, 0.6% for N. gonorrhea, and 8% for syphilis. Incarceration was associated with the detection of trichomonas infection (between-subject OR 2.4, 95%CI 1.85 to 3.14, p<0.01; within-subject OR 1.56, 95%CI 1.26 to 1.92, p<0.01). The association with incarceration remained significant after adjusting for age, race, HIV status, enrollment risk group, number of sexual partners, marital status, education, bacterial vaginosis (BV), vaginal candidiasis, drug use (crack, cocaine, heroin), alcohol use, health insurance, receipt of public assistance, employment status, visit number and study site.
A history of incarceration was independently associated with the detection of trichomonas infection in a cohort of high-risk women. These data have implications for increased STI prevention, screening and treatment upon entry to jail as well as in the communities most affected by incarceration.
trichomonas; incarceration; sexually transmitted infections; HIV; jail
This study evaluated the performance of the BD ProbeTec Chlamydia trachomatis Qx (CTQ) Amplified DNA Assay on the BD Viper System with XTR Technology in a multicenter study.
Specimens were collected at 7 geographically diverse clinical sites from 1538 women and men attending sexually transmitted disease, family planning, and obstetrics and gynecology clinics. There were 1465 evaluable participants, 993 women and 472 men. CTQ assay results from female endocervical, self-collected vaginal, male urethral swab specimens, and male and female neat (unpreserved) urine specimens as well as those obtained using the Urine Preservative Transport (UPT) tube for the CTQ assay were compared with patient-infected status (PIS). PIS was determined based on the combined results from Aptima Combo 2 and BD ProbeTec ET CT Amplified DNA Assay.
The sensitivity versus PIS for endocervical, vaginal, and both female urine samples was 91.3%, 96.5%, and 93.0%, respectively. The specificity for the same specimen types was 98.3%, 99.2%, and 99.4% (urine neat) and 99.2% (UPT), respectively. The sensitivity versus PIS for male urethral swabs and both male neat and UPT urine were 92.1% and 98%, respectively, with specificities of 98.4%, 99.2%, and 98.1%, respectively.
The CTQ assay demonstrated performance characteristics comparable with other commercially available nucleic acid-based tests such as Aptima Combo 2 and BD ProbeTec ET CT-Amplified DNA assay. Vaginal swabs and male urine specimens, the sample types recommended by the Centers for Disease Control for chlamydia screening, both performed at least as well as other sample types evaluated.
To estimate the prevalence of concurrency (more than 1 sex partner overlapping in time), the attitudes/behaviors of those engaged in concurrency, length of relationship overlap, and the association between concurrency and human immunodeficiency virus (HIV) among South Africans aged 15 to 24 years.
A cross-sectional, nationally representative, household survey of HIV infection, and sexual attitudes and behaviors was conducted among 11,904 15 to 24 year old South Africans in 2003. Analyses were conducted among sexually experienced youth.
Men were more likely to report having concurrent (24.7%) than serial partners (5.7%) in the past 12 months, but concurrency was not associated with HIV. Among women, concurrency and serial monogamy were equally common (4.7%), and concurrency, defined by respondent reports of multiple ongoing partners, was associated with HIV in multivariate analysis (odds ratio, 3.4; 95% confidence interval, 1.8–6.5). Median length of relationship overlap was approximately 4 months for women and 3 months for men. Compared to serial monogamists, concurrents reported less consistent condom use, and female concurrents were more likely to report transactional sex and problems negotiating condoms and refusing intercourse.
Concurrency is a common partnership pattern among those youth with multiple partners, especially men. For women, having concurrent relationships may be associated with relationship power imbalances and less ability to protect against HIV. Given the prevalence and likely significance of concurrency in the spread of HIV throughout a sexual network, our findings underscore the need for prevention efforts targeting fidelity.
Incorrect condom use is a common problem that can undermine their prevention impact. We assessed the prevalence of two condom use problems, breakage/slippage and partial use, compared problems by partnership type, and examined associations with respondent, partner, and partnership characteristics.
Data were collected at 3-month intervals over a 12-month period (1999–2000) among urban STD clinic users. Condom use problems were compared between partnership types using z-tests for equality of proportions. Logistic generalized estimating equations modeling accounted for within-participant correlation of repeated measures.
Overall, 3,297 respondents reported 9,304 main and 6,793 non-main partnerships; condoms were used at least once in 4,942 (53.0%) and 4,523 (66.6%) of these partnerships respectively. Condom breakage/slippage was reported during 6.0% of uses (5.1% main, 9.4% non-main) and partial use during 12.5% of uses (12.8% main, 11.5% non-main). The proportion of respondents experiencing any condom use problem in the prior 3 months was higher among main compared to non-main partnerships: 39.1% v. 29.9% had either problem; 22.5% v. 19.0% had breakage/slippage only; 21.8% v. 18.7%, partial use; and 8.7% v. 7.1% had both use problems. In multivariable analysis, factors associated with condom use problems varied by partnership type and respondent sex. The most common predictors of problems across models were sex while high and inconsistent condom use.
This study highlights the diverse set of risk factors for condom use problems at the individual, partner and partnerships levels.
condom use problems; sexual partnerships
To assess factors associated with having a Trichomonas vaginalis (TV) infection among persons receiving care for HIV and estimate the number of transmitted HIV infections attributable to TV.
HIV clinic patients were recruited from two secondary prevention studies, screened by urine nucleic-acid amplification tests for sexually transmitted infections (STIs) and interviewed about risk factors (baseline, 6 and 12 months). We conducted mathematical modeling of the results to estimate the number of transmitted HIV infections attributable to TV among a cohort of HIV-infected patients receiving medical care in North Carolina.
TV was prevalent in 7.4%, and incident in 2% – 3% of subjects at follow-up. Individuals with HIV RNA less than 400 copies/ml (OR 0.32, 95% CI: 0.14 – 0.73) and at least 13 years of education (OR 0.24, 95% CI: 0.08 –0.70) were less likely to have TV. Mathematical modeling predicted that 0.062 HIV transmission events occur per 100 HIV infected women in the absence of TV infection and 0.076 HIV infections per 100 HIV and TV-infected women (estimate range: 0.070 – 0.079), indicating that 23% of the HIV transmission events from HIV-infected women may be attributable to TV infection when 22% of women are co-infected with TV.
The data suggest the need for improved diagnosis of TV infection and suggest that HIV-infected women in medical care may be appropriate targets for enhanced testing and treatment.
HIV; Secondary prevention; Trichomonas infections; Sexually transmitted diseases
Serosorting is the practice of choosing sex partners or selectively using condoms based on a sex partner’s perceived HIV status. The extent to which serosorting protects African American (AA) and Hispanic men who have sex with men (MSM) is unknown.
We analyzed data collected from MSM STD clinic patients in Seattle, WA, 2001–10. Men were asked about the HIV status of their anal sex partners in the prior year and about their condom use with partners by partner HIV status. We defined serosorters as MSM who had unprotected anal intercourse (UAI) only with partners of the same HIV status, and compared the risk of testing HIV positive among serosorters and men who reported having UAI with partners of opposite or unknown HIV status (i.e. nonconcordant UAI). We used generalized estimating equations to evaluate the association of serosorting with testing HIV positive.
A total of 6694 MSM without a prior HIV diagnosis were tested during 13,657 visits; 274 men tested HIV positive. Serosorting was associated with a lower risk of testing HIV positive than nonconcordant UAI among white MSM (2.1 vs. 4.5%, OR 0.45 95% CI 0.34–0.61), but not AA MSM (6.8 vs. 6.0%, OR 1.1 95% CI 0.57–2.2). Among Hispanics, the risk of testing HIV positive was lower among serosorters than men engaging in nonconcordant UAI, though this was not significant (4.1 vs. 6.0%, OR 0.67 95% CI 0.36–1.2).
In at least some AA MSM populations, serosorting does not appear to be protective against HIV infection.
In female sexually transmitted infection (STI) clinic attendees, Mycoplasma genitalium (MG) was more frequently detected using vaginal (53/73) versus endocervical (43/73) specimens. In women without other STIs, MG detection (N=44) was associated with age≤ 22 years (odds ratio (OR) 2.53, P=0.006) and clinical evidence of cervicitis (OR 2.11, P=0.03).
Mycoplasma genitalium; detection rate; cervicitis
HIV testing is the gateway for prevention and care. We explored factors associated with HIV testing among Chinese men who have sex with men (MSM).
In Chongqing City, we recruited 492 MSM in 2010 using respondent driven sampling in a cross-sectional study. Computer-assisted self-interviews were conducted to collect information on history of HIV testing.
Only 58% of participants reported ever having taken an HIV test. MSM who had a college degree [adjusted odds ratio (AOR): 1.7; 95% confidence interval (CI): 1.2-2.6; P=0.008] were more likely to take a test; those who preferred a receptive role in anal sex were less likely to do so than those with insertive sex preference (AOR: 0.6; 95% CI: 0.35-0.94; P=0.03); those who used condoms with the recent male partner during the past 6 months were more likely to get tested (AOR: 2.87; 95%CI: 1.25-6.62; P=0.01). Principal perceived barriers to testing included: fear of knowing a positive result, fear of discrimination if tested positive, low perceived risk of HIV infection, and not knowing where to take a test. Factors reported to facilitate testing were sympathetic attitudes from health staff and guaranteed confidentiality. Prevalence was high: 11.7% HIV-positive and 4.7% syphilis positive.
The HIV testing rate among MSM in Chongqing is still low, though MSM prevalence is high compared to other Chinese cities. MSM preferring receptive anal sex are less likely to get testing and perceive having lower HIV risk. Along with expanded education and social marketing, a welcoming and non-judgmental environment for HIV testing is needed.
Human immunodeficiency virus; syphilis; men who have sex with men; HIV testing; respondent driven sampling; China