Little is known about the incidence of bacterial sexually transmitted infections (STIs) among HIV-infected vs. HIV-uninfected adolescents. This secondary analysis of a national, multisite study included adolescents aged 12–18 years who were behaviorally HIV-infected (n=346) or HIV-uninfected but at-risk (n=182). Incidence rates of bacterial STIs (gonorrhea, chlamydia [CT], and trichomonas [TV; females]) were calculated using Poisson modeling. Factors associated with incident STIs were explored using Cox proportional hazards modeling. HIV-infected vs. HIV-uninfected women had higher TV incidence (1.3 vs. 0.6/100 person-months; p=0.002). HIV-uninfected vs. HIV-infected women had higher CT incidence (1.6 vs. 1.1/100 person-months; p=0.04). Among women, demographic, behavioral, and HIV-related factors were associated with incident STIs. Among men, there were no differences in incident STIs. In this first analysis comparing STI incidence between HIV-infected and HIV-uninfected adolescents, bacterial STI incidence among women significantly differed by HIV status, and factors associated with incident STIs varied by STI and HIV status.
Adolescent; HIV; STI; Incidence
Herpes simplex virus type 2 (HSV-2) HIV co-infection is common and associated with increased risk of HIV transmission. HSV-2 seroprevalence was assessed on stored samples from baseline and one year follow-up from 81 patients identified with acute HIV infection and 81 age-matched chronically infected men. HSV-2 seroprevalence at baseline was lower for those with acute rather than chronic HIV-infection, 51.9 versus 71.6% (P = 0.01); relative risk 0.72 (95% confidence interval [CI] 0.57–0.92). Since HSV-2 seroprevalence is lower in those newly HIV-infected, the diagnosis of early HIV infection may allow for counselling to reduce subsequent HSV-2 acquisition.
herpes simplex virus type 2; HSV-2; seroprevalence; acute HIV infection; chronic HIV infection
HIV transmission risk is increased during ART use if individuals are not virologically suppressed and engage in high risk transmission behavior. Baseline data of HIV-infected MSM with recent history of risky behavior on ART for ≥3 months (n=139) was evaluated to assess predictors of detectable viremia and HIV transmission risk taking behavior. 24 subjects had VL>75 c/mL and 12 had VL>1000 c/mL. In multivariable regression analyses, subjects with VL>75 c/mL were more likely to be Black (OR 4.48, p=0.007), have lower CD4 cells (OR 0.727, p=0.005) and have used methamphetamines in the last month (OR 6.64, p=0.019). Subjects with VL>1000 c/mL were more likely to have lower CD4 cells (OR 0.494, p=0.004), report <90% adherence (OR 7.94; p=0.046) and have used methamphetamines in the last month (OR 10.01, p=0.034). Subjects with VL>75c/mL with the greatest transmission risk behavior (n=14) were more likely to be Black (OR 8.00, p=0.006), have lower CD4 cells (OR 0.657, p=0.009) and have used methamphetamines in the last month (OR 5.20, p=0.042). High risk HIV transmission behavior with viremia occurred in 10% of the cohort. Future efforts to reduce HIV transmission among MSM on ART will require combined interventions that target risk-taking behaviors and substance use.
Research emphasises the role that social structures play in shaping national HIV prevalence. This study examined how social, economic, and political contexts that may represent the confluence of individual capabilities and environmental affordances or constraints are associated with national HIV prevalence. Based on social-ecological perspectives, we examined social-structural dimensions in relation to national HIV prevalence. The study identified six publicly available nation-level social, political, and economic indices and examined their associations with national 2009 HIV prevalence across 225 nations. National indices, (a) education expenditures, (b) unemployment rate, (c) homicide rate, (d) freedom of religion, and (e) women’s social rights, altogether explained 43% of the variability in national HIV prevalence. Education expenditures, homicide rate, and freedom of religion were significant predictors of national HIV prevalence in the multivariate analysis. The present study identified nation-level factors that capture social, economic, and political contexts to explain between-nation differences in HIV prevalence. Findings extend current literature on the social-structural foundation of HIV-risk and the relationship between human rights and health. National safeguards that afford individuals the power to promote general quality of life and protection from structural violence may be most important to lowering overall rates of HIV transmission.
National HIV prevalence; national indices; social and structural factors; power; human rights
This study explores the feasibility of recruiting minority men who have sex with men (MSM) Facebook users for HIV prevention studies, and notes demographic and sexual risk behaviors. Facebook-registered MSM (N=118) were recruited using online and offline methods. Participants validated Facebook-user status through using a Facebook Connect (computer science) application. Participants were primarily Latino (60.2%) and African-American (28.0%), with 33.1% using social media to find sex partners. Black MSM social networking users reported engaging in a lower frequency (Coeff = −.48, p < .05) of unprotected receptive anal intercourse (URAI) compared to Latino MSM. Results suggest that minority social media-users can be recruited for HIV studies and that sexual risk behavioral differences exist among minority social networking users. Findings highlight the importance of incorporating technologies into population-focused HIV interventions.
HIV prevention; social networking; at-risk populations; MSM
There is currently no ‘gold standard’ for diagnosis of latent tuberculosis infection
(LTBI), and both the tuberculin skin test and interferon-gamma release assays (IGRAs) are
used for diagnosis; the latter have a higher sensitivity than tuberculin skin tests for
diagnosis of LTBI in HIV-infected individuals with lower CD4 counts. No evidence base
exists for selection of IGRA methodology to identify LTBI among human immunodeficiency
virus-infected patients in the UK. We prospectively evaluated two commercially available
IGRA methods (QuantiFERON-TB Gold In Tube [QFG] and T-SPOT.TB) for testing LTBI among
HIV-infected patients potentially nosocomially exposed to an HIV-infected patient with
‘smear-positive’ pulmonary tuberculosis. Among the exposed patients median CD4 count was
550 cells/µL; 105 (90%) of 117 were receiving antiretroviral therapy, of who 104 (99%) had
an undetectable plasma HIV load. IGRAs were positive in 12 patients (10.3%); QFG positive
in 11 (9.4%) and T-SPOT.TB positive in six (5.1%); both IGRAs were positive in five
patients (4.3%). There was one indeterminate QFG and one borderline T-SPOT.TB result.
Concordance between the two IGRAs was moderate (κ = 0.56, 95% confidence
interval = 0.27–0.85). IGRAs were positive in only 4 (29%) of 14 patients with previous
culture-proven tuberculosis. No patient developed tuberculosis during 20 months of
Interferon-gamma release assays; latent tuberculosis infection; HIV; screening; tuberculin skin test; AIDS; IGRA; Mycobacterium tuberculosis
Human immunodeficiency (HIV)-infected patients and men who have sex with men (MSM) have a higher rate of high-grade anal intraepithelial neoplasia (HGAIN), a likely precursor to anal cancer. This retrospective study describes the outcome of treating MSM with incident biopsy-proven HGAIN in an urban community health setting with access to outpatient ablation or operative treatment. The main outcome was freedom from HGAIN at follow-up. 153 met inclusion criteria; 86 (56%) were HIV-infected. Eighty (52%) received outpatient ablation, 49(61%) had a follow-up within 9 months. Among those, 26 (53%) were free of high-grade disease, 19 (39%) had high-grade disease; and 4 (8%) had unknown grading. In a logistic regression model, a lower extent of anal disease (1 quadrant vs. 2,3, or 4 quadrants) was significantly associated with a lower probability of high-grade disease (p-value 0.04.) HGAIN could be managed in a community health setting; however, systems are needed to ensure follow-up care.
HIV/AIDS; HPV; Treatment; Homosexual
Self-reported condom use is a commonly collected statistic, yet its use in research studies may be inaccurate. We evaluated this statistic among women in HIV-discordant couples enrolled in a clinical trial in Nairobi, Kenya. Vaginal swabs were acquired from 125 women and tested for prostate-specific antigen (PSA), a biomarker for semen exposure, using an enzyme-linked immunosorbent assay. Ten (10%) of 98 women who reported 100% use of condoms in the previous month tested PSA positive. In a bivariate logistic regression analysis, among women who reported 100% condom use in the previous month, those with ≤8 years of school had significantly higher odds of testing PSA-positive (odds ratio [OR] = 8.39, 95% confidence interval [CI] 1.02–69.13) than women with more schooling. Our estimate may be conservative, as the ability to detect PSA may be limited to 24–48 hours after exposure. Less educated women may be a target group for counselling regarding reporting sexual behaviour in clinical trials.
HIV; AIDS; transmission; prevention; condom use; self-reported; semen exposure; biomarker; prostate-specific antigen; PSA; women; discordant couples; sexual behaviour
A cross-sectional prevalence survey was conducted to determine the sociodemographic correlates of HSV-2 infection among commercial sex workers (CSWs) in Kunming, Yunnan Province of China. HSV-2 prevalence was 33.0%, HIV infection was 2.4%, and HCV infections was 6.8%. Subjects who were positive for HSV-2 had a significantly higher prevalence of HIV infection (5.5% vs. 0.9%, p=0.002; OR: 6.4, p=0.006) and HCV infection (18.7% vs. 2.4%, p<0.001; OR: 7.6, p<0.001) compared to HSV-2 negative individuals. Risk factors that increased the odds of HSV-2 infection were HIV infection, HCV infection, being female, and having a steady sex partner within the last six months (p≤0.01). In a multivariate analysis, female sex workers (OR: 6.6, p<0.001), HCV infection (OR: 5.9, p<0.001), and having a sex partner within the last 6 months (OR: 2.2, p<0.05) had greater odds of being infected with HSV-2. A strong relationship was found between HSV-2, HIV, and HCV infections.
commercial sex workers (CSWs); herpes simplex virus type 2 (HSV-2); human immunodeficiency virus (HIV); hepatitis C virus (HCV); China
Preventing HIV infection is a priority for militaries. HIV prevention research is needed to monitor existing programs, identify areas for modification, and develop new interventions. Correct and consistent condom use is highly effective against HIV. However, use among soldiers is lower than ideal. This study describes condom use behaviors and examines correlates of use in the Botswana Defence Force (BDF). Analyses were based on 211 male personnel, aged 18–30, who completed a cross-sectional survey that collected baseline data for an intervention study. Results showed that 51% of participants reported always using condoms, 35% used condoms most times, and 14% used condoms occasionally/never. Condom use varied by partner type and was typically higher with casual partners in comparison to regular partners. After adjustment for age and marital status, factors associated with lower condom use included excessive alcohol use, perception that using condoms reduce sexual pleasure, and having a trusted partner. However, higher levels of HIV knowledge and reports of being circumcised were protective against lower condom use. HIV interventions aimed at increasing condom use in the BDF should address condom perceptions, alcohol abuse, and issues of trust. Innovative ways to increase condom use in this population should also be explored.
HIV/AIDS; military populations; sexual behaviors; condom use
We examined the relationship between venue stability and consistent condom use (CCU) among female sex workers who inject drugs (FSW-IDUs; n = 584) and were enrolled in a behavioural intervention in two Mexico–USA border cities. Using a generalized estimating equation approach stratified by client type and city, we found venue stability affected CCU. In Tijuana, operating primarily indoors was significantly associated with a four-fold increase in the odds of CCU among regular clients (odds ratio [OR]: 3.77, 95% confidence interval [CI]: 1.44, 9.89), and a seven-fold increase among casual clients (OR: 7.18, 95% CI: 2.32, 22.21), relative to FSW-IDUs spending equal time between indoor and outdoor sex work venues. In Ciudad Juarez, the trajectory of CCU increased over time and was highest among those operating primarily indoors. Results from this analysis highlight the importance of considering local mobility, including venue type and venue stability, as these characteristics jointly influence HIV risk behaviours.
HIV; AIDS; sexually transmitted infections; sexual risk behaviours; prevention; injection drug use; venue stability; mobility; condom use; female sex workers; longitudinal analysis; Mexico
By comparing younger to older participants enrolled in a HIV vaccine efficacy trial, we aimed to gain insights into the inclusion of adolescents in future trials. This was a sub-analysis of a multisite HIV vaccine randomized clinical trial in South Africa, conducted January-September, 2007. Motivations for trial enrollment, social harms, adverse events, and loss to follow-up were compared between younger (18-20 years old) and older participants (21-35 years old). Both younger (n=238) and older participants (n=563) were equally likely to report enrolling for altruistic reasons. Younger females were less likely than older participants to join for trial reimbursement (p=0.005), while younger males were more likely to enroll because the vaccine may provide protection from HIV-acquisition (p<0.001). There were no significant differences in the number of social harms reported. Compared to males over 20 years-old, 18-20-year-old females were less likely to experience adverse events (OR=0.1, CI 0.01-0.80) and no more likely to be lost to follow up (OR=0.7, CI 0.39-1.25), while 18-20-year-old males were no more likely to experience adverse events (OR=1.3, CI 0.58-2.83) or loss to follow-up (OR=0.8, CI 0.51-1.41). Our data support the inclusion of younger participants who are at risk for HIV in future HIV vaccine efficacy trials.
HIV; vaccine trials; clinical trials; youth; South Africa
Routine screening is a key component of sexually transmitted infection (STI) prevention and control; however, traditional programmes often fail to effectively reach men and women in hidden communities. To reduce prevalence, we must understand the programmatic features that would encourage utilization of services among asymptomatic individuals. Using incentivized snowball sampling, 44 women and men recently engaging in transactional sex were recruited (24 women, 20 men); median age 37 years. Respondents were offered the opportunity to collect genital, oropharyngeal and rectal samples for STI testing and completed a face-to-face interview about their experience with self-obtained sampling. Interviews were analysed using qualitative methods. Participants were unaware of potential risk for STI, but found self-sampling in non-clinical settings to be acceptable and preferable to clinic-based testing. All participants collected genital specimens; 96% and 4% collected oropharyngeal and rectal specimens, respectively. The burden of disease in this population was high: 38% tested positive for at least one STI. We detected multiple concomitant infections. Incorporating field collection of self-obtained samples into STI control programmes may increase utilization among high-risk populations unlikely to access clinic-based services. High infection rates indicate that individuals engaging in transactional sex would benefit from, and be responsive to, community-based self-sampling for STI screening.
sexually transmitted infections; diagnosis; sex workers; field collection; self-administered sampling; preferences; STI screening; transactional sex
Diarrhoeal diseases are a common cause of morbidity and are associated with mortality in HIV-infected populations. Little is known about the contribution of clinical and socio-environmental factors to the risk of diarrhoea in these populations in rural sub-Saharan Africa. We conducted a case-control study of people attending a rural HIV clinic with an episode of diarrhoea in Bushbuckridge, South Africa. Cases were defined as HIV-positive adults with symptoms of diarrhoea before or after initiation of antiretroviral therapy (ART). Controls without diarrhoea were randomly selected from clinic attendees. Structured questionnaires and case-file reviews were undertaken to describe clinical and socioenvironmental risk factors. We recruited 103 cases of diarrhoea from 121 patients meeting case definitions. Cases were more likely to be women (P = 0.013), aged over 45 years (P = 0.002), divorced or separated (P = 0.006), have limited formal education (P = 0.003), have inadequate access to sanitation facilities (P = 0.045), have water access limited to less than three days per week (P = 0.032) and not yet initiated on ART (P < 0.001). In multivariate analysis, diarrhoea remained associated with female gender (adjusted odds ratio [aOR]: 2.02, 95% CI 1.10–3.73), older age (aOR: 6.31, 95% CI 1.50–26.50), limited access to water (aOR: 2.66, 95% CI 1.32–5.35) and pre-ART status (aOR: 5.87, 95% CI 3.05–11.27). Clinical and socio-environmental factors are associated with occurrence of diarrhoeal disease among rural HIV patients in South Africa. Further intervention research is urgently needed, combining community- and clinic-based approaches, to improve access to water, sanitation and ART for rural areas with high HIV prevalence, along with structural interventions to address gender inequities.
HIV/AIDS; antiretroviral therapy; diarrhoea; risk factors; environment; women; water; sanitation; rural; South Africa
We investigated depression in relationship to sexual risk behavior with primary partners among HIVclients in Uganda.
Baseline data were analyzed from a cohort of clients starting ART. The Patient Health Questionnaire (PHQ-9) was used to classify depressive severity (none, minor and major depression) and symptom type (cognitive and somatic). Condom use was assessed over the past 6 months and during the last episode of sexual intercourse.
386 participants had a primary sex partner, with whom 41.6% always used condoms during sex over the past 6 months, and 62.4% during last sex. Use of a condom during last sex was associated with having no depression and lower PHQ-9 total and cognitive and somatic subscale scores in bivariate analyses; most of these relationships were marginally significant for sex over the past 6 months. Controlling for demographics, HIV disclosure and partner HIV status, only minor depression was associated with unprotected sex.
Depressive symptoms, even if not a clinical disorder, warrant early detection and treatment for promoting HIV prevention among HIV-affected couples.
depression; HIV; Uganda; sexual risk behavior; condom use
HIV facilitates an increase in human papillomavirus (HPV) associated conditions. HIV-positive men living in a substance use context in Los Angeles were recruited using Respondent Driven Sampling, completed a questionnaire and had biological samples including an anal HPV swab taken. 316 evaluable men were enrolled in the study. The prevalence of all HPV, high-risk (HR) infection, and multiple type infection was highest for men who have sex with men (MSM) (93.9%, 64.6%, 29.7% respectively). When all HPV and HR-HPV prevalence in all men was stratified by age, the youngest group had 100% and 68.2% prevalence respectively with similarly high rates maintained up to 49 years. The individual’s use of alcohol, marijuana, cocaine, methamphetamine or heroin was not significantly associated with anal HPV isolation. In this marginalized population, high anal HPV and HR-HPV prevalence rates over a wide age range may increase the individual’s risk for anal dysplasia and anal cancer.
human papillomavirus (HPV); substance use; anal; HIV; men who have sex with men (MSM)
Negotiation for condom use by female sex workers (FSWs) with their male clients can enhance condom use. A cross-sectional study was conducted among 1395 FSWs; 439 from two brothels, 442 from 30 hotels, and 514 from streets of two cities in Bangladesh to determine the predictors of condom use negotiation. Consistent condom use rates in the seven days prior to interview were reported to be 16.2%, 21.7%, and 4.5% among the brothel, hotel, and street based FSWs respectively. Overall, 28.1% of FSWs negotiated for condom use with their clients. Participation in behaviour change communication (BCC) programmes (AOR, 1.5; 95% CI, 1.2.–2.0), and self-perceived risk of HIV infection (AOR, 1.8 95% CI, 1.6–2.1) were positive predictors for condom negotiation. Compared to the hotel based FSWs, street (AOR, 0.6; 95% CI, 0.4–0.9), and brothel based FSWs (AOR, 0.7; 95% CI, 0.5–0.9) were less likely to negotiate for condom use. FSWs in Bangladesh are at high risk for STI/HIV infection because of low overall negotiation for condom use. Participation in BCC programmes had positive effect on condom negotiation by FSWs, and should be strengthened in commercial sex venues.
Condom use negotiation; Female sex workers; Bangladesh
Adolescents are at high risk for HIV acquisition, and thus need to be included in HIV vaccine trials. In preparation for inclusion of adolescents in HIV vaccine trials in an urban community in Cape Town with a high antenatal HIV prevalence, the study assessed the attitudes towards the inclusion of adolescents in HIV vaccine trials. A total of 18 focus group discussions were conducted using a semistructured interview guide. The participants (n = 200) were adolescents, young adults, parents and other key informants. Participants from all groups welcomed the inclusion of adolescents in HIV vaccine trials due to their high-risk status. There were, however, concerns about sexual disinhibition, fear of side-effects, fear of HIV testing and disclosure of HIV status, mistrust of nurses and clinics. The study highlighted a number of ethical and social issues that need to be addressed before the trials.
HIV vaccine trials; adolescents; community consultation; South Africa
Adaptive immunity requires antigenic priming of the lymphatic system. As lymphatic tissue is abundant in the oropharynx, oral sex could lead to effective immune stimulation and prevent pelvic inflammatory disease (PID).
To determine whether oral sex could be a protective factor for PID.
The relationship between self-reported oral sex and endometritis was analysed among 619 women with clinically suspected PID who participated in the PID Evaluation and Clinical Health (PEACH) study.
Nearly one quarter of participants reported oral sex in the past 4 weeks. These women also reported a higher number of sexual partners, a new partner within the past 4 weeks, and a higher frequency of sexual intercourse (all p< 0.03). They were more likely to smoke (p<0.0001) and use alcohol (p<0.004) and recreational drugs (p<0.02). Participants reporting oral sex were significantly less likely to be black or to have a positive test for Neisseria gonorrhoeae (7.8% vs 21.6%, p= 0.001).
Women who disclosed oral sex were significantly less likely to have endometritis after adjusting for race, number of partners, recent new partner, smoking, alcohol use, and drug use (adjusted OR 0.5 (0.3 – 0.8)).
This is the first paper showing a negative association between oral sex and endometritis. This may be mediated by a protective immune response in the genital tract following priming in the pharynx. This hypothesis needs to be tested in further studies.
Research on HIV infection and sexual behaviour in sub-Saharan Africa typically focuses on individuals aged 15-49 under the assumption that both become less relevant for older individuals. We test this assumption using data from rural Malawi to compare sexual behaviour and HIV infection for individuals aged 15-49 with individuals aged 50-64 and 65+. Although general declines with age were observed, levels of sexual activity and HIV remained considerable: 26.7% and 73.8% of women and men aged 65+ reported having sex in the last year; men's average number of sexual partners remained above 1; and HIV prevalence is significantly higher for men aged 50-64 (8.9%) than men aged 15-49 (4.1%). We conclude that older populations are relevant to studies of sexual behaviour and HIV risk. Their importance is likely to increase as access to ARVs in Africa increases. We recommend inclusion of adults over 49 in African HIV/AIDS research and prevention efforts.
We assessed prevalence and factors associated with hepatitis B in a cross-section of HIV-infected primary care and anti-natal clinic patients in South Africa and evaluated a rapid hepatitis B surface antigen (HBsAg) assay. We enrolled 998 patients; 88% were women, median age was 29 years, and median CD4 count was 354 cells/mm3. HBsAg ELISA, anti-hepatitis B core (HBc) antibodies, and hepatitis C virus antibody were positive among 4.2%, 37%, and 0.1% of subjects, respectively. Univariate and multivariate associations were assessed using logistic regression. Anti-HBc antibodies were associated with alcohol use, traditional medicines, and higher CD4. HBsAg positivity was associated with lower CD4. Compared to the HBsAg ELISA, a rapid HBsAg test had a sensitivity of 75.0% and specificity of 99.6%. In conclusion, we identified a moderate prevalence of both HBsAg and anti-HBc. Importantly, we found subjects with HBsAg positivity had lower CD4 counts.
HIV/AIDS; HBV; HBsAg; HCV; rapid test; Africa
We assessed trends in the relative prevalences of HIV-1, HIV-2 and dual HIV-1/HIV-2 infection in 10,321 women attending outpatient clinics in Senegal between 1990 and 2009. The relative prevalence of HIV-1 (defined as the proportion of seropositive subjects having HIV-1) rose sharply from 38% in 1990 until 1993 (P < 0.001), whereupon it continued to rise, but at a slower rate, reaching 72% of HIV infections in 2009. As compared with HIV-1, the relative prevalence of HIV-2 decreased sharply from 54% in 1990 until 1993 (P < 0.001) and continued to decrease at a slower rate through 2009. The relative prevalence of dual infection, as compared with HIV-1, was stable from 1990 to 1993, but decreased slightly thereafter (P < 0.001). These study findings indicate that during the early 1990s, the relative prevalence of HIV-1 increased markedly, while the relative prevalence of HIV-2 decreased and the relative prevalence of dual infection remained stable in Senegal. From 1993 to 2009, the relative prevalence of HIV-1 increased at a slower rate, while the relative prevalences of HIV-2 and dual infection decreased. These results confirm trends in HIV prevalence observed in other West African populations and provide a critical update on HIV transmission risk among women in Senegal.
HIV; epidemiology; HIV-1; HIV-2; trends; seroprevalence; Africa; Senegal; dual infection
This study examined the prevalence and factors associated with Mycoplasma genitalium (MG) infection among HIV-positive women and the association between MG and vaginal HIV-1 RNA shedding. HIV-positive women attending an outpatient clinic in New Orleans, Louisiana, USA, from 2002 to 2005 were examined for a battery of sexually transmitted infections (STIs) and underwent a behavioural survey. A selected subset had a measurement of vaginal shedding analysed. Of the 324 HIV-positive women, 32 (9.9%) were infected with MG. HIV-positive women with MG were more likely to be co-infected with Neisseria gonorrhoeae and Chlamydia trachomatis and to have had ≥1 male sexual partners in the last month. In the subset (n = 164), no differences were found in the presence of detectable vaginal HIV-1 RNA between women infected and not infected with MG (30.8% versus 34.8% shedding; P = 0.69). While MG was a common co-STI in this sample of HIV-positive women, it was not associated with vaginal HIV shedding.
Mycoplasma genitalium; HIV-infected women; vaginal shedding
Professional organizations recommend rescreening chlamydia-infected women. The iwantthekit Internet-screening program offered rescreening opportunities by using iwantthekit. Mailed, home-collected vaginal swabs were tested for chlamydia, gonorrhea, and trichomonas by nucleic acid amplification tests. Demographics and risk behaviors of repeat users were determined from questionnaires. Predictors of repeat users were measured in a matched case–control study. Of 1747 women, 304 (17%), who used iwantthekit, indicated they had used the kit previously. Mean age was 24.7 ± 5.7 year and 69% were African American. Repeat iwantthekit users were more likely to be ≥20 years (OR = 2.10); were more likely to have been treated for a sexually transmitted infection (OR = 2.32); less likely to drink alcohol before sex (OR = 0.63); and to never use condoms (OR = 0.43). Of repeaters, 84.2% had a negative prior test and 15.8% had a positive. At current test, 13.2% were infected. Previous trichomonas was associated with current trichomonas (p < 0.05). The iwantthekit may offer rescreening opportunities for previously infected women.
Chlamydia (Chlamydia trachomatis); sexually transmitted infection; gonorrhea; Neisseria gonorrhoeae; epidemiology; screening; sexual behavior; trichomonas