B01A STD Clinic Clients With Repeat Bacterial STDs: Who
Are They and How Do We Intervene?
JS
Leichliter1, N Liddon1, C McGhan2, K Bernstein3, EJ
Erbelding3
1Centers for Disease Control and Prevention,
Atlanta, GA; 2University of Florida, Gainesville, FL; 3Johns
Hopkins University, Baltimore, MD
Background:
Repeat infections with bacterial STDs are
relatively common and are associated with adverse sequelae.
Individuals with repeat STDs account for a substantial proportion
of those seeking care at public STD clinics and may be core
transmitters. An improved understanding of factors underlying
acquisition of repeat infections may assist in designing
specialized and more successful prevention interventions.
Objectives:
To describe the range of correlates, psychosocial,
and contextual factors that underlie STD acquisition among
adolescents and adults diagnosed with repeat bacterial STDs. To
discuss possible interventions for repeat STDs that may be
feasible to deliver in an STD clinic.
Content:
The investigators will describe various studies
that examine STD repeaters using diverse methodologies. The first
presentation will provide retrospective clinic information on
behavioral factors and clinician actions related to repeat STDs
among previously undiagnosed adolescents. The second presentation
will discuss the STD repeater as a core transmitter and provide
examples of how locally obtained morbidity data can be useful
to
drive intervention and new research initiatives. The third
presentation will present several brief case studies or profiles
of adolescent STD repeaters to demonstrate the differences in
these teens’ lives suggesting that any intervention would need
to be individualized. The fourth presentation will describe themes
contributing to STD acquisition among adult STD repeaters in
a
public STD clinic, present possible interventions related to each
theme that could feasibly be delivered within the context of
standard STD clinical services, and present interventions that
would require additional community resources beyond the clinical
setting.
Implications
for Programs, Policy, and/or Research:
This session will provide detailed information
about STD repeaters that will allow STD programs to better
understand this portion of the clinic population. Additionally,
information on STD repeater intervention feasibility in an STD
clinic will be useful to STD programs, clinic staff, and
researchers.
Panel Line-up
Moderator:
Jami S Leichliter, PhD
CDC, Atlanta
Panelists:
Repeat
Infections Among Adolescents: Findings from a Philadelphia STD
Clinic
Nicole Liddon,
PhD
CDC, Atlanta
Repeat STIs
and Core Transmitters
Kyle
Bernstein, ScM
Johns Hopkins
University, Baltimore
Life Story
Narratives: Similarities and Differences in Adolescents Who
Acquire Repeat STDs
Cheryl McGhan,
MSN, CNM
University of
Florida College of Nursing, Gainesville
Repeat STDs:
Why Are So Many STD Clinic Patients Refractory to Clinic-based
Interventions?
Emily J
Erbelding, MD, MPH
Johns Hopkins
University, Baltimore
Learning
Objectives:
By the end of this session, participants will be
able to identify the correlates, psychosocial, and contextual
factors that are related to repeat bacterial STDs. Participants
will also understand the challenges in developing a prevention
intervention for STD repeaters and identify possible interventions
that may be feasible to deliver in an STD clinic.
Contact
Information:
Jami S Leichliter/Phone no. 1 404 639
1821/JLeichliter@cdc.gov
B01B Changes in Sex Networks and Repeat STDs Among Male
Adolescents
JM
Ellen1, C Gaydos1, M Chung1, N Willard1, CA
Rietmeijer2
1Johns
Hopkins School of Medicine, Baltimore, MD; 2Denver Public Health
Department, Denver, CO
Background:
Predictors of repeat gonorrhea (GC) or chlamydia
(CT) have been difficult to identify. This failure may be due to
individuals who engage in risk behaviors and have risky sex
networks at their initial infection continue to engage in these
behaviors and remain in the same network. However, if individuals
changed sexual networks subsequent to initial infection, the
risks
for repeat infection might decrease.
Objectives:
To determine whether decrease in the percentage
of sex partners who are within the index’s social network is
associated with decrease risk for repeat GC and/or CT.
Methods:
Asymptomatic men, 12-21 years old, infected with CT
and/or GC were interviewed about sex partners in past two months.
One and 4 months later, participants were interviewed about
interim sex partners and tested for GC and CT. We defined the sex
partner as within the social network if met through close friends,
went to same school, more than _ of friends knew, friends had
sex
with partner, or partner knew any of other of the sex partners.
Percentage of sex partners within social network was calculated
as
number of sex partners within social network / number of total
sex partners.
Results:
109 participants completed 216 follow-up
interviews. At 71 (33%) interviews, participants reported having
sex since previous visit and 30 (42%) had at least one new sex
partner. The positivity rate for GC and/or CT was 10%. Having
a
new sex partner was not associated with repeat gonorrhea or
chlamydia (p>0.1). Among participants reported having a new sex
partner, none (0/13) with decreased overlap between networks were
infected while 29% (5/17) with unchanged or increased overlap were
infected (p<0.05).
Conclusion:
Having a new partner outside social network is
protective for repeat infection.
Implications:
Network-level interventions may be the most
effective strategy for reducing rates of repeat GC and CT.
Learning
Objective:
By the end of this presentation, participants will
be able to list factors associated with repeat GC and CT
infection.
Contact
Information:
Jonathan M
Ellen/jellen@jhmi.edu
B02A “The Clap Doctor,” “The Father of Spin,” and
Other Historical Lessons for Syphilis Elimination
W Petz
North
Carolina HIV/STD Prevention and Care Branch, Black Mountain, NC
Background:
The current “Syphilis Elimination: History in the
Making” plan calls for combining “intensified traditional
approaches with innovative approaches” to achieve its goal of
elimination of syphilis. Five strategies are identified and
expanded.
Objective:
To explore the early syphilis intervention work
of Dr. Ben Reitman, “The Clap Doctor” and Edward Bernays, “The Father
of Spin,” and the Public Health Services’ syphilis control effort
initiated at the 1936 National Conference on Venereal Disease
Control Work as they illuminate current syphilis elimination
activities and issues.
Methods:
Research used biographies of Reitman and Bernays,
contemporary assessments of their work, and histories of early
syphilis programs. Information was compared to strategies and
concepts in the 1999 Syphilis Elimination plan.
Results:
Dr. Reitman, rooted Chicago’s radical and poor
community, established the first “venereal disease” clinic there
in 1917. He began clinics in jails, treated prostitutes in
brothels, and began a “CBO” as part of the Chicago Syphilis
Project where he also worked. Reitman argued for teaching
“prophylaxis”/prevention in the local climate of “abstinence only”
and facilitated services and surveillance in disenfranchised
communities. Edward Bernays, the “father of public relations,”
began (1912) his career promoting the play “Damaged Goods” about a
man with syphilis. To overcome resistance, he gathered prominent
civic, business and church leaders to support open discussion. His
success led to productions for high federal officials. Much of the
language, strategies and programs of Surgeon General Parren’s
national syphilis control “war” parallel the strategies of the
1999 syphilis elimination plan.
Conclusions:
Understanding historical precedent can focus “traditional” approaches and sharpen “innovative” approaches
for greater success.
Implications
for Programs, Policy, and/or Research:
Greater knowledge of what worked in past syphilis
control efforts may result in an altered assessment of traditional
and innovative approaches.
Learning
Objectives:
Participants will be able to describe syphilis
control programs and issues of the early 1900s.
Contact
Information:
Bill Petz/Phone no. 1 828 669
3350/Bill.Petz@ncmail.net
B02B World War II: “The Most Extensive Syphilis Case
Finding Program in the History of the World”
L
McGough
Johns
Hopkins University, Baltimore, MD
Background:
Previous research has emphasized the importance
of the biomedical model, first Ehrlich’s “magic bullet” followed by
penicillin, in the campaign to control STDs during WWII. This
paper re-examines the strategies undertaken by public health
officials during WWII in order to determine what policies were
adopted during this period, regarded as one of the “successes” of
twentieth century STD control.
Objectives:
To evaluate the successes and failures of one of
the largest STD control efforts in US history
Methods:
The records of the US Public Health Service (USPHS)
at the National Archives were read, along with relevant
publications from the 1940s
Results:
Despite initial conflict with the Armed Forces,
by 1943 the USPHS and the Armed Forces cooperated in an effort
to
reduce the prevalence and incidence of STDs among soldiers as well
as the civilian population. The result was an STD control program
that integrated prevention, treatment, surveillance, research
and
education. Rapid Treatment Centers (RTCs), primarily for the
treatment of women, were opened as early as 1942. The rationale
behind these centers was that civilian women served as a reservoir
of infection for soldiers. Early publicity focused on how the
RTCs
would treat prostitutes, a strategy that undermined the
effectiveness of the centers in reaching out to infected women
not engaged in prostitution. Because the American public regarded
STDs
primarily as a problem of prostitution, USPHS officials expressed
concern that public support for the backbone of the STD control
program—contact tracing and case holding—could be undermined.
Conclusions:
Control of STDs during WWII cannot be attributed to
the introduction of penicillin therapy alone, but to the
combination of case finding, education, prophylaxis, and
surveillance with treatment.
Implications
for Programs, Policy, and/or Research:
Comprehensive STD control programs are more
effective than treatment alone.
Learning
Objectives:
By the end of the session, participants will be
familiar with the range of programs adopted by the USPHS to
control STDs during WWII.
Contact
Information:
Laura McGough/Phone no. 1 443 287 3492
B02C Repeat Infection with
Chlamydia trachomatis:
Rate and Predictors among Males
EF
Dunne1, JB Chapin1, C Rietmeijer2, CK Kent3, J
Ellen4, C Gaydos4, N Willard4, L Lloyd2, N Birkjukow3, S Chung4,
JA Schillinger1, LE Markowitz1
1Centers
for Disease Control and Prevention (CDC), Atlanta, GA, US; 2Denver
Public Health, Denver, CO, US. 3San Francisco Department of Public
Health, San Francisco, CA, US; 4Johns Hopkins University School
of
Medicine, Baltimore, MD, US
Background:
Reinfection rates are an important measure of the
effectiveness of interventions intended to interrupt disease
transmission. There have been no previous longitudinal studies
of reinfection among men treated for
Chlamydia trachomatis
(Ct) infection.
Objective:
To measure the rate and predictors of repeat Ct
infection in men.
Methods:
Ct-infected men identified by screening at various
venues in Baltimore, Denver, and San Francisco were treated, had
partner elicitation interviews conducted, and were offered
enrollment in a longitudinal study of repeat Ct infection. At 1
and 4-month follow up visits, men completed questions on
demographics and sexual health and were tested for Ct infection
using nucleic acid amplification testing (NAAT). Overall and
venuespecific repeat infection rates were calculated for all three
cities. Men with at least one repeat infection were compared
to
men without repeat infection using Chi square test.
Results:
Three hundred and sixty-one men were recruited into
the study, and 271 (75%) had at least one follow-up visit.
Overall, the repeat infection rate was 11% (Denver 11%; Baltimore
12%; San Francisco 11%). Low educational attainment (less than
high school education), low income, and history of sexually
transmitted disease were associated with Ct repeat infection. Men
reported a median of 2 partners during the study (range 0-8),
and
40% of men had new partners during the study. Nine percent of men
without a new partner had repeat infection compared with 14%
of
men with new partners; this difference was not statistically
significant.
Implications
for Programs, Policy and/or Research:
Information on rate and predictors of repeat Ct
infection in men will help identify specific strategies to prevent
Ct infection in men and women. This information will be used
for
cost-effectiveness evaluations of male Ct screening, and to
support Ct screening programs and partner notification activities.
Measurable
Learning Objectives:
By the end of the session, participants will be
able to describe the rate and predictors of Ct repeat infection
in men
Contact
Information
Eileen Dunne,
dde9@cdc.gov
B02D The Cost-Effectiveness of Screening Men for
Chlamydia to Prevent Pelvic Inflammatory Disease (PID) in Women
T
Gift1, EF Dunne1, J Chapin1, C Kent2, C Gaydos3, JM Marrazzo4,
J Ellen3,
C Rietmeijer5, J Schillinger1, LE Markowitz1
1Centers
for Disease Control and Prevention, Atlanta, GA; 2San Francisco
Department of Public Health, San Francisco, CA; 3Johns Hopkins
University School of Medicine, Baltimore, MD; 4University of
Washington, Seattle, WA; 5Denver Public Health, Denver, CO
Background:
Screening asymptomatic men for Chlamydia
trachomatis (Ct) using urine-based testing may be a cost-effective
way of preventing PID and its sequelae compared to the alternative
of not screening men. However, guidance for state and local STD
control programs should compare the costs and benefits of male
screening against other interventions to prevent PID.
Objectives:
To compare the cost-effectiveness of screening men
for Ct to prevent PID in women with screening women directly, and
to describe key considerations in determining whether starting
or
continuing a male screening program represents an optimal use of
Ct prevention resources.
Methods:
Using data from a male screening demonstration
project (35,000 men screened for Ct between 2001-2003), we
conducted a cost-effectiveness analysis comparing screening men
for Ct with two partner management strategies (partner
notification (PN) and patient referral) to screening women with
patient referral for partners. The primary outcome was cases
of
PID prevented. Variables not collected as part of the
demonstration project were obtained from the literature. We
conducted sensitivity analyses on key variables.
Results:
If the Ct prevalence among men screened is markedly
higher than that of women who can potentially be screened, (e.g.,
7.4% in men vs. 2% in women), then screening the men and providing
PN can prevent more PID cases than screening women. However,
the
net program cost will be higher. Adding PN to a male screening
program is generally cost-effective compared to relying on patient
referral.
Conclusions:
Screening men for Ct can be an effective
intervention to prevent PID compared to screening women if the
prevalence among men to be screened is substantially higher
than
in women who can be screened. Screening men is generally more
costly than screening women.
Implications
for Programs, Policy and/or Research:
These findings will help STD control programs
determine whether screening men may be a cost-effective adjunct
to screening of women for PID prevention.
Measurable
Learning Objectives:
1. By the end
of the session, participants will be able to describe the
cost-effectiveness of male screening for chlamydia and the key
elements that programs need to consider to implement male
screening
2. By the end
of the session, participants will be able to describe in what
settings male screening for chlamydia infection could be effective
and cost-effective
Contact
Information:
Thomas L. Gift / phone no. 1 404 639 1831;
tgift@cdc.gov
B02E Communicating the Facts and Figures about Sexually
Transmitted Diseases in Youth
JR
Cates1, H Weinstock2, H Chesson2, RJ DiClemente3
1University
of North Carolina at Chapel Hill, School of Journalism and Mass
Communication, Chapel Hill, NC; 2Centers for Disease Control and
Prevention, Atlanta, GA; 3Rollins School of Public Health and
Emory University School of Medicine
Background:
Sexually transmitted diseases (STDs) are among the
most common infections in the United States. Quantifying the human
and economic costs of STDs in youth is important to inform
discussions about risk reduction strategies and policy solutions
with health policymakers. Previous estimates have not been
available on the extent and cost of STDs in youth.
Objectives:
(a) To present new findings on estimates of the
health, social, and economic consequences of STDs in youth, 15-24
years old; and (b) To identify key discussion points appropriate
for different audiences.
Methods:
This session will present new national estimates on
(1) the incidence and prevalence of specific STDS in youth, (2)
the direct economic costs as a result of these STDs, and (3)
the
socio-ecological perspective for designing STD prevention
strategies. These estimates will be translated into language
useful for research or program settings.
Results:
An estimated half of the18.8 million new STDs each
year occur in youth ages 15-24. The associated medical costs will
top $6.6 billion. Most STDs are undetected and undiagnosed. These
infections have a considerable impact not only on individual
health but also on the social and economic costs to communities.
Some factors that help to reduce the risk of STDs include access
to STD services and parental support. Missed opportunities for
STD
screening and for communication about risk reduction are
undermining efforts to contain the spread of infection.
Conclusions:
The “silent epidemic” of STDs in youth is costly
in both human and financial terms for individuals and society.
These
costs can be reduced by concerted action to utilize the public
health tools currently available.
Implications
for Programs, Policy, and/or Research:
Multiple levels of effort are needed to confront
STDs in youth. Communicating the facts and figures lays the
foundation for change.
Learning
Objectives:
At the end of this session, participants will be
able to:
1. Identify
the main findings from new research on the human, social, and
economic costs of STDs in youth;
2.
Describe the research findings in bullet points applicable for
different
audiences.
Contact
information:
Joan R. Cates, MPH/1 919 843 5793/JoanCates@unc.edu
B03 Turning STD Surveillance Data into Action
LM
Newman1, M Samuel2, J Stover3, M Stenger4, and J
Ellen5 for the Outcomes Assessment through Systems of Integrated
Surveillance (OASIS) Project
1Centers
for Disease Control and Prevention, Atlanta, GA; 2California
STD
Control Branch; 3Virginia Department of Health, Richmond, VA;
4Washington State Department of Health, Olympia, WA; 5Johns
Hopkins University School of Medicine, Baltimore, MD
Background and
Rationale:
Since 1998, CDC has funded the OASIS Project
(Outcomes Assessment through Systems of Integrated Surveillance)
to promote the integrated interpretation and use of surveillance
data to improve planning and evaluation of STD programs.
Representatives from the nine sites currently participating in
OASIS will present their experiences with the OASIS Project
and
discuss the value of different methods of data collection and
analysis for guiding STD program activities.
Objectives:
To discuss the utility of matching databases,
geocoding and mapping, and enhanced surveillance for STD program
activities.
Content:
The panel will discuss methods of matching data
from different sources such as STD, HIV, and vital statistics
databases, and present examples of useful applications for matched
data. We will provide an overview of basic principles of geocoding,
practical tools, and ways in which geocoding and mapping can
be
used in planning STD program activities. We will review the
different domains of information that can be collected to enhance
STD surveillance (i.e. geographic, behavioral, treatment,
laboratory data). We will also discuss the challenges and
advantages of implementing enhanced gonorrhea surveillance from
a programmatic perspective, using examples from several OASIS
sites.We will conclude with a discussion of how these methods
have
been used by one site to direct STD program activities, including
STD screening using mobile vans, rapid syphilis response efforts,
and identification of core populations at increased risk of
gonorrhea transmission.
Implications
for Programs, Policy and/or Research:
This symposium is designed to provide STD
prevention program managers and staff with practical information
on novel ways to use existing data and to collect additional
information useful in guiding program activities.
Panel Line-up:
Moderator:
Lori
Newman, MD
CDC, Atlanta,
GA
Panelists:
Michael Samuel, DrPH
California
STD Control Branch, Berkeley, CA
Jeff Stover
Virginia
Department of Health, Richmond, VA
Mark Stenger
Washington
State Department of Health, Olympia, WA
Jonathan
Ellen
Johns Hopkins
University School of Medicine, Baltimore, MD
Learning
Objectives:
By the end of the session, participants will be
able to discuss how matching databases, geocoding and mapping,
enhanced surveillance data, and other analytic techniques can
be
used to guide their local STD program activities.
Contact
Information:
Lori Newman/Phone no. 1 404 639 6183/len4@cdc.gov
B04 Bathhouses and Sex Clubs: How Risky Are Their
Patrons? How Can That Drive Our Programs and Policies?
D
Wohlfeiler1, WJ Woods2, T Farley3, J Montoya4, C
Cadabes5, M Mutchler5, F Spielberg6
1STD
Control Branch, California DHS, Berkeley, CA; 2Center for AIDS
Prevention Studies, UCSF, San Francisco, CA; 3Tulane University,
New Orleans, LA; 4STD Program, Department of Health Services, Los
Angeles, CA; 5AIDS Project Los Angeles, Los Angeles, CA;
6University of Washington, Seattle, WA
Background and
Rationale:
Bathhouses and sex clubs continue to attract many
gay men and other MSM. Few data have been available to inform
program and policy to reduce STD/HIV transmission among men who
attend them.
Objectives:
(1) To present data from three west coast studies
regarding risk in bathhouses and sex clubs. (2) To identify how
programs are using data, and in the absence of program and policy
evaluation, to discuss which programs and policies may reduce
transmission amongst patrons.
Content:
Researchers conducted exit surveys of a probability
sample of men (N=440; 62% response rate) as they left a single
northern California club during a 5-week period in 2001 regarding
their sexual activity, with emphasis on behavior while at the
club. Additionally, participants were asked about whether they’d
seen testing in the club, as well as about their HIV/STD testing
history. In Los Angeles County, a cross-sectional needs assessment
survey was administered to 150 patrons of 8 commercial sex using
a
venue-based sampling strategy. Outcome indicators include
unprotected anal intercourse, communication about safer sex, and
receptivity to HIV/STD services in the commercial sex
environments. Seattle researchers completed HIV rapid testing on
437 patrons in a randomized trial of different testing strategies
(standard blood, oral fluid, and rapid blood). Data revealed
25%
had unprotected anal sex in the previous two months. Rapid testing
in venues was highly acceptable by patrons and staff and resulted
in higher numbers of tests being conducted at lower cost.
Implications
for Programs, Policy, and/or Research:
Participants will discuss what programmatic and
policy options their jurisdictions are making based on available
data; what other data would be needed to inform policies; and
in
the absence of data, what theories and values are being considered
to support different interventions. Participants will discuss
respective roles of researchers, CBOs, venue owners, and public
health departments.
Panel Line-Up:
Moderator:
D Wohlfeiler
STD Control
Branch, California DHS, Berkeley, CA
Panelists:
WJ Woods
Center for
AIDS Prevention Studies, UCSF, San Francisco, CA
T Farley
Tulane
University, New Orleans, LA
J Montoya
STD Program,
Department of Health Services, Los Angeles,
CA C Cadabes
AIDS Project
Los Angeles, Los Angeles, CA
M Mutchler
AIDS Project
Los Angeles, Los Angeles,
CA F
Spielberg
University of
Washington, Seattle, WA
Learning
Objectives:
1. By the end
of this session, participants will understand the levels of risk
behavior in several different types of bathhouses and sex clubs
2. By the end
of this session, participants will learn what additional data,
theories, and concepts may be useful to inform programs and policy
options aimed at reducing transmission among bathhouse/sex club
patrons
Contact
Information:
Dan
Wohlfeiler/dwohlfei@dhs.ca.gov
B05 The Prevention and Management of Sexually
Transmitted Diseases in Persons Living with HIV/AIDS: A Training
Developed by the Eastern Geographic Quadrant of the National
Network of STD/HIV Prevention Training Centers (PTCs)
P
Coury-Doniger1, S Ratelle2, S Payette3, and the
Eastern Geographic Quadrant of the National Network of STD/HIV
Prevention Training Centers
1Infectious
Diseases Unit, University of Rochester, Rochester, New York;
2Division of STD Prevention, State Laboratory Institute, Boston,
Massachusetts; 3STD Program, New York State Department of Health,
Albany, New York
Background and
Rationale:
Prevention services for persons living with
HIV/AIDS (PLWHA) have become a public health priority as the
incidence of HIV has not decreased for several years and the
incidence of STDs is increasing in this population. An integrated
approach to STD/HIV prevention for PLWHA requires a combination
of
clinical services, behavioral interventions, and partner
counseling services. The PTCs in the Eastern Geographic Quadrant
(EGQ) of the United States serve federal Regions I, II, and III
; areas
which are currently experiencing this national trend. The PTCs
are a collaboration of universities and public health departments
which provide training in clinical management of STDs,
science-based prevention interventions to influence behavior
change, and STD/HIV partner services. In response to the emerging
need for prevention for positives, the EGQ PTCs collaborated
to
develop a training curriculum, “The Prevention and Management of
Sexually Transmitted Diseases in Persons Living with HIV/AIDS”.
Purpose:
To present a workshop based on this curriculum
along with evaluation data from a training of trainers (TOT)
provided to the AIDS Education and Training Centers of New
England. Copies of the curriculum will be distributed.
Methods:
Representatives of the EGQ PTCs will provide
training on each of the four sections; clinical prevention
services, management of STDs, behavioral counseling, and partner
counseling. Methods will include didactic presentation, case
studies and a demonstration video, with opportunities for
discussion and skills building.
Measurable
Learning Objectives:
At the end of the workshop, participants will be
able to:
1. Explain
the inter-relationships between STDs and HIV
2. Describe
the STD screeningand treatment recommendations for PLWHA.
3. Assess
the patient’s readiness for sexual, substance use, and health care
seeking behavior change and use a behavioral counseling strategy
that matches the patient’s readiness
4. Describe
strategies for partner counseling
Contact
Information:
Patricia Coury-Doniger/Phone no. 1 585 464 5928
B06A Trends in Incidence of Sexually Transmitted Enteric
Infections in Neighborhoods with Differing Proportions of Men Who
Have Sex with Men, New York City 1998-2002
MA
Marx1,2, J Schillinger3,4, S Blank3,4, M Layton1
1Bureau
of Communicable Disease, New York City Department of Health and
Mental Hygiene; 2Epidemiology Program Office, Centers for Disease
Control and Prevention; 3Bureau of Sexually Transmitted Disease
Prevention and Control, New York City Department of Health and
Mental Hygiene; 4Division of STD Prevention, National Center for
HIV, STD and TB Prevention, Centers for Disease Control and
Prevention
Background:
Men who have sex with men (MSM) are at high risk of
enteric sexually-transmitted infections (STI) from oral-anal
sexual practices. The magnitude and trends of enteric STI in MSM
should be characterized to inform prevention messages.
Objectives:
To describe and compare trends in incidence of
enteric infections by proportion of MSM.
Methods:
Incidence rates (IR) of four reportable enteric
infections (amebiasis, cryptosporidiosis, giardiasis and hepatitis
A) were calculated for adult males (>18 years) in all NYC
neighborhoods using surveillance reports and population estimates
from the U.S. census. Sexual risk factors are not collected with
reports of enteric infections, so neighborhood-level MSM
proportions were estimated using self-reported sexual behavior
collected for a citywide telephone survey. The ratios of IR of
enteric infections in neighborhoods with >15% MSM were calculated
relative to the IR in neighborhoods with <15% MSM and the
associations of proportion MSM and enteric infection were
quantified using Poisson regression.
Results:
The IR was significantly higher in neighborhoods
with >15% MSM compared with neighborhoods with <15% MSM for each
year (2002 Rate Ratios [RRs]) for amebiasis (RR: 4.5, 95% CI =
3.6-5.6) cryptosporidiosis (RR: 4.9, 95% CI = 3.3-7.4), giardiasis
(RR: 4.3, 95% CI = 3.7-5.0); and hepatitis A, (RR: 1.9, 95% CI =
1.4-2.5). Controlling for year of infection, counts for each
infection increased >15% with each percent increase in proportion
of MSM (Relative IRs: amebiasis: 1.18, cryptosporidiosis: 1.14,
giardiasis: 1.14, hepatitis A: 1.13; all p<0.001).
Conclusions:
Incidence rates of enteric infection were higher in
neighborhoods with higher proportions of MSM. Overall, the
relative incidence rates of enteric infections in high MSM
neighborhoods have decreased slightly in recent years, however,
enteric infections continue to affect MSM disproportionately.
Implications
for Programs, Policy, and/or Research:
Messages about prevention of enteric infections
should be integrated into STD prevention messages for MSM to
address this excess risk.
Learning
Objectives:
By the end of this session, the participants will
be able to describe the trends in four enteric infections in
communities with variable proportions of MSM in NYC.
Contact
information:
Melissa A. Marx /Phone no. 1 212 442 9072/mmarx@health.nyc.gov
B06B The Impact of the 1992 Los Angeles Civil Unrest on
Gonorrhea
DA
Cohen1, R Bluthenthal1, P Robinson2, TA Farley3, RA
Scribner4, PK Kerndt5, M Scott6, A Miu1, B Ghosh-Dastidar1
1RAND,
Santa Monica, CA; 2Charles Drew University, Los Angeles, CA;
3Tulane School of Public Health and Tropical Medicine, Tulane
University, New Orleans, LA; 4Louisiana State University Health
Sciences Center, New Orleans, LA; 5Los Angeles County STD Program,
Los Angeles, CA; 6University of California - Los Angeles, Los
Angeles, CA
Background:
In the 1992 civil unrest in Los Angeles over $1
billion in property damage occurred and 270 alcohol outlets
surrendered their licenses due to arson and vandalism. Prior
studies suggest that gonorrhea is associated both with alcohol
outlets and deteriorated neighborhoods. However, these studies
have all been cross-sectional so causality cannot be established.
The 1992 civil unrest provides a natural experiment in which
to
test whether these associations hold up over time.
Objectives:
To investigate whether a decline in alcohol outlets
was associated with a decrease in gonorrhea rates, and whether
an increase in neighborhood deterioration was associated with
an
increase in gonorrhea rates.
Methods:
We geocoded all reported gonorrhea cases from
1988-2000 in Los Angeles County and the addresses of all alcohol
outlets licensed annually from the California Alcohol Beverage
Control Agency between 1991 and 2000. We also identified alcohol
licenses that were surrendered in May, 1992. We geocoded all
damaged properties reported to the State Insurance Commission as
a result of the riots.We ran preliminary models using ordinary
least-squared regressions to predict post-riot gonorrhea rates
after controlling for pre-riot gonorrhea rates, number of off-sale
outlets, sociodemographic factors, race and ethnicity.We will
also
examine models such as the Poisson and negative binomial that are
a better fit for these data, as well as apply spatial models
to
incorporate the geographic clustering in the data.
Results:
Preliminary analysis with ordinary least-squares
regression models indicate that increases in property damage
were
associated with an increase in gonorrhea rates (p<.01), roughly
accounting for about 2.4 cases/100,000 persons per census tract.
Conclusions:
Neighborhood physical conditions appear to have a
significant, though small effect on gonorrhea rates.
Implications
for Programs, Policy, and/or Research:
Land use, urban planning and zoning issues have an
impact on health outcomes that is not readily apparent. Public
health professionals should conduct additional investigations
as
to how living conditions impact health and health behaviors.
Learning
Objectives:
By the end of this session, participants may be
able to describe why “broken windows” and alcohol outlets can
facilitate transmission of gonorrhea.
Contact
Information:
Deborah Cohen/dcohen@rand.org
B06C Implications of Measures of Hispanic Ethnicity for
STD Prevention and Transmission
M
Adam1, V Reyna1, K Poirier1, C LeCroy2, K Metz1, J Roberts1,
S Fankem1, J
Velazquez1
1University
of Arizona, Tucson AZ; 2School of Social Work, Arizona State
University, Tucson, AZ
Background:
Hispanics are the fastest growing minority group in
the US (57.9% since 1990) and are young (35.7% under age 18).
Hispanic adolescents are at greater risk for STDs/HIV than
non-Hispanic whites. However, Hispanic ethnicity is complex,
encompassing different racial, language, and immigrant (or
non-immigrant) groups.
Objectives:
We report Phase I data from a five-year study of
adolescent risky sexual decision, focusing on the impact of
Hispanic ethnicity.
Methods:
In Phase I, 255 adolescents age 14-19 responded
to a survey questionnaire which included: (1) self-reported
ethnicity; (2) subjects’ birth country, parents’ and grandparents’ birth
countries; (3) language-use scales (in general, with family or
friends, and media); (4) religious affiliation; (5) level of
risk for pregnancy and STDs/HIV (48% were sexually active).
Results:
45.5% were Mexican-American/Chicano (MA), and
75% of MA teens were born in the US, compared to 50% of mothers
and
25% of fathers. 35% of foreignborn MA teens reported being
sexually active versus 49% of teens born in the US. 46% of MA
teens whose mothers were born outside the US were sexually active
versus 54% of those whose mothers were US born. 47.1% of MA teens
who “almost always spoke English” reported being sexually active
versus 0% who “almost never spoke English.” 39% of MA Catholics
reported being sexually active compared with 53% of Anglo
Catholics. Sexual risk behavior varied according to selfreported
ethnicity and within Mexican-American ethnicity based on location
of birth, location of parents’ birth, English language use, and
religious affiliation.
Conclusions:
Hispanic ethnicity is multifaceted; some
differences are greater among Hispanics than between Hispanics
and other groups. Therefore, differentiated measures of Hispanic
ethnicity are essential.
Implications
for Programs, Policy, and/or Research:
Accurate measures of Hispanic ethnicity are
necessary in order to appropriately target STD/HIV interventions
and prevention messages.
Learning
Objectives:
By the end of this session, participants will be
able to identify the importance of differentiated measures of
Hispanic ethnicity and evaluate the implications for STD/HIV
prevention messages.
Contact
Information:
Mary B Adam/Phone no. 1 520 626
1123/adammb@pol.net
B06D Qualitative Assessment of the Cognitive Difference
Among Abused and Nonabused Minority Women with STD: Implications
for Behavioral Interventions
JD
Champion, A Longoria, D Reid, RN Shain, JM Piper, S Perdue
The
University of Texas Health Science Center, San Antonio, TX
Background:
Research has identified the need for modification
of standardized STD behavioral interventions for minority women
with a history of sexual or physical abuse.
Objective:
The objective was to obtain qualitative data to
provide more in-depth understanding of the configuration of
psychosocial and situational factors associated with high-risk
sexual behavior, substance use, health seeking behavior,
contraceptive use and treatment compliance among minority women
with STD and sexual or physical abuse history.
Methods:
Participants included Mexican-and African- American
women, aged 15-45 years enrolled in a randomized study of
behavioral intervention to reduce STD recurrence. Individual,
open-ended, semi-structured interviews lasting approximately 30-45
minutes were conducted with 513 participants. These interviews
focused on participants’ perceptions of their sexual risk, sexual
relationships, individual histories of sexual, physical or
psychological abuse and factors influencing their sexual
behaviors. Additionally, participants were asked about
health-seeking behavior, contraceptive use and STD treatment
compliance.
Results:
Key categories and themes from qualitative data
provided the context for interpretation of the data. The interview
data was searched for elaboration of associations found in prior
statistical analysis. The words of participants were used to
corroborate, refute, substantiate and supplement previous
quantitative results, comparing responses by history of abuse.
Examining results of survey data in context of participants’ own
words provided alternative explanations and conclusions. Various
themes included “Why women have sex?”, “Ex-sex,” “My Baby’s Dad,”
“Why a woman stays with a man after he has given her a STD?”, “I
didn’t tell my man about the STD,” “I don’t think I can get
pregnant,” and “What do men (women) want from a woman (man).”
Conclusions:
Context for modification of risk-reduction
interventions specifically designed for abused minority women to
realize a reduction in sexual risk behaviors, abuse and STD
re-infection rates is identified.
Implications
for Programs, Policy and/or Research:
Incorporation of results to modify existing STD
prevention programs.
Learning
Objective:
To provide more in-depth understanding of the
configuration of psychosocial and situational factors associated
with high-risk sexual behavior, substance use, health seeking
behavior, contraceptive use and treatment compliance among
minority women with STD and sexual or physical abuse history.
B06E County-level Characteristics Associated with Rates
of
Neiserria gonorrhoeae
in the United States, 2000 to 2002
M
Greenberg1, E Koumans1, E Swint1, R Kerani2
1Centers
for Disease Control and Prevention, Atlanta, GA; 2University
of
Washington, Seattle, WA
Background:
Since 1998, the gonorrhea rate (GCR) in the United
States has decreased slightly, yet the GCR among African-Americans
remains 27 times that among non- Hispanic whites.
Objectives:
To describe population characteristic associated
with gonorrhea case rates derived from the National Electronic
Telecommunications Surveillance System from 2000 to 2002.
Methods:
We calculated Pearson correlation coefficients
between the GCR and county-level characteristics from the US
Census, grouped into categories of poverty, housing, crime,
education and geographic indicators, before and after adjusting
for the percentage of the population that was black. We
log-transformed data which were not normally distributed and
report associations with r > 0.4 and p < 0.0001.
Results:
From 2000 through 2002, among the 3141 US counties,
the average GCR was 127.2 cases per 100,000 population (range 0
to 921.3). The overall US rate (per 100,000) was 21.7 for whites,
587.8 for blacks, 51.9 for Hispanics, and 45.3 for Asian/others.
Unadjusted, county characteristics associated with the GCR were
the percent of the population that was black (r=0.796), being
in a
Southern state (r=0.507), persons per square mile (r=0.479), the
percent of those under age 18 below poverty (r=.401). After
adjusting for race, the GCR was weakly associated with percent
of households renter occupied (r=0.231) and the percent of those
under age 18 below poverty (r=0.204). However, the GCR was no
longer associated with geographic location or population density.
Conclusions:
Accounting for racial distribution demonstrates
that county characteristics relating to housing and poverty may
be associated with a higher GCR. These associations are obscured
when
only crude rates are evaluated.
Implications
for Programs, Policy, and/or Research:
Better characterization of community
characteristics associated with a higher GCR may allow local
jurisdictions to more effectively target screening and inform
national policy for changes in screening recommendations.
Learning
Objectives:
By the end of this presentation, the participants
will be able to summarize racial and geographic disparities in
the distribution of gonorrhea cases in the United States and
discuss
county-level characteristics associated with increased rates of
gonorrhea.
Contact
Information:
Michael E Greenberg/Phone no. 1 404 639 8191/aup9@cdc.gov
B06F Large Gonorrhea Outbreak in a Rural California
County, 2003
MC
Samuel1, S Coulter1, J Chase1, Terrence Lo1, ED
Sawtelle2, A Kienzle2, S Bloker2, MA Lundberg2, G Bolan1
1California
Department of Health Services, STD Control Branch, Berkeley, CA;
2Butte County Department of Public Health, Oroville, CA
Background:
In July of 2003, the California STD Control Branch
was notified of an increase in reported cases of gonorrhea in
Butte County. Reported cases increased in the Oroville area from
an average of 9 per year from 1998 to 2002 (with only 2 in 2002),
to 83 cases in 2003 (as of October 6). Gonorrhea increases of
this
magnitude are unusual and rapid investigation and identification
of key facilitating factors are important for control.
Objectives:
To determine factors associated with a gonorrhea
outbreak and to analyze the sexual network structure among
case-patients.
Methods:
Gonorrhea case-patients and named sexual contacts
reported to the Butte County Health Department in 2003 were
interviewed. A standardized questionnaire was used to collected
demographic, drug use, venue attendance and sexual risk behavior
data. Sexual contacts were offered gonorrhea testing and
treatment.
Results:
Among the 83 cases, 50 (60%) were female and 33
(40%) were male. The median age was 24 (range 5-43) among females
and 30 (range 17-58) among males. The median age among males
decreased substantially from March-May to June-October from 36
to 27 (p=0.003). Among females 62% were white, 4% African- American,
and 10% Latino; among males 46% were white, 27% African-American,
and 9% Latino (p=0.03 for race/ethnic difference by gender).
Preliminary analysis of interviewed case-patients indicated that
46% of casepatients reported drug use (46% alcohol, 35% marijuana,
14% methamphetamine); 54% were unemployed; and 35% had sexual
partners of a different race than their own. Of the 60% of
case-patients that reported having medical insurance, 82% were
covered by publiclyfunded insurance programs. At least two key
persons in this outbreak have been identified, and further network
analysis is underway.
Conclusions:
Many cases in this large outbreak were unemployed,
older than typical gonorrhea cases, and covered by publicly-funded
insurance. Case-patients were noted to reside in communities
known
for drug use, prostitution, neglected homes and abandoned cars.
Neighborhood-targeted screening and treatment of individuals
in
identified sexual networks was used for outbreak control efforts.
Implications
for Programs, Policy and/or Research:
STD outbreak control and prevention strategies
should use knowledge of existing sexual networks to develop
outreach efforts.
Learning
Objectives:
By the end of the session, participants will be
able to name three risk factors associated with gonorrhea
transmission and the usefulness of network analyses in an outbreak
setting.
Contact
Information:
Michael C Samuel/Phone no. 1 510 540
2311/msamuel@dhs.ca.gov
B07 A Social Skills Counseling Intervention to Enhance
Condom Use by Female Family Planning Clients
L
Winter1, JM Garrity2, AS Goldy3
1Thomas
Jefferson University, Philadelphia, PA; 2Garrity Health Consulting & Training,
Baltimore, MD; 3Family Health Council of Central Pennsylvania,
Camp Hill, PA
Background and
Rationale:
STI/HIV infection rates have increased rapidly
among US women, with heterosexual contact posing the greatest
risk. Interventions aimed at condom use have a particular
relevance for STI/ HIV prevention in women. Most condom-related
counseling focuses on technical instruction. Yet research has
shown that the major barriers to condom use are interpersonal
(eg,
difficulty with discussing condoms with partners). The present
study evaluated a Social Skill Counseling (SSC) protocol,
targeting the social skills needed to negotiate condom use with
a sexual partner. The protocol was tested in a randomized
control-group design in four clinics with 1,407 White and
African-American women aged 12 to 48 years (mean age= 20). It
proved superior to usual care in improving intentions to use
condoms, condom acceptance, and use at 12-month follow-up,
especially among teenaged clients.
Purpose:
This workshop will present the Social Skill
Counseling protocol.
Methods:
(a) The counselor elicits the client’s experience
with condoms to surface obstacles to condom use. If a client
reports no current or anticipated obstacles, the counselor
describes typical obstacles to condom use: partner refusal,
challenge of talking to partner about condoms, interruption of
intimacy, trust issues raised between partners, decrease or change
in sensation, impact on sexual functioning, lack of confidence in
condom reliability, lack of availability. (b) The counselor next
helps the client to develop her own plan to overcome obstacles by
asking open-ended questions (“What could you say or do to get your
partner to use a condom?”). When a client is unable to create her
own plan, the counselor offers suggestions in a third-person
approach and then assesses the client’s sense of the feasibility
of that approach. The counselor expresses support for any plan
or
expression of positive intention regarding condom. All clients
received a handout listing the common obstacles and suggested
strategies.
Learning
Objectives:
By the end of this session, participants will be
acquainted with:
1. The major
barriers to condom use reported by female family planning clinic
clients
2. Key
components of a social skills training approach to condom
counseling
Contact
Information:
Laraine Winter/Phone no. 1 215 503
B08 Intervening With Substance-using Men Newly Released
From Jail: Challenges and Strategies
C
Sperling1, J Tomlin1, A Rakestraw1, T Hall1, J
Greenberg2, K Elifson2, SP Williams3
1STAND,
Inc, Atlanta, GA; 2Georgia State University, Atlanta, GA; 3Centers
for Disease Control and Prevention, Atlanta, GA
Background and
Rationale:
The literature on the STD risk associated with
being incarcerated is extensive. Much of this literature focuses
on HIV risk or STD screening among men or women in prison or
post-release from prison. Far less literature focuses on the STD
risk associated with jail incarceration particularly that of
men
newly released from jail. In addition, few evidencebased
interventions for post-incarceration males are led by a
community-based organization. To impact the sexual risk behavior
of men newly released from jail, it is important to examine and
address other issues that may contribute to risk behavior, or
its
reduction. The MISTERS study is an on-going randomized control
trial of a comprehensive intervention that targets men who are
newly released from jail and have a history of drug use
Objectives:
To describe the challenges in working with this
population and the strategies utilized to address these issues.
Content:
Investigators will describe the development,
implementation and progress of this study including: 1)
collaboration between health, legal, and community agencies, 2)
issues related to recruitment and retention, and 3) issues related
to conducting a group intervention with men who are newly released
from jail and who have multiple life challenges. Panelists will
also discuss issues that community-based service organizations
need to consider when collaborating on a research project.
Suggestions for future research will also be discussed.
Implications
for Programs, Policy, and/or Research:
STD Programs may use the information presented to
guide their collaboration with community-based organizations and
jail programs in providing interventions.
Panel Line-Up:
Moderator:
Charles
Sperling,
MS STAND Inc,
Atlanta, GA
Panelists:
Charles Sperling, MS
Antonya
Pierce, MPH
James Tomlin
Tricia Hall,
MPH
STAND Inc,
Atlanta, GA
Learning
Objectives:
1. By the end
of the session, participants will be able to identify challenges
in intervening with this population
2. By the end
of the session, participants will be able to identify strategies
to maximize the efficacy of interventions with men who have a
drug-use and jailincarceration history
Contact
Information:
Charles Sperling/Phone no. 1 404 299 3494/i_stand@bellsouth.net
B09A HIV Partner Notification in the U.S.: A National
Survey of Program Coverage and Outcomes
MR
Golden1, M Hogben2, JJ Potterat, HH Handsfield1
1Center
for AIDS & STD, University of Washington and Public Health –
Seattle & King County STD Program, Seattle, WA; 2Division of STD
Prevention, Center for Disease Control & Prevention, Atlanta,
GA
Background:
National data on the effectiveness of HIV partner
notification (PN) have not been reported and uncertainty exists
about the outcomes of public health PN programs.
Objectives:
To define the coverage and outcomes of HIV PN
programs in the United States.
Methods:
Health departments in metropolitan areas >500,000
that reported more than 200 cases of AIDS in 2001 were sent
written surveys; incomplete or unclear responses were resolved
by telephone.
Results:
Of 39 eligible health departments, 11 (28%)
reported that they had no data on the number of persons receiving
PN services or PN outcomes and 28 (72%) provided data for the
study. A total of 6565 (32%) of 20,353 HIV cases among all
jurisdictions were interviewed for PN; the median percentage
interviewed was 55 (range 2%- 100%). Investigations were initiated
on 6394 partners, of whom 1232 (19%) were previously known to
be
HIV positive; 612 (9.6%) were newly diagnosed with HIV; 2037
(31.9%) tested HIV negative; and 2513 (39.3%) were not notified,
denied previous HIV diagnosis and refused HIV testing, or had
no
disposition recorded. Overall, the number of persons with HIV that
health departments needed to interview (NNTI) to identify one
new
case of HIV was 13.8; the median NNTI was 13.4 (range 1-196).
Areas with higher proportions of AIDS cases among MSM had higher
NNTI (r=46, p=.01).
Conclusions:
HIV PN programs in the U.S. have highly variable
levels of coverage and success. Process outcomes suggest PN is
successful in some jurisdictions, particularly those reporting
fewer AIDS cases among MSM.
Implications
for Programs, Policy and Research:
HIV PN programs should be expanded. Better ongoing
efforts are needed to assess, target, and evaluate HIV PN
programs.
Learning
Objectives:
Participants will learn the current scope of the
U.S. HIV PN system, the success of the system in identifying new
cases of HIV and factors that appear to affect HIV PN success.
Contact
Information:
Matthew Golden/Phine no. 1 206 731 6829/
B09B HIV Status Disclosure Among Men Who Have Sex with
Men (MSM): Use, Mis-Use, and Implications for Prevention
R
Hutcheson1, H Thiede1, M Golden1,2
1Public
Health - Seattle and King County, Seattle, WA; 2University of
Washington, Seattle, WA
Background:
HIV status disclosure is receiving increasing
emphasis in Seattle area public health prevention efforts through
encouraging negative men to ask partners about their HIV status
and positive men to disclose prior to sex.
Objectives:
To explore the use and mis-use of HIV status
disclosure as a prevention tool among MSM, facilitators and
barriers to discussing status, and behavior change after status
disclosure.
Methods:
Recently diagnosed HIV+ MSM and MSM who tested HIV-
were recruited from Seattle-area public HIV testing sites between
6/02 and 8/03 as part of the ongoing Seattle Area MSM Study.
The
prevalence of HIV status disclosure was obtained from Audio
Computer Administered Self-Interviews (ACASI). Content analysis
of qualitative interviews obtained main reasons for and against
asking about status and behavior change after status disclosure.
Results:
Eighty-eight participants were included in this
analysis, including 28 newly-diagnosed HIV+ and 60 HIVMSM. Median
age was 33 and median number of recent sex partners was 5.
Sixty-one percent discussed HIV status with their most recent anal
sex partner; only 33% knew this partner’s status before sex.
According to qualitative interviews, the status information
was
often distorted and/or ignored by the participant, leading to
unprotected sex. Primary barriers to status discussion included
sexual desire, lack of communication with anonymous partners,
and
doubting the veracity of disclosure. Primary facilitators included
having the partner initiate discussion, developing a relationship
with the partner, and having internal motivation and skills to
ask.
Conclusions:
In this analysis a minority of participants learned
of their partners’ HIV statuses before sex. Among many, HIV status
disclosure alone was not sufficient to affect sexual risk
behaviors.
Implications
for Programs:
These preliminary results suggest that
interventions using status disclosure should emphasize the
potential for inaccurate negative disclosures and the importance
of condom use regardless of the status disclosed.
Learning
Objectives:
By the end of this session participants will be
able to identify how HIV status can be used and mis-used as an
HIV prevention tool by HIV- MSM and identify ways to increase
the
effectiveness of status disclosure promotion in prevention
efforts.
Contact
Information:
Rebecca Hutcheson/Phone no. 1 206 205 7357/
rebecca.hutcheson@metrokc.gov
B09C “Don’t Ask, Don’t Tell”:
Patterns of HIV Disclosure Among HIV Positive Men Who Have Sex
with Men (MSM) Practicing
High
Risk Behavior In Los Angeles and Seattle
PM
Gorbach1, B Amani1, A Shin1, C Fernandez- Ortega1,
C Celum2, H Handsfield2, M Golden2
1University
of California, Los Angeles, CA; 2University of Washington,
Seattle, WA
Background:
Continuing high incidence of STIs including HIV
along the West Coast suggests HIV positive MSM may not disclose
their HIV status prior to having unprotected sex with partners
of
unknown status.
Objectives:
To identify themes around disclosure among MSM in
LA and Seattle.
Methods:
55 MSM HIV positive MSM (24 in Seattle, 31 in LA)
reporting recent STI or unprotected anal intercourse with
serostatus discordant or unknown partners were recruited from STD
clinics in Seattle and LA and underwent indepth interviews that
were taperecorded, transcribed verbatim, coded and content
analyzed for themes using Ethnograph.
Results:
Ages ranged from 24-52 years (mean 39). Mean years
since HIV diagnosis was 9 years and 6 years with one-third and
one-half diagnosed in the past 5 years in LA and Seattle
respectively. Most interviewed in LA (67%) and some (29%) in
Seattle were minority. Themes around disclosure include MSM being
more likely to disclose when having sex in a home, context of
dating, when feelings for a partner, had a previous positive
disclosure experience, or feel responsible for transmission.
Nondisclosure themes included not being asked about HIV status,
not having insertive anal intercourse, having bathhouse sex,
anonymous partners, fearing of rejection, overcome by passion,
and using methamphetamines. Many minority MSM in LA reported
disclosing because of fear of legal prosecution. MSM reported
disclosing indirectly by introducing condoms, asking for low risk
sex, showing medications, not listing status online, and
displaying HIV materials. Some MSM felt partners should ask for
HIV status; many assumed if not asked partner must be positive.
Conclusions:
Our findings suggest many HIV positive MSM either
do not disclose or disclose HIV status indirectly and engage in
high risk sex with partners with unknown serostatus, fueling
incidence of STIs/HIV in Seattle and LA. Indirect ways to
disclosure may offer promise.
Implications
for Programs, Policy, and/or Research:
Programs to encourage HIV positive MSM’s skills
around disclosure are needed.
Learning
Objectives:
By the end of the session, participants will learn
of themes around disclosure and not disclosure of HIV status among
HIV positive MSM practicing risky sex.
B09D Self-efficacy of Disclosure in Adolescents
L
Lowery, B Glass, P Parham, J Ellen
Johns
Hopkins University School of Medicine, Baltimore, MD
Background:
Disclosure to a sex partner is an integral part of
sexually transmitted infection (STI) counseling and is important
in decreasing transmission. Self-efficacy has been demonstrated
to
be a significant predictor of partner notification. STI-related
stigma has been shown to influence adolescent females reactions
to
disclosure of sexual behaviors to health care providers.
Objective:
To assess the association among disclosure
selfefficacy, perceived barriers to disclosure and STI-related
stigma.
Methods:
Cross-sectional data of 130 sexually experienced
adolescent females participating in a larger on-going longitudinal
study was analyzed to examine the associations of STI disclosure
self-efficacy, perceived stigma of having a STI, and perceived
barriers to sex partner notification.
Results:
The participants ages ranged from 14-22 with a
mean age of 19 years (SD=1.73). Self-efficacy and barriers were
stratified by main and casual partners. Simple linear regression
demonstrated greater perceived barriers of disclosure were
associated with decreased disclosure self-efficacy across main
and casual sex partners (b=1.28 main, b=0.73 casual; p<0.05). Simple
linear regression demonstrated that greater stigma was associated
with less disclosure self-efficacy for main sex partners (b=-0.38,
p<0.05). Additionally, after controlling for age and stigma,
greater perceived barriers were associated with a lower level of
disclosure self-efficacy for both main and casual sex partners
(b=1.07 main, b=0.72 casual; p<0.05).
Conclusions:
In this study perceived barriers of disclosure were
associated with disclosure self-efficacy for both main and casual
sex partners. Not surprisingly, STIrelated stigma and its
association with disclosure selfefficacy was statistically
significant for main sex partners but not for casuals.
Implications
for Programs, Policy, and/or Research:
Understanding barriers to partner notification and
the relationship between self-efficacy and barriers to disclosure
may result in improved counseling. Continued research is needed
to
assess how interventions in improving self-efficacy, and lessening
barriers and stigma can decrease STI rates.
Learning
Objectives:
By the end of this session participants will be
able to describe the association of disclosure self-efficacy,
perceived barriers to disclosure of a STI, and STI-related stigma.
Contact
Information:
Lisa M Lowery/Phone no. 1 410 955 2910/llowery1@jhmi.edu
B09E Utilizing the Internet for Partner Notification
P
Constant
Minnesota Department of Health, Minneapolis, MN
Background:
The use of the Internet for meeting sexual partners
has been strongly implicated in influencing rates of sexually
transmitted infections. As a result, many public health programs
are struggling with how to utilize the Internet as a tool for
partner notification. Issues of confidentiality and security
complicate the use of the Internet but should not supersede its
importance as a tool to enhance HIV/STD Partner Services.
Objectives:
To share practical information on using the
Internet as a tool to enhance HIV/STD partner services.
Methods:
Similar to other states, Minnesota has experienced
an increase in syphilis cases among men who have sex with men
whose only means of locating their partners was online. To address
this issue, a procedure and Internet log were established in
collaboration with IT and Human Resources to meet our need to
locate individuals via the Internet, yet safeguard client
confidentiality.
Results:
Among a cluster of 176 individuals who were either
infected or at risk for HIV, syphilis, gonorrhea, and/or chlamydia
infection, 108 (61%) were confirmed to utilize the Internet to
meet sexual partners. Of the 108 Internet users, 50 were only
locatable via e-mail or screen name. Of those, 30 (60%) were
contacted via email and responded to online partner notification
efforts, 13 (26%) did not respond, and 7 (14%) were sent to other
states for follow-up.
Conclusions:
While public health agencies are suffering from
decreasing resources, the Internet is not only a necessary but
cost effective way of reaching partners.
Implications
for Programs, Policy, and/or Research:
Programs will receive information and tools with
which to be able to develop or complete a protocol for partner
notification via the Internet.
Learning
Objectives:
By the end of the session, participants will be
able to identify and utilize tools to overcome barriers to utilize
the Internet for partner notification.
Contact
Information:
Patti Constant/Phone no. 1 612 676 5593
B09F Initiating Partner Notification Over the Internet
A
Delicata, B Gratzer
Howard Brown Health Center, Chicago, IL
Background:
As more men who have sex with men (MSM) seek sex
partners online, it is increasingly important for Disease
Intervention Specialists (DIS) to utilize the internet to identify
and contact partners who have been exposed to a disease.
Objectives:
To present a manual for partner notification (PN)
on the Internet.
Methods:
As part of a syphilis elimination grant, Howard
Brown Health Center has its own staffed DIS position. This DIS
initiated an online PN protocol to reach sex partners of original
syphilis patients (OP). There are two primary focuses. First,
on
initiating PN through email, and, second, through chat rooms, such
as gay.com and AOL. While an encounter with someone met online
does not implicitly include a long-term commitment, nor the
exchange of real names, many OPs do have enough identifying
information to provide a DIS. Such information can include screen
names, e-mail addresses, a physical description, age, etc…. In
this project, screen names and e-mail addresses are used to PN.
This type of disease intervention follows standard DIS regulatory
guidelines for protecting confidentiality, anonymity of the
original patient, and safety of all involved. When a DIS enters a
chat room the philosophy and policy requires DIS to be
non-harassing, non-solicitous, and sensitive to the person’s
potential state-of-mind at all times.
Results:
Since the inception of this protocol, all partners
of the subset of eligible patients providing online contact
information have been successfully referred into care, though this
is a small sample and the data is preliminary. Some screen names
given have enabled the linkage of cases between DIS.
Conclusion:
PN online provides an effective tool for the
benefit of public health.
Implications
for programs:
Any agency looking to develop better internet
partner notification policies can use this as a guide.
Learning
Objectives:
By the end of this presentation, participants will
be able to describe and understand how one program has implemented
an Internet partner notification policy.
Contact
Information:
Andrew Delicata/ Phone no. 1 773 572 6976/andrewd@howardbrown.org
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