D01A Legal Status
of Patient Delivered Partner Therapy (PDPT) in the U.S.: A
National Survey of State Pharmacy Boards and Boards of Medical
Examiners
Uzoeshi Anukam1,2, H Hunter
Handsfield1, Donald Williams3, Matthew
R Golden1
1Center for AIDS & STD,
University of Washington and Public Health Seattle & King
County STD Program, Seattle, WA; 2Howard University,
Washington, D.C.; 3Washington State Pharmacy Board,
Olympia, WA
Background: Many clinicians and some health
departments provide patients with gonorrhea, chlamydial infection,
or trichomonas with medications to give to their sex partners,
a practice called patient delivered partner therapy (PDPT).
Observational studies and a randomized trial suggest PDT can
decrease the recurrence rate of gonorrhea and possibly chlamydial
infection.
Objectives: To define the legal status of
PDPT in the U.S.
Methods: Survey of State Pharmacy Board
(SPB) Directors and Directors of State Boards of Medical Examiners
(BME).
Results: A total of 39 (76%) of 51 SPB Directors
and 21 (41%) of 51 Directors of BME completed the survey. Six
pharmacy boards and 1 medical board either refused to complete
the survey or indicated they had no authority to assess the
legality of PDPT. Data were available from 44 (86%) states
and the D.C. Among these 44 areas, 7 (16%) indicated that PDPT
was legal, 24 (54%) indicated that PDT was not legal, and 13
(30%) indicated that they did not know whether PDT was legal
or not.
Respondents indicated that the issue of PDPT had never been
addressed in 20 (83%) areas where PDPT was considered illegal,
12 (92%) areas where the legal status of PDPT was unknown,
and 3 (43%) areas where PDPT was thought to be legal. Among
34 respondents from states indicating that PDT was not legal
or that the legal status of PDPT was uncertain, 22 (65%) indicated
that a new law would be needed to make PDPT legal. Updated
data will be presented.
Conclusions: The legal status of PDT is
ill-defined in much of the U.S., but is widely considered to
be unlawful.
Implications for Programs, Policy, and/or Research: New
laws may be needed if PDPT is to be widely instituted.
Learning Objectives: By the end of the session,
participants will learn that the legal status of PDPT is poorly
defined, but that the practice is considered illegal in much
of the United States.
D01B Concurrent STD Morbidity
in Sexual Contacts to Persons with Bacterial STDs: Implications
for Patient-Delivered Partner Therapy
J Stekler1, L Bachmann2,
E Erbelding3, P Kissinger4, HH Handsfield1,
M Golden1
1University of Washington,
Seattle, WA; 2University of Alabama, Birmingham,
AL; 3Johns Hopkins University, Baltimore, MD; 4Tulane
University, New Orleans, LA
Background: Patient-delivered partner therapy
(PDPT) is one approach to partner notification employed by
some providers and health departments. In PDPT, patients deliver
medications to their sex partners in addition to referral to
seek medical care. One potential negative consequence of PDPT
is the missed opportunity to diagnose PID and other STDs
in partners who forgo examination.
Objectives: To describe STD morbidity in
patients attending public health STD clinics who present as
sexual contacts to persons with bacterial STDs.
Methods: Of 55026 patients attending clinics
in Baltimore (Jan-Dec 2000) and Seattle (Jan 2001-Dec 2002),
3506 patients presented as contacts to patients with chlamydia,
gonorrhea, non-gonococcal urethritis, and/or trichomonas. 2195
and 1311 patients were seen in Baltimore and Seattle, respectively.
Results: Among 1384 women, 41 (3.0%) were
diagnosed with PID, 3 (0.2%) had early syphilis, and 3 (0.2%)
had late latent syphilis or syphilis of unknown duration. One
(0.1%) of 733 women tested positive for HIV. Among 1848 heterosexual
men, 3 (0.2%) and 6 (0.3%) had early and late syphilis, respectively;
9 (0.9%) of 968 tested positive for HIV. Among 274 MSM, 2 (0.7%)
had late syphilis, and 5 (4.2%) of 118 were newly diagnosed
with HIV. Results will be presented from two additional clinics
to evaluate how morbidity may vary with local epidemiology.
Conclusions: Major STD morbidity was uncommon
among heterosexuals evaluated as contacts to bacterial STDs
and trichomonas in Baltimore and Seattle. A higher proportion
of MSM was diagnosed with either HIV or syphilis.
Implications for Programs, Policy, and/or Research: Use
of PDPT would not be associated with important missed STD comorbidities
among heterosexuals in Baltimore and Seattle. The opportunity
to diagnose HIV among MSM who seek care as contacts to STDs
is more significant. Depending on local epidemiologic patterns,
PDPT may not be suitable for MSM and/or other populations.
Learning Objectives: By the end of the session,
participants will recognize the potential negative consequences
of PDPT due to missed STD comorbidities and will appreciate
the regional variability of STD comorbidity.
Contact Information: Joanne Stekler/Phone
no. 1 206 731 8312
D01C A Randomized Trial of
Three Different Strategies to Treat Partners of Women with Trichomonas
vaginalis
P Kissinger1, N Schmidt1,
B Meadors2, J Leichliter3, C Sanders1,
H Mohammed1, TA Farley1
1Tulane University School of
Public Health and Tropical Medicine; 2Louisiana
State University Health Sciences Center; 3Centers
for Disease Control and Prevention
Background: Better methods of treating partners
of women with trichomonas are needed.
Objectives: This randomized trial was to
determine if booklet enhanced partner referral (BR) or patient
delivered partner medicine (PDPM) was better than the standard
partner referral (PR) for reducing recurrent trichomonas vaginalis
(TV) infection among women.
Methods: Women attending a Family Planning
clinic in New Orleans from 12/01 to 09/03 who tested positive
for TV via culture and were treated were randomized to either
PR, BR or PDPM. They were administered computer assisted self-administered
survey at baseline and one month and retested at one month.
Results: Women in the trial (N=346) reported
information on 389 partners. Most women had one partner (77.6%),
mean age was 25.8 (s.d. 6.9), and 99% were African American.
Arms were similar by age, education, race and number of partners
at baseline and newly acquired partners in follow-up and follow-up
rates. During follow-up, 85.3% returned, 82.6% saw their baseline
sex partners, 87.7% talked to these partners, 51.1% resumed
sex and 5.4% acquired a new sex partner. Of those who had sex
during follow-up, 76.6 % used a condom consistenly. These factors
were similar by arm. Women reported that their partner told
them they took the medicine most often in the PDPM and least
often in BR compared to PR (90.3%/58.1%/72.5%, P < 0.01).
Of 346 women enrolled in the study, 8.2% were TV positive at
one-month repeat testing. There were no statistical differences
in recurrence among study arms (PDPM 7.6%/BR 10.2/PR 6.9%,
P< 0.70). Isolates of TV from four women were tested for
metronidazole-resistance and were found to be sensitive at
higher doses.
Conclusion: In women, while PDPM results
in more partners taking the medicine than the standard or booklet
enhanced methods, recurrence rates were similar. Lack of difference
in recurrence rates could be attributed to lack of exposure
to reinfection.
Implications: PDPM may be effective, but
future studies should follow women longer.
Learning Objectives: By the end of this
session, participants will be able to describe the benefits
of PDPM for women with TV and to discuss methodological issues
studying PDPM.
Contact Information:Patty Kissinger/Phone
no. 1 504587 7320
D01D Acceptance of Patient-delivered
Partner-therapy for Syphilis Among Men Who Have Sex with Men
(MSM), San Francisco, CA
W Tun1, C Walsh1, J
Siller2, B Apt1, W Wolf2,
J Klausner2
1Centers for Disease Control
and Prevention, Atlanta, GA; 2San Francisco Department
of Public Health, San Francisco, CA
Background: San Francisco has experienced
increases in early syphilis in MSM, from 32 cases in 1999 to
436 cases in 2002. In July 2002, San Francisco City Clinic
(SFCC) implemented patient-delivered partner-therapy (PDT).
Syphilis-case patients were offered preventive therapy (1-gram
azithromycin) to distribute to recent sex partners and friends
at high-risk for syphilis. The rate of patient acceptance of
PDT, however, has been low (10%).
Objective: To identify barriers and facilitators
of PDT distribution to and acceptance by patients and sex partners
among MSM at high-risk for syphilis.
Methods: We conducted three focus-group
interviews with syphilis-case patients, sexual contacts, and
friends of patients and contacts, and in-depth interviews with
community leaders, private medical providers who see gay male
patients, and Disease Control Investigators at SFCC. Interviews
focused on barriers and facilitators of PDT provision among
MSM. Interviews were audio-recorded and transcribed; transcripts
were analyzed to discern themes.
Results: Barriers to distributing PDT by
MSM to recent sex partners included patients inability
to contact anonymous sex partners, patients perceived
liability if a recipient should have adverse drug reactions,
and patients belief that medications should only be dispensed
by healthcare providers. Facilitators of PDT distribution to
recent partners included patients sense of social responsibility,
caring for and trusting partners, and prior knowledge of PDT.
Barriers to sex partners accepting PDT from case-patients included
distrust of sex partner giving PDT, suspicion of the medication,
and lack of awareness of the intervention. While convenient,
no-cost treatment was cited as a facilitator of using PDT,
many MSM desired a clinician evaluation before taking medications.
Conclusions: This information on barriers/facilitators
to PDT provision will guide modifications of the PDT program.
A community awareness campaign and new PDT packages are under
development.
Implications for Programs, Policy, and/or Research: Innovative
partner services must be tailored to address multi-dimensional
concerns of all involved.
Learning Objectives: By the end of this
session, participants will understand the potential barriers
and facilitators to patient-delivered partner-therapy for incubating
syphilis among MSM.
Contact Information: Waimar Tun/Phone no.
1 404 639 8297
D01E Patient-delivered Partner
Therapy for Chlamydia Infections: Attitudes and Practices of
California Physicians and Nurse Practitioners
L Packel, S Guerry, H Bauer, M Rhew, G Bolan
California Department of Health Services, STD
Control Branch, Berkeley, CA
Background: Effective partner management
is important for reducing Chlamydia trachomatis (CT)
transmission and repeat infection. Since 2001, California State
law allows clinical providers to dispense or prescribe antibiotic
therapy for sexual partners of patients infected with CT without
examination. The use of patient-delivered partner therapy (PDPT)
needs to be evaluated.
Objective: To examine attitudes and practices
around PDPT for chlamydia among clinicians in California.
Methods: In 2002, a stratified random sample
of primary care physicians and nurse practitioners (NPs) completed
a mailed, self-administered survey about STD care practices
including attitudes towards and use of PDPT.
Results: Eligible respondents included 708
physicians (49% response rate) and 865 NPs (63% response rate).
Approximately half of physicians and NPs stated that they usually
or always provide medication for partners. Ob/gyn physicians
and providers seeing 20 or more young females per week were
more likely to report using PDPT. Nearly 90% of respondents
agreed that PDPT protects patients from reinfection and that
PDPT helps provide better care for patients with chlamydia.
Barriers to using PDPT included concerns about inadequate knowledge
of partner medical history and lack of direct partner care,
potential litigation, and lack of reimbursement. Barriers were
generally more common among private practice providers, male
providers, and general practice and internal medicine physicians.
Conclusions: Despite legislation to support
PDPT as acceptable medical practice, PDPT is currently not
a common practice among California primary care providers.
Potential important barriers to use of PDPT were identified.
Implications for Programs, Policy and/or Research: Provider
education interventions, as well as development of detailed
guidelines and reimbursement mechanisms, are needed to address
common barriers to PDPT. Further research is needed to determine
how physicians assess patients for PDPT, and the circumstances
under which clinicians give PDPT.
Learning Objectives: By the end of this
session participants will be able to describe frequency of
PDPT use in primary care in California; identify barriers to
provider use of PDPT; identify potential areas for intervention
to decrease barriers to PDPT.
Contact information: Laura Packel/Phone
no. 1 510 883 6660/lpackel@dhs.ca.gov
D01F Partner-Delivered Partner
Therapy for STD: Evidence and Prospects for Implementation
JS St. Lawrence1, M Hogben1,
M Golden2, P Kissinger3
1Centers for Disease Control
and Prevention, Atlanta, GA; 2University of Washington
and Public Health-Seattle and King County, Seattle, WA; 3Tulane
University
Background and Rationale: Notification of
partners of index cases tested and treated for STD has been
a fundamental element of STD infection control policy for over
50 years. Public health agencies use of professionals
to track, notify, and bring to treatment the sex partners of
index cases is, however, constrained. Constraints include the
prevalence of many STD and the nature of many sexual partnerships
severely test the ability of most public health agencies to
conduct partner notification.
Objectives: This symposium is aimed at exploring
partner-delivered partner therapy (PDPT) as an alternative
or as a complement to prototype partner notification services,
specifically, services offered for curable STD. To do so, we
will outline the status of public partner notification today
and then cover several PDPT trials from the past decade.
Content: Investigators describe the extent
to which public health partner notification services are currently
offered in jurisdictions that were among the 50 jurisdictions
with highest morbidity for any of gonorrhea, chlamydial infection,
syphilis, or HIV. We also describeprivate partner notification
practices. We then present results from the following randomized,
control trials of PDPT (a) prescription-driven PDPT for chlamydial
infection and gonorrhea in Seattle, (b) medication dispensation
for male partners of women with trichomoniasis in New Orleans,
and (c) medication dispensation for sex partners of men with
urethritis in New Orleans. The control conditions are standard
of care in each location. We will also devote attention to
program experiences and costs, as well as other experimental
alternatives to standard of care tested within the trials.
Implications for Programs, Policy, and Research: These
data may guide especially those programs facing a high burden
of disease compared to resources. Policy-makers may consider
the impact of permitting or authorizing PDPT in their jurisdictions.
We finally suggest synthesizing study results and refining
estimates of PDPT effectiveness.
Panel Line-up:
Moderator
Janet S. St. Lawrence, PhD CDC, Atlanta
Panelists
Matthew Hogben, PhD CDC, Atlanta
Matthew Golden, MD, MPH
University of Washington and Public Health-Seattle & King County Service
of King County, Seattle
Patricia Kissinger, DrPH
Tulane University, New Orleans
Measurable Learning Objectives: Attendees
will learn about the costs and benefits of PDPT as assessed
across multiple public heath programs, allowing them to gauge
more accurately whether and for whom to practice PDPT in their
own programs. Attendees interested in advancing the research
on PDPT will learn about the details of the most recent national
trials, which should inform their own efforts.
D02 Practical Examples Evaluating
Community Partnerships for Syphilis Prevention
B Apt1, A Williams2,
M King3, T Roberts4, D Napp5,
T Gunter6
1Centers for Disease Control
and Prevention, Atlanta, GA; 2Independent Consultant,
Indianapolis IN; 3Indiana Center for Evaluation,
Indiana University, Bloomington, IN; 4Independent
Consultant, Indianapolis, IN; 5Practical Applications
of Public Heath, Durham NC; 6Metro Health Department,
Nashville, TN
Background: Optimal program performance
is important, particularly in resource-constrained environments.
Evaluation is essential to determine whether STD activities
are effective in achieving desired goals. And, evaluation can
be used to document progress toward goals, and suggest needed
modifications.
Objectives: To present the experiences of
three local STD project areas when they evaluated components
of their partnerships with community organizations.
Content: Representatives from three STD
project areas will present evaluation plans, barriers, and
results. Each areas methods and analyses differed slightly,
based on the focus of their evaluation. Challenges included
competing interests of local and national stakeholders, lack
of stakeholder agreement on the evaluation focus, and lack
of sustained stakeholder engagement in the evaluation process.
Area representatives will present uses of qualitative and quantitative
data, discuss evaluation findings, and give examples of how
findings were used to modify programs.
Implications for Programs, Policy, and/or Research: Demand
for evaluation continues to grow; these three STD project areas
offer pragmatic approaches and solutions to common evaluation
concerns.
Panel Line-up:
Moderator:
Betty Apt
CDC, Atlanta
Panelists:
Mindy King, PhD
Indiana Center for Evaluation, Indiana University, Bloomington IN
David Napp, MPH
Practical Applications of Public Heath, Durham NC
Tonya Gunter, MS
Metro Health Department, Nashville TN
Measurable Learning Objectives: By the end
of this session, participants will be able to (1) describe
three methods used to evaluate community partnerships and (2)
identify two common challenges in conducting evaluations at
the local level.
Contact Information: Betty Apt/1 404 639
8035
D02 Evaluating the Impact of
Integrating Viral Hepatitis Services in HIV and STD Settings
D Lentine1, L Schowalter2,
J Beltrami3, A Goldstein4, K Schlanger5,
J Subiadur6, T Badsgard7
1CDC, Division of HIV/AIDS
Prevention, Atlanta, GA; 2National Alliance of
State and Territorial AIDS Directors, Washington, DC; 3RTI
International, Atlanta, GA; 4Multnomah County
Health Department, Portland, OR; 5New York City
Department of Health and Mental Hygiene, New York, NY; 6Denver
Public Health, Denver, CO; 7CDC, Division of Viral
Hepatitis, Atlanta, GA
Background and Rationale: Hepatitis A, B
and C impact many of the same populations as HIV and other
STDs. Due to the similarities in disease transmission and populations
affected, CDCs Division of Viral Hepatitis (DVH) funded
HIV, STD and other public health programs to integrate viral
hepatitis services (ie, hepatitis A and B vaccine, HCV counseling
and testing) into their existing activities. These programs
have found that integrating hepatitis services into HIV and
STD settings is both feasible and acceptable. Anecdotally,
HIV and STD programs report that many high-risk clients are
drawn to STD clinics and other settings by the availability
of hepatitis services, suggesting that hepatitis services may
serve as a link to HIV and STD services. A CDC-funded viral
hepatitis integration evaluation project specifically examined
the impact of integrating hepatitis services on HIV and STDs.
Objectives: To describe the CDC-funded viral
hepatitis integration evaluation; to share strategies used
to measure the impact of integration on existing services;
and to share the experiences of several CDC-funded viral hepatitis
integration projects on evaluating their integration projects.
Content: The viral hepatitis integration
evaluation project methods will be presented, and preliminary
results from the evaluation will be shared. Experience in Multnomah
County, Oregon, New York City and Denver, Colorado on how to
evaluate the effectiveness of integration and its impact on
HIV and STD services will be presented. Strategies used for
measuring and evaluating the impact of services on existing
programs will be discussed.
Implications for Programs, Policy, and/or Research: The
provision of hepatitis services may serve as an incentive for
high-risk clients to access other disease prevention and treatment
services, and HIV and STD programs can benefit by providing
multiple services to clients at-risk. The dissemination of
evaluation results and jurisdictional best practices can inform
the development of policy to support the integration of services
in settings that reach persons at risk for multiple infections.
Learning Objectives:
- By the end of the session participants will be able to
discuss different approaches to measuring the impact of integrating
viral hepatitis services into existing HIV and STD settings
- By the end of the session, participants will be able to
identify the advantages, best practices and lessons learned
of integrating hepatitis services into HIV and STD settings
Panel Line-up:
Moderator:
Kevin OConnor, MA
CDC, Division of Viral Hepatitis, Atlanta, GA
Panelists:
Danni Lentine, MPH
CDC, Division of HIV/AIDS Prevention, Atlanta, GA
Karen Schlanger, MPH
New York City Department of Health, New York, NY
Alison Goldstein, LCSW
Multnomah County Health Department, Portland, OR
Julie Subiadur, RN
Denver Public Health, Denver, CO
Contact Information: Danni Lentine/Phone
no. 1 404 639 0462/dhl2@cdc.gov
D03 Advancing HIV Prevention:
New Strategies for a Changing Epidemic
LM Lee, SD Griffiths, B Branson, J Prejean,
R Romaguera
Centers for Disease Control and Prevention,
Atlanta GA
Background and Rationale: CDCs HIV
prevention activities over the past two decades have focused
on helping uninfected persons at high risk for HIV change and
maintain behaviors to keep them uninfected. Despite these efforts,
the number of new HIV infections is estimated to have remained
stable and may be increasing in some populations. Survival
with HIV has improved and the number of persons living with
HIV continues to increase. CDC has launched Advancing HIV Prevention
(AHP), a new initiative aimed at reducing barriers to early
diagnosis of HIV infection and increasing access to quality
medical care, treatment, and ongoing prevention services.
Objectives: 1] To describe the four strategies
of AHP and the activities associated with each. 2] To facilitate
collaboration between CDC, other federal agencies, and HIV
prevention providers to ensure that prevention efforts for
HIV-positive persons are sustained.
Content: The 4 strategies of AHP include
making HIV testing a routine part of medical care, implementing
new models for diagnosing HIV infection outside of the medical
setting, working with PLWH and their partners to prevent new
infections, and further reducing perinatal HIV transmission.
AHP emphasizes the use of proven public health approaches to
reduce the incidence and spread of infectious disease. The
initiative capitalizes on new rapid testing technologies, interventions
to help persons to become aware of their HIV status, and behavioral
interventions to improve prevention skills to persons living
with HIV (PLWH) and their partners. Greater access to testing,
prevention, and care services for PLWH can reduce new infections
and also reduce HIV-associated morbidity and mortality.
Implications for Programs, Policy, and/or Research: Innovations
in access to testing and emphasis on prevention and care services
for PLWH constitute new components that prevention programs
will need to incorporate in order to maximize opportunities
to reduce the incidence of new HIV infections.
Panel Line-up
Moderator:
Lisa M. Lee, PhD
Office of the Director, Division of HIV/AIDS Prevention, CDC
Panelists:
Sean David Griffiths, MPH
Office of the Director, Division of HIV/AIDS Prevention, CDC
Bernard M. Branson, MD
Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention,
CDC
Joseph Prejean, PhD
Capacity Building Branch, Division of HIV/AIDS Prevention, CDC
Raul Romaguera, DMD, MPH
Office of the Director, Division of HIV/AIDS Prevention, CDC
Measurable Learning Objectives: By the end
of the session participants will be able to
- Describe the 4 strategies of CDCs new Advancing HIV
Prevention initiative
- Describe how CDC is working with other federal agencies
and the HIV prevention community to ensure that prevention
efforts outlined in this initiative are sustained
Contact Information: Lisa M. Lee/Phone no.
1 404 639 5052
D04A Gonorrhea Positivity Among
Men Who Have Sex With Men Attending STD Clinics in the United
States, 2002
CA McLean1, K Hutchins1,
DJ Mosure1, and the MSM Prevalence Monitoring Project
1Division of Sexually Transmitted
Disease Prevention, Centers for Disease Control and Prevention,
Atlanta, GA
Background: National gonorrhea data among
men who have sex with men (MSM) in the US are limited.
Objectives: To describe gonorrhea positivity
among MSM visiting STD clinics in 2002.
Methods: Eight US cities participating in
the MSM Prevalence Monitoring Project (Chicago, IL; Denver,
CO; District of Columbia; Houston, TX; Long Beach, CA; Philadelphia,
PA; San Francisco, CA; Seattle, WA) submitted gonorrhea test
data from MSM attending STD clinics. Data were collected during
routine care and reflect testing practices at participating
clinics. Median STD clinic-specific gonorrhea positivity and
ranges were calculated.
Results: Overall, data from 16,336 STD clinic
visits by MSM were submitted; 73% (clinic range 19-95%) of
MSM were tested for urethral gonorrhea, 33% (clinic range 1-61%)
were tested for rectal gonorrhea, and 59% (clinic range 2-83%)
were tested for pharyngeal gonorrhea. Median gonorrhea positivity
among MSM was 17.1% (clinic range 11.4-23.0%). Median urethral
gonorrhea positivity among MSM was 13.5% (clinic range 8.3-36.1%),
rectal gonorrhea positivity was 5.7% (clinic range 4.6-10.0%),
and pharyngeal gonorrhea positivity was 4.2% (clinic range
0.6-10.4%). Median urethral gonorrhea positivity was 21.0%
among HIV positive MSM and 12.5% among MSM who were HIV-negative
or had an unknown HIV status; median rectal gonorrhea positivity
was 10.3% among HIV positive MSM and 5.5% among MSM who were
HIV-negative or had an unknown HIV status. Median pharyngeal
gonorrhea positivity was 7.7% among HIV positive MSM and 3.9%
among MSM who were HIV-negative or had an unknown HIV status.
Conclusions: Gonorrhea positivity is high
among MSM attending STD clinics. Gonorrhea positivity is higher
among HIV positive MSM than among MSM who are HIV-negative
or had an unknown HIV status. Gonorrhea testing should be offered
to MSM visiting STD clinics, especially those with HIV, who
may still be engaging in unsafe sexual practices.
Implications for Programs: STD clinics should
evaluate gonorrhea screening coverage among MSM.
Learning Objectives:
- To describe the role of the MSM Prevalence Monitoring Project
in national STD surveillance
- To describe gonorrhea testing coverage and gonorrhea positivity
among MSM and the impact of this project on STD prevention
and control
Contact Information: Catherine McLean/Phone
no. 1 404 639 8467
D04B Crystal Use, Viagra Use,
and Specific Sexual Risk Behaviors of Men who have Sex with
Men (MSM) during a Recent Anal Sex Encounter
G Mansergh1, RL Shouse2,
G Marks1, M Rader1, S Buchbinder3,
GN Colfax3
1Centers for Disease Control
and Prevention, Atlanta, GA; 2Georgia Department
of Human Resources, Atlanta, GA; 3San Francisco
Department of Public Health, San Francisco, CA
Background: A subpopulation of MSM use crystal
(methamphetamine) and/or Viagra to enhance sex. Crystal can
intensify physical and emotional sensitivity during sex, however
it can also inhibit erectile functioning. Viagra works to facilitate
and maintain erections.
Objectives: To assess associations between
crystal and Viagra use and specific sexual risk behaviors (i.e.,
unprotected insertive and receptive anal sex [UIA, URA] with
HIV concordant and discordant partners).
Methods: Cross-sectional sample of MSM surveyed
in San Francisco during Fall 2001; the sample was diverse in
race/ethnicity, age, HIV status, income, education and non/gay
identification. Men in this analysis (n=388) reported on drug
use and risk behavior during their most recent anal sex encounter
in the prior 2 years.
Results: 53% of the 388 men reported unprotected
anal (UA) sex during the encounter, including URA (37%) and
UIA (29%); 24% reported UA with an HIV discordant or unknown-status
partner (DUA), including receptive (DURA, 17%) and insertive
(DUIA, 12%). 16% used crystal during that encounter (the most
common such drug besides alcohol and marijuana), and 6% used
Viagra. In multivariate models that included demographic variables,
crystal was associated with URA (OR=2.03, 95% CI=1.09-3.76)
and Viagra was associated with UIA (OR=6.51, 95% CI=2.46-17.24);
similar results were found for DURA and DUIA.
Conclusions: A notable proportion of MSM
in our diverse sample reported using crystal and/or Viagra
during their most recent anal sex encounter; this is particularly
note-worthy given that we assessed behavior in only one encounter
for each participant. In controlled analyses, we found that
crystal was linked to risk behavior for the receptive role
and that Viagra was linked to risk behavior for the insertive
role.
Implications for Programs, Policy and/or Research: MSM
who use crystal or Viagra during anal sex should be targeted
for STD/HIV risk reduction regarding URA and UIA respectively.
Future research should assess multiple recent anal sex encounters
for a more comprehensive examination of risk.
Learning Objectives: By the end of the session,
attendees will be able to state the prevalence of crystal use,
Viagra use, and STD/HIV risk behaviors (UA, URA, UIA, DURA,
DUIA) during a recent anal sex encounter among a diverse sample
of MSM. Attendees will understand the unique links between
crystal and URA and between Viagra and UIA.
Contact Information: Gordon Mansergh/gcm2@cdc.gov
D04C Methamphetamine Use, Sexual
Behavior, and Sexually Transmitted Diseases Among Men Who Have
Sex with Men Seen in an STD Clinic, San Francisco 20022003
SJ Mitchell1,2, W Wong1,
CK Kent1, JK Chaw1, JD Klausner1
1San Francisco Department of
Public Health, San Francisco, CA; 2EIS Program,
Centers for Disease Control and Prevention, Atlanta, GA
Background: San Francisco and many metropolitan
areas have experienced recent increases in sexually transmitted
diseases (STDs) among men who have sex with men (MSM). Community
surveys in San Francisco indicate that methamphetamine use
is also widespread.
Objectives: To determine the association
between methamphetamine use, sexual behavior, and STDs among
MSM at the San Francisco municipal STD clinic (City Clinic).
Methods: We performed univariate and bivariate
analyses and calculated prevalence risk ratios (RR) on data
from a cross-sectional behavioral survey of 1,318 MSM attending
City Clinic during November 2002March 2003.
Results: Of 1,263 surveyed patients who
provided drug-use responses, 219 (17.4%) reported methamphetamine
use during the prior 4 weeks. Methamphetamine users were more
likely to be younger (median age 33 versus 36 years; p<0.05),
less educated (some college or less versus college graduate,
RR=1.3, 1.0-1.7), and to have incomes < $30,000/yr (RR=1.4,
1.1-1.8). Users were more likely to be depressed (RR=2.3, 1.7-3.0)
and to use other drugs of abuse (RR=2.9, 2.6-3.3) or Viagra
(RR=3.5, 2.9-4.4). Users were more likely to be HIV positive
(RR=2.2, 1.7-2.7) and to report more sexual partners (median
number during the prior 4 weeks: users 5.0 versus nonusers
2.0; p<0.05). Users were more likely to be diagnosed with
an STD, including chlamydia (RR=1.9, 1.3-2.7), gonorrhea (RR=1.7,
1.2-2.3), or syphilis (RR=2.5, 1.8-3.4); multiple STDs simultaneously
(one STD, RR=1.6, 1.2-3.0; two STDs, RR=4.0, 2.5-6.3; three
STDs, RR=12.4, 1.2-136.1); or a rectal STD (RR=2.0, 1.4-2.9).
Conclusions: Methamphetamine use was strongly
associated with an increased number of STDs and increased number
of partners among MSM at San Francisco City Clinic.
Implications for Programs, Policy, and/or Research: STD
prevention programs should ask MSM about methamphetamine use
and offer cessation information and referrals to substance
abuse treatment. Methamphetamine treatment programs should
consider assessing STD risks in their MSM clients and referral
if indicated.
Measurable Learning Objectives: This analysis
will aid the audience in understanding factors for riskier
sexual behavior and STD exposure associated with methamphetamine
use among MSM. This information will be useful to health-care
workers in STD clinics for screening patients for methamphetamine
use and the associated STD risks. We will discuss current clinic,
community-based, and substance abuse center-based activities
regarding prevention of STDs and methamphetamine use.
Contact Information: Samuel J. Mitchell/Phone
no. 1 415 5548469/sam.mitchell@sfdph.org
D04D Characteristics of MSM
Syphilis Cases Using the Internet to Seek Male Sex Partners,
California, 2001-2003
T Lo1, M Samuel1,
C Kent2, J Klausner2, P Kerndt3,
S Coulter1, G Mehlhaff1, D Wohlfeiler1,
G Bolan1
1California Department of Health
Services, STD Control Branch, Berkeley, California; 2San
Francisco Department of Public Health, STD Prevention and
Control Services, San Francisco, CA; 3Los Angeles
County Public Health Department, Sexually Transmitted Diseases
Program, Los Angeles, CA
Background: The Internet is a virtual venue
for meeting sex partners and plays an important role in the
current California syphilis epidemic among men who have sex
with men (MSM).
Objective: To characterize the California
trends of MSM syphilis cases reporting the Internet and use
of this data in HIV/STD prevention efforts.
Methods: Infectious syphilis cases are interviewed
by disease intervention specialists (DIS) for patient/partner
management and surveillance purposes. DIS investigate sex partners
of cases for counseling, testing, and treatment. Since 1999,
interview data are transcribed onto standardized case report
forms to capture patient demographic and risk behavior information.
These data include: venues where cases report meeting sex partners,
drug use, and HIV serostatus.
Results: From 2001 through the first half
of 2003, 84.4% of 2276 primary and secondary (P&S) cases
were MSM. Among MSM, 522 P&S cases were diagnosed in the
first half of 2003, a 246% increase from the first half of
2001 (p<0.0001). Among interviewed MSM, 37% reported meeting
partners through the Internet in the first half of 2003, an
increase from 12% in the first half of 2001 (p<0.0001).
MSM patients reporting the Internet had higher numbers of period
sex partners than those who did not for primary (9.7 vs 6.5,
p<0.0001) and secondary (18.7 vs 10.6, p<0.0001) stages.
A greater number of non-locatable sex partners were from patients
reporting the Internet than those who did not for primary (8.2
vs 5.5, p=0.0001) and secondary (16.4 vs 9.6, p<0.0001)
stages.
Conclusions: The Internet is an emerging
venue associated with a substantial and increasing proportion
of MSM syphilis patients in California. With high numbers of
non-locatable sex partners from MSM cases reporting the Internet,
traditional contact investigation alone is not an effective
syphilis control measure.
Implications for Programs, Policy, and/or Research: The
Internet plays a key role in social/sexual networks, therefore
current syphilis control strategies should incorporate the
Internet for targeted HIV/STD prevention activities. Data on
use of the Internet needs to be further explored and refined
for HIV/STD prevention and outreach.
Learning Objectives: By the end of this
session, participants should be able to identify the Internet
as a key emerging venue among California MSM syphilis cases.
Participants should also realize that traditional sex partner
management alone is not an effect syphilis control strategy.
Contact Information: Terrence Lo/Phone no.
1 510 883 6653/tlo@dhs.ca.gov
D04E Factors Associated With
Potential Exposure to and Transmission of HIV in a Probability
Sample of Men Who Have Sex with Men
DD Brewer1,2, MR Golden1,2,
HH Handsfield1,2
1Public Health-Seattle & King
County, Seattle, WA; 2University of Washington,
Seattle, WA
Background: Recent research suggests that
unprotected anal intercourse (UAI) by partner serostatus is
a stronger and more useful predictor of HIV acquisition risk
in men who have sex with men (MSM) than UAI not stratified
by partner serostatus.
Objectives: To estimate the proportion of
MSM at high risk for HIV acquisition or transmission and examine
factors associated with potential exposure to and transmission
of HIV.
Methods: In 2003, 311 MSM participated in
a random digit dial telephone survey of MSM in three Seattle
zip codes with high prevalences of MSM.
Results: Ten percent (25/241, 95%CI:7%-15%)
of HIV-negative MSM were potentially exposed to HIV, based
on reported UAI with a man who was HIV-positive or of unknown
HIV status in the last 12 months. Thirty-one percent (14/45,
95%CI:20%-46%) of HIV-positive MSM were potential HIV transmitters,
based on reported UAI with a man of negative or unknown status
in the last 12 months. The strongest correlates of potential
exposure were having sex at a bathhouse (OR=9.1, 95%CI:3.7-22.3),
use of methamphetamine (OR=8.0, 95%CI:2.0-32.3), amyl nitrite
(OR=6.2, 95% CI:2.6-14.8), or sildenafil (Viagra) (OR=4.4,
95% CI:1.7-11.3), and recent STD diagnosis (OR=4.4, 95% CI:1.2-15.5).
Potential transmitters had more male sex partners (r=.41, 95%CI:.13-.63)
and were more likely to have had recent concurrent anal sex
partners (OR=6.9, 95%CI:1.7-28.9) than other HIV-positive MSM.
Based on STD/HIV testing history and stated preferences for
healthcare sites, few potentially exposed MSM (36%) or potential
transmitters (38%) have attended or would likely attend public
health STD/HIV clinical sites.
Conclusions: MSM potentially exposed to
HIV and potential HIV transmitters are fairly well-defined
subsets of MSM. Most do not attend public health STD/HIV facilities.
Implications for Programs, Policy, and/or Research: Preventive
interventions should be focused on MSM with characteristics
associated with potential exposure to, or transmission of,
HIV, especially in clinical settings outside the public health
system.
Learning Objectives: By the end of the session,
participants will be able to identify the characteristics of
MSM who are potentially exposed to or potential transmitters
of HIV.
Contact Information: Devon D Brewer/Phone
no. 1 206 731 2257/ddbrewer@u.washington.edu
D04F No Need to Wrap It: HIV
Gift-giver Newsgroups, Gift Theory and Exchanging HIV as a
Gift
ME Graydon
Carleton University, Ottawa, Ontario
Background: In the 1990s after 10 years
during which safer sex became a gay community norm, a growing
number of North American gay men disclosed engaging in unprotected
anal sex, so-called barebacking. While barebackers
seek intimacy and freedom, and fulfilling a masculine ideal,
others have unprotected sex to facilitate exchanging HIV. So-called Gift-givers wish
to give HIV, while Bug-chasers wish to receive
it. At Internet newsgroups Gift-givers and Bug-chasers post
offers to give/receive HIV and conversion stories.
Objective: Interrogate conceptualizing of
HIV as a gift, referencing sociological and anthropological
theories of gift exchange to chart its impact on self-identity
and social roles.
Methods: Data from 281 messages from 17
newsgroups was qualitatively analyzed creating a Gift typology.
Results: Using disease meta-narratives and
HIV/AIDS public narratives, Gift-givers create an ontological
narrative wherein HIV is acquired not avoided. Categorized
according to the meanings ascribed to the Gift, messages revealed
that even though a desirable, erotic object of exchange, HIV
was still considered a dangerous, disease-causing pathogen.
Conclusions: As with the exchange of any
gift, exchanging HIV established and maintained social roles
and relationships. In offers to give/receive HIV, Gift-givers
and Bug-chasers describe HIV infection as inevitable thus they
sought to control when and from whom they got it. They manifest
hostility to HIV prevention and treatment, highlighting the
failure of safer sex programs to provide a set of sustainable
and meaningful sexual practices.
Implications for Programs: With effective
HIV vaccines decades distant and the potential for transgressive
sexual behaviours such as Gift-giving and Bug-chasing to increase
transmission, a thorough understanding of such behaviours is
essential.
Learning Objectives: Participants will be
provided with a particular way of interrogating Gift-giver
and Bug-chaser newsgroup messages, one that engages with their
narrative discourses to consider potential meanings behind
planned exchanges of HIV.
Contact Information: Michael Graydon/Phone
no. 1 613 729 4443/mgraydon@magma.ca
D05 Educating State and National
Policymakers
Deborah Arrindell1, L Speissegger2
1American Social Health Association,
Washington, DC; 2National Conference of State
Legislatures, Denver, Colorado
Background and Rationale: Educating policymakers
to encourage the development of effective STD prevention and
treatment programs is essential. The 1997 IOM report acknowledges: unlike
many other health issues, there are virtually no patient-based
constituent groups for STDs other than HIV infection. Strengthening
the public investment and improving resources available for
STD prevention, treatment, and research will require advocacy
and education efforts by a broad array of public and private
organizations. Issues related to sexually are still poorly
understood on Capitol Hill and in state legislatures. While
the sequelae of STDs infertility, cervical cancer, infant
mortality, and AIDS are major concerns, policy makers
have been unwilling to acknowledge the link between controversial
political topics and STDs.
Purpose: (a)To demystify the policymaking
process. (b) To encourage those involved in STDs to be more
proactive about educating policymakers. (c) To provide tools
for effective efforts to educate policymakers.
Methods: In this participatory workshop,
we will discuss the importance of advocacy and the difficulties
of garnering support for STDs. Effective strategies for presenting
information, and building coalitions to maximize impact will
be discussed. Presenters will discuss these issues from the
perspective of both state legislatures, and congress. Workshop
participants will share strategies and experiences and describe
efforts to work in collaboration with other organizations to
achieve improved investment in STD programs. Materials that
can be used to implement the strategies will be provided.
Measurable Learning Objectives:
At the end of this workshop, participants will be able to:
- Identify the benefits of educating policymakers
- Describe methods of working with policy makers
- Implement strategies to educate policymakers
Contact Information: Deborah McNeal Arrindell/Phone
no. 1 202 789 5950/ debarrindell@aol.com
D06A Provision of Emergency
Contraception in an STD Clinic: Results from a Pilot Project
in New York City
L Evans1,2, JA Schillinger2,3,
L Farhang1, N Mussington1, M Mavinkurve3,
L Kupferman3, R Recant3, S Wright3,
D Kaplan1, S Blank2,3
1New York City Department of
Health and Mental Hygiene, Bureau of Maternal Infant and
Reproductive Health, New York, NY; 2Centers for
Disease Control and Prevention, Atlanta, GA; 3New
York City Department of Health and Mental Hygiene, Bureau
of Sexually Transmitted Disease Control, New York, NY
Background: Emergency contraception pills
(EC) are very effective in preventing pregnancy if taken within
72 hours of unprotected intercourse. The NYC Department of
Health and Mental Hygiene (NYCDOHMH) conducted a pilot project
offering EC at a sexually transmitted diseases (STD) clinic.
Objectives: To describe the results of a
pilot project integrating EC into STD clinic services.
Methods: We extracted data from medical
records for all female first-time visits during 59 clinic days
between March and July 2003. Reason for visit was categorized
as: STD examination, HIV counseling and testing, or seeking
EC only. Women reporting vaginal intercourse within the past
72 hours without contraception, or with contraception failure
were considered eligible to receive EC.
Results: A total of 728 women attended the
clinic for an initial visit during the period of interest.
The majority of women (71%) were Black Non-Hispanic, <30
years of age (77%), and used either a barrier method, or no
method of contraception (76%). The majority (77%) presented
for an STD examination; 55 (7.6%) attended the clinic seeking
EC only. Among 644 women assessed for EC eligibility, 124 (19%)
were eligible, 56% (70/124) were offered, and 74% (52/70) accepted
EC. Only 1 of 18 (6%) women visiting the clinic for EC only,
and for whom physical examination results were available was
treated for an STD. In comparison, 62% of women attending the
clinic for an STD examination were treated for an STD.
Conclusions: Eight percent of women attended
the clinic for EC only. EC was accepted by the majority of
eligible women offered EC. STDs were infrequent among women
visiting the clinic for EC only.
Implications for Programs, Policy, and/or Research: Clinic
utilization should be monitored to assure the number of women
receiving STD services is not reduced by introduction of EC,
and that women seeking EC only are encouraged to get screened
for STDs.
Learning Objectives: By the end of the session,
participants will be able to: 1) describe the proportion of
women attending this NYC STD clinic who were eligible for EC,
and 2) discuss some of the ramifications of integrating EC
into STD clinic services.
Contact Information: Linnea Evans/Phone
no. 1 212 442 1759/levans@health.nyc.gov or
Julie Schillinger/Phone no. 1 212 788 4429/jschilli@health.nyc.gov
D06B Evaluating Efforts to
Increase Testing for Repeat Chlamydia Infection Among Women
in California Family Planning Clinics
R Gindi1, H Bauer2,
J Chow2, M Deal1
1California Family Health Council,
Berkeley, CA; 2California Sexually Transmitted
Disease Control Branch, Berkeley, CA
Background: Repeat chlamydia infection may
increase the risk of adverse reproductive outcomes in women.
CDC 2002 STD treatment guidelines recommend that non-pregnant
women treated for chlamydia be tested for repeat infection
within 3-4 months. Educational outreach to providers may increase
adherence.
Objectives: Evaluate the impact of targeted
guideline distribution on testing for repeat CT infection.
Methods: Between 1999-2003, family planning
clinics collected chlamydia test data as part of a statewide
chlamydia prevalence monitoring program. CDC guidelines were
released in May 2002 and promoted through targeted mailings
to family planning providers at >250 clinics. Initial positives
after January 2003 and re-tests within 30 days were excluded.
The proportion of cases that were tested for repeat infection
within a strict 3-4 month interval and a broad 1-6
month interval was calculated per 6-month period. Repeat infection
was assessed among women re-tested within 6 months.
Results: Of 47,841 women tested, 3066 were
chlamydia positive (6%). Five hundred and eighty women with
an initial positive test after January 2003 and re-tests within
30 days were excluded from further analysis. The proportion
of cases that were re-tested within the strict interval
per 6-month period remained stable between 4-6% (p=.8), with
a slight increase between the first and second halves of 2002
(4% to 6%, p=.13). The proportion of cases that were re-tested
within the broad interval varied between 14-27%
(p=.001), with an increase between the first and second halves
of 2002 (16% to 24%, p=.01). Repeat infection rates were stable
at 11% across 6-month periods (p=.2).
Conclusions: By a broad interpretation of
the CDC guidelines, the rate of testing for repeat infection
increased commensurate with targeted guideline distribution.
Repeat infection rates remained stable.
Implications for Programs, Policy and/or Research: Repeated
targeted dissemination of re-screening guidelines to family
planning agencies may encourage changes in testing for repeat
infection. Existing data sources may be used to monitor adherence
and evaluate changes in provider practice.
Learning Objectives: By the end of the session,
participants will be knowledgeable about current recommendations
on testing for repeat chlamydia infection. Participants will
also be able to describe the impact of a targeted guideline
distribution on the rates of repeat testing in the family planning
population.
Contact Information: Renee Gindi/Phone no.
1 510 486 0412 ext 19
D06C HIV/STD Prevention for
HIV Positive Women: Integration of Family Planning Services
and HIV Care
B Green1, R Abdul-Khabeer1,
E Aaron2, J Foster3, J Witek2,
M Ranselle1, A Beatty1
1Circle of Care, Philadelphia,
PA; 2Drexel University College of Medicine, Philadelphia,
PA; 3St. Christophers Hospital for Children,
Philadelphia, PA
Background: CDC has recently prioritized Prevention
for Positives as an initiative for reducing new HIV infections.
For HIV positive women, HIV/STD prevention can be effectively
provided in a clinical setting through integration of family
planning services. Seeing the need for family planning services
first acknowledges that HIV positive women are sexually active.
Objective: To identify a model for effectively
integrating family planning and HIV care and prevention services,
and to assess how HIV/STD prevention for HIV positive women
can be achieved through integration of family planning services.
Methods: Implementation analysis, and a
CQI process were used to assess integration models. This paper
will present 3 models, using a written client case study approach,
and a FAQ handout will allow participants to be able to assess
their own organizations ability to implement similar
program components.
Results: Three case studies were written
representing different care models. One case study is from
an ambulatory HIV clinic that serves approximately 400 HIV
positive women; this clinic has implemented multiple strategies
for integrating HIV/STD prevention, including family planning
services. A second case study is from a ambulatory HIV family
clinic located in a pediatric hospital that serves approximately
80 HIV positive youth and women; this clinic has integrated
HIV/STD prevention, family planning services and is implementing
HIV rapid testing using a mobile outreach model. The final
case study is from family planning clinics in which peer counselors
outreach to women who are getting a pregnancy test and may
also be newly identified as HIV positive (approximately 80
a year) in order to facilitate their entry into care.
Implications for Programs, Policy and/or Research: These
3 case studies identify a range of issues that required a multi-disciplinary
perspective to achieve integration of services. A number of
tools and methods for integrating HIV/STD prevention for HIV
positive women in clinical settings were developed, as well
as a FAQ guide for other organization who are interested in
assessing their ability to integrate services.
Measurable Learning Objectives: At the end
of the presentation, participants will be able to:
- Discuss different approaches to integration of HIV/STD
prevention and family planning
- Identify 5 steps that will enhance their clinics
ability to integrate HIV/STD prevention, family planning,
and HIV care
Contact Information: Brian M. Green/Phone
no. 1 215 985 2627
D06D Gonorrhea Screening Strategies
and Guideline Development for Non-Pregnant Female Patients
in the California Family Planning Clinic Setting
H Howard1, JM Chow1,
H Bauer1, M Deal2, R Gindi2,
R Neiman1, G Bolan1
1STD Control Branch, California
Department of Health Services, Berkeley, CA; 2California
Family Health Council, Berkeley, CA.
Background: Gonorrhea (GC) prevalence in
the US has declined; in 2001, GC prevalence in California family
planning sentinel surveillance sites was <1%. High GC testing
volume in these clinics may indicate unnecessary screening.
However, limiting testing to symptomatic patients may not be
effective since many GC infections are asymptomatic or associated
with mild symptoms. GC screening criteria are needed that are
sensitive for capturing cases and specific for reducing over-screening.
Objectives: To assess the predictive value
of different GC screening algorithms among GC-infected, non-pregnant
female patients.
Methods: Medical record review was conducted
for non-pregnant female patients tested for GC in 2001 at five
geographically diverse California sentinel site family planning
clinics. All GC-positive cases and randomly sampled GC-negative
controls were reviewed. Data abstracted included age, race/ethnicity,
clinic site, presenting symptoms, clinical signs, chlamydia
co-infection, contact to STDs, sexual behavior risk factors,
and STD history.
Results: Patients with contact to STDs or
with clinical signs (pelvic inflammatory disease or cervicitis)
comprised 29% of 126 GC cases. Cases with chlamydia co-infection
comprised 23%. Of the remaining 61 GC cases, 39 were age < 20
years, had multiple sexual partners in past 12 months, or had
a partner who may have other partners. This screening
strategy, when compared to universal screening, would have
reduced testing/screening in this sample by 42% and detected
82% of GC cases. Specificity and cost-effectiveness of various
screening algorithms vary considerably by criteria.
Conclusions: Targeted GC testing based on
diagnostic findings and chlamydia test results, in addition
to screening based on young age, multiple partners in past
year, and/or partner concurrency is sensitive and specific
for case finding.
Implications for Programs, Policy, and/or Research: Targeted
and cost-effective screening strategies can be developed to
optimize case-finding without over-screening individuals who
are unlikely to be infected.
Learning Objectives: By the end of the session,
participants will be able to describe a methodology for assessing
the effectiveness of various screening algorithms and will
be able to compare the impact of these strategies on program
resources.
Contact Information: Holly Howard (Chaney)/Phone
no. 1 510 883 6610
D06E STD Testing Protocols,
STD Testing and Discussion of Sexual Behaviors in HIV Clinics
M Taylor1,2, T McClain2,
G Aynalem2, LV Smith2, B Brown2,
PR Kerndt2, TA Peterman1
1Division of STD Prevention,
National Center for HIV, STD, and TB Prevention, Centers
for Disease Control and Prevention, Atlanta, GA; 2Los
Angeles County STD Program, Los Angeles, CA
Background: Sexually transmitted diseases
(STD) such as syphilis among HIV positive men who have sex
with men (MSM) represent a significant proportion of the syphilis
morbidity in Los Angeles. Routine screening for STDs in HIV
positive MSM may prevent incident HIV and other STDs in sexual
partners
Objectives: To evaluate the use of written
protocols for STD screening, the frequency and types of STD
tests performed and the occurrence and frequency of obtaining
sexual risk assessments by HIV clinicians in Los Angeles County.
Methods: A survey was administered to 27
medical directors, clinic directors and HIV providers representing
39 clinics and 24,521 HIV infected patients in Los Angeles.
Results: The use of a written or electronic
protocol for STD testing was reported by 62% of clinics. Screening
of HIV positive patients upon the initial visit for syphilis
was reported by 100% of respondents and by 30% for chlamydia
and gonorrhea. Testing for syphilis after the initial visit
was reported every 3 months by 69%, every 6 months by 8%, every
year by 18%, based on sexual risk by 3% and only with symptoms
by 3% of clinics. Testing for chlamydia and gonorrhea was reported
every 3 months by 26%, every 6 months by 8%, yearly by 49%,
based on sexual risk by 3% and only with symptoms by 6%. Clinics
with written or electronic protocols were no more likely to
report more frequent syphilis, gonorrhea or chlamydia testing.
Clinics with written or electronic STD protocols were significantly
more likely to report questioning patients at each visit regarding
their sexual practices (p = 0.003).
Conclusions: Written protocols for STD testing
may promote sexual risk assessment questioning among HIV providers
and insure STD testing per CDC/IDSA guidelines for HIV positive
persons at sexual risk.
Implications for Programs, Policy and/or Research: Standardized
STD testing protocols that include sexual risk assessments
should be evaluated in HIV care settings.
Learning Objectives: By the end of this
presentation, participants will be able to discuss the value
of standardized STD screening protocols for use in HIV clinics,
the need for discussion of sexual risk behaviors between HIV
providers and their patients, and the currently recommended
guidelines for STD screening among HIV infected persons.
Contact Information: Melanie Taylor/Phone
no. 1 213 744 3093
D06F The Integration of Sexually
Transmitted Disease Testing and HIV Counseling and Testing
In Los Angeles County, 2002
H Rotblatt1, J Montoya1,
G Freehill2, M Perez2, E Alvarado2,
PR Kerndt1
1Los Angeles County Department
of Health Services, Sexually Transmitted Disease Program,
Los Angeles, California; 2Los Angeles County Department
of Health Services, Office of AIDS Programs and Policy, Los
Angeles, California
Background: To address ongoing high rates
of syphilis in men who have sex (MSM) with men, Los Angeles
County (LAC) DHS sought to expand STD testing services by integrating
these services into the existing framework of HIV services
for MSM.
Objectives: To increase STD testing capacity
at community based organization (CBO) HIV counseling and testing
sites (HCT) serving MSM in the Hollywood area.
Methods: The LAC DHS STD Program (STDP)
and the LAC DHS Office of AIDS Programs and Policies (OAPP)
joined with representatives of the LAC HIV Prevention Planning
Committee and the LAC Counseling and Testing Task Force to
form an STD/HIV integration committee. The committee has worked
on the notification of HCT contractors that STD testing was
permitted under their contracts, training of HCT Contractor
staff in venipuncture, STD information and STD counseling and
record-keeping protocols, revision of laboratory requisition
forms and HIV counseling forms to minimize paperwork, and creation
of funding mechanisms and funding schedules to reimburse HCT
Contractor staff time spent performing STD services.
Results: Venipuncture training was conducted
by the STD Program resulting in 85 CBO employees being certified
in venipuncture. These employees were also trained in urine
collection for chlamydia and gonorrhea testing. Seven CBOs
have integrated STD testing into HCT sessions. Modifications
were developed for HIV and STD lab forms, and for the California
DHS HIV-5 form to streamline record keeping, and combine HIV/STD
risk data. A draft reimbursement schedule and funding mechanism
has been developed for STD testing. Process data of integrated
services will be presented.
Conclusions: STD and HIV testing services
can be integrated through concerted collaborative effort. CBOs
with access to at-risk MSM populations may serve as resources
for expanded STD testing capacity.
Implications for Programs, Policy and/or Research: STD
and HIV integration liaisons should be established in all jurisdictions
where these functions are separated.
Learning Objectives: By the end of this
presentation, participants will be able to discuss advantages
of integrating HIV and STD testing for MSM, key obstacles in
achieving such integration, and solutions for overcoming key
obstacles.
D07 Issues Surrounding the Promotion
of Condoms for STD Prevention
J Shlay1,2, L Warner3,
M Steiner4, G Mansergh3
1Denver Public Health; 2University
of Colorado Health Sciences Center, Denver, Colorado; 3Division
of HIV Prevention, Centers for Disease Control and Prevention,
Atlanta, GA; 4Family Health International, Research
Triangle Park, NC
Background and Rationale: When used correctly
and consistently, male condoms are the most effective method
to reduce the risk of STD/HIV transmission during sexual intercourse.
However, recommendations for using condoms have recently been
questioned because of concerns about their effectiveness for
disease prevention. Programs working with clients at risk for
STD/HIV need more information on the overall effectiveness
of condoms and information on how to ensure that clients use
condoms effectively.
Objectives: (1) To review the methodological
challenges for assessing condom effectiveness. (2) To discuss
challenges surrounding promotion of condoms in the context
of the ABCs (abstinence, be faithful, condoms). (3) To discuss
barriers and potential strategies to using condoms for oral,
vaginal, or anal sex. (4) To discuss the efficacy of focused
messages to increase condom use.
Content: Investigators will review the following:
challenges associated with evaluating condom effectiveness
for STD prevention, with emphasis on the importance of properly
measuring consistent and correct condom use and the infection
status of partners; issues surrounding the challenges of successfully
promoting condoms with factual information that is easily understood;
barriers surrounding the lack of condom use during intercourse
by clients at risk for STD; and efficacy of short messages
for men who have sex with men to increase awareness of HIV
infection risk during sex without a condom. A closing presentation
will summarize potential issues that STD/HIV programs should
consider when promoting condoms to clients.
Implications for Programs and Policy: STD
programs will be able to use the information presented to discuss
strategies for promoting condom use with their clients.
Implications for Research: Future research
should focus on implementing strategies to improve consistent
and correct use of condoms, both for the purpose of evaluating
condom effectiveness and also for educating clients on the
risks associated with unprotected sexual intercourse and how
to use condoms effectively.
Panel Line-up
Moderator:
Judith C Shlay, MD, MSPH
Panelists:
Judith C Shlay, MD, MSPH
Denver Public Health, Denver, CO
Lee Warner, PhD, MPH
Centers for Disease Control and Prevention, Atlanta, GA
Markus Steiner, PhD
Family Health International, Research Triangle Park, NC
Gordon Mansergh, PhD, MA, MEd
Centers for Disease Control and Prevention, Atlanta, GA
Learning Objectives: By the end of the session,
participants will be able to discuss the relationship between
condom use and STD prevalence and its connection with other
aspects of sexual activity and how these factors may impact
the effectiveness of condoms. By the end of the session, participants
will have learned about potential methods to communicate to
clients about issues surrounding condom use and risks associated
with unprotected sexual intercourse.
Contact Information: Judy Shlay/Phone no.
1 303 436 7200/jshlay@dhha.org
D08 Partnering With Hospital
Emergency Departments for Syphilis Elimination
C Moseley1, M Mahadevappa2,
M Shulz2, E Hawkins3, L Duncan4,
K Conklin4, K Olsen4, R Beaton5,
J McGoldrick5
1Guilford County Department
of Public Health; 2University of North Carolina
at Greensboro; 3University of North Carolina at
Chapel Hill, School of Medicine; 4High Point Regional
Hospital, NC; 5Moses Cone Health System
Background and Rationale: In a time when
public STD resources are shrinking and other demands like bioterrorism
are taxing our public system, it becomes even more crucial
that nontraditional partners join STD prevention, such as the
hospital emergency department (HED). Like jails, HEDs are frequently
the only source of primary care for many people at highest
risk for syphilis, like cocaine users and sex workers. It is
now generally accepted that a successful syphilis elimination
program must include collaboration with local jails and these
collaborations have helped reduce syphilis; HEDs may be the
next step. Under this premise, a local community has partnered
with its HEDs to identify and treat cases of syphilis that
would not have been uncovered otherwise.
Purpose: a) To demonstrate how local HEDs
can assist in reducing syphilis in high morbidity areas. b)
To provide public health workers with specific tools for engaging
their local HEDs in their syphilis elimination efforts. c)
To present findings from the current project.
Methods: We will use a case study approach
to assist participants in developing a strategy for enlisting
their local HEDs in syphilis elimination. We will use field
experience as a starting point for discussion of the potential
barriers participants foresee in working with their local HEDs.
Participants will identify the assets they already have that
will be useful in starting this partnership. Finally, attendees
will work alone and in small groups to design a plan of action
with specific steps for immediate implementation.
Learning Objectives: Participants will be
able to:
- Understand the vital role that HEDs play in syphilis elimination
- Develop a strategy for engaging their HEDs in syphilis
elimination
- Implement a plan for incorporating HEDs into their strategic
plans for eliminating syphilis
Contact Information: Caroline Moseley/Phone
no. 1 336 641 3136/cmosele@co.guilford.nc.us
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