MTN-001: randomized pharmacokinetic cross-over study comparing tenofovir vaginal gel and oral tablets in vaginal tissue and other compartments

Background

Oral and vaginal preparations of tenofovir as pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) infection have demonstrated variable efficacy in men and women prompting assessment of variation in drug concentration as an explanation. Knowledge of tenofovir concentration and its active form, tenofovir diphosphate, at the putative vaginal and rectal site of action and its relationship to concentrations at multiple other anatomic locations may provide key information for both interpreting PrEP study outcomes and planning future PrEP drug development.

Objective

MTN-001 was designed to directly compare oral to vaginal steady-state tenofovir pharmacokinetics in blood, vaginal tissue, and vaginal and rectal fluid in a paired cross-over design.

Methods and Findings

We enrolled 144 HIV-uninfected women at 4 US and 3 African clinical research sites in an open label, 3-period crossover study of three different daily tenofovir regimens, each for 6 weeks (oral 300 mg tenofovir disoproxil fumarate, vaginal 1% tenofovir gel [40 mg], or both). Serum concentrations after vaginal dosing were 56-fold lower than after oral dosing (p<0.001). Vaginal tissue tenofovir diphosphate was quantifiable in ≥90% of women with vaginal dosing and only 19% of women with oral dosing. Vaginal tissue tenofovir diphosphate was ≥130-fold higher with vaginal compared to oral dosing (p<0.001). Rectal fluid tenofovir concentrations in vaginal dosing periods were higher than concentrations measured in the oral only dosing period (p<0.03).

Conclusions

Compared to oral dosing, vaginal dosing achieved much lower serum concentrations and much higher vaginal tissue concentrations. Even allowing for 100-fold concentration differences due to poor adherence or less frequent prescribed dosing, vaginal dosing of tenofovir should provide higher active site concentrations and theoretically greater PrEP efficacy than oral dosing; randomized topical dosing PrEP trials to the contrary indicates that factors beyond tenofovir’s antiviral effect substantially influence PrEP efficacy.

Trial Registration

ClinicalTrials.gov NCT00592124

Migration Decision-Making among Mexican Youth: Individual, Family, and Community Influences

We explored migration decisions using in-depth, semi-structured interviews with male and female youth ages 14 to 24 (n=47) from two Mexican communities, one with high and one with low U.S. migration density. Half were return migrants and half were non-migrants with relatives in the U.S. Migrant and non-migrant youth expressed different preferences, especially in terms of education and their ability to wait for financial gain. Reasons for migration were mostly similar across the two communities; however, the perceived risk of the migration journey was higher in the low density migration community while perceived opportunities in Mexico were higher in the high density migration community. Reasons for return were related to youths' initial social and economic motivations for migration. A greater understanding of factors influencing migration decisions may provide insight into the vulnerability of immigrant youth along the journey, their adaptation process in the U.S., and their reintegration in Mexico.

ACASI and face-to-face interviews yield inconsistent estimates of domestic violence among women in India: The Samata Health Study 2005-2009

BACKGROUND

Audio computer-assisted self-interviews (ACASI) are increasingly used in health research to improve the accuracy of data on sensitive behaviors. However, evidence is limited on its use among low-income populations in countries like India and for measurement of sensitive issues such as domestic violence.

METHOD

We compared reports of domestic violence and three less sensitive behaviors related to household decision making and spousal communication in ACASI and face-to-face interviews (FTFI) among 464 young married women enrolled in a longitudinal study of gender-based power and adverse health outcomes in low-income communities in Bangalore, India. We used a test-retest design. At the 12-month study visit, we elicited responses from each participant through FTFI first, followed by ACASI. At the 24-month visit, we reversed the order, implementing ACASI first, followed by FTFI. Univariable log-linear regression models and kappa statistics were used to examine ACASI's effects on self-reports.

RESULTS

Regression results showed significantly lower reporting in ACASI relative to FTFI at both visits, including for domestic violence (12-month risk ratio [RR] = 0.61, 95% CI = 0.52, 0.73; 24-month RR = 0.74, 95% CI = 0.62, 0.89). Response agreement between interview modes, calculated by kappa scores, was universally low, though highest for domestic violence (12-month κ = 0.45; 24-month κ = 0.48). Older age and greater educational attainment appeared associated with higher response agreement.

CONCLUSIONS

Greater reporting in FTFI may be due to social desirability bias for the less sensitive questions and perceptions of therapeutic benefit for domestic violence. These results cast doubt on the appropriateness of using ACASI for measurement of sensitive behaviors in India.

First Report of Leaf Rust of Blueberry Caused by Thekopsora minima in Mexico

Blueberry (Vaccinium corymbosum L.) is becoming an important crop in the states of Jalisco and Michoacan in Mexico. Leaf rust, a disease causing extensive defoliation on plants with severe infections, was observed in the autumn of 2007 and it has become one of the most significant diseases of blueberry in these states. Symptoms on the upper surfaces of leaves appear as small, yellow spots that later turn necrotic as they enlarge and coalesce and eventually cover large areas of individual leaves. On the undersides of leaves, small flecks surrounded by small water-soaked halos appear, turn yellow, and produce powdery sori that are uredinia with urediniospores. Uredinia were hypophyllous, scattered to gregarious and at times superficially appearing confluent, up to about 300 μm in diameter, dome shaped and peridium hemispherical in cross section, orangish, becoming pulverulent, lacking obviously enlarged, well-differentiated ostiolar cells. Urediniospores were subglobose, obovate, oblong or ellipsoid, 17.6 to 27.2 × 12.8 to 17.6 μm, with hyaline, echinulate walls that are 1.2 to 1.8 μm thick, and with yellow-to-hyaline contents. Telia were not observed. On the basis of uredinial morphology (3,4), the rust was identified as Thekopsora minima P. Syd. & Syd. To distinguish this rust from other rust species causing disease on Vaccinium (2,3), a 1,414-bp region consisting of ITS2 and the 5' end of the 28S was amplified with primers Rust2inv/LR6 from uredinial lesions on infected leaves of V. corymbosum 'Biloxi' and sequenced (BPI 880580; GenBank Accession No. HM439777) (1). Results of a BLAST search of GenBank found 100% (1,414 of 1,414) identity to T. minima (GenBank Accession No. GU355675) from South Africa (3). Pathogenicity tests were completed as follows: (i) during the autumn of 2009, rusted leaves of cvs. Biloxi and Sharpblue were collected from the field; (ii) mature leaves from healthy plants of both blueberry cultivars were surface disinfested with 1% sodium hypochlorite for 2 min and rinsed with sterile distilled water; (iii) fresh urediniospores from rusted leaves were brushed directly onto the undersides of disinfested detached leaves; (iv) to avoid drying, wet cotton balls were placed on the petioles of inoculated leaves that were subsequently placed in resealable plastic bags; and (v) leaves were then incubated in a growth chamber at 22°C with a 12-h photoperiod. For each cultivar, 20 leaves were inoculated and five uninoculated leaves were included as controls and the test was repeated once. Yellow uredinia were observed 13 and 10 days after inoculation in cvs. Biloxi and Sharpblue, respectively. Leaf symptoms and uredinial characters were the same as observed previously in the field. To our knowledge, this is the first report of T. minima in Mexico. This report is significant for growers who need a diagnosis to control the disease and for breeders and plant pathologists who should consider developing more resistant cultivars. References: (1) M. C. Aime. Mycoscience 47:112, 2006. (2) F. L. Caruso and D. C. Ramsdell, eds. Compendium of Blueberry and Cranberry Diseases. The American Phytopathological Society, St. Paul, MN, 1995. (3) L. Mostert et al. Plant Dis. 94:478, 2010. (4) P. Sydow and H. Sydow. Monographia Uredinearum. Vol. III. Fratres Borntraeger, Leipzig, Germany, 1915.

Predictive ability and stability of adolescents' pregnancy intentions in a predominantly Latino community

Using data from a prospective cohort of 555 adolescent girls and boys from a predominantly Latino neighborhood of San Francisco, we examined how well four survey questionnaire items measuring pregnancy intentions predicted the incidence of pregnancy. We also compared consistency of responses among items and assessed how intentions fluctuated over time. Girls experienced 72 pregnancies over two years (six-month cumulative incidence = 8 percent), and boys reported being responsible for 50 pregnancies (six-month cumulative incidence = 10 percent). Although the probability of becoming pregnant generally increased with higher intention to do so, the risk of becoming pregnant was elevated only at the highest response categories for each item. Most pregnancies occurred among teenagers reporting the lowest levels of intention: for instance, 73 percent of pregnancies occurred among girls who reported that they definitely did not want to become pregnant. Considerable change in respondents' intentions were found over short periods of time: 18 percent and 41 percent of responses to the wantedness and happiness items, respectively, changed between six-month survey visits. The development of appropriate strategies to reduce pregnancy among adolescents would benefit from a more nuanced understanding of how teenagers view the prospect of pregnancy and what determines whether they actively protect themselves from unintended pregnancy.

Immigration and sexual partner risk among Latino adolescents in San Francisco

Sexual partner characteristics increase risk for adverse reproductive health outcomes. Evidence is limited regarding whether choice of sexual partners among Latino adolescents changes with U.S. acculturation/adaptation. We used generalized estimating equations to assess the associations between immigrant generation (recent immigrant, 1.5 [immigrated prior to adolescence], 2nd and 3rd) and sexual partner risk in a prospective cohort study of 411 Latino adolescents aged 14-19. We examined three measures of partner risk and mediating effects of family influence (familism and parental monitoring). The odds of reporting a partner with frequent substance use increased with increasing immigrant generation (odds ratios (OR) [reference = recent immigrants]: 2.3, 3.4, and 5.6) as did having a partner who was in a gang/incarcerated (OR [reference = recent immigrants]: 2.4, 3.6, and 5.7). Though the odds of having high-risk partners decreased with higher parental monitoring, neither family influence measure mediated these relationships. Findings underscore the need for a prevention focus on partner choice with attention to increased risk with increasing U.S. generation.

A trajectory analysis of alcohol and marijuana use among Latino adolescents in San Francisco, California

PURPOSE

We examined alcohol and marijuana use trajectories among Latino adolescents in the San Francisco Bay Area.

METHODS

A total of 410 Latino adolescents aged 14-19 years were recruited from community venues from years 2001 to 2004 and followed up for 2 years. In separate models, we identified groups with similar temporal patterns of alcohol and marijuana use using semi-parametric latent group trajectory modeling. Multivariable multinomial logistic regression was used to identify factors associated with the probability of trajectory group membership.

RESULTS

The use of alcohol (76%) and marijuana (55%) in the previous 6 months was common. Three alcohol-use trajectories were identified: low users (18%), moderate users (37%), and frequent users (45%). Low alcohol users (vs. moderate users) were found to be younger in age, preferred Spanish language, and had more parental monitoring. Frequent users were more likely to be male, sexually active, gang exposed, and have less parental monitoring than moderate users. Similarly, three marijuana-use trajectories were identified: low users (36%), moderate users (35%), and frequent users (28%), with similar correlates of group membership.

CONCLUSIONS

Urban Latino adolescents' substance use is shaped by complex cultural and environmental influences. Patterns of substance use emerge by early adolescence highlighting the need for timely intervention.

Change in condom and other barrier method use during and after an HIV prevention trial in Zimbabwe

Background

We examined the use of male condoms and the diaphragm following completion of a clinical trial of the diaphragm's HIV prevention effectiveness. In the trial, called Methods for Improving Reproductive Health in Africa (MIRA), women were randomized to a diaphragm group (diaphragm, gel and condoms) or a condom-only control group. At trial exit, all women were offered the diaphragm and condoms.

Methods

Our sample consisted of 801 Zimbabwean MIRA participants who completed one post-trial visit (median lapse: nine months; range two to 20 months). We assessed condom, diaphragm and any barrier method use at last sex act at enrolment, final MIRA and post-trial visits. We used multivariable random effects logistic regression to examine changes in method use between these three time points.

Results and discussion

In the condom group, condom use decreased from 86% at the final trial visit to 67% post trial (AOR = 0.20; 95% CI: 0.12 to 0.33). In the diaphragm group, condom use was 61% at the final trial visit, and did not decrease significantly post trial (AOR = 0.77; 95% CI: 0.55 to 1.09), while diaphragm use decreased from 79% to 50% post trial (AOR = 0.18; 95% CI: 0.12 to 0.28). Condom use significantly decreased between the enrolment and post-trial visits in both groups. Use of any barrier method was similar in both groups: it significantly decreased between the final trial and the post-trial visits, but did not change between enrolment and the post-trial visits.

Conclusions

High condom use levels achieved during the trial were not sustained post trial in the condom group. Post-trial diaphragm use remained relatively high in the diaphragm group (given its unknown effectiveness), but was very low in the condom group. Introducing "new" methods for HIV prevention may require time and user skills before they get adopted. Our findings underscore the potential benefit of providing a mix of methods to women as it may encourage more protected acts.

Pregnancy intentions and teenage pregnancy among Latinas: a mediation analysis

CONTEXT

The extent to which pregnancy intentions mediate the relationship between individual, familial and cultural characteristics and adolescent pregnancy is not well understood. The role of intentions may be particularly important among Latina teenagers, whose attitudes toward pregnancy are more favorable than those of other groups and whose pregnancy rates are high.

METHODS

Prospective, time-varying data from 2001-2004 were used to investigate whether two measures of pregnancy intentions, wantedness and happiness, mediated associations between risk factors and pregnancy among 213 Latina adolescents in San Francisco. Participants were tested for pregnancy and interviewed about pregnancy intentions, partnerships, family characteristics and activities every six months for two years. Associations and mediation were examined using logistic regression.

RESULTS

Neither pregnancy intention variable mediated relationships between participant characteristics and pregnancy. After adjustment for other measures, wantedness was strongly associated with pregnancy (odds ratio, 2.6), while happiness was not. Having a strong family orientation was associated with happiness (3.7) but unrelated to pregnancy. Low power in a sexual relationship with a main partner was associated with an elevated risk of pregnancy (3.3). If the pregnancy intentions of all participants were changed to definitely not wanting pregnancy, the estimated decline in pregnancy risk would be 16%.

CONCLUSIONS

Pregnancy intentions were important not as mediators but rather as independent risk factors for pregnancy. Differences in pregnancy rates between groups of Latinas may be less a function of intentional choice than of situational factors. Interventions and research should focus on identifying and targeting factors that hinder effective contraceptive use among teenagers who want to avoid pregnancy.

Uromyces ciceris-arietini, the Cause of Chickpea Rust: New Hosts in the Trifolieae, Fabaceae

Uromyces ciceris-arietini has been reported on Cicer arietinum (chickpea) and Medicago polyceratia. Plants of Medicago polymorpha in Riverside and San Diego, CA were collected with severe rust caused by U. ciceris-arietini. To confirm the identification and potential new host range, a monouredinial isolate of U. ciceris-arietini from M. polymorpha was inoculated on eight accessions each of C. arietinum and M. polyceratia. All plants showed symptoms of the disease. Consequently, a range of fabaceous hosts were evaluated for their reaction to U. ciceris-arietini. New hosts for U. ciceris-arietini included 29 species of Medicago, specifically M. arabica, M. blancheana, M. ciliaris, M. constricta, M. coronata, M. doliata, M. granadensis, M. intertexta, M. italica, M. laciniata, M. lanigera, M. lesinsii, M. lupulina, M. minima, M. murex, M. muricoleptis, M. orbicularis, M. praecox, M. radiata, M. rigidula, M. rotata, M. rugosa, M. sativa, M. sauvagei, M. scutellata, M. soleirolii, M. tenoreana, M. truncatula, and M. varia, and three species of Melilotus, specifically M. italicus, M. speciosus, and M. spicatus. This isolate of U. ciceris-arietini produced no symptoms on plants in the 33 accessions tested in the genera Anthyllis, Astragalus, Lotus, and Lupinus. DNA sequences are provided to aid in the identification of this pathogen.

First Report of Uromyces acuminatus on Honckenya peploides, the Endangered Seabeach Sandwort

Honckenya peploides (L.) Ehrh. (Caryophyllaceae), commonly known as seabeach sandwort, is a species of special concern in Connecticut (4). Nearly an entire population of H. peploides in New London County, CT was found to be severely infected by the aecial stage of a rust fungus in June of 2008. Representative plants in the population were infected with aecia on more than 50% of the leaves. Aecia were amphigenous, gregarious, cupulate, pulverulent, yellowish, and erumpent with a hyaline to whitish peridium having a lacerate, somewhat recurved margin. Peridial cells were rhomboidal, 26 to 31 × 25 to 29 μm, smooth to finely verrucose. Aeciospores were globose to ellipsoid, 23.5 to 29 × 20.5 to 22 μm, hyaline to pale yellowish with a verrucose surface and hyaline walls 1.5 to 2 μm thick. Morphological characters corresponded to a reference specimen (BPI 000105) of the aecial stage of Uromyces acuminatus Arthur from Nova Scotia, as well as published descriptions (1,2). Subsequently, telia of U. acuminatus were discovered on Spartina patens (Aiton) Muhl. (Poaceae) in May of 2009 in New London County, CT. Telia were adaxial, intercostal, scattered to gregarious, linear and at times elongate, dark brown to black, pulverulent, and erumpent. Teliospores were obovate to ellipsoid with rounded to acuminate apices rarely having two points, 30 to 41 × 19 to 24 μm, with a smooth surface and brownish-yellow to brown walls 9 to 14 μm thick at apex, which is sometimes paler, and 1 to 3 μm thick laterally, pedicels with a portion persisting on the teliospore that is up to 82 μm long and brownish-yellow. The ITS2 and 5' region of the 28S rDNA (998 bp) from the rust on H. peploides (GenBank Accession No. GU109282, BPI 879300) and the rust on S. patens (GenBank Accession No. GU058008, BPI 879285B) were sequenced to confirm the identification of U. acuminatus on H. peploides with the resulting sequences identical. U. acuminatus is widespread in the eastern United States and Canada (1-3). The telial stage is found on Spartina spp., while the aecial stage is found on numerous taxa including members of the Asparagaceae (formerly Ruscaceae, Liliaceae), Caryophyllaceae, Polemoniaceae, and Primulaceae (1-3). Puccinia arenariae (Schumach.) G. Winter, previously reported from H. peploides (4), is microcyclic and stages 0, I, and II are unknown. To our knowledge, this is the first report of U. acuminatus on the genus Honckenya. This report has significance to natural resource conservation managers and scientists working in endangered plant habitats because H. peploides and H. peploides subsp. robusta are listed as plants of special concern or endangered/extirpated in Connecticut, Maryland, New Hampshire, and Rhode Island (4). References: (1) J. C. Arthur. Order Uredinales. N. Am. Flora 7(3):161, 1912. (2) G. B. Cummins. The Rust Fungi of Cereals, Grasses and Bamboos. Springer-Verlag, New York, 1971. (3) D. F. Farr and A. Y. Rossman. Fungal Databases. Systematic Mycology and Microbiology Laboratory. Online publication. ARS, USDA, 2009. (4) USDA, NRCS. The PLANTS Database. Online publication. National Plant Data Center, Baton Rouge, LA, 2009.

First Report of Powdery Mildew Caused by Podosphaera leucotricha on Callery Pear in North America

Callery pear, often referred to as Bradford pear, is a species native to China that is planted throughout North America as an ornamental tree for its white flowers in spring, bright colored foliage in autumn, and resistance to disease. In some regions it is becoming an invasive species that is replacing native trees. In May 2009, leaves of Pyrus calleryana 'Cleveland Select' showing distortion and signs of powdery mildew were collected in Columbia (Howard County), Maryland. A survey of the surrounding area found numerous similarly diseased trees of this cultivar. Microscopic observation of the leaves revealed a fungus with an Oidium anamorph having nipple-shaped appressoria; conidiophores erect, foot cells cylindric, straight, of terminal origin, 41 to 55 × 9.5 to 12.5 μm, with the following cells present in variable numbers; conidia catenulate, broadly ellipsoid to rarely slightly ovoid, 22 to 27 × 11 to 17 μm, with fibrosin bodies. Chasmothecia were absent. On the basis of morphology and host, the fungus was identified as Podosphaera leucotricha (Ellis & Everh.) E.S. Salmon (Leotiomycetes, Erysiphales) (1). The specimen on P. calleryana was deposited in the U.S. National Fungus Collections as BPI 879141. Additional confirmation resulted from a comparison of internal transcribed spacer (ITS) region DNA sequence data (GenBank Accession No. GU122230) obtained with the custom designed primer, Podoprimer Forward (5'-3' ACTCGTTCTGCGCGGCTGAC), and the ITS4 primer. The sequence of the fungus on Callery pear was identical to available GenBank sequences of P. leucotricha. P. leucotricha is the etiological agent of a powdery mildew disease that occurs on rosaceous plants, primarily Malus and Pyrus. This fungus occurs nearly worldwide (1), and the pathology of the disease on Callery pear is similar to that of known hosts (1,4). To our knowledge, this is the first report of P. leucotricha on Pyrus calleryana in North America. P. leucotricha has been reported previously only once on Callery pear, Pyrus calleryana 'Chanticleer', in Hungary (4). Additionally, the powdery mildew fungus was heavily parasitized by Ampelomyces quisqualis Ces. sensu lato, a cosmopolitan coelomycetous mycoparasite of the Erysiphales that is well known on this species (2,3). ITS region DNA sequence data from the Ampelomyces (GenBank Accession No. GU122231) obtained with the ITS1 and ITS4 primers was identical to that of other isolates parasitic on P. leucotricha (2). References: (1) U. Braun. The Powdery Mildews (Erysiphales) of Europe. Gustav Fischer Verlag, Jena, Germany, 1995. (2) C. Liang et al. Fungal Divers. 24:225, 2007. (3) B. C. Sutton. The Coelomycetes. Fungi Imperfecti with Pycnidia, Acervuli and Stromata. Commonwealth Mycological Institute, Kew, England, 1980. (4) L. Vajna and L. Kiss. Plant Dis. 92:176, 2008.

Factors Associated With Delayed Childbearing: From the Voices of Expectant Latina Adults and Teens in California

There has been limited research on the protective factors that help Latinas delay childbearing until adulthood. In-depth interviews were conducted with 65 pregnant Latina teenage and adult women in California who were about to have their first child. Lack of or inconsistent birth control use as teens was attributed to wanting or ambivalence toward childbearing, concern about contraceptive side effects and infertility, and/or inadequate contraceptive information. Parental influence was cited as the primary reason for avoiding teen childbearing, as well as the feeling that a baby would have interfered with life plans. Close parental supervision and positive relationships with parents appeared to protect some adults from teen childbearing. The findings from this study point to the need to improve Latinos’ birth control knowledge and strengthen parents’ ability to establish supportive relationships with their children.

Biomarker validation of reports of recent sexual activity: results of a randomized controlled study in Zimbabwe

Challenges in the accurate measurement of sexual behavior in human immunodeficiency virus (HIV) prevention research are well documented and have prompted discussion about whether valid assessments are possible. Audio computer-assisted self-interviewing (ACASI) may increase the validity of self-reported behavioral data. In 2006-2007, Zimbabwean women participated in a randomized, cross-sectional study that compared self-reports of recent vaginal sex and condom use collected through ACASI or face-to-face interviewing (FTFI) with a validated objective biomarker of recent semen exposure (prostate-specific antigen (PSA) levels). Of 910 study participants, 196 (21.5%) tested positive for PSA, an indication of semen exposure during the previous 2 days. Of these 196 participants, 23 (11.7%) reported no sex in the previous 2 days, with no difference in reported sexual activity between interview modes (12.5% ACASI vs. 10.9% FTFI; Fisher's exact test: P = 0.72). In addition, 71 PSA-positive participants (36.2%) reported condom-protected vaginal sex only; their reports also indicated no difference between interview modes (33.7% ACASI vs. 39.1% FTFI; P = 0.26). Only 52% of PSA-positive participants reported unprotected sex during the previous 2 days. Self-report was a poor predictor of recent sexual activity and condom use in this study, regardless of interview mode, providing evidence that such data should be interpreted cautiously.

First Report of Japanese Apple Rust Caused by Gymnosporangium yamadae on Malus spp. in North America

Plants in the genus Malus Mill. are grown in temperate regions for fruit crops such as apple and ornamental landscape plants such as flowering crab apple. Gymnosporangium yamadae Miyabe ex G. Yamada, cause of Japanese apple rust, is known to attack economically important species of Malus in Asia. In August 2004 and July 2008, the aecial stage of a rust fungus was observed in Wilmington, DE and nearby in Media, PA on leaves of toringo crab apple (Malus toringo (Siebold) Siebold ex de Vriese), a cultivated plant native to Asia. On the basis of morphological and molecular characteristics, the fungus was identified as G. yamadae. This pathogen has not been previously reported in North America. The identification was confirmed by morphological comparisons with specimens of G. yamadae from Asia and descriptions (1-3) as well as using the D1/D2 domain of 28S rDNA sequence data G. clavariiforme (GenBank Accession No. AR426211), G. clavipes (GenBank Accession No. DQ354545), G. cornutum (GenBank Accession No. AF426210), G. juniperi-virginianae (GenBank Accession Nos. AF522167, AY629316, and DQ354547), G. libocedri (GenBank Accession No. AF522168), G. sabinae (GenBank Accession Nos. AF426209 and AY512845) and G. yamadae (GenBank Accession Nos. FJ559373 and FJ559375). The specimens from North America included aecia of G. yamadae that are foliicolous, hypophyllous, roestelioid, and 4 to 7 mm high. The peridia are yellow-brown to brown and cornute to tubular with a closed brown tip at the apex and lacerate sides; the peridial remains often form a reticulate pattern. The peridial cells are long-narrow rhomboid, 83 to 120 μm long with smooth outer walls and verrucose to echinulate inner and side walls. The aeciospores are globose, 18 to 28 × 19 to 29 μm, with a slightly coronate surface and brown-yellow walls 2 to 3 μm thick. The telia known on Juniperus spp. were not observed. The specimens were deposited in the U.S. National Fungus Collections (BPI 878846, BPI 878847, BPI 878848, and BPI 878849). The 28S rDNA sequence of G. yamadae from BPI 878849 was deposited in GenBank as Accession No. FJ455091. Aecia of G. juniperi-virginianae, cause of cedar apple rust, differ from G. yamadae in having recurved peridial walls at maturity. References: (1) F. D. Kern. A Revised Taxonomic Account of Gymnosporangium. Pennsylvania State University Press, University Park, PA, 1973. (2) S. K. Lee and M. Kakishima. Mycoscience 40:109, 1999. (3) S. K. Lee and M. Kakishima. Mycoscience 40:121. 1999.

Gang exposure and pregnancy incidence among female adolescents in San Francisco: evidence for the need to integrate reproductive health with violence prevention efforts

Among a cohort of 237 sexually active females aged 14-19 years recruited from community venues in a predominantly Latino neighborhood in San Francisco, California, the authors examined the relation between gang exposure and pregnancy incidence over 2 years of follow-up between 2001 and 2004. Using discrete-time survival analysis, they investigated whether gang membership by individuals and partners was associated with pregnancy incidence and determined whether partnership characteristics, contraceptive behaviors, and pregnancy intentions mediated the relation between gang membership and pregnancy. Pregnancy incidence was determined by urine-based testing and self-report. Latinas represented 77% of participants, with one in five born outside the United States. One quarter (27.4%) became pregnant over follow-up. Participants' gang membership had no significant effect on pregnancy incidence (hazard ratio = 1.25, 95% confidence interval: 0.54, 3.45); however, having partners who were in gangs was associated with pregnancy (hazard ratio = 1.90, 95% confidence interval: 1.09, 3.32). The male partner's perceived pregnancy intentions and having a partner in detention each mediated the effect of partner's gang membership on pregnancy risk. Increased pregnancy incidence among young women with gang-involved partners highlights the importance of integrating reproductive health prevention into programs for gang-involved youth. In addition, high pregnancy rates indicate a heightened risk for sexually transmitted infections.

Poverty, gender inequities, and women's risk of human immunodeficiency virus/AIDS

Entrenched economic and gender inequities together are driving a globally expanding, increasingly female, human immunodeficiency virus (HIV)/AIDS epidemic. To date, significant population-level declines in HIV transmission have not been observed, at least in part because most approaches to prevention have presumed a degree of individual control in decision making that does not speak to the reality of women's and girls' circumstances in many parts of the world. Such efforts have paid insufficient attention to critical characteristics of the risk environment, most notably poverty and gender power inequities. Even fewer interventions have addressed specific mechanisms through which these inequities engender risky sexual practices that result in women's disproportionately increased vulnerabilities to HIV infection. This article focuses on identifying those mechanisms, or structural pathways, that stem from the interactions between poverty and entrenched gender inequities and recommending strategies to address and potentially modify those pathways. We highlight four such structural pathways to HIV risk, all of which could be transformed: (1) lack of access to critical information and health services for HIV/sexually transmitted infection (STI) prevention, (2) limited access to formal education and skill development, (3) intimate partner violence, and (4) the negative consequences of migration prompted by insufficient economic resources. We argue for interventions that enhance women's access to education, training, employment, and HIV/STI prevention information and tools; minimize migration; and by working with men and communities, at the same time reduce women's poverty and promote gender-equitable norms. In conclusion, we identify challenges in developing and evaluating strategies to address these structural pathways.

Audio computer-assisted self-interviewing in reproductive health research: reliability assessment among women in Harare, Zimbabwe

PURPOSE

Research on the measurement of HIV risk demonstrates that interview mode can affect reporting; however, few studies have applied these findings to assessments of hormonal contraceptive use. This paper examines how audio computer-assisted self-interviewing (ACASI) influenced reports of hormonal contraceptive use and pregnancy among Zimbabwean women.

METHODS

Using a prospective, randomized, cross-over design, we compared self-reports obtained with ACASI and face-to-face (FTF) interview among 655 women enrolled in a prospective study on hormonal contraceptive use and HIV acquisition. In addition, self-report data were compared to those collected during clinical exams.

RESULTS

Compared to FTF interviews, reports of hormonal contraceptive use were lower in ACASI [odds ratio (OR)=0.6; 95% confidence interval (95% CI)=0.5-0.6], and reports of pregnancy were higher (OR=1.5; 95% CI=1.1-1.9). Both modes of self-report differed from records on contraceptive method disbursement.

CONCLUSION

Although ACASI yielded higher reports of several reproductive health behaviors, discrepancies between self-reports and clinical data on method disbursement highlight persistent measurement challenges.

Pluteus aurantipes sp. nov. from Wisconsin, United States

Pluteus aurantipes sp. nov. was discovered in Wisconsin, United States. This agaric species is characterized by its yellowish brown pileus, reddish orange stipe, pileipellis consisting of a trichoderm and lack of pleurocystidia.

Effectiveness of female controlled barrier methods in preventing sexually transmitted infections and HIV: current evidence and future research directions

OBJECTIVES

To evaluate evidence for the effectiveness of female controlled physical and chemical barrier methods in preventing STI/HIV transmission, to examine recent reviews on microbicide development, and to highlight promising research directions. To discuss challenges in conducting effectiveness research and in translating results to public health intervention.

METHODS

Systematic review of articles that examined the disease prevention effectiveness of at least one female controlled barrier method. Review of conference abstracts that presented clinical and preclinical microbicide data.

RESULTS

Randomised controlled trials provide evidence that female condoms confer as much protection from STIs as male condoms. Observational studies suggest that the diaphragm protects against STI pathogens. Several microbicide effectiveness studies are under way and new directions, such as adaptation of therapeutic agents as preventive products, are being examined. Substantial attention is now given to product formulation and novel delivery strategies. Combining microbicide products with different mechanisms of action as well as combining chemical and physical barriers will be necessary to maximise prevention effectiveness.

CONCLUSIONS

Increased investment in the development and identification of female controlled barrier methods offers promise that additional products will be available in the years ahead. Generalizing trial results to a community setting, promoting products that may be less effective than male condoms, and bringing an effective product to scale introduce public health challenges that warrant attention. The need for female controlled barrier methods that provide women with the opportunity to take an active role in reducing their STI/HIV risk are urgently needed and constitute an essential tool to prevent continued spread of these infections.

Sexual partners and use of emergency contraception

OBJECTIVE

This study investigates the role of male sexual partners and relationships in determining whether women seek emergency contraception (EC) when needed.

STUDY DESIGN

Data on EC use from a clinic-based sample of sexually active women, aged 15 to 30 years, in the San Francisco Bay area (n=497) were analyzed with multivariate logistic regression analysis.

RESULTS

Results show that factors measuring power dynamics, such as male dominant decision making (odds ratio [OR]=4.1, P=.035) and pressure for sex (OR=2.7, P=.006), as well as a strong desire to avoid pregnancy on the part of the male partner (OR=4.2, P <or=.001), have a significant association with the use of EC. However, relationship factors known to be associated with use of other contraceptive methods, such as communication, satisfaction, and commitment, show no association with EC use.

CONCLUSION

Factors predicting EC use, including male partner and relationship factors, may not always be evident to a clinician, so it is important to include EC as part of routine counseling.

Barrier contraceptive method acceptability and choice are not reliable indicators of use

BACKGROUND

The need for safe and effective female-controlled methods that protect against sexually transmitted pathogens is widely recognized. Product effectiveness is inextricably bound to use, and, therefore, the needs and preferences of potential consumers must be considered. The degree to which measures of acceptability correlate with actual barrier method use remains unexamined.

GOAL

The goal was to evaluate associations between measures of acceptability and use of existing over-the-counter barrier methods.

STUDY DESIGN

In the San Francisco Bay Area, 510 females aged 15 to 30 years were recruited from reproductive health clinics for this longitudinal study.

RESULTS

Neither hypothetical acceptability nor product choice predicted use. Fewer than 50% of participants who chose a female-controlled method used it. Similarly, method satisfaction was not associated with use (14.3-51.4% of satisfied users used the method again). However, dissatisfaction was predictive of low levels of subsequent use (0-15.3% used the method again). Male condoms were used despite dissatisfaction.

CONCLUSION

The lack of association among assessments of acceptability, choice, satisfaction, and use suggests a need to reframe how product acceptability is evaluated in prevention research so it is more predictive of method use.

Determinants of contraceptive method among young women at risk for unintended pregnancy and sexually transmitted infections

The objective of this study was to examine the relationship between contraceptive method choice, sexual risk and various demographic and social factors. Data were collected on 378, 15- to 24-year-old women, recruited from health clinics and through community outreach in Northern California. Logistic regression analysis was used to estimate the association of predictors with contraceptive method used at last sex. Asian and Latina women were less likely to use any method. Women who were raised with a religion, or thought they were infertile, were also less likely to use any method. Women with multiple partners were generally less likely to use any method, but were more likely to use barrier methods when they did use one. Few women (7%) were dual method users. Women appear to act in a rational fashion within their own social context and may use no methods at all or use methods that are less effective for pregnancy prevention but offer more protection from sexually transmitted infections.

Reproductive health differences among Latin American- and US-born young women

Investigations of reproductive health within Latinos living in the United States suggest that sexual behaviors and contraception use practices vary by ethnicity and between foreign- and US-born adolescents. This article compares high-risk sexual behaviors and reproductive health among foreign-born Latinas, US-born Latinas, and US-born non-Latinas aged 15-24 years. We recruited 361 females from reproductive health clinics in the San Francisco Bay Area of California between 1995 and 1998; these women completed an interview that assessed sexual risk behaviors and history of pregnancy, abortion, and sexually transmitted infections. Current chlamydial and gonococcal infections were detected through biological testing. Among participants aged 15-18 years, US-born Latinas were more likely to have been pregnant (odds ratio [OR] comparing US-born Latinas and US-born non-Latinas = 3.9, 95% confidence interval [CI] 1.3, 11.4), whereas among respondents aged 19-24 years, foreign-born Latinas were more likely to have been pregnant than US-born Latinas (OR = 11.3, 95% CI 1.0, 130.8) and US-born non-Latinas (OR = 64.2, 95% CI 9.9, 416.3). US-born Latinas were most likely to have had an abortion (OR comparing US-born Latinas and US-born non-Latinas = 2.0, 95% CI 0.9, 4.7). They were also most likely to have chlamydial infection at study enrollment (8.2% prevalence compared to 2.2% and 1.0%for foreign-born Latinas and US-born non-Latinas, respectively; P =.009). Reproductive health differences between foreign and US-born females and within the US-born population warrant further examination and highlight the need for targeted prevention.

Reliability of adolescents' self-reported sexual behavior: a comparison of two diary methodologies

PURPOSE

To evaluate techniques for measuring high-risk sexual behaviors by comparing the reliability and acceptability of two daily sexual behavior diary modes: a written calendar and an automated telephone interview.

METHODS

This randomized controlled study included 105 sexually active female adolescents aged 15-19 years recruited from among teens seeking reproductive health care services at a family planning clinic in the San Francisco Bay Area. Participants completed a standardized sexual behavior questionnaire each day for 4 weeks. Contraceptive use by method type was recorded. Reporting differences between the two diary modes were assessed using generalized estimating equations, concordance of diary and retrospective interview responses was evaluated using kappa statistics, and contingency table analysis and Poisson regression models were constructed to examine mode acceptability.

RESULTS

Respondents randomized to the telephone diary cohort reported less frequent use of barrier contraceptive methods, specifically less spermicide use (odds ratio 0.27, 95% confidence interval 0.08, 0.95), and decreasing male condom use over time, whereas reports of male condom use increased for written diary respondents (p = .007). Participant characteristics associated with diary acceptability, defined as the frequency of diary completion, were assessed and teens classified as higher risk provided fewer diary reports (p < .01). Regardless of mode completed, 65% of respondents believed the telephone diary would be preferable to the written diary for most teens.

CONCLUSIONS

The automated telephone diary offered an acceptable, even preferred, methodologic alternative to the written diary calendar and elicited more accurate reporting of selected contraceptive behavior.

Choice of female-controlled barrier methods among young women and their male sexual partners

CONTEXT

Little is known about the factors associated with the choice of female-controlled, over-the-counter barrier contraceptive methods among women and their male sexual partners.

METHODS

Predictors of method choice were assessed following an educational presentation on contraceptive use and risk reduction among 510 sexually active females aged 15-30 who were recruited in the San Francisco Bay Area. In addition, the primary partners of 160 of these women participated in the survey

RESULTS

Twenty-two percent of women who enrolled in the study alone, 25% of those who enrolled with their main partner and 18% of these male partners chose female-controlled, over-the-counter barrier methods alone. The strongest predictor of this choice was current use of a hormonal contraceptive both for women who participated in the study on their own (odds ratio, 2.1) and for those who enrolled their partner in the study (odds ratio, 6.3). Female-controlled methods were also chosen significantly more often by teenagers than by older women; for example, among those who enrolled with a male partner, the odds ratio for selection of a female-controlled barrier method by women younger than 18 was 6.0. Among women who enrolled without a partner, those who had had multiple partners in the previous six months and those who were current users of male condoms were less likely to choose female-controlled methods (odds ratios, 0.7 and 0.5, respectively).

CONCLUSIONS

Although the majority of participants did not choose female-controlled, over-the-counter barrier methods without also choosing male condoms, such female-controlled methods appear to offer an acceptable alternative for prevention of sexually transmitted infections. They may be a particularly attractive option for individuals using hormonal contraceptives and for teenage women.