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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 829] [Impact Index Per Article: 276.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs.
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West BS, Becerra Ramirez M, Bristow CC, Abramovitz DA, Vera A, Staines H, Gudelia Rangel M, Patterson TL, Strathdee SA. Correlates of trichomoniasis among female sex workers who inject drugs in two Mexico-US border cities. Int J STD AIDS 2020; 31:866-875. [PMID: 32623979 DOI: 10.1177/0956462420929463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper evaluates correlates of trichomoniasis among female sex workers who inject drugs (FSWIDs) in two Mexico-US border cities. HIV-negative FSWIDs aged 18 years or older were enrolled in a study between 2008 and 2010 in Tijuana and Ciudad Juarez (Cd.), Mexico. All participants underwent a baseline interviewer-administered survey and did a rapid test for trichomoniasis. Using regression to estimate prevalence ratios, we examined sociodemographics, sex work characteristics, sexual health and behavior, substance use, and police and violence exposures as potential correlates of trichomoniasis. Of 584 women (284 in Tijuana, 300 in Cd. Juarez), prevalence of trichomoniasis was 33.6%. Factors associated with trichomoniasis in multivariable analysis were having money stolen by police in the past six months (adjusted prevalence ratio [aPR] =1.448, 95% confidence interval [CI] = 1.152-1.821), recent methamphetamine use (aPR = 1.432, CI = 1.055-1.944), lifetime syphilis infection (aPR = 1.360, CI = 1.061-1.743), ever use of a home remedy to treat vaginal symptoms (aPR = 1.301, CI = 1.027-1.649), and number of regular clients in the past month (aPR = 1.006 per client, CI = 1.004-1.009), while controlling for age and city of interview. Alongside the need for trichomoniasis surveillance and treatment programs, findings indicate that both structural and behavioral factors serve as primary correlates of trichomoniasis among FSWIDs in these cities.
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Affiliation(s)
- Brooke S West
- Columbia University School of Social Work, New York, NY, USA
| | - Milagros Becerra Ramirez
- Department of Family Medicine, University of California Los Angeles International Medical Graduate Program, Los Angeles, CA, USA
| | - Claire C Bristow
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Daniela A Abramovitz
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Alicia Vera
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Hugo Staines
- Departamento de Ciencias Médicas, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez, México
| | | | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Steffanie A Strathdee
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
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Nolan MS, Cruz AT, Erickson T. Retrospective Chart Analysis of Child and Adolescent Trichomonas vaginalis Infection in Houston, Texas. J Pediatric Infect Dis Soc 2020; 9:75-81. [PMID: 30624683 DOI: 10.1093/jpids/piy134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/21/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Trichomonas vaginalis infection causes significant morbidity in the United States. Despite its high national disease burden, the epidemiologic characteristics of child and adolescent cases are not well understood. In this study, we aimed to describe the socioeconomic, transmission risk factors, clinical manifestations, and geospatial variables associated with cases of T vaginalis infection in the Houston, Texas, metropolitan area. METHODS We performed a retrospective chart abstraction of all T vaginalis cases at 2 large pediatric hospitals in Houston between 2008 and 2016. RESULTS We identified 87 patients (mean age, 16 years; range, 4-18 years); 30% of them were asymptomatic, and 39% were coinfected with another sexually transmitted infection(s). Almost all T vaginalis infections in sexually assaulted patients were diagnosed incidentally. Geospatial analysis identified clustering of cases in areas of high poverty and in minority populations. CONCLUSIONS Our findings indicate that children and adolescents are at risk for T vaginalis infection; however, their risk factors might differ from those in adults. In addition, our geospatial analysis revealed the need for dedicated resources in neighborhoods associated with health disparities to prevent future incident cases.
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Affiliation(s)
- Melissa S Nolan
- Section of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Department of Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia
| | - Andrea T Cruz
- Section of Emergency Medicine & Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Tim Erickson
- Section of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Fallon SA, Pathela P, Mikati T. Prevalence and Correlates of Trichomonas vaginalis Infection Using the OSOM Rapid Point-of-Care Test Among Women Attending New York City Sexual Health Clinics, May-July 2016. Sex Transm Dis 2019; 46:748-750. [PMID: 31356528 DOI: 10.1097/olq.0000000000001038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Using electronic medical record data and OSOM Trichomonas Rapid Tests, Trichomonas vaginalis prevalence was 9.3% among women attending New York City sexual health clinics in 2016. Positivity was associated with black race (adjusted odds ratios 3.73; 95% confidence interval, 1.9-7.1) and vaginal pH of 4.5 or greater (adjusted odds ratios, 1.9; 95% CI, 1.2-3.3).
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Affiliation(s)
- Susan A Fallon
- From the New York City Department of Health and Mental Hygiene, New York, NY
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Kohtz AS, Walf AA, Frye CA. Effects of non-contingent cocaine on 3 alpha-androstanediol. II. Disruption of lordosis of proestrous rats. Physiol Behav 2019; 203:113-119. [PMID: 29273454 DOI: 10.1016/j.physbeh.2017.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 12/03/2017] [Accepted: 12/14/2017] [Indexed: 01/21/2023]
Abstract
Drug use influences sexual behavior, performance, and can be associated with increased sexual risk-taking. Our prior results using an animal model indicate that progestogens contribute to hormonally-mediated changes in sexual behavior of female rodents during acute cocaine exposure. Androgens, such as testosterone, and its metabolite 3ɑ-androstanediol (3α-diol), and estradiol, are known to influence male sexual behavior, but can also alter the expression of sexual behavior of female rodents. As such, we investigated the influence of endogenous androgen and estradiol fluctuations on cocaine-mediated changes in motor behavior and sexual receptivity of rats during diestrous or proestrous phases of the estrous cycle. Female rats were administered saline or cocaine (5, 10, or 20mg/kg, i.p.). Motor behavior was observed in the first 30min following drug administration, and then sexual responding was assessed for 15min. Cocaine decreased aggressive behavior in response to attempted mounts by a male among non-receptive (diestrous) rats and inhibited sexual behavior among sexually receptive (proestrous) rats. Cocaine dose-dependently altered concentrations of testosterone metabolites (estradiol and 3α-diol), but not testosterone, which correlated to motor and sexual behaviors of diestrous and proestrous rats, respectively. These data suggest that actions of 3α-diol may be involved in female sexual and motor behavior in response to cocaine, in a cycle-dependent manner.
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Affiliation(s)
- Amy S Kohtz
- Dept. of Psychology, The University at Albany, SUNY, Albany, NY, USA
| | - Alicia A Walf
- Dept. of Psychology, The University at Albany, SUNY, Albany, NY, USA; Cognitive Science Dept., Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Cheryl A Frye
- Dept. of Psychology, The University at Albany, SUNY, Albany, NY, USA; Biological Sciences, The University at Albany, SUNY, Albany, NY, USA; Center for Neuroscience, The University at Albany, SUNY, Albany, NY, USA; Center for Life Sciences Research, The University at Albany, SUNY, Albany, NY, USA.
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Abstract
BACKGROUND Trichomonas vaginalis is the most common nonviral sexually transmitted infection. T. vaginalis nucleic acid amplification testing (NAAT) recently became available at the University of Alabama at Birmingham human immunodeficiency virus (HIV) clinic. The objective of this study was to determine the uptake of T. vaginalis NAAT testing among clinic providers during the first year of test availability in addition to T. vaginalis prevalence and predictors based on NAAT results. METHODS This was a retrospective review of HIV+ women and men ages ≥16 years at the University of Alabama at Birmingham HIV Clinic, including those receiving a T. vaginalis NAAT on a genitourinary specimen. RESULTS Between August 2014 and August 2015, 3163 HIV+ patients were seen (768 women, 2395 men), of whom 861 (27.3%) received a T. vaginalis NAAT; 402 women (52.3%) and 459 men (19.2%). Among those with T. vaginalis NAAT results, 70 (17.4%) of 402 women and 12 (2.6%) of 459 men (9 men who have sex with women, 1 man who has sex with men, 2 unknown) tested positive. In adjusted analyses for women, age ≤40 years (odds ratio [OR], 2.93; 95% confidence interval [CI], 1.23-6.96), current cocaine use (OR, 4.86; 95% CI, 1.57-15.06), and CD4 < 200 cells/mm (OR, 6.09; 95% CI, 1.68-22.11) were significantly associated with increased odds of a positive T. vaginalis NAAT. For those with a positive T. vaginalis NAAT, treatment was prescribed for 65 (92.9%) of 70 women and 10 (83.3%) of 12 men. CONCLUSIONS Initial uptake of T. vaginalis NAAT testing was modest at this HIV clinic yet identified a high prevalence among women tested. Emphasis on the need for testing in HIV+ women is necessary.
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Health outcomes associated with crack-cocaine use: Systematic review and meta-analyses. Drug Alcohol Depend 2017; 180:401-416. [PMID: 28982092 DOI: 10.1016/j.drugalcdep.2017.08.036] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Crack-cocaine use is prevalent largely in socio-economically marginalized populations in the Americas. Its use has been associated with diverse health outcomes, yet no recent or systematic reviews of these exist. METHODS A systematic review of health outcomes associated with crack-cocaine use was performed, using MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, and LILACS up to October 2016. Search terms included crack-cocaine and health outcome-related keywords, targeting peer-reviewed studies on quantified health outcomes associated with crack-cocaine use. Random effects meta-analyses produced pooled odds ratios. Levels of evidence for major results were assessed using the GRADE approach. A review protocol was registered with PROSPERO (CRD42016035486). RESULTS Of 4700 articles returned, 302 met eligibility criteria, reporting on health outcomes for 14 of 22 ICD-10 chapters. Conclusive evidence and meta-analyses showed positive associations between crack-cocaine use and blood/sexually transmitted diseases (HIV and hepatitis C virus, others); moderate evidence and meta-analyses supported associations with neonatal health, and violence. There were mixed associations for mental and other health outcomes, yet insufficient evidence to perform meta-analyses for many categories (e.g., mortality). Most underlying research was of limited or poor quality, with crack-cocaine commonly assessed as a secondary covariate. CONCLUSIONS Crack-cocaine use was associated with a range of health outcomes, although it was unclear if there was direct causal impact, interactions between risk factors, or external drivers of both crack-cocaine use and outcomes. Rigorous epidemiological studies are needed to systematically assess health outcomes of crack-cocaine use and underlying pathways, also to inform evidence-based interventions.
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Practice Bulletin No. 167: Gynecologic Care for Women and Adolescents With Human Immunodeficiency Virus. Obstet Gynecol 2017; 128:e89-e110. [PMID: 27661659 DOI: 10.1097/aog.0000000000001707] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the United States in 2013, there were an estimated 226,000 women and adolescents living with human immunodeficiency virus (HIV) infection (1). Women with HIV are living longer, healthier lives, so the need for routine and problem-focused gynecologic care has increased. The purpose of this document is to educate clinicians about basic health screening and care, family planning, prepregnancy care, and managing common gynecologic problems for women and adolescents who are infected with HIV. For information on screening guidelines, refer to the American College of Obstetricians and Gynecologists' Committee Opinion No. 596, Routine Human Immunodeficiency Virus Screening (2).
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Meites E, Gaydos CA, Hobbs MM, Kissinger P, Nyirjesy P, Schwebke JR, Secor WE, Sobel JD, Workowski KA. A Review of Evidence-Based Care of Symptomatic Trichomoniasis and Asymptomatic Trichomonas vaginalis Infections. Clin Infect Dis 2016; 61 Suppl 8:S837-48. [PMID: 26602621 DOI: 10.1093/cid/civ738] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Trichomonas vaginalis is the most prevalent nonviral sexually transmitted infection, affecting an estimated 3.7 million women and men in the United States. Health disparities are prominent in the epidemiology of this infection, which affects 11% of women aged ≥40 years and a disproportionately high percentage of black women. Particularly high prevalences have been identified among sexually transmitted disease (STD) clinic patients and incarcerated individuals. This article reviews and updates scientific evidence in key topic areas used for the development of the 2015 STD Treatment Guidelines published by the Centers for Disease Control and Prevention. Current evidence is presented regarding conditions associated with Trichomonas vaginalis infection, including human immunodeficiency virus (HIV) and pregnancy complications such as preterm birth. Nucleic acid amplification tests and point-of-care tests are newly available diagnostic methods that can be conducted on a variety of specimens, potentially allowing highly sensitive testing and screening of both women and men at risk for infection. Usually, trichomoniasis can be cured with single-dose therapy of an appropriate nitroimidazole antibiotic, but women who are also infected with HIV should receive therapy for 7 days. Antimicrobial resistance is an emerging concern.
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Affiliation(s)
- Elissa Meites
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Charlotte A Gaydos
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marcia M Hobbs
- Departments of Medicine and Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill
| | - Patricia Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Paul Nyirjesy
- Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Jane R Schwebke
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham School of Medicine
| | - W Evan Secor
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jack D Sobel
- Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, Michigan
| | - Kimberly A Workowski
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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Hashemi-Shahri SM, Sharifi-Mood B, Kouhpayeh HR, Moazen J, Farrokhian M, Salehi M. Sexually Transmitted Infections Among Hospitalized Patients With Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS) in Zahedan, Southeastern Iran. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2016; 5:e28028. [PMID: 27818966 PMCID: PMC5086419 DOI: 10.5812/ijhrba.28028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 06/16/2015] [Accepted: 06/30/2015] [Indexed: 02/06/2023]
Abstract
Background Studies show that nearly 40 million people are living with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) around the world and since the beginning of the epidemic, about 35 million have died from AIDS. Heterosexual intercourse is the most common route for transmission of HIV infection (85%). People with a sexually transmitted infection (STI), such as syphilis, genital herpes, chancroid, or bacterial vaginosis, are more likely to obtain HIV infection during sex. On the other hand, a patient with HIV can acquire other infections such as hepatitis C virus (HCV) and hepatitis B virus (HBV) and also STIs. Co-infections and co-morbidities can affect the treatment route of patients with HIV/AIDs. Sometimes, physicians should treat these infections before treating the HIV infection. Therefore, it is important to identify co-infection or comorbidity in patients with HIV/AIDS. Objectives This study was conducted in order to understand the prevalence of HIV/AIDS/STI co-infection. Patients and Methods In this cross-sectional study, we evaluated all HIV/AIDS patients who were admitted to the infectious wards of Boo-Ali hospital (Southeastern Iran) between March 2000 and January 2015. All HIV/AIDS patients were studied for sexually transmitted infections (STI) such as syphilis, gonorrhea, hepatitis B virus (HBV) and genital herpes. A questionnaire including data on age, sex, job, history of vaccination against HBV, hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), hepatitis B surface antigen (anti-HBs), HCV-Ab, venereal disease research laboratory (VDRL) test, fluorescent treponemal antibody absorption (FTA-Abs) test, and urine culture was designed. Data was analyzed by the Chi square test and P values of < 0.05 were considered significant. Results Among the 41 patients with HIV/AIDS (11 females and 30 males; with age range of 18 to 69 years) five cases (12.1%) had a positive test (1:8 or more) for VDRL. The FTA-Abs was positive for all patients who were positive for VDRL. Gonorrhea was found in seven patients (17%) and three cases had genital herpes in clinical examinations. All patients who had positive test results for these STIs were male. Eleven patients (26.8%) had HBV infection (three females and eight males). hepatitis C virus (HCV) was found in 13 cases (31%). Eighty percent of patients were unemployed. Seventy-eight percent of patients with HIV/STI were aged between 18 and 38 years. There was a significant difference between sex and becoming infected with HIV and also STI (P < 0.05). Conclusions Patients with HIV/AIDS are more likely to acquire other STIs, because the same behaviors that increase the risk of becoming HIV infected can also increase the risk of acquiring STIs. Having a sore on the skin due to an STI can make the transmission of HIV to the sex partner more likely than people who don’t have such sore in their genital area.
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Affiliation(s)
| | - Batool Sharifi-Mood
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Hamid-Reza Kouhpayeh
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Javad Moazen
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Mohsen Farrokhian
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Masoud Salehi
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
- Corresponding author: Masoud Salehi, Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel: +98-54132281012, Fax: +98-5413236722, E-mail:
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Alcaide ML, Feaster DJ, Duan R, Cohen S, Diaz C, Castro JG, Golden MR, Henn S, Colfax GN, Metsch LR. The incidence of Trichomonas vaginalis infection in women attending nine sexually transmitted diseases clinics in the USA. Sex Transm Infect 2015; 92:58-62. [PMID: 26071390 DOI: 10.1136/sextrans-2015-052010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/25/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Trichomoniasis (TV) is associated with an increased risk of acquisition of sexually transmitted diseases (STDs) and HIV. The purpose of this study is to evaluate factors associated with incidence TV among female STD clinic attendees in the USA. METHODS Data were collected from women participating in a randomised controlled trial evaluating brief risk reduction counselling at the time of HIV testing to reduce sexually transmitted infections (STIs) incidence in STD clinics. Participants recruited from STD clinics underwent STI testing at baseline and 6-month follow-up. TV testing was performed using Nucleic Acid Amplification Test. RESULTS 1704 participants completed study assessments. Prevalence of TV was 14.6%, chlamydia 8.6%, gonorrhoea 3.0%, herpes simplex virus 2 44.7% and HIV 0.4%. Cumulative 6-month incidence of TV was 7.5%. Almost 50% of the incident TV cases had TV at baseline and had received treatment. Factors associated with incidence of TV were having chlamydia, TV and HIV at baseline: TV relative risk (RR)=3.37 (95% CI 2.35 to 4.83, p<0.001); chlamydia RR=1.92 (95% CI 1.23 to 2.99, p=0.04); and HIV=1.59 (95% CI 1.01 to 2.50, p=0.047). CONCLUSIONS Prevalent and incident TV is common among STD clinic attendees; and baseline TV is the main risk factor for incident TV, suggesting high rates of reinfection or treatment failures. This supports the importance of rescreening women after treatment for TV, evaluating current treatment regimens and programmes to ensure treatment of sexual partners. CLINICAL TRIAL NUMBER NCT01154296.
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Affiliation(s)
- Maria L Alcaide
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rui Duan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stephanie Cohen
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Chanelle Diaz
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jose G Castro
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Sarah Henn
- Whitman-Walker Health, Washington DC, USA
| | - Grant N Colfax
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
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Co-occurrence of Trichomonas vaginalis and bacterial vaginosis and vaginal shedding of HIV-1 RNA. Sex Transm Dis 2014; 41:173-9. [PMID: 24521723 DOI: 10.1097/olq.0000000000000089] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trichomonas vaginalis (TV) and bacterial vaginosis (BV) are independently associated with increased risk of vaginal shedding in HIV-positive women. Because these 2 conditions commonly co-occur, this study was undertaken to examine the association between TV/BV co-occurrence and vaginal shedding of HIV-1 RNA. METHODS HIV-positive women attending outpatient HIV clinics in 3 urban US cities underwent a clinical examination; were screened for TV, BV, Neisseria gonorrhoeae, Chlamydia trachomatis, and vulvovaginal candidiasis; and completed a behavioral survey. Women shedding HIV-1 RNA vaginally (≥50 copies/mL) were compared with women who had an undetectable (<50 copies/mL) vaginal viral load to determine if women who were TV positive and BV positive or had co-occurrence of TV/BV had higher odds of shedding vaginally when compared with women who did not have these conditions. RESULTS In this sample of 373 HIV-positive women, 43.1% (n = 161) had co-occurrence of TV/BV and 33.2% (n = 124) were shedding HIV-1 RNA vaginally. The odds of shedding HIV vaginally in the presence of TV alone or BV alone and when TV/BV co-occurred were 4.07 (95% confidence interval [CI], 1.78-9.37), 5.65 (95% CI, 2.64-12.01), and 18.63 (95% CI, 6.71-51.72), respectively, when compared with women with no diagnosis of TV or BV, and after adjusting for age, antiretroviral therapy status, and plasma viral load. CONCLUSIONS T. vaginalis and BV were independently and synergistically related to vaginal shedding of HIV-1 RNA. Screening and prompt treatment of these 2 conditions among HIV-positive women are important not only clinically but for HIV prevention, as well.
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Goldman DP, Juday T, Seekins D, Linthicum MT, Romley JA. Early HIV treatment in the United States prevented nearly 13,500 infections per year during 1996-2009. Health Aff (Millwood) 2014; 33:362-9. [PMID: 24590932 PMCID: PMC4124881 DOI: 10.1377/hlthaff.2013.0830] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In recent years, guidelines for HIV treatment have recommended initiation of combination antiretroviral therapy (cART) earlier in the course of the disease than was previously the case. These recommendations stem in part from growing evidence that treatment reduces the risk of sexual transmission. We used an epidemiological model of disease transmission and progression to assess HIV prevention through early treatment-that is, initiation of cART when CD4 white blood cell counts are in excess of 350 cells per cubic millimeter. (CD4 cells are involved in the immune system's defense against tumors and infection; the number of CD4 cells in a cubic millimeter of blood is a standard measure of immune response to antiretroviral therapy.) We estimated that the actual timing of treatment initiation in the United States prevented 188,000 HIV cases in the period 1996-2009. "Very early" treatment (at CD4 counts greater than 500) accounted for four-fifths of the prevented cases. For all of the prevented cases, the losses in life expectancy that were avoided were worth $128 billion, assuming that a life-year has a value of $150,000. These findings underscore the cost-effectiveness of early HIV treatment.
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Active Drug-Using Women Use Female-Initiated Barrier Methods to Reduce HIV/STI Risk: Results from a Randomized Trial. ISRN ADDICTION 2013; 2013:768258. [PMID: 25938118 PMCID: PMC4392969 DOI: 10.1155/2013/768258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 08/02/2013] [Indexed: 11/18/2022]
Abstract
Background. We tested an original, woman-focused intervention, based on body empowerment, and female-initiated barrier methods, including the female condom (FC) and cervical barriers. Methods. Eligible women were >= 18 years of age, HIV seronegative, and active drug users, reporting 30% or greater unprotected sex acts. Both controls (C) and intervention (I) participants received enhanced HIV/STI harm reduction counseling. I participants underwent 5 additional weekly group sessions. We compared change in frequency of unprotected vaginal intercourse across arms at 12 months. Results. Among 198 enrolled women, over 95% completed followup. Two-thirds were African-American; most of them used crack, had a primary partner, and reported sex exchange. In paired t-tests from baseline to followup, the frequency of unprotected vaginal sex dropped significantly for I (primary P < 0.00, nonprimary P < 0.002) and C (primary P < 0.008, nonprimary P < 0.000) arms with all partners. The difference in change across arms was of borderline significance for primary partner (P = 0.075); no difference was seen for nonprimary partner (P = 0.8). Use of male condom and FC increased with both partner types over time, but more consistently among I women. Conclusion: The “value-added” impact of the intervention was observed mainly with primary partners. Body knowledge with routine FC counseling should be incorporated into interventions for drug-using women.
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Stevens-Watkins D, Knighton JS, Mitchell N, Oser CB, Leukefeld C. Perception of Eligible Black Men as a Context for HIV Risk Behavior Among Black Women. JOURNAL OF COMMUNITY PSYCHOLOGY 2013; 41:776-782. [PMID: 24052684 PMCID: PMC3774051 DOI: 10.1002/jcop.21571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
African American women are leading in number of newly diagnosed HIV cases, which is a cause for alarm and has a deleterious impact on families and communities. Research suggests the gender-ratio imbalance as a contextual factor leading to increases in high risk sexual behavior and subsequent increases in the rates of HIV infection among African American women. The current study examines correlates of consistent condom use among 213 single, heterosexual, African American women in the community, on probation, and incarcerated who believe it is difficult to find an eligible Black man. Results of this study reveal that drug using women and incarcerated women were less likely to use condoms consistently. In addition, after controlling for drug use and criminal justice status, age emerged as significant. Specifically, older African American women were less likely to use condoms consistently. Community level implications and targeted prevention efforts are discussed.
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Abstract
OBJECTIVE To discuss the epidemiology of Trichomonas vaginalis (TV) and HIV co-infections, the role of TV in acquisition and transmission of HIV, special treatment considerations for TV among women with HIV and the prevention of TV among HIV-infected persons. DESIGN Systematic review. DATA SOURCE Review of literature of EMBASE and PubMed databases from January 1990 to February 2013. Search keywords included TV, HIV co-infections, HIV acquisition, HIV transmission, HIV shedding, TV treatment, HIV and couples studies. REVIEW METHOD We included studies of any design that contained the selected search words and were published during the specified time frame. We then searched the reference lists of included papers for additional papers and included these when relevant. RESULTS There is strong evidence that TV increases both transmission and acquisition of HIV among women, and that successful treatment for TV can reduce HIV genital shedding. Single dose metronidazole (MTZ) should no longer be used for HIV+ women with TV given the high rates of asymptomatic bacterial vaginosis co-infections and other factors that may render MTZ less effective in HIV+ women. Prevention of TV among HIV+ persons is similar to among HIV, including promotion of condoms as well as regular screening and prompt treatment. There may be a role for expedited partner treatment for the prevention of repeat infections, but most repeat infections are clinical treatment failures. Diligence in screening and treating TV among both HIV- susceptible and HIV+ persons is an important public health strategy.
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Affiliation(s)
- Patricia Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana 70012, USA.
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Khan MR, Berger A, Hemberg J, O'Neill A, Dyer TP, Smyrk K. Non-injection and injection drug use and STI/HIV risk in the United States: the degree to which sexual risk behaviors versus sex with an STI-infected partner account for infection transmission among drug users. AIDS Behav 2013; 17:1185-94. [PMID: 22890684 DOI: 10.1007/s10461-012-0276-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We used the National Longitudinal Study of Adolescent Health (N = 14,322) to measure associations between non-injection crack-cocaine and injection drug use and sexually transmitted infection including HIV (STI/HIV) risk among young adults in the United States and to identify factors that mediate the relationship between drug use and infection. Respondents were categorized as injection drug users, non-injection crack-cocaine users, or non-users of crack-cocaine or injection drugs. Non-injection crack-cocaine use remained an independent correlate of STI when adjusting for age at first sex and socio-demographic characteristics (adjusted prevalence ratio (APR): 1.64, 95 % confidence interval (CI): 1.16-2.31) and sexual risk behaviors including multiple partnerships and inconsistent condom use. Injection drug use was strongly associated with STI (APR: 2.62, 95 % CI: 1.29-5.33); this association appeared to be mediated by sex with STI-infected partners rather than by sexual risk behaviors. The results underscore the importance of sexual risk reduction among all drug users including IDUs, who face high sexual as well as parenteral transmission risk.
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Affiliation(s)
- Maria R Khan
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100231, Gainesville, FL, 32607, USA.
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Lorvick J, Bourgois P, Wenger LD, Arreola SG, Lutnick A, Wechsberg WM, Kral AH. Sexual pleasure and sexual risk among women who use methamphetamine: a mixed methods study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:385-92. [PMID: 22954501 DOI: 10.1016/j.drugpo.2012.07.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 06/25/2012] [Accepted: 07/13/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The intersection of drug use, sexual pleasure and sexual risk behaviour is rarely explored when it comes to poor women who use drugs. This paper explores the relationship between sexual behaviour and methamphetamine use in a community-based sample of women, exploring not only risk, but also desire, pleasure and the challenges of overcoming trauma. METHODS Quantitative data were collected using standard epidemiological methods (N=322) for community-based studies. In addition, using purposive sampling, qualitative data were collected among a subset of participants (n=34). Data were integrated for mixed methods analysis. RESULTS While many participants reported sexual risk behaviour (unprotected vaginal or anal intercourse) in the quantitative survey, sexual risk was not the central narrative pertaining to sexual behaviour and methamphetamine use in qualitative findings. Rather, desire, pleasure and disinhibition arose as central themes. Women described feelings of power and agency related to sexual behaviour while high on methamphetamine. Findings were mixed on whether methamphetamine use increased sexual risk behaviour. CONCLUSION The use of mixed methods afforded important insights into the sexual behaviour and priorities of methamphetamine-using women. Efforts to reduce sexual risk should recognize and valorize the positive aspects of methamphetamine use for some women, building on positive feelings of power and agency as an approach to harm minimization.
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Bachmann LH, Hobbs MM, Seña AC, Sobel JD, Schwebke JR, Krieger JN, McClelland RS, Workowski KA. Trichomonas vaginalis genital infections: progress and challenges. Clin Infect Dis 2012; 53 Suppl 3:S160-72. [PMID: 22080269 DOI: 10.1093/cid/cir705] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Trichomonas vaginalis (TV) infection is the most prevalent curable sexually transmitted infection in the United States and worldwide. Most TV infections are asymptomatic, and the accurate diagnosis of this infection has been limited by lack of sufficiently sensitive and specific diagnostic tests, particularly for men. To provide updates for the 2010 Centers for Disease Control and Prevention's Sexually Transmitted Diseases Treatment Guidelines, a PubMed search was conducted of all TV literature published from 9 January 2004 through 24 September 2008. Approximately 175 pertinent abstracts and articles were reviewed and discussed with national experts. This article describes advances in TV diagnostics which have led to an improved understanding of the epidemiology of this pathogen, as well as potential biologic and epidemiological interactions between TV and human immunodeficiency virus (HIV). New data on treatment outcomes, metronidazole-resistant TV, management of nitroimidazole-allergic patients, frequency of recurrent TV infection following treatment, and screening considerations for TV in certain populations are also presented.
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Affiliation(s)
- Laura H Bachmann
- Infectious Diseases, Wake Forest University Health Sciences, Medical Center Blvd, Winston-Salem, NC 27157, USA.
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Elias LDA, Bastos FI. Saúde pública, redução de danos e a prevenção das infecções de transmissão sexual e sanguínea: revisão dos principais conceitos e sua implementação no Brasil. CIENCIA & SAUDE COLETIVA 2011; 16:4721-30. [DOI: 10.1590/s1413-81232011001300021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 01/23/2010] [Indexed: 11/22/2022] Open
Abstract
Este artigo aborda o contexto histórico e o marco conceitual da implantação dos programas de redução de danos no campo da saúde pública, com ênfase nos programas brasileiros. A presente revisão teve como objetivo principal investigar a pertinência atual de tais programas no enfrentamento das infecções de transmissão sexual e sanguínea, em especial, a AIDS e a hepatite C. Os resultados sistematizados pela literatura nacional e internacional indicam que as ações práticas de redução de danos são mais efetivas quando integradas a outras medidas de saúde pública, guiadas por princípios em comum. Iniciativas de redução de danos afinadas com princípios de saúde pública não se prendem a modelos, nem se esgotam em cuidados de saúde propriamente ditos. Abrangem diversas modalidades de ações pragmáticas, com base em políticas públicas, devem estar em sintonia com a comunidade desde seu planejamento, e serem executadas em parceria com esta.
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Ober AJ, Iguchi MY, Weiss RE, Gorbach PM, Heimer R, Ouellet LJ, Shoptaw S, Anglin MD, Zule WA. The relative role of perceived partner risks in promoting condom use in a three-city sample of high-risk, low-income women. AIDS Behav 2011; 15:1347-58. [PMID: 20976538 PMCID: PMC3180610 DOI: 10.1007/s10461-010-9840-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We examined the effect of women’s perceptions of sexual partner risks on condom use. Women from three US cities (n = 1,967) were recruited to provide data on HIV risks. In univariate models, increased odds of condom use were associated with perceiving that partners had concurrent partners and being unaware of partners': (a) HIV status, (b) bisexuality, (c) concurrency; and/or (d) injection drug use. In multivariate models, neither being unaware of the four partner risk factors nor perceiving a partner as being high risk was associated with condom use. Contextual factors associated with decreased odds of condom use were having sex with a main partner, homelessness in the past year, alcohol use during sex, and crack use in the past 30 days. Awareness of a partner’s risks may not be sufficient for increasing condom use. Contextual factors, sex with a main partner in particular, decrease condom use despite awareness of partner risk factors.
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Affiliation(s)
- Allison J Ober
- Integrated Substance Abuse Programs, David Geffen School of Medicine, Semel Institute for Neuroscience and Behavior, University of California, Los Angeles, 90025, USA.
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Williams M, Bowen A, Atkinson JS, Nilsson-Schönnesson L, Diamond PM, Ross MW, Pallonen UE. An assessment of brief group interventions to increase condom use by heterosexual crack smokers living with HIV infection. AIDS Care 2011; 24:220-31. [DOI: 10.1080/09540121.2011.597707] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mark Williams
- a College of Public Health and Social Work , Florida International University , Miami , FL , USA
| | - Anne Bowen
- b School of Nursing , University of Wyoming, School of Nursing , Laramie , WY , USA
| | - John S. Atkinson
- c School of Public Health , University of Texas Health Science Center , Houston , TX , USA
| | | | - Pamela M. Diamond
- c School of Public Health , University of Texas Health Science Center , Houston , TX , USA
| | - Michael W. Ross
- c School of Public Health , University of Texas Health Science Center , Houston , TX , USA
| | - Unto E. Pallonen
- e Center for Health Promotion and Prevention Research , University of Texas Health Science Center , Houston , TX , USA
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Kucirka LM, Sarathy H, Govindan P, Wolf JH, Ellison TA, Hart LJ, Montgomery RA, Ros RL, Segev DL. Risk of window period HIV infection in high infectious risk donors: systematic review and meta-analysis. Am J Transplant 2011; 11:1176-87. [PMID: 21366859 PMCID: PMC3110509 DOI: 10.1111/j.1600-6143.2010.03329.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The OPTN defines high risk donors (HRDs), colloquially known as 'CDC high risk donors', as those thought to carry an increased risk of HIV window period (WP) infection prior to serologic detectability. However, the true risk of such infection remains unknown. To quantify the risk of WP infection in each HRD behavior category, we performed a systematic review and meta-analysis of studies of HIV prevalence and incidence. Of 3476 abstracts reviewed, 27 eligible studies of HIV infection in HRD populations were identified. Pooled HIV incidence estimates were calculated for each category of HRD behavior and used to calculate the risk of WP HIV infection. Risks ranged from 0.09-12.1 per 10 000 donors based on WP for ELISA and 0.04-4.9 based on nucleic acid testing (NAT), with NAT reducing WP risk by over 50% in each category. Injection drug users had the greatest risk of WP infection (4.9 per 10 000 donors by NAT WP), followed by men who have sex with men (4.2:10 000), commercial sex workers (2.7:10 000), incarcerated donors (0.9:10 000), donors exposed to HIV through blood (0.6:10 000), donors engaging in high-risk sex (0.3:10 000) and hemophiliacs (0.035:10 000). These estimates can help inform patient and provider decision making regarding HRDs.
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Affiliation(s)
- Lauren M. Kucirka
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Harini Sarathy
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Joshua H. Wolf
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Trevor A. Ellison
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Robert A. Montgomery
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - R. Lorie Ros
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD
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Clinical Trial Report: Duration of Metronidazole Therapy in HIV-infected Women with Trichomonas vaginalis: Is More Metronidazole Better? Curr Infect Dis Rep 2011; 13:112-4. [PMID: 21365373 DOI: 10.1007/s11908-010-0161-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
PURPOSE OF REVIEW We review recent evidence about the link between sexually transmitted infections (STI) and HIV transmission and consider implications for control programmes. RECENT FINDINGS New studies and meta-analyses confirm the association of HIV acquisition and transmission with recent STIs, although there is considerable heterogeneity between organisms and populations. Much of the recent evidence relates to herpes simplex virus type 2 (HSV-2), for which the population-attributable risk percentage (PAR%) for HSV-2 is between 25 and 35 in Africa. Mathematical models show how transmission attributable to STI varies with HIV epidemic phase, and HSV-2 becomes increasingly important as the epidemic matures. HSV-2 suppressive therapy reduces HIV concentrations in plasma and the genital tract in people coinfected with HSV-2, in part due to direct inhibition of HIV reverse transcriptase. Recent trials of HSV-2 suppressive therapy have not shown an impact on the risk of HIV acquisition, nor in controlling transmission from dually infected people to their serodiscordant heterosexual partners. SUMMARY Although there is a plausible link between STI and HIV risk, intervention studies continue to be disappointing. This fact does not disprove a causal link, but mechanisms of action and the design and implementation of interventions need to be better understood.
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Affiliation(s)
- Helen Ward
- Department of Infectious Disease Epidemiology, Imperial College, London, UK.
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Oramasionwu CU, Brown CM, Ryan L, Lawson KA, Hunter JM, Frei CR. HIV/AIDS disparities: the mounting epidemic plaguing US blacks. J Natl Med Assoc 2010; 101:1196-204. [PMID: 20070007 DOI: 10.1016/s0027-9684(15)31130-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The human immunodeficiency virus (HIV)/AIDS epidemic presents a formidable challenge for the black community. Blacks, although a small proportion of the US population, are overrepresented, not only in the number of people living with HIV, but also in the categories of new diagnoses and AIDS-related deaths. Fortunately, national initiatives are in place to slow and ultimately reverse these racial inequities. While these disparities may be widely recognized, their causes are not clearly understood. A variety of underlying issues exist for blacks in the United States that may also contribute to these growing disparities. These include transmission risk factors, socioeconomic factors, underrecognition, delayed presentation, and other comorbid conditions. We present a review of the literature regarding the potential causes of racial disparities and how they may contribute to health outcomes for blacks with HIV/AIDS in the United States. We also identify possible gaps in knowledge and offer future directions for research of HIV/AIDS racial disparities.
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Semaan S, Neumann MS, Hutchins K, D'Anna LH, Kamb ML. Brief counseling for reducing sexual risk and bacterial STIs among drug users--results from project RESPECT. Drug Alcohol Depend 2010; 106:7-15. [PMID: 19720471 DOI: 10.1016/j.drugalcdep.2009.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 06/30/2009] [Accepted: 07/16/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Project RESPECT's brief risk reduction counseling (BRRC) reduced sexual risk and bacterial STIs among at-risk heterosexuals and has been packaged for use with this population. We assessed BRRC's efficacy with RESPECT participants who used drugs and examined BRRC's applicability to present-day users of heroin, cocaine, speedball, or crack. METHODS We compared baseline demographic and economic variables, risk behaviors, and prevalence and correlates of bacterial STIs for ever-injectors ([EIs], N=335) and never-injectors ([NIs], N=3963). We assessed changes in risk behaviors and bacterial STIs for EIs and NIs at 12 months. We compared prevalence of HSV-2, hepatitis B core antigen virus (HBV), hepatitis C virus (HCV), and trichomonas among EIs with recently reported rates among drug users. RESULTS At baseline, 19% of EIs and 29% of NIs had bacterial STIs. Both groups had similar baseline STI correlates. At 12 months, 4% of EIs and 7% of NIs had bacterial STIs. Twelve-month cumulative incidence of bacterial STIs in BRRC was 21% lower among EIs and 18% lower among NIs compared to the informational condition. At 12 months, EIs reported fewer sexual risk behaviors than at baseline. Baseline positivity rates of trichomoniasis in EIs (female: 15%) and in male and female EIs of HSV-2 (39%, 68%), HBV (41%, 37%), and HCV (60%, 58%) were similar to rates in present-day drug users. CONCLUSION Efficacy of BRRC in reducing sexual risk and bacterial STIs in EIs, and similar profiles for EIs and present-day drug users suggest evaluating BRRC with present-day drug users.
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Affiliation(s)
- Salaam Semaan
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Office of the Director, 1600 Clifton Rd, NE, E-07, Atlanta, GA 30333, United States.
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