Illicit drug use in university students in the UK and Ireland: a PRISMA-guided scoping review

BACKGROUND

Interest in the health and well-being of university students has increased in the UK and Ireland in the past two decades as their numbers have grown. Recent high-profile deaths of students after using illicit drugs have highlighted the importance of the topic for policy makers. This scoping review maps the state of the existing literature evaluating use of illicit drugs in university students in the UK and Ireland. It aims to highlight research gaps and inform policy.

METHOD

We conducted a systematic search of papers related to psychoactive drug use in university students in the UK and Ireland published before August 2021. The 18 extracted study characteristics included author(s); year of publication; journal; location of data collection; study design; delivery method (e.g., online survey, in-person, postal survey); number of participants; response rate; participant course of study, year of study, degree level (i.e., undergraduate, postgraduate), gender and age; time-period assessed (e.g., lifetime, current use, past 12 months); primary aim; primary outcome; ethical approval; and funding source.

RESULTS

The PRISMA-guided search strategy identified 1583 papers for abstract review; of 110 papers retained for full-text review, 54 studies met criteria for inclusion for this paper. Primary outcomes were coded into five groups: prevalence and patterns of drug use; factors associated with drug use; attitudes and knowledge about, and motivation for, drug use; supply of drugs; consequences of drug use. The results show that there is no coherent body of research in this area. The prevalence of reported drug use has crept up and the range of substances reported has broadened over time, and attitudes to drugs on average have normalised. However, there are significant methodological limitations that limit the utility of these findings. There was little evidence of published work on prevention of, or intervention to reduce, drug-related harms.

CONCLUSION

The domains identified offer a framework for university administrators, researchers and policy makers to understand the potential response to drug use in university students in the UK and Ireland. Recommendations are made to fill the gaps in the research evidence base.

Willingness to human papillomavirus (HPV) vaccination and influencing factors among male and female university students in China

This study compared the willingness to receive human papillomavirus (HPV) vaccination and the influencing factors between male and female university students who had never been vaccinated against HPV in China. University students were recruited from seven universities in China. A self-administered questionnaire was used to collect information about demographic characteristics, willingness to HPV vaccination, and possible influencing factors including demographics, knowledge, and attitude toward HPV vaccination. The χ2 test was used to test the difference between males and females' knowledge and attitudes to HPV vaccination. Multivariate logistic regression was employed to detect the factors associated with willingness to HPV vaccination. A total of 7335 university students participated in the survey (3570 males and 3765 females). Over 70% of the participants had previously received sex education and knowledge. The average age of sexual debut was 17.5 years old. More male students reported acceptance of premarital sex than female students did (χ2  = 708.458, p < 0.001). Female students had better knowledge and attitudes to HPV in general, while male students perceived a higher chance of being infected by HPV compared with female students (χ2  = 6.047, p =  0.014). The level of knowledge (male: adjusted odds ratio [AOR] = 1.935, 95% confidence interval [CI]:1.516-2.470; female: AOR = 1.227, 95% CI: 1.055-1.428) and receiving sex education (male: AOR = 1.414, 95% CI: 1.109-1.804; female: AOR = 1.289, 95% CI: 1.064-1.562) were indicators of the HPV vaccination willingness for both genders. For male students, those who had ever inoculated optional self-paid vaccines were more likely to receive the HPV vaccine than those who had not (AOR = 1.567, 95% CI: 1.242-1.977). Female students were more willing to be vaccinated against HPV, if they had higher living expenses (AOR = 1.395 and 3.717, 95% CI: 1.071-1.426 and 1.776-7.752), relatives or friends had certain cancer (AOR = 1.290, 95% CI: 1.095-1.518), ever had sexual experiences (AOR = 2.628, 95% CI: 1.788-3.863), and had ever consulted on HPV vaccination issues (AOR = 1.612, 95% CI: 1.367-1.901). In China, more active education should be provided to improve university students' knowledge and attitudes on HPV and HPV vaccination. Including HPV vaccine uptake for both males and females at recommended ages in National Immunization Program would be the most cost-effective way to prevent HPV infection.

Association between coping strategies and drug use in a large cohort of students from a northern Italian University

BACKGROUND AND AIM OF THE WORK

Illicit drug (ID) use/abuse represent a social and economic burden for most countries worldwide which, in spite of the efforts to prevent this phenomena, is often a growing habit especially in the young adults. Preventive measurements, are needed to reduce the adverse health and social consequences of ID use/abuse.

METHODS

This study investigated the relationship between coping strategies and ID use in students (N=12316) from the University of Parma, Italy. Information about the ID use in the past 12 months and coping strategies were collected with a cross-sectional research design using an online questionnaire.

RESULTS

More than 25% of the participants used ID in the past year; men were more likely to use drugs than female; the likelihood of using drugs was inversely related to age. The relationship between coping strategies and ID use was analyzed with a multilevel logistic model taking into account the within-department nested structure of data. Analysis revealed that transcendence-orientation and problem-orientation were associated with a reduction of the likelihood to have used drugs. Conversely, avoidance and positive attitude were associated with an increase of the likelihood to have used drugs. Finally, seeking social support revealed a positive but modest association with increasing in drug use.

CONCLUSIONS

The ID use association factors identified in this study could be utilized by the appropriate institutions/authorities as a critical review in order to develop relevant public health policies and preventive measures aimed at minimizing the use of ID in this critical age group.

The Sexual Risk Behaviors Scale (SRBS): Development & Validation in a University Student Sample in the UK

University students are at risk of poor sexual health outcomes. The aim of this study was to develop and test the psychometric properties of the Sexual Risk Behaviors Scale (SRBS), a novel short tool for measuring engagement in sexual risk behaviors in university students. We developed a pool of six items based on a review of recent literature and tested its properties in 547 undergraduate students in the United Kingdom. We used Exploratory Factor Analysis and Confirmatory Factor Analysis to explore and determine the factor structure and dimensionality of the SRBS. We used Item Response Theory and specifically the Graded Response Model to investigate items’ discrimination, information, and differential functioning, respectively, and logistic regression to test whether higher SRBS scores predicted a diagnosis of any sexually transmitted infections in the past 12 months. Results showed that a unidimensional, five-item model fitted the data well, showing satisfactory fit indices and reliability, with all items providing adequate discrimination and information, and no differential item functioning by gender nor by sexual orientation. SRBS total scores significantly predicted the odds of being diagnosed with sexually transmitted infections in the past 12 months. Implications for public health prevention and intervention are discussed.

Health outcomes associated with crack-cocaine use: Systematic review and meta-analyses

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.

Self-reported sexually transmitted infections among female university students

AIM

To investigate the occurrence of self-reported sexually transmitted infections (STIs) and associated factors among female university students requesting contraceptive counselling.

MATERIAL AND METHODS

Cross-sectional study. Female university students (n = 353) completed a waiting-room questionnaire in connection with contraceptive counselling at a Student Health Centre in Uppsala, Sweden.

RESULTS

Ninety-three (26.3%) female students had experienced an STI. The three most frequently reported STIs were chlamydia trachomatis, condyloma, and genital herpes. The experience of an STI was significantly associated with the total number of sexual partners (OR 1.060, 95% CI 1.030-1.091, P < 0.001), being heterosexual (OR 4.640, 95% CI 1.321-16.290, P = 0.017), having experienced an abortion (OR 2.744, 95% CI 1.112-6.771, P = 0.028), not being HPV-vaccinated (OR 2.696, 95% CI 1.473-4.935, P = 0.001), and having had intercourse on first night without using a condom (OR 2.375, 95% CI 1.182-4.771, P = 0.015).

CONCLUSIONS

Contraceptive counselling should also include information about primary and secondary prevention of STI, such as the importance of correct use of a condom and STI testing, to prevent a further spread of STIs.

How university students view human papillomavirus (HPV) vaccination: A cross-sectional study in Jinan, China

The acceptability of HPV vaccination among university students in China is not well understood. Our study was of cross-sectional study design. We collected a questionnaire about socio-demographic characteristics, knowledge of, attitude toward and acceptability of HPV vaccination. A total of 351 students were included in data analyses, among whom 47.6% were males and 70.0% aged 19-21. Only 10.3% had previously heard of HPV and 5.4% HPV vaccine. Male and female students were equally likely to accept HPV vaccine (71.8 vs 69.4%, p = 0.634) and recommend it to sexual partners (73.1 vs 76.7%, p = 0.441). The great majority of students could only afford RMB 300 (USD 50) or less for HPV vaccination. HPV vaccination acceptance was associated with being in year-one (Adjusted odds ratio (AOR)  = 3.78, 95% confidence interval (CI): 2.12-6.75), being from a key university (AOR = 1.88, 95%CI: 1.07-3.31), having heard of HPV-related morbidities (AOR = 1.88, 95% CI: 1.05-3.35), being concerned about HPV-related morbidities (AOR = 2.23, 95% CI: 1.16-4.27) and believing the vaccine should be given before first sexual contact (AOR = 2.44, 95% CI: 1.38-4.29). Female students were more likely to anticipate a late uptake of HPV vaccination (p = 0.002). The relatively lower levels of HPV knowledge but higher levels of vaccine acceptance among undergraduates highlighted the need for education on the roles of sexual behaviors in HPV transmission.

ATTITUDES TOWARDS AND PRACTICE OF SEXUALITY AMONG UNIVERSITY STUDENTS IN LEBANON

Sexuality is still a taboo in Middle Eastern countries, and Lebanon is no exception. This study’s objective was to evaluate attitudes towards sexuality and its practice among university students in Lebanon and assess their respective correlates. The cross-sectional study was carried out among students selected from seventeen universities across Lebanon. The participants received a self-administered standardized questionnaire that assessed their attitudes towards sexuality. It included questions on socio-demographic factors, risk-taking, risky behaviours and sexuality-related questions. Among 3384 students, 2700 (79.8%) answered the questions on sexuality. Around 15% had engaged in sexual activity, while 20% were regularly sexually active. Among males, 34.8% had never had sexual activity, 29.9% had tried it and 35.3% were regularly sexually active. Among females the results were respectively 85.1%, 5.3% and 9.6% (p<0.001). Only 36% regularly used condoms during their relationships. A liberal attitude towards sex, male sex, motives for risky behaviours, current cigarette smoking and problematic alcohol consumption were associated with sexual activity. Realizing that risky behaviours are dangerous, health concerns related to sexual relationships and a liberal attitude towards sex were associated with regular condom use. However, being bothered by condoms and female sex were inversely associated with condom use. Finally, participants who had motives for, and those who felt excited about risky behaviours, and those reporting current cigarette and waterpipe smoking and problematic alcohol consumption (β=0.600; p=0.002) embraced a more liberal attitude towards sex. Conversely, females (β=−7.58; p<0.001) and individuals who considered risky behaviours as dangerous reported an unfavourable attitude towards sexuality. A substantial proportion of Lebanese university students have regular sexual activity, but a low percentage use condoms for protection. Interventions are required among males in particular in view of these attitude and behavioural changes towards sexuality.

Predictors of illicit drug/s use among university students in Northern Ireland, Wales and England

INTRODUCTION

The use of illicit drug/s among university students is a public health concern. Nevertheless, many UK studies investigated a narrow spectrum of variables to explore their association/s with illicit drug/s use.

METHODS

We assessed the associations between a wide range of socio-demographic, health and wellbeing variables (independent variables) and having used illicit drug/s regularly, occasionally or never in life (dependent variables). Data (3706 students) were collected from seven universities in England, Wales, and Northern Ireland, using a self-administered questionnaire.

RESULTS

About 5% of the sample had regularly used illicit drug/s, 25% occasionally, and 70% never. Regular drug use (RDU) was significantly more likely among males aged 21-29 years, daily smokers, those with heavy episodic drinking or possible alcohol dependency (CAGE test), and those who perceived their academic performance better than their peers. RDU was less likely among students with high health awareness and those living with parents. The predictors of occasional drug use (ODU) were similar to those of RDU. However, in addition, students with higher perceived stress were less likely, and students who felt financial burden/s were more likely to report ODU, while no association with academic performance was found. Never use of illicit drug/s was inversely associated with most of the variables listed above, and was positively associated with religiosity. Illicit drug/s use goes along with other substance use (alcohol and smoking). The finding that illicit drug/s use was higher among students reporting good academic performance was surprising and raises the question of whether illicit drug/s may be used as performance enhancing drugs.

CONCLUSION

The factors identified with illicit drug/s use in this study could be utilized to develop appropriate public health policies and preventive measures for the health of students. Multilevel, value based, comprehensive, and strategic long-term intervention plans are required. This could include social interventions aimed at generating recreations alternatives and opportunities for youth, and a critical review for current authorities' interventions and services. Suggestions for coping with problems of campus illicit drug use/abuse also need to be offered.

Drug use, sexual risk behaviour and sexually transmitted infections among swingers: a cross-sectional study in The Netherlands

OBJECTIVES

Recreational drug use has been found to be associated with high-risk sexual behaviour and with sexually transmitted infections (STI). This study is the first to assess the prevalence of drug use among swingers (heterosexuals who, as a couple, practise mate swapping or group sex, and/or visit sex clubs for couples), and its association with high-risk sexual behaviour and STI.

METHODS

We recruited individuals who self-identified as swingers and visited our STI clinic (from 2009 to 2012, South Limburg, The Netherlands). Participants (n=289; median age 45 years; 49% female) filled in a self-administered questionnaire on their sexual and drug use behaviour while swinging, over the preceding 6 months. We assessed associations between sexual behaviour, drug use and STI diagnoses (Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), syphilis, HIV and hepatitis B) using logistic regression analyses.

RESULTS

Overall, the prevalence of CT and/or NG was 13%. No other STIs were observed. Seventy-nine percent of swingers reported recreational drug use (including alcohol and use of erectile dysfunction drugs); 46% of them reported multiple drug use. Recreational drug use excluding alcohol and erectile dysfunction drugs (reported by 48%) was associated with high-risk behaviours in men and women. Drug use was independently associated with STI in female swingers, especially those who practice group sex.

CONCLUSIONS

High rates of multiple drug use, as well as risky sexual behaviour and STIs among swingers, warrant paying more attention to this key population in prevention and care, as they are a risk group that is generally under-recognised and underserved in care.

Social and psychosocial factors associated with high-risk sexual behaviour among university students in the United Kingdom: a web-survey

In the UK there are limited data about university students’ risky sexual behaviour. A cross-sectional web-survey was conducted to investigate factors associated with high-risk sex among students at two UK universities. High-risk sex was reported by 25% of 1108. High personal sexually transmitted infection (STI) risk perception and permissive attitudes towards casual sex were associated with high-risk sex for both men (odds ratio [OR]: 12.12; 95% confidence interval [CI]: 4.10–35.81; OR: 2.49; 95%CI: 1.11–5.56, respectively) and women (OR: 22.31; 95% CI: 9.34–53.26; OR: 3.02; 95% CI: 1.82–5.01, respectively). For men, drinking alcohol (OR: 17.67; 95% CI: 1.90–164.23) and for women age and frequent drinking (OR: 2.02; 95% CI: 1.05–3.89; OR: 1.89; 95% CI: 1.08–3.31, respectively) were associated with high-risk sex. However, perceiving an average student as more likely to contract STIs (men, OR: 0.34; 95% CI: 0.16–0.75) or HIV (men, OR: 0.44; 95% CI: 0.20–0.96; women, OR: 0.42; 95% CI: 0.28–0.63) and finding it difficult to discuss sexual matters (women, OR: 0.60; 95% CI: 0.39–0.91) were negatively associated with high-risk sex. Most of the factors found were similar to other populations, but some psychosocial factors showed complex patterns of association that require further investigation.

Prevention and treatment of college student drug use: A review of the literature

Drug use during the college years is a significant public health concern. The primary goal of this paper is to provide a comprehensive review of prevention and treatment studies of college student drug use in order to guide college prevention efforts and to inform and stimulate new research in this area. First, established risk factors for drug use were reviewed. High levels of personality traits including, impulsivity, sensation-seeking, negative emotionality, emotional dysregulation, and personality disorder symptoms increase risk for drug use. Drug use has also been linked to overestimating normative levels of drug use and experiencing negative life events, and specific motives for drug use are linked to more problematic patterns. There have been very few studies examining prevention and treatment, but parent-based and in-person brief motivational interventions appear to be promising. Longitudinal studies of the development and course of drug use among college students, as well as clinical trials to evaluate novel theoretically-based intervention and prevention programs that take into account established risk factors for drug abuse are needed.

School-based sex education is associated with reduced risky sexual behaviour and sexually transmitted infections in young adults

OBJECTIVE

To quantify the effectiveness of school-based sexual education on risky sexual behaviour and sexually transmitted infection (STI) acquisition in adulthood.

STUDY DESIGN

Online survey of sexual attitudes and behaviours.

METHODS

Students at a British university were surveyed regarding where they learnt most about sex at 14 years of age, how easy they found talking about sexual issues with their parents and age at first intercourse. The effects of these factors were modelled on risk of recent unprotected intercourse and self-reported STIs in adulthood.

RESULTS

Seventy-eight of 711 (11%) students reported unprotected intercourse in the 4 weeks before the survey, and 44 (6.2%) students had ever been diagnosed with an STI. Both age at first intercourse (risk reduced by 11% per year of delayed intercourse, 95% confidence interval (CI) 3-19%) and learning about sex from lessons at school (66% reduction in risk compared with learning from one's mother, 95% CI 5-88%) were associated with reductions in risk of unprotected intercourse. Factors associated with fewer STIs were age at first intercourse (17% reduction per year of delayed intercourse, 95% CI 5-28%); and learning about sex from lessons at school (85% reduction, 95% CI 32-97%), from friends of the same age (54% reduction, CI 7-77%) and from first boy/girlfriend (85% reduction, 95% CI 35-97%) compared with learning from one's mother.

CONCLUSION

School-based sexual education is effective at reducing the risk of unprotected intercourse and STIs in early adulthood. Influence from friends in adolescence may also have a positive effect on the risk of STIs in later life.

Recreational drug use during sex and sexually transmitted infections among clients of a city sexually transmitted infections clinic in Amsterdam, the Netherlands

BACKGROUND

Recreational drug use is associated with high-risk sexual behavior and sexually transmitted infections (STIs). We assessed the prevalence of drug use during sex and the associations between such use and STI (chlamydia, gonorrhea, or syphilis).

METHODS

During 3 periods in 2008 and 2009, attendees of an STI clinic in Amsterdam were interviewed about sexual behavior and drug use during sex and tested for STI. Associations between sex-related drug use and STI were assessed separately for heterosexual men, men who have sex with men (MSM), and women. We examined whether drug use was associated with STI after adjusting for high-risk sexual behavior.

RESULTS

Nine hundred sixty-one heterosexual men, 673 MSM, and 1188 women participated in this study. Of these, 11.9% had chlamydia, 3.4% gonorrhea, and 1.2% syphilis. Sex-related drug use in the previous 6 months was reported by 22.6% of heterosexual men, 51.6% of MSM, and 16.0% of women. In multivariable analyses, adjusting for demographics (and high-risk sexual behavior in MSM), sex-related drug use was associated with STI in MSM (any drugs and poppers) and women (GHB and XTC) but not in heterosexual men. Stratified analysis in MSM showed that sex-related use of poppers was associated with STI in HIV-negative MSM but not in HIV-infected MSM.

CONCLUSION

Clients reported frequent sex-related drug use, which was associated with STI in MSM and women. In MSM, sex-related drug use was associated with STI after adjusting for high-risk sexual behavior but only in HIV-negative MSM. Prevention measures targeted at decreasing sex-related drug use could reduce the incidence of STI.

Health Risk Behavior and Sexual Assault Among Ethnically Diverse Women

Sexual assault is associated with a number of health risk behaviors in women. It has been hypothesized that these risk behaviors, such as hazardous drinking, may represent women's attempts to cope with psychological distress, such as symptoms of depression and anxiety. However, extant research has failed to evaluate these relationships among ethnic minority samples or identify the mechanisms responsible for this association. The current study examined sexual assault history and two health risk behaviors (hazardous drinking and engaging in sexual behavior to regulate negative affect) in a diverse sample of 1,620 college women. Depression and anxiety were examined as mediators of the relationship between sexual assault and health risk behaviors. There was evidence of moderated mediation, such that for European American women, but not for ethnic minority women, both forms of psychological distress were significant mediators of the sexual assault/hazardous drinking relationship. In contrast, among all ethnic groups, the relationship between sexual assault and both forms of psychological distress was mediated by the use of sexual behavior as an affect regulation strategy. Results support a need to evaluate the assault experiences of ethnically diverse women, as well as the impact of the assault on their postassault experiences including health risk behaviors and psychological adjustment. Additionally, results suggest that practitioners should carefully assess health risk behaviors among victims of sexual assault and be aware that there may be differences in the risk factors and motives for these behaviors among women of various ethnic backgrounds.

Discordance between adolescent real and ideal sex partners and association with sexually transmitted infection risk behaviors

PURPOSE

Epidemic levels of sexually transmitted infections (STIs) among urban youth have drawn attention to the potential role of sex partner selection in creating risk for STIs. The objectives of this study were to describe the ideal preferences and real selection of sex partners, to evaluate sex partner ideal versus real discordance using quantitative methods, and to determine the association between discordance and STI risk behaviors.

METHODS

Data are obtained from an urban, household sample of 429 individuals aged 15-24 years. Trait clusters were developed for participants' ratings of their real and ideal sex partners and tested for reliability. Discordance between the ratings of real and ideal partners was measured. Logistic regression was used to assess associations between sex partner discordance and STI risk behaviors.

RESULTS

Ratings of the real sex partners were often lower than participants' ideal sex partner ratings. A total of 33% of male adolescents and young men and 66% of female adolescents and young women were discordant on at least one trait cluster. Male adolescents and young men who were discordant on the emotional support they expected of their partner were more likely to report more than two sex partners in the past 90 days (odds ratio = 2.13, 95% confidence interval: 1.06-4.26) and perceived partner concurrency (odds ratio = 3.85, 95% confidence interval: 1.53-9.72). For female adolescents and young women, discordance on fidelity or emotional support significantly increased the odds of all risk behaviors.

CONCLUSION

Male and female adolescents with discordant real and ideal sex partner ratings were more likely to report STI-related risk behaviors. Further steps should involve identification of factors associated with ideal versus real sex partner discordance, such as features of the social context.

Foreign travel associated with increased sexual risk-taking, alcohol and drug use among UK university students: a cohort study

We conducted a prospective cohort study to assess sexual behaviour of students at a British University during the summer break, to explore the role of foreign travel as a risk factor of sexually transmitted infections acquisition and to determine characteristics associated with casual sex. We found that those who travelled abroad were more likely to use alcohol (RR 1.59, 95% CI 1.17–2.16) and cannabis (RR 1.35, 95% CI 1.13–1.62) and to have casual sex during holidays. They also reported more sexual relationships after holidays (RR 1.26, 95% CI 1.09–1.53). New partnerships during holidays were associated with being single, foreign travel, drinking alcohol and having previously had large number of sexual partners. The adjusted relative risk of developing new sexual partnerships with foreign travel was 2.70 (95% CI 1.11–6.61). People who travel abroad during holidays are more likely to engage in risk taking behaviour and have casual sex. They are also more sexually active after holidays.

Denial of risk behavior does not exclude asymptomatic anorectal sexually transmitted infection in HIV-infected men

BACKGROUND

The Centers for Disease Control recommend screening for asymptomatic sexually transmitted infection (STI) among HIV-infected men when there is self-report of unprotected anal-receptive exposure. The study goals were: (1) to estimate the validity and usefulness for screening policies of self-reported unprotected anal-receptive exposure as a risk indicator for asymptomatic anorectal infection with Neisseria gonorrhoeae (GC) and/or Chlamydia trachomatis (CT). (2) to estimate the number of infections that would be missed if anal diagnostic assays were not performed among patients who denied unprotected anorectal exposure in the preceding month.

METHODS AND FINDINGS

Retrospective analysis in HIV primary care and high resolution anoscopy (HRA) clinics. HIV-infected adult men were screened for self-reported exposure during the previous month at all primary care and HRA appointments. Four sub-cohorts were defined based on microbiology methodology (GC culture and CT direct fluorescent antibody vs. GC/CT nucleic acid amplification test) and clinical setting (primary care vs. HRA). Screening question operating characteristics were estimated using contingency table methods and then pooled across subcohorts. Among 803 patients, the prevalence of anorectal GC/CT varied from 3.5-20.1% in the 4 sub-cohorts. The sensitivity of the screening question for self-reported exposure to predict anorectal STI was higher in the primary care than in the HRA clinic, 86-100% vs. 12-35%, respectively. The negative predictive value of the screening question to predict asymptomatic anorectal STI was > or = 90% in all sub-cohorts. In sensitivity analyses, the probability of being an unidentified case among those denying exposure increased from 0.4-8.1% in the primary care setting, and from 0.9-18.8% in the HRA setting as the prevalence varied from 1-20%.

CONCLUSION

As STI prevalence increases, denial of unprotected anal-receptive exposure leads to an increasingly unacceptable proportion of unidentified asymptomatic anorectal STI if used as a criterion not to obtain microbiologic assays.

Sexual behaviour, drugs and alcohol use of international students at a British university: a cross-sectional survey

The aim of the study was to determine whether international students have greater risk-taking behaviours that could lead to importing novel and resistant strains of sexually transmitted infections (STIs). We conducted a cross-sectional web-based survey of university students' sexual behaviour, alcohol and drug use, and self-reported diagnosis of STIs and compared these between British and international students. In all, 827 students completed the survey, of whom 123 (15%) were international students. International students were less likely to have ever drunk alcohol (95.4% versus 87.8%, P = 0.002) and used drugs (56.4% versus 41.5%, P = 0.002). International students were on average almost two years older at first intercourse (18.7 versus 17 years; P < 0.001). There were no differences in the number of sexual partners between national and international students. On a discriminant analysis model, international students were characterized by being older and from a non-white background, less likely to use cocaine, they drank alcohol less frequently and were more likely to have had unprotected intercourse with two or more partners in the previous year. In conclusion, international students tend to drink more moderately and use fewer recreational drugs than British students. However, they exhibit higher sexual risk behaviours that could lead to importing novel and resistant strains of STIs.