Evaluation of Horn Bud Wound Healing Following Cautery Disbudding of Dairy Calves With and Without the Use of Oxytetracycline Aerosol Spray

Oxytetracycline is commonly applied as a topical agent to burn lesions post cautery disbudding of calves. Judicial use of antibiotics dictates that they should only be used where necessary to reduce the development of resistance in target bacteria. The objective of this study, therefore, was to evaluate the efficacy of topical oxytetracycline spray on wound healing post cautery disbudding of dairy calves over a 6-week period. Dairy calves were disbudded by veterinarians, technicians, or veterinary surgeons, using a standard cautery disbudding protocol. Oxytetracycline spray was randomly applied to the right or left horn bud of each animal (OXY), while the other horn bud received no antibiotic spray (NA). The outcomes measured were wound diameter (WD) and lesion score (LS), either normal healing (NH) or abnormal healing (AH). These assessments were conducted every 14 days following disbudding, until 42 days. A total of 360 animals completed the study. There was a difference in wound diameter and lesion score on day 14 post disbudding between the two groups. Cautery lesions sprayed with oxytetracycline (OXY) were 0.5 ± 0.15 mm smaller than NA lesions (P = 0.001), and there were fewer abnormal healing lesions for OXY compared to the NA (2.5 vs. 11%, respectively; P ≤ 0.001). There were no differences at day 28 and day 42 post disbudding, and on day 42, 34% of wounds had healed in both groups.

In summary, the authors were unable to demonstrate a difference in healing between the groups using the described methods.

Limited phylogenetic overlap between fluoroquinolone-resistant Escherichia coli isolated on dairy farms and those causing bacteriuria in humans living in the same geographical region

BACKGROUND

Our primary aim was to test whether cattle-associated fluoroquinolone-resistant (FQ-R) Escherichia coli found on dairy farms are closely phylogenetically related to those causing bacteriuria in humans living in the same 50 × 50 km geographical region suggestive of farm-human sharing. Another aim was to identify risk factors for the presence of FQ-R E. coli on dairy farms.

METHODS

FQ-R E. coli were isolated during 2017-18 from 42 dairy farms and from community urine samples. Forty-two cattle and 489 human urinary isolates were subjected to WGS, allowing phylogenetic comparisons. Risk factors were identified using a Bayesian regularization approach.

RESULTS

Of 489 FQ-R human isolates, 255 were also third-generation-cephalosporin-resistant, with strong genetic linkage between aac(6')Ib-cr and blaCTX-M-15. We identified possible farm-human sharing for pairs of ST744 and ST162 isolates, but minimal core genome SNP distances were larger between farm-human pairs of ST744 and ST162 isolates (71 and 63 SNPs, respectively) than between pairs of isolates from different farms (7 and 3 SNPs, respectively). Total farm fluoroquinolone use showed a positive association with the odds of isolating FQ-R E. coli, while total dry cow therapy use showed a negative association.

CONCLUSIONS

This work suggests that FQ-R E. coli found on dairy farms have a limited impact on community bacteriuria within the local human population. Reducing fluoroquinolone use may reduce the on-farm prevalence of FQ-R E. coli and this reduction may be greater when dry cow therapy is targeted to the ecology of resistant E. coli on the farm.

Characterization of AmpC-hyperproducing Escherichia coli from humans and dairy farms collected in parallel in the same geographical region

OBJECTIVES

To characterize putative AmpC-hyperproducing third-generation cephalosporin-resistant E. coli from dairy farms and their phylogenetic relationships; to identify risk factors for their presence; and to assess evidence for their zoonotic transmission into the local human population.

METHODS

Proteomics was used to explain differences in antimicrobial susceptibility. WGS allowed phylogenetic analysis. Multilevel, multivariable logistic regression modelling was used to identify risk factors.

RESULTS

Increased use of amoxicillin/clavulanate was associated with an increased risk of finding AmpC hyperproducers on farms. Expansion of cephalosporin resistance in AmpC hyperproducers was seen in farm isolates with marR mutations (conferring cefoperazone resistance) or when AmpC was mutated (conferring fourth-generation cephalosporin and cefoperazone resistance). Phylogenetic analysis confirmed the dominance of ST88 amongst farm AmpC hyperproducers but there was no evidence for acquisition of farm isolates by members of the local human population.

CONCLUSIONS

Clear evidence was found for recent farm-to-farm transmission of AmpC-hyperproducing E. coli and of adaptive mutations to expand resistance. Whilst there was no evidence of isolates entering the local human population, efforts to reduce third-generation cephalosporin resistance on dairy farms must address the high prevalence of AmpC hyperproducers. The finding that amoxicillin/clavulanate use was associated with an increased risk of finding AmpC hyperproducers is important because this is not currently categorized as a highest-priority critically important antimicrobial and so is not currently targeted for specific usage restrictions in the UK.

Measuring antimicrobial use on dairy farms: A method comparison cohort study

Antimicrobial use on UK dairy farms is measured for surveillance purposes, with veterinary sales data as a proxy for use. Two other methods of recording use have been used commonly on-farm: medicine waste bins and farm medicine records. However, none of these methods has been validated to measure antimicrobial use. The objective of this research was to assess agreement between the 3 most common methods for measuring on-farm antimicrobial use with a predetermined reference method on UK dairy farms. Antimicrobial use was measured prospectively on 26 UK dairy farms using medicine waste bins into which participants placed all discarded medicine packaging for a 12-mo period. At the end of 12 mo, farm medicine records and veterinary sales data were obtained retrospectively for participating farms. The reference method used was based on pre- and poststudy inventories combined with veterinary sales data. We investigated the systematic difference between the mean on-farm antimicrobial use measured by each of the 3 methods and a reference method, using one-way repeated-measures ANOVA models. Reliability and clinical relevance of the agreement between each pair of methods was quantified using the concordance correlation coefficient (CCC) and the Bland-Altman method, respectively. When compared with the reference method, veterinary sales data had excellent reliability for injectable antimicrobials and intramammary antimicrobials [95% confidence interval (CI) of CCC > 0.90] and moderate to excellent reliability for other antimicrobials (95% CI of CCC: 0.68-0.97). Medicine waste bins had good to excellent reliability for injectable (95% CI of CCC: 0.84-0.99), and intramammary products (95% CI of CCC: 0.78-0.94) and no agreement for other forms of antimicrobial. Farm medicine records did not agree for any form of antimicrobial when compared with the reference method. The use of veterinary sales data as a proxy for on-farm antimicrobial use in the UK represented excellent statistical reliability and offered clinically good agreement with the reference method when used to measure injectable antimicrobials. This study applies to the UK context and included a relatively small number of farms. However, these results have research and policy implications, both nationally and internationally, and are essential in accurately quantifying agricultural antimicrobial use to inform both animal and human health.

Diagnostics and the challenge of antimicrobial resistance: a survey of UK livestock veterinarians' perceptions and practices

BACKGROUND

This paper explores the current role and place of diagnostic tests in the treatment of farm animal disease. With the growing focus on reduced reliance on antibiotic medicines in both animal and human patient care, attention is increasingly being focused on the practice, the technology and the function of diagnostic tests and how these can support responsible antimicrobial use. Emerging diagnostic technologies offer the possibility of more rapid testing for bacterial disease, while food chain actors and others are increasingly seeking to make diagnostic tests mandatory before the use of critically important antibiotics.

METHOD

This paper reports the findings of a recent large-scale online survey of UK farm animal veterinarians (n=153) which investigated current veterinary diagnostic practice with particular attention to the relationship between diagnostic test use and antibiotic treatment.

RESULTS

Results revealed a range of factors that influence veterinary diagnostic practice and demonstrate the continuing importance of clinical observation and animal/herd knowledge in the selection of antibiotic treatment.

CONCLUSION

The findings identify a considerable ambivalence on the part of farm animal veterinarians regarding the current and future uses of rapid and point-of-care diagnostic tests as a means of improving clinical diagnosis and addressing inappropriate antibiotic medicine use.

Welfare Challenges of Dairy Cows in India Identified Through On-Farm Observations

Simple Summary

India has the largest population of dairy cattle in the world, but little work has been done to objectively assess their welfare. Formal welfare assessment is needed to identify any welfare problems and inform solutions to these problems. Dairy cattle on 38 farms in Kerala, India, were observed using standardised welfare assessment protocols. The major welfare problems identified in this study were that all cows were tied to their housing on a rope < 1 m that attached to a halter that pierced the nasal septum, most farms did not provide cattle with unlimited access to water, and access to food was also limited. On half the farms, cattle were tied up inside for the whole day, and most of those given outdoor access were also tied when outside. These results show the need to encourage dairy farmers in India to stop tying their cattle, and to provide them with unlimited access to drinking water and a readier supply of a good healthy diet. Welfare assessment protocols were used successfully in this study, suggesting that they can and should be used regularly to assess cattle welfare in India. Making these changes could substantially improve the welfare of tens of millions of cattle.

Abstract

India has the largest population of dairy cattle in the world at over 48 million animals, yet there has been little formal assessment of their welfare reported. Through observations of dairy cows on 38 farms in Kerala, India, we aimed to investigate the welfare of these animals and the practicality of animal-based assessments within common farming systems. Substantial welfare challenges were identified. All cows were close-tied (less than 1 m length) via a halter that pierced the nasal septum when housed, which was for the entire day (50% of farms) or part thereof. When outside access was available, it was also usually restricted by close-tying, longline tether, or hobbling. Ad libitum water was only available on 22% of farms and food access was also restricted (mean of 4.3 h/day). Future work should focus on encouraging dairy farmers in India to improve the welfare of their dairy cattle by: ceasing to tie and tether cattle (or at least providing tied and tethered cattle with exercise opportunities); providing unlimited access to drinking water and a readier supply of food (especially quality green forage/fodder); cleaning housing more frequently; providing strategies to prevent heat stress; breeding cattle suited to environmental conditions and with increased resistance to heat stress; and carrying out welfare assessments more regularly using a validated protocol and rectifying the causes of poor welfare. Such changes could substantially improve the welfare of tens of millions of cattle.

'Antibiotic footprint' as a communication tool to aid reduction of antibiotic consumption

'Superbugs', bacteria that have become resistant to antibiotics, have been in numerous media headlines, raising awareness of antibiotic resistance and leading to multiple action plans from policymakers worldwide. However, many commonly used terms, such as 'the war against superbugs', risk misleading people to request 'new' or 'stronger' antibiotics from their doctors, veterinary surgeons or pharmacists, rather than addressing a fundamental issue: the misuse and overuse of antibiotics in humans and animals. Simple measures of antibiotic consumption are needed for mass communication. In this article, we describe the concept of the 'antibiotic footprint' as a tool to communicate to the public the magnitude of antibiotic use in humans, animals and industry, and how it could support the reduction of overuse and misuse of antibiotics worldwide. We propose that people need to make appropriate changes in behaviour that reduce their direct and indirect consumption of antibiotics.

Storage of prescription veterinary medicines on UK dairy farms: a cross-sectional study

Prescription veterinary medicine (PVM) use in the UK is an area of increasing focus for the veterinary profession. While many studies measure antimicrobial use on dairy farms, none report the quantity of antimicrobials stored on farms, nor the ways in which they are stored. The majority of PVM treatments occur in the absence of the prescribing veterinarian, yet there is an identifiable knowledge gap surrounding PVM use and farmer decision making. To provide an evidence base for future work on PVM use, data were collected from 27 dairy farms in England and Wales in Autumn 2016. The number of different PVMs stored on farms ranged from 9 to 35, with antimicrobials being the most common therapeutic group stored. Injectable antimicrobials comprised the greatest weight of active ingredient found, while intramammary antimicrobials were the most frequent unit of medicine stored. Antimicrobials classed by the European Medicines Agency as critically important to human health were present on most farms, and the presence of expired medicines and medicines not licensed for use in dairy cattle was also common. The medicine resources available to farmers are likely to influence their treatment decisions; therefore, evidence of the PVM stored on farms can help inform understanding of medicine use.

Lateralized behaviour as indicator of affective state in dairy cows

In humans, there is evidence that sensory processing of novel or threatening stimuli is right hemisphere dominated, especially in people experiencing negative affective states. There is also evidence for similar lateralization in a number of non-human animal species. Here we investigate whether this is also the case in domestic cattle that may experience long-term negative states due to commonly occurring conditions such as lameness. Health and welfare implications associated with pain in lame cows are a major concern in dairy farming. Behavioural tests combining animal behaviour and cognition could make a meaningful contribution to our understanding of disease-related changes in sensory processing in animals, and consequently enhance their welfare. We presented 216 lactating Holstein-Friesian cows with three different unfamiliar objects which were placed either bilaterally (e.g. two yellow party balloons, two black/white checkerboards) or hung centrally (a Kong™) within a familiar area. Cows were individually exposed to the objects on three consecutive days, and their viewing preference/eye use, exploration behaviour/nostril use, and stop position during approach was assessed. Mobility (lameness) was repeatedly scored during the testing period. Overall, a bias to view the right rather than the left object was found at initial presentation of the bilateral objects. More cows also explored the right object rather than the left object with their nose. There was a trend for cows appearing hesitant in approaching the objects by stopping at a distance to them, to then explore the left object rather than the right. In contrast, cows that approached the objects directly had a greater tendency to contact the right object. No significant preference in right or left eye/nostril use was found when cows explored the centrally-located object. We found no relationship between lameness and lateralized behaviour. Nevertheless, observed trends suggesting that lateralized behaviour in response to bilaterally located unfamiliar objects may reflect an immediate affective response are discussed. Further study is needed to understand the impact of long-term affective states on hemispheric dominance and lateralized behaviour.

Antimicrobial use in food-producing animals: a rapid evidence assessment of stakeholder practices and beliefs

Food-producing animals throughout the world are likely to be exposed to antimicrobial (AM) treatment. The crossover in AM use between human and veterinary medicine raises concerns that antimicrobial resistance (AMR) may spread from food-producing animals to humans, driving the need for further understanding of how AMs are used in livestock practice as well as stakeholder beliefs relating to their use. A rapid evidence assessment (REA) was used to collate research on AM use published in peer-reviewed journals between 2000 and 2016. Forty-eight papers were identified and reviewed. The summary of findings highlights a number of issues regarding current knowledge of the use of AMs in food-producing animals and explores the attitudes of interested parties regarding the reduction of AM use in livestock. Variation between and within countries, production types and individual farms demonstrates the complexity of the challenge involved in monitoring and regulating AM use in animal agriculture. Many factors that could influence the prevalence of AMR in livestock are of concern across all sections of the livestock industry. This REA highlights the potential role of farmers and veterinarians and of other advisors, public pressure and legislation to influence change in the use of AMs in livestock.

Participatory Policy Making by Dairy Producers to Reduce Anti-Microbial use on Farms

Pressures for more responsible use of anti-microbial (AM) medicines in food animals are likely to increase from policymakers and the food industry, including retailers. To address this challenge, participatory approaches to welfare interventions and disease prevention may also be necessary alongside more conventional regulatory measures. This article describes the process of enabling groups of dairy producers to use a participatory policy making approach to develop an AM stewardship policy. The policy includes measures agreed to by all producers for more responsible use of AMs, whilst maintaining or improving dairy herd health and welfare. This process provided a unique opportunity for collaboration and dialogue between producers, veterinarians, industry and researchers. Its participatory nature encouraged comprehensive learning for all involved. This integration of science with producers' knowledge and experience led to credible and practical recommendations designed to deliver real and lasting change in AM use. The multidisciplinary nature of this research marks a significant contribution to embedding social science skills and approaches into the veterinary sphere. As an initial step in creating better understanding of how participatory approaches with farmers can be applied in a UK context and more widely, this work serves as a pilot for promoting more responsible use of veterinary medicines in other livestock species.

Renal dysplasia and nephrosclerosis in calves

Renal dysplasia and nephrosclerosis in six calves, which were aged three to six months and from different farms in western Scotland and north-west England, was characterised clinically by stunted growth and renal failure with uraemia. Affected animals were depressed and one case exhibited severe neurological signs. Reduced erythrocyte counts were evident in three of four animals from which blood samples were submitted for haematology. At postmortem examination, the kidneys were bilaterally small, pale and firm, with marked fibrosis and sometimes contraction of the capsule. Histologically, affected calves had disorganised atrophic glomeruli, dilatation of tubules, loss of nephrons, areas of undifferentiated mesenchyme and diffuse interstitial and periglomerular fibrosis. There was minimal inflammation. Renal dysplasia and nephrosclerosis is a form of juvenile nephropathy of unknown aetiology that occurs sporadically in calves in the UK.

Epidermolysis bullosa in calves in the United Kingdom

Epidermolysis bullosa (EB) was diagnosed in eight calves from four farms in the United Kingdom on the basis of clinical, histological and ultrastructural findings. In three affected herds, pedigree Simmental bulls had been mated with Simmental-cross cows. In a fourth herd two Holstein-Friesian calves were affected. Lesions included multifocal erosion and ulceration of the hard and soft palates, tongue, nares and gingiva, with onychomadesis (dysungulation). There was alopecia, erosion and crusting of the coronets, pasterns, fetlocks, carpi, hocks, flanks and axillae. Histopathological findings included segmental separation of full thickness epidermis from the dermis, with formation of large clefts containing eosinophilic fluid, extravasated red blood cells and small numbers of neutrophils. Follicular and interfollicular areas of skin were affected, with clefts extending around hair follicles and sometimes involving whole follicles. Ultrastructurally, there was evidence of vacuolar change within basal keratinocytes, corresponding to areas of histological clefting. Preliminary genetic screening of the candidate keratin genes (bKRT5 and bKRT14) has excluded mutations of these as the cause of this condition.

Clinicopathological presentation of cardiac disease in cattle and its impact on decision making

The records of 116 cattle suffering from cardiac disease were examined retrospectively. On the basis of the results of postmortem examinations there were 52 cases of endocarditis, 39 of pericarditis and 25 congenital cardiac defects. The most useful clinical tool for differentiating between these conditions was auscultation of the heart. The cases of pericarditis were characterised by muffled heart sounds, and the cases of endocarditis and congenital cardiac defects were characterised by a cardiac murmur. Endocarditis could be differentiated from congenital cardiac defects by the presence of a jugular pulse, venous distension, oedema, a reduced appetite, pain and polyarthritis, whereas congenital defects were associated with conformational abnormalities. These two conditions could also be differentiated by differences in the plasma sodium concentration, the albumin:globulin ratio, red blood cell count, lymphocyte count and haematocrit. The ability to differentiate between these three groups of cardiac diseases can help the veterinary practitioner in deciding whether treatment, economic salvage (slaughter for human consumption) or disposal (slaughter not for human consumption) is likely to be the best option.

Treatment of persistent intramammary infections with Streptococcus uberis in dairy cows

A survey was conducted of the prevalence of environmental pathogens, especially Streptococcus uberis, as causes of clinical mastitis in dairy cows. The response of intramammary infections with S uberis to conventional treatment was monitored by taking milk samples for bacteriology and somatic cell counting seven, 14 and 21 days after the treatment. The results showed that 51 per cent of the infections failed to respond, and the odds of cases failing to respond was significantly increased when the individual quarter somatic cell count seven days after the treatment was greater than 201,000 cells/ml. Ninety-six per cent of the suspected S uberis isolates identified by culture were confirmed as S uberis by using the api 20 Strep system. Restriction endonuclease fingerprinting was used to type the strains of S uberis isolated from 75 milk samples from 32 cows. Analysis showed that 96 per cent of the cases of S uberis that failed to respond to conventional treatment were persistent infections with one strain rather than reinfections with different strains. The persistent cases of S uberis were treated further with an extended course of intramammary preparations containing either procaine penicillin with dihydrostreptomycin or cefquinome. There was no significant difference between the cure rates achieved by the two preparations, and 55 per cent of the cases that had failed to respond to conventional treatment responded to the additional treatment.

Clinical and pathological features of dilated cardiomyopathy in Holstein-Friesian cattle

Dilated cardiomyopathy is a primary disease of the heart muscle that has been reported in Holstein-Friesian cattle worldwide in the past 20 years. Nine cases of the condition were compared in terms of their clinical and pathological characteristics with nine unaffected animals matched for age, sex and breed. Their clinical signs included right-sided heart failure with severe subcutaneous oedema, ascites and/or hydrothorax and distended jugular veins. There were no characteristic biochemical or haematological changes. Postmortem, the affected hearts were enlarged with all the chambers dilated and walls of variable thickness. In most cases the kidneys were pale with a pitted surface. Histologically there was marked perimysial and endomysial fibrosis, extensive loss of cardiomyocytes by coagulative or colliquative necrosis, increased variation in the cross-sectional area of the myocardial fibres, and multifocal disarray and vacuolation of myocytes. Scanning electron microscopy showed that in all cases there was a mild myocardial inflammatory infiltrate, either diffuse or multifocal, which was identified by immunohistochemical labelling as T cells.

Use of clinical information to predict the characteristics of bacteria isolated from clinical cases of bovine mastitis

Farmers recorded the clinical signs of cows with clinical mastitis and submitted milk samples for bacteriological examination, so that the clinical signs could be correlated with the bacteriological findings. Odds ratios for the demeanour of the cow, the appearance of the milk, milk yield, udder texture, and the administration of parenteral antibiotics were calculated for mastitis cases classified in terms of their microbiology as either enterobacteriaceae, major Gram-positive pathogens, minor pathogens, 'no growths' or 'all other pathogens'. Animals infected with enterobacteriaceae had the highest odds of being reported as having a reduced milk yield, swollen or hard udders, watery milk and/or being systemically sick. A logistic regression model was used to predict the Gram-staining characteristics of the bacteria causing clinical mastitis. The clinical findings found to be significant predictors in the model were the demeanour of the cow and its milk yield. The regression model was used as a basis for a predictive test. Using a test data set, the sensitivity of the test was 28 per cent, its specificity was 96 per cent, the positive predictive value was 74 per cent and the negative predictive value was 80 per cent. The overall accuracy of these predictions was 79 per cent.

Dissecting aneurysm of the carotid artery as a cause of respiratory distress in adult cattle

A two-and-a-half-year-old Friesian cow and a five-year-old Charolais cow developed severe respiratory distress and palpable swellings to the left of the larynx as a result of a dissecting aneurysm of the common carotid artery. Neither cow responded to medical treatment. The underlying pathogenesis of the condition was uncertain, but direct trauma to the carotid artery was a possible contributory factor. Aneurysms of the common carotid artery should be considered when swelling occurs in the region of the larynx or when respiratory distress is due to laryngeal compression.

Observations on ascites in nine cattle

Signs of ascites were observed in only nine of 1863 cattle examined over a period of five years. The ascites was most commonly associated with either primary or secondary cardiac disease; cattle with ascites have a poor prognosis because the condition is usually assocaited with terminal disease. Two animals had cor pulmonale with chronic pneumonia, three had cardiomyopathy, one had bacterial endocarditis, two had thrombosis of the caudal vena cava and one had diffuse abdominal epithelioid mesothelioma.

Cost-effective antimicrobial drug selection for the management and control of respiratory disease in European cattle

Respiratory disease in growing cattle has both animal welfare and economic implications, but the use of antimicrobial drugs to treat and control it is under public scrutiny owing to concerns that their use in food-producing animals may be detrimental to human health. This paper outlines criteria for the selection of appropriate and cost-effective drugs, based on good dinical practice and sound economic principles. It also suggests that these principles should be integrated into quality assurance schemes, and that the monitoring of antimicrobial resistance patterns among known bacterial respiratory pathogens should be improved.

Substance use and HIV risk profile of gay/bisexual males who drop out of substance abuse treatment

This analysis was undertaken to identify (a) the level of HIV sexual risk behaviors of men who drop out of treatment and (b) baseline variables associated with later treatment dropout. A cross-sectional sample of 340 gay/bisexual men were recruited from an outpatient substance abuse treatment facility in San Francisco. We compared participants who completed less than 15 visits with participants who graduated from the program. Men who dropped out were more likely than treatment graduates to report injection drug use, social problems related to substance use, self-blaming coping strategies, and more recent substance use prior to entering treatment and less likely to have a college degree, report using sex for tension relief, and have previously attended Alcoholics Anonymous or Narcotics Anonymous. Given the strong link between the substance abuse and HIV epidemics, substance abuse treatment agencies have been forced into addressing the issues of HIV sexual risk taking with their clients. Strategies toward reducing substance use relapse and HIV risk reduction are offered.

An outcome evaluation to measure changes in sexual risk-taking among gay men undergoing substance use disorder treatment

OBJECTIVE

To evaluate the effects of safe sex intervention at a substance use disorder treatment agency designed to serve gay men.

METHOD

Of all eligible men, 456 (78%) were recruited as they entered treatment for a substance use disorder. This cohort was followed for five waves of data collection, each wave measuring the previous 90 days. Assigned to the experimental condition (treatment for substance use disorder plus a safe sex intervention) were 82 men; 65 were assigned to the regular substance use disorder treatment.

RESULTS

Although levels of risk within each wave were never significantly different between the two treatment groups, reductions in unprotected anal intercourse (UAI) with a nonmonogamous partner for both groups from the baseline Wave-1 levels were uniformly significant (all p's < .05). Such high-risk sex in the year-long follow-up period was correlated with UAI reported at intake, enjoyment of UAI, relative youth, heavier concurrent use of alcohol or amphetamines and greater numbers of sexual partners.

CONCLUSIONS

We conclude that: (1) substantial HIV risk reductions can occur after initiation of treatment for substance use disorder among gay men; (2) risk reductions begin soon after treatment begins; (3) lapses to unsafe sex are common during treatment; (4) continued UAI is most likely among those men who are riskier at intake, who continue to be more sexually active and who are more likely to combine substance use and sexual behavior; (5) AIDS prevention activities conducted at treatment agencies cannot reach all high-risk substance-using gay men.

Alcohol and drug use patterns have declined between generations of younger gay-bisexual men in San Francisco

OBJECTIVES

To describe changes in alcohol and drug use between two independent samples of gay-bisexual men aged 25-29.

METHODS

Comparisons between the 1984 San Francisco Men's Health Survey (SFMHS) and the 1992 San Francisco Young Men's Health Survey (SFYMHS).

RESULTS

Heaviest levels of alcohol use decreased between the 1984 and 1992 samples as did most types of drug use, with the exception of an increase in the use of MDA.

CONCLUSIONS

Important declines in heavy alcohol use and overall drug use occurred among young gay men between 1984 and 1992. However, levels of substance use still remain high and may constitute a continued threat to the health of gay-bisexual men.

Self-reports of alcohol use, drug use and sexual behavior: expanding the Timeline Follow-back technique

OBJECTIVE

The purpose of this study is to compare reports of alcohol use, drug use and sexual behavior from 30-day Summary measures with an expanded version of a Timeline Follow-back (Timeline) interview technique among gay/bisexual men entering outpatient substance abuse treatment at a gay-identified agency.

METHOD

Respondents (N = 418) first completed self-administered questionnaires covering the 30-day period prior to their last use of alcohol or drugs. Summary measures included alcohol use, number of days of use for five categories of drugs and number of episodes of anal intercourse (with and without condoms) by partner type (primary or secondary). Participants then completed the Timeline interview procedure to recall their daily drinking, drug use and sexual behavior during the same 30-day period.

RESULTS

The findings indicate that the Timeline method yielded significantly lower estimates of mean number of drinks consumed when heavier than usual drinking days is included in the Summary measure (124.0 vs 147.0 drinks), mean number of days drugs were used (9.3 vs 10.7) and mean number of episodes of anal intercourse with a primary partner (1.2 vs 2.2). Differences generally remained significant when assessed by length of time between the study interview and last use of alcohol or drugs, with the exception of number of anal sex episodes with primary partners.

CONCLUSIONS

These findings indicate that Timeline estimates are lower than estimates using a more standard method (Summary measures). Discrepancies between these findings and those reported by other researchers indicate a need for further exploration of the effects of the mode of administration on various populations.

Risk factors for repeated gonococcal infections: San Francisco, 1990-1992

Gonococcal (GC) infections are very common and are sustained by a core group of persons who often have repeated GC infections. Identifying individual risk factors for repeated GC infection is essential so that infection control programs can develop better strategies for decreasing the incidence of GC infection. A case-control study among high-risk persons found that being African American, having previous chlamydia infection, and having less than a high-school education were associated with repeated GC infections. Remarkably, measures of sexual behavior and access to health care were not associated with repeated GC infections. These findings suggest that among high-risk persons, the community prevalence of GC infection is more important in predicting risk for repeated GC infections than individual behavior. Interventions should include continued use of resources in high-prevalence communities and better understanding of the roles social and economic discrimination play in the risk for GC infections.

Histories of substance use and risk behavior: precursors to HIV seroconversion in homosexual men

OBJECTIVES

This study compared history of substance use and episodic use in terms of HIV seroconversion.

METHODS

A sample of 337 baseline HIV-negative gay men was followed for 6 years. Bivariate and survival analyses were used to compare 39 converters with nonconverters on substance use behaviors.

RESULTS

Seroconverters were consistently more likely to report use of marijuana, nitrite inhalants, amphetamines, and cocaine than nonconverters. Consistent use of nitrite inhalants and amphetamines increases the relative risk of seroconversion, while episodic use does not. Both patterns of cocaine use increase seroconversion risk.

CONCLUSIONS

There are three potential mechanisms for an increased risk of conversion due to consistent substance use.