Human immunodeficiency virus (HIV) seroprevalence in persons attending STD clinics in the United States, 1985-1987

We reviewed published and unpublished studies on seroprevalence of HIV antibody in persons attending sexually transmitted disease (STD) clinics in the United States from 1985 through 1987. We identified 23 studies from 16 states; nine studies determined risk factors for HIV. Overall, 899 (4.2%) of the 21,352 clinic attendees were seropositive; the seroprevalence rate was higher for men (5.9%) than for women (1.7%). Clinic seroprevalence ranged from 0.5% to 15.2% (median, 3.5%), reflecting in part the proportion of all attendees who were homosexual or bisexual, intravenous-drug users (IVDUs), or heterosexual partners of bisexual men or IVDUs (median proportion, 21.8% for the nine sites with this information). Most HIV-seropositive persons were at recognized risk (median for the same nine studies, 85.3%). Homosexual/bisexual men had the highest seroprevalence (median, 32.2%), followed by heterosexual IVDUs (median, 3.6%). Heterosexuals who denied intravenous-drug use had a median rate of 0.9%, which strongly correlated with rates in IVDUs in the same clinics (r = 0.88). We conclude many STD clinic attendees are infected with HIV. Because AIDS is an STD and seroprevalence has been associated with other STDs, STD clinics are important sites for HIV surveillance and risk-reduction education.     

Who goes to sexually transmitted disease clinics? Results from a national population survey.

OBJECTIVES: To examine the pattern of attendance at sexually transmitted disease (STD) clinics in Britain. To compare the demographic characteristics, behaviours and attitudes of STD clinic attenders with those of non-attenders, and to assess the extent to which STD clinics are used by those with high-risk sexual lifestyles. DESIGN: Random sample general population survey of sexual attitudes and lifestyle. SUBJECTS: 18,876 randomly selected men and women resident in Britain aged 16-59 years. MAIN OUTCOME MEASURES: Demographic characteristics, pattern of homosexual partnerships, heterosexual partnerships, payment for sex, abortion, drug injection in the last five years, and attitudes to sexual behaviours amongst 512 respondents who had attended STD clinic in the last five years compared with those who had not. RESULTS: 8.3% of men and 5.6% of women had attended a clinic in their lifetime and 3.4% and 2.6% respectively in the last five years. Attendance rates varied substantially with area of residence. 11% of Inner London residents had attended in the last five years. In multivariate analysis, STD clinic attendance for men was most strongly associated with increased numbers of heterosexual partners, (OR = 6.01 (4.44-8.15) and homosexual partnerships (OR = 9.59 (5.83-15.8)) and more weakly associated with payment for sex, non-manual social class, age 25-44, unmarried status and smoking. Clinic attendance for women was most strongly associated with numbers of heterosexual partners (OR = 3.74 (2.76-5.08) and injecting drug use (OR = 4.39 (1.73-11.1)). A weaker independent association was found with a history of abortion, anal sex, non-manual social class, non-married status and age 16-24. From the total population, 1 in 6 men and 1 in 7 women in the top 5% of the distribution for numbers of heterosexual partners and 1 in 5 men paying for sex and 1 in 4 of those with a homosexual partner had attended a clinic in the last five years. The probability of attendance increased with multiple risk behaviours. Of women 64.2% and of men 69.7% attending clinics reported major risk markers for STD transmission. CONCLUSIONS: STD clinics in Britain are used by a wide demographic spectrum of the population. The behaviours, but not the attitudes, of attenders differed markedly from those of non-attenders. Clinics are relatively efficient in attracting only those with high-risk lifestyles, but, at a population level, the minority of those reporting risk-markers for STD transmission attend clinics. These findings suggest that STD clinics are an important focus for sexual health promotion, but that community programmes are also important for reaching non-attenders.     

Prevalence of human immunodeficiency virus in the patient population of a sexually transmitted disease clinic. Association with syphilis and gonorrhea.

An unlinked seroprevalence survey of human immunodeficiency virus (HIV) antibody was conducted using stored sera from all patients who attended the sexually transmitted disease (STD) clinic in Halifax, Nova Scotia between 1980 and 1986. None of the sera collected from 584 patients during 1980 were HIV positive. Of the 2867 patients who visited the clinic between 1981 and 1986, 27 (0.9%; 95% CI 0.6% to 1.2%) had the antibody. None of the 784 female patients were HIV seropositive. Of the 1,884 heterosexual men in the study, 5 (0.3%; 95% CI 0.1% to 0.5%) were HIV seropositive, and 22 (11.1%; 95% CI 6.7% to 15.5%) of the 199 homosexual men were HIV seropositive. There was a strong association between a history of syphilis and HIV antibody among heterosexual men (OR = 76.8; 95% CI 12.0 to 491.3; P = 0.001). Among homosexual men younger than 30 years of age, HIV infection was associated with a history of syphilis (OR = 18.2; 95% CI 5.1 to 64.7; P = 0.035) and a history of gonorrhea (OR = 8.2; 95% CI 4.2 to 16.0; P = 0.001). The association between a history of gonorrhea and HIV infection was strongest among homosexual men who had three or more sexual partners in the last month. These findings supplement existing evidence that STDs increase the likelihood of HIV transmission.     

Assessing behavioral risk for HIV infection in family-planning and STD clinics: similarities and differences

Four hundred fifty-five women in family-planning and sexually transmitted disease (STD) clinics were surveyed to determine the degree of participation in behaviors known to be associated with increased risk of human immunodeficiency virus (HIV) infection. A previous history of STD (20%) and multiple sexual partners (73%) were shown to be the high-risk behaviors most prevalent in these populations. Sexual intercourse with persons in high-risk groups (6%) and intravenous (IV) drug use (3.7%) were less prevalent. Differences between the populations from each type of clinic and between races were noted. Overall, almost one third of family-planning clinic clients and nearly half of STD clinic clients reported participation in at least one risk behavior, emphasizing the need for educational efforts toward disease prevention in these settings.     

HIV-1 infection-associated risk factors among sexually transmitted disease patients in Athens, Greece: 1990 to 1996

OBJECTIVE: To determine trends in HIV seroprevalence and related risk factors among patients with sexually transmitted diseases (STDs) and to report the respective epidemiologic history characteristics. METHODS: A cross-sectional seroepidemiologic study conducted from 1990 to 1996 among 5,669 symptomatic STD cases was carried out. RESULTS: The overall HIV test acceptance was 98.9%, and 1.2% patients (n = 66) were seropositive. Highest rates were detected among those who were born or resided in Sub-Saharan Africa. Seropositivity fluctuates significantly by age, and is excessive in persons 45 years and older (2.6%). A significant decreasing trend in STD incidence and HIV seroprevalence among patients younger than 25 years was detected. Male homosexuals and bisexuals (MSM) exhibited the highest overall rate of infection (5.8%) followed by intravenous drug users (2%). Highly promiscuous STD patients (ie, those who had more than 10 partners during the past 6 months) presented a significantly increased HIV seroprevalence when compared with patients of the same sexual orientation. STD patients infected with HIV mostly belonged to notable risk categories of AIDS (men who have sex with men, 72.7%). Awareness of serostatus was low (13.6%). In male patients, the HIV seropositivity rate was significantly higher among early syphilis and proctitis cases, whereas in females this higher rate occurred with herpes genitalis. CONCLUSIONS: Promiscuity and sexual orientation significantly influence the seroprevalence rate. Exposure to HIV remained stable despite the above declining time trends, which implies the need for additional preventive interventions targeted to the real health and illness behavior of the partner.     

AIDS related changes in pattern of sexually transmitted disease (STD) in an STD clinic in Copenhagen.

Testing for antibodies against human immunodeficiency virus (HIV) was introduced in 1984 in this major sexually transmitted disease (STD) clinic in Copenhagen, which is attended by about 10,000 new patients each year. From 1984 to 1987 the proportion of patients examined for antibodies to HIV rose from 6% to 32%. The overall incidence of HIV antibody positivity decreased from 30% in 1984 to 3% in 1987, the combined result of decreased positivity in high risk patients tested and increased screening in low risk patients. HIV antibody positivity has been confined largely to homosexual men and drug addicts. Since 1985, however, 21 out of 2623 (0.8%) heterosexuals who were not drug addicts were found to be HIV antibody positive. During 1984-6 the incidence of STDs most often encountered in high risk groups (syphilis and gonorrhoea) decreased by 64% and 41% respectively, whereas the incidence of diseases most often diagnosed in low risk groups (condylomata acuminata and genital herpes) increased by 70% and 34% respectively in the same period. The addition of HIV infection to the list of STDs requires the allocation of more resources to the STD clinics to enable these clinics to handle this new problem. Screening for all patients attending an STD clinic for antibodies to HIV must be considered, and in our area it would be cost effective.     

The effect of treating sexually transmitted diseases on the transmission of HIV in dually infected persons: a clinic-based estimate. Ad Hoc STD/HIV Transmission Group

BACKGROUND: The effect of sexually transmitted disease (STD) treatment on HIV transmission is a topic of considerable current interest and controversy. GOAL: To assess the potential effect of STD treatment on HIV transmission in persons who are dually infected with STD and HIV. STUDY DESIGN: Using data from eight STD clinic sites in the United States, the authors estimate the actual achievable reduction in HIV transmission by multiplying the prevented fraction associated with treatment of STDs (set at an average of 0.8) by the maximum potential reduction in HIV transmission achieved by treating STDs (using an average relative risk of 3.0 for increased HIV transmission in the presence of STDs). Subgroup analysis assessed infection proportions for genital ulcer disease, nonulcerative STDs, and any STD by sex, ethnicity, age, and sexual orientation. RESULTS: The maximum achievable reduction in HIV transmission from dually infected persons to their partners is approximately 33%. The actual achievable reduction is approximately 27% (range, 10.0-38.1%) at the eight clinic sites. If each of the 4,516 dually infected persons in this cohort experienced a single sexual exposure with an uninfected person, 28 HIV infections would occur in the absence of STD treatment whereas 16 infections would occur with STD treatment. CONCLUSIONS: The estimate of a 27% reduction provides a qualitative assessment of the potential impact of STD treatment on HIV transmission in the absence of any other behavioral intervention. Identification of dually infected persons in STD clinics is an important mechanism for targeting interventions to a social milieu with high risk for HIV infection and other STDs.     

HIV prevalence in patients with syphilis, United States

BACKGROUND: Among persons with a sexually transmitted disease (STD), the proportion who are also infected with HIV is a major factor influencing the public health impact of that STD on HIV transmission. GOAL: To assess HIV infection in persons with syphilis in the United States. STUDY DESIGN: A systematic literature review was conducted of U.S. studies with HIV seroprevalence data in patients with syphilis. RESULTS: Thirty studies were identified and analyzed. The median HIV seroprevalence in men and women infected with syphilis was 15.7% (interquartile range [IQR]: 13.6-21.8%), among men was 27.5% (23.1-29.6%), and among women was 12.4% (8.3-20.5%). Median odds ratios for men and women, men only, and women only were 4.5, 8.5, and 3.3, respectively. Seroprevalences among men who have sex with men (MSM) and injecting drug users (IDU) ranged from 64.3-90.0% and 22.5-70.6%, respectively. CONCLUSIONS: Despite substantial variability, HIV seroprevalence is high among patients with syphilis in the United States, identifying them as a critical target group for HIV prevention efforts.     

Unsuspected Chlamydia trachomatis infection in heterosexual men attending a sexually transmitted diseases clinic: evaluation of risk factors and screening methods.

To characterize the problem of unsuspected Chlamydia trachomatis infection in heterosexual men attending a sexually transmitted diseases (STD) clinic, the authors assessed risk factors for infection and the value of screening for infection by gram-stained smears and urinalysis in 438 men who did not have conventional clinical indications for chlamydial treatment at their initial visit. Evaluations included urethral swabs for gram-stained smears and Neisseria gonorrhoeae and C. trachomatis cultures and microscopy of first-catch urine sediment. C. trachomatis was isolated from 29 subjects (6.6%) and N. gonorrhoeae from 6 subjects (1.3%), (P less than .05). The only demographic or clinical factors that were associated with C. trachomatis were age younger than 21 years and five or more lifetime sexual partners. Screening for C. trachomatis with urethral gram stain and urine sediment examination had sensitivities of only 23% and 35%, respectively. Risk factor assessment and screening with standard microscopic procedures do not adequately predict infection in this group, which accounts for almost 25% of the C. trachomatis burden in heterosexual men who visit an STD clinic. More specific chlamydia detection methods are needed for effective control programs.     

Characteristics of individuals with male-to-male and heterosexually acquired infectious syphilis during an outbreak in Calgary,Alberta, Canada

BACKGROUND: Eliminating syphilis is important not only to prevent the sequelae of infection but also to control the spread of HIV. Current prevention and control efforts in Canada have been ineffective in eliminating this disease. GOAL: The goal of the study was to determine the characteristics of individuals with infectious syphilis due to male-to-male and heterosexual contact, diagnosed during an outbreak in Calgary, Alberta, Canada. STUDY DESIGN: This was a prospective study of individuals with infectious syphilis diagnosed at the STD clinic in Calgary between January 2000 and April 2002. RESULTS: The outbreak reported here (September 2000 to April 2002) involves 32 cases of infectious syphilis, corresponding to rates of 0.9/100,000 population during 2000 and 1.8/100,000 population during 2001. Between September 2000 and June 2001, the cases diagnosed were among men who have sex with men (MSM); between May 2001 and April 2002, they were due to locally acquired infections among heterosexuals, including one case of congenital syphilis. Compared to the heterosexuals, MSM tended to be older, be coinfected with HIV, and report excessive alcohol use (versus injection drug use) and had infectious syphilis diagnosed earlier. MSM used the Internet and bars or bathhouses to initiate sexual contact, whereas heterosexually acquired infections were largely among sex workers and their clients. Contact tracing was more successful among the heterosexuals than among MSM. The public health staff at the STD clinic initiated a series of multifaceted interventions in response to the outbreak. These interventions were moderately successful, as measured by the increased numbers of individuals seeking counseling and testing services at the clinic. CONCLUSION: The results highlight key differences in the risk factor-specific characteristics of the outbreak that should be taken into account when designing prevention and control strategies.     

广州市男男性行为人群STD/HIV相关高危行为特征及就诊延误影响因素调查分析

目的:了解广州市男男性行为(MSM)人群STD/HIV相关高危行为特征和就诊延误影响因素,为制定有针对性的防控措施提供依据。方法:2014年10月至2015年9月期间,对参加STD/HIV自愿咨询检测且已经出现疑似STD/HIV感染相关症状、近2年内发生过同性性行为的MSM进行面对面问卷调查,采集静脉血检测HIV和梅毒。结果:共调查313名MSM,38.02%近2年内与异性发生过性行为,40.89%拥有固定的同性性伴,肛交性行为中每次都使用安全套的比例为47.04%。本次病程中80.51%发生就诊延误,首次就诊间隔时间平均为30天,影响就诊延误的因素主要包括职业、对同性恋的态度、近2年是否发生异性性行为、是否曾患其它非梅毒性病、就诊频次、是否暂停性生活。血清学监测结果 HIV感染率为20.77%,现症梅毒感染率为6.39%,同时感染HIV和梅毒的比例为4.79%,就诊延误发生者的HIV感染率和梅毒感染率均高于未发生就诊延误者,差异有统计学意义(P值均0.05)。结论:广州市MSM人群HIV感染率高,高危行为普遍存在,就诊延误发生率高,防控形势严峻,应加大宣传教育、提高医疗服务可及性和服务质量以减少就诊延误的发生。     

Trends in undiagnosed HIV-1 infection among attenders at genitourinary medicine clinics, England, Wales, and Northern Ireland: 1990-6

OBJECTIVE: To describe trends in seroprevalence of undiagnosed HIV-1 infection among attenders at 15 genitourinary medicine clinics in England, Wales, and Northern Ireland between 1990 and 1996. METHOD: Prospective, cross sectional sentinel serosurvey. Unlinked anonymous testing of remnant serum drawn for routine syphilis screening. RESULTS: In 1996, the seroprevalence of undiagnosed HIV-1 infection was 5% in homosexual men, 0.48% in heterosexual men, and 0.33% in heterosexual women. Between 1990 and 1996, there was a significant linear decrease in the seroprevalence of undiagnosed HIV-1 infection among homosexual and bisexual men within and outside London (p < 0.0001; p = 0.0141), equivalent to yearly decreases of 7.65% and 10.73% respectively. However, seroprevalence among homosexual and bisexual men under 25 years of age did not decline either inside or outside London. Seroprevalence among heterosexual men declined outside London (p < 0.005), equivalent to an average annual decrease of 14.54%. There was a significant increase among male heterosexuals inside London (p < 0.05) equivalent to a 8.09% increase per annum. Seroprevalence over time was unchanging among female heterosexuals both inside and outside London. Seroprevalence was significantly higher among those who injected drugs than those who did not report injecting in the following groups: homosexual and bisexual males within London (p < 0.005), male heterosexuals both within and outside London (p < 0.05; p < 0.05) and female heterosexuals within London (p < 0.05). CONCLUSIONS: The study highlights a significant burden of undiagnosed HIV-1 infection more than 15 years since the HIV epidemic began. Methods of offering HIV testing need to be reassessed to extend the practice of routinely testing for HIV in GUM clinics. HIV transmission among young homosexual and bisexual men continues. The contrasting trends between homosexual and bisexual men, injecting drug users, and heterosexuals attending GUM clinics indicate these groups should be considered separately. The substantial HIV seroprevalence in each group indicates that they should be priorities for targeted HIV prevention.     

HIV-related risk behaviors and history of sexually transmitted diseases among male migrants who patronize commercial sex in China

BACKGROUND AND OBJECTIVE: Men who pay for sexual services are at increased risk for HIV/sexually transmitted disease. Data on the sociodemographic and behavioral characteristics of such men in China are limited. STUDY DESIGN: Two cross-sectional surveys, using similar instruments, were completed among Chinese migrants in Beijing, Shanghai, and Nanjing in 2002. A total of 1304 rural-to-urban migrant men from community settings ("community sample") and 465 migrant men attending sexually transmitted disease clinics ("STD clinic sample") were included in the current study. RESULTS: Ten percent of men in the community sample and 32.7% of men in the STD clinic sample reported having ever paid for sex. Nearly 20% of clients from the community sample and 60% of clients from the STD clinic sample reported a history of STDs. For both the community and STD clinic samples, working at industrial or construction sectors, multiple sexual partners, regular sex partner having sex with others, and a history of drug use were associated with being a male client. In addition, perceived peer sexual risk and perceived vulnerability to STD were associated with being a male client in the community sample, and a history of STD and being tested for STD/HIV were associated with being a male client in the STD sample. CONCLUSION: Male migrants who paid for sex in China were vulnerable to HIV/STDs. HIV prevention efforts should target young migrant men who work at factory and construction sectors. STD clinics may be important sites for outreach and intervention efforts among male clients.     

Gonorrhoea reinfection in heterosexual STD clinic attendees: longitudinal analysis of risks for first reinfection

OBJECTIVES: Gonorrhoea is associated with adverse reproductive health outcomes, including pelvic inflammatory disease and increased HIV transmission. Our objective was to determine the association of demographic factors, sexual risk behaviours, and drug use with incident gonorrhoea reinfection among public STD clinic clients. METHODS: A retrospective cohort study conducted from January 1994 through October 1998, of heterosexual public STD clinic attendees age >/=12 years having at least one gonorrhoea infection in Baltimore, MD. The outcome was first incident gonorrhoea reinfection over a maximum 4.8 years, compared in STD clinic clients with or without sexual risk behaviours and drug use at initial gonorrhoea infection. RESULTS: 910 reinfections occurred among 8327 individuals and 21 246 person years of observation, for an overall incidence of 4.28 reinfections per 100 person years (95% CI 4.03 to 4.53). Median time to reinfection was 1.00 year (95% CI 0.91 to 1.07 years). In multivariate Cox regression, increased reinfection risk was associated with male sex, younger age, greater number of recent sex partners, and having a sex partner who is a commercial sex worker. Injection drug use and coming to the clinic as an STD contact were protective. Among risk factors that differed significantly between men and women, injection drug use was protective of reinfection in men, and "any" condom use was a risk factor for reinfection in women CONCLUSIONS: Reinfection represents a significant proportion of STD clinic visits for gonorrhoea. Prevention counselling and routine screening for patients at high risk for reinfection should be considered to maximally reduce transmission and resource utilisation.     

HIV infection and high risk behavior among patients attending an STD referral clinic in Prague, Czech Republic

OBJECTIVE: This survey was conducted to determine the prevalence of HIV infection and associated risk behaviour in a high risk population of clients attending an STD clinic in Prague, Czech Republic. METHODS: Between September 1994 and January 1995, clients entering the Apolinar STD clinic in Prague, Czech Republic, were enrolled in a blinded, unlinked HIV antibody seroprevalence study. Non-identifying demographic characteristics, STD diagnoses, HIV risk exposures, and voluntary HIV testing experience were extracted from medical charts. RESULTS: Of 1394 patients for whom serum was available for testing, one was positive for HIV (HIV prevalence 0.07%, 95% confidence interval (CI) 0.01, 0.41%). This person was one of 28 men having sex with men (MSWM) (HIV prevalence among MSWM 3.6%, 95% CI 0.6, 17.7%). Among the 775 male clients, 75.5% had heterosexual unprotected sex, 11.1% had sex with high risk partners or prostitutes, 3.6% were MSWM, 1.0% were injecting drug users (IDUs), 0.7% were both MSWM and IDUs, and 6.8% and 1.8% had other or no recognized risk for HIV/STDs, respectively. Among the 619 female clients, 74.5% had heterosexual unprotected sex, 11.6% were prostitutes, 7.8% had sex with high risk partners, 1.1% were IDUs, and 3.9% and 2.3% had other or no recognised risk, respectively. The 304 adolescent patients (age 11-19 years) differed significantly (p < 0.05) in risk behaviour and STD diagnoses from the 1090 patients who were 20 years and older. Adolescents were significantly more likely to be female (58.6% v 40.5%, OR = 2.1), IDUs (3.6% v 0.4%, OR = 10.2), prostitutes (8.9% v 4.7%, OR = 2.0), and have sex partners with STDs (7.6% v 4.4%, OR = 1.8). The adolescent patients were also significantly more likely to be diagnosed with gonorrhoea (21.1% v 12.3%, OR = 1.9) and non-gonococcal urethritis (27.6% v 17.2%, OR = 1.8), and significantly less likely to have been tested previously for HIV (19.1% v 31.9%, OR = 0.5). CONCLUSIONS: HIV infection is currently uncommon in this population. However, the high rates of unprotected sex, prostitution, injecting drug use, and STDs, especially among adolescents, provide the basis for an epidemic in this population. Aggressive prevention education should be started before adolescence.


     

HIV prevalence among clients attending a sexually transmitted diseases clinic in Amsterdam: the potential risk for heterosexual transmission.

INTRODUCTION--Patients attending a clinic for sexually transmitted diseases (STD) in general have engaged in at risk sexual behaviour. Therefore they are at increased risk of acquiring HIV through sexual contact. OBJECTIVE--To determine the HIV prevalence among patients attending a STD clinic in Amsterdam. METHODS--An anonymous cross sectional study was conducted in two 5-week periods in Spring and Autumn 1991. RESULTS--Of the 2362 patients attending the clinic during the study period, 2292 (97%) consented to participate; of these, 2138 (93%) were interviewed and anonymously tested, while 154 (7%) consented to be interviewed but refused HIV antibody testing. The HIV prevalence was 4.2% (90/2138); 93% of seropositive participants reported homosexual contacts and/or intravenous use of drugs (IVDU). HIV prevalence among heterosexual non-IVDU men was 0.5% and among non-IVDU women 0.1%. Among all heterosexually active participants, including IVDU and bisexual men, the HIV prevalence was 1.5%. The 28 of 90 HIV infected participants that were heterosexually active reported together approximately 135 heterosexual partners in the six months preceding the study; 13 of these 28 heterosexually active participants had a STD diagnosed at their present clinic visit, while four (30%) of them already knew they were HIV infected. CONCLUSIONS--From these data we conclude that there is a substantial risk of further transmission of HIV through heterosexual contact. In order to try to reduce this potential for further sexual transmission of HIV, services offered by the STD clinic should not only include voluntary confidential counselling and HIV testing, but also notification of partners of HIV infected clinic-attendants. Finally, we conclude that anonymous HIV prevalence studies that link HIV test results to risk behaviour for HIV infection can be performed with a high rate of participation. Repeating such prevalence studies in time can help in monitoring the HIV incidence in the heterosexually active population.     

Sexually transmitted disease testing protocols, sexually transmitted disease testing, and discussion of sexual behaviors in HIV clinics in Los Angeles County

OBJECTIVE/GOAL: The objective of this study was to evaluate the use of written protocols for sexually transmitted disease (STD) screening, the frequency and types of STD tests performed, and the occurrence and frequency of obtaining sexual risk assessments among HIV clinics. STUDY: A survey was administered to 36 medical directors, clinic directors, and HIV providers representing 48 HIV healthcare clinics in Los Angeles. RESULTS: The use of a written or electronic protocol for STD testing was reported by 50% of clinics. Clinics with written or electronic STD protocols were significantly more likely to report questioning patients at each visit regarding their sexual practices (prevalence ratio, 2.2; 95% confidence interval, 1.4-3.4). Clinics with written or electronic protocols were not more likely to report more frequent STD testing. CONCLUSIONS: Written or electronic protocols for STD testing may promote sexual risk assessment questioning among HIV healthcare providers and may help to ensure STD testing per Centers for Disease Control and Prevention/IDSA guidelines for HIV-positive persons at sexual risk.     

No evidence of an epidemic of locally acquired heterosexual HIV infection in Norway

BACKGROUND: An early sign of a major heterosexual human immunodeficiency virus (HIV) epidemic will be heterosexual infection acquired from persons who were themselves infected through heterosexual intercourse. GOAL: To test the hypothesis that there is a growing heterosexual epidemic of HIV in Norway. STUDY DESIGN: Data from the mandatory, comprehensive, anonymous HIV case reporting system were analyzed concerning Norwegian residents who had acquired HIV heterosexually and for whom such infections were diagnosed before the year 2001. RESULTS: One hundred fifty-five (71%) of 221 men were infected abroad, whereas 107 (76%) of 140 women were infected in Norway (mainly by drug injectors and immigrants); 23 men and 55 women had been infected in Norway by partners who themselves acquired HIV through heterosexual intercourse (secondary heterosexual transmission). There was a slightly increasing incidence of all heterosexual cases and secondary cases. CONCLUSIONS: Secondary heterosexual HIV transmission remains rare in Norway, and a sustainable epidemic of locally acquired infection seems unlikely in the foreseeable future. The magnitude of the heterosexual epidemic will be strongly influenced by infections acquired abroad.     

Factors associated with newly diagnosed HIV among persons with concomitant sexually transmitted diseases

OBJECTIVE: We evaluated Illinois and Chicago Departments of Public Health surveillance databases to determine risk factors associated with newly diagnosed HIV among persons with bacterial sexually transmitted diseases (STDs). METHODS: Test results for Chlamydia, gonorrhea, early syphilis (primary, secondary, and early latent), and HIV from public health clinics in Illinois in 2002 were merged with demographic and behavioral survey data collected during patient visits. STD was defined as any positive non-HIV result. RESULTS: Among 43,517 patient encounters, 5814 (13.4%) had positive STD test results. There were 308 (0.7%) positive new HIV test results, of which 71 (23.1%) had concomitant infection with an STD. Compared with STD-positive, HIV-negative cases, age >30 years (OR = 1.9, 95% CI, 1.0,4.4), men who have sex with men (MSM) (OR = 22.2, 95% CI 11.3-43.7), and bisexual male (OR = 22.4, 95% CI 7.8-64.8) were independently associated with STD and HIV coinfections. Among distinct STDs, syphilis (n = 438) was the least frequent (7.5%), but was reported in the highest proportion (10.1%) of all new HIV infections and conferred the greatest risk (OR = 11.0, 95% CI 7.7-15.8) for newly diagnosed HIV. CONCLUSIONS: MSM were at increased risk for newly diagnosed HIV with STD coinfection. Persons with a concomitant STD and HIV were older than US populations that generally constitute the greatest proportion of STD cases. These results highlight the role in particular of syphilis among populations at high risk for HIV transmission. Public health interventions targeting MSM and older adults for effective testing and prevention strategies are critically needed within high-risk networks for cotransmission of STDs and HIV.     

Trends in, and determinants of, HIV testing at genitourinary medicine clinics and general practice in England, 1990-2000

OBJECTIVES: To describe the trends in and determinants of HIV testing and positivity at genitourinary medicine (GUM) clinics and in general practice (GP) in England between 1990 and 2000. METHODS: Data on all first HIV specimens from GUM and GP clinics and tested at seven sentinel laboratories were related to key demographic, clinical, and behavioural variables. RESULTS: During the observation period, 202 892 eligible first HIV tests were reported. 90% (182 746) of specimens were from GUM clinics, of which 55% were from heterosexuals, 12% from men who have sex with men (MSM), and 3% from injecting drug users (IDU). In contrast, only 3% of GP specimens were from MSM and 13% from IDUs. The total number of first HIV tests increased threefold between 1990 and 2000. Overall, 1.6% of GUM and 0.9% of GP first testers were diagnosed HIV positive. In GUM clinics, HIV positivity was highest among heterosexuals who have lived in Africa (11.7%), MSM (6.9%), and IDUs (2.8%) and lowest among heterosexuals with no other specified risk (0.3%). Consistently lower prevalences were observed in GP settings. HIV positivity among GUM first testers declined in MSM, from 13.6% in 1990 to 5.2% in 2000 (p<0.01), and in IDUs, from 7.5% in 1990 to 2.0% in 2000 (p = 0.03). Prevalence remained constant in the groups heterosexually exposed to HIV infection. CONCLUSIONS: HIV testing in GUM settings increased over the decade, with a concomitant reduction in HIV positivity among MSM and IDUs. Increased testing among heterosexual first testers overall was not associated with declining positivity.