Missed Opportunities for HIV Testing Among STD Clinic Patients

Current HIV testing guidelines recommend that all adolescents and adults aged 13–64 be routinely screened for HIV in healthcare settings. Sexually transmitted disease (STD) clinic patients represent a population at increased risk for HIV, justifying more frequent risk assessment and testing. This analysis describes missed opportunities for HIV testing among a sample of STD clinic patients to identify areas where HIV testing services may be improved. Secondary analysis was conducted using data from Project AWARE, a randomized trial of 5012 adult patients from 9 STD clinics in the United States, enrolled April–December 2010. HIV testing history, healthcare service utilization, and behavioral risks were obtained through audio computer-assisted self-interview. Missed opportunities for HIV testing, defined as having a healthcare visit but no HIV test in the last 12 months, were characterized by location and frequency. Of 2315 (46.2%) participants not tested for HIV in the last 12 months, 1715 (74.1%) had a missed opportunity for HIV testing. These missed opportunities occurred in both traditional (54.9% at family doctor, 20.3% at other medical doctor visits) and non-traditional (28.5% at dental, 19.0% at eye doctor, 13.9% at correctional facility, and 13.3% at psychology visits) testing settings. Of 53 participants positive for HIV at baseline, 16 (30.2%) had a missed testing opportunity. Missed opportunities for HIV testing were common in this population of STD clinic patients. There is a need to increase routinized HIV screening and expand testing services to a broader range of healthcare settings.     

Development and testing of an HIV-risk screening instrument for use in health care settings

Objective: To develop and test a brief, reliable, and valid HIV-risk screening instrument for use in primary health care settings.Design: A two-phase study: (1) developing a self-administered HIV-risk screening instrument, and (2) testing it with a primary care population, including testing the effect of confidentiality on disclosure of HIV-risk behaviors.Setting: Phase 1: 3 types of sites (a blood donor center, a methadone clinic, and 2 STD clinics) representing low and high HIV-seroprevalence rates. Phase 2: 4 primary care sites.Participants: Phase 1: 293 consecutively recruited participants. Phase 2: 459 randomly recruited primary care patients.Main Outcome Measure: Phase 1: comparison of the responses of participants from low and high HIV-seroprevalence sites. Phase 2: primary care patients’ rates of disclosure of HIV-risk behaviors and ratings of acceptability.Results: Phase 1: through examining item-confirmation rates, item-total correlations, and comparison of responses from low and high HIV-seroprevalence sites, we developed a final 10-item HIV-risk Screening Instrument (HSI) with an internal consistency coefficient of .73. Phase 2: 76% of primary care patients disclosed at least 1 risky behavior and 52% disclosed 2 or more risky behaviors. Patients were willing to disclose HIV-risk behaviors even knowing that their physician would see this information. Ninety-five percent of our patient participants were comfortable with the questions on the HSI, 78% felt it was important that their doctor know their answers, and 52% wished to discuss their answers with their physician.Conclusion: Our brief, self-administered HSI is a reliable and valid measure. The HSI can be used in health care settings to identify individuals at risk for HIV and to initiate HIV testing, early care, and risk-reduction counseling, necessary goals for effective HIV prevention efforts.     

枞阳县重点人群性行为学特征和梅毒感染状况调查分析

目的了解枞阳县重点人群性行为学特征及梅毒感染状况,为制定性病艾滋病防控措施提供科学依据。方法对性病门诊就诊者、孕产妇及娱乐场所暗娼人群进行面对面问卷调查,并抽取5ml静脉血进行梅毒血清学检测。结果调查暗娼40名,280名性病门诊就诊者和402例孕产妇,暗娼及性病门诊就诊者的艾滋病知识知晓率分别为47.5%和43.2%,他们在最近一次性行为中安全套的使用率分别为37.5%和28.9%。孕产妇有1.7%的人曾经患过性病,有11.7%的人有过非婚性性行为。暗娼的梅毒感染率为12.5%,性病门诊就诊者的梅毒感染率为6.4%,0.5%的孕产妇梅毒血清学实验阳性。结论梅毒已经在高危人群中流行与扩散,加强性病艾滋病宣传和干预力度,规范性病门诊及强化孕产妇保健工作是控制梅毒流行与传播的关键措施。     

Integrating cervical cancer prevention initiatives with HIV care in resource-constrained settings: A formative study in Durban,South Africa

Cervical cancer screening rates remain suboptimal among women in South Africa (SA), where cervical cancer prevalence is high. The rollout of HIV-related services across SA may provide a means to deliver cervical cancer screening to populations with limited access to health care systems. In this mixed methods study, psychosocial factors influencing cervical cancer prevention and perceptions of the provision of Pap smears in HIV care settings were examined. Structured interviews were conducted with women (n = 67) from a municipal housing estate in Durban, SA. Key informants (n = 12) also participated in semi-structured interviews. Findings revealed that participants had low cervical cancer knowledge, but desired more information. Relevant themes included the normalisation of HIV and beliefs that cervical cancer might be worse than HIV. A comprehensive community clinic was desired by most, even if HIV-positive patients were treated there. This study provides important insight into integrating cervical cancer screening with HIV clinics, which may increase cancer screening among South African women.     

Serological studies on health care workers caring for patients with human immunodeficiency virus

Between 1982 and July 1987, more than 1200 patients attending St Stephen's Hospital were found to be HIV antibody positive. Four hundred were inpatients and most of the outpatients attended the sexually transmitted disease clinic. Two hundred and twenty-one patients had AIDS, 480 HIV-related disorders and 500 were asymptomatic. Most inpatients had invasive procedures within the operating theatres and there were 25 postmortems. Four hundred and five antibody tests from 220 health care workers from the STD clinic, operating theatres, isolation ward, intensive care unit and clinical laboratories were voluntarily tested for HIV antibody by an ELISA screening method. All were negative, except one male nurse who had other risk factors. Twenty-nine staff suffered needlestick injury with blood of HIV antibody positive patients; none has developed serological evidence of HIV infection.     

1798例性病门诊就诊者HIV检测结果分析

目的：了解性病门诊就诊者HIV感染情况。方法：对我中心1997年4月至1999年10月性病门诊就诊者1798例（其中性病患者1134例，占63．07％），进行HIV血清检测，检测方法采用明胶颗粒凝集法（PA）和酶联免疫（ELISA）方法作为初筛，两者阳性者应用蛋白印迹法确认。结果：2例HIV阳性，占性病门诊就诊者0．11％，占性病患者0．18％，2例患者均承认有多次嫖娼史，否认吸毒史，证实通过性接触感染，结论：提示HIV病毒已有一定程度上播散于性病人群，对性乱者的HIV监测，在预防和控制HIV传播具有重要意义。     

Barriers to asymptomatic screening and other STD services for adolescents and young adults: focus group discussions

Background  

Sexually transmitted diseases (STDs) are a major public health problem among young people and can lead to the spread of HIV. Previous studies have primarily addressed barriers to STD care for symptomatic patients. The purpose of our study was to identify perceptions about existing barriers to and ideal services for STDs, especially asymptomatic screening, among young people in a southeastern community.     

An approach to addressing ethical issues in a community-based risk assessment for HIV: a case from Chennai, India

Community-based assessment of HIV prevalence and behavioural risk factors is the basis for deciding priorities of prevention and care programmes. Here, upholding the human rights of participants in assessment is of utmost importance. The objective of the paper was to describe the process of implementation of an epidemiological survey to assess HIV-related behavioural and biological factors in Chennai city in South India and to suggest an ethical framework for conducting similar assessment activities in developing-country settings. A survey was conducted with participation from residents (n=1,659) of low-income urban communities (slums) as part of a community-based HIV/STD-prevention trial. Administration of the survey was preceded by extensive community contact and household visits to inform community members about the trial and assessment activities. Formative research further strengthened rapport with community, highlighted community concerns, and identified HIV-related risk behaviours that informed questionnaire design. The process of obtaining informed consent began before assessment activities and provided an opportunity for individuals to discuss participation with their families and friends. Privacy during assessment, comprehensive follow-up care for those who tested positive for HIV/STDs, such as nutritional and prevention counselling, referral services for opportunistic infections, and antenatal-care options for pregnant women increased trust and credibility of the project. The sustained availability of trial staff to facilitate access to resources to address non-HIV/STD-related felt-needs further strengthened participation of the community members. These resources included liaison services with local government to obtain public services, such as water and electricity and resources, to address concerns, such as alcohol abuse and domestic violence. Based on this experience, an ethical framework is suggested for conducting HIV epidemiological risk assessment in developing countries. This framework discusses the role of community participation, transparent and comprehensive informed consent, timely dissemination of results, and access to follow-up care for those living with HIV/STDs.     

#86 Changes in hiv prevalence among emnt who have sex with men (Msm) Who attend public sexually transmitted disease clinics in the western region of the us (1989–1999)

PURPOSE: To compare the distribution and trends in HIV infection among MSM STD clinic attendees in four Western urban counties.METHODS: As part of CDC's national HIV seroprevalence surveys, unlinked HIV testing was performed on sera routinely collected for syphilis screening between 1989 and 1999 from public STD clinics in Denver, Los Angeles, San Francisco, and Seattle. HIV test results were linked to demographic and risk information abstracted from clinic records.RESULTS: Greater than 70% of MSM attendees were between the ages of 20 and 39. The majority in 3 of 4 counties was white. HIV prevalence over the study period ranged from 13% in Seattle to 30% in San Francisco. In all counties, prevalence was highest among blacks, lowest among Asian/Pacific Islanders, and similar between whites and Hispanics. The 30–39 year-old age group was most likely to be infected. After adjustment for age, race, and injection drug use, mean annual declines in HIV prevalence from 1989 to 1999 ranged from 2.1% (95% CL 1.6, 2.6) in Seattle to 2.8% (95% CL 2.6, 3.1) in San Francisco. All counties except San Francisco saw larger adjusted declines among whites and Hispanics than among blacks.CONCLUSION: Despite variations in the severity of the HIV epidemic across the Western region counties, relative differences in prevalence by race and age were similar. Moreover, all four counties saw temporal declines in HIV prevalence. Trends in HIV prevalence among the MSM STD clinic attendees may not, however, reflect population trends in HIV incidence or prevalence. This may be due to more HIV-positive MSM becoming aware of their status and seeking STD treatment in other settings, thus biasing downward the HIV prevalence observed in public STD clinics, compared with prevalence in the general population.     

Rapid HIV testing in outreach and other community settings--United States, 2004-2006

In 2003, an estimated 1 million persons in the United States were living with human immunodeficiency virus (HIV) infection. Approximately 25% were unaware of their infection; however, that percentage might have been greater among persons at high risk for HIV infection, including racial/ethnic minority populations. To increase the proportion of persons aware of their HIV serostatus, CDC launched the Advancing HIV Prevention initiative in 2003. One strategy of the initiative is to implement new models for diagnosing HIV infections outside medical settings. During 2004-2006, CDC funded a demonstration project to provide rapid HIV testing and referral to medical care, targeted to racial/ethnic minority populations and others at high risk in outreach and other community settings. This report summarizes the results of that project, which indicated that, of 23,900 clients who received a rapid HIV test, 39% were non-Hispanic blacks, 31% were Hispanics, 17% reported male-male sex, and 6% were injection-drug users. A total of 267 (1%) persons had confirmed HIV-positive test results; of these, 195 (74%) were either non-Hispanic blacks or Hispanics. The project results demonstrate that rapid HIV testing in outreach and other community settings can identify large numbers of persons in racial/ethnic minority populations and others at high risk who are unaware they are infected with HIV.     

天津市2005-2009年部分人群HIV监测分析

目的了解天津市2005-2009年艾滋病监测结果,探索天津市艾滋病流行特征与趋势,为制定艾滋病防治策略提供依据。方法对2005-2009年天津市部分人群的监测结果进行统计分析。结果本组3 373 026份样本中检出阳性905例,男男性接触人群(MSM)、性传播疾病(STD)门诊就诊者等人群中阳性检出率较高,MSM每年检出率都在1 600/10万以上,STD门诊就诊者阳性检出率除2005年以外其余各年都在200/10万以上;阳性病例中同性传播所占比例呈现上升趋势。结论天津市一般人群艾滋病感染率较低,但MSM、STD门诊就诊者等人群感染率较高。在继续开展一般人群防治工作的同时应加强对MSM、STD门诊就诊者等人群的艾滋病防治工作。     

安徽省马鞍山市社区吸毒人群HIV、梅毒感染状况及其行为特征分析

目的了解马鞍山市社区吸毒人群艾滋病病毒（human immunodeficiency virus,HIV）、梅毒感染状况并分析该人群行为特征。方法采用方便抽样法抽取385名吸毒者,收集艾滋病相关行为及有关的信息,分析马鞍山社区吸毒人群的行为特征。血清学检测采用两次血清酶联免疫吸附试验（ELISA）的方法进行血清HIV抗体检测。采用快速血浆反应素环状卡片试验（简称RPR）的方法检测血清中梅毒抗体,以确定梅毒感染状况。结果 2008年4月～7月在马鞍山市共调查385名社区吸毒对象,HIV阳性感染率为0.78%;梅毒阳性感染率为6.75%。3名HIV阳性感染者均有共用注射器吸毒史,其中2名有非婚性行为,吸毒方式间差异有统计学意义（P〈0.05）;梅毒阳性的有26人,阳性感染者年龄主要集中在31～40岁。吸毒者自愿做HIV检测的相关因素回归分析显示,影响因素有与别人共用注射器、自愿去戒毒所戒毒、参加美沙酮维持治疗和接受艾滋病咨询服务、最近一次性交时使用安全套、最近一年与临时性伴发生性行为。结论建议在社区开展HIV、性传播疾病的咨询与检测,宣传教育是目前最为有效的防止艾滋病/性传播疾病在人群中传播的手段,同时开展有针对性的行为干预,以控制艾滋病等传染性疾病由高危人群向一般人群的传播。     

性病门诊男性就诊者艾滋病、丙肝、梅毒哨点监测结果分析

目的了解性病专科门诊男性就诊者艾滋病知识知晓情况,艾滋病高危行为发生状况,以及艾滋病、丙肝和梅毒的感染情况,为干预策略的制定提供参考依据。方法对性病专科门诊403例男性就诊者进行问卷调查,同时采集该就诊者血清进行HIV、HCV和TP血清学检测。结果性病门诊403例男性就诊者对艾滋病知识知晓率在83.4%～98.3%。最近3个月内与小姐发生过性行为者占20.6%,与临时性伴发生过性行为者占21.1%,近1年内曾患过性病者占12.2%。403例监测标本中HIV抗体阳性样未检出;HCV抗体阳性样共检出并确认2例,占0.5%;TP抗体阳性样共检出4例,占1.0%。结论性病门诊男性就诊者是艾滋病哨点监测的重点人群。此次监测人群艾滋病相关知识有所欠缺,高危行为发生比例较高,应加强性病门诊男性就诊者监测,加大该类人群干预力度。     

Understanding sex partner selection from the perspective of inner-city black adolescents

CONTEXT: Black adolescents in inner-city settings are at increased risk for HIV and other STDs. Sex partner characteristics, as well as individual behavior, influence individuals' STD risk, yet little is known about the process of sex partner selection for adolescents in this setting. METHODS: Semistructured in-depth interviews were conducted during the summer and fall of 2002 with 50 inner-city black adolescents (26 females and 24 males) who had been purposively recruited from an STD clinic. Content analysis was used to study interview texts. RESULTS: Young women desire a monogamous romantic partner, rather than a casual sex partner; however, to fulfill their desire for emotional intimacy, they often accept a relationship with a nonmonogamous partner. Young men seek both physical and emotional benefits from being in a relationship; having a partner helps them to feel wanted, and they gain social status among their peers when they have multiple partners. For men, these benefits may help compensate for an inability to obtain jobs that would improve their financial and, as a result, social status. Both women and men assess partners' STD risk on the basis of appearance. CONCLUSIONS: HIV and other STD prevention initiatives must go beyond the scope of traditional messages aimed at behavior change and address the need for social support and socioeconomic opportunities among at-risk, inner-city adolescents.     

Screening for Post-traumatic Stress Disorder in Prenatal Care: Prevalence and Characteristics in a Low-Income Population

Objectives Investigate the feasibility of using a brief, 4-item PTSD screening tool (PTSD-PC) as part of routine prenatal care in two community health care settings serving ethnically and linguistically diverse low-income populations. Report prevalence and differences by sub-threshold and clinical levels, in demographic, health, mental health, risk behaviors, and service use. Methods Women were screened as part of their prenatal intake visit over a 2-year period. Those screening positive at clinical or sub-threshold levels were recruited if they spoke English, Spanish, Portuguese, Vietnamese or Arabic. Enrolled women were interviewed about psychosocial risk factors, prior traumas, PTSD symptoms, depression, anxiety, substance use, health and services, using validated survey instruments. Results Of 1362 women seen for prenatal intakes, 1259 (92 %) were screened, 208 (17 %) screened positive for PTSD at clinical (11 %) or sub-threshold levels (6 %), and 149 (72 % of all eligible women) enrolled in the study. Those screening positive were significantly younger, had more prior pregnancies, were less likely to be Asian or black, and were more likely to be non-English speakers. Enrolled women at clinical as compared to sub-threshold levels showed few differences in psychosocial risk, but had significantly more types of trauma, more trauma before age 18, more interpersonal trauma, and had greater depression, anxiety, and PTSD symptoms. Only about 25 % had received mental health treatment. Conclusions The PTSD-PC was a feasible screening tool for use in prenatal care. While those screening in at clinical levels were more symptomatic, those at subthreshold levels still showed substantial symptomology and psychosocial risk.     

Results of the Expanded HIV Testing Initiative--25 jurisdictions, United States, 2007-2010

Approximately 20% of the estimated 1.2 million persons living with human immunodeficiency virus (HIV) infection in the United States at the end of 2008 were not aware of their infection. Testing, diagnosis, medical care, treatment with highly active antiretroviral therapy (HAART), and access to prevention services soon after HIV infection can prevent morbidity and mortality and reduce a person's risk for transmitting HIV. In 2006, CDC recommended screening patients aged 13--64 years for HIV infection in health-care settings that have a prevalence of undiagnosed HIV infection of ≥0.1%. In October 2007, CDC initiated the Expanded HIV Testing Initiative (ETI), through which it funded 25 health departments to facilitate HIV screening and increase diagnoses of HIV infections and linkage to care among populations disproportionately affected by HIV, especially non-Hispanic blacks. This report describes the results of that effort. Annual progress reports designed to provide data specific to ETI indicated that 2,786,739 HIV tests were conducted, of which 29,503 (1.1%) were positive and 18,432 (0.7%) resulted in new HIV diagnoses. Blacks accounted for 1,411,780 (60%) of tests and 11,638 (70%) of new HIV diagnoses. Clinical settings comprised at least 75% of the 1,331 testing venues and accounted for 90% of all tests and 81% of all new HIV diagnoses. Based on follow-up data available for 16,885 persons with new HIV diagnoses, 12,711 (75.3%) were linked successfully to HIV primary care. Through expanded HIV testing activities, substantial numbers of persons previously unaware of their HIV infection were identified and linked to care. Health departments should continue to partner with clinical-care providers to provide routine HIV screening, especially in populations disproportionately affected by HIV.     

Association of stereotypes about physicians to health care satisfaction, help-seeking behavior, and adherence to treatment

The present research consists of three studies examining the role of patients' stereotypes about health care providers in the health care decision process. Study 1 examined the association of stereotypes to health care satisfaction and help-seeking behavior among a low-income clinic sample; Study 2 examined the relationship of stereotypes to satisfaction and adherence to treatment among low-income individuals living with HIV; and Study 3 examined the association of stereotypes to satisfaction and help-seeking among a sample of homeless individuals. Overall findings indicate that individuals who held more negative stereotypes about physicians sought care less often when sick, were less satisfied with the care that they did obtain, and were less likely to adhere to physician recommendations for treatment. Moreover, African Americans, but not Whites, with more positive stereotypes reported better adherence in Study 2 and were more satisfied with their health care in Study 3. Our findings point to the need to better understand the role of patients' beliefs about health care in predicting health care satisfaction and health behaviors.     

High time for wide application of an opting-out strategy for HIV testing

--Despite the current active HIV test policy, the effects of the former policy are still visible, i.e. a relatively low number of individuals that have ever been tested for HIV. --The number of HIV tests and knowledge of current HIV status has increased among visitors to the STI clinic in Amsterdam. --Nevertheless, anonymous HIV surveillance among visitors to the STI clinic shows that a considerable proportion of HIV-infected individuals (24% of men who have sex with men (MSM) and 80% of heterosexuals) are unaware of the infection. --A new opting-out strategy for HIV testing in STI clinics is recommended. --The opting-out strategy may also be applicable to other medical settings, especially those that treat target populations such as MSM, heterosexuals with STI-related symptoms, and persons originating from AIDS-endemic regions. --The opting-out system was initiated in the Amsterdam STI clinic in 2007 in order to further reduce the number of undiagnosed HIV infections.