Comparing prevalence of condom use among 15,379 female sex workers injecting or not injecting drugs in China

OBJECTIVES: To compare the prevalence of condom use with clients and regular sex partners between female sex workers (FSWs) who were or were not injecting drug users (IDUs). METHODS: Behavioral surveillance data (2002-2004) conducted in Sichuan, China were analyzed. Mapping exercises were done. About 250 to 400 FSWs were anonymously interviewed from selected establishments in 19 surveillance sites. RESULTS: Of all 15,379 FSWs studied, 3.2% were IDUs. This group, when compared with the non-IDU group, was less likely to have used condoms with clients (last episode: 71.1% vs. 81.2%, OR = 0.6, P < 0.01; consistent use in the last month: 26.7% vs. 40.4%, OR = 0.5, P < 0.01) or to possess a condom (68.7% vs. 77.8%, OR = 0.6, P < 0.01). The between-group difference in last month's consistent condom use with clients remained significant in the multivariate analyses, after adjusting for other significant factors [age, education level, age at first sex, having a regular sex partner, HIV-related knowledge and perceptions, HIV antibody testing (OR = 1.1-2.9, P < 0.05); STD symptoms, type of sex workers, longer duration of sex work, larger number of clients per week, and not having received HIV-related information (OR = 0.4-0.9)]. Comparable results were obtained for condom use with the last client. Such between-group differences were, however, not observed for condom use with regular sex partners (P > 0.05). Exposure to HIV-related services was associated with condom use with clients (OR = 1.3-2.8, P < 0.05). CONCLUSIONS: Higher sexual risk behaviors were found among FSWs who were also IDUs, when compared with those who were non-IUDs. A double-risk bridging population for HIV transmission thereby exists.     

Temporal trends in sexual behaviors and sexually transmitted disease history among 18- to 39-year-old Seattle, Washington, residents: results of random digit-dial surveys

OBJECTIVES: The objectives of this study were to describe sexual behaviors of Seattle residents in 2003-2004 and report changes since 1995. METHODS: We conducted a random digit-dial (RDD) survey among 18- to 39-year-old men and women in 2003-2004. We compared the results with the results of a 1995 RDD survey conducted in the same population. Questionnaire batteries and sampling methods were similar in the 2 surveys. RESULTS: Between 1995 and 2004, the median number of lifetime sex partners increased from 7 to 8. Vaginal douching declined from 70.6% to 25.9% (P = 0.004) among black women; from 8.3% to 5.9% (P <0.05) among Asian American women; and from 15.5% to 2.4% (P <0.05) overall. After adjustment, proportions of women who reported practicing vaginal douching (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.7-0.22), the proportion of respondents who reported a history of any sexually transmitted disease (OR, 0.70; 95% CI, 0.53-0.93) and a history of gonorrhea (OR, 0.48; 95% CI, 0.25-0.89) declined between 1995 and 2004. Conversely, the proportion of respondents who reported only same-sex partners (OR, 3.27; 95% CI, 1.33-9.88), condom use at first sex with their most recent sex partner (OR, 1.38; 95% CI, 1.06-1.78), and reported practice of anal sex (OR, 2.01; 95% CI, 1.21-3.48) increased between 1995 and 2004. Among blacks, proportions reporting an age difference of only 2 years with their partners declined from 64.3% to 25.9% (P <0.05), indicating increased age mixing. CONCLUSIONS: Some risk behaviors declined whereas others increased between 1995 and 2004; several trends were divergent between the general population and minority populations. Our data hint at an increasing divergence in risk behaviors and morbidity between minority populations and the general population. Also, anal sex and number of sex partners have increased. These patterns have serious implications for the design, targeting, and implementation of prevention programs.     

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.


     

Factors affecting vaginal pH levels among female adolescents attending genitourinary medicine clinics

OBJECTIVES: Vaginal pH is related to hormonal status, and adolescents experience disturbed hormonal patterns following menarche. We assessed hormonal factors and risk of abnormal vaginal pH and bacterial vaginosis (BV) among adolescents attending genitourinary medicine (GUM) clinics. METHODS: In a cross sectional study adolescents within 5 years of menarche, < or =17 years, or with oligo-amenorrhoea were recruited. Vaginal pH and BV were assessed and among those not using hormonal contraceptives, estrone-3-glucuronide (E3G) and pregnanediol-3alpha-glucuronide (P3G) concentrations were measured. RESULTS: Among 102 adolescents, 59.8% (61) had a high vaginal pH (>4.5), which was higher than the prevalence of BV, detected in 33% (34). No association was found between presence of sexually transmitted infections (STI) and vaginal pH. In logistic regression, after controlling for BV and condom use, vaginal pH was positively associated with cervical ectopy (OR = 2.5; 95% CI 1.0 to 6.6, p = 0.05) and STI treatment history (OR = 2.5; 95% CI 0.9 to 6.5, p = 0.07), and negatively associated with use of Depo-Provera (OR = 0.1; 95% CI 0.03 to 0.6, p = 0.003) and recent onset (<12 months) of sexual activity (OR = 0.2; 95% CI 0.1 to 0.7, p = 0.004). Among 23 adolescents not using hormonal contraceptives, a high pH occurred more often in abnormal compared to normal menstrual cycles (OR = 10.8; 95% CI 1.4 to 85.4; p = 0.026). E3G concentrations were inversely correlated with vaginal pH in the follicular phase (Spearman: r = 0.51; p = 0.024). CONCLUSIONS: Ectopy and abnormal menstrual cycles are common features of adolescence. Their presence is associated with increased risk of abnormal pH, and may also predispose to BV.     

Methamphetamine use and risky sexual behaviors during heterosexual encounters

OBJECTIVE: This study examined the association between event-level methamphetamine use and heterosexual risk behaviors. METHOD: Data on 1213 heterosexual encounters were collected using audio-computer assisted self interviews from 703 injecting drug users in North Carolina. Data were obtained by asking participants a series of questions about the last time that they had sex (oral, vaginal, and/or anal). Although participants were interviewed at up to 3 time points, data were analyzed at the event level rather than as longitudinal because we were interested in the co-occurrence of methamphetamine use and sexual risk behaviors. Multivariate generalized estimating equations models were developed to examine the association between co-occurring methamphetamine use and each of 6 heterosexual risk behaviors. RESULTS: Methamphetamine was used in 7% of encounters. Methamphetamine use by either or both partners was associated with an increased likelihood of anal intercourse (odds ratio [OR] = 2.41, 95% confidence interval [CI] = 1.29-4.53), vaginal and anal intercourse (OR = 2.41, 95% CI = 1.22-4.77), and sex with a new partner (OR = 1.98, 95% CI = 1.09-3.61). In addition to these behaviors, methamphetamine use by both partners was also significantly associated with unprotected intercourse with a new partner (OR = 5.20, 95% CI = 2.09-12.93) and unprotected anal intercourse (OR = 4.63, 95% CI = 1.69-12.70). CONCLUSIONS: Methamphetamine use during heterosexual encounters appears to increase sexual risk-taking, especially when both partners are using it.     

Clustering of syringe sharing and unprotected sex risk behaviors in male injecting drug users in China

OBJECTIVES: To investigate, among male injecting drug users (IDU), the relationships between higher risk IDU-related and sex-related behaviors. GOAL: To highlight the clustering effects of the 2 forms of risk behaviors. STUDY DESIGN: Behavioral surveillance surveys conducted in Sichuan were analyzed (n = 3105). RESULTS: Of all respondents, 35.7% had injected with others' used syringes in the last 6 months, which was associated with female sex workers (FSW) and nonregular sex partners (NRP) partnership (OR = 1.81 and 1.59 respectively), and having had unprotected sex with FSW, NRP, and regular sex partners (OR = 1.96, 1.57, and 1.38 respectively). Higher drug use frequency was associated with having unprotected sex with FSW (among client of FSW, OR = 1.7) and with NRP (among those with NRP, OR = 1.61). Giving used syringes to others for injection was also associated with unprotected sex with NRP (OR = 1.97). CONCLUSIONS: Interventions are urgently required to reduce both IDU-related and sex-related risk behaviors among male IDU.     

Predictors of syphilis seroreactivity and prevalence of HIV among street recruited injection drug users in Los Angeles County, 1994-6

OBJECTIVES: To describe HIV prevalence and the association between syphilis incidence and sexual and drug injection risk behaviours in a cohort of street recruited injecting drug users (IDUs) in Los Angeles County, between 1994 and 1996. METHODS: During the study period, 513 street recruited African-American and Latino IDUs were screened for syphilis and antibodies to HIV. Subjects were administered a risk behaviour survey at baseline and followed up at 6 month intervals for 18 months with repeated interviews and serological screening. Rate ratios were used to examine associations between syphilis incidence and demographic characteristics and risk behaviours. A proportional hazard model was used to identify predictors of syphilis incidence independent of demographic characteristics. RESULTS: 74% of the sample were male, 70% African-American, 30% Latino; and the median age was 43 years. Overall baseline serological prevalence of HIV was 2.5% and of syphilis 5.7%. None of the participants were co-infected for HIV and syphilis at baseline or at any of the 6 month follow ups. Among 390 eligible IDUs retained for analysis of incidence data, the overall syphilis incidence was 26.0 per 1000 person years. Higher syphilis incidence was found for women compared with men (RR = 2.70; 95% CI 1.60, 4.55), and for those 44 years of age or younger compared with those 45 years of age and older (RR = 2.26; 95% CI 1.25, 4.08). African-Americans were more likely to be syphilis incident cases when compared with Latinos, although the difference did not reach statistical significance (RR = 1.27; 95% CI 0.72, 2.23). In bivariate analysis, risk behaviours significantly associated with higher syphilis incidence included injection of cocaine, "speedball" and heroin, "crack" smoking, recency of first injection event, backloading of syringes, injecting with others, exchanging drugs or money for sex, multiple sex partners, and non-heterosexual sexual preference. Variables that significantly predicted syphilis infection at follow up in the multivariate analysis included multiple sex partners (RR = 7.8; 95% CI 2.4, 25.0), exchanging money for sex (RR = 3.0; 95% CI 0.9, 9.6), and recent initiation to injection drug use (RR = 4.6; 95% CI 1.1, 18.8). CONCLUSION: Syphilis transmission among IDUs in Los Angeles County remains a serious public health concern, particularly among IDUs who engage in trading of sex for money or drugs. Although low, the prevalence of HIV observed in this study constitutes a serious concern because of the potential for expanded HIV transmission in this susceptible population of IDUs with high syphilis incidence. Enhanced case finding screening efforts and prevention of transmission of sexually transmitted infections should specifically target hard to reach IDUs and their sexual partners.     

Self-reported condom use is associated with reduced risk of chlamydia, gonorrhea, and trichomoniasis

OBJECTIVES: To evaluate the association between self-reported condom use and prevalent and incident chlamydia, gonorrhea, and trichomoniasis. STUDY DESIGN: Prospective study of 414 males attending a sexually transmitted infection (STI) clinic in Jamaica. Condom use and STI status were assessed at enrollment and at 4 follow-up visits. RESULTS: The analyses on condom use and prevalent STI included data from 414 men, while those on incident STI were based on 1111 intervals from 355 men. We diagnosed prevalent STI (chlamydia, gonorrhea, and/or trichomoniasis) in 54.6% (n = 226) of the participants at enrollment. About 14% (n = 51) of participants had at least 1 of the study STIs during follow-up. Follow-up visits in which participants reported consistent condom use (100% of acts) for the past 7 days had less incident STI (adjusted OR, 0.4; 95% CI, 0.2-0.9) compared with visits where no condom use was reported. Self-reported condom use was more closely correlated with incident than prevalent STI. For example, the adjusted OR for prevalent infection for participants reporting consistent versus no condom use in past 7 days was 0.7 (95% CI, 0.4-1.2). Classifications based on the number of unprotected acts yielded findings similar to those based on the proportion of acts protected. CONCLUSIONS: Consistent condom use was associated with reduced risk of incident urethral STI. Research on condom effectiveness should focus on incident STI outcomes, where the temporal relationship between condom use and infection is clearer.     

Syphilis among female sex workers in southwestern China: potential for HIV transmission

OBJECTIVE: The objective of this study was to investigate the prevalence and risk factors of syphilis infection among female sex workers in a southwestern Chinese city along a drug trafficking route. METHODS: From December 2004 to January 2005, 343 female sex workers (FSWs) were recruited through community outreach and peer referring. Confidential questionnaire interviews were administered to collect information on sexual and other sexually transmitted diseases/HIV risk behaviors. Cervical and blood samples were collected to test for syphilis and HIV antibodies and Neisseria gonorrhoeae infection; Condyloma acuminatum infection was diagnosed clinically. RESULTS: Of 343 FSWs, 15.7% were infected with syphilis. The prevalence of HIV, gonorrhea, and C. acuminatum was 0.6%, 2.0%, and 1.5%, respectively. The subtype of 2 HIV-1 infections was both CRF 07BC. Nearly 10% of FSWs reported using illicit drugs. Consistent use, inconsistent use, and never use of condoms with commercial sex clients in the last month were reported by 53.9%, 38.5%, and 7.6% FSWs, respectively. Longer duration of sex work (odds ratio [OR] = 1.98; 95% confidence interval [CI] = 1.08-3.62), working at low-end establishments (OR = 2.03; 95% CI = 1.10-3.76), and if primary sex partners had sex with other women in the past 6 months (OR = 2.06; 95% CI = 1.08-3.91) were independently associated with syphilis infection. CONCLUSIONS: High prevalence of syphilis and overlapped unprotected commercial sex and drug using behaviors among FSWs along a drug-trafficking route may suggest a potential for rapid spread of HIV from injection drug users to FSWs and then to the general population and underscore the urgency of preventive interventions to break the bridge of FSWs for HIV/sexually transmitted disease spread.     

Evaluation of the overall program effectiveness of HIV-related intervention programs in a community in Sichuan, China

OBJECTIVES: The study evaluates the overall effectiveness of intervention programs among female sex workers in a Chinese community. STUDY DESIGN: Behavioral surveillance data in 2003, 2004, and 2005 obtained from 2 communities (intervened and control) were compared. RESULTS: The baseline data (2003) of the 2 counties were not significantly different. In 2004 and 2005, the intervened county had significantly higher prevalence of condom use with their clients and regular sex partners (last-time and consistent use in the last month; OR = 2.2-33.2 in 2004 and 3.8-8.3 in 2005), higher HIV-related knowledge level (OR = 7.9 in 2004 and 17.3 in 2005), and lower STD prevalence (OR = 0.22 in 2004 and 0.11 in 2005). Coverage rates of HIV antibody testing and HIV-related services increased in the intervened county but decreased in the control county. CONCLUSIONS: Intervention programs may result in substantial behavioral changes in a community within a few years.     

Alcohol and drug use and related disorders: An underrecognized health issue among adolescents and young adults attending sexually transmitted disease clinics

OBJECTIVES: The objectives of this study were to describe patterns of alcohol and drug use disorders among young persons attending a public sexually transmitted disease (STD) clinic and to determine their associations with sexual risk behaviors and STDs. STUDY DESIGN: Four hundred forty-eight men and women aged 15 to 24 who were attending an urban STD clinic completed an interviewer-administered questionnaire that assessed a broad range of substance use in general and for alcohol and marijuana use disorders. RESULTS: Overall, 42.9% had an alcohol or marijuana use disorder (51.6% of males and 34.2% of females), whereas 30.6% had a confirmed STD. Participants with a substance use disorder were significantly more likely to have multiple sexual partners (odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.5-3.4), to be inconsistent condom users (OR = 3.1; 95% CI = 1.5-6.3), and to have an STD (OR = 1.7; 95% CI = 1.1-2.6). CONCLUSIONS: Among young STD clinic attendees, substance use disorders were more common than confirmed STDs. STD clinics may be an appropriate setting to screen for and address substance use disorders in young persons.     

中国16个城区男男性行为人群梅毒感染情况及影响因素分析

目的 了解中国6个省（自治区、直辖市）的16个城区的男男性行为人群（MSM）的梅毒感染情况及其影响因素。方法 于2007年在开展绘制MSM活动场所地理分布图及人群规模估计的基础上，用分类的非概率抽样方法在MSM中开展横断面调查；通过问卷调查收集人口学、危险行为以及梅毒感染等信息。用SPSS软件对数据进行单因素及多因素Logistic回归分析。结果 2007年共收集4211份有效问卷。所调查的MSM平均年龄为28岁，自报为同性恋占66.7%，未婚占72.5%，高中及其以上教育程度占76.4%。近6个月MSM的性行为调查结果显示：8.7%有10个以上的男性性伴，5.6%曾买男性性服务，11.3%曾为男性提供商业性服务，18.9%曾与女性发生过性关系，与男性肛交性行为中的安全套坚持使用率仅为36.3%。所调查MSM的梅毒感染率为10.6%。多因素Logistic回归分析结果显示：年龄 > 25岁［调整OR（AOR） = 1.7，95% CI：1.3 ~ 2.0］、本市户籍（AOR = 1.3，95% CI：1.0 ~ 1.7）、调查地区、酒吧/公园招募对象（AOR = 1.3，95% CI：1.1 ~ 1.7）、买男性性服务（AOR = 1.5，95% CI：1.0 ~ 2.1）、男男肛交行为中不坚持使用安全套（AOR = 1.2，95% CI：1.0 ~ 1.5）和自报性病史（AOR = 1.3，95% CI：1.0 ~ 1.7）是梅毒感染的独立相关变量。结论 16个城区MSM的梅毒感染率已达一定水平、男男商业性服务及不安全性行为的流行率较高，亟待加强MSM的梅毒防治工作，包括梅毒和ＨＩＶ筛查、推广使用安全套等综合干预措施。     

Chlamydia trachomatis among young Norwegian men: sexual behavior and genitourinary symptoms

OBJECTIVE: The study objective was to assess Chlamydia trachomatis (CT) prevalence, risk factors, and genitourinary symptoms among young men. METHODS: Sexually active men 18 to 30 years old were recruited during April through October 2005 at the student health services and through field work at university campuses in 2 Norwegian cities. A total of 1,032 participants completed a questionnaire on sexual behavior and provided first-void urine for CT testing. RESULTS: The overall CT prevalence was 7.8% (81 of 1,032). In multivariable analysis, >or=5 lifetime sexual partners (adjusted odds ratio [aOR]: 2.7, 95% confidence interval [CI]: 1.4-5.2), a burning sensation on urination (aOR: 5.7, 95% CI: 3.1-10.5), and penile discharge (aOR: 2.6, 95% CI: 1.1-6.3) were significant risk factors for a positive CT test, whereas condom use (last intercourse) was preventive (aOR: 0.4, 95% CI: 0.2-0.8). CONCLUSIONS: A CT prevalence of 7.8% was found among male students. Promotion of increased testing among men is important to prevent CT transmission.     

Sexually transmitted infections and sexual practices in injection drug users and their regular sex partners in Chennai, India

OBJECTIVE: Measuring sexually transmitted infections (STIs) and sexual practices in injection drug users (IDUs) and their regular sex partners. GOAL: Informing HIV intervention programs. DESIGN: Cross-sectional. RESULTS: One percent IDUs and 2% of their regular female sex partners were syphilis infected; 40% (84/211) and 38% respectively (81/211) were infected with HSV-2. 30% IDUs and 5% of their female regular sex partners were HIV positive. Serodiscordant results for syphilis and HSV-2 were noticed. Women having first sex at ageor=38 years had seven times the odds of having any non-HIV-STI. CONCLUSION: Reaching out to IDUs and their female regular sex partners with modified STI management guideline and promoting women-controlled safer sex measures are needed harm-reduction measures.     

Low prevalence of hepatitis B markers among Mexican female sex workers

OBJECTIVES: To estimate the prevalence and associated risk factors of hepatitis B virus (HBV) serological markers in female sex workers (FSW) in Mexico City. METHODS: The study population consisted of 1498 FSW who attended a detection centre for human immunodeficiency virus (HIV) in Mexico City, between January and October 1992. Study participants responded to a standardised questionnaire and provided a blood sample for serology of syphilis, HIV, and HBV. RESULTS: A total of 0.2% (95% CI 0.1-0.3) of the population were hepatitis B surface antigen (HBsAg) carriers. The general prevalence of antibodies to hepatitis B core antigen (anti-HBc) was 6.3% (95% CI 5.5-7.1). This marker of previous exposition to HBV, was independently associated by logistic regression multivariate analysis with age, working in the street, and history of blood transfusion (BT) before 1987 (OR 4.8, 95% CI 2.1-11.3). Syphilis prevalence was 7.6% (95% CI 6.2-8.9) and HIV prevalence was 0.1% (95% CI 0-0.3). CONCLUSIONS: The prevalence of HBV infection in this group of Mexican FSW is lower than previously reported in other countries. In addition, the frequency of HBsAg carriers is similar to that in the general Mexican population. The absence of two major risk factors for HBV transmission in this group of FSW--that is, injecting drug use and anal intercourse, could help to explain this finding. However, the positive association between anti-HBc and history of blood transfusion demonstrated here, highlights the need to reinforce strict control of blood supplies in Mexico.     

Relationship between syphilis and HIV infections among men who have sex with men in Beijing, China

BACKGROUND: Little is known about risk of HIV and other STDs among men who have sex with men (MSM) in China. OBJECTIVE: To survey the prevalence and risk factors of HIV and syphilis and evaluate correlation of two infections among MSM in the Chinese capital city. METHODS: A community-based sample of 526 MSM was recruited in 2005 through Internet advertising, community outreach, and peer referring. Interviewer-administered interviews were conducted to collect information on demographics and sexual and other risk behaviors, and blood samples were collected to test for syphilis and HIV infections. RESULTS: Seventeen (3.2%) participants were HIV seropositive and 59 (11.2%) syphilis seropositive. Sixty-four percent of participants were migrants who did not have Beijing residence. Forty percent had >10 lifetime male sex partners and 28.8% reported having ever had sex with women. Consistent condom use with primary male sex partners ranged from 21% to 24%, with nonprimary male sex partners from 35% to 42%, and with female partners around 33%. Illicit drug use was not common; only 2.5% reported using Ecstasy or ketamine in the past 6 months. Multivariate logistic regression analyses demonstrated that >10 lifetime male sex partners were independently associated with seropositivity of both syphilis (OR, 1.9; 95% CI, 1.1-3.4) and HIV (OR, 4.3; 95% CI, 1.4-13.6). In addition, HIV infection is significantly associated with syphilis seropositivity (OR, 3.8; 95% CI, 1.3-10.8). CONCLUSIONS: High mobility, multiple sexual partners, and high prevalence of unprotected sex behaviors and syphilis infection suggest a potential rapid spread of HIV in Chinese MSM.     

Correlates of Internet use to meet sex partners among men who have sex with men diagnosed with early syphilis in Los Angeles County

OBJECTIVE: The objective of this study was to evaluate use of the Internet to solicit sex partners by men who have sex with men (MSM) who were diagnosed with early syphilis infection. STUDY: Field interview records for syphilis patients were reviewed for factors associated with Internet use. RESULTS: Internet users were more likely to be of white race (prevalence ratio [PR], 1.6; 95% confidence interval [CI], 1.4-1.8), to report anal insertive sex (PR, 1.1; 95% CI, 1.1-1.2), sex with anonymous partners (PR, 1.2; 95% CI, 1.1-1.3), intravenous drug use (PR, 2.7; 95% CI, 1.1-6.7), and nonintravenous drug use (PR, 1.4; 95% CI, 1.1-1.8). Controlling for race and sexual risk behaviors, white race (odds ratio [OR], 2.8; 95% CI, 1.8-4.6), having anonymous sex partners (OR, 3.4; 95% CI, 1.6-7.0), and nonintravenous drug use (OR, 1.6; 95% CI, 1.1-2.6) were associated with meeting sex partners through the Internet. CONCLUSIONS: Effective sexually transmitted disease risk reduction interventions using the Internet are needed to reach Internet-using, sex-seeking MSM populations engaging in high-risk behaviors.     

Education attainment and the risk of HIV-1 infections in rural Kilimanjaro Region of Tanzania, 1991-2005: a reversed association

OBJECTIVE: Previous studies found educated individuals to have higher risk of human immunodeficiency virus (HIV)-1 infection in Africa. A reverse in this association was predicted. We investigated the change in this association from 1991 to 2005 in a rural population in Tanzania. STUDY DESIGN: Two cross-sectional surveys were conducted in 1991(N = 1,152, response rate 76.4%) and 2005 (N = 1,528, 73.0%). Consenting individuals aged 15 to 44 years living in Oria village were interviewed and gave blood for HIV-1 testing. RESULTS: Primary [adjusted odds ratio (AOR), 2.7; 95% confidence interval (CI): 1.3-20.0] and secondary/higher education (AOR, 4.5; 95% CI: 1.4-24.9) were associated with increased risk of HIV-1 infection in 1991. A reversed association was observed in 2005 where reduced odds of infection were associated with primary (AOR, 0.5; 95% CI: 0.2-0.8) and secondary/higher education (AOR, 0.4; 95% CI: 0.3-0.9). This was most pronounced among educated men. Corresponding reduction in risk behaviors were observed. Increased odds of reporting ever use of condom (AOR, 2.8; 95% CI: 1.1-7.3) and 70% reduction in reporting >or=2 sexual partners in the past year was observed among educated women. Educated men reported 60% reduction in the odds of reporting >or=2 sexual partners in the past month preceding the last survey. CONCLUSIONS: A reversed association between education attainment and HIV-1 infection was observed in this population between 1991 and 2005. Education seems to have an empowering role in women. Decreased risk among educated men may have an impact on HIV-1 transmission. Improving education sector in rural areas might be instrumental in the fight against the HIV epidemic.     

Trends in HIV postexposure prophylaxis prescription and compliance after sexual exposure in Amsterdam, 2000-2004

OBJECTIVE: The objective of this study was to evaluate trends in HIV postexposure prophylaxis (PEP) requests after sexual exposure, compliance, and outcome of follow-up HIV tests. STUDY DESIGN: The authors conducted a retrospective analysis of all HIV PEP requests after sexual exposure between January 1, 2000, and December 31, 2004, in Amsterdam. RESULTS: In 5 years, there was a very modest increase in PEP requests, of which most (75%) came from men who have sex with men (MSM). Although 70% reported side effects, 85% completed their PEP course. Sexual assault victims less often completed their course (odds ratio [OR] = 0.1; 95% confidence interval [CI] = 0.05-0.4, P = 0.001). People who used HIV PEP more often complied with follow-up tests than people who did not use PEP (OR = 3.5; 95% CI = 1.6-7.9, P = 0.002). One HIV seroconversion was found caused by a later exposure than that for which PEP was given. CONCLUSIONS: Despite a widely available PEP program in Amsterdam, the number of PEP requests remained low. Most people completed their PEP course; compliance with follow-up HIV testing was high.     

Correlates of human herpesvirus-8 seropositivity among U.S. military members recently infected with human immunodeficiency virus

BACKGROUND: Human herpesvirus 8 (HHV-8), the cause of Kaposi's sarcoma, is common among HIV-infected persons. The exact route of transmission of HHV-8 in various populations is still debated. GOAL: The goal was to define the correlates of HHV-8 infection among men recently infected with human immunodeficiency virus. STUDY DESIGN: Three hundred forty-two HIV-infected U.S. military men were evaluated using a questionnaire regarding potential risk factors and laboratory data, including HHV-8, herpes simplex virus 2 (HSV-2), syphilis, hepatitis B, and hepatitis C serologies. RESULTS: The seroprevalence of HHV-8 was 32%. HHV-8 was significantly associated with hepatitis B seropositivity (odds ratio [OR], 2.44; 95% confidence interval [CI], 1.5-4.1), and black ethnicity was negatively associated with HHV-8 (OR, 0.6; 95% CI, 0.3-0.9) in the multivariate analysis. HHV-8 was not associated with drug use or hepatitis C seropositivity. Among men who have sex with men (MSM), HHV-8 infection correlated with hepatitis B seropositivity (OR, 2.2; 95% CI, 1.1-4.3) and HSV-2 (OR, 2.6; 95% CI, 1.4-4.9). Among heterosexuals, the correlates of HHV-8 were different; blacks as compared with whites (OR, 0.3; 95% CI, 0.1-0.8) and married versus single status (OR, 0.4; 95% CI, 0.2-0.9) were associated with a lower rate of HHV-8 infection. Among heterosexuals, hepatitis B, HSV-2, and sexual behaviors were not associated with HHV-8. CONCLUSION: This study suggests that the seroprevalence of HHV-8 is increased in both MSM and heterosexual men with HIV infection, and that the route(s) of HHV-8 acquisition might be different between MSM and heterosexuals.