2004 STD Prevention Conference - Symposium D - Oral, Symposium and Workshop Abstracts - Thursday Morning Sessions
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D01A Legal Status of Patient Delivered Partner Therapy (PDPT) in the U.S.: A National Survey of State Pharmacy Boards and Boards of Medical Examiners
Uzoeshi Anukam1,2, H Hunter Handsfield1, Donald Williams3, Matthew R Golden1
1Center for AIDS & STD, University of Washington and Public Health – Seattle & King County STD Program, Seattle, WA; 2Howard University, Washington, D.C.; 3Washington State Pharmacy Board, Olympia, WA
Background: Many clinicians and some health departments provide patients with gonorrhea, chlamydial infection, or trichomonas with medications to give to their sex partners, a practice called patient delivered partner therapy (PDPT). Observational studies and a randomized trial suggest PDT can decrease the recurrence rate of gonorrhea and possibly chlamydial infection.
Objectives: To define the legal status of PDPT in the U.S.
Methods: Survey of State Pharmacy Board (SPB) Directors and Directors of State Boards of Medical Examiners (BME).
Results: A total of 39 (76%) of 51 SPB Directors and 21 (41%) of 51 Directors of BME completed the survey. Six pharmacy boards and 1 medical board either refused to complete the survey or indicated they had no authority to assess the legality of PDPT. Data were available from 44 (86%) states and the D.C. Among these 44 areas, 7 (16%) indicated that PDPT was legal, 24 (54%) indicated that PDT was not legal, and 13 (30%) indicated that they did not know whether PDT was legal or not.
Respondents indicated that the issue of PDPT had never been addressed in 20 (83%) areas where PDPT was considered illegal, 12 (92%) areas where the legal status of PDPT was unknown, and 3 (43%) areas where PDPT was thought to be legal. Among 34 respondents from states indicating that PDT was not legal or that the legal status of PDPT was uncertain, 22 (65%) indicated that a new law would be needed to make PDPT legal. Updated data will be presented.
Conclusions: The legal status of PDT is ill-defined in much of the U.S., but is widely considered to be unlawful.
Implications for Programs, Policy, and/or Research: New laws may be needed if PDPT is to be widely instituted.
Learning Objectives: By the end of the session, participants will learn that the legal status of PDPT is poorly defined, but that the practice is considered illegal in much of the United States.
D01B Concurrent STD Morbidity in Sexual Contacts to Persons with Bacterial STDs: Implications for Patient-Delivered Partner Therapy
J Stekler1, L Bachmann2, E Erbelding3, P Kissinger4, HH Handsfield1, M Golden1
1University of Washington, Seattle, WA; 2University of Alabama, Birmingham, AL; 3Johns Hopkins University, Baltimore, MD; 4Tulane University, New Orleans, LA
Background: Patient-delivered partner therapy (PDPT) is one approach to partner notification employed by some providers and health departments. In PDPT, patients deliver medications to their sex partners in addition to referral to seek medical care. One potential negative consequence of PDPT is the missed opportunity to diagnose PID and other STD’s in partners who forgo examination.
Objectives: To describe STD morbidity in patients attending public health STD clinics who present as sexual contacts to persons with bacterial STD’s.
Methods: Of 55026 patients attending clinics in Baltimore (Jan-Dec 2000) and Seattle (Jan 2001-Dec 2002), 3506 patients presented as contacts to patients with chlamydia, gonorrhea, non-gonococcal urethritis, and/or trichomonas. 2195 and 1311 patients were seen in Baltimore and Seattle, respectively.
Results: Among 1384 women, 41 (3.0%) were diagnosed with PID, 3 (0.2%) had early syphilis, and 3 (0.2%) had late latent syphilis or syphilis of unknown duration. One (0.1%) of 733 women tested positive for HIV. Among 1848 heterosexual men, 3 (0.2%) and 6 (0.3%) had early and late syphilis, respectively; 9 (0.9%) of 968 tested positive for HIV. Among 274 MSM, 2 (0.7%) had late syphilis, and 5 (4.2%) of 118 were newly diagnosed with HIV. Results will be presented from two additional clinics to evaluate how morbidity may vary with local epidemiology.
Conclusions: Major STD morbidity was uncommon among heterosexuals evaluated as contacts to bacterial STD’s and trichomonas in Baltimore and Seattle. A higher proportion of MSM was diagnosed with either HIV or syphilis.
Implications for Programs, Policy, and/or Research: Use of PDPT would not be associated with important missed STD comorbidities among heterosexuals in Baltimore and Seattle. The opportunity to diagnose HIV among MSM who seek care as contacts to STD’s is more significant. Depending on local epidemiologic patterns, PDPT may not be suitable for MSM and/or other populations.
Learning Objectives: By the end of the session, participants will recognize the potential negative consequences of PDPT due to missed STD comorbidities and will appreciate the regional variability of STD comorbidity.
Contact Information: Joanne Stekler/Phone no. 1 206 731 8312
D01C A Randomized Trial of Three Different Strategies to Treat Partners of Women with Trichomonas vaginalis
P Kissinger1, N Schmidt1, B Meadors2, J Leichliter3, C Sanders1, H Mohammed1, TA Farley1
1Tulane University School of Public Health and Tropical Medicine; 2Louisiana State University Health Sciences Center; 3Centers for Disease Control and Prevention
Background: Better methods of treating partners of women with trichomonas are needed.
Objectives: This randomized trial was to determine if booklet enhanced partner referral (BR) or patient delivered partner medicine (PDPM) was better than the standard partner referral (PR) for reducing recurrent trichomonas vaginalis (TV) infection among women.
Methods: Women attending a Family Planning clinic in New Orleans from 12/01 to 09/03 who tested positive for TV via culture and were treated were randomized to either PR, BR or PDPM. They were administered computer assisted self-administered survey at baseline and one month and retested at one month.
Results: Women in the trial (N=346) reported information on 389 partners. Most women had one partner (77.6%), mean age was 25.8 (s.d. 6.9), and 99% were African American. Arms were similar by age, education, race and number of partners at baseline and newly acquired partners in follow-up and follow-up rates. During follow-up, 85.3% returned, 82.6% saw their baseline sex partners, 87.7% talked to these partners, 51.1% resumed sex and 5.4% acquired a new sex partner. Of those who had sex during follow-up, 76.6 % used a condom consistently. These factors were similar by arm. Women reported that their partner told them they took the medicine most often in the PDPM and least often in BR compared to PR (90.3%/58.1%/72.5%, P < 0.01). Of 346 women enrolled in the study, 8.2% were TV positive at one-month repeat testing. There were no statistical differences in recurrence among study arms (PDPM 7.6%/BR 10.2/PR 6.9%, P< 0.70). Isolates of TV from four women were tested for metronidazole-resistance and were found to be sensitive at higher doses.
Conclusion: In women, while PDPM results in more partners taking the medicine than the standard or booklet enhanced methods, recurrence rates were similar. Lack of difference in recurrence rates could be attributed to lack of exposure to reinfection.
Implications: PDPM may be effective, but future studies should follow women longer.
Learning Objectives: By the end of this session, participants will be able to describe the benefits of PDPM for women with TV and to discuss methodological issues studying PDPM.
Contact Information:Patty Kissinger/Phone no. 1 504587 7320
D01D Acceptance of Patient-delivered Partner-therapy for Syphilis Among Men Who Have Sex with Men (MSM), San Francisco, CA
1Centers for Disease Control and Prevention, Atlanta, GA; 2San Francisco Department of Public Health, San Francisco, CA
Background: San Francisco has experienced increases in early syphilis in MSM, from 32 cases in 1999 to 436 cases in 2002. In July 2002, San Francisco City Clinic (SFCC) implemented patient-delivered partner-therapy (PDT). Syphilis-case patients were offered preventive therapy (1-gram azithromycin) to distribute to recent sex partners and friends at high-risk for syphilis. The rate of patient acceptance of PDT, however, has been low (10%).
Objective: To identify barriers and facilitators of PDT distribution to and acceptance by patients and sex partners among MSM at high-risk for syphilis.
Methods: We conducted three focus-group interviews with syphilis-case patients, sexual contacts, and friends of patients and contacts, and in-depth interviews with community leaders, private medical providers who see gay male patients, and Disease Control Investigators at SFCC. Interviews focused on barriers and facilitators of PDT provision among MSM. Interviews were audio-recorded and transcribed; transcripts were analyzed to discern themes.
Results: Barriers to distributing PDT by MSM to recent sex partners included patient’s inability to contact anonymous sex partners, patient’s perceived liability if a recipient should have adverse drug reactions, and patient’s belief that medications should only be dispensed by healthcare providers. Facilitators of PDT distribution to recent partners included patient’s sense of social responsibility, caring for and trusting partners, and prior knowledge of PDT. Barriers to sex partners accepting PDT from case-patients included distrust of sex partner giving PDT, suspicion of the medication, and lack of awareness of the intervention. While convenient, no-cost treatment was cited as a facilitator of using PDT, many MSM desired a clinician evaluation before taking medications.
Conclusions: This information on barriers/facilitators to PDT provision will guide modifications of the PDT program. A community awareness campaign and new PDT packages are under development.
Implications for Programs, Policy, and/or Research: Innovative partner services must be tailored to address multi-dimensional concerns of all involved.
Learning Objectives: By the end of this session, participants will understand the potential barriers and facilitators to patient-delivered partner-therapy for incubating syphilis among MSM.
Contact Information: Waimar Tun/Phone no. 1 404 639 8297
D01E Patient-delivered Partner Therapy for Chlamydia Infections: Attitudes and Practices of California Physicians and Nurse Practitioners
California Department of Health Services, STD Control Branch, Berkeley, CA
Background: Effective partner management is important for reducing Chlamydia trachomatis (CT) transmission and repeat infection. Since 2001, California State law allows clinical providers to dispense or prescribe antibiotic therapy for sexual partners of patients infected with CT without examination. The use of patient-delivered partner therapy (PDPT) needs to be evaluated.
Objective: To examine attitudes and practices around PDPT for chlamydia among clinicians in California.
Methods: In 2002, a stratified random sample of primary care physicians and nurse practitioners (NPs) completed a mailed, self-administered survey about STD care practices including attitudes towards and use of PDPT.
Results: Eligible respondents included 708 physicians (49% response rate) and 865 NPs (63% response rate). Approximately half of physicians and NPs stated that they usually or always provide medication for partners. Ob/gyn physicians and providers seeing 20 or more young females per week were more likely to report using PDPT. Nearly 90% of respondents agreed that PDPT protects patients from reinfection and that PDPT helps provide better care for patients with chlamydia. Barriers to using PDPT included concerns about inadequate knowledge of partner medical history and lack of direct partner care, potential litigation, and lack of reimbursement. Barriers were generally more common among private practice providers, male providers, and general practice and internal medicine physicians.
Conclusions: Despite legislation to support PDPT as acceptable medical practice, PDPT is currently not a common practice among California primary care providers. Potential important barriers to use of PDPT were identified.
Implications for Programs, Policy and/or Research: Provider education interventions, as well as development of detailed guidelines and reimbursement mechanisms, are needed to address common barriers to PDPT. Further research is needed to determine how physicians assess patients for PDPT, and the circumstances under which clinicians give PDPT.
Learning Objectives: By the end of this session participants will be able to describe frequency of PDPT use in primary care in California; identify barriers to provider use of PDPT; identify potential areas for intervention to decrease barriers to PDPT.
Contact information: Laura Packel/Phone no. 1 510 883 6660/lpackel@dhs.ca.gov
D01F Partner-Delivered Partner Therapy for STD: Evidence and Prospects for Implementation
JS St. Lawrence1, M Hogben1, M Golden2, P Kissinger3
1Centers for Disease Control and Prevention, Atlanta, GA; 2University of Washington and Public Health-Seattle and King County, Seattle, WA; 3Tulane University
Background and Rationale: Notification of partners of index cases tested and treated for STD has been a fundamental element of STD infection control policy for over 50 years. Public health agencies’ use of professionals to track, notify, and bring to treatment the sex partners of index cases is, however, constrained. Constraints include the prevalence of many STD and the nature of many sexual partnerships severely test the ability of most public health agencies to conduct partner notification.
Objectives: This symposium is aimed at exploring partner-delivered partner therapy (PDPT) as an alternative or as a complement to prototype partner notification services, specifically, services offered for curable STD. To do so, we will outline the status of public partner notification today and then cover several PDPT trials from the past decade.
Content: Investigators describe the extent to which public health partner notification services are currently offered in jurisdictions that were among the 50 jurisdictions with highest morbidity for any of gonorrhea, chlamydial infection, syphilis, or HIV. We also describeprivate partner notification practices. We then present results from the following randomized, control trials of PDPT (a) prescription-driven PDPT for chlamydial infection and gonorrhea in Seattle, (b) medication dispensation for male partners of women with trichomoniasis in New Orleans, and (c) medication dispensation for sex partners of men with urethritis in New Orleans. The control conditions are standard of care in each location. We will also devote attention to program experiences and costs, as well as other experimental alternatives to standard of care tested within the trials.
Implications for Programs, Policy, and Research: These data may guide especially those programs facing a high burden of disease compared to resources. Policy-makers may consider the impact of permitting or authorizing PDPT in their jurisdictions. We finally suggest synthesizing study results and refining estimates of PDPT effectiveness.
Panel Line-up:
Moderator
Janet S. St. Lawrence, PhD CDC, Atlanta
Panelists
Matthew Hogben, PhD CDC, Atlanta
Matthew Golden, MD, MPH
University of Washington and Public Health-Seattle & King County Service of King County, Seattle
Patricia Kissinger, DrPH
Tulane University, New Orleans
Measurable Learning Objectives: Attendees will learn about the costs and benefits of PDPT as assessed across multiple public heath programs, allowing them to gauge more accurately whether and for whom to practice PDPT in their own programs. Attendees interested in advancing the research on PDPT will learn about the details of the most recent national trials, which should inform their own efforts.
D02 Practical Examples Evaluating Community Partnerships for Syphilis Prevention
B Apt1, A Williams2, M King3, T Roberts4, D Napp5, T Gunter6
1Centers for Disease Control and Prevention, Atlanta, GA; 2Independent Consultant, Indianapolis IN; 3Indiana Center for Evaluation, Indiana University, Bloomington, IN; 4Independent Consultant, Indianapolis, IN; 5Practical Applications of Public Heath, Durham NC; 6Metro Health Department, Nashville, TN
Background: Optimal program performance is important, particularly in resource-constrained environments. Evaluation is essential to determine whether STD activities are effective in achieving desired goals. And, evaluation can be used to document progress toward goals, and suggest needed modifications.
Objectives: To present the experiences of three local STD project areas when they evaluated components of their partnerships with community organizations.
Content: Representatives from three STD project areas will present evaluation plans, barriers, and results. Each area’s methods and analyses differed slightly, based on the focus of their evaluation. Challenges included competing interests of local and national stakeholders, lack of stakeholder agreement on the evaluation focus, and lack of sustained stakeholder engagement in the evaluation process. Area representatives will present uses of qualitative and quantitative data, discuss evaluation findings, and give examples of how findings were used to modify programs.
Implications for Programs, Policy, and/or Research: Demand for evaluation continues to grow; these three STD project areas offer pragmatic approaches and solutions to common evaluation concerns.
Panel Line-up:
Moderator:
Betty Apt
CDC, Atlanta
Panelists:
Mindy King, PhD
Indiana Center for Evaluation, Indiana University, Bloomington IN
David Napp, MPH
Practical Applications of Public Heath, Durham NC
Tonya Gunter, MS
Metro Health Department, Nashville TN
Measurable Learning Objectives: By the end of this session, participants will be able to (1) describe three methods used to evaluate community partnerships and (2) identify two common challenges in conducting evaluations at the local level.
Contact Information: Betty Apt/1 404 639 8035
D02 Evaluating the Impact of Integrating Viral Hepatitis Services in HIV and STD Settings
D Lentine1, L Schowalter2, J Beltrami3, A Goldstein4, K Schlanger5, J Subiadur6, T Badsgard7
1CDC, Division of HIV/AIDS Prevention, Atlanta, GA; 2National Alliance of State and Territorial AIDS Directors, Washington, DC; 3RTI International, Atlanta, GA; 4Multnomah County Health Department, Portland, OR; 5New York City Department of Health and Mental Hygiene, New York, NY; 6Denver Public Health, Denver, CO; 7CDC, Division of Viral Hepatitis, Atlanta, GA
Background and Rationale: Hepatitis A, B and C impact many of the same populations as HIV and other STDs. Due to the similarities in disease transmission and populations affected, CDC’s Division of Viral Hepatitis (DVH) funded HIV, STD and other public health programs to integrate viral hepatitis services (ie, hepatitis A and B vaccine, HCV counseling and testing) into their existing activities. These programs have found that integrating hepatitis services into HIV and STD settings is both feasible and acceptable. Anecdotally, HIV and STD programs report that many high-risk clients are drawn to STD clinics and other settings by the availability of hepatitis services, suggesting that hepatitis services may serve as a link to HIV and STD services. A CDC-funded viral hepatitis integration evaluation project specifically examined the impact of integrating hepatitis services on HIV and STDs.
Objectives: To describe the CDC-funded viral hepatitis integration evaluation; to share strategies used to measure the impact of integration on existing services; and to share the experiences of several CDC-funded viral hepatitis integration projects on evaluating their integration projects.
Content: The viral hepatitis integration evaluation project methods will be presented, and preliminary results from the evaluation will be shared. Experience in Multnomah County, Oregon, New York City and Denver, Colorado on how to evaluate the effectiveness of integration and its impact on HIV and STD services will be presented. Strategies used for measuring and evaluating the impact of services on existing programs will be discussed.
Implications for Programs, Policy, and/or Research: The provision of hepatitis services may serve as an incentive for high-risk clients to access other disease prevention and treatment services, and HIV and STD programs can benefit by providing multiple services to clients at-risk. The dissemination of evaluation results and jurisdictional best practices can inform the development of policy to support the integration of services in settings that reach persons at risk for multiple infections.
Learning Objectives:
- By the end of the session participants will be able to discuss different approaches to measuring the impact of integrating viral hepatitis services into existing HIV and STD settings
- By the end of the session, participants will be able to identify the advantages, best practices and lessons learned of integrating hepatitis services into HIV and STD settings
Panel Line-up:
Moderator:
Kevin O’Connor, MA
CDC, Division of Viral Hepatitis, Atlanta, GA
Panelists:
Danni Lentine, MPH
CDC, Division of HIV/AIDS Prevention, Atlanta, GA
Karen Schlanger, MPH
New York City Department of Health, New York, NY
Alison Goldstein, LCSW
Multnomah County Health Department, Portland, OR
Julie Subiadur, RN
Denver Public Health, Denver, CO
Contact Information: Danni Lentine/Phone no. 1 404 639 0462/dhl2@cdc.gov
D03 Advancing HIV Prevention: New Strategies for a Changing Epidemic
Centers for Disease Control and Prevention, Atlanta GA
Background and Rationale: CDC’s HIV prevention activities over the past two decades have focused on helping uninfected persons at high risk for HIV change and maintain behaviors to keep them uninfected. Despite these efforts, the number of new HIV infections is estimated to have remained stable and may be increasing in some populations. Survival with HIV has improved and the number of persons living with HIV continues to increase. CDC has launched Advancing HIV Prevention (AHP), a new initiative aimed at reducing barriers to early diagnosis of HIV infection and increasing access to quality medical care, treatment, and ongoing prevention services.
Objectives: 1] To describe the four strategies of AHP and the activities associated with each. 2] To facilitate collaboration between CDC, other federal agencies, and HIV prevention providers to ensure that prevention efforts for HIV-positive persons are sustained.
Content: The 4 strategies of AHP include making HIV testing a routine part of medical care, implementing new models for diagnosing HIV infection outside of the medical setting, working with PLWH and their partners to prevent new infections, and further reducing perinatal HIV transmission. AHP emphasizes the use of proven public health approaches to reduce the incidence and spread of infectious disease. The initiative capitalizes on new rapid testing technologies, interventions to help persons to become aware of their HIV status, and behavioral interventions to improve prevention skills to persons living with HIV (PLWH) and their partners. Greater access to testing, prevention, and care services for PLWH can reduce new infections and also reduce HIV-associated morbidity and mortality.
Implications for Programs, Policy, and/or Research: Innovations in access to testing and emphasis on prevention and care services for PLWH constitute new components that prevention programs will need to incorporate in order to maximize opportunities to reduce the incidence of new HIV infections.
Panel Line-up
Moderator:
Lisa M. Lee, PhD
Office of the Director, Division of HIV/AIDS Prevention, CDC
Panelists:
Sean David Griffiths, MPH
Office of the Director, Division of HIV/AIDS Prevention, CDC
Bernard M. Branson, MD
Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, CDC
Joseph Prejean, PhD
Capacity Building Branch, Division of HIV/AIDS Prevention, CDC
Raul Romaguera, DMD, MPH
Office of the Director, Division of HIV/AIDS Prevention, CDC
Measurable Learning Objectives: By the end of the session participants will be able to
- Describe the 4 strategies of CDC’s new Advancing HIV Prevention initiative
- Describe how CDC is working with other federal agencies and the HIV prevention community to ensure that prevention efforts outlined in this initiative are sustained
Contact Information: Lisa M. Lee/Phone no. 1 404 639 5052
D04A Gonorrhea Positivity Among Men Who Have Sex With Men Attending STD Clinics in the United States, 2002
1Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, GA
Background: National gonorrhea data among men who have sex with men (MSM) in the US are limited.
Objectives: To describe gonorrhea positivity among MSM visiting STD clinics in 2002.
Methods: Eight US cities participating in the MSM Prevalence Monitoring Project (Chicago, IL; Denver, CO; District of Columbia; Houston, TX; Long Beach, CA; Philadelphia, PA; San Francisco, CA; Seattle, WA) submitted gonorrhea test data from MSM attending STD clinics. Data were collected during routine care and reflect testing practices at participating clinics. Median STD clinic-specific gonorrhea positivity and ranges were calculated.
Results: Overall, data from 16,336 STD clinic visits by MSM were submitted; 73% (clinic range 19-95%) of MSM were tested for urethral gonorrhea, 33% (clinic range 1-61%) were tested for rectal gonorrhea, and 59% (clinic range 2-83%) were tested for pharyngeal gonorrhea. Median gonorrhea positivity among MSM was 17.1% (clinic range 11.4-23.0%). Median urethral gonorrhea positivity among MSM was 13.5% (clinic range 8.3-36.1%), rectal gonorrhea positivity was 5.7% (clinic range 4.6-10.0%), and pharyngeal gonorrhea positivity was 4.2% (clinic range 0.6-10.4%). Median urethral gonorrhea positivity was 21.0% among HIV positive MSM and 12.5% among MSM who were HIV-negative or had an unknown HIV status; median rectal gonorrhea positivity was 10.3% among HIV positive MSM and 5.5% among MSM who were HIV-negative or had an unknown HIV status. Median pharyngeal gonorrhea positivity was 7.7% among HIV positive MSM and 3.9% among MSM who were HIV-negative or had an unknown HIV status.
Conclusions: Gonorrhea positivity is high among MSM attending STD clinics. Gonorrhea positivity is higher among HIV positive MSM than among MSM who are HIV-negative or had an unknown HIV status. Gonorrhea testing should be offered to MSM visiting STD clinics, especially those with HIV, who may still be engaging in unsafe sexual practices.
Implications for Programs: STD clinics should evaluate gonorrhea screening coverage among MSM.
Learning Objectives:
- To describe the role of the MSM Prevalence Monitoring Project in national STD surveillance
- To describe gonorrhea testing coverage and gonorrhea positivity among MSM and the impact of this project on STD prevention and control
Contact Information: Catherine McLean/Phone no. 1 404 639 8467
D04B Crystal Use, Viagra Use, and Specific Sexual Risk Behaviors of Men who have Sex with Men (MSM) during a Recent Anal Sex Encounter
G Mansergh1, RL Shouse2, G Marks1, M Rader1, S Buchbinder3, GN Colfax3
1Centers for Disease Control and Prevention, Atlanta, GA; 2Georgia Department of Human Resources, Atlanta, GA; 3San Francisco Department of Public Health, San Francisco, CA
Background: A subpopulation of MSM use crystal (methamphetamine) and/or Viagra to enhance sex. Crystal can intensify physical and emotional sensitivity during sex, however it can also inhibit erectile functioning. Viagra works to facilitate and maintain erections.
Objectives: To assess associations between crystal and Viagra use and specific sexual risk behaviors (i.e., unprotected insertive and receptive anal sex [UIA, URA] with HIV concordant and discordant partners).
Methods: Cross-sectional sample of MSM surveyed in San Francisco during Fall 2001; the sample was diverse in race/ethnicity, age, HIV status, income, education and non/gay identification. Men in this analysis (n=388) reported on drug use and risk behavior during their most recent anal sex encounter in the prior 2 years.
Results: 53% of the 388 men reported unprotected anal (UA) sex during the encounter, including URA (37%) and UIA (29%); 24% reported UA with an HIV discordant or unknown-status partner (DUA), including receptive (DURA, 17%) and insertive (DUIA, 12%). 16% used crystal during that encounter (the most common such drug besides alcohol and marijuana), and 6% used Viagra. In multivariate models that included demographic variables, crystal was associated with URA (OR=2.03, 95% CI=1.09-3.76) and Viagra was associated with UIA (OR=6.51, 95% CI=2.46-17.24); similar results were found for DURA and DUIA.
Conclusions: A notable proportion of MSM in our diverse sample reported using crystal and/or Viagra during their most recent anal sex encounter; this is particularly note-worthy given that we assessed behavior in only one encounter for each participant. In controlled analyses, we found that crystal was linked to risk behavior for the receptive role and that Viagra was linked to risk behavior for the insertive role.
Implications for Programs, Policy and/or Research: MSM who use crystal or Viagra during anal sex should be targeted for STD/HIV risk reduction regarding URA and UIA respectively. Future research should assess multiple recent anal sex encounters for a more comprehensive examination of risk.
Learning Objectives: By the end of the session, attendees will be able to state the prevalence of crystal use, Viagra use, and STD/HIV risk behaviors (UA, URA, UIA, DURA, DUIA) during a recent anal sex encounter among a diverse sample of MSM. Attendees will understand the unique links between crystal and URA and between Viagra and UIA.
Contact Information: Gordon Mansergh/gcm2@cdc.gov
D04C Methamphetamine Use, Sexual Behavior, and Sexually Transmitted Diseases Among Men Who Have Sex with Men Seen in an STD Clinic, San Francisco 2002–2003
SJ Mitchell1,2, W Wong1, CK Kent1, JK Chaw1, JD Klausner1
1San Francisco Department of Public Health, San Francisco, CA; 2EIS Program, Centers for Disease Control and Prevention, Atlanta, GA
Background: San Francisco and many metropolitan areas have experienced recent increases in sexually transmitted diseases (STDs) among men who have sex with men (MSM). Community surveys in San Francisco indicate that methamphetamine use is also widespread.
Objectives: To determine the association between methamphetamine use, sexual behavior, and STDs among MSM at the San Francisco municipal STD clinic (City Clinic).
Methods: We performed univariate and bivariate analyses and calculated prevalence risk ratios (RR) on data from a cross-sectional behavioral survey of 1,318 MSM attending City Clinic during November 2002–March 2003.
Results: Of 1,263 surveyed patients who provided drug-use responses, 219 (17.4%) reported methamphetamine use during the prior 4 weeks. Methamphetamine users were more likely to be younger (median age 33 versus 36 years; p<0.05), less educated (some college or less versus college graduate, RR=1.3, 1.0-1.7), and to have incomes < $30,000/yr (RR=1.4, 1.1-1.8). Users were more likely to be depressed (RR=2.3, 1.7-3.0) and to use other drugs of abuse (RR=2.9, 2.6-3.3) or Viagra (RR=3.5, 2.9-4.4). Users were more likely to be HIV positive (RR=2.2, 1.7-2.7) and to report more sexual partners (median number during the prior 4 weeks: users 5.0 versus nonusers 2.0; p<0.05). Users were more likely to be diagnosed with an STD, including chlamydia (RR=1.9, 1.3-2.7), gonorrhea (RR=1.7, 1.2-2.3), or syphilis (RR=2.5, 1.8-3.4); multiple STDs simultaneously (one STD, RR=1.6, 1.2-3.0; two STDs, RR=4.0, 2.5-6.3; three STDs, RR=12.4, 1.2-136.1); or a rectal STD (RR=2.0, 1.4-2.9).
Conclusions: Methamphetamine use was strongly associated with an increased number of STDs and increased number of partners among MSM at San Francisco City Clinic.
Implications for Programs, Policy, and/or Research: STD prevention programs should ask MSM about methamphetamine use and offer cessation information and referrals to substance abuse treatment. Methamphetamine treatment programs should consider assessing STD risks in their MSM clients and referral if indicated.
Measurable Learning Objectives: This analysis will aid the audience in understanding factors for riskier sexual behavior and STD exposure associated with methamphetamine use among MSM. This information will be useful to health-care workers in STD clinics for screening patients for methamphetamine use and the associated STD risks. We will discuss current clinic, community-based, and substance abuse center-based activities regarding prevention of STDs and methamphetamine use.
Contact Information: Samuel J. Mitchell/Phone no. 1 415 5548469/sam.mitchell@sfdph.org
D04D Characteristics of MSM Syphilis Cases Using the Internet to Seek Male Sex Partners, California, 2001-2003
T Lo1, M Samuel1, C Kent2, J Klausner2, P Kerndt3, S Coulter1, G Mehlhaff1, D Wohlfeiler1, G Bolan1
1California Department of Health Services, STD Control Branch, Berkeley, California; 2San Francisco Department of Public Health, STD Prevention and Control Services, San Francisco, CA; 3Los Angeles County Public Health Department, Sexually Transmitted Diseases Program, Los Angeles, CA
Background: The Internet is a virtual venue for meeting sex partners and plays an important role in the current California syphilis epidemic among men who have sex with men (MSM).
Objective: To characterize the California trends of MSM syphilis cases reporting the Internet and use of this data in HIV/STD prevention efforts.
Methods: Infectious syphilis cases are interviewed by disease intervention specialists (DIS) for patient/partner management and surveillance purposes. DIS investigate sex partners of cases for counseling, testing, and treatment. Since 1999, interview data are transcribed onto standardized case report forms to capture patient demographic and risk behavior information. These data include: venues where cases report meeting sex partners, drug use, and HIV serostatus.
Results: From 2001 through the first half of 2003, 84.4% of 2276 primary and secondary (P&S) cases were MSM. Among MSM, 522 P&S cases were diagnosed in the first half of 2003, a 246% increase from the first half of 2001 (p<0.0001). Among interviewed MSM, 37% reported meeting partners through the Internet in the first half of 2003, an increase from 12% in the first half of 2001 (p<0.0001). MSM patients reporting the Internet had higher numbers of period sex partners than those who did not for primary (9.7 vs 6.5, p<0.0001) and secondary (18.7 vs 10.6, p<0.0001) stages. A greater number of non-locatable sex partners were from patients reporting the Internet than those who did not for primary (8.2 vs 5.5, p=0.0001) and secondary (16.4 vs 9.6, p<0.0001) stages.
Conclusions: The Internet is an emerging venue associated with a substantial and increasing proportion of MSM syphilis patients in California. With high numbers of non-locatable sex partners from MSM cases reporting the Internet, traditional contact investigation alone is not an effective syphilis control measure.
Implications for Programs, Policy, and/or Research: The Internet plays a key role in social/sexual networks, therefore current syphilis control strategies should incorporate the Internet for targeted HIV/STD prevention activities. Data on use of the Internet needs to be further explored and refined for HIV/STD prevention and outreach.
Learning Objectives: By the end of this session, participants should be able to identify the Internet as a key emerging venue among California MSM syphilis cases. Participants should also realize that traditional sex partner management alone is not an effect syphilis control strategy.
Contact Information: Terrence Lo/Phone no. 1 510 883 6653/tlo@dhs.ca.gov
D04E Factors Associated With Potential Exposure to and Transmission of HIV in a Probability Sample of Men Who Have Sex with Men
DD Brewer1,2, MR Golden1,2, HH Handsfield1,2
1Public Health-Seattle & King County, Seattle, WA; 2University of Washington, Seattle, WA
Background: Recent research suggests that unprotected anal intercourse (UAI) by partner serostatus is a stronger and more useful predictor of HIV acquisition risk in men who have sex with men (MSM) than UAI not stratified by partner serostatus.
Objectives: To estimate the proportion of MSM at high risk for HIV acquisition or transmission and examine factors associated with potential exposure to and transmission of HIV.
Methods: In 2003, 311 MSM participated in a random digit dial telephone survey of MSM in three Seattle zip codes with high prevalences of MSM.
Results: Ten percent (25/241, 95%CI:7%-15%) of HIV-negative MSM were potentially exposed to HIV, based on reported UAI with a man who was HIV-positive or of unknown HIV status in the last 12 months. Thirty-one percent (14/45, 95%CI:20%-46%) of HIV-positive MSM were potential HIV transmitters, based on reported UAI with a man of negative or unknown status in the last 12 months. The strongest correlates of potential exposure were having sex at a bathhouse (OR=9.1, 95%CI:3.7-22.3), use of methamphetamine (OR=8.0, 95%CI:2.0-32.3), amyl nitrite (OR=6.2, 95% CI:2.6-14.8), or sildenafil (Viagra) (OR=4.4, 95% CI:1.7-11.3), and recent STD diagnosis (OR=4.4, 95% CI:1.2-15.5). Potential transmitters had more male sex partners (r=.41, 95%CI:.13-.63) and were more likely to have had recent concurrent anal sex partners (OR=6.9, 95%CI:1.7-28.9) than other HIV-positive MSM. Based on STD/HIV testing history and stated preferences for healthcare sites, few potentially exposed MSM (36%) or potential transmitters (38%) have attended or would likely attend public health STD/HIV clinical sites.
Conclusions: MSM potentially exposed to HIV and potential HIV transmitters are fairly well-defined subsets of MSM. Most do not attend public health STD/HIV facilities.
Implications for Programs, Policy, and/or Research: Preventive interventions should be focused on MSM with characteristics associated with potential exposure to, or transmission of, HIV, especially in clinical settings outside the public health system.
Learning Objectives: By the end of the session, participants will be able to identify the characteristics of MSM who are potentially exposed to or potential transmitters of HIV.
Contact Information: Devon D Brewer/Phone no. 1 206 731 2257/ddbrewer@u.washington.edu
D04F No Need to Wrap It: HIV Gift-giver Newsgroups, Gift Theory and Exchanging HIV as a Gift
Carleton University, Ottawa, Ontario
Background: In the 1990s after 10 years during which safer sex became a gay community norm, a growing number of North American gay men disclosed engaging in unprotected anal sex, so-called ‘barebacking.’ While barebackers seek intimacy and freedom, and fulfilling a masculine ideal, others have unprotected sex to facilitate exchanging HIV. So-called ‘Gift-givers’ wish to give HIV, while ‘Bug-chasers’ wish to receive it. At Internet newsgroups Gift-givers and Bug-chasers post offers to give/receive HIV and ‘conversion stories.’
Objective: Interrogate conceptualizing of HIV as a gift, referencing sociological and anthropological theories of gift exchange to chart its impact on self-identity and social roles.
Methods: Data from 281 messages from 17 newsgroups was qualitatively analyzed creating a Gift typology.
Results: Using disease meta-narratives and HIV/AIDS public narratives, Gift-givers create an ontological narrative wherein HIV is acquired not avoided. Categorized according to the meanings ascribed to the Gift, messages revealed that even though a desirable, erotic object of exchange, HIV was still considered a dangerous, disease-causing pathogen.
Conclusions: As with the exchange of any gift, exchanging HIV established and maintained social roles and relationships. In offers to give/receive HIV, Gift-givers and Bug-chasers describe HIV infection as inevitable thus they sought to control when and from whom they got it. They manifest hostility to HIV prevention and treatment, highlighting the failure of safer sex programs to provide a set of sustainable and meaningful sexual practices.
Implications for Programs: With effective HIV vaccines decades distant and the potential for transgressive sexual behaviors such as Gift-giving and Bug-chasing to increase transmission, a thorough understanding of such behaviors is essential.
Learning Objectives: Participants will be provided with a particular way of interrogating Gift-giver and Bug-chaser newsgroup messages, one that engages with their narrative discourses to consider potential meanings behind planned exchanges of HIV.
Contact Information: Michael Graydon/Phone no. 1 613 729 4443/mgraydon@magma.ca
D05 Educating State and National Policymakers
Deborah Arrindell1, L Speissegger2
1American Social Health Association, Washington, DC; 2National Conference of State Legislatures, Denver, Colorado
Background and Rationale: Educating policymakers to encourage the development of effective STD prevention and treatment programs is essential. The 1997 IOM report acknowledges: “unlike many other health issues, there are virtually no patient-based constituent groups for STDs other than HIV infection.” Strengthening the public investment and improving resources available for STD prevention, treatment, and research will require advocacy and education efforts by a broad array of public and private organizations. Issues related to sexually are still poorly understood on Capitol Hill and in state legislatures. While the sequelae of STDs — infertility, cervical cancer, infant mortality, and AIDS — are major concerns, policy makers have been unwilling to acknowledge the link between controversial political topics and STDs.
Purpose: (a)To demystify the policymaking process. (b) To encourage those involved in STDs to be more proactive about educating policymakers. (c) To provide tools for effective efforts to educate policymakers.
Methods: In this participatory workshop, we will discuss the importance of advocacy and the difficulties of garnering support for STDs. Effective strategies for presenting information, and building coalitions to maximize impact will be discussed. Presenters will discuss these issues from the perspective of both state legislatures, and congress. Workshop participants will share strategies and experiences and describe efforts to work in collaboration with other organizations to achieve improved investment in STD programs. Materials that can be used to implement the strategies will be provided.
Measurable Learning Objectives:
At the end of this workshop, participants will be able to:
- Identify the benefits of educating policymakers
- Describe methods of working with policy makers
- Implement strategies to educate policymakers
Contact Information: Deborah McNeal Arrindell/Phone no. 1 202 789 5950/ debarrindell@aol.com
D06A Provision of Emergency Contraception in an STD Clinic: Results from a Pilot Project in New York City
L Evans1,2, JA Schillinger2,3, L Farhang1, N Mussington1, M Mavinkurve3, L Kupferman3, R Recant3, S Wright3, D Kaplan1, S Blank2,3
1New York City Department of Health and Mental Hygiene, Bureau of Maternal Infant and Reproductive Health, New York, NY; 2Centers for Disease Control and Prevention, Atlanta, GA; 3New York City Department of Health and Mental Hygiene, Bureau of Sexually Transmitted Disease Control, New York, NY
Background: Emergency contraception pills (EC) are very effective in preventing pregnancy if taken within 72 hours of unprotected intercourse. The NYC Department of Health and Mental Hygiene (NYCDOHMH) conducted a pilot project offering EC at a sexually transmitted diseases (STD) clinic.
Objectives: To describe the results of a pilot project integrating EC into STD clinic services.
Methods: We extracted data from medical records for all female first-time visits during 59 clinic days between March and July 2003. Reason for visit was categorized as: STD examination, HIV counseling and testing, or seeking EC only. Women reporting vaginal intercourse within the past 72 hours without contraception, or with contraception failure were considered eligible to receive EC.
Results: A total of 728 women attended the clinic for an initial visit during the period of interest. The majority of women (71%) were Black Non-Hispanic, <30 years of age (77%), and used either a barrier method, or no method of contraception (76%). The majority (77%) presented for an STD examination; 55 (7.6%) attended the clinic seeking EC only. Among 644 women assessed for EC eligibility, 124 (19%) were eligible, 56% (70/124) were offered, and 74% (52/70) accepted EC. Only 1 of 18 (6%) women visiting the clinic for EC only, and for whom physical examination results were available was treated for an STD. In comparison, 62% of women attending the clinic for an STD examination were treated for an STD.
Conclusions: Eight percent of women attended the clinic for EC only. EC was accepted by the majority of eligible women offered EC. STDs were infrequent among women visiting the clinic for EC only.
Implications for Programs, Policy, and/or Research: Clinic utilization should be monitored to assure the number of women receiving STD services is not reduced by introduction of EC, and that women seeking EC only are encouraged to get screened for STDs.
Learning Objectives: By the end of the session, participants will be able to: 1) describe the proportion of women attending this NYC STD clinic who were eligible for EC, and 2) discuss some of the ramifications of integrating EC into STD clinic services.
Contact Information: Linnea Evans/Phone no. 1 212 442 1759/levans@health.nyc.gov or Julie Schillinger/Phone no. 1 212 788 4429/jschilli@health.nyc.gov
D06B Evaluating Efforts to Increase Testing for Repeat Chlamydia Infection Among Women in California Family Planning Clinics
R Gindi1, H Bauer2, J Chow2, M Deal1
1California Family Health Council, Berkeley, CA; 2California Sexually Transmitted Disease Control Branch, Berkeley, CA
Background: Repeat chlamydia infection may increase the risk of adverse reproductive outcomes in women. CDC 2002 STD treatment guidelines recommend that non-pregnant women treated for chlamydia be tested for repeat infection within 3-4 months. Educational outreach to providers may increase adherence.
Objectives: Evaluate the impact of targeted guideline distribution on testing for repeat CT infection.
Methods: Between 1999-2003, family planning clinics collected chlamydia test data as part of a statewide chlamydia prevalence monitoring program. CDC guidelines were released in May 2002 and promoted through targeted mailings to family planning providers at >250 clinics. Initial positives after January 2003 and re-tests within 30 days were excluded. The proportion of cases that were tested for repeat infection within a “strict” 3-4 month interval and a “broad” 1-6 month interval was calculated per 6-month period. Repeat infection was assessed among women re-tested within 6 months.
Results: Of 47,841 women tested, 3066 were chlamydia positive (6%). Five hundred and eighty women with an initial positive test after January 2003 and re-tests within 30 days were excluded from further analysis. The proportion of cases that were re-tested within the “strict” interval per 6-month period remained stable between 4-6% (p=.8), with a slight increase between the first and second halves of 2002 (4% to 6%, p=.13). The proportion of cases that were re-tested within the “broad” interval varied between 14-27% (p=.001), with an increase between the first and second halves of 2002 (16% to 24%, p=.01). Repeat infection rates were stable at 11% across 6-month periods (p=.2).
Conclusions: By a broad interpretation of the CDC guidelines, the rate of testing for repeat infection increased commensurate with targeted guideline distribution. Repeat infection rates remained stable.
Implications for Programs, Policy and/or Research: Repeated targeted dissemination of re-screening guidelines to family planning agencies may encourage changes in testing for repeat infection. Existing data sources may be used to monitor adherence and evaluate changes in provider practice.
Learning Objectives: By the end of the session, participants will be knowledgeable about current recommendations on testing for repeat chlamydia infection. Participants will also be able to describe the impact of a targeted guideline distribution on the rates of repeat testing in the family planning population.
Contact Information: Renee Gindi/Phone no. 1 510 486 0412 ext 19
D06C HIV/STD Prevention for HIV Positive Women: Integration of Family Planning Services and HIV Care
B Green1, R Abdul-Khabeer1, E Aaron2, J Foster3, J Witek2, M Ranselle1, A Beatty1
1Circle of Care, Philadelphia, PA; 2Drexel University College of Medicine, Philadelphia, PA; 3St. Christopher’s Hospital for Children, Philadelphia, PA
Background: CDC has recently prioritized “Prevention for Positives” as an initiative for reducing new HIV infections. For HIV positive women, HIV/STD prevention can be effectively provided in a clinical setting through integration of family planning services. Seeing the need for family planning services first acknowledges that HIV positive women are sexually active.
Objective: To identify a model for effectively integrating family planning and HIV care and prevention services, and to assess how HIV/STD prevention for HIV positive women can be achieved through integration of family planning services.
Methods: Implementation analysis, and a CQI process were used to assess integration models. This paper will present 3 models, using a written client case study approach, and a FAQ handout will allow participants to be able to assess their own organization’s ability to implement similar program components.
Results: Three case studies were written representing different care models. One case study is from an ambulatory HIV clinic that serves approximately 400 HIV positive women; this clinic has implemented multiple strategies for integrating HIV/STD prevention, including family planning services. A second case study is from a ambulatory HIV family clinic located in a pediatric hospital that serves approximately 80 HIV positive youth and women; this clinic has integrated HIV/STD prevention, family planning services and is implementing HIV rapid testing using a mobile outreach model. The final case study is from family planning clinics in which peer counselors outreach to women who are getting a pregnancy test and may also be newly identified as HIV positive (approximately 80 a year) in order to facilitate their entry into care.
Implications for Programs, Policy and/or Research: These 3 case studies identify a range of issues that required a multi-disciplinary perspective to achieve integration of services. A number of tools and methods for integrating HIV/STD prevention for HIV positive women in clinical settings were developed, as well as a FAQ guide for other organization who are interested in assessing their ability to integrate services.
Measurable Learning Objectives: At the end of the presentation, participants will be able to:
- Discuss different approaches to integration of HIV/STD prevention and family planning
- Identify 5 steps that will enhance their clinic’s ability to integrate HIV/STD prevention, family planning, and HIV care
Contact Information: Brian M. Green/Phone no. 1 215 985 2627
D06D Gonorrhea Screening Strategies and Guideline Development for Non-Pregnant Female Patients in the California Family Planning Clinic Setting
H Howard1, JM Chow1, H Bauer1, M Deal2, R Gindi2, R Neiman1, G Bolan1
1STD Control Branch, California Department of Health Services, Berkeley, CA; 2California Family Health Council, Berkeley, CA.
Background: Gonorrhea (GC) prevalence in the US has declined; in 2001, GC prevalence in California family planning sentinel surveillance sites was <1%. High GC testing volume in these clinics may indicate unnecessary screening. However, limiting testing to symptomatic patients may not be effective since many GC infections are asymptomatic or associated with mild symptoms. GC screening criteria are needed that are sensitive for capturing cases and specific for reducing over-screening.
Objectives: To assess the predictive value of different GC screening algorithms among GC-infected, non-pregnant female patients.
Methods: Medical record review was conducted for non-pregnant female patients tested for GC in 2001 at five geographically diverse California sentinel site family planning clinics. All GC-positive cases and randomly sampled GC-negative controls were reviewed. Data abstracted included age, race/ethnicity, clinic site, presenting symptoms, clinical signs, chlamydia co-infection, contact to STDs, sexual behavior risk factors, and STD history.
Results: Patients with contact to STDs or with clinical signs (pelvic inflammatory disease or cervicitis) comprised 29% of 126 GC cases. Cases with chlamydia co-infection comprised 23%. Of the remaining 61 GC cases, 39 were age < 20 years, had multiple sexual partners in past 12 months, or had a partner who “may” have other partners. This screening strategy, when compared to universal screening, would have reduced testing/screening in this sample by 42% and detected 82% of GC cases. Specificity and cost-effectiveness of various screening algorithms vary considerably by criteria.
Conclusions: Targeted GC testing based on diagnostic findings and chlamydia test results, in addition to screening based on young age, multiple partners in past year, and/or partner concurrency is sensitive and specific for case finding.
Implications for Programs, Policy, and/or Research: Targeted and cost-effective screening strategies can be developed to optimize case-finding without over-screening individuals who are unlikely to be infected.
Learning Objectives: By the end of the session, participants will be able to describe a methodology for assessing the effectiveness of various screening algorithms and will be able to compare the impact of these strategies on program resources.
Contact Information: Holly Howard (Chaney)/Phone no. 1 510 883 6610
D06E STD Testing Protocols, STD Testing and Discussion of Sexual Behaviors in HIV Clinics
M Taylor1,2, T McClain2, G Aynalem2, LV Smith2, B Brown2, PR Kerndt2, TA Peterman1
1Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; 2Los Angeles County STD Program, Los Angeles, CA
Background: Sexually transmitted diseases (STD) such as syphilis among HIV positive men who have sex with men (MSM) represent a significant proportion of the syphilis morbidity in Los Angeles. Routine screening for STDs in HIV positive MSM may prevent incident HIV and other STDs in sexual partners
Objectives: To evaluate the use of written protocols for STD screening, the frequency and types of STD tests performed and the occurrence and frequency of obtaining sexual risk assessments by HIV clinicians in Los Angeles County.
Methods: A survey was administered to 27 medical directors, clinic directors and HIV providers representing 39 clinics and 24,521 HIV infected patients in Los Angeles.
Results: The use of a written or electronic protocol for STD testing was reported by 62% of clinics. Screening of HIV positive patients upon the initial visit for syphilis was reported by 100% of respondents and by 30% for chlamydia and gonorrhea. Testing for syphilis after the initial visit was reported every 3 months by 69%, every 6 months by 8%, every year by 18%, based on sexual risk by 3% and only with symptoms by 3% of clinics. Testing for chlamydia and gonorrhea was reported every 3 months by 26%, every 6 months by 8%, yearly by 49%, based on sexual risk by 3% and only with symptoms by 6%. Clinics with written or electronic protocols were no more likely to report more frequent syphilis, gonorrhea or chlamydia testing. Clinics with written or electronic STD protocols were significantly more likely to report questioning patients at each visit regarding their sexual practices (p = 0.003).
Conclusions: Written protocols for STD testing may promote sexual risk assessment questioning among HIV providers and insure STD testing per CDC/IDSA guidelines for HIV positive persons at sexual risk.
Implications for Programs, Policy and/or Research: Standardized STD testing protocols that include sexual risk assessments should be evaluated in HIV care settings.
Learning Objectives: By the end of this presentation, participants will be able to discuss the value of standardized STD screening protocols for use in HIV clinics, the need for discussion of sexual risk behaviors between HIV providers and their patients, and the currently recommended guidelines for STD screening among HIV infected persons.
Contact Information: Melanie Taylor/Phone no. 1 213 744 3093
D06F The Integration of Sexually Transmitted Disease Testing and HIV Counseling and Testing In Los Angeles County, 2002
1Los Angeles County Department of Health Services, Sexually Transmitted Disease Program, Los Angeles, California; 2Los Angeles County Department of Health Services, Office of AIDS Programs and Policy, Los Angeles, California
Background: To address ongoing high rates of syphilis in men who have sex (MSM) with men, Los Angeles County (LAC) DHS sought to expand STD testing services by integrating these services into the existing framework of HIV services for MSM.
Objectives: To increase STD testing capacity at community based organization (CBO) HIV counseling and testing sites (HCT) serving MSM in the Hollywood area.
Methods: The LAC DHS STD Program (STDP) and the LAC DHS Office of AIDS Programs and Policies (OAPP) joined with representatives of the LAC HIV Prevention Planning Committee and the LAC Counseling and Testing Task Force to form an STD/HIV integration committee. The committee has worked on the notification of HCT contractors that STD testing was permitted under their contracts, training of HCT Contractor staff in venipuncture, STD information and STD counseling and record-keeping protocols, revision of laboratory requisition forms and HIV counseling forms to minimize paperwork, and creation of funding mechanisms and funding schedules to reimburse HCT Contractor staff time spent performing STD services.
Results: Venipuncture training was conducted by the STD Program resulting in 85 CBO employees being certified in venipuncture. These employees were also trained in urine collection for chlamydia and gonorrhea testing. Seven CBOs have integrated STD testing into HCT sessions. Modifications were developed for HIV and STD lab forms, and for the California DHS HIV-5 form to streamline record keeping, and combine HIV/STD risk data. A draft reimbursement schedule and funding mechanism has been developed for STD testing. Process data of integrated services will be presented.
Conclusions: STD and HIV testing services can be integrated through concerted collaborative effort. CBOs with access to at-risk MSM populations may serve as resources for expanded STD testing capacity.
Implications for Programs, Policy and/or Research: STD and HIV integration liaisons should be established in all jurisdictions where these functions are separated.
Learning Objectives: By the end of this presentation, participants will be able to discuss advantages of integrating HIV and STD testing for MSM, key obstacles in achieving such integration, and solutions for overcoming key obstacles.
D07 Issues Surrounding the Promotion of Condoms for STD Prevention
J Shlay1,2, L Warner3, M Steiner4, G Mansergh3
1Denver Public Health; 2University of Colorado Health Sciences Center, Denver, Colorado; 3Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA; 4Family Health International, Research Triangle Park, NC
Background and Rationale: When used correctly and consistently, male condoms are the most effective method to reduce the risk of STD/HIV transmission during sexual intercourse. However, recommendations for using condoms have recently been questioned because of concerns about their effectiveness for disease prevention. Programs working with clients at risk for STD/HIV need more information on the overall effectiveness of condoms and information on how to ensure that clients use condoms effectively.
Objectives: (1) To review the methodological challenges for assessing condom effectiveness. (2) To discuss challenges surrounding promotion of condoms in the context of the ABCs (abstinence, be faithful, condoms). (3) To discuss barriers and potential strategies to using condoms for oral, vaginal, or anal sex. (4) To discuss the efficacy of focused messages to increase condom use.
Content: Investigators will review the following: challenges associated with evaluating condom effectiveness for STD prevention, with emphasis on the importance of properly measuring consistent and correct condom use and the infection status of partners; issues surrounding the challenges of successfully promoting condoms with factual information that is easily understood; barriers surrounding the lack of condom use during intercourse by clients at risk for STD; and efficacy of short messages for men who have sex with men to increase awareness of HIV infection risk during sex without a condom. A closing presentation will summarize potential issues that STD/HIV programs should consider when promoting condoms to clients.
Implications for Programs and Policy: STD programs will be able to use the information presented to discuss strategies for promoting condom use with their clients.
Implications for Research: Future research should focus on implementing strategies to improve consistent and correct use of condoms, both for the purpose of evaluating condom effectiveness and also for educating clients on the risks associated with unprotected sexual intercourse and how to use condoms effectively.
Panel Line-up
Moderator:
Judith C Shlay, MD, MSPH
Panelists:
Judith C Shlay, MD, MSPH
Denver Public Health, Denver, CO
Lee Warner, PhD, MPH
Centers for Disease Control and Prevention, Atlanta, GA
Markus Steiner, PhD
Family Health International, Research Triangle Park, NC
Gordon Mansergh, PhD, MA, MEd
Centers for Disease Control and Prevention, Atlanta, GA
Learning Objectives: By the end of the session, participants will be able to discuss the relationship between condom use and STD prevalence and its connection with other aspects of sexual activity and how these factors may impact the effectiveness of condoms. By the end of the session, participants will have learned about potential methods to communicate to clients about issues surrounding condom use and risks associated with unprotected sexual intercourse.
Contact Information: Judy Shlay/Phone no. 1 303 436 7200/jshlay@dhha.org
D08 Partnering With Hospital Emergency Departments for Syphilis Elimination
C Moseley1, M Mahadevappa2, M Shulz2, E Hawkins3, L Duncan4, K Conklin4, K Olsen4, R Beaton5, J McGoldrick5
1Guilford County Department of Public Health; 2University of North Carolina at Greensboro; 3University of North Carolina at Chapel Hill, School of Medicine; 4High Point Regional Hospital, NC; 5Moses Cone Health System
Background and Rationale: In a time when public STD resources are shrinking and other demands like bioterrorism are taxing our public system, it becomes even more crucial that nontraditional partners join STD prevention, such as the hospital emergency department (HED). Like jails, HEDs are frequently the only source of primary care for many people at highest risk for syphilis, like cocaine users and sex workers. It is now generally accepted that a successful syphilis elimination program must include collaboration with local jails and these collaborations have helped reduce syphilis; HEDs may be the next step. Under this premise, a local community has partnered with its HEDs to identify and treat cases of syphilis that would not have been uncovered otherwise.
Purpose: a) To demonstrate how local HEDs can assist in reducing syphilis in high morbidity areas. b) To provide public health workers with specific tools for engaging their local HEDs in their syphilis elimination efforts. c) To present findings from the current project.
Methods: We will use a case study approach to assist participants in developing a strategy for enlisting their local HEDs in syphilis elimination. We will use field experience as a starting point for discussion of the potential barriers participants foresee in working with their local HEDs. Participants will identify the assets they already have that will be useful in starting this partnership. Finally, attendees will work alone and in small groups to design a plan of action with specific steps for immediate implementation.
Learning Objectives: Participants will be able to:
- Understand the vital role that HEDs play in syphilis elimination
- Develop a strategy for engaging their HEDs in syphilis elimination
- Implement a plan for incorporating HEDs into their strategic plans for eliminating syphilis
Contact Information: Caroline Moseley/Phone no. 1 336 641 3136/cmosele@co.guilford.nc.us
- Page last reviewed: June 1, 2005 (archived document)
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