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

Trends in HIV seroprevalence among patients with sexually transmitted diseases in 17 European sentinel networks, 1990-1996. European Study Group

OBJECTIVE

To monitor trends in HIV seroprevalence among sentinel populations of patients with new sexually transmitted disease episodes in 17 networks of 15 European countries.

METHODS

Time trends were estimated by logistic regression for homo-/bisexual men, injecting drug users (IDU) and non-IDU heterosexuals. The networks were included as independent variables to account for different prevalence levels across Europe. Socio-demographic and behavioural data were also included in the model. The interactions of time and each factor in the model were evaluated to determine whether trends differed across networks or population subgroups.

RESULTS

Overall, more than 150,000 sexually transmitted disease episodes were registered in this study. In the European network as a whole, the prevalence decreased significantly among IDU [n = 2619; odds ratio (OR) for annual change, 0.86; 95% confidence interval (CI), 0.80-0.93]. It also decreased among homo-/bisexual men (n = 11,809; OR, 0.92; 95% CI, 0.89-0.94). In both groups, trends did not differ statistically between networks. Among non-IDU heterosexuals (n = 114,024) the prevalence increased significantly (OR, 1.08; 95% CI, 1.04-1.13), especially among women (OR, 1.13) and the time trends differed statistically across networks. A significant increase was observed in four networks, whereas no specific change was detected in the others.

CONCLUSIONS

By applying a standardized protocol, trends in HIV prevalence could be compared across networks and estimated at a more global level. For the validity of HIV trends in such surveys, it is essential to minimize the number of patients not being tested in networks where voluntary testing is required.

Sexually transmitted diseases and the increased risk for HIV transmission: implications for cost-effectiveness analyses of sexually transmitted disease prevention interventions

We estimated the annual number and cost of new HIV infections in the United States attributable to other sexually transmitted diseases (STDs). We used a mathematical model of HIV transmission to estimate the probability that a given STD infection would facilitate HIV transmission from an HIV-infected person to his or her partner and to calculate the number of HIV infections due to these facilitative effects. In 1996, an estimated 5,052 new HIV cases were attributable to the four STDs considered here: chlamydia (3,249 cases), syphilis (1,002 cases), gonorrhea (430 cases), and genital herpes (371 cases). These new HIV cases account for approximately $985 million U.S. in direct HIV treatment costs. The model suggested that syphilis is far more likely than the other STDs (on a per-case basis) to facilitate HIV transmission. This analysis provides a framework for incorporating STD-attributable HIV treatment costs into cost-effectiveness analyses of STD prevention programs.

A night with Venus: partner assessments and high-risk sexual encounters

This study examined partner assessments and high-risk sexual encounters among STD clinic patients. Participants were 42 English-speaking attendees of a public STD clinic in Southern California with ages ranging between 18 and 60. Twelve focus groups were conducted. Qualitative data from the focus groups were analyzed using grounded theory. The analysis resulted in delineating five temporally-ordered stages of causal sexual encounters. Participants reported that they did not use condoms when they perceived new sexual partners as being safe. Instead of directly addressing their partner's sexual history, they relied heavily on both visual and verbal cues to judge if their partner was clean, or disease-free. This assessment process reflects an error in judgement, particularly because most of the participants had already contracted a STD. Suggestions are provided for incorporating the information about the partner assessment process into AIDS educational programmes.

Cocaine use and high-risk sexual behavior among STD clinic patients

BACKGROUND AND OBJECTIVES

Crack-smoking sexually transmitted disease (STD) patients are at high-risk for contracting HIV.

GOAL OF THE STUDY

To examine the effects of cocaine use and other correlates on high-risk sexual behavior among STD clinic patients.

STUDY DESIGN

This was a cross-sectional study of 1,490 consecutive patients attending three Los Angeles County STD clinics between 1992 and 1994.

RESULTS

Logistic regression analysis found high-risk sexual activity was associated with being a male and being of younger age. Among women, high-risk sexual behavior was associated with crack cocaine use and a perceived need for help. Among the men in the study, ethnicity (being black) and having an arrest history were associated with high-risk behavior.

CONCLUSIONS

Effective intervention strategies should address cocaine use among STD patients and provide them with referrals to drug treatment.

HIV seroincidence and risk factors among patients repeatedly tested for HIV attending sexually transmitted disease clinics in the United States, 1991 to 1996. STD Clinic HIV Seroincidence Study Group

To assess the incidence of HIV infection and risk factors associated with HIV seroconversion among patients attending clinics for sexually transmitted diseases (STD), medical record reviews were conducted in 12 clinics in 7 U.S. cities. The records of all patients who initially tested negative for HIV from 1991 through 1996 and who received at least one additional HIV test during the study period were reviewed. In each of 7 cities, 5 to 112 patients seroconverted. Of the 286 seroconverters identified in total, 53% (152 of 286) were heterosexual men and 28% (81 of 286) were women. HIV incidence rates among men who have sex with men (MSM) ranged by city from 0.81 to 7.0 new infections/100 person-years. Rates among heterosexual men and women ranged from 0.018 to 1.2 infections/100 person-years. Multivariate analyses showed that drug use was associated with HIV seroconversion only among heterosexuals. Most new HIV infections in these clinics are being transmitted heterosexually and are associated with drug use. Nevertheless, MSM, particularly young MSM, are at greatest risk for HIV in this population: 1 of 47 seroconvert/year. The effective use of targeted prevention efforts depends upon the continued ability to monitor the incidence of HIV infection.

Human immunodeficiency virus seroprevalence and risk behaviors in patients attending sexually transmitted disease clinics in Alberta

OBJECTIVE

To investigate the dissemination of human immunodeficiency virus (HIV) and hepatitis C infection in association with sexually transmitted diseases (STDs), sexual practices, and injection drug use. All eligible men and women attending two STD clinics in Alberta, Canada, from May 1994 to May 1995 were studied.

STUDY DESIGN

Anonymous, unlinked serosurveys were performed using leftover sera drawn for routine syphilis, hepatitis B, or HIV testing. Self-administered questionnaires collected a wide range of data: demographic, sexual behaviors, condom use, STD history, the exchange of drugs or money for sex, and drug and alcohol use.

RESULTS

HIV seroprevalence in the overall sample group (n = 6,668) was 1.5%. Univariate analysis showed significant relationships for age between 30 years and 49 years, men having sex with men, injection drug use regardless of sexual orientation, history of STD, anal sex, and exchanging money or drugs for sex. At the multivariate level, only men having sex with men, injection drug use, and age more than 30 years remained predictive of HIV infection. The prevalence of hepatitis C was 3.4% with significant associations being injection drug use and exchanging money or drugs for sex.

CONCLUSION

The behavioral associations between sex practices, injection drug use, and HIV and hepatitis C seroprevalence warrant ongoing investigation. Continuing prevention programs targeted at safer sex practices (particularly for men having sex with men) and the use of clean needles are needed.

Self-reports of HIV risk factors by patients at a sexually transmitted disease clinic: audio vs written questionnaires

OBJECTIVES

The purpose of this study was to determine how the method of assessment affects patient report of human immunodeficiency virus (HIV) risks.

METHODS

Patients at a sexually transmitted disease clinic randomly received either a written self-administered questionnaire or an audio self-administered questionnaire delivered by cassette player and headset. These questionnaires were followed by face-to-face interviews.

RESULTS

Audio questionnaires had fewer missing responses than written questionnaires. Audio questionnaires also identified more unprotected vaginal intercourse and sexual partners suspected or known to have HIV infection or acquired immunodeficiency syndrome than did written questionnaires. Although both the audio and written questionnaires identified more risks than the face-to-face interviews, the difference in the mean number of reported risks between the audio questionnaires and the face-to-face interviews was greater than that between the written questionnaires and the face-to-face interviews.

CONCLUSIONS

Audio questionnaires may obtain more complete data and identify more HIV risk than written questionnaires. Research is warranted about whether audio questionnaires overcome barriers to the completion and accuracy of HIV risk surveys. This study emphasizes the need to elucidate the relative strengths and weaknesses of written questionnaires, audio questionnaires, and face-to-face interviews for HIV risk assessment.

HIV-seropositive rate and HIV test activity among STD clinic attendees in Bergen, Norway

We wanted to determine the HIV seropositive rate and to study the connection between previous HIV testing, acceptance of HIV testing and sexual behaviour among STD clinic patients in Bergen, Norway. Patients attending the STD clinic in 1986-93 requesting HIV testing were registered, and all patients visiting the clinic in April-June 1989 received a questionnaire and were asked if they wanted to be HIV tested. The overall HIV seropositive rate was 0.4% (14/3805); in homo-/bisexual men: 2.9% (8/278); IVDUs: 0.4% (1/236) and in heterosexual non-IVDUs: 0.2% (5/3291). Among the 599 individuals offered anonymous HIV testing, 42.2% were HIV tested and 69.2% did not object to HIV-testing. IVDUs/prostitutes (p < 0.001), customers of prostitutes (p < 0.001), homo-/bisexuals (p < 0.01), and patients receiving blood transfusion (p < 0.005) had all been HIV tested more frequently than 'other heterosexuals'. Respondents reporting casual sex, casual sex abroad, infection with STDs, and a greater number of partners were more frequently HIV tested and also accepted HIV testing more frequently than respondents without such behaviour, indicating that there is some rationale behind the decision to be tested.

HIV and adolescents

Human immunodeficiency virus has entered the adolescent population, and pediatricians will be caring for youngsters who are HIV positive or at risk of being infected. We should remember that it is risky sexual behavior and injection drug use that places a teen at risk for HIV infection, not their sexual orientation, ethnicity, or gender. Parents and their teenagers desire and expect their pediatricians to provide care and guidance for the diseases and problems that adolescents face. A screening psychosocial assessment of teenagers can identify those who need more in-depth counseling. Although the subjects of sex and drug use initially may be uncomfortable for a physician, practice using the HEADSS assessment will rapidly lead to comfort in discussing these important subjects. An understanding of HIV testing and pre- and post-test counseling will prepare the physician for the inevitable patient who wishes testing or who is HIV positive. Much of the treatment of HIV-positive adolescents involves patience and support while the adolescent grapples with the serious implications of being HIV positive. The initial history and physical exam establishes baselines regarding previous infections and illnesses that may bear on HIV infection, as well as determining which symptoms and signs of HIV infection are present. The initial laboratory tests further define the patient's current clinical state and will determine what therapies are immediately needed. Human immunodeficiency virus continues to evolve toward a manageable chronic illness that responds most favorably to early intervention.

HIV seroprevalence in sexually transmitted disease clients in a low-prevalence southern state. Evidence of endemic sexual transmission

We studied human immunodeficiency virus (HIV) seroprevalence and risk factors in 3052 clients attending three large public, sexually transmitted disease (STD) clinics in central North Carolina in mid-1988. Anonymous self-administered questionnaires linked to HIV serologies obtained by testing extra blood from syphilis serologies without personal identifiers showed the following characteristics of the respondents: 60% were men, 81% were black, the median age was 24 years, 5% were injecting drug users since 1978, 7% reported a history of syphilis, and 8% of men were homosexual or bisexual. HIV seropositivity was found in 76 subjects (2.5%), including 46% of the homosexual men, 25% of the bisexual men, 1.6% of the heterosexual men, and 0.6% of the women. Elevated HIV seroprevalence rates were found in subjects with a history of or seroreactivity for syphilis (HIV-positive rate of 53% in homosexual or bisexual men, 9% in heterosexual men, 3% in women) and with histories of gonorrhea (HIV-positive rate of 37% in homosexual or bisexual men, 2.6% in heterosexual men, 1% in women), and intercourse (41% in homosexual or bisexual men, 2% in women), prostitute contact (5% in heterosexual men), and sex with casual partners (2% in women). Even a state with a low incidence of acquired immunodeficiency syndrome can include subpopulations with a high HIV seroprevalence, apparently disseminated endemically in association with bacterial STDs.