Expanding sexually transmitted infection screening among women and men engaging in transactional sex: the feasibility of field-based self-collection

Routine screening is a key component of sexually transmitted infection (STI) prevention and control; however, traditional programmes often fail to effectively reach men and women in hidden communities. To reduce prevalence, we must understand the programmatic features that would encourage utilization of services among asymptomatic individuals. Using incentivized snowball sampling, 44 women and men recently engaging in transactional sex were recruited (24 women, 20 men); median age 37 years. Respondents were offered the opportunity to collect genital, oropharyngeal and rectal samples for STI testing and completed a face-to-face interview about their experience with self-obtained sampling. Interviews were analysed using qualitative methods. Participants were unaware of potential risk for STI, but found self-sampling in non-clinical settings to be acceptable and preferable to clinic-based testing. All participants collected genital specimens; 96% and 4% collected oropharyngeal and rectal specimens, respectively. The burden of disease in this population was high: 38% tested positive for at least one STI. We detected multiple concomitant infections. Incorporating field collection of self-obtained samples into STI control programmes may increase utilization among high-risk populations unlikely to access clinic-based services. High infection rates indicate that individuals engaging in transactional sex would benefit from, and be responsive to, community-based self-sampling for STI screening.

Herpes simplex virus type 2 serological testing at a community court: predictors of test acceptance and seropositivity among female defendants

Despite the high prevalence of herpes simplex virus type 2 (HSV-2), testing for asymptomatic infections is uncommon. One population for whom targeted interventions may be prioritized include individuals involved with the correctional system. Here we describe the acceptability of a novel HSV-2 screening program, implemented in a court setting, as a possible intervention for corrections-involved women. Female defendants completed an interviewer administered survey assessing factors associated with uptake/refusal of free point-of-care HSV-2 serologic testing and HSV-2 seropositivity. Participants included 143 women, 18-62 years old (mean 32.85) with diverse ethnicities. The majority (65.7%) accepted testing and 62.4% tested HSV-2 seropositive. Factors independently associated with test acceptance included higher perceived susceptibility to genital herpes infection and not receiving a preventative health screen. Women who were seropositive tended to be older, Black, report having previous STI, and be arrested on a prostitution charge. Findings suggest point-of-care testing in a court setting is acceptable to women and can be implemented to improve case finding of STI.

MDM2 overexpression in benign and malignant lesions of the human breast

MDM2 overexpression has been detected in women with benign or cancerous lesions of the breast. Immunohistochemical methods were used to identify overexpression in 11 of 27 benign cases (41%) and 15 of 22 (68%) cancer cases. MDM2 overexpression correlated well with immunohistochemically detected estrogen receptor (ER), suggesting that expression of these proteins was coordinately regulated. To test this, the MCF-10A human breast cell line, negative for both ER and MDM2 expression, was transfected with a wild-type ER. Following transfection, both ER and MDM2 were strongly expressed in two independent clones. Expression of both was reduced in the presence of increasing concentrations of estradiol (10(-10)-10(-8) M) thus, estrogen may be involved in regulation of MDM2 expression in proliferative breast lesions.

USA study of sex toy use by HIV-positive men who have sex with other men: implications for sexual health

HIV/AIDS disproportionately impacts men who have sex with men (MSM) in the USA. Most existing literature on MSM with HIV focuses on transmission risk, but does not acknowledge health-promoting sexual behaviours men may undertake. This study examined sex toy use within this population to describe the extent to which using toys is incorporated into their sexual repertoires as a risk reduction practice. Data regarding sociodemographics, sexual/health-related behaviours and sex toy use were collected from 2275 MSM using an online survey. Most participants reported being sexually active (88.5%), and the majority (70.2%) of participants reported sex toy use within the previous year. Sex toy users were more likely to be white, in sexual relationships with others, and reported higher levels of sexual satisfaction. Given that sex toy use is common among this population, room for discussion exists about sex toys as tools to enhance pleasure and reduce HIV/sexually transmitted infection (STI) transmission.

Low acceptance of HSV-2 testing among high-risk women

We evaluated the acceptability of a community-based herpes simplex virus type 2 (HSV-2) screening programme for at-risk women and assessed factors related to uptake of point of care HSV-2 testing. One hundred recently arrested women (median age 34 years) were recruited from a community court handling lower-level misdemeanour cases in Indianapolis, Indiana. Individuals completed a survey assessing factors related to HSV-2 screening intentions and were offered point of care HSV-2 testing. Rates of HSV-2 infection in this population are high; 61.1% of women tested were positive. The majority (81%) accepted a prescription for suppressive therapy. Women in this sample indicated that HSV-2 screening is an important component of health care but were unwilling to pay the US$10 it cost to be tested. To encourage this and other high-risk populations to be screened for HSV-2, public health resources will be needed to help individuals overcome cost-related barriers to care.

Sexual behavior of young adults in Sri Lanka: Implications for HIV prevention

While many Asian countries have been challenged by an increasingly high incidence of HIV infection, Sri Lanka has not been among those most impacted to date. However, little is known about sexual behaviors in this country, particularly those of young adults and, as the population of youth grows and becomes more sexually active, there could be implications for the incidence of HIV in this country. Using a two-staged clustered sampling method to achieve a geographically representative sample of young adults in Sri Lanka, data related to sexual behaviors were collected from 3,134 individuals aged 18-20 years. Over half of the males and approximately one-third of the females reported that they were sexually active at the time of the study, with penetrative sexual experiences reported by 20.1% of males and 3.1% of females. Only 26.5% of males and less than 10% of females reported having ever used a condom when participating in vaginal, anal or oral intercourse. The findings of this study suggest that unique partnerships between both governmental and non-governmental entities, both within and outside Sri Lanka and particularly those that involve young adults, may help to maintain this country's low HIV incidence.

Field collection of rectal samples for sexually transmitted infection diagnostics among men who have sex with men

Rectal sexually transmitted infections (STIs) are common in men at risk for urethral infections with these pathogens, particularly men who have sex with men (MSM). However, for those individuals not regularly seen by a clinician, screening for rectal STI is not currently a widespread option. Qualitative data and samples (i.e. self-obtained rectal specimens) were collected from 75 MSM in a variety of venues. Upon completion of the rectal self-sampling, each participant completed a brief interview regarding their overall experience with the process. Participants reported an overall high level of acceptability and comfort-level involved with self-sampling for rectal STI. Of the majority of men who agreed to provide a rectal self-sample, all reported that they would provide a sample again in the future. However, many men also appreciated the interaction with a health-care provider that a clinical setting offered. In conclusion, self-sampling is a feasible and acceptable option when offered to MSM in a range of community-based venues. Further research is needed to determine which combinations of STI testing and treatment methods (including self-sampling) are most appropriate for diverse groups of men.

Penile dimensions and men's perceptions of condom fit and feel

OBJECTIVES

Sexual health professionals continue to promote correct and consistent condom use among sexually active individuals yet research indicates that some men remain resistant to using condoms because of perceptions that they do not fit properly or feel comfortable. This study empirically assessed relations between men's penile dimensions and their perceptions of condom fit and feel.

METHODS

Data related to demographics, a bivariate calculation of erect penile length and circumference, and perceptions of condom fit and feel were analysed from 1661 adult men from 50 US states

RESULTS

While many men reported that condoms generally fit fine and feel comfortable, at clearly identifiable intersections of length and circumference relations between penile dimensions and perceptions of condom fit and feel existed, particularly for those men who felt that condoms were "too long" (p<0.004), "too short" (p<0.001), "too loose" (p<0.047) or "too tight" (p<0.001).

CONCLUSIONS

These analyses provide empirical insights into the relations between bivariate penile dimensions (the intersection of length and circumference) and men's perceptions of the positive and negative aspects of condom fit and feel. Those men with the most negative perceptions of condom fit and feel may benefit from an assessment of their condom-related concerns as a component of community and clinic based STI prevention interventions in order to help them select from the variety of condoms in the marketplace that they may find to be better fitting or more comfortable.

Psychological distress symptoms of individuals seeking HIV-related psychosocial support in western Kenya

While researchers in many western countries have documented the nature of psychological distress that is commonly present among individuals living with HIV, there has been virtually no research on the same topic among other high prevalence areas of the world, particularly in countries like Kenya. This study sought to document the nature of psychological distress among 397 individuals living with HIV in western Kenya and who were participating in psychosocial support groups in conjunction with their enrollment in HIV-related treatment. Psychological distress was assessed using the Brief Symptom Inventory (BSI), a 53-item self-report psychological inventory that asks individuals to recall symptoms experienced in the prior seven days. The levels of psychological distress in this sample were moderate with a substantial proportion of participants meeting the criteria that suggested a need for further psychiatric evaluation. Findings support the need for further assessments of the range and nature of psychological distress among the diverse communities of countries like Kenya and the need for greater attention to the inclusion of mental health services in the rapidly developing treatment and prevention programs in this region of the world.

Increased farnesylation of p21-Ras and neonatal macrosomia in women with gestational diabetes

Six of 22 mothers with gestational diabetes mellitus had infants with macrosomia, cord blood hyperinsulinemia, and increased amounts of a key mitogenic intermediate, farnesylated p21-Ras. The ability of fetal hyperinsulinemia to increase the availability of farnesylated p21-Ras may represent one mechanism of the growth-promoting action of insulin during fetal development.

Omega-3 for Baby and Me: Material Development for a WIC Intervention to Increase DHA Intake during Pregnancy

OBJECTIVE

The purpose of this project was to develop educational materials for a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program intervention in Denver, Colorado. Despite accumulating evidence of the importance of docosahexaenoic acid (DHA) during pregnancy, there has been no attempt to develop a targeted nutrition intervention to improve birth outcomes among high-risk women. The goal of the Omega-3 for Baby and Me intervention, for which these materials were developed, is to increase the consumption of DHA-rich foods to decrease the risk for premature delivery and low-birth weight babies among this population.

METHOD

Following collection of data from eight focus groups among the target audience, the principles of the Health Belief Model were used to develop materials to address the needs, barriers, and motivators of this audience. In addition, process evaluation pilot testing was used to evaluate recipes and logos during the material development.

RESULTS

Materials developed for this intervention include a logo, 9-month calendar, stickers, shopping lists, recipes, recipe holder, magnetic clip, nylon pouch, and recruitment materials.

CONCLUSION

The use of focus groups and pilot testing increased the target audience acceptance of education materials that are being used for the Omega-3 for Baby and Me intervention. Successful outcomes from the Omega-3 for Baby and Me intervention, i.e., decreasing the incidence of preterm birth and low-birth weight, will have implications for supplemental food policies at state and national levels.

HIV-related mental health care: factors influencing dropout among low-income, HIV-positive individuals

A prospective design was used to collect data from 132 HIV-positive individuals presenting for mental health care at an inner-city HIV-related mental health clinic located in a large metropolitan area of the Southeastern USA. Data were analyzed to assess associations between study variables and whether participants returned for care following an initial mental health assessment. Hierarchical logistic regression analyses were conducted to determine the extent to which the addition of measures of health beliefs and HIV-related stigma would enhance the predictive capacity of a dropout model that included demographics and health status measures. As health beliefs and HIV-related stigma were added to the model, the predictive capacity increased significantly (R(2)=0.29 to R(2)=0.63, p<0.05). Those who did not return for care had higher levels of perceived barriers to mental health care, higher levels of HIV-related stigma, were more likely to be of non-white ethnicity and had lower T-cell counts. These findings indicate that mental health providers may need to ensure care systems are responsive to the social and cultural characteristics of clients, and the HIV epidemic itself, in order to effectively engage clients into care.

Modified minimum-distance criterion for blended random and nonrandom encoding

Two pixel-oriented methods for designing Fourier transform holograms--pseudorandom encoding and minimum-distance encoding-usually produce higher-fidelity reconstructions when combined than those produced by each method individually. In previous studies minimum-distance encoding was defined as the mapping from the desired complex value to the closest value produced by the modulator. This method is compared with a new minimum-distance criterion in which the desired complex value is mapped to the closest value that can be realized by pseudorandom encoding. Simulations and experimental measurements using quantized phase and amplitude modulators show that the modified approach to blended encoding produces more faithful reconstructions than those of the previous method.

Functional characterization of ORCTL2--an organic cation transporter expressed in the renal proximal tubules

Chromosome 11p15.5 harbors a gene or genes involved in Beckwith-Wiedemann syndrome that confer(s) susceptibility to Wilms' tumor, rhabdomyosarcoma, and hepatoblastoma. We have previously identified a transcript at 11p15.5 which encodes a putative membrane transport protein, designated organic cation transporter-like 2 (ORCTL2), that shares homology with tetracycline resistance proteins and bacterial multidrug resistance proteins. In this report, we have investigated the transport properties of ORCTL2 and show that this protein can confer resistance to chloroquine and quinidine when overexpressed in bacteria. Immunohistochemistry analyses performed with anti-ORCTL2 polyclonal antibodies on human renal sections indicate that ORCTL2 is localized on the apical membrane surface of the proximal tubules. These results suggest that ORCTL2 may play a role in the transport of chloroquine and quinidine related compounds in the kidney.

Divergently transcribed overlapping genes expressed in liver and kidney and located in the 11p15.5 imprinted domain

Human chromosomal band 11p15.5 has been shown to contain genes involved in the development of several pediatric and adult tumors and in Beckwith-Wiedemann syndrome (BWS). Overlapping P1 artificial chromosome clones from this region have been used as templates for genomic sequencing in an effort to identify candidate genes for these disorders. PowerBLAST identified several matches with expressed sequence tags (ESTs) from fetal brain and liver cDNA libraries. Northern blot analysis indicated that two of the genes identified by these ESTs encode transcripts of 1-1.5 kb with predominant expression in fetal and adult liver and kidney. With RT-PCR and RACE, full-length transcripts were isolated for these two genes, with the largest open reading frames encoding putative proteins of 253 and 424 amino acids. Database comparison of the predicted amino acid sequence of the larger transcript indicated homology to integral membrane organic cation transporters; hence, we designate this gene ORCTL2 (organic cation transporter-like 2). An expressed sequence polymorphism provided evidence that the ORCTL2 gene exhibits "leaky" imprinting in both human fetal kidney and human fetal liver. The mouse orthologue (Orctl2) was identified, and a similar polymorphism was used to demonstrate maternal-specific expression of this gene in fetal liver from interspecific F1 mice. The predicted protein of the smaller gene showed no significant similarity in the database. Northern and RACE analyses suggest that this gene may have multiple transcription start sites. Determination of the genomic structure in humans indicated that the 5'-end of this transcript overlaps in divergent orientation with the first two exons of ORCTL2, suggesting a possible role for antisense regulation of one gene by the other. We, therefore, provisionally name this second transcript ORCTL2S (ORCTL2-antisense). The expression patterns of these genes and the imprinted expression of ORCTL2 are suggestive of a possible role in the development of Wilms tumor (WT) and hepatoblastoma. Although SSCP analysis of 62 WT samples and 10 BWS patients did not result in the identification of any mutations in ORCTL2 or ORCTL2S, it will be important to examine their expression pattern in tumors and BWS patients, since epigenetic alteration at these loci may play a role in the etiology of these diseases.

The murine Sim-2 gene product inhibits transcription by active repression and functional interference

The Drosophila single-minded (Dsim) gene encodes a master regulatory protein involved in cell fate determination during midline development. This protein is a member of a rapidly expanding family of gene products possessing basic helix-loop-helix (bHLH) and hydrophobic PAS (designated a conserved region among PER, ARNT [aryl hydrocarbon receptor nuclear translocator] and SIM) protein association domains. Members of this family function as central transcriptional regulators in cellular differentiation and in the response to environmental stimuli such as xenobiotics and hypoxia. We have previously identified a murine member of this family, called mSim-2, showing sequence homology to the bHLH and PAS domains of Dsim. Immunoprecipitation experiments with recombinant proteins indicate that mSIM-2 associates with the arnt gene product. In the present work, by using fine-structure mapping we found that the HLH and PAS motifs of both proteins are required for optimal association. Forced expression of GAL4/mSIM-2 fusion constructs in mammalian cells demonstrated the presence of two separable repression domains within the carboxy terminus of mSIM-2. We found that mSIM-2 is capable of repressing ARNT-mediated transcriptional activation in a mammalian two-hybrid system. This effect (i) is dependent on the ability of mSIM-2 and ARNT to heterodimerize, (ii) is dependent on the presence of the mSIM-2 carboxy-terminal repression domain, and (iii) is not specific to the ARNT activation domain. These results suggest that mSIM-2 repression activity can dominantly override the activation potential of adjacent transcription factors. We also demonstrated that mSIM-2 can functionally interfere with hypoxia-inducible factor 1alpha (HIF-1alpha)/ARNT transcription complexes, providing a second mechanism by which mSIM-2 may inhibit transcription.

Characterization of msim, a murine homologue of the Drosophila sim transcription factor

Mutations in the Drosophila single-minded (sim) gene result in loss of precursor cells that give rise to midline cells of the embryonic central nervous system. During the course of an exon-trapping strategy aimed at identifying transcripts that contribute to the etiology and pathophysiology of Down syndrome, we identified a human exon from the Down syndrome critical region showing significant homology to the Drosophila sim gene. Using a cross-hybridization approach, we have isolated a murine homolog of the Drosophila sim gene, which we designated msim. Nucleotide and predicted amino acid sequence analyses of msim cDNA clones indicate that this gene encodes a member of the basic-helix-loop-helix class of transcription factors. The murine and Drosophila proteins share 88% residues within the basic-helix-loop-helix domain, with an overall homology of 92%. In addition, the N-terminal domain of MSIM contains two PAS dimerization motifs also featured in the Drosophila sim gene product, as well as a small number of other transcription factors. Northern blot analysis of adult murine tissues revealed that the msim gene produces a single mRNA species of approximately 4 kb expressed in a small number of tissues, with the highest levels in the kidneys and lower levels present in skeletal muscle, lung, testis, brain, and heart. In situ hybridization experiments demonstrate that msim is also expressed in early fetal development in the central nervous system and in cartilage primordia. The characteristics of the msim gene are consistent with its putative function as a transcriptional regulator.

Deletion of tp53 exon-1 in human epithelial ovarian-cancer

In ovarian cancer, allelic loss within 17p 13.1-13.3, which contains the tumor suppressor TP53, occurs with a frequency of 66%, and mutations within conserved TP53 exons are reported in approximately 50% of cases. We examined DNA from 26 Stage III/IV ovarian carcinomas and 7 non-malignant ovaries by Southern blot hybridization and PCR for gene rearrangement or deletion within the,TP53 locus. Deletion specifically involving loss of the transcription-regulatory exon 1/intron 1 region on at least one allele was detected in 24/26 (92%) cases, and 0/7 noncancerous ovaries. Immunocytochemical analysis confirmed absence of expression of mutant p53 protein in those tumors where loss of the exon 1 region involved both alleles.

Effect of plasma fibronectin, macrophages, and glycosaminoglycans on tumor cell growth

Fibronectin (Fn) synergizes with macrophages (M phi) in inducing cytostasis and cytotoxicity of neoplastic cells in culture. Since heparin enhances Fn's opsonic activity in many systems, we investigated its effect on Fn-macrophage synergy in cytostasis. MCG-T14 (a spontaneous mouse mammary adenocarcinoma) cells (4 X 10(4] were added to wells both with and without C. parvum activated M phi monolayers. To these cultures were added increasing concentrations of Fn with or without heparin. Fn synergizes with both M phi S and heparin in inhibiting tumor cell growth. The combined cytostatic effect of Fn, heparin and M phi S is more than additive. In other experiments, MCG-T14 cells were pre-incubated for 2 hr with Fn, washed free of Fn, and treated as above. The results of these experiments were similar to coculture experiments, but the effect of heparin was even more pronounced. Dermatan sulfate and hyaluronic acid had a variable effect on Fn and Fn-macrophage induced cytostasis.