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2002 National STD Conference - Poster Abstracts 176-204


Partnerships in Practice: Standardized STD Curriculum in a Graduate Level Nurse Practitioner Program

S Kendig1, D Rother2, B Stoner2

1Barnes College of Nursing and Health Sciences at the University of Missouri–St. Louis, St. Louis, MO; 2St. Louis STD/HIV Prevention Training Center at Washington University School of Medicine, St. Louis, MO

Background: Nurse Practitioners (NP) practice in a variety of settings that target populations at risk for sexually transmitted diseases. However, few programs provide comprehensive information regarding sexual health assessment, STD assessment, management, and prevention strategies. Factors such as time constraints within the NP curriculum, perception of relevance to practice, and availability of faculty and preceptors with expertise specific to sexual health limit the availability of information to students. Typically, only NPs and students interested in the topic seek out non-credit, continuing-education programs regarding STDs, thus limiting the number of professionals equipped to adequately address the problem of STDs among all populations. Therefore, comprehensive STD prevention education should be an essential part of NP education.

Objectives: To increase NP students’ knowledge and skills regarding STD prevention, assessment and management through integration of a standardized STD curriculum component into NP program requirements.

Methods: Barnes College of Nursing at the University of Missouri–St. Louis, and the St. Louis STD/HIV Prevention Training Center (PTC) developed a curriculum specific to NP students, which is incorporated into the NP program requirements. The STD curriculum consists of 12 hours of didactic information offered on campus and telecommunicated to outreach sites in rural areas, and 16 hours of clinical experience provided at the STD/HIV PTC clinical training sites. Material is taught jointly by College of Nursing and STD/HIV Prevention Training Center faculty. Students complete pre- and post-test assessments of knowledge and attitudes, and complete a qualitative program evaluation.

Conclusions: Pre- and post-test scores indicate increased knowledge related to STDs. Student comments indicate an increased awareness of STDs as a major public health threat.

Implications for Programs: NP programs should strongly consider incorporating a standardized curriculum that addresses STD prevention, assessment, and management into curriculum.

Implications for Research: Additional information regarding how integration of STD prevention and management concepts into practice post graduation would be useful in evaluating program impact.

Measurable Learning Objectives: Participants will be able to describe components of an STD curriculum that are relevant to NP students and discuss methods for integration of a standardized comprehensive STD curriculum into the NP program requirements.

Contact Information: Susan Kendig / 314-516-7076 /


Development of a Visually Intuitive Disease Intervention Specialist Procedure Manual to Train Staff & Promote Consistency of Case Management & STD*MIS Data

D Brooks, N Thomas, C Kennel

Marion County Health Department, Indianapolis, IN

Background: The 1998 emergence of a syphilis epidemic in Indianapolis, IN prompted the Marion County Health Department (MCHD) to increase its Disease Intervention Specialist (DIS) staff and implement the Sexually Transmitted Disease Management Information System (STD*MIS ). A need for an easy-to-use desk reference about DIS administrative procedures accompanied the staffing and software transitions. In response, DIS staff developed a visually intuitive manual that concisely explained local procedures and the use of STD*MIS .

Objective: To enhance DIS skills through the development and dissemination of a visually intuitive procedure manual.

Methods: To make a procedure manual, DIS staff outlined information related to gathering field bloods, performing interviews, clinical documentation, and laboratory interactions. Screens from all major STD*MIS activities were printed, annotated, and arranged chronologically. All DIS-related forms were annotated and compiled as a syphilis documentation example or appendix. Hyperlinks were added to the manual, which was made available in print and digital formats.

Results: Use of the procedure manual has reduced the need for DIS staff to consult their supervisors with technical questions and has improved the consistency of STD*MIS case entries. The visual orientation of the STD*MIS component has made it more appealing and easier to use than previous STD*MIS manuals.

Conclusions: The MCHD’s DIS procedure manual has helped improve staff productivity by enhancing skills, promoting data quality, and reducing the burden on supervisors.

Implications for Programs: Other programs could use our manual as a template for developing their own protocol handbooks. With a user-friendly procedure manual, DIS can be trained more effectively. The manual can help programs shift the burden of answering technical and procedural questions from DIS supervisors to the DIS staff themselves, thus enhancing workplace efficiency.

Implications for Research: The procedure manual promotes accuracy in filling out forms and STD*MIS data entry. Higher quality data entry allows more complete and reliable epidemiological analysis.

Contact Information: Christopher Kennel / 317-221-8314 /


Provider Awareness of Syphilis Reporting Requirements, New York City, 2001

J Grayson1,2, A Hernandez1, B Parker1, L Tarrantino1, J Brown1,2, S Blank1,2

1New York City Department of Health, Sexually Transmitted Disease Control Program, New York, NY; 2Centers for Disease Control and Prevention, Atlanta, GA

Background: From 1999 to 2000, a notable increase occurred in the proportion of reported male primary and secondary syphilis (P&S) cases diagnosed by non-institutional providers. Sixty percent of cases in 2000 were diagnosed by such providers compared to 37% in 1999.

Objective: To assess the knowledge of reporting requirements among non-institutional providers diagnosing P&S cases during 2000.

Methods: A provider visitation program was implemented from March to September 2001 targeting all non-institutional providers who diagnosed reported P&S cases during 2000. The group of providers targeted were those who reported cases to the health department and those from whom a case report was solicited as a result of investigating a reactive syphilis serology reported by a laboratory. A brief survey was administered to each of the providers and an information package was distributed.

Results: A total of 40 providers were targeted; 28 (70%) providers were visited, three (8%) providers declined to meet with STD staff and nine (23%) visitations are pending. Awareness of syphilis reporting laws varied as 68% (n = 19) reported full knowledge of syphilis reporting requirements and 32% (n = 9) acknowledged gaps in their knowledge of reporting laws. These gaps included being unfamiliar with conditions that are reportable (n = 1) and being unfamiliar with reporting processes (n = 8).

Conclusion: Among non-institutional providers surveyed, approximately 1/3 were not fully aware of mandatory reporting laws. Awareness among providers who have never reported a syphilis case is likely to be lower.

Implications for Programs: Initiatives to educate providers on mandated reporting of sexually transmitted conditions must be developed and implemented.

Implications for Research: User-friendly methods for reporting STDs should be developed and evaluated.


Assessment of STD Knowledge, Skills and Training Needs Among Infertility Prevention Providers (IPP) in New York State (NYS)

ML Newcomb1, G Pozzi-Galluzi2, SA Payette3, A Muse1

1Bureau of STD Control NYSDOH; 2Dutchess Community College; 3New York State STD/HIV Prevention Training Center

Background: The NYS IPP provides free chlamydia testing to at-risk women at selected public health clinics.

Objective: To determine the knowledge, skills, and training needs of clinicians at participating IPP clinics.

Methods: A questionnaire was mailed to 139 clinicians at 52 sites to assess demographic information, STD clinical proficiency, training needs, and STD knowledge of selected bacterial and viral STDs. A two-week turnaround time was set for survey completion. Telephone follow-ups were made to non-respondents at four weeks.

Results: A total of 77 surveys (55%) were completed. Respondents were nurse practitioners (47%), registered nurses (19%), physicians (12%), physician’s assistants (9%), or other clinicians (14%). Respondents worked in college (48%), STD (40%), adolescent (19%), and community health center clinics (12%). STD knowledge differed by profession and clinic. By profession, physicians and nurse practitioners had the highest test scores (mean = 76.7% and 75.5%, respectively). By clinic, college and STD clinic providers had the highest scores (mean = 76.3% and 71.0%, respectively). Self-reported efficacy was highest in the areas of sexual history taking (93%) and collection of female endocervical specimens (82%). Less than 70% reported proficiency in the use of CDC treatment guidelines, STD screening criteria for pregnant women, partner elicitation/referral methods, and collection of anorectal, conjunctival, or male urethral specimens. Over 50% requested updated training in STD clinical manifestations, treatment, and laboratory diagnosis. Over 55% wanted to learn more about syphilis and gonorrhea compared to other viral/bacterial STD.

Conclusions: Survey results identified gaps in STD knowledge and clinical proficiency among IPP providers in NYS. These data correlated with respondent-identified training needs.

Implications for Program: To promote quality STD services for women at IPP clinics, a targeted training program must be designed and delivered to IPP providers.

Implications for Research: Future research should assess improvement in STD knowledge and practice following the delivery of training.


Health Educators’ Understanding of Risk in Sexually Transmitted Infections

MB Adam, VF Reyna, ME Walsh

University of Arizona College of Medicine, Informatics and Decision Making Laboratory, Tucson, AZ

Background: The ability of health educators to accurately convey risk depends on their understanding of that risk. Fuzzy-trace theory is used to predict systematic distortions in risk perception among health educators. According to fuzzy-trace theory, mental representations of risk are qualitative (gist-based) rather than quantitative, among health educators and highly trained health care professionals.

Objectives: To determine if health educators’ estimates of risk are imprecise and based on the gist of categories, producing underestimation of risk associated with “atypical” category members (in this case, STDs other than HIV) and to compare these risk estimates with other groups of health care professionals.

Methods: Twenty-four educators from the Arizona Abstinence Only Sex Education Program answered a 14-item questionnaire in which they estimated the risk a sexually active teenager would have of contracting a variety of STIs, gender differences in risk, reinfection rates for sexually active teens, as well as interpretation of CDC statements and FDA package labeling regarding effectiveness of condoms in reducing such risks. These results were compared with other health care professionals.

Results: Health educators and health care professionals underestimated STI risks for sexually active youth (especially HPV), but overestimated effectiveness of condoms in reducing such risks. All groups suffered from processing deficits in that bias was still present when they made re-estimates after all relevant information had been provided.

Conclusions: These results are consistent with the assumptions of fuzzy-trace theory, which predicts that risk estimates are imprecise and based on health educators’ and professionals’ concepts of typical STIs (ie, fluid born diseases) producing risk underestimation associated with atypical category members (HPVskin-to-skin transmission).

Implications for Programs/Policy: Although CDC and FDA statements concerning risk reduction apply primarily to fluid-borne illness, risk estimates revealed inappropriate generalization to skin-to-skin transmission as in HPV. Implications of qualitative gist representations for risk communication in educating the public will be discussed.


Training as a Facilitator of Best Practice and Continuity of Care for Inmates at Risk or Infected with HIV, Hepatitis, and Syphilis

J Zalumas

Southeast AIDS Training and Education Center, Emory University School of Medicine Atlanta, GA

Background: Rates of HIV, hepatitis, and syphilis are higher in corrections facilities than in the general population, presenting a public health opportunity because of concentration of at risk or infected individuals and because most incarcerated persons will return to the community. The Corrections Technical Assistance and Training Project targets medical and security personnel in corrections facilities for training about HIV, other STDs, and hepatitis.

Objective: To discuss the impact of training in corrections settings about occupational exposure to blood borne diseases. The goals are to strengthen staff in place in these facilities relative to the above content and link them to community resources. Training topics include standards of practice, practice issues specific to corrections settings, and inmate release into the community.

Methods: Training activities encompass learning needs assessments, training and curriculum content, and evaluation of learning and application of content.

Results: Initial needs assessments and training in the corrections settings provide data on the content needed for future training on corrections specific issues, best practice, and the transition to community or corrections discharge process.

Conclusions: After training, staff are less fearful and more appropriate in issues of confidentiality, request for sick call, transportation by correctional officers to the medical unit, and medical coverage in some short-term facilities like jails and detention centers

Implications for Programs: Assist in identification of appropriate staff development, access issues into corrections settings, characteristics of corrections health care that dictate how care is delivered, and custody issues that influence care.

Implications for Research: Developing effective models for corrections settings safe staff and that meet the public health challenge of reducing infectious disease rates in the community.

Learning Objectives: Participants will: identify characteristics of inmate populations that influence infectious disease rates; discuss the impact of training designed to reduce HIV, hepatitis, and syphilis rates in corrections facilities.

Contact Information: Jacqueline Zalumas / 404-727-2927 /


Integrating Hepatitis Policy into STD Programs: A Progress Report

K Scanlon, K Ford, L Gilbert, D Bergmire-Sweat

American Social Health Association (ASHA), Research Triangle Park, NC

Background: STD clinics are potential settings for hepatitis-prevention activities (vaccine administration and education). In 1997, the hepatitis branch of the CDC surveyed federally funded STD program managers in 65 states and territories and clinic managers in 89 individual clinics to assess the extent to which hepatitis B (HBV) prevention efforts had been integrated into STD clinic settings. Less than half considered HBV an STD Program responsibility.

Objectives: To assess HBV integration changes since the 1997 survey, and to collect baseline measures of hepatitis A and C, HAV and HCV respectively, prevention activities.

Methods: HAV and HCV measures were added to the 1997 survey. Surveys were distributed to 65 program managers and 74 clinic managers. Follow-up (e-mail, mail, and voice message reminders) was conducted. Data were analyzed to measure HBV integration changes and to establish baseline HAV and HCV measures.

Results: Program managers reported a significant increase in HBV prevention, vaccination, and education policies from 1997 to 2001. Nearly 10% more believed HBV is an STD program responsibility. Less than one-third reported having HAV or HCV prevention or education policies however, some plan on expanding or implementing programs. Clinic managers reported a dramatic increase in HBV client education from 1997 to 2001, respectively. In 2001, 27% more reported that all clients were eligible for HBV vaccine.

Conclusions: While STD clinics have a relatively high inclusion rate of HBV policies, HAV and HCV have largely been overlooked. Lack of funding still appears to be the most prominent barrier.

Implications for Programs/Policy: To improve HAV, HBV, and HCV inclusion in STD programs, supplemental funding and policies are still needed.

Implications for Research: Data about model integration programs, effective policies and educational materials can provide the federally funded programs with information on how to plan, implement, and evaluate effective viral hepatitis prevention programs.

Measurable Learning Objectives: By the end of this session, participants will be able to:

1. Explain to what degree STD programs and clinics have integrated HAV, HBV and HCV education, testing, vaccination, and treatment.

2. Identify the barriers to viral hepatitis integration.

Contact Information: Kelli Scanlon / 919-361-4891 /


Sexual Risk Behaviors and Epidemic HIV and Hepatitis B Among Injection Drug Users Receiving Prescriptions for Syringes

JI Harwell, EG Martin, SL Sanford, GE Macalino, LE Taylor, A Osei, SF McNamara, JD Rich

The Miriam Hospital/Brown University

Background: The prescription of syringes to injection drug users (IDUs) provides sterile syringes, as well as access to medical and substance abuse treatment. Such a service can also be effective in addressing risky sexual behaviors.

Objectives: To report serologic results and sexual risk-taking behaviors of 200 IDUs enrolled in a syringe prescription pilot project in Providence, Rhode Island.

Methods: Patients seeking legal access to sterile syringes were recruited for this pilot study. They were interviewed about their sexual and injection practices and strongly encouraged to undergo free hepatitis B (HBV) and HIV testing.

Results: Seventy-six percent of all participants reported having sex in the three months prior to the interview; of these individuals, 41% had at least two, and 27% had at least three partners. Sixty-three percent of HIV-negative individuals considered themselves to be at risk for infection with HIV. Reasons most commonly cited for considering oneself at risk were sharing needles (60%), being an IDU (57%), and unsafe sexual practices (43%). Those who did not consider themselves at risk for infection with HIV said they never shared needles (71%), had HIV-negative partners (32%), or regularly used condoms (21%). Serologic tests indicate that 20% of participants were HIV-positive and 63% had evidence of past or current infection with HBV. Using HBV IgM results as markers of recent infection, annual hepatitis incidence was calculated to be at least 32%. Sixty-two percent of HBV-naïve participants initiated the HBV vaccine series.

Conclusions: Many IDUs are engaging in high-risk sexual behaviors, independent of HIV status. Physician prescription of syringes is an ideal setting in which to promote primary and secondary prevention of HIV and hepatitis.

Implications for Programs/Policy: Programs that attract active drug users are ideal settings for the prevention of STDs with harm-reduction counseling and the provision of condoms and HBV vaccinations. Programs designed for injection drug users need to addresss sexual risk taking as well.

Implications for Research: Further research should be performed to evaluate the feasibility of expanding physician prescription of syringes.

Measurable Learning Objectives: By the end of this session, participants will be able to discuss key components of STD prevention among IDUs.


Hepatitis B Immunization in a STD Clinic: “Lessons Learned in San Diego County—A Practical Guide”

S O’Neill1, R Gunn1,2, P Murray1, H Margolis2

1Health and Human Services Agency, San Diego, CA; 2Centers for Disease Control and Prevention, Atlanta, GA

Background: Hepatitis B vaccination is recommended for high-risk adolescents and adults; more programs targeting these populations need to be implemented. Many at-risk persons attend STD clinics where hepatitis B vaccination can be integrated into routine clinical and preventive care.

Objectives: To develop a comprehensive practical guide for STD managers who want to integrate hepatitis B vaccination into their clinical service.

Methods: Vaccine administration began in the San Diego STD Clinic in February 1998. All policies, procedures, and forms developed during the planning, training, implementation, and maintenance stages of the program were documented.

Results: This guide contains essential information about the hepatitis B virus, the vaccine, program planning, training, patient education, and implementation. In addition, the experience in San Diego regarding each of these issues is provided and all forms, protocols, and procedural documents are included in an appendix. The guide has been printed and distributed to STD, hepatitis, and immunization programs across the United States (Oct. 2001).

Conclusion: Integrating hepatitis B vaccination into STD clinical services is feasible with planning, staff participation, and procedural updates. The do’s and don’ts can be shared with others to facilitate the process in clinics starting or planning hepatitis B vaccination services.

Implications for Program/Policy: STD programs should review this guide and work to integrate hepatitis B vaccination in their STD clinic.

Implications for Research: An evaluation of hepatitis B vaccination services in STD clinics and the usefulness of this or similar guides should be periodically conducted.

Learning Objectives: Participants will be able to identify key factors necessary to incorporate hepatitis B vaccine in a STD clinic.


Emergency Response to an Outbreak of Hepatitis C by New York City Department of Health (NYCDOH) STD Control Program

S Sebiyam, S Rubin, T Cherneskie, M Layton, A Hernandez, C Martinez, S Blank

New York City Department of Public Health, New York, NY

Background: In May of 2001, NYCDOH was notified of a cluster of patients who were hospitalized with acute hepatitis C. All had undergone endoscopy at the same outpatient facility (facility A).

Objective: To provide counseling and testing (C&T) for hepatitis C, hepatitis B and HIV among persons who had undergone endoscopy at facility A between January 2000 and March 2001.

Methods: The STD Control Program (STDCP) established and operated a special clinic to provide C&T to the 2200 potentially exposed patients.

Results: Clinic patients were notified of their potential exposures via certified mail and local media and were advised to be screened for hepatitis C, hepatitis B and HIV either via their own providers or NYCDOH. Using existing NYCDOH resources, STDCP stablished a special outbreak-related clinic within 2 days of agency request. Medical charts and special lab test forms were created. The STDCP provided training to staff on C&T for hepatitis C, hepatitis B and HIV. C&T for hepatitis C, hepatitis B and HIV was provided to 370 persons at the special clinic, including 333 potentially exposed patients and 37 of their sexual partners. Screening tests identified 10 (2.7%) persons with hepatitis C antibodies, 9 (2.4%) with evidence of chronic hepatitis B infection, 55 (14.9%) with past hepatitis B infection, and one person (0.3%) with a positive HIV serology.

Conclusion: Experience with C&T and clinic operations make STDCP staff a valuable asset in large scale outbreak investigations.

Implications for Program/Policy: STD Programs need planned flexibility to accommodate non-traditional emergency response. Epidemiologic and laboratory analyses are ongoing to determine if these infections were associated with the endoscopy clinic or unrelated sources.

Implications for Research: The feasibility of and best methods for cross-training public health staff to provide non-traditional counseling services in response to an outbreak should be assessed.

Contact Person: Samuel Z. Sebiyam / Phone 212-788-2167 /


Successful Referral of Hepatitis C–Infected Persons Detected through Screening at a Public STD Clinic

JB Lynch1, HH Handsfield1,2, MR Golden1,2

1University of Washington, Seattle, WA; 2Public Health–Seattle & King County, Seattle, WA

Background: Many persons attending public STD clinics are at risk for hepatitis C virus (HCV) infection. It is unknown whether persons diagnosed with hepatitis C in STD clinics will seek follow-up medical care.

Objectives: To determine the prevalence of HCV among people tested at an urban STD clinic and to establish how frequently infected persons seek follow-up medical care.

Methods: Computerized records were reviewed for those testing positive for HCV antibody from January 2000 through March 2001. We attempted to interview HCV-positive persons and searched the medical database of the hospital to which most patients were referred.

Results: During this 15-month period, 153 (23%) of 662 STD clinic patients tested HCV positive. Of 825 injection drug users attending the clinic, 310 (48%) were tested and 134 (43%) were HCV-positive. Of the 153 infected persons, 137 (90%) were documented to have received their test results, and 51 (33%) were documented to have attended the referral hospital and received some follow-up medical care for HCV. We successfully contacted 25 of these 51 persons; 17 (68%) of 25 reported they first learned their HCV status through STD clinic screening. Ten (83%) of 13 who drank alcohol at their time of diagnosis reported they decreased or stopped drinking after learning they were infected with HCV.

Conclusion: Even though HCV usually is not sexually transmitted, HCV screening in an STD clinic identifies large numbers of undiagnosed cases, and many infected STD clinic patients follow through with medical evaluation for HCV infection. Many such persons report reduced alcohol intake.

Implications for Programs: Hepatitis C screening should be integrated into STD clinic services.

Implication for Research: Innovative efforts to improve patient follow-up are warranted.

Measurable Learning Objectives: By the end of this session, participants will have access to data supporting hepatitis C screening, testing, and referral in STD clinics.


Hepatitis Integration in the STD Clinic Setting

KA Hafford, LG Walser

Virginia Department of Health, Division of HIV/STD

Background: Hepatitis C (HCV) is a serious public health concern impacting an estimated 2.7 million people nationally. Based on national estimates, 67,500 individuals may be chronically infected in Virginia. Until now, many individuals have been unaware of their infection. Because of a lack of available screening for individuals at risk for HCV and because STD clients are believed to be at high risk for infection (primarily injecting drug users), there is a need to offer HCV screening in the STD clinic. There is also a need to offer hepatitis A and B vaccinations to high-risk individuals.

Objectives: To determine the effectiveness of integrating hepatitis education and screening within health department STD clinics in Virginia.

Methods: With federal and state funding initially awarded in 2000, the Department of Health set up pilot sites in six local health department STD clinics to implement three separate screening protocols. The pilot implemented with federal funds utilized the protocol recommended by CDC. State-funded sites expanded selected risk factors to evaluate the cost benefit of including additional screening criteria.

Results: Testing has been conducted in five sites since May. As of August 17, 217 clients have been tested for HCV, yielding 3 positive results. None of the 3 clients identified IDU as a risk; one was a transfusion recipient. Fifty-four clients have been tested for hepatitis B, with 9 positives.

Conclusions: Staff has integrated hepatitis screening fairly smoothly into the STD setting. Additional testing is needed for protocol comparisons.

Implications for Programs/Policy: Evaluation of the protocols will be used to determine the one to be implemented. Expansion of testing is expected pending availability of funding.

Implications for Research: Virginia’s results could be compared to those from other states.

Learning Objectives:

By the end of this session, participants will be able to:

1. Describe the process for implementing a hepatitis education and screening program in STD clinics. 2. Discuss screening protocols as determined by risk.

Contact Information:

Kathryn Hafford / Phone 804-786-6267 / Laura G Walser /


HIV Counseling and Testing Through Hepatitis A Intervention

D Coppedge, G Hansen, J Seltzer

Kansas Department of Health and Environment, Topeka, KS

Background and Rationale: Expansion of HIV/STD disease intervention specialists (DIS) services to include intervention into non-sexually transmitted diseases in communities that exhibit risks associated with HIV/STD could be an efficient and effective way to reach intravenous drug users (IDUs). IDUs are often identified in outbreaks of non-sexually transmitted diseases. DIS have an opportunity through intervention in these non-sexually transmitted diseases to provide testing and counseling to IDUs. The Kansas Bureau of Investigation reported that there was a 500 percent increase in “clandestine methamphetamine labs” in Kansas for fiscal year 2001. From interviews, DIS have become aware that methamphetamine users in Kansas prefer to consume intravenously.

Objective: To demonstrate how DIS could shift emphasis from disease intervention to risk intervention. DIS interventions could incorporate all disease outbreak situations that include IDU communities.

Methods: DIS intervened in a hepatitis A outbreak in Reno County, Kansas. The majority of these cases were reported to be IDUs. All the hepatitis A cases and their contacts were sought for counseling and testing for HIV and other blood-borne pathogens.

Results: On four different occasions DIS performed interventions for hepatitis A cases in Reno County. A total of 16 hepatitis A cases were investigated. Fourteen of the 16 cases were located and 11 gave history of intravenous drug use and were offered counseling and testing. All eleven IDU hepatitis A cases received counseling while eight received HIV testing (two field bloods) and six received hepatitis C testing. Sixteen contacts were elicited from the 11 cases. Five of these contacts were referred into the local county health department for counseling and testing. Five contacts received counseling and field blood tests for hepatitis A and HIV from the DIS. Four contacts were referred to other counties within Kansas for the local county personnel to follow up. Two contacts were investigated by DIS and were un-locatable. Eight IDU hepatitis A cases and 11 contacts to these cases received counseling and testing for blood borne pathogens including HIV. All HIV tests were negative.

Conclusions: Kansas is aware of increased intravenous drug use within its communities. Through expansion of DIS services to include intervention into non-sexually transmitted diseases in IDU communities, Kansas is able to reach individuals at highest risk for HIV.

Implications for Programs: Programs that are seeking avenues to reach IDUs should strongly consider including DIS intervention into non-sexually transmitted diseases in IDU communities.

Learning Objective: How can one define and reach a major new group of individuals that are at high risk for HIV infection?


Hepatitis C Virus (HCV) Testing Experience in Various Public Health Venues

J Landrigan, J Subiadur, CA Rietmeijer, JM Douglas

Denver Public Health (DPH), Denver, CO

Background: There have been limited efforts to identify persons with asymptomatic hepatitis C virus (HCV) infection; it is estimated that less than 60% of the 3.9 million persons in the U.S. with HCV know of their infection.

Objectives: To implement and evaluate HCV screening in public health venues.

Methods: Denver Public Health (DPH) began offering HCV testing to high risk persons, including injection drug users (IDUs), blood product recipients, and exposed sex partners in its HIV Counseling and Testing Services (CTS) site in January 2000, as well as in its Sexually Transmitted Disease (STD) clinic and among Denver County Jail (DCJ) inmates in April 2000.

Results: Through June 2001, HCV testing was accepted by 357/500 (71%) CTS clients, 441/928 (48%) STD clients, and 587/640 (92%) DCJ inmates. HCV positivity rates were higher among IDUs at CTS (54.2%), STD (37.4%), and DCJ (59.1%) sites than among non-IDUs at these sites (9.9%, 9.2% and 8.6%, respectively). For those testing HCV+, results were obtained by 65%, 67%, and 75% of clients, respectively; HCV+ males were significantly more likely than females to return for results (adjusted OR = 2.0). In multivariate analysis, IDU was the strongest predictor of a positive HCV test result (OR = 15.2); age (OR = 1.1 for each year), race (OR = 1.6 for non-whites), and female gender (OR = 1.5) were also significant predictors.

Conclusions: STD, CTS and jail-based clinics are effective venues to test high risk persons for HCV and inform them of the results.

Implications for Programs: HCV testing can be implemented in CTS, STD and jail-based clinics with high rates of return.

Implications for Research: Research is needed into the clinical follow-up of these patients, including those effectively referred and receiving appropriate care.

Learning Objectives: Participants will be able to describe the implementation and yield of HCV testing in different public health settings.

Contact Information: Jennifer Landrigan / Phone: 303-436-7354 /


What People Need to Know about Herpes: Caller Profiles and Concerns on the National Herpes Hotline

M Herndon, F Wyand

American Social Health Association, Durham, NC

Background: It is estimated that 1 out of 5 adults in the United States has genital herpes. The American Social Health Association’s oldest hotline, the National Herpes Hotline, provides information and referrals to anyone concerned about herpes simplex virus (HSV). Trained Health Communication Specialists are available to address questions related to transmission, prevention and treatment of HSV. The National Herpes Hotline also provides support for psychosocial issues surrounding herpes such as self-esteem and partner communication.

Objective: To profile callers to the National Herpes Hotline and identify topics about which callers have the greatest need for education and counseling.

Methods: Authors analyzed data collected from 4,617 callers between July 1, 2000 and July 1, 2001.

Results: Of callers surveyed, 60% were female, 31% were between the ages of 20 to 29, 37% were between the ages of 30 to 39, 19% were between the ages of 40 to 49 and 10% were over the age of 50. Seventy-four percent were White, 14% were African-American and 6% were Hispanic. Fifteen percent of callers had a household income of less than $25,000 and 50% had an income of over $45,000. Forty percent of callers were diagnosed with genital herpes and 37% suspected contracting genital herpes. Sixty-four percent of callers discussed emotional issues surrounding the virus. Sixty percent of callers expressed concerns about transmission, 57% discussed symptoms of herpes, 41% had questions about diagnostics, and 29% discussed treatment options.

Conclusions: Persons diagnosed with genital herpes or concerned about the virus may need in-depth information on both clinical and psychosocial aspects of the condition.

Implications for Programs: Programs serving clients with concerns about herpes need to consider the importance of offering accurate, in-depth information and appropriate referrals.

Implications for Research: Research and evaluation into the public’s perception and knowledge of herpes may benefit the health care industry while also leading to increased public awareness of the condition.


Insights into the Long-Term Acceptance of Genital Herpes: A Qualitative Study

S Sherman1, J Grosshans2, L Jolley2

1Johns Hopkins University, Baltimore, MD; 2ASHA, Durham, NC

Background: A genital herpes diagnosis often includes a wide variation of physical, psychological, sexual, and social effects. However, few studies have investigated the potential variables that may explain or predict the long-term psychosocial adjustment process to a genital herpes diagnosis.

Objectives: To analyze how individuals with genital herpes adjust over time by exploring the complex array of psychosocial effects associated with a genital herpes diagnosis, examining diagnosed individuals’ perceptions about healthcare providers, and identifying general effects of herpes on individuals’ quality-of-life.

Methods: Two focus-group interviews were conducted in Milwaukee, WI in December 2000 consisting of a moderator, a note-taker, and eight herpes support group coordinators. Each group followed a semi-structured interview lasting 90 minutes, and was audio-recorded. Transcripts were analyzed to identify recurring themes.

Results: Themes that were identified included wide-ranging emotions that were associated with initial diagnoses and recurrences, disclosure choices that were related to trust issues, negative experiences that occurred with healthcare providers, and diagnoses that affected subsequent quality-of-life including sexual aspects. Initial experiences with providers left many uninformed. Participants agreed that education and support helped stabilize their emotions over time. This shaped choices on how, when, and to whom participants disclosed their diagnosis.

Conclusions: Having genital herpes may affect quality-of-life over time, although not as significantly as upon initial diagnosis. Support services can help alleviate fear, anxiety, and negative self-perceptions.

Implications for Programs: Programs for providers should emphasize education not only about physical ramifications, but also psychological sequelae as well. Improving patient education services may help improve the adjustment process.

Implications for Research: Further research can investigate how these themes can be used to conduct quantitative studies among larger samples.

Contact Information: Joanne Grosshans / Phone no. 919-361-8485 /


Genital Herpes: What Do Patients Want?

LK Gilbert1, CE Ebel2, KM Ford1

1American Social Health Association, Research Triangle Park, NC; 2ConnectivHealth, Durham, NC

Background: People with genital herpes (GH) face issues about management and prevention as well as psychosocial morbidity. Conveying education/ counseling messages is often the task of the healthcare provider; previous research suggests a substantial amount of dissatisfaction from the patient perspective

Objective: To determine the education/counseling satisfaction and needs of persons with genital herpes

Methods: A questionnaire was sent to a confidential database of 10,000 people who responded to a televised ad for GH medication. Eligible participants had to be 18 or older and diagnosed with GH after January 1, 1995. Data were collected on providers, the importance and satisfaction of topics covered, disclosure, adjustment, and demographics.

Results: Almost all of the 394 respondents consider discussions of disclosure and emotions to be important but only one-third reported having received this information from their provider; of these, three-fourths were satisfied with the information. Disclosure to current partner was associated with having received this information (p=.02) and being well adjusted to genital herpes (p=.008) but was unrelated to gender, age, or date of GH diagnosis. Embarrassment was cited as a barrier to talking with the HCP by 57%, regardless of gender, relationship status, or date of diagnosis.

Conclusions: Gaps exist between what patients want and what they receive and patients may be embarrassed to discuss this. Patient behavior may be influenced by providers and adjustment to GH may be enhanced if providers facilitate communication with their patients.

Implications for Programs: Providers should recognize patient embarrassment as a barrier both to communications and to adjustment.

Implications for Research: Additional studies of persons with GH should be undertaken to explore aspects of adjustment and its correlates.

Learning Objectives: Participants will be able to describe barriers to and salient issues in GH education/counseling. Participants will be able to discuss topics of importance as well as levels of patient satisfaction for those topics actually covered.

Contact Information: Susan Lloyd Schulz / 919-969-9700/ / or Lisa K. Gilbert / 919-361-4809 /


New HSV Serologies: Are STD Clinic Patients Really Ready?

LK Joyce1, JE Alcaraz1, RA Gunn2, RA Gilchick2

1San Diego State University, San Diego, CA; 2Health and Human Services Agency, San Diego, CA

Background: As many as 80% of HSV-2 infected individuals are unaware of their infection because they lack “classic” symptoms. The gold standard for HSV diagnosis remains viral culture, but type-specific serology may be the only means to identify those infected without symptomatology. Highly accurate, FDA approved HSV serologies are now available, but acceptability requires evaluation.

Objective: To assess HSV serology acceptability among STD clinic patients in San Diego County. Factors considered high risk for HSV acquisition were assessed to learn what affect specific beliefs or behaviors would have on desire for serology.

Methods: A self-administered anonymous survey was completed by STD clinic patients as part of intake. Limited demographics were collected; sexual preference was not.

Results: There were 927 surveys collected; 71% of patients wanted HSV serology. Seventy one percent of patients were willing to pay $5 and 43% would pay $10. Multivariate analysis revealed patients were more likely to want serology if they thought they might have genital herpes (80% vs 67%, p=.05) or if their current partner had genital herpes (87% vs 67%, p=.014). Having ever had a partner who had genital herpes was associated with desire for serology (85% vs 68%, p=.093). Neither age, gender, nor ethnic group, were associated with wanting the serology; however, fewer African Americans (65% vs. 70% white, 76% Hispanic, 72% Asian/Pacific Islander, and 78% other, p=.038) wanted testing.

Conclusions: Specific high-risk behaviors were predictive of wanting serology. Sexual orientation should perhaps be considered for future studies as a possible predictor of desire for HSV serology.

Implications for Programs: STD programs may have to offer this service, especially to patients reporting high-risk behaviors.

Implications for Research: Pilot studies are recommended to evaluate patient acceptability, and to follow up on how patients use the information to prevent transmission.

Learning Objectives: To be able to understand risk factors associated with desire for HSV serology.


College Students’ Attitudes About HSV/HPV Vaccines

CW Boehner1, SR Howe1, RB Noll1,2, RM Stutz1, DI Bernstein3, SL Rosenthal4

1Department of Psychology, University of Cincinnati, Cincinnati, OH; 2Department of Hematology and Oncology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; 3Division of Infectious Diseases, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; 4Division of Psychology and Behavioral Pediatrics, Department of Pediatrics, University of Texas, Galveston, TX

Background: There may be unique barriers associated with acceptance of vaccines for human papillomavirus (HPV) and herpes simplex virus (HSV). Poor acceptance will lead to limited impact on the sexually transmitted disease epidemic.

Objectives: To examine college students’ acceptance of an HSV or HPV vaccine based on health beliefs and a presentation of the vaccine in terms of sexual, reproductive, or sexual/reproductive issues. Logistic regression was used to assess predictors of acceptance of HSV and of HPV.

Methods: College students completed questionnaires in which the HSV (n = 259) or HPV (n = 256) vaccine acceptance was examined in terms of one of the three presentations.

Results: Overall acceptance (74%) was not different between HSV and HPV, or between the three presentations of the vaccine. The following were associated with HSV vaccine acceptance: belief that partners, physicians and parents would recommend it, belief in vaccination, belief (or actually being) at risk, and belief that it was safe, likelihood ratio, ?2 (19, n = 170) = 103.10; p=.0001. The following were associated with HPV vaccine acceptance: belief that friends and partners would recommend it; low cost; endorsement of universal HPV vaccination; and frequent alcohol use during sex, likelihood ratio, ?2 = (17, n = 141) = 79.04; p=.0001.

Conclusions: Most college students would take an HSV or HPV vaccine regardless of whether reproductive or sexual issues were highlighted. Providers should not avoid discussing the sexual transmission of these viruses with young adults when offering vaccines. Models predicting vaccine acceptance for HSV and HPV are different, suggesting that strategies to foster acceptance will need to be pathogen-specific.

Implications for Programs/Policy: Information regarding factors associated with acceptability among target populations can aid successful implementation of HSV/HPV vaccines.

Implications for Research: Further research should examine the acceptability of HSV/HPV vaccines among parents of pre-teens and examine the underlying reasons why the models were pathogen-specific.


Prevalence and Predictors of Human Papillomavirus Infection in HIV-Positive and Negative Women

A Chaturvedi1, A Gaffga2, K Mire2, J Dumestre2, R Clark2, P Braly2, K Dunlap3, J Slavinsky1, P Kissinger1, M Hagensee2

1Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; 2Department of Medicine, Section of Infectious Diseases, Louisiana State University, New Orleans, LA; 3Department of Obstetrics and Gynecology, Louisiana State University, New Orleans, LA

Background: Histopathology of genital human papillomavirus (HPV) infection ranges from warts, to cervical cancer. Prevalence of individual genotypes largely depends on the population studied. Few studies have described prevalence and predictors of infection with individual genotypes in diverse populations.

Objectives: To describe the prevalence of individual genotypes, and cytological abnormalities and determine risk factors for infection with high-risk, low-risk and multiple HPV genotypes in HIV positive and negative women.

Methods: Cervical/vaginal swabs and Pap smears were collected from 727 women (109 low-risk, 422 high-risk and 196 HIV-positive women). HPV DNA was detected using the PGMY09/11consensus polymerase chain reaction (PCR) method and genotyped using the reverse line blot system. Sexual history and demographic characteristics were collected from a subset of women (N = 363) and bivariate and multivariate analyses were performed.

Results: Overall, HPV prevalence was 39.6%. Prevalence of high-risk, low-risk and multiple HPV types was 35.1%, 14.0% and 17.5% respectively. The most prevalent genotypes were MM7 and 53 in HIV+ women and types 16 and 52 in the HIV- women. After adjusting for age, race, number of recent sex partners and history of STDs, women aged <25 years and HIV+ women had a greater prevalence of any HPV infection, any high-risk type and multiple types. After adjusting for infection with multiple types, HPV types 16, 35, 39, 52,and 56 were significantly associated with prevalence of abnormal Pap smears.

Conclusions: Prevalence was significantly higher in HIV+ and younger women with different genotypes being prevalent in different populations.

Implications for Programs: Prevention programs for genital HPV infection should target younger and HIV+ populations. The utilization of the line blot assay to follow the natural history of individual HPV genotypes and identify multiple infections may lead to improved cancer screening strategies.

Implications for Research: Longitudinal studies describing disease progression of individual genotypes in diverse populations would contribute to current vaccine strategies.

Learning Objectives: By the end of this session participants will be able to identify: 1. Prevalent genotypes in different populations and 2. Populations at risk for HPV infections.

Contact Information: Anil Chaturvedi / phone: 504-568-4369 / 504-568-4398 /


Association Between MSM Behavior and the Seroprevalence of HPV-16 and HSV-2

F Xu1, MR Sternberg1, K Karem2, E Unger2, KM Stone1, LE Markowitz1

1Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA; 2Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA

Background: Men who have sex with men (MSM) are at high risk for STDs and HIV infection. The seroprevalence of HSV-2 is high in MSM, but little is known about the epidemiology of HPV in men.

Objectives: To describe the seroprevalence of HSV-2 and HPV type 16 (HPV-16) infections in men who did and did not have sex with men.

Methods: Data were collected during a national representative survey (NHANES III) from 1988 to 1994. Interview data and antibody results for HSV-2 and HPV-16 were available for persons 17 to 59 years of age. Antibodies to HSV-2 were tested using a type-specific immunodot assay. HPV specific IgG was detected using an HPV-16 virus-like particle ELISA. MSM was defined as men who reported ever having a male sexual partner. All estimates were weighted to represent non-institutionalized US population.

Results: Eighty-three men (1.8%) reported having had sex with a man. Compared with other males, MSM were more likely to have >2 partners in the past year (40% vs 20%, p<.05), and to have >10 lifetime partners (65% vs 43%, p<.05). The seroprevalence of HPV-16 among MSM was 38%, almost 5 times of that in other men (8%) and 2 times of that in women (19%). The seroprevalence of HSV-2 was also higher in MSM than in other men (31% vs 18%), although the difference was not statistically significant. The lifetime number of sexual partners was a predictor for HPV-16 and HSV-2 infections in men. After adjusting for the number of sexual partners, race/ethnicity, and age, MSM behavior was a risk factor for HPV-16 infection (p<.001) but not for HSV-2 infection in men (p=.2)

Conclusions: MSM are at higher risk for HPV-16 and probably for HSV-2 infections. The transmission and epidemiology of HPV-16 in MSM may be different from that of HSV-2.

Implications for Program/Policy: The high seroprevalence of HSV-2 in MSM indicates the need for improved intervention for this population.

Implications for Research: The clinical implications of HPV-16 seropositivity in men are not known. Further studies on HPV are needed to understand the transmission and clinical complications of HPV infection in MSM.


Launching the National HPV and Cervical Cancer Prevention Hotline: Assessment of Caller Data during the First Two Years of Existence

F Wyand, M Herndon, B Ames

American Social Health Association, Durham, NC

Background: HPV is considered to be the most common sexually transmitted disease in the United States. The National HPV and Cervical Cancer Prevention Hotline, launched in January of 2000, provides up-to-date information on HPV and its link to cancer. The hotline is able to address topics such as risk reduction, diagnosis and treatment of HPV and the prevention of cervical cancer, the latest FDA-approved technologies, and emotional issues surrounding the virus including self-esteem and partner communication.

Objective: To determine the demographic data of callers to the National HPV and Cervical Cancer Prevention Hotline and identify topics that are most often discussed.

Methods: Authors analyzed data collected from 5,214 callers between January 2000 and January 2002.

Results: Of those surveyed, 64% were female, 49% were between the ages 20 to 29, 27% were between the ages of 30 to 39, and roughly 20% were over the age of 40. Seventy-eight percent were white, 10% were African American and 7% were Hispanic. Twenty-two percent had an income below $25,000, and 42% had an income of over $45,000. Calls were received from 49 states with 15% of the calls coming from the state of New York and 12% from California. Fifty-five percent of callers’ primary concerns were about external genital warts, and 47% were about cervical dysplasia. Over 30% of callers discussed cervical cancer concerns.

Conclusions: Persons needing information about HPV cover all socioeconomic groups. Individuals concerned about HPV need in-depth information about the clinical and psychosocial issues surrounding the virus, but also cervical cancer prevention.

Implications for Programs: Programs serving clients concerned about HPV and cervical cancer should understand the importance of offering accurate, in-depth information and appropriate referrals.

Implications for Research: Future research and evaluation on the public’s knowledge of HPV, cervical cancer and cervical cancer prevention may benefit the health care industry. Strategies for increasing public awareness of the condition should be explored.


HPV Screening and Diagnosis Practices—Findings from a National Survey

DH McCree, JS Leichliter, M Hogben, and JS St Lawrence

Behavioral Interventions and Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA

Background: From 10% to 46% of sexually active women are infected with human papillomavirus and the lifetime risk for infection is 70% or greater. Specific high-risk types of HPV are the primary cause of cervical cancer and its precursor lesions. Studies conducted in the US suggest that HPV testing is useful for managing women with borderline or equivocal Pap smear findings. There is no literature, however, describing current HPV screening practices of US.

Objectives: This paper reports findings on HPV screening and diagnosis from a national survey of physicians.

Methods: Data was collected between May 1999 and January 2000. Surveys were mailed to a randomly selected sample of physicians (n = 7,300) practicing in five medical specialties that provide care for 85% of the STDs reported in the United States. Respondents provided information on the types of patients screened for HPV and the number of cases of HPV diagnosed.

Results: The response rate was 70%. About 22% (n = 927) of the total sample reported screening for HPV. Obstetrician/gynecologists were more likely to screen for HPV than physicians in any other medical specialty and female physicians were more likely than male physicians to report screening patients for HPV. Finally, physicians who reported screening patients for other viral STDs, e.g., HSV-2 and HIV, were also more likely to report screening patients for HPV.

Conclusions: The conclusions are limited because no information was collected on the diagnostic methods physicians used to screen for HPV.

Implications for Program/Policy: Information on HPV screening should be disseminated to private providers.

Implications for Research: Additional study is needed to determine the diagnostic methods utilized in HPV screening and providers’ awareness and knowledge of HPV.

Learning Objectives: By the end of this session, participants will be able to:

(1) Discuss the HPV screening practices of physicians in the sample.

(2) Discuss the HPV diagnosis history of physicians in the sample.

(3) Describe differences in HPV screening and diagnosis history among physicians in the sample. (4) Discuss the need for future studies on HPV screening practices among US physicians.


HIV Testing with Same-Day Results

M Lally1, P Shah1, S Frater1, M DiSpigno1, J Harwell1, D Pugatch2

1Miriam Hospital, Providence, RI; 2Hasboro Children’s Hospital, Providence, RI

Background: Substance users in drug treatment centers are at high risk for HIV and may benefit from rapid HIV testing.

Objective: To evaluate the feasibility and acceptability of HIV testing with same day results in a drug treatment center.

Methods: Women in drug treatment were approached and those who agreed to participate provided informed consent. A risk-assessment questionnaire was administered and participants were offered HIV testing. ELISAs were run on blood samples and ELISA results were returned to patients the same evening. A satisfaction questionnaire was administered.

Results: Thirty women were approached, 90% (27/30) agreed to participate, and 89% (24/27) of participants were tested. Of all participants, 61% engaged in high-risk behavior in the last 30 days including needle sharing, multiple sexual partners, or sex with a high-risk partner. However, only 40% (11/27) had been tested for HIV in the last 6 months. Twenty-two results were negative and two results were ELISA-positive. On subsequent Western blot, both were HIV-negative. The false-positive results caused both participants extreme distress and the participants required extensive supportive counseling. Of those tested, 92% (22/24) received their results. Of these, 95% (21/22) preferred same-day testing to traditional testing.

Conclusions: Testing women in drug treatment is acceptable and returning ELISA results in the same day is feasible. However, returning false-positive results to this vulnerable population causes unnecessary anxiety. Patients in drug treatment are often at one location for several days; it would be preferable to return confirmed test results to them before they are discharged. The protocol has been amended to return results the day after testing, with Western blots run on any positive ELISAs.

Implications for Programs: In-patient drug-treatment centers should offer HIV testing with results returned before patients are discharged from care.

Implications for Research: Additional research should explore alternative methods of HIV testing with 2–3 day turnaround times for confirmed results.

Measurable Learning Objectives: By the end of this session, participants will understand several issues related to offering HIV testing to persons in drug treatment centers.

Contact Information: Michelle Lally / Phone 401-793-4773 /


Voluntary HIV Partner Counseling and Referral Services (PCRS): An Examination of HIV Positive Original Client Decisions to Participate

H Rasmussen, C Baker, V Eckert

California Department of Health Services, Office of AIDS, CA

Background: The California Office of AIDS has established a voluntary HIV Partner Counseling and Referral Services (PCRS) program that offers an array of client-oriented services. Services include: 1) counseling with HIV positive persons about partner disclosure issues; 2) coaching clients in how to tell their partners themselves; 3) notifying selected partners without disclosing client identity; and 4) providing counseling, testing and referral to informed partners. In addition, the State PCRS Program offers guidelines, training and technical assistance to local health jurisdictions and community and private medical providers.

Method: Data was collected from HIV service providers in eight local health jurisdictions. Logistic regression analysis was used to examine variables significantly associated with PCRS acceptance (vs. not interested). Data collection is ongoing. The following analyses include all of those clients who were offered PCRS (N = 875).

Results: Number of partners, length of time since diagnosed with HIV, relationship status, ethnicity, martial status, geographical region and type of testing venue were all significant factors in client acceptance of PCRS. Gender, age, IV drug use and sexual preference were not associated with acceptance.

Conclusion: PCRS should be offered soon after a client learns of his/her HIV infection. Specific training curriculum may be developed for counselors in anonymous test sites and providers who work in early and long-term care clinics. Special emphasis needs to be directed at determining barriers that may exist for single clients and those with multiple partners. Increasing efforts to hire providers with whom clients can identify culturally or otherwise might also be recommended.

Implications for Programs: This information will help to identify clients that are less likely to accept PCRS and to tailor counseling accordingly.

Implications for Research: Further data collection should carefully examine why clients refuse PCRS. Information about why a client chooses not to notify a partner will be critical to developing appropriate counseling and education interventions and provider training.


Identifying Potential HIV Transmitters in an STD Clinic: Association of Unprotected Anal Sex with Sexual Behavior and Not Taking Antiretroviral Medications

MR Golden1,2, DD Brewer1, WLH Whittington2, KK Holmes2, HH Handsfield1,2

1Public Health – Seattle & King County & Center for AIDS & STD, 2University of Washington, Seattle, WA

Background: Enhanced emphasis is being placed on targeting HIV-infected persons for prevention interventions.

Objective: To determine the feasibility of identifying potential HIV transmitters in an STD clinic, and to define characteristics of persons at high risk of transmitting HIV to others.

Methods: As part of routine sexual histories, clinicians asked HIV-positive MSM attending an urban STD clinic if they had anal sex with any men who were HIV-negative or whose HIV status they did not know, and how frequently they used condoms with these partners.

Results: Data were available on 88 (79%) of 111 HIV infected MSM seen from 11/00 through 7/01. Thirty-nine (44%) of these 88 men reported having unprotected anal sex either with an HIV-negative partner or a partner whose HIV status they did not know. These 39 were classified as potential transmitters. n (%) of potential transmitters n (%) of non-transmitters Univariate OR 95 % CI Anonymous SP(s) in preceding yr 23 (59) 9 (22) 4.9 (1.9–13.2) Not taking antiretrovirals 22 (56) 13 (32) 2.7 (1.1–6.7) >10 SP in preceding yr 18 (55) 7 (21) 2.1 (1.3–3.4) Bacterial STD 15 (40) 7 (20) 2.7 (.95–7.8) SP=sex partner. Non-transmitters and potential transmitters did not differ by age, race, or number of years since HIV diagnosis.

Conclusion: Many HIV-infected MSM attending STD clinics are potential HIV transmitters and these men can be identified during routine clinical encounters. Because of their high level of sexual activity, concurrent bacterial STD, and frequent failure to take antiretrovirals, these men may constitute a core group transmitting HIV.

Implications for Programs: STD clinics can identify many potential HIV transmitters during routine clinical encounters.

Implications for Research: Clinic based intervention studies designed to understand and change the behavior of potential HIV transmitters are urgently needed. We have begun collecting data linking condom use with specific sexual practices and partner serostatus.


MSM with HIV/AIDS: Trends and Co-infections

BJ Mitts, CD Meade

Houston Department of Health and Human Services, Houston, TX

Background: AIDS surveillance in Houston, TX was initiated in 1983, name-based HIV reporting in 1999. HIV/AIDS data are from the HIV/AIDS reporting system (HARS), gonorrhea and syphilis data are from the sexually transmitted diseases surveillance system (STD.MIS), and hepatitis data are from the epidemiology database.

Objectives: To study trends among men who have sex with men (MSM) with HIV/AIDS and co-infections among MSM with HIV/AIDS and other sexually transmitted infections.

Methods: MSM reported to the Houston Department of Health and Human Services (HDHHS) with HIV/AIDS were matched to other databases to determine the number of reported co-infections.

Results: Fourteen thousand one hundred seventy-seven MSM have been reported to the HDHHS with an HIV/AIDS diagnosis since 1983. In 1983, 83% of the reported AIDS diagnoses among MSM were white, 11% black, and 7% Hispanic. In 2000, 37% of the reported HIV/AIDS diagnoses among MSM were white, 37% black, and 25% Hispanic. Today, there are 5,644 MSM reported in Houston living with HIV/AIDS. One hundred sixty-five MSM with HIV/AIDS matched as having a co-infection with gonorrhea, 248 with syphilis. Twenty-seven MSM with HIV/AIDS matched as having a co-infection with hepatitis A, 259 with hepatitis B, and 104 with hepatitis C.

Conclusions: HIV/AIDS in Houston, TX is no longer a predominantly gay, white male disease. New diagnoses of HIV/AIDS among MSM are increasingly affecting minority populations. Co-infections with other sexually transmitted infections among MSM are more predominant among minority populations.

Implications for Programs/Policy: It is apparent that HIV-positive MSM are still engaging in unsafe sexual practices that implicates the need for HIV prevention and educational interventions among HIV-positive MSM.

Implications for Research: This project can be expanded in scope to include the entire reported HIV-positive population to determine if there is a similar trend.

Contact Information: Beau J. Mitts, Houston Department of Health and Human Services /(713) 794-295/ ; C. Dawn Meade, Houston Department of Health and Human Services / (713) 794-9194 /


HIV in Puerto Rico: HIV Serostatus, Demographic, and Behavioral Characteristics of Priority Populations Served by HIV Counseling and Testing Sites

E Tirado, B López

Puerto Rico Department of Health, STD Surveillance Office, STD/HIV/AIDS Prevention Program, San Juan, Puerto Rico

Objective: To assess HIV serostatus, sociodemograph-ics, and behavioral characteristics of priority populations served by HIV counseling and testing sites (CTS) in Puerto Rico from 1996–2000.

Methods: The HIV serostatus sociodemographics and behavioral characteristics are collected in a special form for individuals served by HIV counseling and testing sites in Puerto Rico. A profile for priority population—injection drug users (IDUs), adolescents, men having sex with men (MSM), inmates, and heterosexual (females and males)—were depicted for period 19962000. The data was obtained from the HIV Counseling and Testing System, a computerized database developed by CDC. It is a very reliable source of data on HIV in Puerto Rico.

Results: Throughout period 1990–2000 there were 308, 274 HIV tests reported at the HIV counseling and testing sites in Puerto Rico. Slightly more than a half of all HIV test were requested by males (males: 65.1% vs. females: 34.9%). A priority population that most often requested HIV tests was heterosexual females (126,256/308,274 = 41.0%). With the exception of adolescents, the highest percentages of HIV test among all priority populations were observed in the age group of 20–29. There was an average of 6.2% HIV-positive cases among all priority populations that requested HIV tests. The population of MSM (12.7%) and IDUs (12.0%) obtained the highest percentages of HIV-positive results. HIV-positive clients from MSM, IDUs, and heterosexual male populations reported most often MSM/IDU together as their risk factors with 16.2%, 14.2%, and 13.4%, respectively. Heterosexual females presented a higher percentage of HIV-positive tests among those reporting heterosexual/IDU exposure (16.0%). The risk mostly reported for HIV-positive adolescents was Child of HIV-positive women (6.0% exposure). HIV-positive inmates most often reported having sex for drugs and/or money as their risk factor (11.6%). In terms of having a sexual partner at risk, all priority populations most frequently reported having a sex partner with HIV/AIDS. About 80.0% of individuals from all priority populations received post counseling.

Conclusions: Injection drug use seems to be a common risk behavior for a great part of all priority populations for HIV prevention counseling and testing centers in Puerto Rico. Remarkably, both IDUs and heterosexual males’ populations showed their highest HIV-positive rate among those reporting MSM/IDU together as exposure. These findings expose the complexity and interaction of risky behaviors among priority populations that need to be addressed.

Implications for Programs: Programs that provide CTS should maintain an updated database to describe the population served.

Implications for Research: Establish a continuous monitoring process of the HIV counseling and testing sites.

Learning Objective: The participants will understand the importance of the CTS monitoring as part of the prevention services. The participants will able to describe to the population their HIV risk factors.

Contact Information: Elbia Tirado / 787-751-2106 /


HIV/AIDS in the Aging Population

L Del-Rose

New England AIDS Education & Training Center, Brookline, MA

Background: Every day there is more evidence that the aging population is just as much at risk as young people. Most statistics published today focus on young men having sex with men (MSM), adolescence, mother-to-child, injection drug users, and women who engage in risky behavior. The categories appear to be focusing on the younger populations and once again the aging population is forgotten.

Objectives: To educate older adults in a comfortable peer group setting. To supply them with the necessary information and tools needed in today’s society to have safe sex. To include HIV/AIDS prevention in main stream health prevention.

Methods: Training physicians to feel comfortable talking with their older patient population. Developing peer advocacy programs for the older adult population with focus on a one-on-one approach to HIV/AIDS/STD prevention. Evaluate risky behaviors in older adults and address these issues.

Results: Decreased infection rates with informed, older adults. An increase in the older population living longer and healthier lives. This will result in less disabled and disenfranchised older people.

Conclusions: HIV infection often goes undetected and misdiagnosed among the aging populations, due to similar symptoms of the aging factor. Living with HIV into the aging years requires a close look at overall health maintenance issues including sexual health.

Implications for Program/Policy: Aging, older adults are engaging in risky behaviors. No longer does fruition of marriage mean “till death do you part.” Many middle-aged people lose a spouse to divorce, disease, or accidents. Men and women are now challenged with finding a new partner.

Implications for Research: HIV-infection rate will decrease. The fact is that the aging population is sexually active and engaging in risky behaviors. Erectile dysfunction (ED) affects over 30 million men to some degree in the United States. A sexually active life is a quality-of -life issue. The aging population is not included in the high-risk group category.


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