2002 National STD Conference - Poster Abstracts 126-150


Communicating with Adolescents for Optimal Care: Practical Techniques for Primary Care Providers

E Fishburn, S Ball-Garza

Planned Parenthood of Central Washington, Yakima, WA

Background: Although adolescence is a time of initial involvement in risk behaviors, teens rarely seek preventive care. Research shows that teens admire their health care provider but they are uncomfortable disclosing risk-related information due to lack of rapport, concerns about confidentiality and being treated respectfully. While providers receive education on patient communication, it may not be specific to the adolescent population.

Objective: To assess whether adolescent-specific communication training increases the effectiveness of interactions between primary care providers and their adolescent patients, resulting in increased identification of sexual and other risk behaviors.

Methods: The training began with a discussion on teen health issues, risk behaviors, localized STD and teen pregnancy rates and adolescent-specific communication techniques. After a demonstration role-play between an adolescent and a provider, the program participants broke into small groups and practiced the techniques with teens playing patients with an at-risk background. A trained supervisor provided feedback before participants regrouped to debrief. In order to establish knowledge and behavior changes, each participant was pre and post tested, with 6-month follow up surveys.

Results: There was a statistically significant increase in providers’ reported comfort level when asking adolescent patients about their high-risk behaviors in situations when the patient was embarrassed and when it was not relevant to their visit.

Conclusions: Adolescent-specific communication training for primary care providers raises awareness of adolescent issues and increases comfort levels, leading to increased identification of sexual and other risk behaviors.

Implications for Programs/Policy: Training programs for primary care providers should include an adolescent-specific communication component.

Implications for Research: Additional studies on comprehensive approaches to helping adolescents feel more comfortable when discussing sexuality issues with adults would assist in serving this population.

Contact Information: Erin Fishburn / Phone 509-225-3414 / fishburne@ppcentwa.org / Samantha Ball-Garza / 509-225-3410 / garzas@ppcentwa.org


Baja California and California Syphilis Elimination Project

P Cleary1, G Kennedy2, R Lozada3, P Quijada4, G Rutherford2, M Samuel4, G Bolan4, S Waterman5

1Border Health Initiative, National City, CA; 2University of California, San Francisco; 3ISESALUD, Tijuana, Mexico; 4California Department of Health Services, STD Control Branch; 5CDC, California Office of Border Health

Background: The California Syphilis Elimination Initiative was funded in 1999 with the goal of eliminating indigenous syphilis in California by 2004. While cases of primary and secondary syphilis have generally declined in California, several cases have identified sexual contacts and sought diagnosis and treatment in Baja California, Mexico. Given the number of people who travel between California and Mexico, elimination of syphilis in California will not be possible without controlling it in Mexican border communities.

Objectives: Enhance syphilis elimination in California by extending syphilis control efforts to Tijuana and Mexicali, Baja California, Mexico.

Methods: Enhanced bi-national disease control activities using a Mexico-based rapid response team to follow-up with contacts of syphilis cases identified in California. Also, syphilis cases identified in Mexico with contacts in California are reported to appropriate persons in California. The rapid response team is employed by Project Concern International with funding from the California HealthCare Foundation, but functions as an integral part of the local jusidic-ciones sanitarias. Training of laboratory technicians in Mexico in confirming RPR- or VDRL-positive samples with enzyme-linked immunosorbent assays or mixed hemagglutination assays. Pharmacist education project to train pharmacists in Mexico to recognize the symptoms of syphilis and genital ulcer disease, and to report cases to health department officials.

Results: From July to September 2001, follow-up was attempted in Mexico with eight syphilis cases and 12 contacts. In addition, staff is developing protocols to facilitate bi-national referrals and has identified training needs.

Conclusions: Intersectoral collaboration and creative mechanisms are necessary if bi-national syphilis investigations and control activities are to be possible.

Implications for Programs/Policy: Multilateral collaboration must be explored in order to achieve disease control objectives in a globalized world.

Implications for Research: Further research is warranted to determine long-term results and the most effective strategies for conducting bi-national collaborative health prevention projects.

Measurable Learning Objectives: By the end of this session, participants will understand how conditions in Mexican border communities affect syphilis elimination in California, and will be able to discuss strategies to address disease control and elimination in a bi-national context.

Presenting Authors Contact Information:

Priscila Quijada / Border Health Specialist, California Department of Health Services, STD Branch / Phone 619-692-5793 / Remdios Lozada, Chief, HIV/STI Program, Jurisdicción 202, ISESALUD, Tijuana. Baja California, Mexico / 011-526-685-2930


An Assessment of STD Services in California’s Migrant and Rural Clinics

J Miller, R Gindi, H Bauer, G Bolan

Sexually Transmitted Disease Control Branch, California Department of Health Services, Berkeley, CA

Background: Migrant farm workers are an underserved population in California. In an attempt to address the need for clinical services, approximately 150 rural and migrant health centers are funded throughout California. It is unknown whether STD services are currently offered in these clinics.

Objective: To determine the level and quality of STD services in rural and migrant health centers in California.

Methods: This was a cross-sectional study of a convenience sample of 111 publicly funded migrant clinics throughout California. Data were collected from two sources: administrative data and survey data. The data elements analyzed include: number of patients, type of practitioner, number of STD visits, languages spoken by clinic staff, patient demographics, type of STD testing and diagnostic services, screening and sexual history taking policies, and use of guidelines and protocols.

Results: All clinics surveyed provide STD services; 55% have written protocols for taking sexual histories and 59% do not ask about the number of sex partners; 72% have for protocols for chlamydia screening of adolescents and/or all sexually active women aged 15-25 annually and of those clinics providing prenatal care, 98% reported policies for syphilis screening at the first prenatal visit; 80% reported use of CDC Treatment Guidelines. 96% of clinics who have at least one ESL client provide services in Spanish.

Conclusions: There is a high level of STD services available at most migrant and rural clinics. Although many of those clinics use appropriate protocols for screening and treatment of STDs, adherence to those protocols and policies is still unknown.

Implications for Programs/Policy: In order to ensure that STD services are comprehensive and appropriate, site/agency-specific training should be provided. Further, population-specific guidelines and protocols regarding chlamydia and syphilis screening should be developed and provided to agencies serving this population. Chlamydia and syphilis prevalence monitoring in rural and migrant health clinics may be very useful for STD Programs.

Implications for Research: More information needs to be gathered to understand the quality and level of STD services in these clinics. Site visits and chart reviews are needed to determine what proportion of the eligible clinic population are screened for chlamydia and syphilis as well as to collect information regarding sexual histories, test methods and treatment choice practices.


STD Lay Health Advisors for Migrant and Seasonal Farm Workers: A Feasibility Study

FR Bloom, K Kroeger

Centers for Disease Control and Prevention, Atlanta, GA

Background: Hispanic seasonal and migrant farm-workers have high rates of STDs and limited health care access. Training of lay health advisors has been successful in improving Hispanic maternal and child health, and STD prevention in other groups. However, the feasibility of using STD lay health advisors for Hispanic farm-workers has not been adequately demonstrated.

Objective: To explore the feasibility of instituting STD lay health advisors for Hispanic seasonal and migrant farm-workers in southern Dade County, Florida.

Methods: Ethnographic interviews and observation were conducted with farm-workers, health providers and others working with Hispanic farm-workers.

Results: Male and female farm-workers were willing to talk with a peer (interviewer) or supervisor about STD prevention, sexual risk, and personal experience with STDs. Hispanic farm workers were found to be a culturally heterogeneous group, including non-Spanish speakers (Mixtec or another indigenous language). Reported migration patterns were variable, ranging from permanent residents to frequent migration (between Dade County and Mexico or a variety of regions in the US). Respondents indicating interest in serving as STD lay-health advisors included personnel at an agency that provides HIV prevention education and condom distribution to farm-workers, and a curandera (a traditional healer providing herbal and spiritual remedies).

Conclusion: Implementation of STD lay health advisors is feasible and can be facilitated by working with existing lay health advisors, traditional healers, and community organizations. Consideration should be given to variation in migration patterns and diversity within populations of migrants from Mexico and Central America.

Implications for Program: Use of lay health advisors may be a useful adjunct or alternative to existing outreach to Hispanic farm-workers.

Implications for Research: Additional research should be conducted to determine: the efficacy of lay health advisors for STD prevention in this population the best method for instituting a sustainable lay health advisor program


Parece que va a Llover…Compadre, Ponte el Sombrero [It Looks Like Rain . . . Put On Your Hat, My Friend]: An HIV/STD Risk Awareness Fotonovela for Latino Immigrant Day Laborers

D Y Estremera, M Arevalo, J Armbruster

Los Angeles County Department of Health Services, STD Program, Los Angeles, CA

Background: Culture, gender roles, and social stigma make it difficult for Latino immigrant day laborer men who have sex with men and women (MSM/W) to disclose bisexual activity. To identify individuals engaging in high-risk behaviors, staff employ a fotonovela (photo-illustrated narrative). Fotonovelas are a very popular form of communication in some Latin-American countries and therefore provide a non-threatening means to convey and discuss high-risk behaviors. Fotonovelas currently available neither directly address MSM/W behavior nor day laborers’ life circumstances that contribute to HIV/STD risk.

Objective: To develop a fotonovela designed by and for day laborers that will serve to initiate dialogue, intensify HIV/STD education, and increase perceived susceptibility.

Methods: To appropriately represent lifestyle and other characteristics of day laborers, observations, informal conversations, and focus groups were conducted. Day laborers were recruited for the photo illustrations. The resulting fotonovela was pre-tested through focus groups to assess for appropriateness, explicit messages, and impact. Pre/post questionnaires assessed knowledge and attitudes. Staff piloted the day-laborer-amended fotonovela and documented responses and discussions initiated.

Results: The fotonovela proved to be effective in initiating discussion of taboo high-risk behaviors and in increasing both knowledge of HIV/STD and perceived susceptibility. This poster displays the 12-page, 8.5 x 11, color fotonovela of which 5,000 will be distributed to immigrant men at day labor sites throughout LA County.

Conclusions: Tailored fotonovelas can provide an effective means of communicating HIV/STD messages to Latino communities.

Implications for Programs: Programs that serve the Latino immigrant community should strongly consider using the developed fotonovela or the methods described to develop a tailored fotonovela.

Implications for Research: It is important to investigate other means of popular communication among different Latino cultures to address MSM/W behavioral risks for HIV/STD.

Contact Information: Doris Y. Estremera / Phone 213-744-5971 / yurixy@ucla.edu


Sexually Transmitted Disease Risk Behaviors among California Agricultural Workers – Results from a Population-Based Survey

M Brammeier1, G Gould1, J Miller1, J Chow1, D Lighthall2, G Bolan1

1Sexually Transmitted Disease Prevention and Control Branch, California Department of Health Services, Sacramento, CA; 2California Institute for Rural Studies, Davis, CA

Background: Little is known about risk behaviors among agricultural workers in California who may have limited access to health care and exposure to sexually transmitted disease (STD) reduction messages. Population-based studies are needed to determine behavioral patterns and to assess needs of the community in order to reduce the occurrence of STD’s.

Objective: Determine risk behaviors of agricultural workers.

Methods: A population-based household survey was conducted within five randomly selected and two purposively chosen agricultural worker communities from all six California agricultural regions. A financial incentive was offered to participants who agreed to a second interview and physical exam at a clinic location. Data collected were: demographic, medical history, health care utilization, work history, occupational safety, risk factors, and STD test results. Results were analyzed for younger adults 18 to 50.

Results: Of the 1,165 eligible individuals contacted, 965 participated in the household survey. Of those who participated in the household survey, 638 agreed to a second interview and physical exam. Five-hundred-forty-seven participants were between the ages of 18 and 50 (mean = 32.9 ± SD 8.5). Three males (ages 18, 37, and 39) tested positive for chlamydia. Eleven percent (35/321) of males and 5% (10/182) of females had been previously diagnosed with a STD. Eleven percent of males (58/532) and 5% of females (16/315) use condoms. Thirty-nine percent (123/312) of males had ever had sex with a prostitute. Thirty-eight percent (76/198) of married men had sex with a prostitute at some time. Of those men who have had sex with prostitutes, 12% (11/95) also have had sex with IV drug users.

Conclusions: Data indicate that agricultural workers in this population engage in risk behaviors associated with STDs.

Implications for Programs/Policy: The data suggests that education is needed in these communities about STDs and safer sexual practices.

Implications for Research: Additional studies are needed to assess safer sex practices and risky behaviors among agricultural workers and partners, including sex workers in these communities.


Examining Risk Factors Associated with HIV Among Men Who Have Sex in California

DS Webb, SR Truax

Department of Health Services, Office of AIDS, HIV Prevention Research and Evaluation Section, Sacramento, California

Background: A revised HIV Counseling Information Form now provides specific information on recent STD/hepatitis diagnoses.

Objective: Examine demographic, behavioral, and recent STD history variables significantly associated with HIV infection among men who have sex with men (MSM) accessing publicly funded HIV test sites in California.

Methods: Responses from MSM clients with valid test results from January to June 2001 (n = 10,393) were used for this analysis. Variables found to be statistically significant in univariate regressions were considered in a multivariate model.

Results: African American and Latino MSM were over twice as likely to be HIV infected (OR 2.64 and OR 2.34). Amphetamines users were nearly two times more likely to be positive (OR 1.98). MSM who reported having gonorrhea (n = 609) in the past two years were 11/2 times more likely to be HIV positive (OR 1.66). Sixteen percent of the MSM (n = 1684) testing reported having an STD in the last two years.

Conclusions: Gonorrhea and amphetamine use is significantly associated with HIV infection among MSM testing at public HIV test sites in California. African American and Latino men are especially at-risk for HIV infection.

Implications for Programs: STD and HIV prevention counselors should consider incorporating a discussion of STD diagnosis and amphetamine use as risk factors for HIV in addition to comprehensive risk reduction strategies.

Implications for Research: Additional studies examining the relationship of HIV and STDs in MSM may be useful in developing prevention activities.

Learning Objectives: Participants will learn about risk factors associated with HIV in MSM and specific demographics of MSM reporting HIV, STDs, and hepatitis in publicly funded HIV test sites.

Contact Information: David S Webb / Phone 916-327-6773 / dwebb1@dhs.ca.gov


Uncovering STD Concerns of Men Who Have Sex with Men

D Thomas, KM Ford

CDC National STD and AIDS Hotlines, Research Triangle Park, NC

Background: STD outbreaks among men who have sex with men (MSM) attract attention, but concerns of MSM, especially those not identifying as gay or bisexual, remain obscure. The CDC National STD and AIDS Hotlines (CDC NSTDAH) provide anonymous services to the public, and call data allow insights into STD issues concerning MSM.


  • To determine the percentage of inquiries to CDC NSTDAH from MSM.
  • To analyze MSM inquiries and assess whether expressed concerns differ from those of other male callers.
  • To offer suggestions for addressing unique concerns of MSM.
  • To propose content public health educators could include in interventions with all male clients.

Methods: The newly integrated CDC NSTDAH handled over 464,000 calls between September 2000 and June 2001. One in 15 productive calls was surveyed. Because sexual orientation and behavior are not directly surveyed, an algorithm was designed to identify over 6,000 MSM. This and other anonymous data were electronically recorded and descriptive analyses preformed.

Results: MSM differed from other male callers in several ways: they were less likely to be white or African-American; they were more likely to report particular STD infections; and surveys showed more MSM demonstrated high levels of emotion. Also, more MSM callers reported having unprotected sex (33% compared to 26%).

Conclusions: The CDC NSTDAH is a valuable resource for many MSM, and data indicates MSM may have different concerns from other men.

Implications for Programs/Policy: Health services should provide all male clients complete risk and protection education and include information about the hotlines and other STD resources.

Implications for Research: It would be useful to know why the hotlines are such an important resource for MSM of certain ethnic backgrounds. It would then be beneficial to know if greater promotion of STD information services would encourage their increased use by men, whatever their ethnic background or sexual behavior.

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

1) Understand how data on MSM was collected on the anonymous service of the hotlines.

2) List the important demographic characteristics of MSM callers.

3) Describe the most common issues discussed by these callers.

4) Mention the most common services the hotlines provided these callers.

5) Compare these callers with other male callers to the hotlines.


Creating Alliances Between Venues Attracting MSM and STD Prevention Programs

R Smith1, J Brown1,2, S Blank1,2

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

Background: In 2000, 107 cases of primary and secondary syphilis were reported among men; at least 57% were men who have sex with men (MSM). Venues where partners were recruited included dance clubs, bathhouses, sex clubs, and private parties. Efforts to forge alliances between the NYC Department of Health and these venues have had mixed results. Other urban centers may have had similar experiences.

Purpose: To examine innovative ways for STD programs to establish relationships with organizers of venues serving MSM.

Discussion: Authors will present their experiences, engage respondents to brainstorm ways of creating alliances between venue organizers and STD prevention programs, and explore barriers which may be encountered. Participants will share experiences with venue-based initiatives and identify activities which were most effective in reaching MSM. The information shared may lead to the exploration of further innovative approaches and new policies for STD outreach, education, and prevention for the MSM community.

Contact: Robert Smith / Phone 212-788-4423 / rsmith2@nyc.health.gov


Syphilis Among Men Who Have Sex with Men (MSM) in Miami-Dade County, Florida

R Bronzan1, L Echavarria3, J Hermida2, M Trepka2, T Burns2, K Fox1

1Division for STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; 2Miami-Dade County Health Department, Florida Department of Health, Miami, FL; 3Florida International University, Miami, FL

Background: Rates of infectious syphilis in Miami-Dade County, Florida have increased each year since 1998. Cases among MSM have increased twenty-fold during that time. Factors contributing to this increase have not been fully elucidated.

Objectives: To describe characteristics associated with acquiring syphilis, determine the extent of co-infection with HIV and syphilis, and describe knowledge, attitudes, and practices concerning syphilis among MSM in Miami-Dade County.

Methods: A case-control study compared MSM with early syphilis diagnosed between 1 January 2001 and 30 June 2001 and reported to Miami-Dade County Health Department with MSM seeking care at the same venues and having negative syphilis serologies. Two controls per case were frequency matched by age and care venue. Interviews assessed venues where sexual partners were recruited, sexual behaviors, condom use, awareness of partner HIV status, utilization of HIV care (if HIV-infected), and general knowledge of syphilis. For those consenting, HIV tests were performed.

Results: Forty-two men met the case definition. Thirty-five have been successfully contacted, with 71% (n = 25) of those consenting to be interviewed. Six of the interviewed cases and three of the controls were co-infected with HIV (not statistically significant [NS]). Some venues were frequented more often by cases than controls [NS]. There was no difference between cases and controls in knowledge of signs/symptoms of syphilis, with 84% of knowledge questions answered correctly.

Conclusions: Preliminary results suggest that knowledge of syphilis is high in this population, and that attendance at particular venues may be associated with an increased risk for acquiring syphilis.

Implications for Program/Policy: Findings from this study will help the Miami-Dade County Health Department refine and target syphilis prevention activities, and will contribute to an understanding of the national problem of increasing STDs among MSM.

Implications for Research: New approaches to STD prevention among MSM need to be identified and evaluated.

Learning Objectives: By the end of this session, participants will be able to describe characteristics associated with acquiring syphilis among men who have sex with men (MSM) in Miami-Dade County, Florida, and describe the knowledge, attitudes, and practices concerning syphilis in this group. In addition, participants will be able to describe some of the complexities surrounding syphilis prevention in this population.


Predictors of STD Testing and Incidence Among African-American and White Men Who Have Sex with Men ( MSM)

DJ McKirnan1,2, M Tolou-Shams1,2, J Flynn1, B Hope1, L Branch3

1Howard Brown Health Center, Chicago, IL; 2University of Illinois Chicago, Chicago, IL; 3Chicago Department of Health, Chicago, IL

Background & Objectives: Although STDs are increasing among men who have sex with men (MSM), rates of STD testing are low, particularly relative to HIV testing. We examined recent STDs, and rates and predictors of HIV/ STD testing, among African-American and white MSM. Predictors included demographics, health care access, STD knowledge and concern, and attitudes toward sexual risk.

Method: We anonymously surveyed 394 African-American and 231white MSM (M age = 35) at community events in 2000. A replicating sample from 2001 is in analysis.

Results: African Americans were more likely than whites to be HIV+ (29% v. 19%, p<.001) and to have a recent (last 2 years) hepatitis diagnosis (21% v. 13%, p<.007). Recent STD incidence was low (2%). Neither this nor high rates of HIV testing (85%) differed by group. Whites were higher on an STD knowledge scale (p<.001), but were less likely to have been STD tested (34% v. 42%, p<.025). Thirty-eight percent of both groups felt concern over personal risk for STDs.

Demographics: Lower education and income, and higher age, strongly predicted HIV+ status among African-Americans. Demographics were unrelated to HIV status among whites, and STD incidence or HIV / STD testing in either group. HIV+ status did not lead to more STD testing, and only modestly enhanced concern over STD risk. Health care access-insurance, regular care, provider’s knowledge of sexual orientation-were unrelated to HIV testing and STD incidence or testing among African Americans. White MSM whose provider knew their sexual orientation were significantly more likely to get STD tested. STD / HIV knowledge strongly predicted STD and HIV testing in both groups. Among psychosocial variables perceived social support for coping with risk predicted HIV and STD testing. Variables such as depression had no effect. Whites were more likely to get HIV/STD tested if they showed high risk sexual attitudes, while for African-Americans concern over risk predicted STD testing.

Conclusions: While HIV testing was common in this urban MSM sample, STD testing was less so, particularly among whites. Ethnic groups differed in predictive variables: Demographic variables were relevant to African-Americans, whereas provider’s knowledge of sero-status was relevant to whites. Simple health access was generally high, and did not predict testing or infection in this sample. HIV or STD knowledge was a strong predictor of testing in both groups, as was perceived social support for coping with sexual risk.

Implications for Policy: Interventions to enhance basic knowledge and social support for risk reduction may enhance STD/HIV testing, as will providers who are sensitive to sexual orientation. These interventions are relatively straightforward (i.e., in contrast to structural barriers such as health access), thus further testing and prevention is feasible in both these ethnic groups.

Measurable Learning Objectives: By the end of this session, participants will be able to describe some basic factors related to STD and HIV rates, and rates of STD testing, in a community sample of African-American and white MSM.

Contact Information:

David J. McKirnan / davidmck@uic.edu


Many Men, Many Voices: A Science-Based Prevention Intervention for Gay Men of Color (GMOC)

M Scahill1, P McGrath1, K Berkhoudt1, G English2, J Morgan3, M Urban1, P Coury-Doniger1

1Center for Health and Behavioral Training (CHBT), University of Rochester School of Medicine, Rochester, NY; 2People of Color in Crisis (POCC), Brooklyn, NY; 3Men of Color Health Awareness (MOCHA), Rochester, NY

Background: Many proven science-based HIV prevention interventions for men who have sex with men (MSM) were conducted with white, gay men and may not be effective with gay men of color (GMOC). The Center for Health and Behavioral Training (CHBT) established a collaboration with Men of Color Health Awareness (MOCHA), a CBO serving GMOC, to implement a group-level, integrated STD/HIV prevention intervention.

Objective: To assess the need to tailor existing, effective group interventions for MSM.

Methods: A prevention needs assessment was conducted using local data, focus groups of GMOC, and key informants. A group intervention developed by CAIR was tailored to incorporate behavioral influencing factors unique to GMOC.

Results: Unique behavioral influencing factors for GMOC were identified. These included lack of knowledge of STD/HIV interactions, racism, homophobia in communities of color, lack of an identified community for GMOC, and sexual relationship dynamics involving complex interactions between “Tops” and “Bottoms”. These factors were incorporated by tailoring existing sessions. The intervention, Many Men, Many Voices (MMMV), was implemented in 1998 at MOCHA, in 2000 at People of Color in Crisis (POCC), and then diffused through the New York State Black Gay Network. Acceptance of MMMV is very high with excellent recruitment and retention. Evaluation of the intervention is underway using pre-/post-KABB surveys.

Conclusions: This collaboration provided an important mechanism for implementing a science-based, STD/HIV prevention intervention for this hard-to-reach special population of GMOC.

Implications for Programs: Science-based HIV prevention interventions need to be tailored to address the behavioral influencing factors that are unique to each special population. This can be accomplished with focus groups/key informants through collaborations with CBOs serving these populations.

Implications for Research: The behavioral influencing factors for emerging, special populations need to be identified and then used to tailor existing, science-based prevention interventions.

Learning Objectives: Participants will be able to describe and discuss how an existing group intervention was tailored to meet the unique influencing factors of GMOC.

Contact Information: Maureen Scahill / Phone 716-530-4382 / Fax 716-530-4378 / mscahill@mcls.rochester.lib.ny.us


Syphilis Awareness at New York City’s Gay Pride Fest, 2001

J Brown1,2, M Freeman1, R Friedman3, S Blank1,2

1Sexually Transmitted Disease Control Program, New York City Department of Health, New York, NY; 2Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, GA; 3Mailman School of Public Health, Columbia University, New York, NY

Background: New York City (NYC) is currently experiencing a sharp increase in syphilis among men who have sex with men (MSM). In 2000, 57% of reported syphilis cases were among MSM.

Objective: To assess knowledge of and attitudes toward syphilis among attendees at NYC Gay Pride Fest, 2001.

Methods: We distributed anonymous, self-administered surveys to attendees at NYC’s Gay Pride Fest, 2001. Respondents were asked nine true-false questions about syphilis and asked to select which of six symptoms could indicate a syphilis infection.

Results: A total of 269 surveys were completed (117 males, 102 females, 50 gender not specified). Seventy-seven percent of respondents self-identified as gay/lesbian, bisexual, or transgender (82% of males, 80% of females, and 35% of those for whom gender was not specified). Findings included:

  • 52% knew that the presence of syphilis facilitates HIV transmission.
  • 30% knew that rashes on the hands and feet could be a symptom of syphilis.
  • 72% believed that white discharge from the penis or rectum could be a symptom of syphilis.
  • 47% knew about the increase in infectious syphilis in NYC.
  • 44% were concerned about contracting syphilis; a higher proportion of male respondents than female respondents were concerned (males 56%, females 32%, and gender not specified 36%).

Conclusion: Further efforts to augment syphilis awareness and prevention are needed in the face of the current rise in syphilis cases.

Implications for Programs: Programs need to promote knowledge of syphilis and its relationship to HIV transmission in the MSM community so that exposed and symptomatic persons know to seek timely care.

Implications for Research: Further research is needed to identify the best vehicles for syphilis education and prevention messages in the MSM community.

Learning Objective: Participants will be able to identify gaps in awareness of syphilis among attendees of the NYC Gay Pride Fest 2001.


Factors Related to STD Risk Among Women Who Have Sex with Women (WSW)

M Tolou-Shams1,2, DJ McKirnan 1,2, KM Dyslin1, B Wilson2, B Hope1, L Branch3

1Howard Brown Health Center, Chicago, IL; 2University of Illinois, Chicago, IL; 3City of Chicago, Department of Gay and Lesbian Health, Chicago, IL

Background: Research on STD risk among women who have sex with women (WSW) is scarce. Some research suggests that WSW have comparable STD incidence rates to heterosexual women. Little is known about WSWs sexual risk-taking behavior, STD rates, and reasons for STD testing.

Objectives: To describe predictors of STD testing and lifetime STD incidence among WSW.

Method: We anonymously surveyed WSW who had at least one female partner in their lifetime (79% had female partner in past 6 months). 160 African-American (AA) and 70 Caucasian women (M age = 36) were surveyed at Black Gay Pride and a street fair in Chicago using self-report measures of health and sexual behavior.

Results: Lifetime STD incidence. Sixteen percent reported having an STD in their lifetime (65% STD testing rate). Women who reported having at least one STD were more likely to have had sex with a man in their lifetime (n = 39), p<.05. Ethnicity, communication with female partners about sex and STDs, and personal safer sex guidelines were not associated with lifetime STD incidence (ps>.05). STD testing. Women who got tested for STDs were 3 times more likely to have ever had a male partner, Wald test = 2.97, p <.01, were more likely to have communicated with their female partners about sex and STDs, p<.01, and were twice as likely to be African-American, Wald test = 2.03, p=.07.

Conclusions: Women that identify as only having female to female sex may have other risk factors besides unsafe sex with women (e.g., having had sex with a man) that put them at risk for STDs. Rates of STDs among WSW (16%) are comparable to those of heterosexual women. Thus, WSW are not necessarily at any lower STD risk because they identify as only having sex with other women. High rates of testing, particularly among AA WSW, suggest that WSW are perhaps engaging in behaviors that provide concern about STD risk.

Implications for Policy: In order to accurately determine WSW STD risk, health care providers could benefit from 1) education about factors related to WSW STD risk and 2) being more detailed when interviewing WSW patients about sexual behavior.

Implications for Research: Additional research on HIV/STD risk factors for WSW could help the development and provision of more tailored and effective prevention services for this understudied subgroup.

Measurable Learning Objectives: By the end of this session, participants will be able to describe rates of lifetime STDs, and rates of STD testing among a community sample of WSW. They will be able to understand the factors related to WSW STD incidence, as well as to identify the reasons why WSW seek out STD testing.

Contact Information :

Marina Tolou-Shams / Phone 312-413-4600 / toloushm@uic.edu


STD Screening of Actors in the Adult Entertainment Industry: Alternative Testing Opportunities to Detect and Treat STDs

D Kodagoda1, M Boudov1, S Mitchell2, G Smietana1, P Kerndt1

1Los Angeles County Department of Health Services, STD Program, Los Angeles, CA; 2Adult Industry Medical HealthCare Foundation, Los Angeles, CA

Background: With the high STD morbidity in Los Angeles County, non-traditional screening venues are required. A non-profit clinic offering HIV polymerase chain reaction (PCR)-testing to actors in the adult entertainment industry collaborated with the local STD Program in June 2000 to integrate chlamydia and gonorrhea testing into its services. Monthly HIV testing is the only standard for health monitoring among actors in the industry.

Objective: To determine prevalence of chlamydia, gonorrhea, and behavioral risk factors in this population.

Methods: Clients provided urine for LCR testing and reported on STD history, sexual preference, having a steady sex partner, and condom use with this partner. Descriptive statistics were used to analyze the data.

Results: From June 2000-May 31, 2000, 518 (255 female, 263 male) clients were tested. Whites comprised 74%. The median age was 30. Testing detected chlamydia in 7.5% of females and 3.8% of males. Gonorrhea was identified in 2.0% of females and 3.0% of males. Co-infections were found in 23.1% of clients. Of all positive individuals, 63.4% denied previous STD infections and 58.3% reported having a steady sex partner. Of all clients who reported having a previous STD (n = 185), 102 (55.2%) and 79 (42.7%) stated having a previous chlamydia and gonorrhea infection, respectively. More females than males reported a steady sexual partner (72.2% versus 49.0%). Over the past 30 days, 90.6% (n = 193) of clients never used a condom with their steady partner. Most females (62.4%) reported a sexual preference for both genders while males preferred heterosexual partners (82.9%).

Conclusions: High STD prevalence in a young population routinely screened for HIV and the lack of condom use warrant routine STD screening in this setting.

Implications for Programs: Health departments should expand definitions of alternative testing sites.

Implications for Research: Further investigation of the sexual contacts and steady sexual partners of these actors is necessary.

Learning Objective: At the end of the session, participants will be able to describe at least two benefits of STD screening at alternative testing venues.


Changing Socio-Demographic Characteristics and Declining Trends in HIV Infection and Sexually Transmitted Infections (STI) in Female Sex Workers (FSWs) in Abidjan, Côte d’Ivoire, 1992-2000

M Diarrassouba1, V Ettiègne-Traoré1,

CK Anoma1, PD Ghys3, C Maurice, O Tossou1, P Eby1, R Ekpini1, G Adjorlolo-Johnson1, T Roels 1,2, B Vuylsteke 1,3

1Projet RETRO-CI, Abidjan, Côte d’Ivoire ; 2Center for Diseases Control and Prevention, Atlanta, USA; 3Institute of Tropical Medicine, Antwerp, Belgium

Background: Since 1991, the Ivorian Ministry of Health has promoted AIDS awareness and condom use among female sex workers (FSWs) through training of peer educators and targeted education. A confidential clinic in Abidjan, set up in 1992 for FSWs, offers free HIV counseling and testing as well as sexually transmitted infection (STI) diagnosis and treatment.

Objectives: To assess changes in socio-demographic characteristics and trends in HIV prevalence and STI including Neisseria gonorrhoeae (N.G.) and Chlamydia trachomatis (C.T.), among FSWs new attending the clinic in Abidjan, Côte d’Ivoire for the first time.

Methods: Since 1992, all first-time attendees were interviewed and examined. Genital swabs and blood samples were taken. HIV testing was performed for consenting women using a published algorithm. N.G infection was diagnosed by culture, and C.T. infection by ELISA (SYVA).

Results: Data are presented for 6752 FSWs for first-time attendees between 1992 and 2000. The majority of FSWs were Ivorian and Nigerian compared with a predominance of Ghanaian women in earlier years (all p<.001). From 1992 to 2000, significant declines were observed in the prevalence of HIV infection from 89% to 28% (P<.001), gonorrhoea from 33% to 7% (P<.001). These trends coincided with additional sociodemographic changes: women tended to be younger with a median age of 30 years in 1992 and 23 years in 2000, they had more schooling (p<.001), and a shorter duration of sex work (p<.001).

Conclusion: From 1992 to 2000, there have been dramatic changes in FSWs socio-demographic characteristics in Abidjan. FSWs have tended to be younger and more educated, more likely to be Nigerian, and to have been engaged in sex work for a shorter period time. There has been a significant decrease in HIV prevalence and in N.G. infection. Preventive measures against HIV infection and STIs should continue and be supported.


Health Indicators among Low-Income Sex Workers: The Population-Based Northern California Young Women’s Survey

DL Cohan1, A Kim2, W McFarland3

1University of California, San Francisco, CA; 2University of California, Berkeley, CA; 3Department of Public Health, San Francisco, CA

Background: Numerous studies have evaluated the prevalence of sexually transmitted infections (STI) among sex workers. Nearly all of these studies, however, have relied on convenience samples and are vulnerable to significant bias.

Objectives: To examine differences in sexual and drug-using behavior and STI prevalence among a population-based sample of low-income sex workers (SW) and non-sex workers (NSW).

Methods: This is a cross-sectional survey of low-income women in 5 Northern California counties between April 1996 and January 1998. Participants completed a structured interview and were tested for HIV, syphilis, gonorrhea, chlamydia, HSV-1, HSV-2, Hepatitis A (HAV), B (HBV), and C (HCV).

Results: Overall, 9% (226/2543) of the total sample reported a history of sex work. Compared to NSW, SW had more lifetime male sex partners (mean 360.4 vs. 6.8), and were more likely to have sex with an injection drug-using (IDU) partner (OR 6.3), an HIV+ partner (OR 7.6) and an MSM (OR 11.1). SW were also more likely to report sexual coercion (OR 6.0) and IDU (OR 10.6). Nevertheless, SW were more likely to use condoms with new partners during vaginal sex (OR 5.9). The prevalence of HIV, gonorrhea, chlamydia, HAV, and HBV was not different between NSW and SW. SW, however, had a higher prevalence of HSV-2 (OR 3.1), HCV (OR 2.7), and syphilis (OR 3.8), adjusting for demographic characteristics, socioeconomic status, and history of IDU.

Conclusion: There is significant high-risk activity among both SW and NSW. We noted an association between sex work and Hepatitis C even after adjusting for injection drug use, suggesting sexual transmission of Hepatitis C in these women.

Implications for Programs/Policy: Healthcare services aimed at low-income women should include comprehensive STI screening as well as vaccination against Hepatitis A and B.

Implications for Research: Additional research is needed to determine the cost-effectiveness of providing these comprehensive STI programs.


Indigenous People of India are More Prone to HIV/AIDS, Evident From NFHS-II

R Nainakwal

IIPS, Mumbai, Maharastra

Background: NFHS-II, (National Family Health Survey) was conducted in 1998-99. According to NFHS, 9.1 percent of household heads belong to indigenous people of India (popularly know as schedule tribes, STs)

Problem: According to NFHS-II, indigenous women of India (schedule tribes women) know no ways to avoid AIDS, which means the tribal women of India have higher chance of getting HIV/AIDS infection. In this paper an attempt is made to justify the finding by showing association and relationship with major variables like place of residence, education, standard-of-living, and exposure to mass media and other sociocultural variables.


  • To understand the HIV/AIDS awareness level among indigenous people of India.
  • To understand the relationship and association between the socio-demographic variables with
  • AIDS knowledge and awareness.
  • Place of residence.
  • Level of education.
  • Standard of living.
  • Exposure to mass media.

Methodology: Bivariate analysis has been used to explain the relationships between different variables and the AIDS awareness level among indigenous people (Schedule Tribes Women) in India.

Major findings: Forty-four and sixth-tenths percent of schedule tribe women know no ways to avoid AIDS. Forty-eight and nine-tenths percent illiterate women know no ways to avoid AIDS out of which 79 percent are schedule tribes. Urban residence, higher levels of education, standard of living and exposure to mass media all have a strong positive association with AIDS awareness and knowledge. Seventy and three-tenths percent who have heard about AIDS are living in urban sector and 29.7 percent Only 3.7 percent of tribal women households are living in urban areas and 11.2 percent are living in rural areas out of the total households 9.1 percent. 74.3 percent who heard about AIDS have high standard-of-living, having 93.9 percent access to TV, 11.2 percent went to cinema, and 43.4 percent use newspaper and magazines. In comparison to this only 19.6 percent who heard about AIDS have low standard-of-living, having 51.5 percent exposure to TV, 40.4 percent exposure to radio, 5.1 percent to cinema, and 8.3 percent to newspapers. Media exposure varies even more widely by education and standard of living. Four percent of women, a negligible proportion, who have completed at least high school are not regularly exposed to any media compared with 60 percent of illiterate women. Seventy-seven percent of women in household with low standard of living are not exposed to any media, out of which 62 percent of tribal women not regularly exposed to any media.

Conclusion: For the prevention of HIV/AIDS there is an urgent need for universalisation of primary education for girls, decentralization of community resources for wider exposure of mass media, new scheme for income generation programs for women for their autonomy, and provision of basic community requirements like clean water, sanitation, toilets, to have a better quality of life, and information, education, and communication strategy for more awareness among women at remote areas about HIV and AIDS prevention.


Recent STD/Hepatitis Diagnoses Reported by HIV Counseling and Testing Clients in California

C Heusner, S Truax

California Department of Health Services, Office of AIDS, HIV Prevention Research and Evaluation Section, Sacramento, CA

Background: A revised statewide HIV Counseling Information System now provides specific information on recent STD/hepatitis diagnoses.

Objective: Examine the relationship of recent STD/hepatitis diagnoses, risk behaviors, and HIV status among clients accessing publicly funded HIV test sites in California.

Methods: Data were from 62,000 clients testing for HIV at publicly funded test sites throughout California from January to June 2001. First-time testers and repeat testers who previously tested prior to January 2001 were included in the logistic regression analyses.

Results: Individuals with HBV or gonorrhea were 2.5 times more likely to be HIV-positive (OR 2.73 and 2.42). Injection drug users (IDUs) were 20 times more likely to report HCV and 6 times more likely to report HBV than non-IDUs. Individuals who engage in sex for money or non-injection stimulant use were at increased risk for a range of STDs. Compared to heterosexual males, men who have sex with men (MSM) were at increased risk for genital/anal warts (OR 1.75), HBV (OR 1.69), and gonorrhea (OR 1.42), and females were at increased risk for trichomoniasis (OR 7.51) and chlamydia (OR 1.85).

Conclusions: Particular STDs/hepatitis diagnoses appear to be associated with specific risk behaviors. Only gonorrhea and HBV were associated with HIV infection among clients testing at public HIV test sites in California.

Implications for Programs: HIV counseling and testing programs may want to consider revising counseling protocols, referrals, and prevention interventions to address the specific STD/hepatitis risks of particular populations.

Implications for Research: Further investigation into the HIV counseling and testing data of other populations would provide further understanding into the relationship of HIV and STD/hepatitis.

Learning Objectives: Participants will learn the unique patterns of STD/hepatitis diagnoses reported by specific risk groups testing at publicly funded HIV test sites.

Contact Information: Christine Heusner / Phone 916-324-6499 / cheusner@dhs.ca.gov


Standard Risk Assessment (SRA) and Screening for Syphilis, Gonorrhea (GC), and Chlamydia (CT) Among HIV-Infected Patients Receiving Medical Care

C Rietmeijer, J Landrigan, D Britt, P Gourley, W Burman

Denver Public Health, Denver, CO

Background and Rationale: High-risk behavior appears to be increasing among persons with HIV infection, potentially leading to sexually transmitted infections (STI) and ongoing HIV transmission.

Objective: To implement and evaluate SRA and STI screening among HIV-infected patients attending Denver Health’s HIV/AIDS clinics.

Methods: SRA was integrated into routine clinical care. Gonorrhea (GC) and chlamydia (CT) urine screening and serologic syphilis screening were also offered.

Results: To date, SRA has been conducted among 195 persons; 172 (88.2%) men and 23 (11.8%) women. Sexual activity (oral, anal, or vaginal) in the previous 2 months was reported by 138 (70.8%) respondents. The mean number of partners was 2.0 (range 1-25). HIV serostatus was known for 78/92 (84.8%) respondents with main partners and for 27/62 (43.5%) respondents with occasional partners (p<.0001). Of these partners, respectively 48.5% and 59.3% were known to be HIV+. Anal or vaginal sex with a partner whose HIV serostatus was negative or unknown was reported by 38/92 (41.3%) of respondents with main partners and 26/62 (41.9%) of respondents with occasional partners. GC/CT testing was accepted by 163 (83.6%) respondents; 3 (1.8%) were CT+ and 1 (0.6%) was GC+. The RPR was positive for 9/151 (5.9%) with one case of early syphilis diagnosed.

Conclusions: Most HIV-infected persons attending our HIV/AIDS clinics are sexually active. Anal/vaginal sex with a partner whose serostatus is negative or unknown, is common. Testing for STI among asymptomatic patients in this setting did not appear to significantly add to the risk information obtained during SRA.

Implications for programs: SRA can be implemented as part of the clinical encounter in HIV/AIDS clinics and can identify a subset of patients who may be at highest risk for ongoing HIV transmission and in need of behavioral interventions.

Implications for research: Behavioral interventions must be developed for implementation in clinical settings.

Learning Objectives: Participants will be able to describe the implementation and yield of standard risk assessment and STI screening among HIV-infected patients attending HIV/AIDS clinical care clinics.

Contact Information: Cornelis A. Rietmeijer / Phone no. 303-436-7363 / kees.rietmeijer@dhha.org


STDs in an HIV World: Preliminary Results of the STD/HIV Integrated Prevention Services (SHIPS) Project in Los Angeles County

M Campos Bovee, D Kodagoda, H Rotblatt, A Narayanan, P Kerndt

Los Angeles County Department of Health Services, STD Program, Los Angeles, CA

Background: Despite the significance of STD control for HIV prevention, STD screening is generally not offered at either anonymous or confidential HIV testing sites. STD/HIV Integrated Prevention Services (SHIPS) piloted a program to offer confidential STD testing at such sites, including a method for anonymous HIV clients to test for STDs without revealing their name to site staff.

Objective: To determine the acceptability and impact of STD testing at an HIV test site.

Methods: All HIV testers at the site were offered urine LCR chlamydia and gonorrhea testing. Anonymous HIV testers provided personal identifiers to the STD Program in a manner inaccessible to site staff. Demographic and behavioral data were collected during HIV counseling.

Results: From February 1 to May 31, 2001, 511 clients tested for HIV, of whom 321 (166 anonymous; 155 confidential) tested for STDs. STD testers were 59% MSM, 86% male, 64% white, 17% Hispanic, with median age 31, and median number of sex partners 4. No significant demographic differences existed between anonymous and confidential HIV testers. STD testing acceptance was 64% for anonymous and 73% for confidential HIV testers. Principal reasons for declining STD screening included “tested recently” (anonymous) and “don’t need/not at risk” (confidential). Among STD testers, 7 (2.2%) were positive for HIV, 6 (1.9%) for chlamydia, and 6 (1.9%) for gonorrhea. None were HIV-STD co-infected. Anonymous and confidential MSM clients showed no significant differences in sex practices, but more MSM anonymous testers claimed multiple partners (P=.0096).

Conclusions: STD testing was well accepted by both confidential and anonymous HIV testers. Confidential STD testing can be effectively offered at anonymous HIV test sites, enabling assessment of STD prevalence and HIV co-infectivity.

Implications for programs: HIV and STD prevalence data can further guide STD intervention strategies.

Implications for Research: Data will be collected at five additional sites, which have varied populations.

Learning Objectives: Participants will be able to (1) discuss STD testing acceptability and STD prevalence in one HIV test site in Los Angeles County and (2) discuss three key issues in fostering collaboration between public STD programs and HIV service providers.

Contact information: Maria Campos Bovee / Phone 213-744-5972 / mbovee@dhs.co.la.ca.us


Evaluating HIV/Syphilis Prevention Mass Media Campaign Targeting Puerto Rican Women in Childbearing Ages, 2000-2001

AM Lugo, LM Soltero, MM Ayala, J Molina

STD/HIV/AIDS Prevention Program, Central Office for AIDS and Communicable Diseases Affairs, Puerto Rico Department of Health

Background: The HIV and STD detection during the pregnancy is an essential component in the prevention and treatment to avoid the HIV transmission and congenital syphilis. The STD/HIV/AIDS Prevention Program developed a media campaign including TV, radio, movie theaters, and posters to promote the importance of the HIV and VDRL screening among women in childbearing ages.

Objectives: Evaluate the 2000 HIV/syphilis mass media prevention campaign targeting Puerto Rican Women in Childbearing Ages. Measure the HIV/syphilis knowledge and prevention methods presented during the campaign in TV, radio, press, and posters. Identify the opinion/perception about the mass media message targeting women in childbearing ages. Determine if the message was delivered in a format/content acceptable to the target population.

Methods: The design of the study was based on the use of focus groups. The sample size consisted of 16 focus groups of youth between 10-18 years of age from the eight health regions of Puerto Rico and women older than 19 years. The total number of participants was 163 participants.

Results: The distribution by group was 77 adult women and 86 adolescent women. Of the participants, 66% were in junior high school and the adult women have been reached high school level. The mass media preferred by the youth to receive the HIV/syphilis prevention message were TV (57%) and radio (55.8%). Overall, both groups catalogued the spots as good, because they were well explained and caused impression. The participants reported that the campaign was appropriate to promote the TV, radio, and poster messages. The TV spot was the favorite because the message was directed to promote the importance of the HIV and VDRL screening before and after the pregnancy.

Conclusions: Overall the mass media campaign was well accepted by the participants. In specific the TV spot was the favorite. The preferred time to schedule the announcements was during the night for TV and during the morning for radio. The participants recommend that the posters should be distributed in schools, factories, post offices, and places frequented by youth.

Implications for Programs: Programs that provide educational HIV/STD educational services should consider planning and evaluating media campaigns that fit according to the populations that will be served. In addition, the programs should establish coalitions with media enterprises to promote continuously the HIV and STD prevention message to the high-risk populations.

Implications for Research: Programs that provide educational HIV/STD educational services should consider evaluating regularly the interventions implemented.

Contact Information: Alexie M. Lugo / Phone no. 787-274-5562 / alugo@salud.gov.pr


Current STD Infection and HIV Testing: A Case-Control Study

M Smurzynski1, WC Miller1,2, T Moran2, K Irwin3, KK Fox3, R Barnes3, PA Leone2,4

1The University of North Carolina School of Public Health, Chapel Hill, NC; 2The University of North Carolina School of Medicine, Chapel Hill, NC; 3Centers for Disease Control and Prevention, Atlanta, GA; 4North Carolina Department of Health and Human Services, Raleigh, NC

Background: Sexually transmitted diseases (STDs) promote human immunodeficiency virus (HIV) transmission by increasing HIV transmissibility and HIV susceptibility.

Objectives: To measure the relationship between current STD infection and HIV status in persons requesting HIV testing at a public STD clinic.

Methods: We conducted a case-control study using existing medical records at the public STD clinic in Wake County, North Carolina. We identified all 101 persons who tested positive for HIV for the first time between January 1996 and December 2000 and a random sample of 411 persons who tested negative for HIV. Data extracted from the medical records included demographics, presence of STD-related symptoms, self-reported previous STD test results, sexual history, psychosocial risk assessment, and laboratory-documented STD test results and dates.

Results: A diagnosis of syphilis (HIV+: 19/90; HIV-: 9/398; OR = 11.6; 95% CI, 4.7-30.0) was associated with HIV infection, and the magnitude of this relationship differed by gender (men: OR = 22.9; 95% CI, 6.0-127.3; women: OR = 5.5; 95% CI, 1.2-23.5). A diagnosis of gonorrhea was significantly associated with HIV infection (HIV+: 16/80; 35/382; OR = 2.5; 95% CI, 1.2-4.9) overall, and stratified analysis showed a significant association only among men (men: OR = 2.6; 95% CI, 1.1-5.8; women: OR = 1.8; 95% CI, 0.3-7.7). Chlamydial infection was not related to HIV infection (HIV+: 2/55; HIV-: 25/260; OR = 0.4; 95% CI, 0.0-1.5).

Conclusion: In this STD clinic, syphilis and gonorrhea diagnoses were strongly associated with testing positive for HIV infection.

Implications for Programs/Policy: The high prevalence of STD/HIV co-infection among persons undergoing simultaneous testing for HIV and STDs underscores the need to routinely offer both STD testing and HIV screening at these sites.

Implications for Research: Future efforts should address barriers to comprehensive STD testing in persons seeking HIV testing and interventions to increase early detection and treatment of syphilis and gonorrhea in HIV-infected persons.


An Educational Initiative Between the STD and HIV Program Leads to an Increased Utilization of the STD Services

T Bertrand, M Gosciminski, F Tedino, L Martin

Rhode Island Department of Health, Providence, Rhode Island

Background: In recent years there has been an increase in the number of reported cases of gonorrhea and chlamydia in Rhode Island among minority and high-risk groups.

Objectives: Reduce the incidence of gonorrhea and chlamydia in high-risk groups in Rhode Island through the awareness of safe sex and the increased utilization of the state supported STD Clinic.

Methods: A partnership was formed between the STD Program and the HIV Program to coordinate a plan for the distribution of condoms and referral cards for the STD Clinic among high-risk populations for STD’s in Rhode Island. Through existing relationships with community-based organizations, the HIV Program served as a logical conduit to reach high-risk populations. Between January 1 and June 30, 2001, 50,000 STD Clinic referral cards and 95,000 male and 5,000 female condoms were distributed equally to ten different agencies which service high-risk clients across the state.

Results: Following the distribution of the clinic referral cards, the STD Clinic observed an increase in screening appointments made by high-risk patients who received the cards. Although no decrease in the number of reported cases of either gonorrhea or chlamydia was detected, it is thought that the early diagnosis and treatment of these STD’s will prevent secondary cases from occurring.

Conclusions: In the absence of other STD-related interventions, the distribution of STD Clinic referral cards may have led to an increase in the utilization of the STD Clinic. Forming a partnership between the HIV and STD programs allowed high-risk populations to become aware of the services that the STD Clinic could provide.

Implications for Programs/Policy: Partnerships with existing programs and venders could lead to a greater awareness and utilization of STD services through the distribution of STD Clinic cards in high-risk populations.

Implications for Research: A study could be designed to analyze whether increased STD Clinic utilization can lead to decreased STD incidence over time.


Program Assessment and Review (PAAR): A Comprehensive STD/HIV Program Evaluation Tool

C Campbell

Virginia Department of Health, Division of HIV/STD

Background: In 1997, direct program supervision of 45 disease intervention specialists (DIS) was decentralized by transferring the supervision from the State to local health departments, mostly public health nurse supervisors. In doing so, two layers of management charged with program and DIS supervision, program quality control, evaluation, and consultation were eliminated. From 1997 to 1999, disease intervention indicators illustrated a decrease in disease intervention productivity.

Objective: To enhance STD/HIV Program activities and prevention effectiveness at both local health department and state level.

Methods: Using the Centers for Disease Control and Prevention’s Framework for Program Evaluation in Public Health as a model and modifying the Virginia Department of Health’s guidance for periodic formal evaluations previously used, Program Assessment and Review (PAAR) was created. PAARs are conducted as a means of comprehensively assessing STD/HIV program prevention efforts. Health departments selected for PAAR have been based on local requests, epidemiologic trends, and health department’s involvement in the syphilis elimination effort. Evaluation components include health care services, service availability and accessibility, resource utilization, quality of services, and surveillance. Upon completion of the PAAR, exit interviews are conducted with appropriate local health department staff to discuss findings and a written report is later provided consisting of observations and recommendations.

Results: PAARs have been conducted in four local health department sites. Deficiencies in management and supervision of disease intervention were a major program finding in all of the reviews.

Conclusions: PAAR has proven to be an effective comprehensive program evaluation model.

Implications for Programs/Policy: Evaluation findings can influence decisions regarding fiscal and human resource allocation.

Implications for Research: Virginia’s evaluation tools can be shared and compared to those from other states.

Contact Information: Theresa Henry / Phone no. 804-786-6267 / thenry@vdh.state.va.us