2004 STD Prevention Conference - Oral, Symposium and Workshop Abstracts - Tuesday
1Centers for Disease Control and Prevention, Atlanta, GA; 2University of Florida, Gainesville, FL; 3Johns Hopkins University, Baltimore, MD
Background: Repeat infections with bacterial STDs are relatively common and are associated with adverse sequelae. Individuals with repeat STDs account for a substantial proportion of those seeking care at public STD clinics and may be core transmitters. An improved understanding of factors underlying acquisition of repeat infections may assist in designing specialized and more successful prevention interventions.
Objectives: To describe the range of correlates, psychosocial, and contextual factors that underlie STD acquisition among adolescents and adults diagnosed with repeat bacterial STDs. To discuss possible interventions for repeat STDs that may be feasible to deliver in an STD clinic.
Content: The investigators will describe various studies that examine STD repeaters using diverse methodologies. The first presentation will provide retrospective clinic information on behavioral factors and clinician actions related to repeat STDs among previously undiagnosed adolescents. The second presentation will discuss the STD repeater as a core transmitter and provide examples of how locally obtained morbidity data can be useful to drive intervention and new research initiatives. The third presentation will present several brief case studies or profiles of adolescent STD repeaters to demonstrate the differences in these teens’ lives suggesting that any intervention would need to be individualized. The fourth presentation will describe themes contributing to STD acquisition among adult STD repeaters in a public STD clinic, present possible interventions related to each theme that could feasibly be delivered within the context of standard STD clinical services, and present interventions that would require additional community resources beyond the clinical setting.
Implications for Programs, Policy, and/or Research: This session will provide detailed information about STD repeaters that will allow STD programs to better understand this portion of the clinic population. Additionally, information on STD repeater intervention feasibility in an STD clinic will be useful to STD programs, clinic staff, and researchers.
Moderator: Jami S Leichliter, PhD
Repeat Infections Among Adolescents: Findings from a Philadelphia STD Clinic
Nicole Liddon, PhD
Repeat STIs and Core Transmitters
Kyle Bernstein, ScM
Johns Hopkins University, Baltimore
Life Story Narratives: Similarities and Differences in Adolescents Who Acquire Repeat STDs
Cheryl McGhan, MSN, CNM
University of Florida College of Nursing, Gainesville
Repeat STDs: Why Are So Many STD Clinic Patients Refractory to Clinic-based Interventions?
Emily J Erbelding, MD, MPH
Johns Hopkins University, Baltimore
Learning Objectives: By the end of this session, participants will be able to identify the correlates, psychosocial, and contextual factors that are related to repeat bacterial STDs. Participants will also understand the challenges in developing a prevention intervention for STD repeaters and identify possible interventions that may be feasible to deliver in an STD clinic.
Contact Information: Jami S Leichliter/Phone no. 1 404 639 1821/JLeichliter@cdc.gov
1Johns Hopkins School of Medicine, Baltimore, MD; 2Denver Public Health Department, Denver, CO
Background: Predictors of repeat gonorrhea (GC) or chlamydia (CT) have been difficult to identify. This failure may be due to individuals who engage in risk behaviors and have risky sex networks at their initial infection continue to engage in these behaviors and remain in the same network. However, if individuals changed sexual networks subsequent to initial infection, the risks for repeat infection might decrease.
Objectives: To determine whether decrease in the percentage of sex partners who are within the index’s social network is associated with decrease risk for repeat GC and/or CT.
Methods: Asymptomatic men, 12-21 years old, infected with CT and/or GC were interviewed about sex partners in past two months. One and 4 months later, participants were interviewed about interim sex partners and tested for GC and CT. We defined the sex partner as within the social network if met through close friends, went to same school, more than _ of friends knew, friends had sex with partner, or partner knew any of other of the sex partners. Percentage of sex partners within social network was calculated as number of sex partners within social network / number of total sex partners.
Results: 109 participants completed 216 follow-up interviews. At 71 (33%) interviews, participants reported having sex since previous visit and 30 (42%) had at least one new sex partner. The positivity rate for GC and/or CT was 10%. Having a new sex partner was not associated with repeat gonorrhea or chlamydia (p>0.1). Among participants reported having a new sex partner, none (0/13) with decreased overlap between networks were infected while 29% (5/17) with unchanged or increased overlap were infected (p<0.05).
Conclusion: Having a new partner outside social network is protective for repeat infection.
Implications: Network-level interventions may be the most effective strategy for reducing rates of repeat GC and CT.
Learning Objective: By the end of this presentation, participants will be able to list factors associated with repeat GC and CT infection.
Contact Information: Jonathan M Ellenfirstname.lastname@example.org
North Carolina HIV/STD Prevention and Care Branch, Black Mountain, NC
Background: The current “Syphilis Elimination: History in the Making” plan calls for combining “intensified traditional approaches with innovative approaches” to achieve its goal of elimination of syphilis. Five strategies are identified and expanded.
Objective: To explore the early syphilis intervention work of Dr. Ben Reitman, “The Clap Doctor” and Edward Bernays, “The Father of Spin,” and the Public Health Services’ syphilis control effort initiated at the 1936 National Conference on Venereal Disease Control Work as they illuminate current syphilis elimination activities and issues.
Methods: Research used biographies of Reitman and Bernays, contemporary assessments of their work, and histories of early syphilis programs. Information was compared to strategies and concepts in the 1999 Syphilis Elimination plan.
Results: Dr. Reitman, rooted Chicago’s radical and poor community, established the first “venereal disease” clinic there in 1917. He began clinics in jails, treated prostitutes in brothels, and began a “CBO” as part of the Chicago Syphilis Project where he also worked. Reitman argued for teaching “prophylaxis”/prevention in the local climate of “abstinence only” and facilitated services and surveillance in disenfranchised communities. Edward Bernays, the “father of public relations,” began (1912) his career promoting the play “Damaged Goods” about a man with syphilis. To overcome resistance, he gathered prominent civic, business and church leaders to support open discussion. His success led to productions for high federal officials. Much of the language, strategies and programs of Surgeon General Parren’s national syphilis control “war” parallel the strategies of the 1999 syphilis elimination plan.
Conclusions: Understanding historical precedent can focus “traditional” approaches and sharpen “innovative” approaches for greater success.
Implications for Programs, Policy, and/or Research: Greater knowledge of what worked in past syphilis control efforts may result in an altered assessment of traditional and innovative approaches.
Learning Objectives: Participants will be able to describe syphilis control programs and issues of the early 1900s.
Contact Information: Bill Petz/Phone no. 1 828 669 3350/Bill.Petz@ncmail.net
Johns Hopkins University, Baltimore, MD
Background: Previous research has emphasized the importance of the biomedical model, first Ehrlich’s “magic bullet” followed by penicillin, in the campaign to control STDs during WWII. This paper re-examines the strategies undertaken by public health officials during WWII in order to determine what policies were adopted during this period, regarded as one of the “successes” of twentieth century STD control.
Objectives: To evaluate the successes and failures of one of the largest STD control efforts in US history
Methods: The records of the US Public Health Service (USPHS) at the National Archives were read, along with relevant publications from the 1940s
Results: Despite initial conflict with the Armed Forces, by 1943 the USPHS and the Armed Forces cooperated in an effort to reduce the prevalence and incidence of STDs among soldiers as well as the civilian population. The result was an STD control program that integrated prevention, treatment, surveillance, research and education. Rapid Treatment Centers (RTCs), primarily for the treatment of women, were opened as early as 1942. The rationale behind these centers was that civilian women served as a reservoir of infection for soldiers. Early publicity focused on how the RTCs would treat prostitutes, a strategy that undermined the effectiveness of the centers in reaching out to infected women not engaged in prostitution. Because the American public regarded STDs primarily as a problem of prostitution, USPHS officials expressed concern that public support for the backbone of the STD control program—contact tracing and case holding—could be undermined.
Conclusions: Control of STDs during WWII cannot be attributed to the introduction of penicillin therapy alone, but to the combination of case finding, education, prophylaxis, and surveillance with treatment.
Implications for Programs, Policy, and/or Research: Comprehensive STD control programs are more effective than treatment alone.
Learning Objectives: By the end of the session, participants will be familiar with the range of programs adopted by the USPHS to control STDs during WWII.
Contact Information: Laura McGough/Phone no. 1 443 287 3492
1Centers for Disease Control and Prevention (CDC), Atlanta, GA, US; 2Denver Public Health, Denver, CO, US. 3San Francisco Department of Public Health, San Francisco, CA, US; 4Johns Hopkins University School of Medicine, Baltimore, MD, US
Background: Reinfection rates are an important measure of the effectiveness of interventions intended to interrupt disease transmission. There have been no previous longitudinal studies of reinfection among men treated for Chlamydia trachomatis (Ct) infection.
Objective: To measure the rate and predictors of repeat Ct infection in men.
Methods: Ct-infected men identified by screening at various venues in Baltimore, Denver, and San Francisco were treated, had partner elicitation interviews conducted, and were offered enrollment in a longitudinal study of repeat Ct infection. At 1 and 4-month follow up visits, men completed questions on demographics and sexual health and were tested for Ct infection using nucleic acid amplification testing (NAAT). Overall and venuespecific repeat infection rates were calculated for all three cities. Men with at least one repeat infection were compared to men without repeat infection using Chi square test.
Results: Three hundred and sixty-one men were recruited into the study, and 271 (75%) had at least one follow-up visit. Overall, the repeat infection rate was 11% (Denver 11%; Baltimore 12%; San Francisco 11%). Low educational attainment (less than high school education), low income, and history of sexually transmitted disease were associated with Ct repeat infection. Men reported a median of 2 partners during the study (range 0-8), and 40% of men had new partners during the study. Nine percent of men without a new partner had repeat infection compared with 14% of men with new partners; this difference was not statistically significant.
Implications for Programs, Policy and/or Research: Information on rate and predictors of repeat Ct infection in men will help identify specific strategies to prevent Ct infection in men and women. This information will be used for cost-effectiveness evaluations of male Ct screening, and to support Ct screening programs and partner notification activities.
Measurable Learning Objectives: By the end of the session, participants will be able to describe the rate and predictors of Ct repeat infection in men
Contact Information Eileen Dunne, email@example.com
1Centers for Disease Control and Prevention, Atlanta, GA; 2San Francisco Department of Public Health, San Francisco, CA; 3Johns Hopkins University School of Medicine, Baltimore, MD; 4University of Washington, Seattle, WA; 5Denver Public Health, Denver, CO
Background: Screening asymptomatic men for Chlamydia trachomatis (Ct) using urine-based testing may be a cost-effective way of preventing PID and its sequelae compared to the alternative of not screening men. However, guidance for state and local STD control programs should compare the costs and benefits of male screening against other interventions to prevent PID.
Objectives: To compare the cost-effectiveness of screening men for Ct to prevent PID in women with screening women directly, and to describe key considerations in determining whether starting or continuing a male screening program represents an optimal use of Ct prevention resources.
Methods: Using data from a male screening demonstration project (35,000 men screened for Ct between 2001-2003), we conducted a cost-effectiveness analysis comparing screening men for Ct with two partner management strategies (partner notification (PN) and patient referral) to screening women with patient referral for partners. The primary outcome was cases of PID prevented. Variables not collected as part of the demonstration project were obtained from the literature. We conducted sensitivity analyses on key variables.
Results: If the Ct prevalence among men screened is markedly higher than that of women who can potentially be screened, (e.g., 7.4% in men vs. 2% in women), then screening the men and providing PN can prevent more PID cases than screening women. However, the net program cost will be higher. Adding PN to a male screening program is generally cost-effective compared to relying on patient referral.
Conclusions: Screening men for Ct can be an effective intervention to prevent PID compared to screening women if the prevalence among men to be screened is substantially higher than in women who can be screened. Screening men is generally more costly than screening women.
Implications for Programs, Policy and/or Research: These findings will help STD control programs determine whether screening men may be a cost-effective adjunct to screening of women for PID prevention.
Measurable Learning Objectives:
1. By the end of the session, participants will be able to describe the cost-effectiveness of male screening for chlamydia and the key elements that programs need to consider to implement male screening
2. By the end of the session, participants will be able to describe in what settings male screening for chlamydia infection could be effective and cost-effective
Contact Information: Thomas L. Gift / phone no. 1 404 639 1831; firstname.lastname@example.org
1University of North Carolina at Chapel Hill, School of Journalism and Mass Communication, Chapel Hill, NC; 2Centers for Disease Control and Prevention, Atlanta, GA; 3Rollins School of Public Health and Emory University School of Medicine
Background: Sexually transmitted diseases (STDs) are among the most common infections in the United States. Quantifying the human and economic costs of STDs in youth is important to inform discussions about risk reduction strategies and policy solutions with health policymakers. Previous estimates have not been available on the extent and cost of STDs in youth.
Objectives: (a) To present new findings on estimates of the health, social, and economic consequences of STDs in youth, 15-24 years old; and (b) To identify key discussion points appropriate for different audiences.
Methods: This session will present new national estimates on (1) the incidence and prevalence of specific STDS in youth, (2) the direct economic costs as a result of these STDs, and (3) the socio-ecological perspective for designing STD prevention strategies. These estimates will be translated into language useful for research or program settings.
Results: An estimated half of the18.8 million new STDs each year occur in youth ages 15-24. The associated medical costs will top $6.6 billion. Most STDs are undetected and undiagnosed. These infections have a considerable impact not only on individual health but also on the social and economic costs to communities. Some factors that help to reduce the risk of STDs include access to STD services and parental support. Missed opportunities for STD screening and for communication about risk reduction are undermining efforts to contain the spread of infection.
Conclusions: The “silent epidemic” of STDs in youth is costly in both human and financial terms for individuals and society. These costs can be reduced by concerted action to utilize the public health tools currently available.
Implications for Programs, Policy, and/or Research: Multiple levels of effort are needed to confront STDs in youth. Communicating the facts and figures lays the foundation for change.
Learning Objectives: At the end of this session, participants will be able to:
1. Identify the main findings from new research on the human, social, and economic costs of STDs in youth;
2. Describe the research findings in bullet points applicable for different audiences.
Contact information: Joan R. Cates, MPH/1 919 843 5793/JoanCates@unc.edu
1Centers for Disease Control and Prevention, Atlanta, GA; 2California STD Control Branch; 3Virginia Department of Health, Richmond, VA; 4Washington State Department of Health, Olympia, WA; 5Johns Hopkins University School of Medicine, Baltimore, MD
Background and Rationale: Since 1998, CDC has funded the OASIS Project (Outcomes Assessment through Systems of Integrated Surveillance) to promote the integrated interpretation and use of surveillance data to improve planning and evaluation of STD programs. Representatives from the nine sites currently participating in OASIS will present their experiences with the OASIS Project and discuss the value of different methods of data collection and analysis for guiding STD program activities.
Objectives: To discuss the utility of matching databases, geocoding and mapping, and enhanced surveillance for STD program activities.
Content: The panel will discuss methods of matching data from different sources such as STD, HIV, and vital statistics databases, and present examples of useful applications for matched data. We will provide an overview of basic principles of geocoding, practical tools, and ways in which geocoding and mapping can be used in planning STD program activities. We will review the different domains of information that can be collected to enhance STD surveillance (i.e. geographic, behavioral, treatment, laboratory data). We will also discuss the challenges and advantages of implementing enhanced gonorrhea surveillance from a programmatic perspective, using examples from several OASIS sites.We will conclude with a discussion of how these methods have been used by one site to direct STD program activities, including STD screening using mobile vans, rapid syphilis response efforts, and identification of core populations at increased risk of gonorrhea transmission.
Implications for Programs, Policy and/or Research: This symposium is designed to provide STD prevention program managers and staff with practical information on novel ways to use existing data and to collect additional information useful in guiding program activities.
Lori Newman, MD
CDC, Atlanta, GA
Panelists: Michael Samuel, DrPH
California STD Control Branch, Berkeley, CA
Virginia Department of Health, Richmond, VA
Washington State Department of Health, Olympia, WA
Johns Hopkins University School of Medicine, Baltimore, MD
Learning Objectives: By the end of the session, participants will be able to discuss how matching databases, geocoding and mapping, enhanced surveillance data, and other analytic techniques can be used to guide their local STD program activities.
Contact Information: Lori Newman/Phone no. 1 404 639 email@example.com
1STD Control Branch, California DHS, Berkeley, CA; 2Center for AIDS Prevention Studies, UCSF, San Francisco, CA; 3Tulane University, New Orleans, LA; 4STD Program, Department of Health Services, Los Angeles, CA; 5AIDS Project Los Angeles, Los Angeles, CA; 6University of Washington, Seattle, WA
Background and Rationale: Bathhouses and sex clubs continue to attract many gay men and other MSM. Few data have been available to inform program and policy to reduce STD/HIV transmission among men who attend them.
Objectives: (1) To present data from three west coast studies regarding risk in bathhouses and sex clubs. (2) To identify how programs are using data, and in the absence of program and policy evaluation, to discuss which programs and policies may reduce transmission amongst patrons.
Content: Researchers conducted exit surveys of a probability sample of men (N=440; 62% response rate) as they left a single northern California club during a 5-week period in 2001 regarding their sexual activity, with emphasis on behavior while at the club. Additionally, participants were asked about whether they’d seen testing in the club, as well as about their HIV/STD testing history. In Los Angeles County, a cross-sectional needs assessment survey was administered to 150 patrons of 8 commercial sex using a venue-based sampling strategy. Outcome indicators include unprotected anal intercourse, communication about safer sex, and receptivity to HIV/STD services in the commercial sex environments. Seattle researchers completed HIV rapid testing on 437 patrons in a randomized trial of different testing strategies (standard blood, oral fluid, and rapid blood). Data revealed 25% had unprotected anal sex in the previous two months. Rapid testing in venues was highly acceptable by patrons and staff and resulted in higher numbers of tests being conducted at lower cost.
Implications for Programs, Policy, and/or Research: Participants will discuss what programmatic and policy options their jurisdictions are making based on available data; what other data would be needed to inform policies; and in the absence of data, what theories and values are being considered to support different interventions. Participants will discuss respective roles of researchers, CBOs, venue owners, and public health departments.
STD Control Branch, California DHS, Berkeley, CA
Center for AIDS Prevention Studies, UCSF, San Francisco, CA
Tulane University, New Orleans, LA
STD Program, Department of Health Services, Los Angeles,
CA C Cadabes
AIDS Project Los Angeles, Los Angeles, CA
AIDS Project Los Angeles, Los Angeles,
CA F Spielberg
University of Washington, Seattle, WA
1. By the end of this session, participants will understand the levels of risk behavior in several different types of bathhouses and sex clubs
2. By the end of this session, participants will learn what additional data, theories, and concepts may be useful to inform programs and policy options aimed at reducing transmission among bathhouse/sex club patrons
Contact Information: Dan Wohlfeilerfirstname.lastname@example.org
B05 The Prevention and Management of Sexually Transmitted Diseases in Persons Living with HIV/AIDS: A Training Developed by the Eastern Geographic Quadrant of the National Network of STD/HIV Prevention Training Centers (PTCs)
1Infectious Diseases Unit, University of Rochester, Rochester, New York; 2Division of STD Prevention, State Laboratory Institute, Boston, Massachusetts; 3STD Program, New York State Department of Health, Albany, New York
Background and Rationale: Prevention services for persons living with HIV/AIDS (PLWHA) have become a public health priority as the incidence of HIV has not decreased for several years and the incidence of STDs is increasing in this population. An integrated approach to STD/HIV prevention for PLWHA requires a combination of clinical services, behavioral interventions, and partner counseling services. The PTCs in the Eastern Geographic Quadrant (EGQ) of the United States serve federal Regions I, II, and III ; areas which are currently experiencing this national trend. The PTCs are a collaboration of universities and public health departments which provide training in clinical management of STDs, science-based prevention interventions to influence behavior change, and STD/HIV partner services. In response to the emerging need for prevention for positives, the EGQ PTCs collaborated to develop a training curriculum, “The Prevention and Management of Sexually Transmitted Diseases in Persons Living with HIV/AIDS”.
Purpose: To present a workshop based on this curriculum along with evaluation data from a training of trainers (TOT) provided to the AIDS Education and Training Centers of New England. Copies of the curriculum will be distributed.
Methods: Representatives of the EGQ PTCs will provide training on each of the four sections; clinical prevention services, management of STDs, behavioral counseling, and partner counseling. Methods will include didactic presentation, case studies and a demonstration video, with opportunities for discussion and skills building.
Measurable Learning Objectives: At the end of the workshop, participants will be able to:
1. Explain the inter-relationships between STDs and HIV
2. Describe the STD screeningand treatment recommendations for PLWHA.
3. Assess the patient’s readiness for sexual, substance use, and health care seeking behavior change and use a behavioral counseling strategy that matches the patient’s readiness
4. Describe strategies for partner counseling
Contact Information: Patricia Coury-Doniger/Phone no. 1 585 464 5928
1Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene; 2Epidemiology Program Office, Centers for Disease Control and Prevention; 3Bureau of Sexually Transmitted Disease Prevention and Control, New York City Department of Health and Mental Hygiene; 4Division of STD Prevention, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention
Background: Men who have sex with men (MSM) are at high risk of enteric sexually-transmitted infections (STI) from oral-anal sexual practices. The magnitude and trends of enteric STI in MSM should be characterized to inform prevention messages.
Objectives: To describe and compare trends in incidence of enteric infections by proportion of MSM.
Methods: Incidence rates (IR) of four reportable enteric infections (amebiasis, cryptosporidiosis, giardiasis and hepatitis A) were calculated for adult males (>18 years) in all NYC neighborhoods using surveillance reports and population estimates from the U.S. census. Sexual risk factors are not collected with reports of enteric infections, so neighborhood-level MSM proportions were estimated using self-reported sexual behavior collected for a citywide telephone survey. The ratios of IR of enteric infections in neighborhoods with >15% MSM were calculated relative to the IR in neighborhoods with <15% MSM and the associations of proportion MSM and enteric infection were quantified using Poisson regression.
Results: The IR was significantly higher in neighborhoods with >15% MSM compared with neighborhoods with <15% MSM for each year (2002 Rate Ratios [RRs]) for amebiasis (RR: 4.5, 95% CI = 3.6-5.6) cryptosporidiosis (RR: 4.9, 95% CI = 3.3-7.4), giardiasis (RR: 4.3, 95% CI = 3.7-5.0); and hepatitis A, (RR: 1.9, 95% CI = 1.4-2.5). Controlling for year of infection, counts for each infection increased >15% with each percent increase in proportion of MSM (Relative IRs: amebiasis: 1.18, cryptosporidiosis: 1.14, giardiasis: 1.14, hepatitis A: 1.13; all p<0.001).
Conclusions: Incidence rates of enteric infection were higher in neighborhoods with higher proportions of MSM. Overall, the relative incidence rates of enteric infections in high MSM neighborhoods have decreased slightly in recent years, however, enteric infections continue to affect MSM disproportionately.
Implications for Programs, Policy, and/or Research: Messages about prevention of enteric infections should be integrated into STD prevention messages for MSM to address this excess risk.
Learning Objectives: By the end of this session, the participants will be able to describe the trends in four enteric infections in communities with variable proportions of MSM in NYC.
Contact information: Melissa A. Marx /Phone no. 1 212 442 email@example.com
1RAND, Santa Monica, CA; 2Charles Drew University, Los Angeles, CA; 3Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA; 4Louisiana State University Health Sciences Center, New Orleans, LA; 5Los Angeles County STD Program, Los Angeles, CA; 6University of California – Los Angeles, Los Angeles, CA
Background: In the 1992 civil unrest in Los Angeles over $1 billion in property damage occurred and 270 alcohol outlets surrendered their licenses due to arson and vandalism. Prior studies suggest that gonorrhea is associated both with alcohol outlets and deteriorated neighborhoods. However, these studies have all been cross-sectional so causality cannot be established. The 1992 civil unrest provides a natural experiment in which to test whether these associations hold up over time.
Objectives: To investigate whether a decline in alcohol outlets was associated with a decrease in gonorrhea rates, and whether an increase in neighborhood deterioration was associated with an increase in gonorrhea rates.
Methods: We geocoded all reported gonorrhea cases from 1988-2000 in Los Angeles County and the addresses of all alcohol outlets licensed annually from the California Alcohol Beverage Control Agency between 1991 and 2000. We also identified alcohol licenses that were surrendered in May, 1992. We geocoded all damaged properties reported to the State Insurance Commission as a result of the riots.We ran preliminary models using ordinary least-squared regressions to predict post-riot gonorrhea rates after controlling for pre-riot gonorrhea rates, number of off-sale outlets, sociodemographic factors, race and ethnicity.We will also examine models such as the Poisson and negative binomial that are a better fit for these data, as well as apply spatial models to incorporate the geographic clustering in the data.
Results: Preliminary analysis with ordinary least-squares regression models indicate that increases in property damage were associated with an increase in gonorrhea rates (p<.01), roughly accounting for about 2.4 cases/100,000 persons per census tract.
Conclusions: Neighborhood physical conditions appear to have a significant, though small effect on gonorrhea rates.
Implications for Programs, Policy, and/or Research: Land use, urban planning and zoning issues have an impact on health outcomes that is not readily apparent. Public health professionals should conduct additional investigations as to how living conditions impact health and health behaviors.
Learning Objectives: By the end of this session, participants may be able to describe why “broken windows” and alcohol outlets can facilitate transmission of gonorrhea.
Contact Information: Deborah Cohenfirstname.lastname@example.org
1University of Arizona, Tucson AZ; 2School of Social Work, Arizona State University, Tucson, AZ
Background: Hispanics are the fastest growing minority group in the US (57.9% since 1990) and are young (35.7% under age 18). Hispanic adolescents are at greater risk for STDs/HIV than non-Hispanic whites. However, Hispanic ethnicity is complex, encompassing different racial, language, and immigrant (or non-immigrant) groups.
Objectives: We report Phase I data from a five-year study of adolescent risky sexual decision, focusing on the impact of Hispanic ethnicity.
Methods: In Phase I, 255 adolescents age 14-19 responded to a survey questionnaire which included: (1) self-reported ethnicity; (2) subjects’ birth country, parents’ and grandparents’ birth countries; (3) language-use scales (in general, with family or friends, and media); (4) religious affiliation; (5) level of risk for pregnancy and STDs/HIV (48% were sexually active).
Results: 45.5% were Mexican-American/Chicano (MA), and 75% of MA teens were born in the US, compared to 50% of mothers and 25% of fathers. 35% of foreignborn MA teens reported being sexually active versus 49% of teens born in the US. 46% of MA teens whose mothers were born outside the US were sexually active versus 54% of those whose mothers were US born. 47.1% of MA teens who “almost always spoke English” reported being sexually active versus 0% who “almost never spoke English.” 39% of MA Catholics reported being sexually active compared with 53% of Anglo Catholics. Sexual risk behavior varied according to selfreported ethnicity and within Mexican-American ethnicity based on location of birth, location of parents’ birth, English language use, and religious affiliation.
Conclusions: Hispanic ethnicity is multifaceted; some differences are greater among Hispanics than between Hispanics and other groups. Therefore, differentiated measures of Hispanic ethnicity are essential.
Implications for Programs, Policy, and/or Research: Accurate measures of Hispanic ethnicity are necessary in order to appropriately target STD/HIV interventions and prevention messages.
Learning Objectives: By the end of this session, participants will be able to identify the importance of differentiated measures of Hispanic ethnicity and evaluate the implications for STD/HIV prevention messages.
Contact Information: Mary B Adam/Phone no. 1 520 626 email@example.com
The University of Texas Health Science Center, San Antonio, TX
Background: Research has identified the need for modification of standardized STD behavioral interventions for minority women with a history of sexual or physical abuse.
Objective: The objective was to obtain qualitative data to provide more in-depth understanding of the configuration of psychosocial and situational factors associated with high-risk sexual behavior, substance use, health seeking behavior, contraceptive use and treatment compliance among minority women with STD and sexual or physical abuse history.
Methods: Participants included Mexican-and African- American women, aged 15-45 years enrolled in a randomized study of behavioral intervention to reduce STD recurrence. Individual, open-ended, semi-structured interviews lasting approximately 30-45 minutes were conducted with 513 participants. These interviews focused on participants’ perceptions of their sexual risk, sexual relationships, individual histories of sexual, physical or psychological abuse and factors influencing their sexual behaviors. Additionally, participants were asked about health-seeking behavior, contraceptive use and STD treatment compliance.
Results: Key categories and themes from qualitative data provided the context for interpretation of the data. The interview data was searched for elaboration of associations found in prior statistical analysis. The words of participants were used to corroborate, refute, substantiate and supplement previous quantitative results, comparing responses by history of abuse. Examining results of survey data in context of participants’ own words provided alternative explanations and conclusions. Various themes included “Why women have sex?”, “Ex-sex,” “My Baby’s Dad,” “Why a woman stays with a man after he has given her a STD?”, “I didn’t tell my man about the STD,” “I don’t think I can get pregnant,” and “What do men (women) want from a woman (man).”
Conclusions: Context for modification of risk-reduction interventions specifically designed for abused minority women to realize a reduction in sexual risk behaviors, abuse and STD re-infection rates is identified.
Implications for Programs, Policy and/or Research: Incorporation of results to modify existing STD prevention programs.
Learning Objective: To provide more in-depth understanding of the configuration of psychosocial and situational factors associated with high-risk sexual behavior, substance use, health seeking behavior, contraceptive use and treatment compliance among minority women with STD and sexual or physical abuse history.
1Centers for Disease Control and Prevention, Atlanta, GA; 2University of Washington, Seattle, WA
Background: Since 1998, the gonorrhea rate (GCR) in the United States has decreased slightly, yet the GCR among African-Americans remains 27 times that among non- Hispanic whites.
Objectives: To describe population characteristic associated with gonorrhea case rates derived from the National Electronic Telecommunications Surveillance System from 2000 to 2002.
Methods: We calculated Pearson correlation coefficients between the GCR and county-level characteristics from the US Census, grouped into categories of poverty, housing, crime, education and geographic indicators, before and after adjusting for the percentage of the population that was black. We log-transformed data which were not normally distributed and report associations with r > 0.4 and p < 0.0001.
Results: From 2000 through 2002, among the 3141 US counties, the average GCR was 127.2 cases per 100,000 population (range 0 to 921.3). The overall US rate (per 100,000) was 21.7 for whites, 587.8 for blacks, 51.9 for Hispanics, and 45.3 for Asian/others. Unadjusted, county characteristics associated with the GCR were the percent of the population that was black (r=0.796), being in a Southern state (r=0.507), persons per square mile (r=0.479), the percent of those under age 18 below poverty (r=.401). After adjusting for race, the GCR was weakly associated with percent of households renter occupied (r=0.231) and the percent of those under age 18 below poverty (r=0.204). However, the GCR was no longer associated with geographic location or population density.
Conclusions: Accounting for racial distribution demonstrates that county characteristics relating to housing and poverty may be associated with a higher GCR. These associations are obscured when only crude rates are evaluated.
Implications for Programs, Policy, and/or Research: Better characterization of community characteristics associated with a higher GCR may allow local jurisdictions to more effectively target screening and inform national policy for changes in screening recommendations.
Learning Objectives: By the end of this presentation, the participants will be able to summarize racial and geographic disparities in the distribution of gonorrhea cases in the United States and discuss county-level characteristics associated with increased rates of gonorrhea.
Contact Information: Michael E Greenberg/Phone no. 1 404 639 firstname.lastname@example.org
1California Department of Health Services, STD Control Branch, Berkeley, CA; 2Butte County Department of Public Health, Oroville, CA
Background: In July of 2003, the California STD Control Branch was notified of an increase in reported cases of gonorrhea in Butte County. Reported cases increased in the Oroville area from an average of 9 per year from 1998 to 2002 (with only 2 in 2002), to 83 cases in 2003 (as of October 6). Gonorrhea increases of this magnitude are unusual and rapid investigation and identification of key facilitating factors are important for control.
Objectives: To determine factors associated with a gonorrhea outbreak and to analyze the sexual network structure among case-patients.
Methods: Gonorrhea case-patients and named sexual contacts reported to the Butte County Health Department in 2003 were interviewed. A standardized questionnaire was used to collected demographic, drug use, venue attendance and sexual risk behavior data. Sexual contacts were offered gonorrhea testing and treatment.
Results: Among the 83 cases, 50 (60%) were female and 33 (40%) were male. The median age was 24 (range 5-43) among females and 30 (range 17-58) among males. The median age among males decreased substantially from March-May to June-October from 36 to 27 (p=0.003). Among females 62% were white, 4% African- American, and 10% Latino; among males 46% were white, 27% African-American, and 9% Latino (p=0.03 for race/ethnic difference by gender). Preliminary analysis of interviewed case-patients indicated that 46% of casepatients reported drug use (46% alcohol, 35% marijuana, 14% methamphetamine); 54% were unemployed; and 35% had sexual partners of a different race than their own. Of the 60% of case-patients that reported having medical insurance, 82% were covered by publiclyfunded insurance programs. At least two key persons in this outbreak have been identified, and further network analysis is underway.
Conclusions: Many cases in this large outbreak were unemployed, older than typical gonorrhea cases, and covered by publicly-funded insurance. Case-patients were noted to reside in communities known for drug use, prostitution, neglected homes and abandoned cars. Neighborhood-targeted screening and treatment of individuals in identified sexual networks was used for outbreak control efforts.
Implications for Programs, Policy and/or Research: STD outbreak control and prevention strategies should use knowledge of existing sexual networks to develop outreach efforts.
Learning Objectives: By the end of the session, participants will be able to name three risk factors associated with gonorrhea transmission and the usefulness of network analyses in an outbreak setting.
Contact Information: Michael C Samuel/Phone no. 1 510 540 email@example.com
1Thomas Jefferson University, Philadelphia, PA; 2Garrity Health Consulting & Training, Baltimore, MD; 3Family Health Council of Central Pennsylvania, Camp Hill, PA
Background and Rationale: STI/HIV infection rates have increased rapidly among US women, with heterosexual contact posing the greatest risk. Interventions aimed at condom use have a particular relevance for STI/ HIV prevention in women. Most condom-related counseling focuses on technical instruction. Yet research has shown that the major barriers to condom use are interpersonal (eg, difficulty with discussing condoms with partners). The present study evaluated a Social Skill Counseling (SSC) protocol, targeting the social skills needed to negotiate condom use with a sexual partner. The protocol was tested in a randomized control-group design in four clinics with 1,407 White and African-American women aged 12 to 48 years (mean age= 20). It proved superior to usual care in improving intentions to use condoms, condom acceptance, and use at 12-month follow-up, especially among teenaged clients.
Purpose: This workshop will present the Social Skill Counseling protocol.
Methods: (a) The counselor elicits the client’s experience with condoms to surface obstacles to condom use. If a client reports no current or anticipated obstacles, the counselor describes typical obstacles to condom use: partner refusal, challenge of talking to partner about condoms, interruption of intimacy, trust issues raised between partners, decrease or change in sensation, impact on sexual functioning, lack of confidence in condom reliability, lack of availability. (b) The counselor next helps the client to develop her own plan to overcome obstacles by asking open-ended questions (“What could you say or do to get your partner to use a condom?”). When a client is unable to create her own plan, the counselor offers suggestions in a third-person approach and then assesses the client’s sense of the feasibility of that approach. The counselor expresses support for any plan or expression of positive intention regarding condom. All clients received a handout listing the common obstacles and suggested strategies.
Learning Objectives: By the end of this session, participants will be acquainted with:
1. The major barriers to condom use reported by female family planning clinic clients
2. Key components of a social skills training approach to condom counseling
Contact Information: Laraine Winter/Phone no. 1 215 503
1STAND, Inc, Atlanta, GA; 2Georgia State University, Atlanta, GA; 3Centers for Disease Control and Prevention, Atlanta, GA
Background and Rationale: The literature on the STD risk associated with being incarcerated is extensive. Much of this literature focuses on HIV risk or STD screening among men or women in prison or post-release from prison. Far less literature focuses on the STD risk associated with jail incarceration particularly that of men newly released from jail. In addition, few evidencebased interventions for post-incarceration males are led by a community-based organization. To impact the sexual risk behavior of men newly released from jail, it is important to examine and address other issues that may contribute to risk behavior, or its reduction. The MISTERS study is an on-going randomized control trial of a comprehensive intervention that targets men who are newly released from jail and have a history of drug use
Objectives: To describe the challenges in working with this population and the strategies utilized to address these issues.
Content: Investigators will describe the development, implementation and progress of this study including: 1) collaboration between health, legal, and community agencies, 2) issues related to recruitment and retention, and 3) issues related to conducting a group intervention with men who are newly released from jail and who have multiple life challenges. Panelists will also discuss issues that community-based service organizations need to consider when collaborating on a research project. Suggestions for future research will also be discussed.
Implications for Programs, Policy, and/or Research: STD Programs may use the information presented to guide their collaboration with community-based organizations and jail programs in providing interventions.
MS STAND Inc, Atlanta, GA
Panelists: Charles Sperling, MS
Antonya Pierce, MPH
Tricia Hall, MPH
STAND Inc, Atlanta, GA
1. By the end of the session, participants will be able to identify challenges in intervening with this population
2. By the end of the session, participants will be able to identify strategies to maximize the efficacy of interventions with men who have a drug-use and jailincarceration history
Contact Information: Charles Sperling/Phone no. 1 404 299 firstname.lastname@example.org
1Center for AIDS & STD, University of Washington and Public Health – Seattle & King County STD Program, Seattle, WA; 2Division of STD Prevention, Center for Disease Control & Prevention, Atlanta, GA
Background: National data on the effectiveness of HIV partner notification (PN) have not been reported and uncertainty exists about the outcomes of public health PN programs.
Objectives: To define the coverage and outcomes of HIV PN programs in the United States.
Methods: Health departments in metropolitan areas >500,000 that reported more than 200 cases of AIDS in 2001 were sent written surveys; incomplete or unclear responses were resolved by telephone.
Results: Of 39 eligible health departments, 11 (28%) reported that they had no data on the number of persons receiving PN services or PN outcomes and 28 (72%) provided data for the study. A total of 6565 (32%) of 20,353 HIV cases among all jurisdictions were interviewed for PN; the median percentage interviewed was 55 (range 2%- 100%). Investigations were initiated on 6394 partners, of whom 1232 (19%) were previously known to be HIV positive; 612 (9.6%) were newly diagnosed with HIV; 2037 (31.9%) tested HIV negative; and 2513 (39.3%) were not notified, denied previous HIV diagnosis and refused HIV testing, or had no disposition recorded. Overall, the number of persons with HIV that health departments needed to interview (NNTI) to identify one new case of HIV was 13.8; the median NNTI was 13.4 (range 1-196). Areas with higher proportions of AIDS cases among MSM had higher NNTI (r=46, p=.01).
Conclusions: HIV PN programs in the U.S. have highly variable levels of coverage and success. Process outcomes suggest PN is successful in some jurisdictions, particularly those reporting fewer AIDS cases among MSM.
Implications for Programs, Policy and Research: HIV PN programs should be expanded. Better ongoing efforts are needed to assess, target, and evaluate HIV PN programs.
Learning Objectives: Participants will learn the current scope of the U.S. HIV PN system, the success of the system in identifying new cases of HIV and factors that appear to affect HIV PN success.
Contact Information: Matthew Golden/Phine no. 1 206 731 6829/
1Public Health – Seattle and King County, Seattle, WA; 2University of Washington, Seattle, WA
Background: HIV status disclosure is receiving increasing emphasis in Seattle area public health prevention efforts through encouraging negative men to ask partners about their HIV status and positive men to disclose prior to sex.
Objectives: To explore the use and mis-use of HIV status disclosure as a prevention tool among MSM, facilitators and barriers to discussing status, and behavior change after status disclosure.
Methods: Recently diagnosed HIV+ MSM and MSM who tested HIV- were recruited from Seattle-area public HIV testing sites between 6/02 and 8/03 as part of the ongoing Seattle Area MSM Study. The prevalence of HIV status disclosure was obtained from Audio Computer Administered Self-Interviews (ACASI). Content analysis of qualitative interviews obtained main reasons for and against asking about status and behavior change after status disclosure.
Results: Eighty-eight participants were included in this analysis, including 28 newly-diagnosed HIV+ and 60 HIVMSM. Median age was 33 and median number of recent sex partners was 5. Sixty-one percent discussed HIV status with their most recent anal sex partner; only 33% knew this partner’s status before sex. According to qualitative interviews, the status information was often distorted and/or ignored by the participant, leading to unprotected sex. Primary barriers to status discussion included sexual desire, lack of communication with anonymous partners, and doubting the veracity of disclosure. Primary facilitators included having the partner initiate discussion, developing a relationship with the partner, and having internal motivation and skills to ask.
Conclusions: In this analysis a minority of participants learned of their partners’ HIV statuses before sex. Among many, HIV status disclosure alone was not sufficient to affect sexual risk behaviors.
Implications for Programs: These preliminary results suggest that interventions using status disclosure should emphasize the potential for inaccurate negative disclosures and the importance of condom use regardless of the status disclosed.
Learning Objectives: By the end of this session participants will be able to identify how HIV status can be used and mis-used as an HIV prevention tool by HIV- MSM and identify ways to increase the effectiveness of status disclosure promotion in prevention efforts.
Contact Information: Rebecca Hutcheson/Phone no. 1 206 205 7357/ email@example.com
1University of California, Los Angeles, CA; 2University of Washington, Seattle, WA
Background: Continuing high incidence of STIs including HIV along the West Coast suggests HIV positive MSM may not disclose their HIV status prior to having unprotected sex with partners of unknown status.
Objectives: To identify themes around disclosure among MSM in LA and Seattle.
Methods: 55 MSM HIV positive MSM (24 in Seattle, 31 in LA) reporting recent STI or unprotected anal intercourse with serostatus discordant or unknown partners were recruited from STD clinics in Seattle and LA and underwent in depth interviews that were taperecorded, transcribed verbatim, coded and content analyzed for themes using Ethnograph.
Results: Ages ranged from 24-52 years (mean 39). Mean years since HIV diagnosis was 9 years and 6 years with one-third and one-half diagnosed in the past 5 years in LA and Seattle respectively. Most interviewed in LA (67%) and some (29%) in Seattle were minority. Themes around disclosure include MSM being more likely to disclose when having sex in a home, context of dating, when feelings for a partner, had a previous positive disclosure experience, or feel responsible for transmission. Nondisclosure themes included not being asked about HIV status, not having insertive anal intercourse, having bathhouse sex, anonymous partners, fearing of rejection, overcome by passion, and using methamphetamines. Many minority MSM in LA reported disclosing because of fear of legal prosecution. MSM reported disclosing indirectly by introducing condoms, asking for low risk sex, showing medications, not listing status online, and displaying HIV materials. Some MSM felt partners should ask for HIV status; many assumed if not asked partner must be positive.
Conclusions: Our findings suggest many HIV positive MSM either do not disclose or disclose HIV status indirectly and engage in high risk sex with partners with unknown serostatus, fueling incidence of STIs/HIV in Seattle and LA. Indirect ways to disclosure may offer promise.
Implications for Programs, Policy, and/or Research: Programs to encourage HIV positive MSM’s skills around disclosure are needed.
Learning Objectives: By the end of the session, participants will learn of themes around disclosure and not disclosure of HIV status among HIV positive MSM practicing risky sex.
Johns Hopkins University School of Medicine, Baltimore, MD
Background: Disclosure to a sex partner is an integral part of sexually transmitted infection (STI) counseling and is important in decreasing transmission. Self-efficacy has been demonstrated to be a significant predictor of partner notification. STI-related stigma has been shown to influence adolescent females reactions to disclosure of sexual behaviors to health care providers.
Objective: To assess the association among disclosure selfefficacy, perceived barriers to disclosure and STI-related stigma.
Methods: Cross-sectional data of 130 sexually experienced adolescent females participating in a larger on-going longitudinal study was analyzed to examine the associations of STI disclosure self-efficacy, perceived stigma of having a STI, and perceived barriers to sex partner notification.
Results: The participants ages ranged from 14-22 with a mean age of 19 years (SD=1.73). Self-efficacy and barriers were stratified by main and casual partners. Simple linear regression demonstrated greater perceived barriers of disclosure were associated with decreased disclosure self-efficacy across main and casual sex partners (b=1.28 main, b=0.73 casual; p<0.05). Simple linear regression demonstrated that greater stigma was associated with less disclosure self-efficacy for main sex partners (b=-0.38, p<0.05). Additionally, after controlling for age and stigma, greater perceived barriers were associated with a lower level of disclosure self-efficacy for both main and casual sex partners (b=1.07 main, b=0.72 casual; p<0.05).
Conclusions: In this study perceived barriers of disclosure were associated with disclosure self-efficacy for both main and casual sex partners. Not surprisingly, STIrelated stigma and its association with disclosure selfefficacy was statistically significant for main sex partners but not for casuals.
Implications for Programs, Policy, and/or Research: Understanding barriers to partner notification and the relationship between self-efficacy and barriers to disclosure may result in improved counseling. Continued research is needed to assess how interventions in improving self-efficacy, and lessening barriers and stigma can decrease STI rates.
Learning Objectives: By the end of this session participants will be able to describe the association of disclosure self-efficacy, perceived barriers to disclosure of a STI, and STI-related stigma.
Contact Information: Lisa M Lowery/Phone no. 1 410 955 firstname.lastname@example.org
Minnesota Department of Health, Minneapolis, MN
Background: The use of the Internet for meeting sexual partners has been strongly implicated in influencing rates of sexually transmitted infections. As a result, many public health programs are struggling with how to utilize the Internet as a tool for partner notification. Issues of confidentiality and security complicate the use of the Internet but should not supersede its importance as a tool to enhance HIV/STD Partner Services.
Objectives: To share practical information on using the Internet as a tool to enhance HIV/STD partner services.
Methods: Similar to other states, Minnesota has experienced an increase in syphilis cases among men who have sex with men whose only means of locating their partners was online. To address this issue, a procedure and Internet log were established in collaboration with IT and Human Resources to meet our need to locate individuals via the Internet, yet safeguard client confidentiality.
Results: Among a cluster of 176 individuals who were either infected or at risk for HIV, syphilis, gonorrhea, and/or chlamydia infection, 108 (61%) were confirmed to utilize the Internet to meet sexual partners. Of the 108 Internet users, 50 were only locatable via e-mail or screen name. Of those, 30 (60%) were contacted via email and responded to online partner notification efforts, 13 (26%) did not respond, and 7 (14%) were sent to other states for follow-up.
Conclusions: While public health agencies are suffering from decreasing resources, the Internet is not only a necessary but cost effective way of reaching partners.
Implications for Programs, Policy, and/or Research: Programs will receive information and tools with which to be able to develop or complete a protocol for partner notification via the Internet.
Learning Objectives: By the end of the session, participants will be able to identify and utilize tools to overcome barriers to utilize the Internet for partner notification.
Contact Information: Patti Constant/Phone no. 1 612 676 5593
Howard Brown Health Center, Chicago, IL
Background: As more men who have sex with men (MSM) seek sex partners online, it is increasingly important for Disease Intervention Specialists (DIS) to utilize the internet to identify and contact partners who have been exposed to a disease.
Objectives: To present a manual for partner notification (PN) on the Internet.
Methods: As part of a syphilis elimination grant, Howard Brown Health Center has its own staffed DIS position. This DIS initiated an online PN protocol to reach sex partners of original syphilis patients (OP). There are two primary focuses. First, on initiating PN through email, and, second, through chat rooms, such as gay.com and AOL. While an encounter with someone met online does not implicitly include a long-term commitment, nor the exchange of real names, many OPs do have enough identifying information to provide a DIS. Such information can include screen names, e-mail addresses, a physical description, age, etc…. In this project, screen names and e-mail addresses are used to PN. This type of disease intervention follows standard DIS regulatory guidelines for protecting confidentiality, anonymity of the original patient, and safety of all involved. When a DIS enters a chat room the philosophy and policy requires DIS to be non-harassing, non-solicitous, and sensitive to the person’s potential state-of-mind at all times.
Results: Since the inception of this protocol, all partners of the subset of eligible patients providing online contact information have been successfully referred into care, though this is a small sample and the data is preliminary. Some screen names given have enabled the linkage of cases between DIS.
Conclusion: PN online provides an effective tool for the benefit of public health.
Implications for programs: Any agency looking to develop better internet partner notification policies can use this as a guide.
Learning Objectives: By the end of this presentation, participants will be able to describe and understand how one program has implemented an Internet partner notification policy.
Contact Information: Andrew Delicata/ Phone no. 1 773 572 email@example.com