Sex work among people who inject drugs in England, Wales and Northern Ireland

Via:    http://www.nta.nhs.uk/uploads/sex-work-among-people-whoinject-drugs.ppt

Sex Work Regulation and Sexually Transmitted Infections in Tijuana, Mexico

While reducing the transmission of sexually transmitted infections is a common argument for regulating sex work, relatively little empirical evidence is available regarding the effectiveness of these policies. 

We investigate the effects of highly publicized sex work regulations introduced in 2005 in Tijuana, Mexico on the incidence of trichomoniasis. State-level, annual data for the 1995-2012 period are employed that include the incidence rates of trichomoniasis by age group and predictor variables. We find that the regulations led to a decrease in the incidence rate of trichomoniasis. Specifically, while our estimates are somewhat noisy, the all-ages incidence rate in the 2005-2012 period is roughly 37% lower than what is predicted by our synthetic control estimates and corresponds to approximately 800 fewer reported cases of trichomoniasis per year. 

We find that the decreases are especially pronounced for 15-24 and 25-44 age cohorts.

Purchase full article at:   http://goo.gl/CXN1CE

By:  Quast T1, Gonzalez F2.

• 1Health Policy and Management, College of Public Health, University of South Florida, Tampa, FL, USA.
• 2Economics and International Business, Sam Houston State University, Huntsville, TX, USA. 
• Health Econ. 2016 Mar 16. doi: 10.1002/hec.3339

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Thai Health Care Provider Knowledge of Neonatal Male Circumcision in Reducing Transmission of HIV & Other STIs

Background

Male circumcision (MC) reduces the risk of female-to-male transmission of HIV and other sexually transmitted infections (STIs). MC has not been practiced as a disease prevention measure in Thailand probably because of low recognition of its benefits among stakeholders. Neonatal male circumcision (NMC) is simpler, safer and cheaper than adult MC. This study aimed to assess Thai health care provider knowledge of benefits implementing NMC in Thailand.

Methods

Multi-stage sampling identified 16 government hospitals to represent various hospital sizes and regions of the country. Researchers administered a fixed choice questionnaire, developed by the research team based on a previous study, to physician administrators, practicing physicians, and nurses whose jobs involved NMC clinical procedures or oversight. The participants reviewed printed educational materials on the benefits of NMC during questionnaire completion. Data were analyzed using descriptive statistics, chi square tests, odds ratios, and logistic regression.

Results

One hundred thirty-three individuals participated in this quantitative study. Only 38 % of the participants agreed that NMC reduced the risk of sexual transmission of HIV while 65 % indicated that they knew that NMC prevented STIs. Most participants recognized the benefits of NMC on hygiene (96 %) as well as cancer prevention (74 %). Major concerns raised were potential trauma to the child, child rights and safety of NMC. After reviewing written information about the benefits of NMC, 59 % of the participants agreed that NMC should be offered in their hospital. Physicians and nurses who had previous experience with circumcising patients of all ages were more reluctant to have NMC performed in their hospital.

Conclusions

A clear policy advocating NMC, thorough preparation of health facilities, and staff training are needed before NMC could be used in Thailand as prevention strategy for HIV and other STIs.

Full article at:   http://goo.gl/PIvMcp

By: Kriengkrai Srithanaviboonchai^12*, Boonlure Pruenglampoo², Kanittha Thaikla², Namtip Srirak², Jiraporn Suwanteerangkul¹, Jiraporn Khorana¹, Richard M. Grimes³⁴, Deanna E. Grimes⁴⁵, Vipa Danthamrongkul⁶, Suchada Paileeklee⁷ and Uraiwan Pattanasutnyavong⁸

¹Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

²Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand

³Division of General Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA

⁴Baylor-UT Houston Center for AIDS Research, Houston, TX, USA

⁵School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, USA

⁶College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand

⁷Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

⁸Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand

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Sexual Partnership Patterns among South African Adolescent Girls Enrolled in STI Preventions Trial Network 068: Measurement Challenges and Implications for HIV/STI Transmission

Estimates of sexual partnership durations, gaps between partnerships, and overlaps across partnerships are important for understanding sexual partnership patterns and developing interventions to prevent transmission of HIV/sexually transmitted infections (STIs). However, a validated, optimal approach for estimating these parameters, particularly when partnerships are ongoing, has not been established.

We assessed 4 approaches for estimating partnership parameters using cross-sectional reports on dates of first and most recent sex and partnership status (ongoing or not) from 654 adolescent girls in rural South Africa. The first, commonly used, approach assumes all partnerships have ended, resulting in underestimated durations for ongoing partnerships. The second approach treats reportedly ongoing partnerships as right-censored, resulting in bias if partnership status is reported with error. We propose 2 "hybrid" approaches, which assign partnership status to reportedly ongoing partnerships based on how recently girls last had sex with their partner. We estimate partnership duration, gap length, and overlap length under each approach using Kaplan-Meier methods with a robust variance estimator.

Median partnership duration and overlap length varied considerably across approaches (from 368 to 1024 days and 168 to 409 days, respectively), but gap length was stable. Lifetime prevalence of concurrency ranged from 28% to 33%, and at least half of gap lengths were shorter than 6 months, suggesting considerable potential for HIV/STI transmission.

Estimates of partnership duration and overlap lengths are highly dependent on measurement approach. Understanding the effect of different approaches on estimates is critical for interpreting partnership data and using estimates to predict HIV/STI transmission rates.

Purchase full article at: http://goo.gl/4wMczx

By: Nguyen NL1, Powers KA, Hughes JP, MacPhail CL, Piwowar-Manning E, Patel EU, Gomez-Olive FX, Kahn K, Pettifor AE.

• 1From the *Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; †Department of Biostatistics, University of Washington, Seattle, WA; ‡University of New England, Armidale, New South Wales, Australia; §Department of Pathology, Johns Hopkins University, Baltimore, MD; ¶National Institutes of Health, Bethesda, MD; and ∥MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Witwatersrand, South Africa.  

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Feasible, Efficient and Necessary, without Exception – Working with Sex Workers Interrupts HIV/STI Transmission and Brings Treatment to Many in Need

High rates of partner change in sex work—whether in professional, ‘transactional’ or other context—disproportionately drive transmission of HIV and other sexually transmitted infections. Several countries in Asia have demonstrated that reducing transmission in sex work can reverse established epidemics among sex workers, their clients and the general population. Experience and emerging research from Africa reaffirms unprotected sex work to be a key driver of sexual transmission in different contexts and regardless of stage or classification of HIV epidemic. This validation of the epidemiology behind sexual transmission carries an urgent imperative to realign prevention resources and scale up effective targeted interventions in sex work settings, and, given declining HIV resources, to do so efficiently. Eighteen articles in this issue highlight the importance and feasibility of such interventions under four themes: 1) epidemiology, data needs and modelling of sex work in generalised epidemics; 2) implementation science addressing practical aspects of intervention scale-up; 3) community mobilisation and 4) the treatment cascade for sex workers living with HIV.

Decades of empirical evidence, extended by analyses in this collection, argue that protecting sex work is, without exception, feasible and necessary for controlling HIV/STI epidemics. In addition, the disproportionate burden of HIV borne by sex workers calls for facilitated access to ART, care and support. The imperative for Africa is rapid scale-up of targeted prevention and treatment, facilitated by policies and action to improve conditions where sex work takes place. The opportunity is a wealth of accumulated experience working with sex workers in diverse settings, which can be tapped to make up for lost time. Elsewhere, even in countries with strong interventions and services for sex workers, an emerging challenge is to find ways to sustain them in the face of declining global resources.

Below:  Common ‘upstream—downstream‘ transmission pathways in heterosexual networks. High-incidence transmission ‘upstream’ in sex work networks is the source of many secondary or ‘downstream’ infections among lower-risk populations.

Full article at: http://goo.gl/bZ6id7

By:

Richard Steen

Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

Tisha Wheeler

Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, United States of America

Marelize Gorgens, Elizabeth Mziray

The World Bank, Washington, District of Columbia, United States of America

Gina Dallabetta

The Bill & Melinda Gates Foundation, Washington, District of Columbia, United States of America

  

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Individual, Partner, and Partnership Level Correlates of Anal Sex among Youth in Baltimore City

Anal sex is an efficient mode of STI transmission and studies indicate that anal sex is common among heterosexuals, including adolescents. We examined the association between individual, partner, and sexual partnership-level characteristics with anal sex among a household survey of 263 individuals aged 15-24 years in Baltimore City, Maryland. We used weighted multiple logistic regression to examine correlates of anal sex in a heterosexual partnership by gender. 

Twenty-nine percent of males and 15% of females reported anal sex in a partnership in the past 6 months. For males, anal sex was associated with having two or more partners in the past 3 months, having been tested for HIV, and oral sex with a partner For females, anal sex was associated with reporting having a main partner, partner meeting place, partner history of STI, and oral sex with a partner. Anal sex was associated with inconsistent condom use for both males and females. 

We conclude that anal sex is a prevalent risk behavior among heterosexual youth and is associated with a range of factors at the individual and partnership levels. These findings provide support for comprehensive sex education that includes information about anal sex; findings from this study can inform public health campaigns targeting youth at risk for STIs.

Via: http://ht.ly/S8kyk 

By: Hebert LE1, Lilleston PS, Jennings JM, Sherman SG.
1Department of Obstetrics and Gynecology, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, University of Chicago, 1225 E. 60th Street, Rm 122, Chicago, IL, 60637, USA