Acceptance of Treatment of Sexually Transmitted Infections for Stable Sexual Partners by Female Sex Workers in Kampala, Uganda

Background

The prevalence of sexually transmitted infections (STIs) among female sex workers (FSWs) in sub-Saharan Africa remains high. Providing treatment to the affected FSWs is a challenge, and more so to their stable sexual partners. There is scanty research information on acceptance of STI treatment for stable sexual partners by FSWs. We conducted a study to assess acceptance of STI treatment for stable sexual partners by FSWs, and to identify factors associated with acceptance.

Methods

We enrolled 241 FSWs in a cross sectional study; they were aged ≥ 18 years, had a stable sexual partner and a diagnosis of STI. Factors associated with acceptance of STI treatment for stable sexual partners were analysed in STATA (12) using Poisson regression. Mantel-Haenszel tests for interaction were performed.

Results

Acceptance of partner treatment was 50.6%. Majority (83.8%) of partners at the last sexual act were stable partners, and 32.4% of participants had asymptomatic STIs. Factors independently associated with acceptance were: earning ≤ $4 USD per sexual act (aPR 0.68; 95% CI: 0.49–0.94) and a clinical STI diagnosis (aPR 1.95; 95% CI: 1.30–2.92). The effect of low income on acceptance of partner treatment was seen in those with less education.

Conclusion

Acceptance of STI treatment for stable sexual partners was lower than that seen in other studies. Interventions to improve economic empowerment among FSWs may increase acceptance of partner treatment.

Below:  Screening profile of women attending month 24 clinic visit in the Good health for Women project cohort

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

By: Yunia Mayanja,1,* Aggrey David Mukose,2,‡ Susan Nakubulwa,1,‡ Gloria Omosa-Manyonyi,3,‡ Anatoli Kamali,#1 andDavid Guwatudde#2

¹MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda

2Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

3College of Health Sciences, School of Medicine, University of Nairobi, Nairobi, Kenya

2Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

3College of Health Sciences, School of Medicine, University of Nairobi, Nairobi, Kenya

²Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

³College of Health Sciences, School of Medicine, University of Nairobi, Nairobi, Kenya

Simon Fraser University, Canada

Published online 2016 May 12. doi:  10.1371/journal.pone.0155383

1MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda

1MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda

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Is the Risk for Sexually Transmissible Infections (STI) Lower among Women with Exclusively Female Sexual Partners Compared with Women with Male Partners? A Retrospective Study Based on Attendees at a Norwegian STI Clinic from 2004 to 2014

Background:

The prevalence of and the risk for sexually transmissible infections (STIs) for women engaging in same-sex sexual behaviour was investigated among women attending an STI clinic.

Methods:

Data from electronic medical records were reviewed and logistic regression used to estimate the odds ratio (OR) of STIs. Women reporting life-time exclusively female partners (WSW) and women reporting female and male partners (WSWM) were compared with women reporting exclusively male partners (WSM). Outcomes included: Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoea, HIV and syphilis.

Results:

The study population comprised 103 564 women (WSW 641, WSWM 12 010 and WSM 90 913). Overall prevalence of STIs was 8%. Crude OR of STIs for WSW: 0.56 (95% CI 0.39-0.81), for WSWM: 0.99 (95% CI 0.92-1.06) compared with WSM. Multivariate analysis revealed an interaction effect between same-sex sexual behaviour and smoking. Among non-smokers; WSW adjusted OR was 0.41 (95% CI 0.21-0.80), WSWM adjusted OR was 0.91 (95% CI 0.81-1.02) compared with WSM. Among smokers; WSW adjusted OR was 1.03 (95% CI 0.63-1.67) for WSWM adjusted OR was 1.00 (CI 95% 0.93-1.13), compared with WSM.

Conclusion:

This study, including the largest cohort of women reporting life-time exclusively female partners in an STI study, shows that WSW generally are at lower risk for acquiring STIs than WSM. Smoking WSW, however, had the same risk for acquiring bacterial STIs as WSM and WSWM. Our study suggests that all WSW should receive the same encouragement to test for STIs as WSM.

Purchase full article at:   http://goo.gl/sWHIz8

By:  Sol-Britt Molin ^A B F, Birgitte Freiesleben De Blasio ^C D and Anne Olaug Olsen ^A B E 

^A Department of Rheumatology, Dermatology and Infectious Diseases, The Olafia Clinic p.o.b.4763, Oslo University Hospital, 0506 Oslo, Norway. 
^B Norwegian National Advisory Unit on Sexually Transmitted Infections, The Olafia Clinic p.o.b.4763, vv0506 Oslo, Norway. 
^C Oslo Centre for Biostatics and Epidemiology, Department of Biostatics, p.o.b1122 Blindern, Institute of Basic Medical Sciences, University of Oslo, 0317 Oslo, Norway. 
^D Department of Infectious Disease Epidemiology, Division of Infectious Disease Control, Norwegian Institute of Public Health, p.o.b.4404 Nydalen, 0403 Oslo, Norway. 
^E Institute of Clinical Medicine, University of Oslo, p.o.b.1171 Blindern, 0318 Oslo, Norway. 
^F Corresponding author. Email: solmol@ous-hf.no 

Sex Health. 2016 Apr 7. doi: 10.1071/SH15193. 

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HIV Infection Incidence among Men Who Have Sex with Men in Common Bathing Pool in Tianjin

OBJECTIVE:

To investigate incidence of HIV infection and identify associated risk factors among men who have sex with men (MSM) in common bathing pools in Tianjin.

METHODS:

A prospective cohort study was conducted among the MSM recruited in a common bathing pool in Tianjin from 2011 to 2013. A total of 733 MSM were surveyed to obtain the information about their sociodemographic characteristics, HIV-related knowledge awareness and sexual behaviors, and subsequent follow-up surveys were carried out every four months. Cox regression analysis was conducted to identify the risk factors for HIV infection.

RESULTS:

A total of 59 HIV infection cases were found in the 2.5-years follow-up survey. The cumulative follow-up time was 7 384.9 person months. The incidence rate of HIV infection was 9.59/100 person-year. The multivariate Cox regression analysis showed that young age, low score of HIV/AIDS knowledge awareness (HR=1.82, 95%CI:1.03-2.66), having two and more sexual partners during past 6 months (HR=1.74, 95%CI: 1.26-2.58) and syphilis (HR=2.36, 95%CI:1.31-3.27) were significantly associated with HIV infection in this MSM cohort.

CONCLUSIONS:

Low score of HIV/AIDS knowledge awareness, young age, having two and more sexual partners during past 6 months and syphilis were the risk factors for HIV infection in MSM in common bathing pools. It is necessary to strengthen the HIV surveillance and intervention in this population.

Purchase full article (in Chinese) at:   http://goo.gl/HlG5Wc

By:   Yu MH1, Jiang GH1, Dou Z2, Li ZJ3, Guo Y1, Xu P1, Yang J4, Xu J2.

• 1Tianjin Center for Disease Control and Prevention, Tianjin 300011, China.
• 2National Center for STD/AIDS Control and Prevention, Chinese Center for Disease Control and Prevention Beijing 102206, China.
• 3United States Center of Disease Control Global AIDS Program, China Office, Beijing 100600, China.
• 4Shenlan Public Health Counsel Service Center, Tianjin 300121, China. 
• Zhonghua Liu Xing Bing Xue Za Zhi. 2016 Mar 10;37(3):362-6. doi: 10.3760/cma.j.issn.0254-6450.2016.03.014.

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The Meaning of 'Regular Partner' in HIV Research among Gay and Bisexual Men: Implications of an Australian Cross-Sectional Survey

Estimates of the proportion of HIV infections coming from within regular sexual relationships among gay and bisexual men (GBM) vary widely. Research surveys use various partner type categories, but there is little understanding of how men classify their partners. We conducted an online cross-sectional survey of Australian GBM exploring sexual relationships, including 2057 men reporting on 2566 regular partnerships. 

Just over half of the partnerships were considered 'relationships', while the remainder were non-romantic 'fuckbuddy'-style arrangements. In multivariable analysis, factors associated with considering the partnership a 'relationship' were: using a 'romantic' descriptor, partnership length, monogamous agreements, any condomless anal sex with each other, love, and commitment. The category of 'regular partner' can mask diverse partnership types, which have different meanings to GBM, associated behaviours, and HIV risks. 

Certain HIV prevention techniques may be more suited to particular types of partnerships. 'Fuckbuddy' arrangements need to be more explicitly acknowledged in HIV prevention.

Purchase full article at:   http://goo.gl/jee5Hz

By:  Bavinton BR1, Duncan D2, Grierson J3, Zablotska IB4, Down IA4, Grulich AE4, Prestage GP4,5.

• 1Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia. bbavinton@kirby.unsw.edu.au.
• 2University of New England, Armidale, Australia.
• 3Anglia Ruskin University, Cambridge, England, UK.
• 4Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia.
• 5Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia. 
• AIDS Behav. 2016 Mar 12.

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Geosocial Networking App Use among Men Who Have Sex with Men in Serious Romantic Relationships

Geosocial networking (GSN) mobile phone applications ("apps") are used frequently among men who have sex with men (MSM) to socialize and meet sexual partners. Though GSN apps are used by some MSM in partnered relationships, little is known about how the use of GSN apps among MSM in serious romantic relationships can influence couples' sexual and relationship health. MSM in serious relationships (N = 323; M age = 40 years) were recruited through a popular GSN app for MSM. 

Participants completed open-ended items regarding the costs and benefits of app use to their relationships, discussions of app use with their partners, and preferences for relationship education related to app use. 

Reported benefits of app use included improving sex and communication with one's primary partner and fulfilling unmet sexual needs. Although approximately half had not discussed app use with their partners, citing app use as a "non-issue," many cited various drawbacks to app use, including jealousy and being a distraction from the relationship. 

Few described sexual health concerns as a drawback to meeting partners through apps. Regarding relationship education preferences, most wanted help with general communication skills and how to express one's sexual needs to a partner. 

Although GSN app use can enhance relationships and sex among partnered MSM, unclear communication about app use may contribute to negative relationship outcomes and could prevent partners from having sexual needs met. Relationship and sexual health education programs for male couples should consider addressing social media and technology use in their curricula.

Purchase full article at:   http://goo.gl/AOLOq1

By:  Macapagal K1, Coventry R2, Puckett JA2,3, Phillips G 2nd2, Mustanski B2.

• 1Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 2700, Chicago, IL, 60611, USA. kathryn.macapagal@northwestern.edu.
• 2Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 2700, Chicago, IL, 60611, USA.
• 3Department of Psychology, University of South Dakota, Vermillion, SD, USA. 
• Arch Sex Behav. 2016 Mar 11.

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Online Hookup Sites for Meeting Sexual Partners among Men Who Have Sex with Men in Rhode Island, 2013: A Call for Public Health Action

Frequent use of websites and mobile telephone applications (apps) by men who have sex with men (MSM) to meet sexual partners, commonly referred to as "hookup" sites, make them ideal platforms for HIV prevention messaging. This Rhode Island case study demonstrated widespread use of hookup sites among MSM recently diagnosed with HIV. 

We present the advertising prices and corporate social responsibility (CSR) programs of the top five sites used by newly diagnosed HIV-positive MSM to meet sexual partners: Grindr, Adam4Adam, Manhunt, Scruff, and Craigslist. Craigslist offered universal free advertising. Scruff offered free online advertising to selected nonprofit organizations. Grindr and Manhunt offered reduced, but widely varying, pricing for nonprofit advertisers. More than half (60%, 26/43) of newly diagnosed MSM reported meeting sexual partners online in the 12 months prior to their diagnosis. 

Opportunities for public health agencies to promote HIV-related health messaging on these sites were limited. Partnering with hookup sites to reach high-risk MSM for HIV prevention and treatment messaging is an important public health opportunity for reducing disease transmission risks in Rhode Island and across the United States.

Full PDF article at:   http://goo.gl/7MCT2a

By:  Chan PA1, Towey C2, Poceta J2, Rose J3, Bertrand T4, Kantor R1, Harvey J2, Santamaria EK5, Alexander-Scott N4, Nunn A6.

• 1Brown University, Department of Medicine, Providence, RI.
• 2Rhode Island Public Health Institute, Providence, RI.
• 3Wesleyan University, Middletown, CT.
• 4Rhode Island Department of Health, Providence, RI.
• 5Brown University School of Public Health, Department of Behavioral and Social Sciences, Providence, RI.
• 6Rhode Island Public Health Institute, Providence, RI; Brown University School of Public Health, Department of Behavioral and Social Sciences, Providence, RI. 
• Public Health Rep. 2016 Mar-Apr;131(2):264-71.

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Number of Sexual Partners and Relationship Status Are Associated with Unprotected Sex Across Emerging Adulthood

Sex with multiple partners, consecutively or concurrently, is a risk factor for contracting sexually transmitted infections (STIs) as multiple partner-partner contacts present increased opportunity for transmission. It is unclear, however, if individuals who tend to have more partners also use protection less reliably than those with sexual histories of fewer partners. 

Longitudinal data can elucidate whether an individual shows a consistent pattern of sex with multiple partners. We used latent class growth analyses to examine emerging adult survey data (N = 2244) spanning 10 waves of assessment across 6 years. 

We identified three trajectory classes described with respect to number of partners as 

1. Multiple, 
2. Single, and 
3. Rare. 

Trajectory group, relationship status, and their interactions were tested as predictors of using protection against STIs and pregnancy at each wave. 

The Multiple Partners class had the greatest odds ratio of reporting sex without protection against STIs and pregnancy, followed by the Single and Rare classes. Exclusive relationship status was a risk factor for unprotected sex at earlier waves, but a protective factor at most later waves. There was no significant interaction between relationship status and trajectory class in predicting use of protection. The Multiple Partners class reported more permissive values on sex and an elevated proportion of homosexual behavior. This group overlaps with an already identified at-risk population, men who have sex with men. 

Potential mechanisms explaining the increased risk for sex without protection, including communication, risk assessment, and co-occurring risk behaviors are discussed as targets for intervention.

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

By:  Ashenhurst JR1, Wilhite ER2, Harden KP2, Fromme K2.

• 1Department of Psychology, The University of Texas at Austin, 1 University Station, A8000, Austin, TX, 78712, USA. james.ashenhurst@utexas.edu.
• 2Department of Psychology, The University of Texas at Austin, 1 University Station, A8000, Austin, TX, 78712, USA. 
• Arch Sex Behav. 2016 Mar 3.

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Older Sexual Partners and Adolescent Females' Mental Health

CONTEXT:

The physical health detriments associated with adolescent females' having older romantic partners are well documented. However, little is known about the relationship between having an older partner and females' subsequent mental health.

METHODS:

Two waves of data from 1,440 participants in the National Longitudinal Study of Adolescent Health were analyzed. The sample was restricted to females in grades 7-12 who had not had sex at Wave 1 (1994-1995) and reported at least one romantic relationship by Wave 2 (1996). A lagged dependent variable approach with ordinary least-squares regression measured changes in depression and self-esteem associated with sexual and nonsexual relationships with same-age and older partners. Intimate partner violence was tested as a mediator.

RESULTS:

Compared with respondents reporting a nonsexual relationship with a same-age partner, those reporting a nonsexual relationship with an older partner, sex with a same-age partner or sex with an older partner experienced greater increases in depression between surveys; mean predicted depression levels at Wave 2 ranged from 7.7 to 9.0 across these groups (possible range, 0-27). Intimate partner violence explained one-third of the difference between those who had had sex and those who had not had sex with same-age partners. Fewer associations were found for self-esteem, and differences between groups were small.

CONCLUSIONS:

Health correlates of adolescent sexual behavior go beyond physical health outcomes. Future research should identify mechanisms through which relationships, especially those with older partners, are associated with declines in mental health.

Purchase full article at:   http://goo.gl/xY5bUh

By:  Meier A1, Erickson GA2, McLaughlin H3.

• 1Department of Sociology, University of Minnesota, Minneapolis. meierann@umn.edu.
• 2Department of Criminal Justice and Forensic Science, Hamline University, St. Paul, MN.
• 3Department of Sociology, Oklahoma State University, Stillwater.
• Perspect Sex Reprod Health. 2016 Feb 26. doi: 10.1363/48e8316.

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Depression & Sexual Risk Behaviours among People Who Inject Drugs: A Gender-Based Analysis

Background: 

Although many people who inject drugs (PID) contend with comorbidities, including high rates of mental illness, limited attention has been given to the differences in comorbidities among men and women or the potential links between psychiatric disorders and HIV risk behaviours. We sought to longitudinally examine associations between depression and HIV-related sexual risk behaviours among PID, stratified by gender.

Methods: 

Data were derived from a prospective cohort of PID in Vancouver, Canada between December 2005 and November 2009. Using generalised estimating equations, we examined the relationship between depressive symptoms and two types of sexual HIV risk behaviours: engaging in unprotected sex; and having multiple sexual partners. All analyses were stratified by self-reported gender. 

Results: 

Overall, 1017 PID participated in this study, including 331 (32.5%) women. At baseline, women reported significantly higher depressive symptoms than men (P < 0.001). In multivariate generalised estimating equations analyses, after adjustment for potential social, demographic and behavioural confounders, more severe depressive symptomology remained independently associated with engaging in unprotected sex and having multiple sexual partners among women, but was only marginally associated with having multiple sexual partners among men. 

Conclusions: 

These findings call for improved integration of psychiatric screening and treatment services within existing public health initiatives designed for PID, particularly for women. Efforts are also needed to address sexual risk-taking among female PID contending with clinically significant depression.

Purchase full article at:   http://goo.gl/k9E1fb

By:  Tyler Pettes ^A, Thomas Kerr ^A B, Pauline Voon ^A, Paul Nguyen ^A, Evan Wood ^A B andKanna Hayashi ^A B C 

^A British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608–1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. 
^B Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608–1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. 
^C Corresponding author. Email: khayashi@cfenet.ubc.ca 

Sex Health. 2015 May 18. doi: 10.1071/SH14200.

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The Association of Uncontrolled HIV Infection and Other Sexually Transmitted Infections in Metropolitan Atlanta Youth

BACKGROUND:

Half of the 19 million sexually transmitted infections (STIs) and 26% of HIV infections annually in the United States occur in youth aged 13-24 years. STIs are a risk factor for HIV acquisition and transmission, but data are lacking on HIV treatment as an intervention to reduce STIs.

METHODS:

A single-centered, retrospective analysis of HIV-infected sexually active adolescents and young adults from January 2009 to December 2011 was performed to compare STI incidence among patients with controlled and uncontrolled HIV and to identify associated risk factors.

RESULTS:

Of 205 enrolled subjects, 59% were male and 92% African American with mean age of 21 years (2.1 SD). Sixty-six percent were horizontally infected, and 19% met the definition of controlled HIV. Forty-seven percent were men who have sex with men, 76% reported condom use, 27% prior sexual abuse, 58% drug use and 50% claimed >5 lifetime sexual partners. Sixty-seven percent contracted a co-STI for a cumulative incidence rate of 35 STIs per 100 person-years. Subjects with uncontrolled HIV had a significantly higher STI incidence than did subjects with controlled infection (42.7 vs. 19.7 per 100 person-years, P < 0.001). Uncontrolled individuals had more STIs (P = 0.01), sexual partners (P = 0.008) and horizontal acquisition (P = 0.001). In an adjusted logistic model, having ≥1 STI was associated with older age (P = 0.033), >5 sexual partners (6-10 partners, P = 0.001; >10, P < 0.001) and no condom use (P = 0.025). Subjects with uncontrolled infection had 2.8 times [95% confidence interval (CI): 1.16-6.94] the odds of ≥1 STI relative to controlled HIV.

CONCLUSIONS:

Uncontrolled HIV increases the incidence of co-STIs among adolescents and young adults. Interventions to improve antiretroviral compliance and reduce risk behaviors are urgently needed.

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By:  Brownstein PS1, Gillespie SE, Leong T, Chahroudi A, Chakraborty R, Camacho-Gonzalez AF.

• 1From the *Department of Pediatrics, Children's Healthcare of Atlanta, Georgia; †Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; ‡Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia; §Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine & Children's Healthcare of Atlanta, Georgia; and ¶Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia. 

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