Declines in violence and police arrest among female sex workers in Karnataka state, south India, following a comprehensive HIV prevention program

INTRODUCTION:

Female sex workers (FSWs) frequently experience violence, harassment and arrest by the police or their clients, but there is little evidence as to the impact that such factors may have on HIV risk or whether community interventions could mitigate this impact.

METHODS:

As part of the evaluation of the Avahan programme in Karnataka, serial integrated behavioural and biological assessment (IBBA) surveys (four districts) (2005 to 2011) and anonymous polling booth surveys (PBS) (16 districts) (2007 to 2011) were conducted with random samples of FSWs. Logistic regression analysis was used to assess 1) changes in reported violence and arrests over time and 2) associations between violence by non-partners and police arrest and HIV/STI risk and prevalence. Mediation analysis was used to identify mediating factors.

RESULTS:

5,792 FSWs participated in the IBBAs and 15,813 participated in the PBS. Over time, there were 

• significant reductions in the percentages of FSWs reporting being raped in the past year (PBS) (30.0% in 2007, 10.0% in 2011, p<0.001), 
• being arrested in the past year and being beaten in the past six months by a non-partner (clients, police, pimps, strangers, rowdies). 

The proportion drinking alcohol (during the past week) also fell significantly (32.5% in 2005, 24.9% in 2008, 16.8% in 2011; p<0.001). Violence by non-partners (being raped in the past year and/or beaten in the past six months) and being arrested in the past year were both strongly associated with HIV infection. 

They were also associated with drinking alcohol (during the past week), reduced condom self-efficacy with clients, symptomatic STI (during the past year), gonorrhoea infection and syphilis infection, but not with exposure to peer education, community mobilization or HIV testing uptake. 

Mediation analysis suggests that alcohol use and STIs may partially mediate the association between violence or arrests and HIV prevalence.

DISCUSSION:

Violence by non-partners and arrest are both strongly associated with HIV infection among FSWs. Large-scale, comprehensive HIV prevention programming can reduce violence, arrests and HIV/STI infection among FSWs.

Below:  Reductions in reported violence over time in 16 districts in Karnataka (2007 to 2011); polling booth surveys

Full article at:   http://goo.gl/36esUp

By: Beattie TS1, Bhattacharjee P2, Isac S2, Mohan HL2, Simic-Lawson M3, Ramesh BM2,4, Blanchard JF4,5, Moses S4,5, Watts CH3, Heise L3.

• 1Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK; Tara.beattie@lshtm.ac.uk.
• 2Karnataka Health Promotion Trust, Bangalore, India.
• 3Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
• 4Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
• 5Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada. 
• J Int AIDS Soc. 2015 Oct 16;18:20079. doi: 10.7448/IAS.18.1.20079. eCollection 2015.

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Duration of Gonorrhoea & Chlamydia Infection at the Pharynx & Rectum among Men Who Have Sex with Men: A Systematic Review

Background:

Chlamydia and gonorrhoea are the two most common sexually transmissible infections (STI) among men who have sex with men (MSM) worldwide. Infections at the pharynx and rectum are usually asymptomatic; however, the natural history of these infections remains unknown. The aim of this study is to estimate the duration of both infections at the extragenital sites from published epidemiological cohort studies.

Methods:

English peer-reviewed articles were searched from 1 January 2000 to 12 March 2015 in three electronic databases (MEDLINE, EMBASE and Cochrane Central). The prevalence-to-incidence ratio from each study was calculated to reflect the duration of each infection. This review followed the PRISMA guidelines and was registered in PROSPERO (CRD42014007087).

Results:

There were 2585 records identified, with 1721 abstracts and 52 full-text articles screened, resulting in four studies fulfilling the inclusion criteria. Pharyngeal gonorrhoea (114-138 days) had a shorter duration of infection than rectal gonorrhoea (346 days). In addition, chlamydia had a longer duration of infection at the pharynx (667 days) and rectum (579 days) compared with gonorrhoea infection.

Conclusions:

Gonorrhoea has a shorter duration of infection than chlamydia, suggesting that annual STI screening will be more effective at diagnosing chlamydia than gonorrhoea. The current STI guidelines recommend screening gonorrhoea and chlamydia at least once a year in MSM; it would only detect ~30% of incident pharyngeal gonorrhoea cases, with a mean duration of 4 months.

Purchase full article at:   http://goo.gl/jCI3tr

By:  Eric P. F. Chow A B C, Shayne Camilleri A, Christopher Ward A, Sarah 

Huffam A,Marcus Y. Chen A B, Catriona S. Bradshaw A B and Christopher K. Fairley A B 

A Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Melbourne, Vic. 3053, Australia. B Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic. 3004, Australia. C Corresponding author. Email: echow@mshc.org.au 

Sex Health. 2016 Feb 18. doi: 10.1071/SH15175. 

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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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Saliva Use as a Lubricant for Anal Sex Is a Risk Factor for Rectal Gonorrhoea among Men Who Have Sex with Men, A New Public Health Message

BACKGROUND:

Apart from penile-anal intercourse, other anal sexual practices (rimming, fingering and saliva use as a lubricant for anal sex) are common among men who have sex with men (MSM). The aim of this study is to evaluate whether these anal sexual practices are risk factors for rectal gonorrhoea in MSM.

METHOD:

A cross-sectional survey was conducted among MSM attending Melbourne Sexual Health Centre between 31 July 2014 and 30 June 2015. Rectal gonorrhoea cases were identified by culture.

RESULTS:

Among 1312 MSM, 4.3% (n=56) had rectal gonorrhoea. Other anal sexual practices were common among MSM: receptive rimming (70.5%), receptive fingering or penis dipping (84.3%) and using partner's saliva as a lubricant for anal sex (68.5%). Saliva as a lubricant was significantly associated with rectal gonorrhoea after adjusting for potential confounding factors. Receptive rimming and fingering or penis dipping were not statistically associated with rectal gonorrhoea. The crude population-attributable fraction of rectal gonorrhoea associated with use of partner's saliva as a lubricant for anal sex was 48.9% (7.9% to 71.7%).

CONCLUSIONS:

Saliva use as a lubricant for anal sex is a common sexual practice in MSM, and it may play an important role in gonorrhoea transmission. Almost half of rectal gonorrhoea cases may be eliminated if MSM stopped using partner's saliva for anal sex.

Purchase full article at:   http://goo.gl/65Oefu

By:  Chow EP1, Cornelisse VJ1, Read TR1, Lee D2, Walker S1, Hocking JS3, Chen MY1, Bradshaw CS1, Fairley CK1.

• 1Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia Faculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
• 2Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
• 3Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.

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Mass Drug Administration of Azithromycin for Trachoma Reduces the Prevalence of Genital Chlamydia Trachomatis Infection in the Solomon Islands

OBJECTIVES:

Chlamydia trachomatis is the most common bacterial sexually transmitted infection and is frequently asymptomatic; ocular C. trachomatis strains cause trachoma. Mass drug administration (MDA) of azithromycin for trachoma might also reduce the prevalence of genital C. trachomatis. In a survey conducted in the Solomon Islands in 2014, prior to MDA, the prevalence of genital C. trachomatis was 20.3% (95% CI 15.9% to 25.4%). We conducted a survey to establish the impact of MDA with azithromycin on genital C. trachomatis.

METHODS:

Women attending three community outpatient clinics, predominantly for antenatal care, 10 months after MDA with azithromycin given for trachoma elimination, were enrolled in this survey. Self-taken high vaginal swabs were for C. trachomatis and Neisseria gonorrhoeae using the BD Probetec strand displacement assay.

RESULTS:

298 women were enrolled. C. trachomatis infection was diagnosed in 43 women (14.4%, 95% CI 10.6% to 18.9%) and N. gonorrhoeae in 9 (3%, 95% CI 1.4% to 5.7%). The age-adjusted OR for C. trachomatis infection was consistent with a significant decrease in the prevalence of C. trachomatis following MDA (OR 0.58, 95% CI 0.37 to 0.94, p=0.027). There was no change in the prevalence of N. gonorrhoeae between following MDA (OR 0.51, 95% CI 0.22 to 1.22, p=0.13).

CONCLUSIONS:

This study demonstrated a 40% reduction in the age-adjusted prevalence of genital C. trachomatis infection following azithromycin MDA for trachoma elimination.

Full article at:   http://goo.gl/Swy2aV

By:  Marks M1, Bottomley C2, Tome H3, Pitakaka R4, Butcher R5, Sokana O6, Kako H7, Solomon AW1, Mabey DC1.

• 1Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK.
• 2Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
• 3Nursing Division, Honiara City Council, Honiara, Solomon Islands.
• 4National Referral Hospital, Honiara, Solomon Islands.
• 5Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK.
• 6Eye Health Department, Ministry of Health and Medical Services, Honiara, Solomon Islands.
• 7Department of STI and HIV Prevention, Ministry of Health and Medical Services, Honiara, Solomon Islands. 
• Sex Transm Infect. 2016 Feb 17. pii: sextrans-2015-052439. doi: 10.1136/sextrans-2015-052439.

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The Potential Impact of Vaccination on the Prevalence of Gonorrhea

Gonorrhea, one of the most common sexually transmitted infections worldwide, can lead to serious sequelae, including infertility and increased HIV transmission. 

Recently, untreatable, multidrug-resistant Neisseria gonorrhoeae strains have been reported. In the absence of new antibiotics, and given the speed with which resistance has emerged to all previously used antibiotics, development of a vaccine would be the ideal solution to this public health emergency. 

Understanding the desired characteristics, target population, and expected impact of an anti-gonococcal vaccine is essential to facilitate vaccine design, assessment and implementation. The modeling presented herein aims to fill these conceptual gaps, and inform future gonococcal vaccine development. 

Using an individual-based, epidemiological simulation model, gonococcal prevalence was simulated in a heterosexual population of 100,000 individuals after the introduction of vaccines with varied efficacy (10–100%) and duration of protection (2.5–20 years). Model simulations predict that gonococcal prevalence could be reduced by at least 90% after 20 years, if all 13-year-olds were given a non-waning vaccine with 50% efficacy, or a vaccine with 100% efficacy that wanes after 7.5 years. A 40% reduction in prevalence is achievable with a non-waning vaccine of only 20% efficacy. 

We conclude that a vaccine of moderate efficacy and duration could have a substantive impact on gonococcal prevalence, and disease sequelae, if coverage is high and protection lasts over the highest risk period (i.e., most sexual partner change) among young people.

Below:  The prevalence of gonorrhea in the absence of a vaccine, and with (A) vaccines of differing efficacies and 20 years duration of protection, or (B) vaccines with 100% efficacy and of differing durations of protection. Vaccine coverage is 100% of 13-year-olds.

Below:  The prevalence of gonorrhea in the absence of a vaccine, and with different rates and types of vaccine coverage. (A) Vaccines have 100% efficacy and 20 years duration. (B) Vaccines have 50% efficacy and 20 years duration.

By:  Andrew P. Craig,a Richard T. Gray,a Jennifer L. Edwards,b Michael A. Apicella,c Michael P. Jennings,d David P. Wilson,#a and Kate L. Seib#d,*

^a The Kirby Institute, UNSW Australia, Sydney 2052, NSW, Australia

^b Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, and The Ohio State University Department of Pediatrics, Columbus, OH, USA

^c Department of Microbiology, University of Iowa, Iowa City, IA, USA

^d Institute for Glycomics, Griffith University, Southport, QLD, Australia

^#Contributed equally.

^* Corresponding author. Tel.: +61 755527453; fax: +61 7 5552 8098. Email: ua.ude.htiffirg@bies.k (K.L. Seib).

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STDs in Women and Infants in the U.S. - Slides

Via:   http://goo.gl/NQ52uK

Survey of Partner Notification Practices for Sexually Transmissible Infections in the United States

Background:

Partner notification (PN) for sexually transmissible infections (STIs) is a vital STI control method. The most recent evaluation of PN practices in the United States, conducted in 1999, indicated that few STI patients were offered PN services. The objectives of this study were to obtain a preliminary understanding of the current provision of PN services in HIV/STI testing sites throughout the US and to determine the types of PN services available.

Methods:

A convenience sample of 300 randomly selected testing sites was contacted to administer a phone survey about PN practices. These sites were from a large database maintained by the Centers for Disease Control and Prevention. Sites were eligible to participate if they provided testing services for chlamydia, gonorrhoea, HIV or syphilis and were not hospitals or Planned Parenthood locations.

Results:

Of the 300 eligible sites called, 79 sites were successfully reached, of which 74 agreed to participate, yielding a response rate of 24.7% and a cooperation rate of 93.7%. Most surveyed testing sites provided some form of PN service (anonymous or non-anonymous) on site or through an affiliate for chlamydia (100%), gonorrhoea (97%), HIV (91%) and syphilis (96%) infection. Anonymous PN services were available at 67-69% of sites. Only 6-9% of sites offered Internet-based PN services.

Conclusions:

Most surveyed testing sites currently offer some type of PN service for chlamydia, gonorrhoea, HIV or syphilis infection. However, approximately one-third of surveyed sites do not offer anonymous services. Novel, Internet-based methods may be warranted to increase the availability of anonymous services.

Purchase full article at:   http://goo.gl/rZS8Kb

By:  Fidel A. Desir ^A B D, Jessica H. Ladd ^A and Charlotte A. Gaydos ^C 

^A Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA. 
^B Johns Hopkins University School of Medicine, 855 North Wolfe Street, 530 Rangos Building, Baltimore, MD 21215, USA. 
^C Division of Infectious Diseases, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21205, USA. 
^D Corresponding author. Email: fdesir@jhmi.edu 

Sex Health. 2016 Feb 4. doi: 10.1071/SH15136. 

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Young Male Sex Workers Are at High Risk for Sexually Transmitted Infections, A Cross-Sectional Study from Dutch STI Clinics, The Netherlands, 2006-2012

BACKGROUND:

Male sex workers (MSW) are particularly exposed to sexually transmitted infections (STI) including HIV. In the Netherlands, data about STI among MSW are scarce. We estimated chlamydia, gonorrhoea, syphilis and HIV diagnoses among MSW attending STI clinics and determined associated factors to guide prevention policies.

METHODS:

Using 2006-2012 cross-sectional national surveillance data from Dutch STI clinics, we calculated the proportion of consultations with a positive test for any of three bacterial STI or HIV among MSW. Associated factors were determined by using Poisson logistic regression with robust variance.

RESULTS:

We identified 3,053 consultations involving MSW, of which 18.1 % included at least one positive bacterial STI test and 2.5 % a positive HIV test. Factors associated with bacterial STI and/or HIV diagnoses were respectively age groups < 35 y.o. and self-reporting homo- or bisexual preferences (aRR = 1.6; 95 % CI: 1.3-2.1), and age group 25-34 y.o. (aRR = 2.7; 95 % CI: 1.2-6.5) and self-reporting homo- or bisexual preferences (aRR = 24.4; 95 % CI: 3.4-176.9). Newly diagnosed and pre-existing HIV infection were associated with an increased risk for bacterial STI (aRR = 2.7, 95 % CI: 1.7-2.6 and aRR = 2.1, 95 % CI: 2.2-3.4 respectively). MSW with no history of HIV screening were more likely to be tested positive for HIV compared to those with a previous HIV-negative test (aRR = 2.6, 95 % CI: 1.6-4.3).

CONCLUSION:

Health promotion activities should target MSW who are young, homo- or bisexual, those who are HIV-infected or who have never been tested for HIV, to increase early diagnosis, prevention and treatment.

Below:  Percentage of consultations with a positive bacterial STI test or positive HIV test among MSW at STI clinics in the Netherlands, 2006–2012

Full article at:   http://goo.gl/OQJ9ab

By:  Fournet N1,2, Koedijk FD3,4, van Leeuwen AP5, van Rooijen MS6, van der Sande MA7,8, van Veen MG9.

• 1Epidemiology and Surveillance Unit, Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands. nellyfournet@yahoo.fr.
• 2European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. nellyfournet@yahoo.fr.
• 3Epidemiology and Surveillance Unit, Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands. f.koedijk@ggdtwente.nl.
• 4Public Health Service Twente, Enschede, The Netherlands. f.koedijk@ggdtwente.nl.
• 5Public Health Service Amsterdam, Amsterdam, The Netherlands. petravanleeuwenap@gmail.com.
• 6Public Health Service Amsterdam, Amsterdam, The Netherlands. mvrooijen@ggd.amsterdam.nl.
• 7Epidemiology and Surveillance Unit, Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands. marianne.van.der.sande@rivm.nl.
• 8Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands. marianne.van.der.sande@rivm.nl.
• 9Public Health Service Amsterdam, Amsterdam, The Netherlands. MvVeen@ggd.amsterdam.nl. 
• BMC Infect Dis. 2016 Feb 4;16(1):63. doi: 10.1186/s12879-016-1388-3.

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