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1.
Int J STD AIDS ; 21(1): 52-6, 2010 Jan.
Article in English | MEDLINE | ID: mdl-20029065

ABSTRACT

We examined the relative efficiency of non-clinical sites to screen for chlamydia in youth and young adults. Chlamydia screening targeting youth (under 30 years of age) was performed at non-clinical sites in high-morbidity neighbourhoods of two California counties. Venues were subdivided into community outreach, schools, parenting centres and drug treatment/correctional facilities. Relative efficiency was estimated with multivariate Poisson regression using incidence of chlamydia per person-hours labour adjusting for strategy and county. Among the 1514 youths screened, the overall prevalence of chlamydia was 5.5%. By venue, the highest prevalence was in drug treatment/correction facilities at 11.1% followed by parenting centres at 6.3%, community outreach at 4.9% and schools at 4.6%. Drug treatment/correctional facilities were the most labour time efficient at 9.9 person-hours per chlamydia case. Schools and parenting centres had the lowest cost per screen at 0.9 person-hours per screen. Adjusted relative labour time efficiency (chlamydia cases per paid person-hour) was significantly higher in schools, 2.0 (95% confidence interval [CI] 1.0-4.2), parenting centres, 3.2 (95% CI 1.6-6.6) and drug treatment/correctional facilities, 2.9 (95% CI 1.0-7.8), compared with community outreach. In conclusion, parenting centres and drug treatment centres and correctional facilities are the most efficient venues for chlamydia screening.


Subject(s)
Chlamydia Infections/diagnosis , Chlamydia Infections/epidemiology , Chlamydia trachomatis/isolation & purification , Mass Screening/economics , Adolescent , Adult , California/epidemiology , Child , Costs and Cost Analysis , Female , Humans , Male , Prevalence , Young Adult
2.
Sex Transm Infect ; 84(4): 290-1, 2008 Aug.
Article in English | MEDLINE | ID: mdl-18339660

ABSTRACT

OBJECTIVE: We investigated the initial outbreak of fluoroquinolone-resistant Neisseria gonorrhoeae (QRNG) in southern California with analysis of transmission using strain typing. METHODS: Surveillance for QRNG was conducted between 2000 and 2002 in southern California, including epidemiology and strain typing by a combination of antibiogram, auxotype, serovar, Lip type and amino acid alteration patterns in the quinolone-resistance determining region of GyrA and ParC. Combining epidemiological data with strain typing, we describe the emergence of QRNG outbreak strains using risk factor analysis and transmission networks. RESULTS: Two outbreak strains accounted for 82% of isolates. Both strains required proline, were Lip type 17c, had amino acid alterations 91> Phe in GyrA and 87> Arg in ParC, but they differed by their serovar, IB-3C8 versus IB-2H7, 2G2. Outbreak strains were positively associated with men who have sex with men (MSM), adjusted odds ratio (AOR) 23.9 (95% confidence interval (CI) 2.2 to 261) and negatively associated with travel history: AOR 0.05, (95% CI 0.0 to 0.6). Network analysis demonstrated that 17 cases were connected by sexual contacts and/or public venues including bars, bathhouses/sex clubs, and internet sites. CONCLUSIONS: QRNG may have become established among Californian MSM through an identified transmission network of southern Californian bars, bathhouses and internet sites.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Drug Resistance, Microbial , Fluoroquinolones/therapeutic use , Gonorrhea/drug therapy , Homosexuality, Male/statistics & numerical data , Neisseria gonorrhoeae , Adult , California/epidemiology , Gonorrhea/epidemiology , Gonorrhea/transmission , Humans , Male , Microbial Sensitivity Tests
4.
Am J Epidemiol ; 153(10): 925-34, 2001 May 15.
Article in English | MEDLINE | ID: mdl-11384946

ABSTRACT

The authors compared temporal trends in the prevalence and incidence of human immunodeficiency virus (HIV) infection based upon 34,866 specimens from patients who attended the San Francisco, California, municipal sexually transmitted disease clinic between 1989 and 1998. HIV infection data were collected during annual blinded HIV serologic surveys. Incidence was determined by applying a serologic testing algorithm for recent HIV seroconversion that uses both a sensitive and a less sensitive enzyme immunoassay to stored HIV positive sera. The HIV seroprevalence declined from 15.2% in 1989 to 7.2% in 1998 (odds ratio per year = 0.92, 95% confidence interval (CI): 0.91, 0.94). Among homosexual men, the HIV prevalence declined from 50.9% in 1989 to 19.9% in 1998 (odds ratio per year = 0.86, 95% CI: 0.85, 0.88). The pooled seroincidence was 1.6% and did not change significantly over time (odds ratio per year = 1.0, 95% CI: 0.98, 1.1). The pooled seroincidence among homosexual men was 6.6% per year and remained steady between 1989 and 1998 (odds ratio per year = 0.99, 95% CI: 0.92, 1.1). During a dramatic, 10-year decline in seroprevalence of HIV infection, the incidence of HIV infection remained remarkably stable.


Subject(s)
Algorithms , HIV Infections/epidemiology , HIV Seropositivity/epidemiology , Sexually Transmitted Diseases/epidemiology , Adult , Aged , California/epidemiology , Community Health Services , Epidemiologic Studies , Female , HIV Infections/immunology , Health Surveys , Homosexuality, Male , Humans , Incidence , Male , Middle Aged , Research Design , Seroepidemiologic Studies , Serologic Tests
5.
Sex Transm Dis ; 28(2): 117-23, 2001 Feb.
Article in English | MEDLINE | ID: mdl-11234786

ABSTRACT

BACKGROUND: Sequelae of genital Chlamydia trachomatis infection in women are more strongly linked to repeat infections than to initial ones, and persistent or subsequent infections foster continued transmission. OBJECTIVE: To identify factors associated with persistent and recurrent chlamydial infection in young women that might influence prevention strategies. METHODS: Teenage and young adult women with uncomplicated C trachomatis infection attending reproductive health, sexually transmitted disease, and adolescent medicine clinics in five US cities were recruited to a cohort study. Persistent or recurrent chlamydial infection was detected by ligase chain reaction (LCR) testing of urine 1 month and 4 months after treatment. RESULTS: Among 1,194 women treated for chlamydial infection, 792 (66.4%) returned for the first follow-up visit, 50 (6.3 %) of whom had positive LCR results. At that visit, women who resumed sex since treatment were more likely to have chlamydial infection (relative risk [RR], 2.0; 95% CI, 1.03-3.9), as were those who did not complete treatment (RR, 3.4; 95% CI, 1.6-7.3). Among women who tested negative for C trachomatis at the first follow-up visit, 36 (7.1%) of 505 had positive results by LCR at the second follow-up visit. Reinfection at this visit was not clearly associated with having a new sex partner or other sexual behavior risks; new infection was likely due to resumption of sex with untreated partners. Overall, 13.4% of women had persistent infection or became reinfected after a median of 4.3 months, a rate of 33 infections per 1,000 person months. CONCLUSIONS: Persistent or recurrent infection is very common in young women with chlamydial infection. Improved strategies are needed to assure treatment of women's male sex partners. Rescreening, or retesting of women for chlamydial infection a few months after treatment, also is recommended as a routine chlamydia prevention strategy.


Subject(s)
Chlamydia Infections/epidemiology , Chlamydia Infections/prevention & control , Chlamydia trachomatis/isolation & purification , Sexual Partners , Adolescent , Adult , Chlamydia Infections/therapy , Cohort Studies , Female , Humans , Ligase Chain Reaction/methods , Prospective Studies , Recurrence , Risk Factors , United States/epidemiology , Urinalysis
6.
J Infect Dis ; 183(7): 1087-92, 2001 Apr 01.
Article in English | MEDLINE | ID: mdl-11237834

ABSTRACT

To estimate the prevalence of urogenital chlamydial infection among young, low-income women in northern California and to describe correlates of infection, a population-based door-to-door household cluster survey was conducted from 1996 through 1998. The participants included 1439 women 18-29 years of age, with a mean age of 24 years, most of whom were African American (43%) or Latina (23%) and had a median income of $500-$999 per month. Most (94%) had received health care in the past year, and approximately 50% was covered by state insurance programs. Although more than half (62%) had had a recent pelvic examination, only 42% had recently used a condom with a new partner. The prevalence of urogenital chlamydial infection was 3.2% (95% confidence interval, 2.2%-4.2%). Women with chlamydia were more likely to be younger (18-21 years of age) and nonwhite and to have lower socioeconomic status. These data demonstrated an approximately 2-3-fold greater burden of infection than routine surveillance data have suggested.


Subject(s)
Chlamydia Infections/epidemiology , Chlamydia trachomatis , Genital Diseases, Female/epidemiology , Population Surveillance , Poverty , Adolescent , Adult , Black or African American , California/epidemiology , Cohort Studies , Female , Government Programs/statistics & numerical data , Hispanic or Latino , Humans , Insurance, Health , Prevalence , Risk Factors
7.
Eval Health Prof ; 24(4): 363-84, 2001 Dec.
Article in English | MEDLINE | ID: mdl-11817197

ABSTRACT

Project RESPECT was a multisite randomized trial comparing three clinic-based interventions' ability to increase condom use and prevent infection with HIV and sexually transmitted diseases. Because Project RESPECT had guiding concepts that determined the content of the sessions, the authors investigated how the intervention operated using these theoretical variables. Growth curve analysis and structural equation modeling estimated the correlation between intentions toward condom use and self-reports of condom use and isolated the treatment effects on mediating variables--attitudes, self-efficacy, and social norms--that predict intentions. The correlations between intentions and behavior exceeded .70 for both genders, justifying the emphasis on intentions. Project RESPECT was effective through changing attitudes and self-efficacy for females in both counseling interventions. For males, only enhanced counseling had significant effects on these two mediator variables.


Subject(s)
Health Knowledge, Attitudes, Practice , Models, Psychological , Safe Sex , Sexually Transmitted Diseases/prevention & control , Analysis of Variance , Female , HIV Infections/prevention & control , Humans , Male , Motivation , Time Factors , United States
8.
Sex Transm Dis ; 27(9): 539-44, 2000 Oct.
Article in English | MEDLINE | ID: mdl-11034528

ABSTRACT

BACKGROUND: The risk of sexually transmitted hepatitis B virus infection is proportionally higher for young adults and women. Low socioeconomic groups have high rates of hepatitis B infection with no identified source of transmission. The prevalence and correlates of transmission of hepatitis B virus among young women of low socioeconomic status have not been well documented. GOAL: To determine the population-based prevalence and correlates of sexually acquired hepatitis B virus infection in young low-income women in the San Francisco Bay Area. STUDY DESIGN: A three-county, door-to-door serosurvey of hepatitis B virus core antibody among young women living in low-income areas was conducted from April 1996 to January 1998. Multivariate analysis of sexually acquired hepatitis B virus infection excluded participants of Asian or Pacific Islander ethnicity or with a history of intravenous drug use or transfusion. RESULTS: The prevalence of sexually acquired hepatitis B virus infection was 6.4% (95% CI, 4.7%-8.1%). Correlates of infection were black race (odds ratio, 3.9; 95% CI, 1.2-11.9 compared with white race) and herpes simplex virus type 2 infection (odds ratio, 2.0; 95% CI, 1.0-3.9). CONCLUSIONS: Young black women have a higher risk of sexually acquired hepatitis B virus infection. Herpes simplex virus type 2 infection may predispose to hepatitis B virus infection and/or be a marker for lifetime sexual risk behavior.


Subject(s)
Hepatitis B/epidemiology , Poverty , Adolescent , Adult , Ethnicity/statistics & numerical data , Female , Hepatitis B/ethnology , Hepatitis B virus/isolation & purification , Humans , Prevalence , San Francisco/epidemiology , Socioeconomic Factors , Women's Health
9.
Sex Transm Dis ; 27(8): 446-51, 2000 Sep.
Article in English | MEDLINE | ID: mdl-10987449

ABSTRACT

BACKGROUND: Many studies measure sex behavior to determine the efficacy of sexually transmitted disease (STD)/HIV prevention interventions. GOAL: To determine how well measured behavior reflects STD incidence. STUDY DESIGN: Data from a trial (Project RESPECT) were analyzed to compare behavior and incidence of STD (gonorrhea, chlamydia, syphilis, HIV) during two 6-month intervals. RESULTS: A total of 2879 persons had 5062 six-monthly STD exams and interviews; 8.9% had a new STD in 6 months. Incidence was associated with demographic factors but only slightly associated with number of partners and number of unprotected sex acts with occasional partners. Many behaviors had paradoxical associations with STD incidence. After combining behavior variables to compare persons with highest and lowest risk behaviors, the STD incidence ratio was only 1.7. CONCLUSION: Behavioral interventions have prevented STD. We found people tend to have safe sex with risky partners and risky sex with safe partners. Therefore, it is difficult to extrapolate the disease prevention efficacy of an intervention from a measured effect on behavior alone.


Subject(s)
Sexual Behavior , Sexually Transmitted Diseases/epidemiology , Adolescent , Adult , Condoms/statistics & numerical data , Female , Humans , Incidence , Male , Patient Education as Topic , Risk Factors , Risk-Taking , Sexual Partners , Sexually Transmitted Diseases/prevention & control , United States/epidemiology
10.
Health Psychol ; 19(5): 458-68, 2000 Sep.
Article in English | MEDLINE | ID: mdl-11007154

ABSTRACT

To study the structure of beliefs about condom use outcomes, the authors derived and tested 4 psychosocial hypothetical models: (a) a 2-factor model of the personal and social outcomes of condom use; (b) a 2-factor model of the pros and cons of the behavior; (c) a 3-factor model (i.e., physical, self-evaluative, and social) of outcome expectancies; and (d) a thematic 4-factor model of the protection, self-concept, pleasure, and interaction implications of the behavior. All 4 models were studied with a confirmatory factor analysis approach in a multisite study of 4,638 participants, and the thematic solution was consistently the most plausible. Self-concept and pleasure were most strongly associated with attitudes toward using condoms, intentions to use condoms, and actual condom use, whereas protection and interaction generally had little influence.


Subject(s)
Attitude to Health , Condoms , Health Behavior , Risk-Taking , Self Concept , Adult , Counseling , Female , HIV Infections/prevention & control , HIV Infections/psychology , Health Knowledge, Attitudes, Practice , Health Surveys , Humans , Male , Philosophy
11.
Sex Transm Dis ; 27(7): 393-400, 2000 Aug.
Article in English | MEDLINE | ID: mdl-10949430

ABSTRACT

BACKGROUND: Herpes simplex virus type 2 (HSV-2) is one of the most common sexually transmitted infections and may enhance transmission of HIV. However, population-based estimates of HSV-2 prevalence and correlates of infection are rare. GOALS: To obtain population-based estimates of HSV-2 prevalence and to identify demographic and sexual behavioral correlates of infection among women in low-income communities of Northern California. STUDY DESIGN: A randomized, single-stage, cluster sample, cross-sectional survey of women age 18 to 29 years who reside in 1990 US Census block groups at the lowest tenth percentile for household income. RESULTS: The survey-weighted prevalence of HSV-2 infection was 34.8% (95% CI, 30.4-39.2). Factors independently associated with HSV-2 seropositivity were black race, older age, lower income, parity, greater number of lifetime male sexual partners, earlier onset of sexual intercourse, sex work, history of sexually transmitted disease (STD), and cocaine use. CONCLUSION: The high prevalence of HSV-2 and the strong correlation with sexual risk underscores the potential for further spread of STD, including HIV, in this young population.


Subject(s)
Herpes Genitalis/epidemiology , Herpesvirus 2, Human , Population Surveillance , Poverty , Adolescent , Adult , California/epidemiology , Cross-Sectional Studies , Female , Herpes Genitalis/diagnosis , Herpesvirus 2, Human/isolation & purification , Humans , Population Surveillance/methods , Prevalence , Risk Factors , Sexual Behavior
12.
AIDS Care ; 12(3): 357-64, 2000 Jun.
Article in English | MEDLINE | ID: mdl-10928213

ABSTRACT

According to the Stages of Change (SOC) model, behavioural change involves a process of movement from precontemplation (no intention to change), to contemplation (some intention to change, but no behaviour), to preparation (intention to change and early inconsistent behavioural attempts to change), to action (consistent behavioural performance for less than six months) and finally, to maintenance (consistent behavioural performance for six months or more). Moreover, it is argued that cognitive (e.g. attitude change) and action oriented (e.g. changing self-efficacy) strategies are differentially effective at different stages. In contrast, most other behavioural prediction and change models suggest that both cognitive and action oriented approaches are necessary to move people from precontemplation to contemplation (i.e. to develop intentions). This paper tests this and other differences between these two theoretical approaches. Among other findings, our data indicate that a combination of cognitive and action strategies may be the most effective way to target individuals who have no intention to change their behaviour.


Subject(s)
Behavior Therapy/methods , Risk-Taking , Sexual Behavior/psychology , Sexually Transmitted Diseases/prevention & control , Adolescent , Adult , Attitude to Health , Condoms , Female , Follow-Up Studies , Humans , Male , Models, Psychological , Self Efficacy , Sexually Transmitted Diseases/psychology
14.
Arch Pediatr Adolesc Med ; 153(8): 829-33, 1999 Aug.
Article in English | MEDLINE | ID: mdl-10437755

ABSTRACT

OBJECTIVE: To determine the relative importance of various features of health clinics when African American adolescents consider seeking care for sexually transmitted diseases (STDs). DESIGN: Confidential interviewer-administered telephone survey. SETTING: A predominantly low-income, African American neighborhood in San Francisco, Calif. PARTICIPANTS: Random sample of African American adolescents aged 12 to 17 years; 302 (76.6%) of 394 identified eligible adolescents participated. MAIN OUTCOME MEASURES: Items and scales measuring adolescents' sense of the importance of the attributes of the provider (alpha = .58), availability of services (alpha = .61), and perceived confidentiality of health services from family (alpha = . 72) when deciding where to seek care for possible STDs. RESULTS: More than 90% (90.4%) of subjects rated items relating to provider attributes as being highly important when they consider where they would seek care for an STD; between 62.5% and 82.7% rated availability items as being highly important; and between 38.6% and 60.8% rated items pertaining to confidentiality as being highly important. Greater importance was placed on provider attributes and confidentiality by female than male adolescents. The importance placed on provider attributes and confidentiality increased as adolescents aged. CONCLUSIONS: Low-income, African American adolescents place great importance on provider attributes, less importance on availability, and even less importance on confidentiality when deciding where to seek health care for a possible STD. Health care providers and organizations need to be aware of these adolescent preferences to better promote screening and treatment of STDs in this population.


Subject(s)
Adolescent Health Services , Black or African American , Patient Acceptance of Health Care , Poverty Areas , Sexually Transmitted Diseases/prevention & control , Adolescent , Black or African American/psychology , Appointments and Schedules , Confidentiality , Female , Humans , Linear Models , Male , Professional-Patient Relations , San Francisco
15.
J Community Health ; 24(3): 201-14, 1999 Jun.
Article in English | MEDLINE | ID: mdl-10399652

ABSTRACT

The effectiveness of HIV antibody counseling and testing as a prevention intervention is limited: persons testing seronegative do not usually change their risk behaviors, some actually increase their risk behaviors, and decreases in risk behaviors are usually short-lived. Referrals to additional prevention and other needed services are therefore recommended, although the extent and determinants of referral provision for persons testing seronegative are unknown. We assessed the prevalence of referrals and the association between risk behaviors and prevention referrals among seronegatives. We reviewed HIV testing and referral data on all persons receiving confidential seronegative test results in San Francisco (SF) in the first 10 months of 1995 (n = 5,595), and gathered more detailed referral information at the municipal STD clinic from November 1995 through May 1996 (n = 747). The overall prevalence of referrals was low: a referral was given to 19.1% of the SF sample and 10.6% of the STD clinic sample; 15.4% of the SF sample and 5.9% of the STD clinic sample received a prevention referral. Injection drug users (IDUs) were the most likely to receive a prevention referral (48.5% of SF IDUs, 36.4% of STD clinic IDUs); men having sex with men and women with high-risk partners were also more likely to get a prevention referral than others. For SF IDUs, unsafe sex and needle sharing were not associated with an increased likelihood of receiving a prevention referral. Opportunities to link high-risk clients from counseling and testing to HIV prevention services are being missed. The referral component of HIV counseling and testing should be improved.


Subject(s)
AIDS Serodiagnosis , Community Networks/statistics & numerical data , HIV Infections/prevention & control , Patient Education as Topic/statistics & numerical data , Preventive Health Services/statistics & numerical data , Referral and Consultation/statistics & numerical data , AIDS Serodiagnosis/psychology , AIDS Serodiagnosis/statistics & numerical data , Adult , Attitude of Health Personnel , Chi-Square Distribution , Community Networks/standards , Female , HIV Infections/psychology , HIV Infections/transmission , Health Care Surveys , Humans , Male , Patient Education as Topic/standards , Referral and Consultation/standards , San Francisco/epidemiology , Sexual Behavior/statistics & numerical data , Substance Abuse, Intravenous/epidemiology
16.
Sex Transm Dis ; 26(6): 335-8, 1999 Jul.
Article in English | MEDLINE | ID: mdl-10417021

ABSTRACT

BACKGROUND AND OBJECTIVES: Female inmates have high rates of sexually transmitted diseases (STDs), and many incarcerated women and jail providers believe STDs are acquired within the jail. We investigated a suspected outbreak of trichomoniasis among female inmates and described the epidemiology of trichomonas infection. GOALS OF THIS STUDY: To determine the likelihood of within-jail acquisition of trichomoniasis. STUDY DESIGN: Retrospective chart review of gynecologic visits to the jail medical clinic and comparison of trichomoniasis surveillance data over a 6-year time period. RESULTS: The minimum prevalence of trichomoniasis infection among 450 female inmates presenting to the medical clinic for gynecologic evaluation was 37%. Most infections were diagnosed early after incarceration, no woman developed a new infection after adequate treatment, and there was no clustering of cases by time or location. CONCLUSION: There was no evidence to support within-jail acquisition of trichomoniasis. The high rate of trichomoniasis and other STDs among incarcerated women warrant more comprehensive jail-based STD screening programs.


Subject(s)
Disease Outbreaks , Prisoners , Sexually Transmitted Diseases/epidemiology , Trichomonas Vaginitis/epidemiology , Trichomonas vaginalis/isolation & purification , Adult , Animals , Female , Humans , Retrospective Studies , Trichomonas Vaginitis/parasitology
17.
J Infect Dis ; 179(3): 729-33, 1999 Mar.
Article in English | MEDLINE | ID: mdl-9952388

ABSTRACT

From 1994 to 1997, the proportion of Neisseria gonorrhoeae highly resistant to ciprofloxacin (MIC >/=4 microg/mL) increased substantially among female sex workers (FSWs) in the Philippines. Among 1499 Filipina FSWs, we evaluated factors associated with gonococcal infection and with gonococcal antimicrobial resistance. By multivariate analysis, gonococcal infection was associated with sex with a new client, self-prescribed prophylactic antimicrobial use, work in a brothel, and inconsistent condom use and was negatively associated with registration status and vaginal hygiene practices. Factors associated with ciprofloxacin-resistant gonococci included: marital status, living alone, duration of sex work, and clinic site. Further, gonococci highly resistant to ciprofloxacin were isolated from 10 (11.5%) of 87 FSWs reporting self-prescribed antimicrobial use versus 44 (3.4%) of 1295 reporting no antimicrobial use (P<.001). Self-prescribed prophylactic antimicrobial use and inconsistent condom use could be important factors in the continued emergence of gonococcal antimicrobial resistance in the Philippines.


Subject(s)
Anti-Infective Agents/pharmacology , Ciprofloxacin/pharmacology , Drug Resistance, Microbial , Gonorrhea/drug therapy , Neisseria gonorrhoeae/drug effects , Sex Work , Adult , Anti-Infective Agents/therapeutic use , Ciprofloxacin/therapeutic use , Condoms , Female , Gonorrhea/epidemiology , Gonorrhea/microbiology , Humans , Male , Multivariate Analysis , Neisseria gonorrhoeae/genetics , Neisseria gonorrhoeae/isolation & purification , Philippines/epidemiology , Prevalence , Self Medication , Sexually Transmitted Diseases/epidemiology
18.
JAMA ; 280(13): 1161-7, 1998 Oct 07.
Article in English | MEDLINE | ID: mdl-9777816

ABSTRACT

CONTEXT: The efficacy of counseling to prevent infection with the human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) has not been definitively shown. OBJECTIVE: To compare the effects of 2 interactive HIV/STD counseling interventions with didactic prevention messages typical of current practice. DESIGN: Multicenter randomized controlled trial (Project RESPECT), with participants assigned to 1 of 3 individual face-to-face interventions. SETTING: Five public STD clinics (Baltimore, Md; Denver, Colo; Long Beach, Calif; Newark, NJ; and San Francisco, Calif) between July 1993 and September 1996. PARTICIPANTS: A total of 5758 heterosexual, HIV-negative patients aged 14 years or older who came for STD examinations. INTERVENTIONS: Arm 1 received enhanced counseling, 4 interactive theory-based sessions. Arm 2 received brief counseling, 2 interactive risk-reduction sessions. Arms 3 and 4 each received 2 brief didactic messages typical of current care. Arms 1, 2, and 3 were actively followed up after enrollment with questionnaires at 3, 6, 9, and 12 months and STD tests at 6 and 12 months. An intent-to-treat analysis was used to compare interventions. MAIN OUTCOME MEASURES: Self-reported condom use and new diagnoses of STDs (gonorrhea, chlamydia, syphilis, HIV) defined by laboratory tests. RESULTS: At the 3- and 6-month follow-up visits, self-reported 100% condom use was higher (P<.05) in both the enhanced counseling and brief counseling arms compared with participants in the didactic messages arm. Through the 6-month interval, 30% fewer participants had new STDs in both the enhanced counseling (7.2%; P= .002) and brief counseling (7.3%; P= .005) arms compared with those in the didactic messages arm (10.4%). Through the 12-month study, 20% fewer participants in each counseling intervention had new STDs compared with those in the didactic messages arm (P = .008). Consistently at each of the 5 study sites, STD incidence was lower in the counseling intervention arms than in the didactic messages intervention arm. Reduction of STD was similar for men and women and greater for adolescents and persons with an STD diagnosed at enrollment. CONCLUSIONS: Short counseling interventions using personalized risk reduction plans can increase condom use and prevent new STDs. Effective counseling can be conducted even in busy public clinics.


Subject(s)
Counseling , HIV Infections/prevention & control , Sexually Transmitted Diseases/prevention & control , Adolescent , Adult , Community Health Services , Female , Humans , Male , Risk Factors , United States
19.
Am J Obstet Gynecol ; 178(5): 987-90, 1998 May.
Article in English | MEDLINE | ID: mdl-9609572

ABSTRACT

OBJECTIVE: We sought to determine potential risk factors for upper genital tract inflammation in women with cervical Neisseria gonorrhoeae, Chlamydia trachomatis, or bacterial vaginosis. STUDY DESIGN: In a case-controlled study we compared 111 women with cervical Neisseria gonorrhoeae, Chlamydia trachomatis, or bacterial vaginosis (the study group) with 24 women who had negative tests for each of these infections (the control group). We evaluated potential risk factors for upper genital tract inflammation by use of bivariate and then logistic regression analysis. RESULTS: We found plasma cell endometritis in 53 of 111 women in the study group and 3 of 24 controls (odds ratio = 6.4, 95% confidence interval 1.7 to 35.0). On logistic regression, the study group women who were in the proliferative phase had increased likelihood of plasma cell endometritis (odds ratio = 4.5, 95% confidence interval 1.6 to 12.4). CONCLUSION: The proliferative phase of the menstrual cycle seems to be the primary risk factor for ascending infection by organisms associated with pelvic inflammatory disease. This may be due to a hormonal effect or to the loss of the cervical barrier during menstruation.


Subject(s)
Cervix Uteri/microbiology , Chlamydia trachomatis/isolation & purification , Endometritis/microbiology , Neisseria gonorrhoeae/isolation & purification , Plasma Cells , Adolescent , Adult , Black People , Case-Control Studies , Chlamydia Infections/complications , Chlamydia Infections/microbiology , Endometritis/epidemiology , Endometritis/pathology , Female , Gonorrhea/complications , Gonorrhea/microbiology , Humans , Menstrual Cycle , Middle Aged , Risk Factors , Therapeutic Irrigation , Vaginosis, Bacterial
20.
J Infect Dis ; 177(6): 1766-9, 1998 Jun.
Article in English | MEDLINE | ID: mdl-9607868

ABSTRACT

Gonococcal (GC) infections are very common and are sustained by a core group of persons who often have repeated GC infections. Identifying individual risk factors for repeated GC infection is essential so that infection control programs can develop better strategies for decreasing the incidence of GC infection. A case-control study among high-risk persons found that being African American, having previous chlamydia infection, and having less than a high-school education were associated with repeated GC infections. Remarkably, measures of sexual behavior and access to health care were not associated with repeated GC infections. These findings suggest that among high-risk persons, the community prevalence of GC infection is more important in predicting risk for repeated GC infections than individual behavior. Interventions should include continued use of resources in high-prevalence communities and better understanding of the roles social and economic discrimination play in the risk for GC infections.


Subject(s)
Gonorrhea/epidemiology , Adolescent , Adult , Black or African American , Case-Control Studies , Female , Humans , Male , Multivariate Analysis , Prospective Studies , Recurrence , Risk Factors , San Francisco/epidemiology
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