Estimated mortality of adult HIV-infected patients starting treatment with combination antiretroviral therapy

To provide estimates of mortality among HIV-infected patients starting combination antiretroviral therapy.

The experiences of ethnic minority MSM using NHS sexual health clinics in Britain

To compare the experiences of ethnic minority and white British men who have sex with men (MSM) who attend NHS sexual health clinics in Britain.

Insights into the timing of repeated testing after treatment for Chlamydia trachomatis: data and modelling study

The objective of this study was to determine the optimal time interval for a repeated Chlamydia trachomatis (chlamydia) test.

Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis

OBJECTIVES: To synthesize the evidence on the risk of HIV transmission through unprotected sexual intercourse according to viral load and treatment with combination antiretroviral therapy (ART). DESIGN: Systematic review and meta-analysis. METHODS: We searched Medline, Embase and conference abstracts from 1996-2009. We included longitudinal studies of serodiscordant couples reporting on HIV transmission according to plasma viral load or use of ART and used random-effects Poisson regression models to obtain summary transmission rates [with 95% confidence intervals, (CI)]. If there were no transmission events we estimated an upper 97.5% confidence limit. RESULTS: We identified 11 cohorts reporting on 5021 heterosexual couples and 461 HIV-transmission events. The rate of transmission overall from ART-treated patients was 0.46 (95% CI 0.19-1.09) per 100 person-years, based on five events. The transmission rate from a seropositive partner with viral load below 400 copies/ml on ART, based on two studies, was zero with an upper 97.5% confidence limit of 1.27 per 100 person-years, and 0.16 (95% CI 0.02-1.13) per 100 person-years if not on ART, based on five studies and one event. There were insufficient data to calculate rates according to the presence or absence of sexually transmitted infections, condom use, or vaginal or anal intercourse. CONCLUSION: Studies of heterosexual discordant couples observed no transmission in patients treated with ART and with viral load below 400 copies/ml, but data were compatible with one transmission per 79 person-years. Further studies are needed to better define the risk of HIV transmission from patients on ART.

Repeat chlamydia screening among adolescents: cohort study in a school-based programme in New Orleans

OBJECTIVES To describe uptake of chlamydia screening, determine rates of repeated yearly screening and investigate determinants of repeated participation in an organised school-based screening programme. METHODS The authors analysed data from 1995 to 2005 from female and male students in up to 13 schools in New Orleans, Louisiana, USA. The authors calculated proportions of students tested among all enrolled students and among those with parental consent and the percentage of positive chlamydia tests in each school year. The authors used random effects logistic regression to examine the effect of past screening history on subsequent participation. RESULTS 35 041 students were registered for at least one school year. Overall coverage was >30% in all school years. Among all students registered for 4 years, 10.6% (95% CI 9.3% to 12.0%) of women and 12.7% (95% CI 11.2% to 14.2%) of men had a test every year. Among students with parental consent for 4 years, 49.3% (95% CI 44.6% to 54.1%) of women and 59.3% (95% CI 54.5% to 64.0%) of men had a test every year. Among students registered for 2 or more years, those with a previous positive chlamydia test were less likely to have a subsequent test (female adjusted OR 0.77, 95% CI 0.67 to 0.88 and male adjusted OR 0.84, 95% CI 0.69 to 1.02). Chlamydia positivity increased over time. CONCLUSIONS High levels of uptake can be achieved in school-based chlamydia screening programmes, but repeated yearly screening is difficult to sustain over time.

Reinfection by untreated partners of people treated for Chlamydia trachomatis and Neisseria gonorrhoeae: mathematical modelling study

OBJECTIVES Reinfection after treatment for Chlamydia trachomatis or Neisseria gonorrhoeae reduces the effect of control interventions. We explored the impact of delays in treatment of current partners on the expected probability of reinfection of index cases using a mathematical model. METHODS We used previously reported parameter distributions to calculate the probability that index cases would be reinfected by their untreated partners. We then assumed different delays between index case and partner treatment to calculate the probabilities of reinfection. RESULTS In the absence of partner treatment, the medians of the expected reinfection probabilities are 19.4% (IQR 9.2-31.6%) for C trachomatis and 12.5% (IQR 5.6-22.2%) for N gonorrhoeae. If all current partners receive treatment 3 days after the index case, the expected reinfection probabilities are 4.2% (IQR 2.1-6.9%) for C trachomatis and 5.5% (IQR 2.6-9.5%) for N gonorrhoeae. CONCLUSIONS Quicker partner referral and treatment can substantially reduce reinfection rates for C trachomatis and N gonorrhoeae by untreated partners. The formula we used to calculate reinfection rates can be used to inform the design of randomised controlled trials of novel partner notification technologies like accelerated partner therapy.

Dispelling the Myth: What Parents Really Think about Sex Education in Schools

Background: School-based sex education is effective in reducing risky sexual behavior among adolescents that may lead to unintended pregnancies and sexually transmitted infections. However, most sex education policies in the US do not support evidence-based programs. Understanding parental attitudes around sex education is crucial to overcoming perceived barriers to implementing school-based sex education. Little research has been published on the opinions of parents in Texas, which accounts for 12% of the nation’s teen births. Purpose: The purpose of this study was to examine whether Texas parents favor teaching sex education in schools, in what grades they think sex education should be taught, what content they think should be taught, and who they think should make decisions regarding sex education. Methods: We commissioned a telephone survey of parents of children 18 years or younger in Harris County, Texas. Survey questions assessed demographic characteristics and opinions about sex education. We used chi-square tests to examine differences across sociodemographic characteristics. Results: 1,201 parents completed the survey. The majority of parents (80%) responded that sex education should begin in middle school or earlier, and two-thirds said that it should include information about condoms and contraception. Hispanic parents showed the highest support for teaching sex education and providing medically accurate information on condoms and contraception in middle school or earlier. Conclusion: Parents in Harris County overwhelmingly support sex education that includes medically accurate information about condoms and contraception beginning before high school. These data provide evidence to change sex education policies to better reflect parental opinions.

Genetic Resistance Determinants, In Vitro Time-Kill Curve Analysis and Pharmacodynamic Functions for the Novel Topoisomerase II Inhibitor ETX0914 (AZD0914) in Neisseria gonorrhoeae.

Resistance in Neisseria gonorrhoeae to all available therapeutic antimicrobials has emerged and new efficacious drugs for treatment of gonorrhea are essential. The topoisomerase II inhibitor ETX0914 (also known as AZD0914) is a new spiropyrimidinetrione antimicrobial that has different mechanisms of action from all previous and current gonorrhea treatment options. In this study, the N. gonorrhoeae resistance determinants for ETX0914 were further described and the effects of ETX0914 on the growth of N. gonorrhoeae (ETX0914 wild type, single step selected resistant mutants, and efflux pump mutants) were examined in a novel in vitro time-kill curve analysis to estimate pharmacodynamic parameters of the new antimicrobial. For comparison, ciprofloxacin, azithromycin, ceftriaxone, and tetracycline were also examined (separately and in combination with ETX0914). ETX0914 was rapidly bactericidal for all wild type strains and had similar pharmacodynamic properties to ciprofloxacin. All selected resistant mutants contained mutations in amino acid codons D429 or K450 of GyrB and inactivation of the MtrCDE efflux pump fully restored the susceptibility to ETX0914. ETX0914 alone and in combination with azithromycin and ceftriaxone was highly effective against N. gonorrhoeae and synergistic interaction with ciprofloxacin, particularly for ETX0914-resistant mutants, was found. ETX0914, monotherapy or in combination with azithromycin (to cover additional sexually transmitted infections), should be considered for phase III clinical trials and future gonorrhea treatment.

Association of part-time employment and sexual risk-taking behaviors among middle school students

Background. Previous research shows inconsistent results as to the association between part-time employment and sexual behavior among younger teens. Studies of older teens cannot be generalized to younger teens because of the wide differences in types of work performed, nature of work environments, and work intensity. Objective. Examine the relationship between part-time employment and sexual behavior in a cross-sectional sample of public middle school students in Houston, Texas. Methods . The study presents a secondary analysis of data from the It’s Your Game…Keep it Real baseline data collection (11/2004–1/2005). It’s Your Game… is an intervention program for middle school students designed to prevent Sexually Transmitted Infections. Statistical analysis. Univariate and multivariate logistic regression analyses were conducted to examine the association between part-time employment and vaginal intercourse: (a) ever had sex; and (b) current sexual activity. Results. Overall, 13.2% of students worked for pay; male students were 1.5 times as likely as females to be working. Of all the students, 11.0% had had sexual intercourse; students who worked were 3 times more likely to be sexually experienced than those who did not. Among students who were sexually experienced, 67.0% were currently sexually active. After adjusting for the other covariates, Hispanic students were almost 3.6 times more likely to report current sexual activity compared to students in other racial/ethnic groups. In univariate analysis, students who worked 1-5 hrs/week were more likely to be sexually experienced than those not currently employed, and the likelihood increased with number of hours worked. There is a similar pattern in the multivariate model, but the odds ratios are too close for the evidence to be more than suggestive. Of sexually experienced students, students working 1-5 hrs/week were 2.7 times more likely to report current sexual intercourse than those not working; those working >5 hrs/week were 4.7 times more likely. The multivariate model showed a similar increase in likelihood, and adjustment for covariates increased these associations: students who worked 1-5 hrs/week were 3.6 times more likely to report current sexual intercourse, and students who worked >5 hrs/week were 4.5 times more likely, than students not currently employed.^

Social cognitive theory and factors associated with Mexican-American parents' beliefs, attitudes and practices regarding communication with their adolescent children about sex

Latinos have the highest teen birth rate nationally. Cameron County, Texas is primarily Latino (Mexican-American). This mixed-method study (n=43) examines Mexican-American parents of adolescents' beliefs, attitudes and practices regarding communication with their adolescent children about sex. Social Cognitive Theory (SCT) constructs self-efficacy, behavioral determinism, environment, outcome expectations and reciprocal determinism can be influences on frequency and quality of parent-adolescent sex communication.^ This study describes Mexican-American parents' of adolescents recollections of their own experiences associated with learning about sexuality. It also examines the attitudes and practices regarding communication about sex and the self-efficacy and behavioral capability of participants to teach their adolescent children about sex and sexually transmitted infections. ^ Negative childhood experiences (shame, lies and trauma) of the parents in this study played a key role in terms of their desire to communicate more comprehensively about sexuality with their own children than did their parents. While participants' reported low self-efficacy and behavioral capability to communicate with their adolescent children about sex, they reported relatively high frequency and quality of communication, with 75% of participants receiving a high quality score and over 44% reporting frequent communication with their adolescent children about sex. A Chi square analysis and Fisher's Exact Score revealed no association between acculturation status, gender or having a child who has mothered/fathered a baby and the frequency or quality of communication about sex with adolescent children. Study participants also gave specific recommendations for method, content and setting of sex education for their children and themselves. Promotora delivery of information and education in a comfortable, culturally appropriate neighborhood setting, as well as parent –child learning sessions were identified as possible approaches to address improve self-efficacy and behavioral capability of parents communicating with their adolescent children about sex.^ The results of this analysis provide public health practitioners and interested community entities data to identify and develop interventions that use a theoretical, evidence-based framework for culturally appropriate interventions to encourage and equip Mexican-American parents to effectively communicate with their adolescent children about sexuality, and ultimately to address the high rates of teen pregnancy in this U.S.-Mexico border community. ^

Barriers to adolescent and young men's access of reproductive health care

Purpose. The purpose of this study was to identify the health needs and barriers that young men face in accessing health care and family planning services and to identify what health centers can do to attract young men to the clinic. A focus group format was used to elicit ideas from participants. ^ Methods. Forty-eight young men participated in nine focus groups. The young men were asked about the health issues they have, the barriers they face in accessing reproductive health care, and what clinics can do to attract young men to the clinic. Thematic analysis principles were used to identify the main themes that emerged in the focus groups. ^ Results. Sexually transmitted infections (STIs), mental health problems, and drug use were the major health issues that were mentioned in the majority of the focus groups. The main barriers discussed in the focus groups were attitudinal factors such as young men thinking it is unmanly to seek help, emotional factors such as young men not seeking help because of their ego or pride, and institutional factors such as the location of the clinic. The main suggestions for improvements in the health clinic included decreasing waiting times, emphasizing the fact that the clinics are free for males, having more female nurses, and encouraging clinic staff to treat the young men with respect. Young men suggested advertising and promoting the clinic in schools, in the community, and through the media. Focus group participants also provided their input about the design and format of the clinic flyer. ^ Conclusions. Many studies focus on the reproductive health care needs of adolescent and young females. This study has helped to show that young men also have health care needs and face barriers to accessing reproductive health care services.^

It's your game, keep it real. Sexual education study

Purpose: This study translated and adapted the It's Your Game, Keep It Real study currently being implemented with middle school youth in Southeast Texas for a middle school population in rural western Honduras. The study tested the effects of a sexual health education program focused on human immunodeficiency virus, sexually transmitted infections, and pregnancy prevention. We hypothesized that the number of adolescents in the intervention group who initiate sexual activity will reduce in comparison to the control group and there will be an increase consistent condom use in sexually active adolescents in the intervention group. ^ Methods: The target population included Spanish-speaking Hispanic middle school students from a small, semi-urban city in western Honduras. One school was randomly selected to receive the intervention and one to the comparison condition. The intervention curriculum consisted of 10 seventh-grade lessons that included individual and group classroom-based activities and personal journaling. Follow-up surveys were completed three months after the last lesson with 146 students (79.3% of the defined cohort). ^ Results: In the comparison condition, 21.4% of students initiated sex by the post-test follow-up three months after the intervention compared to 7.8% in the intervention condition. ^ Conclusions: A multi-component, curriculum-based program that is theory driven and culturally relevant can increase knowledge about STIs and HIV, increase self-confidence amongst middle school students, and develop communication skills amongst friends and partners. Further research must be conducted to assess delay in sexual initiation and the generalizability of these results.^

Risk and resiliency: The untold story of youth in military families

Background: Risky sexual behaviors have been shown to increase the risk of unintended pregnancy and sexually transmitted infections (STIs) among youth. Youth in military families may be especially at risk for engaging in risky sexual behaviors because they are exposed to factors that are unique to the military culture, such as multiple relocations and parental deployment. However, data on sexual behaviors among military-dependent youth are limited and few studies have examined how these factors influence the sexual behaviors among youth. Purpose: The purpose of this dissertation was to estimate the prevalence of risky sexual behaviors among military-dependent youth and to describe how military factors may influence their sexual behaviors. Methods: Youth, aged 15–19 years, who attended a military health facility in the southern United States between June 2011 and September 2011 were recruited to complete a short, paper-based survey (N= 208, males and females) and to participate in an in-depth interview (N = 25, females). For quantitative data, prevalence estimates were computed and chi-square analyses were conducted. Logistic regression analyses were also conducted, adjusting for age, gender, and parents' duty status. For qualitative data, thematic coding of transcribed interviews was performed. Common and unique themes were examined across participants' experiences. Results: Over half of the youth was sexually experienced (53.7%). Parental deployment and number of relocations were significantly associated with having had sex in the past 3 months; however no significant associations were found between these military factors and other sexual behaviors. Although some youth felt that being a military-dependent had negatively impacted their sexual decisions, most believed the military experience had little influence on their sexual decisions. Most youth in military families also perceived having higher parental expectations to avoid risky behaviors, in general, than youth in civilian families. Conclusions: The majority of military-dependent youth are sexually experienced; however, individual and parental factors may have a greater role in sexual initiation among youth than military stressors do. The findings highlight the need for implementation of evidence-based strategies to prevent teen pregnancy and STIs at military installations. Future studies with larger sample sizes are needed to further explore how youth may cope with these military factors and the impact of parental factors on the sexual behaviors of youth.^

Exploring parental factors and their influence on early adolescent sexual health

Black and Hispanic youth experience the largest burden of sexually transmitted infections, teen pregnancy, and childbirth (Hamilton, Martin, & Ventura, 2011). Minority youth are disporportionately more likely to sexually debut at every age and debut before the age of 13 compared to whites (Centers for Disease Control and Prevention, 2011). However, there is little known about pre-coital sexual activity or protective parental factors in early adolscent minority youth. Parental factors such as parent-child communication and parental monitoring influence adolescent sexual behaviors and pre-coital sexual behaviors in early adolescence. Three distinct methods were used in this dissertation. Study one used qualitative methods, semi-structured, in-depth, individual interviews, to explore parent-child communication in African American mother-early adolescent son dyads. Study two used quantitative methods, secondary data analysis of a cross sectional study, to conduct a moderation analysis. For study three, I conducted a systematic review of parent-based adolescent sexual health interventions. Study one found that mothers feel comfortable talking about sex with adolescents, provide a two-prong sexual health message, and want their sons to tell their when they are thinking of having sex. Study found that parental monitoring moderates the relation between parent-child communication and pre-coital sexual behaviors. Study three found that interventions use a variety of theory, methods, and strategies and that no parent-based programs target faith-based organizations, mother-son or father-daughter dyads, or parents of LGBTQ youth. Adolescent sexual health interventions should consider addressing youth-to-parent disclosure of sexual activity or intentions to debut, addressing both parent-child sexual health communication and parental monitoring, and using a theoretical framework.^

Advance provision of emergency contraception for pregnancy prevention (Review)

Background Emergency contraception can prevent pregnancy when taken after unprotected intercourse.Obtaining emergency contraception within the recommended time frame is difficult for many women. Advance provision could circumvent some obstacles to timely use. Objectives To summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors. Search strategy In November 2009, we searched CENTRAL, EMBASE, POPLINE,MEDLINE via PubMed, and a specialized emergency contraception article database. We also searched reference lists and contacted experts to identify additional published or unpublished trials. Selection criteria We included randomized controlled trials comparing advance provision and standard access (i.e., counseling whichmay ormay not have included information about emergency contraception, or provision of emergency contraception on request at a clinic or pharmacy). Data collection and analysis Two reviewers independently abstracted data and assessed study quality. We entered and analyzed data using RevMan 5.0.23. Main results Eleven randomized controlled trials met our criteria for inclusion, representing 7695 patients in the United States, China, India and Sweden. Advance provision did not decrease pregnancy rates (odds ratio (OR) 0.98, 95% confidence interval (CI) 0.76 to 1.25 in studies for which we included twelve-month follow-up data; OR 0.48, 95% CI 0.18 to 1.29 in a study with seven-month follow-up data; OR 0.92, 95% CI 0.70 to 1.20 in studies for which we included six-month follow-up data; OR 0.49, 95% CI 0.09 to 2.74 in a study with three-month follow-up data), despite reported increased use (single use: OR 2.47, 95% CI 1.80 to 3.40; multiple use: OR 4.13, 95% CI 1.77 to 9.63) and faster use (weighted mean difference (WMD) -12.98 hours, 95% CI -16.66 to -9.31 hours). Advance provision did not lead to increased rates of sexually transmitted infections (OR 1.01, 95% CI 0.75 to 1.37), increased frequency of unprotected intercourse, or changes in contraceptive methods.Women who received emergency contraception in advance were equally likely to use condoms as other women. Authors’ conclusions Advance provision of emergency contraception did not reduce pregnancy rates when compared to conventional provision. Results from primary analyses suggest that advance provision does not negatively impact sexual and reproductive health behaviors and outcomes. Women should have easy access to emergency contraception, because it can decrease the chance of pregnancy.However, the interventions tested thus far have not reduced overall pregnancy rates in the populations studied.