State-level gonorrhea rates and expedited partner therapy laws: insights from time series analyses.

OBJECTIVE: In this study, we examined state-level monthly gonorrhea morbidity and assessed the potential impact of existing expedited partner therapy (EPT) laws in relation to the time that the laws were enacted. STUDY DESIGN: Longitudinal study. METHODS: We obtained state-level monthly gonorrhea morbidity (number of cases/100,000 for males, females and total) from the national surveillance data. We used visual examination (of morbidity trends) and an autoregressive time series model in a panel format with intervention (interrupted time series) analysis to assess the impact of state EPT laws based on the months in which the laws were enacted. RESULTS: For over 84% of the states with EPT laws, the monthly morbidity trends did not show any noticeable decreases on or after the laws were enacted. Although we found statistically significant decreases in gonorrhea morbidity within four of the states with EPT laws (Alaska, Illinois, Minnesota, and Vermont), there were no significant decreases when the decreases in the four states were compared contemporaneously with the decreases in states that do not have the laws. CONCLUSION: We found no impact (decrease in gonorrhea morbidity) attributable exclusively to the EPT law(s). However, these results do not imply that the EPT laws themselves were not effective (or failed to reduce gonorrhea morbidity), because the effectiveness of the EPT law is dependent on necessary intermediate events/outcomes, including sexually transmitted infection service providers' awareness and practice, as well as acceptance by patients and their partners.

Clinics aren't Meant for Men': Sexual Health Care Access and Seeking Behaviours Among Men in Gauteng Province; South Africa

Men may be key players in the transmission of sexually transmitted infections (STI); and it is important that STI/HIV health services reach men. The objective of this study was to explore sexual health care access and seeking behaviours in men. This study used focus groups to examine sexual health care access and seeking behaviours in men 5 years after implementation of free antiretroviral therapy (ART) in the South African public sector. Six focus groups (N=58) were conducted with men ?18 years in an urban area of Gauteng province. Men were recruited from various locations throughout the community. Men reported several barriers and facilitators to the use of public and private clinics for sexual health services including HIV testing; and many men reported seeking care from traditional healers. Men often viewed public clinics as a place for women and reported experiences with some female nurses who were rude or judgmental of the men. Additionally; some men reported that they sought sexual health care services at public clinics; however; they were not given physical examinations by health care providers to diagnose their STI syndrome. Most men lacked knowledge about ART and avoided HIV testing because of fear of death or being abandoned by their families or friends. Study findings suggest that men still require better access to high-quality; non-judgmental sexual health care services. Future research is needed to determine the most effective method to increase men's access to sexual health care services

The psychosocial impact of serological diagnosis of asymptomatic herpes simplex virus type 2 infection.

OBJECTIVES: To evaluate the impact of a positive herpes simplex virus type 2 (HSV-2) serological test on psychosocial functioning among people with no known history of genital herpes. METHODS: Individuals (age 14-30 years) without a history of genital herpes were recruited from an urban university setting and sexually transmitted diseases (STD), primary care, and adolescent clinics. Participants completed a questionnaire addressing psychological functioning, psychosocial adjustment, and perceived quality of sex and were offered free HSV-2 antibody testing. 33 HSV-2 positive people and 60 HSV-2 negative people demographically matched from the same source of recruitment were re-evaluated at a 3 month follow up visit. HSV-2 positive participants also completed a genital herpes quality of life (GHQOL) measure. RESULTS: Of the 33 who were HSV-2 seropositive, four did not recall their diagnosis. In comparing those who were HSV-2 positive with those who were negative, repeated measures analysis of variance indicated there were no significant differences over time on any of the measures. None the less, many HSV-2 positive individuals indicated that the diagnosis had a notable impact on their quality of life. Also, among the HSV-2 positive people, lower GHQOL at the 3 month follow up was predicted by higher interpersonal sensitivity (r = -0.44, p<0.05), lower social support (r = 0.40, p<0.05), and quality of sex (r = 0.62, p<0.01) at baseline. CONCLUSIONS: A diagnosis of asymptomatic HSV-2 infection does not appear to cause significant lasting psychological difficulties. Those for whom the diagnosis had the greatest impact were interpersonally vulnerable before the diagnosis. These results suggest that assessment of interpersonal distress may be important to include as part of pretest and post-test counselling.

Physicians' opinions about partner notification methods: case reporting, patient referral, and provider referral.

BACKGROUND: The United States has relied upon partner notification strategies to help break the chain of infection and re-infection for sexually transmitted diseases (STD). Physicians are a vital link in the system of STD control, but little is known of physician opinions about partner notification strategies. METHODS: We collected opinions about partner notification from a national probability sample of physicians in specialties diagnosing STDs. Physicians responded to 17 questions about three relevant forms of STD partner notification: patient based referral, provider based referral, and case reporting. RESULTS: Exploratory factor analyses showed that responses for each form of partner notification could be grouped into four categories: perceived practice norms, infection control, patient relationships, and time/money. Multivariate analyses of the factors showed that physicians endorsed patient based referral most favourably and provider based referral least favourably. CONCLUSION: Physicians' opinions about partner notification strategies appear to reflect objective reality in some areas, but not in others. Strategies that improve the fit between physicians' opinions and effective notification are needed: some are discussed here.

Longitudinal prediction of sexually transmitted diseases among adolescents: results from a national survey.

BACKGROUND: Although adolescent use of condoms has been increasing, incidence of sexually transmitted diseases (STDs) among young people remains high. To identify adolescent behavioral risk factors for acquiring STDs, this study assessed adolescent self-reports of acquired chlamydia, gonorrhea, syphilis, and trichomoniasis within 1 year after a baseline interview. METHODS: We used data from the National Longitudinal Survey of Adolescent Health for this study. Data were collected in the homes of survey respondents, using audio-computer-assisted self-interview (audio-CASI) technology and interviews. Participants were enrolled in grades 7-11 from 134 U.S. schools. A cohort of 4593 sexually experienced adolescents was followed for 1 year. We conducted separate analyses for both genders. RESULTS: About 3.1% of the male adolescents and nearly 4.7% of the female adolescents reported having had at least one STD after the baseline interview. For both genders, self-reported STD infection before baseline interview was the best predictor of self-reported STD infection 1 year after baseline interview. Female adolescents were more likely to report diagnosis with an STD after baseline if they self-identified as a minority race (other than Asian) and perceived that their mother did not disapprove of their having sex. Female adolescents were less likely to report STDs if they perceived that adults care about them. No additional variables predicted STD diagnosis after baseline for male adolescents. CONCLUSIONS: We conclude that past history of STD infection is the most important indicator of subsequent STD infection among adolescents. Thus, this study suggests the benefit of specific clinical efforts designed to promote preventive behavior among adolescents newly diagnosed with an STD.

Misperceptions of the norms for the frequency of alcohol and other drug use on college campuses.

Data from surveys of students representing 100 diverse college campuses were used to investigate the difference between the self-reported frequency of a drug's use and students' perceptions of the frequency of use. Students were asked about the frequency of their own use of 11 drugs (alcohol, tobacco, marijuana, cocaine, amphetamines, sedatives, hallucinogens, opiates, inhalants, designer drugs, and steroids) and how often they thought "the average student" on their campus used these drugs. Respondents typically misperceived their peer norms (designated as the median of self-reported use) by substantially overestimating how often the average student used each drug, both in campus samples where abstinence or infrequent use were the median of self-reports and in samples where the median of self-reports revealed more frequent use. To the extent that they may promote or reinforce students' actual use, these misperceptions should be considered in designing college drug prevention programs.

Alcohol use and related consequences among students with varying levels of involvement in college athletics.

Alcohol use, binge drinking, and substance abuse-related consequences among students with varying levels of participation in intercollegiate athletics were examined. Between October 1994 and May 1996, 51,483 students at 125 institutions answered questions about their involvement in athletics, ranging from noninvolvement to participant to leadership positions, on the long form of the Core Alcohol and Drug Survey. In comparisons with nonathletes, both male and female athletes consumed significantly more alcohol per week, engaged in binge drinking more often, and suffered more adverse consequences from their substance use. No support was found for the hypothesis that athletic leaders were more responsible than other team participants in using alcohol. Male team leaders appeared to be at significantly greater risk than female team leaders; they also consumed more alcohol, binged more often, and suffered more consequences than other team members.