Influence of anonymous HIV testing on national HIV surveillance in the Republic of Korea (2000 to 2015): a retrospective analysis.

BACKGROUND: Owing to the continuous increase in the number of new human immunodeficiency virus (HIV) infection in Korea, public health centers (PHCs) have performed anonymous tests since 1989. No study has examined the patterns of anonymous HIV testing performed at PHCs and the characteristics of HIV infection detected in those tests. We aimed to assess the influence of anonymous HIV testing on Korea's national HIV surveillance. METHODS: HIV screening test data from 253 PHCs over a 16-year period were classified into 13 groups based on reason for testing. For anonymous HIV test takers (Anonymous), the HIV positivity per 10,000 tests was calculated, as repetitions could not be distinguished. Those with suspected HIV infection voluntarily underwent HIV testing and revealed their identity (Suspected). HIV prevalence was calculated as the number of HIV-positive persons per 10,000 test takers. Analyses were performed using chi-square and Cochran-Armitage trend test with SAS 9.4. RESULTS: Approximately 400,000 HIV screening tests were performed at PHCs annually, which remained unchanged in the past 10 years. The proportion of anonymous testing increased from < 3.0% before 2014 to 4.8% in 2014 and 6.1% in 2015. While the number of HIV cases increased, the number of anonymous HIV-positive test results per 10,000 tests decreased from 68.8 in 2010 to 41.8 in 2015. The HIV prevalence among the suspected was approximately 20.0 per 10,000 test takers before 2014, which steeply increased to 71.6 in 2015. Those with suspected HIV were predominantly men, aged 20 years, foreigners, and metropolitan city dwellers in the last 6 years. The high prevalence of persons with suspected HIV resulted in a doubling of HIV prevalence at PHCs between 2014 and 2015. CONCLUSIONS: Anonymous and Suspected, which were driven by similar motives, impacted each other. Increase in HIV prevalence among the suspected led to a higher HIV prevalence among all test takers in PHCs and higher proportions of HIV infection nationwide, which could be attributed to the increase in the number of anonymous tests performed in PHCs. HIV positivity among the anonymous and HIV prevalence among the suspected are key indexes of the national HIV surveillance in Korea.

¿Quo vadis, Endocrinología y Nutrición? / Quo vadis, Endocrinology and nutrition?

Introducción: En España, la elección de la especialidad se realiza vía examen médico interno residente (MIR). El número de elección de plaza MIR puede reflejar el interés por una especialidad. El objetivo del estudio es corroborar el aumento del número de elección y analizar los posibles factores influyentes a la hora de elegirla. Material y método: Analizar la evolución del número de orden con el que se elige nuestra especialidad y compararla con otras especialidades afines, así como las preferencias a la hora de elegirla realizando una encuesta anónima a 108 MIR de Endocrinología. Resultados: El número medio de elección ha ido aumentando progresivamente hasta llegar el último año al número 2336, esta tendencia coincide con un aumento en el número de plazas ofertadas, aunque es más marcada que en otras especialidades médicas relacionadas. En la encuesta se evaluaron diferentes factores influyentes a la hora de elegir especialidad. También se preguntó sobre los aspectos considerados más positivos y negativos de la especialidad. Se consideró como más positivo que sea tranquila y el más negativo, la escasez de técnicas. A la pregunta de si la especialidad había cumplido sus expectativas se dio una puntuación de 8,7 sobre 10, aunque la percepción del prestigio de la especialidad se puntuó solo con 6,7 puntos. Conclusiones: Hay un deterioro evidente del número de elección de nuestra especialidad que no es tan marcado en el resto ramas médicas relacionadas

Introduction: In Spain, the system used to select a medical specialty is the MIR (internal resident physician) exam. The MIR selection number may reflect the interest in a given specialty. Our study objective was to confirm the increase in the selection number and to analyze possible factors influencing the decision. Material and method: To analyze change over time in the MIR number with which this specialty is chosen and to compare it with other related specialties, as well as the reasons why it is preferred using an anonymous survey to 108 MIRs of endocrinology. Results: The average number of MIR for Endocrinology and Nutrition has gradually increased to 2336 in year 2018, a trend that coincides with an increase in the number of places offered but is more marked as compared to other medical specialties. Respondents weighed different factors when choosing specialty. When asked about the most positive aspects of the specialty, the highest rated was that day to day activity was "less intense". The most commonly mentioned negative aspect was the low number of techniques. When asked if the specialty had met their expectations, respondents gave an average score of 8.7, although the perceived prestige of the specialty scored only 6.7 points. Conclusions: There is an obvious deterioration of the MIR selection number of our specialty that it is not so marked in other specialties

[Communication preferences of patients with prostate cancer : Preferences regarding the communication of bad news of patients with prostate cancer in Germany-results of an anonymous patient survey]. / Kommunikationspräferenzen von Patienten mit Prostatakrebs : Ergebnisse einer anonymen Patientenbefragung unter Patienten mit Prostatakrebs zu ihren Kommunikationspräferenzen.

BACKGROUND: The communication of bad medical news represents a burdening situation for both patients and physicians which may lead to hurdles in their communication. The questionnaire Measure of Patients' Preferences (MPP-D, validated German translation) was developed to investigate patients' preferences regarding the communication of bad news. OBJECTIVES: The preferences regarding the communication of bad news among patients with prostate cancer was assessed. MATERIALS AND METHODS: Anonymous survey, where approximately 70 office-based urologists were asked to distribute the MPP-D questionnaire to about 20 of their patients with prostate cancer. In addition, information on social demographics was retrieved in order to investigate the influence on communication preferences. RESULTS: In total, 709 questionnaires were evaluated (>50 % return). The majority of patients had clear preferences concerning privacy of the setting, completeness, and unambiguity of information provided and assessment of their subjective information needs. Larger individual differences were observed regarding preferences for emotional support offered by the physician and involvement of family which was also influenced by age and education of the patients. CONCLUSION: This is the first large, multicenter survey of prostate cancer patients in Germany regarding their preferences for communication of bad news. The results confirm previous reports on the importance of cultural affiliation, age, and education as influencing factors.

Prevalence of human immunodeficiency virus, hepatitis C virus, hepatitis B virus and syphilis among individuals attending anonymous testing for HIV in Luanda, Angola.

Human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis remain major infections around the world. In Angola there are about 166 000 individuals living with HIV, representing a prevalence of 1.98% in adults between 15 and 49 years of age. In a 2003 study in Luanda, 4.5% of pregnant women had antibodies to HIV and 8.1% to HBV, and 5.4% were infected with Treponema pallidum. Objectives. The aim of this study was to determine the prevalence of HIV-1 and 2, HBV, HCV and T. pallidum serological markers, and hence the prevalence of these infections, in individuals attending a sexually transmitted disease clinic in Luanda, Angola, and the burden of these infections in the Angolan population. Methods. Individuals attending a centre for anonymous testing for HIV were randomly included in the study. All samples were tested for HBV surface antigen (HBsAg), anti-HCV and anti-HIV-1 and 2 antibodies and antibodies to T. pallidum. Results. A total of 431 individuals (262 women and 169 men) were studied, of whom 10.0% (43/431) were seropositive for T. pallidum and 4.6% had active syphilis; 8.8% (38/431) were seropositive for HIV-1 and/or HIV-2 (of these, 78.9% were HIV-1-positive, 2.6% HIV-2-positive and 18.4% co-infected); 9.3% (40/431) were HBsAg-positive, while 8.1% (35/431) had antibodies to HCV. Of 102 patients with positive results, 26 (25.5%, or 6.0% of the total of 431 patients) were positive for more than one of the organisms studied. Rates of co-infection were as follows: 2.3% (10/431) for HIV/HBV, 0.9% (4/431) for HIV/HCV, and 0.9% (4/431) for HCV/HBV. Three individuals with active syphilis had viral co-infection, hepatitis B in 1 case and HIV in 2. Five individuals (1.2% of the total) were seropositive for three infections, HIV, hepatitis B and hepatitis C in 3 cases and HIV, hepatitis C and syphilis in 2. Conclusions. A high prevalence of co-infection with the infections studied was found in this population, including HIV infection (8.8%). These results demonstrate the need to improve screening for and treatment of HIV and other sexually transmitted infections in Angola, and for educational campaigns to prevent not only the morbidity and mortality associated with these diseases, but also their further transmission.

Internet-based screening for dementia risk.

The Dementia Risk Assessment (DRA) is an online tool consisting of questions about known risk factors for dementia, a novel verbal memory test, and an informant report of cognitive decline. Its primary goal is to educate the public about dementia risk factors and encourage clinical evaluation where appropriate. In Study 1, more than 3,000 anonymous persons over age 50 completed the DRA about themselves; 1,000 people also completed proxy reports about another person. Advanced age, lower education, male sex, complaints of severe memory impairment, and histories of cerebrovascular disease, Parkinson's disease, and brain tumor all contributed significantly to poor memory performance. A high correlation was obtained between proxy-reported decline and actual memory test performance. In Study 2, 52 persons seeking first-time evaluation at dementia clinics completed the DRA prior to their visits. Their responses (and those of their proxy informants) were compared to the results of independent evaluation by geriatric neuropsychiatrists. The 30 patients found to meet criteria for probable Alzheimer's disease, vascular dementia, or frontotemporal dementia differed on the DRA from the 22 patients without dementia (most other neuropsychiatric conditions). Scoring below criterion on the DRA's memory test had moderately high predictive validity for clinically diagnosed dementia. Although additional studies of larger clinical samples are needed, the DRA holds promise for wide-scale screening for dementia risk.

HIV risk profiles differed by gender and experience of men who had sex with men among attendees of anonymous voluntary counseling and testing in Taiwan.

Free voluntary counseling and testing (VCT) has been available in Taiwan as a part of HIV surveillance and prevention program since 1999, but related data were seldom reported. We aimed to examine characteristics of individuals who attended anonymous client-initiated VCT service and factors associated with HIV infection. The study population consisted of clients at two large VCT sites located in northern and southern Taiwan in 2004- 2008. Information on socio-demographic factors and potential risk behaviors was obtained by a questionnaire. Of 5671 clients, 65.1% were younger than 30 years; 42.0%, 41.2%, and 16.8% were men who ever had sex with men (MSM), non-MSM males, and women with HIV seropositivity of 8.0%, 1.2%, and 1.5%, respectively. The proportion of clients who confirmed having a prior HIV test was 66.5% in MSM, followed by 43% in non-MSM, and 30.2% in women. Correlates of HIV seropositivity differed between genders: ever engaging in commercial sex, being married or less educated were associated with increased risks among women but not for men. Different independent predictors were revealed among three groups of clients by multivariable analyses: illicit drug use, anal sex behavior, sexual partner(s) with HIV, and one-night stand in MSM; injection drug use and history of sexually transmitted infections in non-MSM; and injection drug use, sexual partner(s) with HIV and trading sex in women. Of all three groups, illicit drug or injection drug use was associated with the highest risks among all independent predictors. In this population of VCT clients in Taiwan, risk profiles of HIV infection differed according to gender and MSM experience, and different prevention strategies are needed to target different risk groups. In women, risk factors related to low social demographic and relationship power deserves attention in planning future prevention efforts.

Opt-out of voluntary HIV testing: a Singapore hospital's experience.

INTRODUCTION: Since 2008, the Singapore Ministry of Health (MOH) has expanded HIV testing by increasing anonymous HIV test sites, as well as issuing a directive to hospitals to offer routine voluntary opt out inpatient HIV testing. We reviewed this program implemented at the end of 2008 at Tan Tock Seng Hospital (TTSH), the second largest acute care general hospital in Singapore. METHODS AND FINDINGS: From January 2009 to December 2010, all inpatients aged greater or equal than 21 years were screened for HIV unless they declined or were not eligible for screening. We reviewed the implementation of the Opt Out testing policy. There were a total of 93,211 admissions; 41,543 patients were included based on HIV screening program eligibility criteria. Among those included, 79% (n = 32,675) opted out of HIV screening. The overall acceptance rate was 21%. Majority of eligible patients who were tested (63%) were men. The mean age of tested patients was 52 years. The opt out rate was significantly higher among females (OR: 1.5, 95%CI: 1.4-1.6), aged >60 years (OR: 2.3, 95%CI: 2.2-2.4) and Chinese ethnicity (OR: 1.7, 95%CI:1.6-1.8). The false positive rate of the HIV screening test is 0.56%. The proportion of patients with HIV infection among those who underwent HIV screening is 0.18%. All 16 confirmed HIV patients were linked to care. CONCLUSION: The default opt-in rate of inpatient HIV testing was low at Tan Tock Seng Hospital, Singapore. Efforts to address individual HIV risk perception and campaigns against HIV stigma are needed to encourage more individuals to be tested for HIV.

Comparison of free and anonymous testing for HIV and sexually transmitted infections between the University Hospital and Health Center.

We gathered data regarding age, sex, and positivity rates for human immunodeficiency virus (HIV), syphilis, gonococcus, and chlamydia from individuals who underwent free and anonymous sexually transmitted infection (STI) testing conducted at the Jikei University School of Medicine Hospital (our hospital). These data were compared to results of subjects who underwent similar testing at the Minato Health Center and several private facilities of urologists and gynecologists belonging to the Minato Ward Medical Association. The positivity rate of chlamydia was found to be high in female subjects, particularly at the Minato Health Center, with 15 of 194 subjects (7.73 %) testing positive. In our hospital, we only detected 3 of 133 subjects (2.26 %) who were gonococcus positive. On the other hand, at the doctor's facilities, 10 of 188 male subjects (5.32 %) were syphilis positive, and 8 of 185 male subjects (4.32 %) were chlamydia positive, thus showing high positivity rates for both infections. At our hospital, 1 of 231 subjects was positive for gonococcus and 4 of 230 subjects (1.74 %) were positive for chlamydia, thus showing lower positivity rates for both infections. HIV-positive subjects were, however, only confirmed at our hospital, with 2 of 243 subjects (0.82 %) being positive. We were able to diagnose infected patients using free and anonymous STI testing at hospitals, and the same as at doctors' facilities. This result suggests that the hospitals that have many opportunities to diagnose HIV patients may become potential candidates for the development of new consultation facilities, establishment of testing facilities, and enhancement of consultation processes that include STI prevention.

Unlinked anonymous testing to estimate HIV prevalence among pregnant women in Catalonia, Spain, 1994 to 2009.

This paper estimates the prevalence of human immunodeficiency virus (HIV) infections in women giving birth and women voluntarily terminating pregnancy over a period of sixteen years in Catalonia. Samples for HIV antibody detection were collected from the Neonatal Early Detection Programme for congenital metabolic diseases that covers 99% of infants born in Catalonia. The sampling method collected information of 50% of births every year and of all women attending three clinics for voluntary interruption of pregnancy. Using two sequential immunoassays we analysed unlinked anonymous blood spot samples from 549,689 newborns between 1994 and 2009 and from 31,904 women who voluntarily interrupted pregnancy between 1999 and 2006. HIV prevalence among women giving birth decreased from 3.2 per 1,000 in 1994 to 1.7 per 1,000 in 2009 (p<0.01) and the mean age of infected mothers increased from 26 years in 1994 to 32 years in 2009 (p=0.001). A decrease in HIV prevalence was also observed in women voluntarily terminating pregnancy, from 2.3 per 1,000 in 1999 to 1.0 per 1,000 in 2006 (p<0.01). In contrast, estimated HIV prevalence in mothers born outside Spain increased from 2.2 per 1,000 in 2002 to 3 per 1,000 in 2009 (p<0.01) and their average age increased from 27 years in 2003 to 31 years in 2009 (p<0.01).

Voluntary counselling and testing uptake and HIV prevalence among tuberculosis patients in Jogjakarta, Indonesia.

We aimed to establish HIV prevalence and uptake of unlinked anonymous testing and voluntary counselling and testing (VCT) among tuberculosis (TB) patients in Jogjakarta, Indonesia. We introduced unlinked anonymous HIV testing for TB patients attending directly observed treatment, short-course services between April and December 2006. Patients were additionally offered VCT services. Of 1269 TB patients who were offered unlinked anonymous testing, 989 (77.9%; 95% CI 75.6-80.1%) accepted. HIV prevalence was 1.9% (95% CI 1.6-2.2%). HIV infections were less frequently diagnosed among TB patients who attended a public health centre [odds ratio (OR) 0.15; 95% CI 0.03-0.70] rather than public hospital. They were more frequent in TB patients with a university education background (OR 5.16; 95% CI 1.01-26.63) or a history of HIV testing (OR 57.87; 95% CI 9.42-355.62). Of the 989 patients who accepted unlinked anonymous testing, only 133 (13.4%; 95% CI 11.5-15.7%) expressed interest in VCT. Of these, 52 (39.1%; 95% CI 31.2-47.6%) attended VCT, but interest was higher among students and those offered VCT by public health centres. The HIV prevalence in Jogjakarta is higher than expected and needs to be monitored cautiously. Unlinked anonymous HIV testing is well accepted and can be implemented with modest additional efforts.

Uptake of HIV voluntary counselling and testing services in rural Tanzania: implications for effective HIV prevention and equitable access to treatment.

OBJECTIVE: To describe the associations between socio-demographic, behavioural and clinical characteristics and the use of HIV voluntary counselling and testing (VCT) services among residents in a rural ward in Tanzania. METHODS: Eight thousand nine hundred and seventy participants from a community-based cohort were interviewed, provided blood for research HIV testing, and were offered VCT. Univariate and multivariate logistic regression was used to identify socio-demographic, clinical and behavioural factors associated with VCT use. RESULTS: Although 31% (1246/3980) of men and 24% (1195/4990) of women expressed an interest in the service, only 12% of men and 7% of women subsequently completed VCT. Socio-demographic factors, such as marital status, area of residence, religion and ethnicity influenced VCT completion among males and females in different ways, while self-perceived risk of HIV, prior knowledge of VCT, and sex with a high-risk partner emerged as important predictors of VCT completion among both sexes. Among males only, those infected with HIV for 5 years or less tended to self-select for VCT compared to HIV-negatives (adjusted odds ratio = 1.43; 95% CI: 0.99-2.14). This contributed to a higher proportion of HIV-positive males knowing their status compared to HIV-positive females. CONCLUSIONS: In this setting, a disproportionate number of HIV-positive women are failing to learn their status, which has implications for equitable access to onward referral for care and treatment services. Evidence that some high-risk behaviours may prompt VCT use is encouraging, although further interventions are required to improve knowledge about HIV risk and the benefits of VCT. Targeted interventions are also needed to promote VCT uptake among married women and rural residents.

HIV incidence and HIV testing behavior in men who have sex with men: using three incidence sources, The Netherlands, 1984-2005.

BACKGROUND: In The Netherlands, the western part, including Rotterdam and Amsterdam harbors the majority of the known HIV-infected population, of whom men who have sex with men (MSM) comprise the largest transmission category. Given a general rise in sexually transmitted infections (STI) and risky sexual behavior, we examine the HIV incidence among MSM in the Netherlands with data from three different sources. METHODS: To describe the HIV epidemic among MSM we use: a prospective cohort study in Rotterdam (ROHOCO: 1998-2003, n = 265) and another in Amsterdam (ACS: 1984-2005, n = 1498]) plus an anonymous HIV surveillance study (Amsterdam STI clinic: 1991-2004, n = 3733) in which HIV-positive MSM were tested with a less-sensitive HIV assay. We evaluated calendar trends in HIV incidence, also focusing on age effects. RESULTS: Since the start of the HIV epidemic in the early 1980s, incidence has declined strongly in the ACS. In recent years, an increase was noted among older MSM attending the Amsterdam STI clinic (P = 0.0334). In both cohort studies, HIV incidence was lower and recent time-trends were not statistically significant. Among recently infected men at the STI clinic, only 40% accepted named HIV testing at their STI consultation. CONCLUSIONS: Data suggest that among MSM in the Netherlands, the HIV incidence is between one and four infections per 100 person-years. The epidemic expands among older STI clinic attendees. Prevention should be developed specifically for older men, along with a more efficient HIV testing approach such as routine HIV testing of MSM when they are screened for STI.

Uptake of workplace HIV counselling and testing: a cluster-randomised trial in Zimbabwe.

BACKGROUND: HIV counselling and testing is a key component of both HIV care and HIV prevention, but uptake is currently low. We investigated the impact of rapid HIV testing at the workplace on uptake of voluntary counselling and testing (VCT). METHODS AND FINDINGS: The study was a cluster-randomised trial of two VCT strategies, with business occupational health clinics as the unit of randomisation. VCT was directly offered to all employees, followed by 2 y of open access to VCT and basic HIV care. Businesses were randomised to either on-site rapid HIV testing at their occupational clinic (11 businesses) or to vouchers for off-site VCT at a chain of free-standing centres also using rapid tests (11 businesses). Baseline anonymised HIV serology was requested from all employees. HIV prevalence was 19.8% and 18.4%, respectively, at businesses randomised to on-site and off-site VCT. In total, 1,957 of 3,950 employees at clinics randomised to on-site testing had VCT (mean uptake by site 51.1%) compared to 586 of 3,532 employees taking vouchers at clinics randomised to off-site testing (mean uptake by site 19.2%). The risk ratio for on-site VCT compared to voucher uptake was 2.8 (95% confidence interval 1.8 to 3.8) after adjustment for potential confounders. Only 125 employees (mean uptake by site 4.3%) reported using their voucher, so that the true adjusted risk ratio for on-site compared to off-site VCT may have been as high as 12.5 (95% confidence interval 8.2 to 16.8). CONCLUSIONS: High-impact VCT strategies are urgently needed to maximise HIV prevention and access to care in Africa. VCT at the workplace offers the potential for high uptake when offered on-site and linked to basic HIV care. Convenience and accessibility appear to have critical roles in the acceptability of community-based VCT.

Recruitment of sperm donors: the Newcastle-upon-Tyne experience 1994-2003.

BACKGROUND: The demand for sperm donors has continued despite the introduction of ICSI. This study was undertaken in the light of impending changes in donor anonymity laws to evaluate the recruitment process of sperm donors. METHODS: Retrospective analysis of 1101 potential sperm donors in a tertiary referral centre between January 1994 and August 2003. The main outcome measures were to determine the demographic details, recruitment rate and reasons for rejection of donors. RESULTS: The majority of the applicants were aged <36 years (88.07%), students (54.88%), without a partner (53.47%), unmarried (85.38%) and without proven fecundity (78.67%). Only 3.63% of the applicants were released as donors, 30.79% defaulted, whilst 64.48% were rejected. The most common reason for rejection was suboptimal semen quality (85.07%). Over the years, the numbers of the applicants and released donors have declined significantly. The overall clinical pregnancy rate from donor sperm during this period was 23.52%. CONCLUSIONS: In this successful anonymous sperm donor programme only a small proportion of the applicants are released as donors. The significant decline in released sperm donors coupled with the potential effects of loss of donor anonymity means that new strategies for sperm donor recruitment are urgently required.

[Anonymous STD counselling versus mandatory checks for prostitutes--what is effective in STD prevention?]. / Anonyme STD-Sprechstunde versus Pflichtuntersuchung für Prostituierte--was ist effektiv in der STD-Prävention?

BACKGROUND: When in 2001 in Germany the new act for control of infectious diseases came into force, mandatory checks for prostitutes were abolished. The consequences of this paradigm shift in STD prevention are being judged controversially even today. The public health department of the city of Cologne, like others, adapted its programme, staff, equipment, and diagnostic procedures to the new requirements. The department for venereal disease control was converted into a walk-in-clinic for STD and now forms part of a comprehensive STD and Aids prevention unit. The present article illustrates the changes by comparing the clients and the STD numbers of the years 1994 and 2004. METHOD: The following data were compared: number of consultations, number of clients regarding sex, occupation in sex business, health insurance, national or ethnic background, frequency of consultation, number of STD. RESULTS: In 1994, almost all clients of the department for venereal disease control were female prostitutes. 74% of them worked in established sex business venues with a high grade of professionalism, few STD cases were diagnosed. In 2004, the STD clinic was open for anybody considered to be at risk and not having access to the regular health care system. Only 49% of the patients were prostitutes, either female or male. 25% of the clients were male. 68% of the patients were migrants, many of them without any legal status and without any access to regular health care. A high number of acute STD and subsequent disorders that required treatment was registered. Besides the STD-related services, a great need for gynaecological and urological differential diagnostics as well as a high demand for counselling and provision of other problems of sexual health were observed. DISCUSSION: The data show that an STD department providing comprehensive services anonymously and free of charge will reach a broader range of highly vulnerable persons in comparison with an obligatory VD check of prostitutes. The high numbers of STD and STD-related disorders demonstrate the improved effectiveness of the new service.

[Are we testing the right people? Results of a patient questionnaire in the STD and HIV counselling office of the local health authority in the city of Cologne]. / Testen wir die Richtigen? Ergebnisse einer Klientenbefragung in der Beratungsstelle zu STD einschliesslich Aids des Gesundheitsamtes der Stadt Köln.

BACKGROUND: HIV testing and counselling is offered free of charge in most local health offices in Germany. During 2003, a survey was performed among German-speaking clients of the Cologne local health office to look at socio-demographic background, reasons for testing and sexual risk behaviour. METHODS: All German-speaking clients attending the HIV counselling office from March to July 2003 were asked to fill in an anonymous standardised questionnaire. Questions included demographic characteristics, social status, STI history, reasons for HIV testing, sexual orientation and number of sexual partners. Data were compared to the general Cologne population regarding demographic characteristics. Female respondents were compared to heterosexual men and men who have sex with men (MSM); German respondents were compared to migrants using SPSS 14.0. RESULTS: A total of 457 female and 488 male clients participated (response rate 93.9 %). Average age was 28.4 years. Of all participants, 17.7 % were of non-German origin. The respondents had a high school degree in 80.8 % of the cases compared to 33.5 % in the general Köln population (p < 0.001). Among men, 30.2 % were MSM. Having a "new partner" or "unprotected sex with a person with unknown HIV status" were reported by 483 (39.8 %) and 373 (30.8 %) as reasons for testing. 38.7 % of the respondents reported choosing the local health office for HIV testing because it was free of charge and 24.5 % because it was anonymous. Women and heterosexual men had a median of 1, MSM a median of 3 sexual partners within the past 6 months (p < 0.001). Vaccination against hepatitis B was reported by 34.4 % of the clients, the proportion was higher among MSM (46.9 % p < 0.001) and lower among migrants. 112 (11.9 %) persons reported having had a previous STI. CONCLUSIONS: With the exception of MSM, the offer of free and anonymous HIV testing and counselling does not reach persons who carry a higher risk for HIV. As the risk for STI is higher than for HIV in Germany and there is a low public awareness, HIV counselling should be used for comprehensive sexual health counselling and include the offer for STI testing, Further outreaching efforts and other settings are necessary to reach persons with a low education level and highly vulnerable persons.

[Detection of HCV infection among clients of an anonymous testing center for HIV infection]. / Wykrywanie zakazen HCV wsród osób zglaszajncych sie do punktu anonimowego testowania zakazenia HIV.

The aim of the study was to determine the prevalence and risk factors for HCV infection among clients of the centre of anonymous testing for HIV infection. Two hundred and eleven clients of anonymous testing centre for HIV infection in Bialystok were additionally tested for anti-HCV antibodies and the relationship between HCV infection and risk factors was analysed Main observations: Anti-HCV were detected in 6/211 individuals (2,4%). Increased risk of HCV infection was observed among intravenous drug users, unemployed, residents of other woiewodships (administrative regions), and in those who had been tested for HIV infection in the past. Centres for anonymous testing for HIV infection is also a feasible place for screening for HCV infection. It is reasonable to limit testing for HCV to patients with risk factors

Preliminary results from the new HIV surveillance system in France.

In addition to AIDS surveillance, data on HIV infection are necessary to better follow the dynamics of the epidemic. We report the first results of France's mandatory anonymous HIV notification system, which is linked to a virological surveillance of recent HIV infections and of circulating HIV types, groups and subtypes. HIV notifications are initiated by microbiologists who create an anonymous code of patient's identity. Clinicians complete the notification form with epidemiological and clinical data. Notifications are sent to the local health authorities and passed to the Institut de Veille Sanitaire (InVS). Laboratories voluntarily send sera from newly diagnosed HIV infected persons on dried blood spots to the national HIV reference laboratory where an immunoassay for recent infection (< or = 6 months) and a serotyping assay for the determination of group and subtype are done. The virological results are then merged at the InVS with the information from the mandatory reporting. Of the first 1301 new HIV diagnoses reported in 2003, 43% were in women, and overall, 53% were in heterosexuals, of whom 47% were of sub-Saharan African origin. MSM accounted for 36% of male notifications. A dried blood spot was available for 64% of new HIV diagnoses. Evidence of recent infection was found for 38%, ranging from 22% in IDUs to 58% in MSM. Twenty-six percent of infections in sub-Saharan migrants were recent infections. HIV-1 accounted for 98% of all notifications: 48% of these were non-B subtypes. The first results of the HIV notification system indicate that heterosexual transmission is the predominant mode of transmission and that persons originating from sub-Saharan Africa are particularly affected. Over half of infections shown to be recently acquired were in MSM; this may indicate an increased HIV incidence in this population.