Bias in Self-Reported Condom Use: Association Between Over-Reported Condom Use and Syphilis in a Three-Site Study in China.

This study examined over-reporting bias in self-reported condom use and assessed its association with syphilis. A survey was conducted among 1245 female sex workers (FSWs) in three cities in China. Respondent's over-reported condom use was defined as reporting no unprotected sex for the past 24 h but testing positive for prostate specific antigen. The proportion of prevalent syphilis and active syphilis was 23 and 10 % respectively among FSWs. The proportion of over-reported condom use with sex clients only was 27-45 % among the three study sites. The proportion of over-reported condom use with all sex partners (clients, husbands, or boyfriends) was 26-46 %. FSWs who had active or prevalent syphilis were more likely to over report condom use. Self-reported condom use may not be a valid tool to measure the efficacy of HIV/STI intervention because the bias is associated with the outcome measure, i.e., syphilis.

Sexual activities of patients with STDs in the interval between noticing symptoms and presenting for treatment.

Examining the patterns of and reasons for sexual behaviors of patients with sexually transmitted diseases (STDs) while symptomatic may help to develop effective prevention strategies for both STDs and AIDS. However, little is known about patients' sexual activities after noticing STD symptoms in China, where AIDS and STDs are spreading rapidly. We conducted a cross-sectional study at four STD clinics in Hefei, China. Patients' reported sexual activities were queried, using a tape recorder and earphones. A consecutive sample of 406 male patients with STDs were interviewed. One hundred sixty-four (40%) men reported having sex after having STD symptoms; 45% were married, 27% were single, and 47% cohabiting or divorced. Their sex partners included spouses, girlfriends, and prostitutes. Only 10% of patients with STDs who had sex after noticing STDs reported frequently using condoms or using them for every act of sex. Approximately 60% had never used a condom. Logistic regression analysis indicated that having sex after noticing STD symptoms was associated with lower education, having a previous STD episode, having low HIV/STD knowledge, and having other urethral discharge not caused by C. trachomatis or gonorrhea. Our findings suggest that male patients with STDs may serve as a bridge population linking the STD, and potentially, HIV epidemic from individuals at higher risk to the general population. Intervention programs including health education and condom promotion need to target both those at high risk and those at apparently lower risk.

Drug users: a potentially important bridge population in the transmission of sexually transmitted diseases, including AIDS, in China.

OBJECTIVE: The objective of this study was to examine risk characteristics among bridge and nonbridge drug users. STUDY DESIGN: A cross-sectional study was conducted among drug users. Drug users who shared needles and engaged in sex with both high-risk partners and low-risk partners were defined as bridgers. RESULTS: A total of 312 drug users were recruited, among whom 49.4% (154) were bridgers. Among bridgers, 83.1% injected drugs and 35% shared needles in the past month. Eighty-seven percent (134) of bridgers had one or more commercial sex partners in the past year. Only 3.9% of the bridgers and 4.6% of nonbridgers consistently used condoms with regular sex partners. Fifty-eight percent of bridgers and 46.8% of nonbridgers tested positive for hepatitis C virus, whereas 15.6% of bridgers and 7% of nonbridgers tested positive for syphilis. CONCLUSIONS: The pervasiveness of bridgers among drug users and their risky sexual behavior underscore their role in the spread of sexually transmitted diseases.

Stigma, delayed treatment, and spousal notification among male patients with sexually transmitted disease in China.

BACKGROUND: Stigmatization may prevent effective control of sexually transmitted diseases (STDs) in China. Thus, its impact needs to be studied. GOAL: The goal of the study was to explore the effect of perceived stigmatization on control of STDs. STUDY DESIGN: A cross-sectional study was conducted among males attending four STD clinics for the first time for a current STD. RESULTS: Among 406 patients, 80% felt stigmatized, 28% sought treatment only after suffering symptoms for at least 1 week, and 40% reported continuing to have sex while having symptoms. No association was observed between feelings of stigmatization and delay in seeking treatment. Among those married, 77% expressed unwillingness to notify their spouses. Patients who felt stigmatized were less likely to agree to notify their spouses (odds ratio, 0.42; 95% CI, 0.21-0.85). CONCLUSION: Policies are needed to reduce stigmatization, reduce time to treatment, and promote disclosure to sex partners.

Is syndromic management better than the current approach for treatment of STDs in China? Evaluation of the cost-effectiveness of syndromic management for male STD patients.

BACKGROUND: The syndromic treatment approach has not been evaluated in sexually transmitted disease (STD) clinics in China. GOAL: The goal was to evaluate and compare the validity and cost-effectiveness of syndromic management with current STD management for men in clinics in Hefei, China. STUDY DESIGN: Diagnostic accuracy, treatment appropriateness, costs, and effectiveness of current clinical procedures and syndromic management were compared for 406 men attending four STD clinics. RESULTS: A modified World Health Organization (WHO) syndromic algorithm for urethral discharge yielded 100% sensitivity and a 69% positive predictive value (PPV). A syndromic algorithm for genital ulcers correctly treated all syphilis patients, with a 25% PPV. The average cost (in US dollars) per correct treatment by the current approach was 323.48 dollars for urethritis and 85.65 dollars for syphilis. For the syndromic approach, the average cost per correct treatment was 3.15 dollars for urethritis and 13.54 dollars for syphilis. CONCLUSION: Syndromic management can provide better treatment for men with STDs at significantly lower cost in resource-poor settings such as China.