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Catching Up or Missing Out? Human Papillomavirus Vaccine Acceptability Among 18- to 26-Year-old Men Who Have Sex With Men in a US National Sample

imageBackground: Men who have sex with men (MSM) are disproportionately affected by human papillomavirus (HPV)–related outcomes and would benefit from HPV vaccination in adolescence. We assessed HPV vaccine attitudes, uptake, and barriers in this high-risk young MSM (YMSM) population. Methods: An online US sample of 1457 YMSM aged 18 to 26 years were recruited in December 2011 to examine HPV vaccine acceptability and uptake. The online survey included sociodemographics, HPV vaccine attitudes, acceptability, HPV vaccination status, health care use, and HPV knowledge. Results: Despite high use of health care in the past year (86%) and high acceptability (87.8/100) for free HPV vaccine, only 6.8% had received one or more vaccine doses. In addition, only 4% of unvaccinated men had been offered the vaccine by their health care provider (HCP). In a multivariate regression of unvaccinated men, increased vaccine acceptability was associated with an HCP recommendation, worry about getting infected with HPV, and being tested for a sexually transmitted disease in the past year, whereas safety concerns, lower perceived risk of infection, and shame associated with HPV infection/disease were associated with decreased vaccine acceptability. Through logistic regression, vaccine uptake was associated with being tested for a sexually transmitted disease in the past year, disclosure of being gay or bisexual to a doctor, and greater HPV knowledge. Conclusions: Health care providers need to use routine points of contact with YMSM patients to vaccinate against HPV. These data indicated missed opportunities to vaccinate YMSM who are open to HPV vaccination. In the future, HCPs of YMSM should be careful to avoid missed opportunities to vaccinate. 11/01/2015 01:00 AM

Community-Based Screening for Cervical Cancer: A Feasibility Study of Rural Appalachian Women

imageObjectives: To describe women's comfort levels and perceptions about their experience self-collecting cervicovaginal swabs for human papillomavirus (HPV) testing, to determine whether nurse-guided patient navigation increases the odds of women receiving a traditional Papanicolaou (Pap) test after HPV screening, and to test the hypothesis that women testing positive for oncogenic HPV would be more likely to have a subsequent Pap test than those testing negative. Methods: A total of 400 women were recruited from 8 rural Appalachian counties, in 2013 and 2014. After completing a survey, women were provided instructions for self-collecting a cervicovaginal swab. Specimens were tested for 13 oncogenic HPV types. Simultaneously, women were notified of their test results and offered initial navigation for Pap testing. Chart-verified Pap testing within the next 6 months served as the end point. Results: Comfort levels with self-collection were high: 89.2% indicated that they would be more likely to self-collect a specimen for testing, on a regular basis, compared with Pap testing. Thirty women (7.5%) had a follow-up Pap test. Women receiving added nurse-guided navigation efforts were significantly less likely to have a subsequent test (P = 0.01). Women testing positive for oncogenic HPV were no more likely than those testing negative to have a subsequent Pap test (P = 0.27). Data were analyzed in 2014. Conclusions: Rural Appalachian women are comfortable self-collecting cervicovaginal swabs for HPV testing. Furthermore, efforts to recontact women who have received an oncogenic HPV test result and an initial navigation contact may not be useful. Finally, testing positive for oncogenic HPV may not be a motivational factor for subsequent Pap testing. 11/01/2015 01:00 AM

Sexual Partnership Patterns Among South African Adolescent Girls Enrolled in STI Preventions Trial Network 068: Measurement Challenges and Implications for HIV/STI Transmission

imageBackground: Estimates of sexual partnership durations, gaps between partnerships, and overlaps across partnerships are important for understanding sexual partnership patterns and developing interventions to prevent transmission of HIV/sexually transmitted infections (STIs). However, a validated, optimal approach for estimating these parameters, particularly when partnerships are ongoing, has not been established. Methods: We assessed 4 approaches for estimating partnership parameters using cross-sectional reports on dates of first and most recent sex and partnership status (ongoing or not) from 654 adolescent girls in rural South Africa. The first, commonly used, approach assumes all partnerships have ended, resulting in underestimated durations for ongoing partnerships. The second approach treats reportedly ongoing partnerships as right-censored, resulting in bias if partnership status is reported with error. We propose 2 “hybrid” approaches, which assign partnership status to reportedly ongoing partnerships based on how recently girls last had sex with their partner. We estimate partnership duration, gap length, and overlap length under each approach using Kaplan-Meier methods with a robust variance estimator. Results: Median partnership duration and overlap length varied considerably across approaches (from 368 to 1024 days and 168 to 409 days, respectively), but gap length was stable. Lifetime prevalence of concurrency ranged from 28% to 33%, and at least half of gap lengths were shorter than 6 months, suggesting considerable potential for HIV/STI transmission. Conclusions: Estimates of partnership duration and overlap lengths are highly dependent on measurement approach. Understanding the effect of different approaches on estimates is critical for interpreting partnership data and using estimates to predict HIV/STI transmission rates. 11/01/2015 01:00 AM

GYT: Get Yourself Tested Campaign Awareness: Associations With Sexually Transmitted Disease/HIV Testing and Communication Behaviors Among Youth

imageBackground: The GYT: Get Yourself Tested campaign promotes sexually transmitted disease (STD) and HIV testing and communication with partners and providers among youth. We evaluated these behaviors in relation to campaign awareness among youth through a national survey. Methods: We collected data from 4017 respondents aged 15 to 25 years through an online panel survey designed to be representative of the US population. The GYT campaign targeted 4 key behaviors: STD testing, HIV testing, talking to partners about testing, and talking to providers about testing. Results: Respondents who were aware of the GYT campaign (24.4%) were more likely to report engaging in each of the 4 target behaviors. Associations remained significant when stratified by race and sex and when taking into account sexuality, sexual activity, age, insurance status, and use of campaign partner-provided services. Conclusions: Awareness of the GYT campaign is related to the 4 target behaviors promoted by the campaign, suggesting that health promotions campaigns oriented toward youth can be successful in increasing STD-related, health-seeking behavior, including among populations disproportionately affected by STD. 11/01/2015 01:00 AM

Creative Contributory Contests to Spur Innovation in Sexual Health: 2 Cases and a Guide for Implementation

imageAbstract: Sexual health campaigns are often designed “top-down” by public health experts, failing to engage key populations. Using the power of crowdsourcing to shape a “bottom-up” approach, this note describes 2 creative contributory contests to enhance sexual health campaigns. We provide guidance for designing creative contributory contests to improve HIV and other sexually transmitted disease testing. 11/01/2015 01:00 AM

Differing Identities but Comparably High HIV and Bacterial Sexually Transmitted Disease Burdens Among Married and Unmarried Men Who Have Sex With Men in Mumbai, India

imageBackground: Although HIV incidence has declined in India, men and transgender women who have sex with men (MSM) continue to have high rates of HIV and sexually transmitted disease (STD). Indian MSM face substantial pressures to marry and have families, but the HIV/STD burden among married Indian MSM is not well characterized. Methods: A diverse sample of Indian MSM were recruited through respondent-driven sampling. Independent variables that produced a P value of 0.10 or less were then added to a multivariable logistic regression model. Results: Most of the 307 MSM (95 married and 212 unmarried) recruited into the study were younger than 30 years, and less than one-third had more than a high school education. Almost two-thirds of the married men had children, compared with 1.4% of the unmarried men (P < 0.001). The numbers of condomless anal sex acts did not differ by marriage status. Although unmarried MSM more often identified themselves as “kothi” (receptive role), their rates of HIV or bacterial STD were similar to married MSM, with 14.3% being HIV infected. The respondent-driven sampling–adjusted prevalence of any bacterial STD was 18.3% for married MSM and 20% for unmarried MSM (not significant). Participants reported high levels of psychological distress, with 27.4% of married and 20.1% of unmarried MSM reporting depressive symptoms (not significant). Conclusions: Men who have sex with men in Mumbai had high rates of HIV, STD, and behavioral health concerns. Clinicians need to become more comfortable in eliciting sexual histories so that they can identify MSM who need HIV/STD treatment and/or prevention services. 11/01/2015 01:00 AM

Condom Use Errors and Problems: A Comparative Study of HIV-Positive Versus HIV-Negative Young Black Men Who Have Sex With Men

imageObjectives: To describe self-reported frequencies of selected condom use errors and problems among young (age, 15–29 years) black men who have sex with men (YBMSM) and to compare the observed prevalence of these errors/problems by HIV serostatus. Methods: Between September 2012 October 2014, electronic interview data were collected from 369 YBMSM attending a federally supported sexually transmitted infection clinic located in the southern United States. Seventeen condom use errors and problems were assessed. χ2 Tests were used to detect significant differences in the prevalence of these 17 errors and problems between HIV-negative and HIV-positive men. Results: The recall period was the past 90 days. The overall mean (SD) number of errors/problems was 2.98 (2.29). The mean (SD) for HIV-negative men was 2.91 (2.15), and the mean (SD) for HIV-positive men was 3.18 (2.57). These means were not significantly different (t = 1.02, df = 367, P = 0.31). Only 2 significant differences were observed between HIV-negative and HIV-positive men. Breakage (P = 0.002) and slippage (P = 0.005) were about twice as likely among HIV-positive men. Breakage occurred for nearly 30% of the HIV-positive men compared with approximately 15% among HIV-negative men. Slippage occurred for approximately 16% of the HIV-positive men compared with approximately 9% among HIV-negative men. Conclusions: A need exists to help YBMSM acquire the skills needed to avert breakage and slippage issues that could lead to HIV transmission. Beyond these 2 exceptions, condom use errors and problems were ubiquitous in this population regardless of HIV serostatus. Clinic-based intervention is warranted for these young men, including education about correct condom use and provision of free condoms and long-lasting lubricants. 11/01/2015 01:00 AM

Patient-Delivered Partner Treatment for Chlamydia, Gonorrhea, and Trichomonas Infection Among Pregnant and Postpartum Women in Kenya

imageBackground: Patient-delivered partner treatment (PDPT) for sexually transmitted infections (STIs) increases rates of partner treatment and decreases reinfection, but has not been evaluated during pregnancy. Methods: This prospective cohort was nested within a larger study of peripartum HIV acquisition. Participants with microbiologic diagnosis of Chlamydia trachomatis, Neisseria gonorrhoeae, and/or Trichomonas vaginalis were screened for participation. Questionnaires were administered to determine PDPT acceptability and barriers. Women were reassessed at least 30 days to determine partner treatment and reinfection. Women whose partners did or did not receive PDPT were compared. Results: One hundred twelve (22.2%) women in the parent cohort had a treatable STI; 78 within the PDPT study period, of whom 66 were eligible and 59 (89.3%) accepted PDPT. Fifty-one women had PDPT outcome data, 37 (73%) of whom reported partners treated with PDPT. Fourteen women (27%) refused or did not deliver partner treatment. Median age was 22 years (interquartile range, 20–26 years) and 88% were married. Compared with women who delivered PDPT, those who did not were more likely to have a partner living far away (23% vs. 0%, P = 0.004) and to report current intimate partner violence (14% vs. 0%, P = 0.02). Reported PDPT barriers included fear of partner's anger/abuse (5%) and accusations of being STI source (5%). Conclusion: Patient-delivered partner treatment was acceptable and feasible for pregnant/postpartum Kenyan women and may reduce recurrent STIs in pregnancy. 11/01/2015 01:00 AM