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Impact of Public Housing Relocations: Are Changes in Neighborhood Conditions Related to STIs Among Relocaters?

imageBackgroundCross-sectional and ecologic studies suggest that place characteristics influence sexual behaviors and sexually transmitted infections (STIs). Using data from a predominately substance-misusing cohort of African American adults relocating from US public housing complexes, this multilevel longitudinal study tested the hypothesis that participants who experienced greater postrelocation improvements in neighborhood conditions (i.e., socioeconomic disadvantage, social disorder, STI prevalence, and male/female sex ratios) would have reduced the odds of testing positive for an STI over time. MethodsBaseline data were collected in 2009 from 172 public housing residents before relocations occurred; 3 waves of postrelocation data were collected every 9 months thereafter. Polymerase chain reaction methods were used to test participants’ urine for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Individual-level characteristics were assessed via survey. Administrative data described the census tracts where participants lived at each wave (e.g., sex ratios, violent crime rates, and poverty rates). Hypotheses were tested using multilevel models. ResultsParticipants experienced improvements in all tract-level conditions studied and reductions in STIs over time (baseline: 29% tested STI positive; wave 4: 16% tested positive). Analyses identified a borderline statistically significant relationship between moving to tracts with more equitable sex ratios and reduced odds of testing positive for an STI (odds ratio, 0.16; 95% confidence interval, 0.02–1.01). Changes in other neighborhood conditions were not associated with this outcome. DiscussionConsonant with past research, our findings suggest that moving to areas with more equitable sex ratios reduces the risk of STI infection. Future research should study the extent to which this relationship is mediated by changes in sexual network dynamics. 10/01/2014 01:00 AM

Natural Experiments—A Way Forward for Examining Links Between Neighborhood Environments and Sexually Transmitted Infections With the Goal of Informing Policy?

No abstract available 10/01/2014 01:00 AM

Sexuality and Sexual Reproductive Health of Disabled Young People in Ethiopia

imageObjectivesIn Ethiopia, young people with disabilities (YPWD) are often marginalized and not recognized as being sexual, and only little is known about their sexual reproductive health (SRH) status. We therefore aimed to assess the SRH status and associated factors among 426 YPWD in Addis Ababa, Ethiopia. MethodsA cross-sectional survey was conducted in 2012. Data were collected by trained interviewers using a structured questionnaire. ResultsFifty-two percent of YPWD ever had sexual intercourse. Seventy-five percent started sex between 15 and 19 years. Only 35% had used contraceptive during their first sexual encounter. Fifty-nine percent of the sexually experienced YPWD had multiple lifetime sexual partners; 19%, a casual sexual partner; and 21%, a commercial sexual partner. Only 48% consistently used condoms with their casual or commercial sexual partners. Twenty-four percent of the sexually experienced YPWD had a history of sexually transmitted infections. ConclusionsOur findings indicate that YPWD in Ethiopia are sexually active, but also highly involved in risky sexual practices. There is a need for in-depth research to better understand the determinants of risky sexual behavior and to propose preventive approaches. 10/01/2014 01:00 AM

Prevalence and Characteristics of Rectal Chlamydia and Gonorrhea Cases Among Men Who Have Sex With Men After the Introduction of Nucleic Acid Amplification Test Screening at 2 Canadian Sexually Transmitted Infection Clinics

imageAbstractWe sought to determine the prevalence of rectal chlamydia and gonorrhea after the introduction of nucleic acid amplification tests for screening in men reporting receptive anal intercourse. The rectal chlamydia prevalence was 14.1% (95% confidence interval, 11.9–16.3), and the gonorrhea prevalence was 5.9% (95% confidence interval, 4.4–7.3). Most cases were positive only from the rectum. 10/01/2014 01:00 AM

Azithromycin Efficacy in the Treatment of Chlamydia trachomatis Among Detained Youth

imageAbstractWe assessed the efficacy of azithromycin among detained adolescents with Chlamydia trachomatis. Infected adolescents took azithromycin and submitted a test of cure. Of the 128 youth, 5 patients experienced treatment failure. We found that azithromycin was 96.1% (95% confidence interval, 91.1%–98.8%) effective in treating chlamydia infections, supporting its continued use. 10/01/2014 01:00 AM

Evaluation of Gonorrhea Test of Cure at 1 Week in a Los Angeles Community-Based Clinic Serving Men Who Have Sex With Men

imageBackgroundBecause of the decreasing susceptibility of Neisseria gonorrhoeae to cephalosporin therapy, the Centers for Disease Control and Prevention recommends test of cure (TOC) 1 week after gonorrhea (GC) treatment if therapies other than ceftriaxone are used. In addition, the Centers for Disease Control and Prevention asks clinicians, particularly those caring for men who have sex with men (MSM) on the west coast, to consider retesting all MSM at 1 week. However, it is unclear if this is acceptable to providers and patients or if nucleic acid amplification tests (NAATs) are useful for TOC at 7 days. MethodsBetween January and July 2012, MSM with GC were advised to return 1 week after treatment for TOC using NAAT. A multivariate logistic regression model was used to determine demographic and behavioral differences between MSM who returned for follow-up and MSM who did not. ResultsOf 737 men with GC, 194 (26.3%) returned between 3 and 21 days of treatment. Individuals who returned were more likely to have no GC history (P = 0.0001) and to report no initial symptoms (P = 0.02) when compared with individuals who did not return for TOC. Of those who returned, 0% of urethral samples, 7.4% of rectal samples, and 5.3% of pharyngeal samples were NAAT positive at TOC. ConclusionsAlthough TOC may be an important strategy in reducing complications and the spread of GC, low return rates may make implementation challenging. If implemented, extra efforts should be considered to enhance return rates among individuals with a history of GC. If TOCs are recommended at 1 week and NAATs are used, the interpretation of positive results, particularly those from extragenital sites, may be difficult. 10/01/2014 01:00 AM

Monitoring Knowledge Among Family, Sexually Transmitted Infections, and Sexual Partnership Characteristics of African American Adolescent Females

imageAbstractAmong 284 African American girls aged 14 to 17 years, frequent family monitoring knowledge was associated with a reduced likelihood of sexually transmitted infections (STIs) and having a casual sex partner but was not associated with other partnership characteristics. Family monitoring may offer an additional STI prevention opportunity for this vulnerable population. 10/01/2014 01:00 AM

Partner Meeting Place Is Significantly Associated With Gonorrhea and Chlamydia in Adolescents Participating in a Large High School Sexually Transmitted Disease Screening Program

imageBackgroundFrom 2003 to 2012, the Philadelphia High School STD Screening Program screened 126,053 students, identifying 8089 Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (GC) infections. We examined sociodemographic and behavioral factors associated with CT/GC diagnoses among a sample of this high-risk population. MethodsStandardized interviews were given to infected students receiving in-school CT/GC treatment (2009–2012) and to uninfected students calling for results (2011–2012). Sex-stratified multivariable logistic models were created to examine factors independently associated with a CT/GC diagnosis. A simple risk index was developed using variables significant on multivariable analysis. ResultsA total of 1489 positive and 318 negative students were interviewed. Independent factors associated with a GC/CT diagnosis among females were black race (adjusted odds ratio [AOR], 2.27; confidence interval, 1.12–4.58), history of arrest (AOR, 2.26; 1.22–4.21), higher partner number (AOR, 1.75; 1.05–2.91), meeting partners in own neighborhood (AOR, 1.92; 1.29–2.86), and meeting partners in venues other than own school, neighborhood, or through friends (“all other”; AOR, 9.44; 3.70–24.09). For males, factors included early sexual debut (AOR, 1.99; 1.21–3.26) and meeting partners at “all other” venues (AOR, 2.76; 1.2–6.4); meeting through friends was protective (AOR, 0.63; 0.41–0.96). Meeting partners at own school was protective for both sexes (males: AOR, 0.33; 0.20–0.55; females: AOR, 0.65; 0.44–0.96). ConclusionsAlthough factors associated with a GC/CT infection differed between males and females in our sample, partner meeting place was associated with infection for both sexes. School-based screening programs could use this information to target high-risk students for effective interventions. 10/01/2014 01:00 AM