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L Sherr

Publications and source records attributed to L Sherr.

At least 19 recordsLinked to original sources
PubMed2005

Women who decline antenatal screening for HIV infection in the era of universal testing: results of an audit of uptake in three London hospitals.

Universal screening for HIV in early pregnancy is strongly promoted policy in the United Kingdom with a target of 90 per cent uptake. We identified characteristics of women declining screening by conducting an audit at three hospitals in inner north London. In early 2002 midwives were asked to complete an audit form following first antenatal appointment. Of 2,710 women attending 401 (15 per cent) declined an HIV test. Of women who declined 38 per cent reported they had been tested for HIV in the past; 65 per cent accepted every other antenatal test. In multivariable analysis parity (OR: 1.19; 95 per cent CI 1.10-1.29 per additional child), declining other tests (OR: 3.10; 95 per cent CI 2.44-3.93 per test declined) and previous HIV testing (OR: 1.70; 95 per cent CI 1.30-2.23) were predictors of declining an HIV test. Women declining screening were not obviously from high-risk demographic groups: women from sub-Saharan Africa were not at greater risk of declining an HIV test than women from other regions.

Adult↗
PubMed2004

Recruiting London gay men into an HIV vaccine trial: is it feasible?

This paper describes a study among HIV-negative gay men in London to examine willingness to volunteer for an HIV vaccine trial. HIV-negative gay men (n=506) were surveyed in central London gyms in February-March 2002. Information was collected on willingness to volunteer for an HIV vaccine trial, attitudes toward HIV vaccines and sexual risk behaviour. Men reporting unprotected anal intercourse (UAI) in the previous three months with a man of unknown or discordant HIV status were classified as being at high risk of exposure to HIV (n=94, 18.6%). The remainder, who reported no UAI or UAI only with another HIV-negative man, were considered to be at low risk (n=412, 81.4%). Just under a quarter of the HIV-negative men in the study (23.4%) said they were either quite likely or very likely to volunteer for an HIV vaccine trial. High-risk men were more likely to say they would volunteer for a trial than low-risk men (37.2% versus 20.2%, p<0.001). Of the 506 HIV-negative men surveyed, eight (1.6%) were both high risk and very likely to volunteer for an HIV vaccine trial, while a further 27 (5.3%) were both high risk and quite likely to volunteer. Based on these figures, we estimated that to recruit 1,000 high-risk HIV-negative men into a vaccine trial between 15,000 and 62,000 HIV-negative men would need to be approached in the community. Compared with those at low risk, a greater proportion of high-risk men said that if they were in an HIV vaccine trial they would be more likely to have unprotected sex (23.4% versus 7.8%, p<0.001); that an effective vaccine will make safe sex less important (45.7% versus 31.3%, p=0.01); and that they would participate in an HIV vaccine trial even if they thought the vaccine might not work (46.8% versus 29.9%, p<0.01). This study suggests that, in London, to recruit high-risk HIV-negative gay men for an HIV vaccine trial many thousands of gay men may need to be approached in the community. Some HIV-negative men said that they would be more likely to have unprotected sex if they took part in a trial.

AIDS Vaccines↗
PubMed2004

Popular opinion leaders in London: a response to Kelly.

Controlled trials conducted in the USA provide clear evidence that peer education can bring about a reduction in high risk sexual behaviour among gay men. HIV prevention interventions that systematically identified, recruited, trained and engaged popular opinion leaders (POLs) made a significant impact on sexual behaviour at a community level in small US towns. However, recent trials conducted in the UK have failed to replicate these findings. A POL intervention in London made no significant impact at a community level on the risk behaviours of gay men. Jeffrey Kelly, one of the authors of the US studies, has identified nine core elements central to the popular opinion leader model. In Kelly's view 'the UK projects were not tests of the popular opinion leader model because they did not employ most of these POL core elements'. The absence of any significant impact of the UK programmes on sexual risk behaviour at a community level was not, therefore, surprising. In fact, the London POL project incorporated all the core elements into its design and succeeded in employing seven out of nine in its delivery. Attempts to employ all the core elements, however, were hampered by problems in recruiting popular opinion leaders as well as barriers to communication. Process evaluation revealed that it was these obstacles which limited diffusion. This in turn explained the absence of any impact of the London POL project on sexual risk behaviour at a community level. The obstacles to successful diffusion in London have provided a valuable opportunity for examining the processes that underlie the POL model. Our study raises the question as to whether social interventions shown to be effective in one setting, place or moment in time can be replicated in another.

HIV Infections↗
PubMed2004

AIDS impact.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Use of gay Internet sites and views about online health promotion among men who have sex with men.

In May-June 2002, 4,974 men who have sex with men (MSM), average age 31 years, completed a self-administered questionnaire online accessed through two popular gay Internet sites in the UK (gaydar and gay.com UK). Most men were white (95%), employed (83%), lived in the UK (91%) and self-identified as gay (85%). Nearly half (46%) had not been tested for HIV, while 6% said they were HIV-positive. One-third (31%) reported high-risk sexual behaviour in the previous three months, i.e. unprotected anal intercourse with a partner of unknown or discordant HIV status. Nearly all the men (82%) had looked for a sexual partner on the Internet and three-quarters had been doing so for more than a year. Almost half the men (47%) said they preferred to meet men through the Internet rather than in bars or other 'offline' venues. Although nearly 40% of men said the most important reason for using these Internet sites was to find sexual partners, a further 17% said they primarily used them to have contact with other men, 16% because they were bored, 12% for entertainment, 4% because they were lonely and 3% because they were addicted to it. The majority of men in this survey had favourable attitudes towards online health promotion. Most men thought that Internet sites should allow health workers into chat-rooms (75%); would click on a banner to find out about sexual health (78%); and said if they met a health worker in a chat-room they would find out what they had to say (84%). In multivariate analysis, being HIV-positive, older age and high-risk sexual behaviour were all independently associated with an increased frequency of using the Internet to look for sex (p<0.05). The Internet has emerged as an important meeting place for men who have sex with men. As online HIV prevention initiatives are developed it will be important to monitor the extent to which the favourable attitudes seen here are reflected in preventive behaviours.

Adult↗
PubMed2004

Reflecting on the experience of interviewing online: perspectives from the Internet and HIV study in London.

This paper considers some of the strengths and weaknesses of conducting synchronous online interviews for qualitative research. It is based on a study among gay/bisexual men that used both qualitative and quantitative methods to explore the association between seeking sex through the Internet and HIV transmission risk. Between June 2002 and January 2004, 128 gay/bisexual men living in London were interviewed one-to-one by the first author (MD) about their experience of using the Internet to find sexual partners and negotiating condom use for anal sex. Thirty-five men were interviewed online, while 93 were interviewed face-to-face (i.e. offline). This paper draws on MD's experience of conducting these interviews--both online and face-to-face. Synchronous online interviews have the advantage of being cheap, convenient and attractive to people who do not like face-to-face interviews. However, some of the social conventions and technical limitations of computer-mediated-communication can introduce ambiguity into the online dialogue. To minimize this ambiguity, both interviewer and interviewee have to edit their online interaction. One of the distinctive features of the online interview is that it emerges as a form of textual performance. This raises fundamental questions about the suitability of the synchronous online interview for exploring sensitive topics such as risky sexual behaviour.

Adult↗
PubMed2004

British HIV Association (BHIVA)/British Association for Sexual Health and HIV (BASHH) guidelines on provision of adherence support to individuals receiving antiretroviral therapy (2003).

The widespread use of highly active antiretroviral therapy (HAART) has dramatically reduced HIV-associated morbidity and mortality where treatment has been made available. Very high levels of adherence to HAART are a prerequisite for a successful virological and immunological response. Low adherence increases the risk of treatment failure and disease progression. It is also likely to lead to further transmission of resistant viruses, and to have a negative impact on the cost effectiveness of HAART. Low adherence is difficult to predict, and this has two key implications for service provision. Firstly, HAART should not be withheld on the basis of assumptions about adherence. Secondly, support with adherence should be provided to all patients prescribed HAART. Our understanding of barriers to and enablers of high adherence, and the evidence base regarding effective interventions, is limited. Meta-analysis of randomized controlled trials available from the general literature suggests multiple interventions are required to maintain high adherence to chronic therapy. This document recommends a series of measures for adoption within HIV clinical care settings, based on evaluation of existing data. High adherence is a process, not a single event, and therefore adherence support must be integrated into clinical follow up. Every prescribing unit should have a written policy on provision of adherence support, and ensure that staff are appropriately trained to make delivery of such services possible.

Anti-HIV Agents↗
PubMed2004

Fatherhood and HIV-positive heterosexual men.

OBJECTIVES: The study of HIV and issues of reproduction is women-focused. HIV-positive men are overlooked and understudied. This study examined views on reproduction of heterosexual HIV-positive men. METHODS: Systematic questionnaire data were gathered from HIV-positive men (n=32) attending an HIV clinic in London. RESULTS: Heterosexual men were rarely given medical advice on reproduction (only 9.4%). Few felt fully informed (21.9%), while many felt uninformed (46.9%) or needed more information (28.1%). Over half would value fertility/fathering consultations, up-to-date information and quick referral to fertility clinics. Nearly half (43.8%) had considered having children and 37.5% had had a child prior to HIV diagnosis. HIV status affected views on fathering, and the advent of new treatments changed views in over half of the men. Almost half (41%) believed they would experience discrimination if they conceived a baby and a quarter would withhold their HIV status when attending antenatal clinics. The majority (81%) believed that a child gave meaning to life and something to live for - only 3.1% felt a child would be a burden. Most men overestimated potential vertical transmission and would value time to discuss fathering and fatherhood. CONCLUSIONS: There are gaps in provision. The majority of men felt that children gave meaning to life and a reason to live. Reproduction issues are not raised with HIV-positive men who are uninformed and unclear where to turn for information. Fatherhood should not be shunned as an issue for all HIV-positive men.

Adult↗
PubMed2004

Trends in sexual behaviour among London homosexual men 1998-2003: implications for HIV prevention and sexual health promotion.

OBJECTIVES: To examine changes in sexual behaviour among London homosexual men between 1998 and 2003 by type and HIV status of partner. METHODS: Homosexual men (n=4264) using London gyms were surveyed annually between 1998 and 2003 (range 498-834 per year). Information was collected on HIV status, unprotected anal intercourse (UAI) in the previous 3 months, and type of partner for UAI. High risk sexual behaviour was defined as UAI with a partner of unknown or discordant HIV status. RESULTS: Between 1998 and 2003, the percentage of men reporting high risk sexual behaviour with a casual partner increased from 6.7% to 16.1% (adjusted odds ratio (AOR) 1.36 per year, 95% confidence interval (CI) 1.26 to 1.46, p <0.001). There was no significant change in the percentage of men reporting high risk sexual behaviour with a main partner alone (7.8%, 5.6%, p=0.7). These patterns were seen for HIV positive, negative and never tested men alike regardless of age. The percentage of HIV positive men reporting UAI with a casual partner who was also HIV positive increased from 6.8% to 10.3% (AOR 1.27, 95% CI 1.01 to 1.58, p <0.05). CONCLUSION: The increase in high risk sexual behaviour among London homosexual men between 1998 and 2003 was seen only with casual and not with main partners. STI/HIV prevention campaigns among London homosexual men should target high risk practices with casual partners since these appear to account entirely for the recent increase in high risk behaviour.

Adult↗
PubMed2002

Assessment of health-related quality-of-life in males with Anderson Fabry Disease before therapeutic intervention.

Anderson Fabry Disease (AFD) is an extremely painful and debilitating multi-system X-linked disorder due to alpha-galactosidase enzyme deficiency. To date, no baseline data on health-related quality-of-life (HR-QoL) have been reported in males affected with this condition. In this study, 38 males with AFD completed Medical Outcomes Study Short Form, EuroQoL questionnaires and an AFD-specific questionnaire prior to the start of a trial involving replacement therapy with alpha-galactosidase. Results from these questionnaires were compared to the results from a similar HR-QoL study in males with severe haemophilia (factor VIII/IX deficiency) that used the same questionnaires and to the results of two large normative studies. The results on both questionnaires showed that in most instances males with AFD recorded significantly lower HR-QoL compared with males in the general population and individuals with severe haemophilia after adjusting for differences in age. These findings suggest therefore, that the scope for improvement in HR-QoL as a result of treatment with an appropriate agent is extremely large.

Adult↗
PubMed2002

An assessment of current HIV treatment adherence services in the UK.

The aim of this study was to examine current approaches to supporting adherence to antiretroviral therapy in UK HIV clinics. One hundred HIV/AIDS/GUM physicians were interviewed: 97% were personally involved in discussing adherence, spending 22% of consultation time on this issue and assessing adherence most commonly by patient self-report (88%). Other personnel involved included nurses (74%), other doctors (56%), health advisers (54%) and pharmacists (48%). Among criteria for achieving treatment success, adherence support ranked fourth after 'treatment fitting well into patient's lifestyle', regular viral load monitoring and the 'experience of the clinician/healthcare team'. A variety of tools were used to support adherence including dosette boxes (53%), written information (44%) and verbal communication (42%). Only 20% of physicians followed adherence protocols or formal guidelines. Three-quarters of physicians had received no training on adherence issues. The most common ways physicians kept informed about adherence matters were by attending conferences (87%), reading literature (71%) and learning from colleagues (51%). Eighty-seven per cent of physicians believed national adherence guidelines would be valuable. In conclusion, there is a need for training and direction within current adherence support services. National guidelines could provide a valuable framework for health care professionals.

Ambulatory Care↗
PubMed2002

Peer-led HIV prevention among gay men in London: process evaluation.

A peer-led HIV prevention initiative, based on a diffusion of innovation model, was developed for gay men attending gyms in central London. Peer educators were recruited from people who used the gym regularly according to standard selection criteria. After initial training, peer educators agreed to talk to gay men at their gym about HIV prevention, focusing on sexual risk and steroid injecting behaviour. Outcome evaluation revealed that the peer education programme had no significant impact on the risk behaviours of gay men using the gyms. Process evaluation, based on interviews with peer educators, the health promotion team and gym managers threw light on this finding. While it was feasible to set up a peer education programme among gay men in central London gyms, attrition was an important factor. Only one in five potential peer educators initially identified remained with the project throughout, thus limiting the potential for diffusion. Those who did work as peer educators reported barriers to communication within the gyms further limiting the extent to which diffusion occurred. In fact, it appears that the critical mass required for diffusion was never established. This could explain why the intervention had no significant impact on gay men's risk behaviours. A person-time analysis demonstrated that the peer education programme required a substantial input from the health promotion team, equivalent to one team member devoting 2.5 days a week to recruit, train and support peer educators over 18 months. Peer education should not, therefore, be viewed as a low-cost approach to prevention. Many of the insights gained through this process evaluation can inform others planning peer education programmes in other settings.

HIV Infections↗
PubMed2001

Seeking sex on the Internet and sexual risk behaviour among gay men using London gyms.

OBJECTIVE: To examine the association between seeking sex on the Internet and sexual risk behaviour among gay men in London. METHODS: In January-February 2000, gay men in London gyms were asked to complete self-administered questionnaires concerning use of the Internet, history of sexually transmitted diseases (STD) and recent unprotected anal intercourse (UAI). Internet sex seekers were compared with other men, also with Internet access, who did not seek sex in this way. RESULTS: Of 743 gay men included in the analysis (121 HIV-positive, 465 HIV-negative, 157 never-tested), 80.9% (601) had access to the Internet. Among those who had access, 34.4% (207) had used the Internet to find a sexual partner; this did not vary significantly by HIV status (P = 0.3). Internet sex seekers were more likely to have had an STD (HIV-negative men, 26.9 versus 17.5%, P = 0.04) or gonorrhoea (HIV-positive men, 22.2 versus 5.8%, P = 0.04) in the previous year than other men with Internet access. HIV-negative Internet sex seekers were also more likely to report non-concordant UAI in the previous 3 months [23.1 versus 11.8%; adjusted odds ratio (aOR), 1.9; 95% confidence interval (CI), 1.2--3.5; P = 0.01]. HIV-positive Internet sex seekers were more likely to report UAI with another positive man (37.8 versus 7.4%; aOR, 7.9; 95% CI, 1.8--34.6; P = 0.006). CONCLUSION: Seeking sex on the Internet was associated with recent STD and high-risk sexual behaviour among HIV-positive and -negative gay men in London. The contribution of seeking sex on the Internet to the recent increase in high-risk behaviour among London gay men merits further investigation.

Adult↗