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Biomedical subjects

Thomas A Peterman

Publications and source records attributed to Thomas A Peterman.

27 records · Page 2Linked to original sources
PubMed2004

Is HIV/sexually transmitted disease prevention counseling effective among vulnerable populations?: a subset analysis of data collected for a randomized, controlled trial evaluating counseling efficacy (Project RESPECT).

OBJECTIVE: The objective of this study was to evaluate counseling efficacy among high-risk groups. STUDY: We conducted a subset analysis of data collected from July 1993 through September 1996 during a randomized, controlled trial (Project RESPECT). Participants (n = 4328) from 5 public U.S. sexually transmitted disease (STD) clinics were assigned to enhanced counseling, brief counseling, or educational messages. For 9 subgroups (sex, age, city, education, prior HIV test, STD at enrollment, race/ethnicity, injection drug use, exchanging sex for money/drugs), we compared STD outcomes for those assigned either type of counseling with STD outcomes for those assigned educational messages. RESULTS: After 12 months, all subgroups assigned counseling (brief or enhanced) had fewer STDs than those assigned educational messages. STD incidence was similar for most subgroups assigned enhanced or brief counseling. All subgroups had an appreciable number of STDs prevented per 100 persons counseled, especially adolescents (9.4 per 100) and persons with STD at enrollment (8.4 per 100). CONCLUSIONS: HIV/STD prevention counseling (brief or enhanced counseling) resulted in fewer STDs than educational messages for all subgroups of STD clinic clients, including high-risk groups such as adolescents and persons with STDs at enrollment.

Adolescent↗
PubMed2003

Chlamydia trachomatis among patients infected with and treated for Neisseria gonorrhoeae in sexually transmitted disease clinics in the United States.

BACKGROUND: For two decades, treatment guidelines for sexually transmitted diseases (STDs) have recommended empirical co-treatment for chlamydia when patients are treated for gonorrhea. Because the epidemiology of and diagnostic testing for STDs have changed over time, co-treatment may no longer be needed as a clinical or public health strategy. OBJECTIVE: To assess the prevalence of chlamydia among patients at STD clinics who are infected with and treated for Neisseria gonorrhoeae and to determine whether co-treatment recommendations are still justified. DESIGN: Cross-sectional analysis of data from a multisite study. SETTING: Five public STD clinics (Baltimore, Maryland; Denver, Colorado; Long Beach, California; Newark, New Jersey; and San Francisco, California), July 1993 through October 1995. PATIENTS: 3885 heterosexual patients (2184 men and 1701 women) who agreed to participate in a trial of counseling interventions and had conclusive results from diagnostic tests for gonorrhea and chlamydia performed routinely as part of the trial. MEASUREMENTS: Infection with Chlamydia trachomatis as determined by polymerase chain reaction. RESULTS: Chlamydia trachomatis was detected in 20% (95% CI, 16% to 24%) of 411 men and 42% (CI, 35% to 50%) of 151 women with laboratory-confirmed N. gonorrhoeae. Chlamydia trachomatis was detected in 19% (CI, 15% to 22%) of 410 men and 35% (CI, 28% to 43%) of 154 women with treatment indications for gonorrhea who would not otherwise have been treated for chlamydia: chlamydia prevalence among these patients was significantly higher than among patients without treatment indications for either gonorrhea or chlamydia: 7% in men and 9% in women (relative risk, 2.58 [CI, 1.92 to 3.47] and 4.12 [CI, 3.05 to 5.57], respectively). CONCLUSION: The frequent presence of chlamydia among patients at STD clinics who received treatment for gonorrhea, including sex partners of gonorrhea-infected patients, supports continuing current recommendations for co-treatment.

Adult↗
PubMed2003

Partner notification for HIV and syphilis: effects on sexual behaviors and relationship stability.

BACKGROUND: Partner notification (PN), originally designed for syphilis control, has been used to control the spread of HIV since 1985. Because HIV infection is noncurable, the benefit of contact tracing and treatment demonstrated for the control of syphilis may not apply to HIV. For HIV, PN must facilitate behavior change that will reduce the spread of the infection. One concern is that HIV PN can promote the breakup of old partnerships and increase the acquisition of new partners, thereby spreading HIV infections. GOAL: The purpose of this study was to determine the effect of partner notification (PN) on sexual behavior and relationship stability among HIV partnerships, with use of syphilis partnerships for comparison. STUDY DESIGN: Partnerships were eligible if the index case was interviewed by a disease intervention specialist (DIS) for PN and named at least one sex partner. Partnership information was reported by index cases interviewed at baseline and 3 and 6 months post-PN. Trends in partnership dissolution and acquisition, sexual abstinence, condom use, emotional abuse, and physical violence reported by HIV infection and syphilis index cases were compared. RESULTS: A total of 157 index cases (76 HIV infection and 81 syphilis) reported 220 partnerships (94 HIV and 126 syphilis). The PN process was completed for 32.7% of partnerships and it was completed more often for partnerships that were classified as main and cohabiting. After PN, 46.8% of partnerships dissolved, 15.9% of cases acquired a new partner, and emotional abuse and physical violence decreased significantly. HIV index cases were somewhat more likely to report using condoms at last sex act and less likely to acquire a new sex partner after PN compared to syphilis index cases. There was no difference post-PN between HIV infection and syphilis partnerships for partnership dissolution, physical violence, emotional abuse and abstention from sex. CONCLUSION: HIV PN did not appear to cause greater partnership dissolution, new partner acquisition, or violence compared with syphilis PN.

Adolescent↗
PubMed2003

Changes in partnerships and HIV risk behaviors after partner notification.

BACKGROUND AND OBJECTIVE: Few studies have examined the effect of partner notification (PN) on behavior change and partnerships. This study investigated both. GOAL: The goal was to examine the effect of PN on sexual behaviors and partnership dissolution and formation. STUDY DESIGN Subjects included HIV-positive persons interviewed to identify partners for notification, partners notified of exposure, and HIV-negative persons receiving HIV counseling and testing (controls). Subjects were interviewed about behaviors and relationships at baseline and at 3- and 6-month visits. Partnerships in which both subject and partner received PN were compared to partnerships in which only the subject received PN and to control partnerships. RESULTS: Partnerships where both persons received PN were less likely to break up or acquire new partners and more likely to use condoms at follow-up. CONCLUSION: PN did not increase partnership dissolution or formation and was associated with higher condom use, suggesting the value of PN in HIV prevention.

Adolescent↗
PubMed2003

Prevalence and correlates of HIV serostatus disclosure.

BACKGROUND AND OBJECTIVE: A study of HIV-positive individuals in New Orleans, Louisiana, found that the majority of patients disclosed to their main partners and family members, but less than one fourth disclosed to any casual sex partner. Older age and lower CD4 cell counts were associated with disclosure. GOAL: The goal was to describe patterns of HIV serostatus disclosure among a diverse sample of patients at an HIV outpatient clinic in New Orleans, Louisiana. STUDY DESIGN: A convenience sample of HIV-seropositive patients provided information about disclosure of seropositivity, demographics, date of HIV diagnosis, CD4 cell count, mode of HIV acquisition, and sexual activity since HIV diagnosis. RESULTS: The 269 persons disclosed their HIV status to people in the following categories: main sex partner (74.2%), casual sex partner (24.8%), immediate family member (69.8%), other relative (27.0%), or friend (26.4%). Adolescents were less likely than adults to disclose to a main partner, immediate family member, or a friend. Immunosuppressed persons were more likely than nonimmunosuppressed persons to disclose to a main partner, immediate family member, or another relative. CONCLUSION: Many HIV-infected individuals delay disclosure until their disease has progressed. Interventions such as partner notification and skill-building to facilitate appropriate HIV disclosure are needed.

Adolescent↗
PubMed2003

Evaluation of a community-based organization's intervention to reduce the incidence of sexually transmitted diseases: a randomized, controlled trial.

BACKGROUND: The study objectives were to determine whether a community-based organization's intensive counseling intervention would reduce sexually transmitted disease (STD) acquisition among high-risk STD clinic patients and to determine whether a low-cost trial could be conducted in a community-based setting with passive follow-up. METHODS: Participants were randomly assigned to routine counseling or intensive counseling consisting of three 1-hour sessions. We reviewed clinic records to determine 1-year cumulative incidence of STD. RESULTS: From September 1994 through December 1995, we enrolled 581 high-risk black men. Among the intervention group, 38% did not attend any intervention session; 38% attended all three. The 1-year cumulative incidence of STD did not differ significantly between the intervention (16%) and control groups (12%) (P = 0.20). CONCLUSION: Our results suggest that the intensive counseling did not reduce STD acquisition. We encountered problems in conducting this low-cost trial, making results difficult to interpret Future trials should schedule follow-up STD assessments and will likely need more staff.

Adolescent↗
PubMed2002

Seroprevalence and correlates of herpes simplex virus type 2 infection in five sexually transmitted-disease clinics.

The seroprevalence of herpes simplex virus type 2 (HSV-2) infection was studied among 4128 patients from sexually transmitted disease (STD) clinics who were enrolled in a randomized controlled trial of human immunodeficiency virus and STD counseling efficacy. HSV-2 seroprevalence was 40.8% and was higher in women than in men (52.0% vs. 32.4%; P<.0001) and higher in blacks than in nonblacks (48.1% vs. 29.6%; P<.0001). Among 14-19-year-old patients, 36.8% of black women and 25.8% of nonblack women were infected with HSV-2. Independent predictors of HSV-2 seropositivity included female sex, black race, older age, less education, more lifetime sex partners, prior diagnosis of syphilis or gonorrhea, and lack of HSV-1 antibody. The majority of HSV-2-seropositive persons (84.7%) had never received a diagnosis of genital herpes. HSV-2 infection is common in STD clinic attendees in the United States, even among young age groups, especially among women. Efforts to prevent genital herpes should begin at an early age. The high rate of undiagnosed HSV-2 infection likely contributes to ongoing transmission.

Adolescent↗
PubMed2002

Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use.

BACKGROUND: Sexual acquisition of HIV is influenced by choice of partner, sex act, and condom use. However, current risk-reduction strategies focus mainly on condom use. GOAL: To estimate the contribution of choice of partner, sex act, and condom use on the per-act relative and absolute risks for HIV infection. STUDY DESIGN: Per-act relative risk for HIV infection was calculated with use of estimates of HIV prevalence, risk of condom failure, HIV test accuracy, and per-act risk of HIV transmission for different sex acts. Absolute risks were calculated on the basis of these relative risk estimates. RESULTS: Choosing a partner who tested negative instead of an untested partner reduced the relative risk of HIV infection 47-fold; using condoms, 20-fold; and choosing insertive fellatio rather than insertive anal sex, 13-fold. Choosing one risk-reduction behavior substantially reduces absolute risk of HIV infection for heterosexuals but not for men who have sex with men. CONCLUSION: Clarifying the magnitude of risk associated with different choices may help people make effective and sustainable changes in behavior.

Condoms↗