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PubMed2004

[Clinical assessment of the risk of Human Immunodeficiency virus (HIV) infection in the population consulting an anonymous and free screening center].

INTRODUCTION: The anonymous and free AIDS screening centers were developed in France in 1987 to incite the general population to undergo screening for HIV infection. The aim of this paper was to conduct a prospective study describing the principle characteristics and level of risk of those consulting a center in the Year 1999. POPULATION AND METHODS: A face to face physician-consultant questionnaire was proposed to all the consultants that Year. It included 20 questions regrouped in general characteristics of the subject, number of previous screenings, reason for screening, type of risk taken, date of last risk taken, and number of sexual partners during the past 12 Months and throughout their life without the use of a condom. RESULTS: Two thousand six hundred seventy-eight persons consulted (sex ratio=1) aged a mean of 25.8 Years. The men were older than the women (respectively 27 versus 24.6; p<0.05). The reason for screening was a decision made by the couple in 44.6 p. 100, an unprotected sexual relationship in 47.6 p. 100 another reason in 7.6 p. 100 and drug abuse in 0.2 p. 100 of cases. The sex mode declared was heterosexual in 94.5 p. 100 and homo or bisexual in 5.4 p. 100. The majority of those consulting (66.2 p. 100) had had between 0 and 2 partners during the past 12 Months; 66 p. 100 had had more than 10 during their life without using a condom. The assessment of the global risk by the physician was: very high in 1 p. 100, high in 2.5 p. 100, moderate in 13.3 p. 100, low in 70.7 p. 100 and nil in 12.5 p. cent. Five HIV infections were diagnosed, all in persons at high or very high risk. DISCUSSION: These results should stimulate the radical differentiation of the management of persons consulting according to the level of risk identified by the medical questionnaire.

Adolescent↗
PubMed2004

[Characteristics and evolution of consultants, their risk factors and their behavior at the free anonymous HIV screening center of Colmar (France)].

INTRODUCTION: Data collected in free anonymous HIV screening centers (Centre d'Information et de Dépistage Anonyme et Gratuit du VIH, CIdAG) are numerous but poorly exploited. The characteristics of the consultants, their risk factors and their behavior were rarely analyzed previously. MATERIAL AND METHODS: Data of 3995 patients attending the CIdAG of Colmar between January 93 and February 99 were prospectively analyzed. Two 18-month periods at the beginning and end of the study were compared. RESULTS: The activity of the center was stable. Nine HIV infections were detected (2 p. 1000 consulting). The male/female ratio was 1.2 and the mean age was 26 years. The proportion of very young patients (<20 years) was 30 p. 100 and increased significantly between the two periods. Six per cent of the consultants were male homo/bisexuals and 2 p. 100 used intravenous drugs. A regular use of condoms when having occasional sexual relations was reported by 40 p. 100 of consultants before 20 years of age, but this proportion decreased regularly as the age increased. It was minimal among intravenous drug users (19 p. 100), and greater among male homo/bisexuals (46 p. 100) than among male heterosexuals (37 p. 100) and women (33 p. 100). This proportion increased significantly during the study period in heterosexual men and women but not in male homo/bisexuals. The number of sexual partners did not vary but the knowledge of the partners'status for HIV infection and drug addiction progressed significantly. Some subjects who attended the centre several times were identified anonymously. They differed from the other consultants by an older age (mean: 31), a higher proportion of male homo/bisexuals (14 p. 100) and a less regular use of condom (26 p. 100). COMMENTS: In some French anonymous HIV screening centers, information and prevention currently appears to prevail over detecting new HIV infections. Modifying at-risk behaviour is difficult. Current messages for prevention must be improved.

Adult↗
PubMed2003

Effects of identification and usefulness of the Lie Scale of the Drug Use Screening Inventory (DUSI-R) in the assessment of adolescent drug use.

OBJECTIVES: The main objectives of this study were to evaluate the effects of subject identification versus anonymity on adolescents' drug use assessment using the Drug Use Screening Inventory-R and to assess the usefulness of the "Lie Scale" of that instrument. METHODS: Six hundred and fifty-five Brazilian students (5th to 11th graders) from a public school of São Paulo participated in the study. One third of them were instructed to put their names on the questionnaire, one third answered it anonymously and the remaining ones were partially identified according to a code list that was kept by one student who represented his classmates. The answers of the identified groups of students were compared with those from the anonymous group. According to their scores in the Lie Scale, the students were divided into two groups: low and high score groups. RESULTS AND CONCLUSIONS: No significant differences were found among anonymous, identified and partially identified groups regarding alcohol or drug consumption report, or in the density of problems in all drug use screening inventory (DUSI) areas. Regarding the Lie Scale, the high score group reported lower alcohol or drug consumption and fewer alcohol or drug related problems in all DUSI areas when compared to the low score group. The results suggest that identification or anonymity does not affect the students' answers to the DUSI and point out the usefulness of the Lie Scale of DUSI-R.

Adolescent↗
PubMed2000

HCV prevalence in pregnant women in the UK.

The objective of the study was to assess the prevalence and epidemiology of hepatitis C virus (HCV) infection in pregnant women in the North Thames region, and in the UK in general. Demographic data were linked to neonatal samples prior to anonymization and testing by anti-HCV EIA, and with RIBA 3 confirmation. Risk factors for maternal infection were explored. Area-specific seroprevalence rates were multiplied into population sizes to estimate HCV prevalence in pregnant women in the UK. A total of 241/126,009 samples were confirmed anti-HCV positive, and a further 40 were indeterminate, representing a seroprevalence of 0.19-0.22%; 51% of maternal HCV infections were in UK-born women (71% of the population), and 22% in women from continental Europe (5% of the population). Among European-born women, HCV prevalence was associated with birth in continental Europe, partner not being notified at birth registration, partner born in a different region to the mother, and inner city residence. Four of the 241 anti-HCV positive samples (1.7%) were also anti-HIV-1 positive. It was estimated that each year an estimated 1150 out of 730,000 pregnancies in the UK would involve a woman infected with HCV (uncertainty range 660-1850), a prevalence of 0.16% (0.09-0.25%). On the basis of reported rates of mother-to-child transmission of HCV, this would represent approximately 70 paediatric HCV infections per year.

Adolescent↗
PubMed2002

Effects of anonymity, gender, and erotophilia on the quality of data obtained from self-reports of socially sensitive behaviors.

This study examined the effects of anonymity, gender, and erotophilia on the quality of self-reports of socially sensitive health-related behaviors. A sample of 155 male and 203 female undergraduate students was randomly assigned to an anonymous and a confidential (i.e., nonanonymous) assessment condition. Gender, erotophilia, self-reports (of substance use, sexual behaviors, illegal activity), and perceived item threat were assessed by questionnaire. Data quality was strongly affected by experimental condition and gender. Thus, terminations were more frequent in the confidential condition and among women. In the confidential condition, women were significantly more likely to "prefer not to respond" to sensitive items compared to men. Both female gender and confidential condition were associated with lower frequency reports of sensitive health behaviors, and greater perceived threat of the assessment questions. Self-reported engagement in sensitive behaviors was positively related to both perceived question threat and erotophilia. Path analyses suggest that question threat mediates the effects of anonymity manipulations and gender on data quality (item refusal, termination), and that erotophilia mediates the effects of gender on incidence and frequency self-reports. The results indicate that anonymous assessments as well as male gender are associated with better data quality.

Adult↗
PubMed1996

Prevalence of markers for hepatitis B virus and HIV-1 among drug injectors in London: injecting careers, positivity and risk behaviour.

Concerns about the risks of HIV infection among drug injectors have eclipsed concerns about the prevalence and transmission of hepatitis, and in particular hepatitis B virus infection. Findings are reported from surveys undertaken with two separate community-recruited samples of drug injectors in London collected in 1992 (n = 505) and in 1993 (n = 507). Anonymized confirmed testing of saliva shows 51.5% of drug injectors in 1992 and 47.9% in 1993 to be antibody positive to the core antigen of hepatitis B virus (anti-HBc). Approximately half of the drug injectors confirmed as anti-HBc positive were unaware that they had been infected with hepatitis. Anti-HIV-1 prevalence was considerably lower at 7.0% in 1992 and 6.9% in 1993. Multivariate analyses showed anti-HBc positivity to be most likely among older injectors with longer injecting careers who had a history of having shared used needles and syringes. HIV-1 positivity was also associated with a history of having shared injecting equipment as well as with recent sharing (i.e. in the last 6 months). Unlike anti-HBc positivity, there were no associations between HIV-1 positivity and age or length of injecting career. Younger injectors with shorter injecting careers were more likely to report recent sharing of used injecting equipment than older injectors with longer injecting careers. We note the potential for continued transmission of HBV and HIV-1, particularly among younger injectors. We recommend an integrated strategy to maximize the health of drug injectors, of which HIV and HBV prevention is a part. There is a need to widen the availability of HBV vaccinations for HBV negative drug injectors and their sexual partners and for clear guidelines to drug injectors about the relative efficacy of bleach to disinfect injecting equipment of HBV and HIV.

Adolescent↗
PubMed2006

[Anonymous STD counselling versus mandatory checks for prostitutes--what is effective in STD prevention?].

BACKGROUND: When in 2001 in Germany the new act for control of infectious diseases came into force, mandatory checks for prostitutes were abolished. The consequences of this paradigm shift in STD prevention are being judged controversially even today. The public health department of the city of Cologne, like others, adapted its programme, staff, equipment, and diagnostic procedures to the new requirements. The department for venereal disease control was converted into a walk-in-clinic for STD and now forms part of a comprehensive STD and Aids prevention unit. The present article illustrates the changes by comparing the clients and the STD numbers of the years 1994 and 2004. METHOD: The following data were compared: number of consultations, number of clients regarding sex, occupation in sex business, health insurance, national or ethnic background, frequency of consultation, number of STD. RESULTS: In 1994, almost all clients of the department for venereal disease control were female prostitutes. 74% of them worked in established sex business venues with a high grade of professionalism, few STD cases were diagnosed. In 2004, the STD clinic was open for anybody considered to be at risk and not having access to the regular health care system. Only 49% of the patients were prostitutes, either female or male. 25% of the clients were male. 68% of the patients were migrants, many of them without any legal status and without any access to regular health care. A high number of acute STD and subsequent disorders that required treatment was registered. Besides the STD-related services, a great need for gynaecological and urological differential diagnostics as well as a high demand for counselling and provision of other problems of sexual health were observed. DISCUSSION: The data show that an STD department providing comprehensive services anonymously and free of charge will reach a broader range of highly vulnerable persons in comparison with an obligatory VD check of prostitutes. The high numbers of STD and STD-related disorders demonstrate the improved effectiveness of the new service.

Adolescent↗
PubMed2003

Evaluation of a clinical skills orientation program for residents.

OBJECTIVE: Our purpose was to implement and evaluate an orientation program for residents, focusing on outpatient clinical skills. STUDY DESIGN: Eleven of 12 residents participated in a clinical skills orientation program immediately preceding the academic year. The skill stations included evaluation of abnormal uterine bleeding, intrauterine device insertion, basic infertility evaluation, endometrial and vulvar biopsies, pelvic organ prolapse quantification examination, hysterosalpingography and office hysteroscopy, ultrasound scanning, labor and delivery triage, and clinic administrative responsibilities. Before test, after test, and anonymous resident evaluations were used to evaluate the program. RESULTS: First-year residents demonstrated a statistically significant increase in posttest scores compared to pretest scores (42.5% vs 71.3%, P=.003). Only first-year resident posttest scores for the labor and delivery triage and basic infertility evaluation stations demonstrated statistically significant increases over pretest scores (14.3% vs 46.4%, P=.009; and 41.7% vs 83.3%, P=.049, respectively). Sixty-four percent of the residents rated the program as "very helpful." Most residents felt that the program was well organized and that the facilities were conducive to learning; all of the participants recommended an annual clinical orientation program. CONCLUSION: A clinical skills orientation program was well received and strongly desired by residents. First-year residents appeared to benefit the most from this orientation.

Clinical Competence↗
PubMed2004

A study of commercial sex and HIV/STI-related risk factors among hospitality girls in entertainment establishments in Wuhan, China.

BACKGROUND: Commercial sex is illegal in China but there are still many hospitality girls (HGs) working at licenced entertainment establishments in many places in the country. Hospitality girls can be categorised as sex-HGs and non-sex-HGs. OBJECTIVE: To understand the proportion of sex-HGs and non-sex-HGs, the prevalence of HIV and sexually transmitted infections, and the high-risk behaviours among HGs. METHODS: A total of 257 HGs at 29 entertainment establishments (13 sauna/massage parlors, 10 dancing/karaoke bars and six barbershops) from seven urban districts in Wuhan were investigated and studied with a two-step sampling frame during November and December 1999. Information on sexual practices, drug abuse, condom use and other related factors were collected by anonymous interviewer-administered questionnaires. Anonymous laboratory testing was performed on 185 (72%) serum samples obtained for HIV-1 and HSV-2 by enzyme-linked immunosorbent assay. RESULTS: Of the 257 HGs, the mean age was 22.7 years (range 16-36 years); 147 (57.2%) stated they were sex-HGs, 15 (5.8%) were drug users, of whom 12 (80%) were injecting and 3 (20%) were inhaling. Sex-HGs was significantly correlated with drug abuse (P < 0.01, OR = 11.47). Among the 147 sex-HGs, 29 (19.7%) had sex with male clients more than seven times per week, 76 (51.7%) claimed to have used condoms consistently. The sero-prevalence survey of 185 HGs revealed that none tested HIV seropositive, and 40 (21.6%) were HSV-2 seropositive, which was positively correlated with sex-HGs (P < 0.01, OR = 3.13). CONCLUSIONS: Although the HIV epidemic in Wuhan has not yet reached a high level, HIV/AIDS prevention and control must be taken into account in entertainment establishments because of the existing high risk-taking behaviours and high STI incidence among HGs. It is feasible to carry out epidemiological investigations, which are concerned with sensitive topics such as sex, drug abuse, etc, among community-based female sex workers if designed and implemented prudently.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Prevalence of substance abuse among patients with physical diseases seen in an emergency room in Japan.

According to a nationwide general population survey on drug use in Japan, the lifetime prevalence of methamphetamine is low when compared to the United States. To confirm the hypothesis of a lower point prevalence of methamphetamine in an emergency room (ER) in Japan than in the United States, we collected blood specimens from an urban area of heavy methamphetamine prevalence in Tokyo, Japan, and analyzed the sera using REMEDi-HS based on an unlinked anonymity. Twenty kinds of drugs other than psychotropics were detected in 55 of 279 subjects (19.7%). Nineteen kinds of psychotropics were detected in twenty (7.2%) subjects. Psychotropics were detected in eleven patients with physical diseases and no acute intoxication. Methamphetamines were detected in three subjects (1.09%, 95% confidence interval 1.073-1.088) and in one of 46 subjects with injury (2.2%). It is necessary to look at the methodological differences between this study and previous studies; however, this finding supports the lower point prevalence of methamphetamine in an ER in Japan than in an ER in the United States.

Amphetamine-Related Disorders↗
PubMed2003

Ethical issues in human prion diseases.

Prion diseases or transmissible spongiform encephalopathies are a group of closely related transmissible neurodegenerative conditions of humans and animals, all of which are incurable. In recent years, they have captured public attention with the emergence of the bovine spongiform encephalopathy (BSE) epidemic in Europe, and more recently with the appearance of variant CJD (vCJD) in humans, a novel form of Creutzfeldt-Jakob disease (CJD) that is linked to dietary exposure to BSE. In this chapter, we outline ethical questions posed by research, diagnostic procedures and therapy in the field of prion diseases.

Adolescent↗
PubMed1997

Access to medical care one year prior to diagnosis in 100 HIV-positive women.

BACKGROUND: Anonymous antenatal testing for HIV antibodies suggests that the majority of HIV-positive women in the UK remain undiagnosed. Primary care reaches the majority of the population and women present more often than men. Sexual health matters are frequently raised, so there is an opportunity to discuss concerns with respect to HIV. Women often present with advanced HIV disease and with antiviral treatments proving to be more effective, there is now an even greater incentive to diagnose HIV early. OBJECTIVE: We aimed to look at access to medical care 1 year prior to HIV diagnosis in 100 HIV-positive women and to establish whether a discussion regarding HIV was recalled. METHOD: The setting was an established clinic for HIV-positive women in the Royal Free Hospital, London. In a 6-month period a questionnaire was completed by 100 women with their clinic doctor. RESULTS: Women were young (mean age 31). Most (84%) were infected by heterosexual sex. Forty-six per cent of the women presented with symptomatic HIV or AIDS and 50% were black Africans, hence there is a large ethnic bias in this sample. General practice was accessed by 65% of the women 1 year prior to HIV diagnosis. Few (14%) women recalled a discussion concerning HIV. Secondary care settings such as gynaecology and general outpatients were also frequently attended, but again HIV was apparently rarely discussed. There was no significant difference when variables such as time since diagnosis, health care setting, or ethnic group were concerned with respect to recall of a discussion concerning HIV. CONCLUSIONS: Despite coming from 'high risk' groups or presenting with symptomatic disease in the year prior to HIV diagnosis, few women recalled discussing HIV in either primary or secondary care settings. As these sites were commonly accessed, we feel that doctors and other health care workers should be encouraged and trained to raise HIV more routinely in their consultations.

Adult↗