Search

Background: Testing for herpes simplex virus type 2 (HSV-2) antibody is not common in clinical practice. Client characteristics associated with HSV-2 rapid antibody test uptake and test positivity were analyzed in clients attending an urban sexually transmitted disease clinic. Methods: This optional test was available for $30. The HerpeSelect Express assay was performed on serum. Demographic and behavioral characteristics were compared between clients who requested testing and those who did not and between those who were HSV-2 antibody positive and negative. Results: In 4 months, 3498 individuals attended the clinic and 443 (12.7%) opted for HSV-2 testing. Clients who were black, younger, or female were less likely to request testing. Recent sexual behavior and self-reported sexual orientation were not associated with uptake of testing. Of the 442 clients with results available, 109 were positive for HSV-2 antibody (24.7%). Women were significantly (P Conclusions: Uptake of testing was modest in this population, especially among the highest risk individuals, possibly due to the cost of the test. Improved education regarding HSV-2 and subsidized testing may be needed in the populations that have the highest prevalence in order to encourage testing. DOI: 10.1097/OLQ.0b013e3181bc9a2f

This analysis examined the role of impactful life events/stressful contextual factors and cannabis use in the patterns of illicit drug use. It utilized semi-structured qualitative interviews with 40 young adult medical cannabis patients and 22 non-patient users collected in Los Angeles during 2014–2015. Three patterns of illicit drug use emerged based on participants’ narratives: regular/problematic, recreational/occasional, and never users. Among regular/problematic users, a common theme was the lasting impact of traumatic life events or stressful contextual factors on transition to and away from problematic drug use, and using cannabis to cope with negative after effects of drug use. In contrast, most recreational/occasional and never users, who reported impactful life events or stressful contextual factors, used cannabis to cope with those experiences. Family history of addiction and acceptance of cannabis use within a family as protective factors against illicit drug use among some recreational/occasional and never users was an unexpected finding.

ObjectivesTo inform the development of targeted sexually transmitted infection (STI) control programmes for persons who inject drugs (PWID).MethodsWe recruited 116 PWID (aged ≥ 18 years) from a community-based syringe exchange programme (SEP) and assessed their STI knowledge and screening preferences via technology assisted self-interview. We estimated prevalence of STI transmission knowledge, attitudes and screening preferences as well as the association between reported sexual behaviours (past 6 months) and willingness to self-collect specimens.ResultsParticipants were white (77%), female (51%) and heterosexual (77%). STI knowledge regarding transmission and testing was high among the sample. More than 70% of participants were aware extragenital infections were possible and were least likely to know urine tests do not detect rectal infections (40.9%). Site-specific specimen collection was highly reflective of reported sexual behaviour. PWID who reported receptive sex (36% vs 5%, p<0.01) and insertive anal sex (31% vs 6%, p=0.01) were more likely to collect rectal specimens than those who did not. A similar trend was seen for oral sex performance on men and self-collection of oropharyngeal swabs (15% vs 3%, p=0.04). In addition, participants preferred collecting their own sample to having a clinician collect it for them (69% vs 31%, p<0.01) and testing at the SEP compared with a STI clinic (86% vs 14%, p<0.01).ConclusionOur findings suggest site-specific specimen collection may be a proxy for risk behaviour engagement in this fairly knowledgeable high-risk population. To increase case finding, STI control programmes should educate patients about site-specific screening and pair outreach with the infrastructure provided by SEPs, in settings where these programmes exist.

•Buprenorphine retention improved with less restrictive policies during COVID-19.•Risk of discontinuing buprenorphine was lowest among patients using telemedicine.•Low-threshold access to buprenorphine should continue to be expanded.

Introduction:We assessed awareness of pre-exposure prophylaxis (PrEP) among HIV-negative Black and Latinx persons living in the Philadelphia Metropolitan Statistical Area. Methods:Using chi-square and Wilcoxon rank-sum tests, we analyzed data from the 2016 heterosexual cycle of the National HIV Behavioral Surveillance system to assess how sociodemographic factors, health care utilization, and risk behaviors affected PrEP awareness. Results:Participants (n = 472) were predominately Black, non-Hispanic (88.1%) with a median age of 41.5 years. Most participants reported having a usual source of medical care (92.1%) and seeing a medical provider within 12 months (87.0%). However, PrEP awareness was low in this sample (4.9%) and was lower among those who had a medical visit compared with those who had not (P< .01). Conclusion:Current Centers for Disease Control and Prevention clinical guidelines suggest that providers counsel high-risk patients about PrEP. Our data suggest that this is not happening with people of color in Philadelphia. Interventions targeting medical providers working with HIV-risk people of color may be appropriate.

IntroductionDespite demonstrated clinical efficacy, little research has focused on implementing pre-exposure prophylaxis (PrEP) programs to prevent HIV among persons who inject drugs (PWID). We sought to determine the proportion of PWID meeting PrEP eligibility criteria and their attitudes towards PrEP as a first step in this process.MethodsParticipants were English-speaking PWID age ≥18 years recruited from a syringe exchange program in Northeastern United States. They self-obtained specimens for gonorrhoea and chlamydia screening and completed a survey assessing factors hypothesised to impact PrEP eligibility and uptake. Eligibility was calculated based on CDC clinical guidelines and included injection drug use plus any affirmative response to: sharing syringes, recent or current STI, sex exchange, having a sex partner of HIV positive or unknown status, inconsistent condom use with a high number of sex partners and opioid replacement therapy all within 6 months.ResultsOf 138 participants, 47% were women, 80% white with median age of 31. Eligibility was high (90.3%). Compared to men, women were more likely to report engaging in: vaginal sex, sex with a person of HIV positive or unknown status; sex exchange, greater numbers of sex partners, and screen positive for STI. Willingness to take PrEP was high (88.9% vs 71.0% among women and men, p<0.02). However, potential barriers to uptake were common and included: embarrassment (45%), anxiety (51.6%), not wanting to disclose PrEP use to a romantic partner (51.4%), being uninsured (30.1%), and not accessing providers where PrEP is routinely offered (52.9%).ConclusionDespite being recruited from a SEP, 9:10 participants were eligible for PrEP. While participants found PrEP acceptable, they reported multiple barriers to uptake including lack of access to clinical care and insurance. To optimise and scale PrEP programs for this population additional research is needed. However, data suggest uptake will remain sub-optimal unless tailored interventions are developed.

IntroductionStudies demonstrate pre-exposure prophylaxis (PrEP) can decrease HIV transmission among heterosexual men and women. To inform targeted promotional campaigns, it is necessary to identify those most likely to benefit from this intervention and assess their knowledge and attitudes towards PrEP.MethodsWe recruited individuals>18 years old from 4 community-based rapid HIV counselling and testing sites in Philadelphia. They completed a brief survey and screener for PrEP eligibility. Eligibility was based on reporting “yes” to: sex with a partner of unknown or HIV positive status, sex in exchange for drugs/money, recent sexually transmitted infection, or syringe sharing. Chi-squared tests were used to examine factors associated with eligibility, knowledge, and attitudes among 111 self-identified heterosexuals.ResultsThe sample is 61% male, with race/ethnicity of Black (48%), Latino (40%), White (9%) and other (3%), and median age 44. 31% screened PrEP eligible. Among males and females, eligibility was associated with reporting sex exchange, sex with persons of unknown HIV status, and recent STI (all p<0.05). By race/ethnicity, only syringe sharing differs significantly: 41.7% of Latinos, 42.9% of White participants and no Black or Other participants (p<0.04) reported sharing. Only 24% of participants had heard of PrEP; knowledge did not vary by group. A sizable minority reported concerns about side effects (44%) and talking to a doctor about PrEP (30%). However, 23% were extremely likely or somewhat likely (30%) to use PrEP to prevent HIV in the future.ConclusionWe identified a diverse and at-risk heterosexual population within community-based HIV counselling and testing. Most participants were unaware of PrEP, signifying promotional information is not reaching this population. Having rapid HIV testers screen for PrEP eligibility and educate clients about PrEP may be an effective way to increase PrEP awareness and acceptability among heterosexuals.