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Significant changes are occurring in the landscape of abortion provision in the UK. More women are having medical abortions and self-managing these at home, resulting in an increase in the proportion of abortions performed before 10 weeks’ gestation.1 Since 2018, women in Britain have been able to take misoprostol, the second medication for medical abortion, at home provided they have attended a clinic to have it prescribed. The COVID-19 pandemic has accelerated the trend towards self-management. As an emergency and temporary measure due to concerns about reduced health service access for women with unwanted pregnancies during the pandemic, consultations about pregnancy options have occurred by telephone or video and, if women wish and are deemed clinically appropriate, a medical abortion pack of both mifepristone and misoprostol can be posted to their home (up to 9 weeks, 6 days’ gestation in England and Wales, and no restriction in Scotland, but clinical guidelines state up to 11 weeks, 6 days). Laws prohibiting abortion have been repealed in Northern Ireland, effectively decriminalising most abortions, and pressure for decriminalisation has been mounting in the rest of the UK. The changes are taking place alongside shifts in thinking about healthcare generally. Recognition of patient-centred approaches and supported self-management, alongside enhancement of activities that complement clinical care in sexual and reproductive health, has gained more prominence. The changes have significant implications for all methods of abortion …

IntroductionYoung people aged 16 to 24 have the highest prevalence of genital chlamydia and gonorrhoea compared with other age groups and re-infection rates following treatment are high. Long-term adverse health effects include subfertility and ectopic pregnancy, particularly among those with repeated infections. We developed the safetxt intervention delivered by text message to reduce sexually transmitted infection (STI) by increasing partner notification, condom use and (STI) testing among young people in the UK.Methods and analysisA single-blind randomised trial to reliably establish the effect of the safetxt intervention on chlamydia and gonorrhoea infection at 1 year. We will recruit 6250 people aged 16 to 24 years who have recently been diagnosed with chlamydia, gonorrhoea or non-specific urethritis from health services in the UK. Participants will be allocated to receive the safetxt intervention (text messages designed to promote safer sexual health behaviours) or to receive the control text messages (monthly messages asking participants about changes in contact details) by an automated remote online randomisation system. The primary outcome will be the cumulative incidence of chlamydia and gonorrhoea infection at 1 year assessed by nucleic acid amplification tests. Secondary outcomes include partner notification, correct treatment of infection, condom use and STI testing prior to sex with new partners.Ethics and disseminationEthics approval was obtained from NHS Health Research Authority - London – Riverside Research Ethics Committee (REC reference: 15/LO/1665) and the London School of Hygiene & Tropical Medicine. We will submit the results of the trial for publication in peer-reviewed journals.Trial registration numberInternational Standard Randomised Controlled Trials Number:ISRCTN64390461. Registered on 17thMarch 2016.WHO trial registration data setavailable at:http://apps.who.int/trialsearch/Trial2.aspx?TrialID=ISRCTN64390461.Trial protocol version12, 19thJuly 2018.

Background Global health policy recognises the need for evidence-based interventions to promote positive sexual health among teenage boys. Creative solutions involving digital technologies have potential for engaging boys, but there remains insufficient evidence regarding the acceptability and effectiveness of these methods. We aimed to address this gap by examining the acceptability and feasibility of a coproduced, teacher-delivered intervention that uses interactive film to encourage adolescents to engage in episodic future thinking to help prepare for relationships and sexual health decision making. Methods Acceptability and feasibility of the intervention was determined with a systematic iterative process of intervention development involving a parallel-group feasibility cluster randomised controlled trial with embedded process and cost evaluation, which piloted trial processes and methods in Northern Ireland and a qualitative evaluation of acceptability in England, Scotland, and Wales. The sampling strategy was a maximum variation quota sample and the control group continued with normal practice. Process evaluation data were also collected. Triangulated data were analysed with thematic analysis. Findings Between November, 2014, and December, 2017, eight post-primary schools (831 adolescents, mean age 14·4 years [SE=0·019]) were enrolled into the pilot trial and 13 schools were involved in the qualitative evaluation of acceptability. Process evaluation data were collected from 17 focus groups with adolescents, 30 small focus groups and individual semi-structured interviews with school management staff and teachers, four classroom observations, and a satisfaction survey with 159 pupils. Results showed that the intervention was acceptable to schools, engaging to adolescents and teachers, and could be feasibly and cost-effectively implemented with minor amendments including development of an English version of the film for use in England and Wales, amendment of materials for faith-based schools, and refinement of parental components to include online materials. The satisfaction survey revealed that 100% (n=6) of teachers and 91% (n=145) of adolescents were satisfied with the intervention materials. Recruitment and retention targets were achieved. Of 21 schools approached, 38% (n=8) agreed to take part with no withdrawal. Of 1027 eligible students, and 81% (n=831) were recruited with 93% (n=774) retention. Interpretation Co-produced interactive film that encourages episodic future thinking is an acceptable method of engaging teenage boys in sexual health behaviour change programmes. Further applications of this technique in adolescent public health are possible and, thus far, have included smoking cessation, marijuana use, and future fatherhood in male prisoners. Funding Intervention design and development were funded by The UK Economic and Social Research Council (RES-189-25-0300). The feasibility trial (ISRCTN99459996) was funded by the National Institute for Health Research (NIHR) Public Health Research programme (15/181/01). The views expressed are those of the authors and not those of the National Health Service, the NIHR, or the Department of Health. The Scottish transferability study was funded by the UK Medical Research Council (MC_UU_12017/11) and the Scottish Government Chief Scientist Office (SPHSU11). The transferability study in Wales and England was funded by the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, Cardiff University and University College London.

Objective To test the procedures proposed for a main trial of a safer sex intervention for young people delivered by mobile phone text message (‘safetxt’). Design and setting Pilot randomised controlled trial. Participants were recruited through sexual health services in the UK. An independent online randomisation system allocated participants to receive the safetxt intervention or to receive the control text messages (monthly messages about participation in the study). Texting software delivered the messages in accordance with a predetermined schedule. Participants Residents of England aged 16–24 who had received either a positive chlamydia test result or reported unsafe sex in the last year (defined as more than 1 partner and at least 1 occasion of sex without a condom). Intervention The safetxt intervention is designed to reduce sexually transmitted infection in young people by supporting them in using condoms, telling a partner about an infection and testing before unprotected sex with a new partner. Safetxt was developed drawing on: behavioural science; face-to-face interventions; the factors known to influence safer sex behaviours and the views of young people. Outcomes The coprimary outcomes of the pilot trial were the recruitment rate and completeness of follow-up. Results We recruited 200 participants within our target of 3 months and we achieved 81% (162/200) follow-up response for the proposed primary outcome of the main trial, cumulative incidence of chlamydia at 12 months. Conclusions Recruitment, randomisation, intervention delivery and follow-up were successful and a randomised controlled trial of the safetxt intervention is feasible. Trial registration number ISRCTN02304709; Results.

Objectives. To investigate physical and mental health and experiences of violence among male and female trafficking survivors in a high-income country.\ud \ud Methods. Our data were derived from a cross-sectional survey of 150 men and women in England who were in contact with posttrafficking support services. Interviews took place over 18 months, from June 2013 to December 2014.\ud \ud Results. Participants had been trafficked for sexual exploitation (29%), domestic servitude (29.3%), and labor exploitation (40.4%). Sixty-six percent of women reported forced sex during trafficking, including 95% of those trafficked for sexual exploitation and 54% of those trafficked for domestic servitude. Twenty-one percent of men and 24% of women reported ongoing injuries, and 8% of men and 23% of women reported diagnosed sexually transmitted infections. Finally, 78% of women and 40% of men reported high levels of depression, anxiety, or posttraumatic stress disorder symptoms.\ud \ud Conclusions. Psychological interventions to support the recovery of this highly vulnerable population are urgently needed.\ud \ud Read More: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303095

Background: The risk of poor sexual health, including unplanned pregnancy and sexually transmitted infections (STIs), is greatest amongst young people. Innovative and acceptable interventions to improve sexual health are required. Mobile phone text messaging (short message service, SMS) interventions have the potential to reach large numbers of people at relatively low cost, but greater understanding is needed on how these interventions should be developed and how they work. Objectives: The aim of this paper is to explore young people’s views of and experiences with a mobile phone text messaging intervention to promote safer sex behavior. Methods: We undertook qualitative interviews with young people aged 16 to 24 years as part of a pilot trial of a sexual health intervention delivered by text message in the United Kingdom. Study participants received sexual health promotion text messages based on behavior-change techniques. The message content, tailored by gender and STI status, included support for correct STI treatment and promotion of safer sex behaviors. Young people were eligible if they had received a positive chlamydia test or had more than one partner and at least one episode of unprotected sex in the last year. Telephone interviews were conducted 2 to 3 weeks after initiation of the intervention. A semi-structured topic guide was followed to explore participant experiences and a thematic analysis was conducted. Results: We conducted 16 telephone interviews with participants who had received the text intervention and an additional four interviews with those in the control group (13 women and 7 men). Intervention participants found text messages easy to understand and appearing to come from a friendly and trustworthy source. They considered the frequency and timing of messages to be appropriate, and delivery via mobile phones convenient. Receipt of support by text message allowed recipients to assimilate information at their own pace, and prompted reflection on and sharing of messages with friends, family members, and partners, thus providing opportunities for education and discussion. For some recipients, the messages had increased their knowledge of how to correctly use condoms. Some described how the messages had increased their confidence and reduced stigma, enabling them to disclose infection to a partner and/or to do so sooner and more calmly. Discussing the messages with a partner reportedly enabled some women to negotiate condom use. Conclusion: From the perspective of the recipients, the tone, frequency, and content of the text messaging-based sexual health intervention was acceptable and appropriate. Their accounts indicated that the intervention increased knowledge, confidence, and safer sex behaviors. A large-scale randomized controlled trial (RCT) is needed to assess effectiveness.

Background Accession of 10 Central and Eastern European (CEE) countries to the EU resulted in the largest migratory influx in peacetime British history. No information exists on the sexual behaviour of CEE migrants within the UK. The aim of this study was to assess the sexual lifestyles and health service needs of these communities. Methods A survey, delivered electronically and available in 12 languages, of migrants from the 10 CEE accession countries recruited from community venues in London following extensive social mapping and via the Internet. Reported behaviours were compared with those from national probability survey data. Results 2648 CEE migrants completed the survey. Male CEE migrants reported higher rates of partner acquisition (adjusted OR (aOR) 2.1, 95% CI: 1.3 to 2.1) and paying for sex (aOR 3.2, 95% CI: 2.5 to 4.0), and both male and female CEE migrants reported more injecting drug use (men: aOR 2.2, 95% CI: 1.3 to 3.9; women: aOR 3.0, 95% CI 1.1 to 8.1), than the general population; however, CEE migrants were more likely to report more consistent condom use and lower reported diagnoses of sexually transmitted infections (STI). Just over 1% of respondents reported being HIV positive. Most men and a third of women were not registered for primary care in the UK. Discussion CEE migrants to London report high rates of behaviours associated with increased risk of HIV/STI acquisition and transmission. These results should inform service planning, identify where STI and HIV interventions should be targeted, and provide baseline data to help evaluate the effectiveness of such interventions.

Ensuring that sexually active adolescents are using contraception consistently and correctly is an effective means of reducing unplanned pregnancy. Use of highly effective long-acting reversible methods, such as subdermal implants, is low. We need to challenge the perception that the pill and condoms, the most commonly used contraceptive methods, are always the most suitable methods for young people. Changes in adolescent sexual behaviour, including increased number of sexual partners, is consistent with a rise in sexually transmitted infections. No contraceptive methods, with the exception of male or female sterilisation, are contra-indicated solely on the grounds of age. Young people need to be counselled about both the benefits and risks associated with each method so that they can make an informed choice. Most of the clinical evidence on contraceptive use comes from studies of 'older' women, with little research identified that specifically addressed implications for adolescent contraceptive use.

Objectives: Young black women are disproportionately affected by sexually transmitted infections (STI) in the UK, but effective interventions to address this are lacking. The Young Brent Project explored the nature and context of sexual risk-taking in young people to inform the translation of an effective clinic-based STI reduction intervention (Project SAFE) from the USA to the UK. Methods: One-to-one in-depth interviews (n = 37) and group discussions (n = 10) were conducted among men and women aged 15–27 years from different ethnic backgrounds recruited from youth and genitourinary medicine clinic settings in Brent, London. The interviews explored the context within which STI-related risks were assessed, experienced and avoided, the skills needed to recognise risk and the barriers to behaviour change. Results: Concurrent sexual partnerships, mismatched perceptions and expectations, and barriers to condom use contributed to STI risk exposure and difficulties in implementing risk-reduction strategies. Women attempted to achieve monogamy, but experienced complex and fluid sexual relationships. Low risk awareness, flawed partner risk assessments, negative perceptions of condoms and lack of control hindered condom use. Whereas men made conscious decisions, women experienced persuasion, deceit and difficulty in requesting condom use, particularly with older partners. Conclusions: Knowledge of STI and condom use skills is not enough to equip young people with the means to reduce STI risk. Interventions with young women need to place greater emphasis on: entering and maintaining healthy relationships; awareness of risks attached to different forms of concurrency and how concurrency arises; skills to redress power imbalances and building self-esteem.

Objective To describe contraceptive service use and identify demographic and sexual behavioural characteristics associated with use (and non-use) of different services. Methods Probability survey sample of men and women aged 16–44 years, resident in Britain. Participants comprised 3369 men and 4375 women reporting vaginal intercourse in the last year (excluding those reporting exclusive use of sterilisation or medical investigations for infertility). Main outcome measures were use of contraceptive services, grouped as: general practice, community contraceptive clinics, retail services and nonuse of services. Results General practice was the most commonly reported source of contraceptive supplies for women (59.2%), while retail services were most frequently reported by men (42.7%). 16.3% of women and 7.3% of men reported using more than one type of service. 20.7% of women and 45.1% of men had used no service in the last year, and amongst 16–17-year-olds the proportions reporting non-use of services was 13.8% and 31.2%, respectively. Use of community contraceptive clinics was associated with being younger, childless, single and reporting more heterosexual partners in the last year. Conclusions There was relatively little 9shopping around9 between different services, suggesting that choice of contraceptive providers ensures a range of needs is met for most people. While general practice is the most commonly used source of supplies, community contraceptive clinics are seeing those potentially at higher sexual health risk, particularly the young and those with multiple partners. Ways of improving young people9s access to services for contraceptive supplies need to be addressed.

Objective To measure agreement between the client9s and the clinician9s responses to questions regarding client history as answered on a questionnaire based on the UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) for combined hormonal contraception (CHC). Methods Clients aged 18 years and over, attending a central London community contraceptive clinic requesting a repeat supply of CHC, completed a history questionnaire and an evaluation form. Clinicians then completed their copy of the same questionnaire during the consultation. Percentage agreement and the Kappa statistic were used to assess the level of client—clinician agreement. Results Data from 328 client—clinician pairs were analysed. Agreement was above 93% for all identified risk factors. There was complete agreement for thrombosis, diabetes, stroke, cancer and liver problems. Least agreement was noted in the recording of migraine and abnormal bleeding. For all risk factors except smoking, the proportion of clients reporting a risk factor was more than the proportion of clinicians reporting a risk factor. No clinically important information relevant to a particular client9s use of CHC was missed and none of them would have been wrongly prescribed the CHC based just on their self-completed questionnaires. Most women (97%) were happy with this method of history taking. Conclusions A self-completed history questionnaire is acceptable to women and can potentially replace traditional routine medical history taking for continuing CHC. Women completed the questionnaire with a high degree of reliability. There was complete client—clinician agreement on UKMEC Category 4 criteria. Overall, clients reported more risk factors than clinicians, which increases the safety of the questionnaire.

BackgroundYounger people bear the heaviest burden of sexually transmitted infections (STIs). Partner notification, condom use and STI testing can reduce infection but many young people lack the knowledge, skills and confidence needed to carry out these behaviours. Text messages can provide effective behavioural support. The acceptability and feasibility of a randomised controlled trial of safer sex support delivered by text message are not known.ObjectivesTo assess the acceptability and feasibility of a randomised controlled trial of a safer sex intervention delivered by text message for young people aged 16–24 years.Design(1) Intervention development; (2) follow-up procedure development; (3) a pilot, parallel-arm randomised controlled trial with allocation via remote automated randomisation (ratio of 1 : 1) (participants were unmasked, whereas researchers analysing samples and data were masked); and (4) qualitative interviews.SettingParticipants were recruited from sexual health services in the UK.ParticipantsYoung people aged 16–24 years diagnosed with chlamydia or reporting unprotected sex with more than one partner in the last year.InterventionsA theory- and evidence-based safer sex intervention designed, with young people’s input, to reduce the incidence of STIs by increasing the correct treatment of STIs, partner notification, condom use and STI testing before unprotected sex with a new partner. The intervention was delivered via automated mobile phone messaging over 12 months. The comparator was a monthly text message checking contact details.Main outcome measures(1) Development of the intervention based on theory, evidence and expert and user views; (2) follow-up procedures; (3) pilot trial primary outcomes: full recruitment within 3 months and follow-up rate for the proposed primary outcomes for the main trial; and (4) participants’ views and experiences regarding the acceptability of the intervention.ResultsIn total, 200 participants were randomised in the pilot trial, of whom 99 were allocated to the intervention and 101 were allocated to the control. We fully recruited early and achieved an 81% follow-up rate for our proposed primary outcome of the cumulative incidence of chlamydia at 12 months. There was no differential follow-up between groups. In total, 97% of messages sent were successfully delivered to participants’ mobile phones. Recipients reported that the tone, language, content and frequency of messages were appropriate. Messages reportedly increased knowledge of and confidence in how to use condoms and negotiate condom use and reduced stigma about STIs, enabling participants to tell a partner about a STI.ConclusionsOur research shows that the intervention is acceptable and feasible to deliver. Our pilot trial demonstrated that a main trial is feasible. It remains unclear which behaviour change techniques and elements of the intervention or follow-up procedures are associated with effectiveness. A further limitation is that in the trial one person entering data and the participants were unmasked. A randomised controlled trial to establish the effects of the intervention on STIs at 12 months is needed.Trial registrationCurrent Controlled Trials ISRCTN02304709.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 57. See the NIHR Journals Library website for further project information.

Objective: Self-harm is common in adolescence, but most young people who self-harm do not seek professional help. The aim of this literature review was to determine (a) the sources of support adolescents who self-harm access if they seek help, and (b) the barriers and facilitators to help-seeking for adolescents who self-harm. Method: Using a pre-defined search strategy we searched databases for terms related to self-harm, adolescents and help-seeking. Studies were included in the review if participants were aged 11–19 years. Results: Twenty articles met criteria for inclusion. Between a third and one half of adolescents who self-harm do not seek help for this behaviour. Of those who seek help, results showed adolescents primarily turned to friends and family for support. The Internet may be more commonly used as a tool for self-disclosure rather than asking for help. Barriers to help-seeking included fear of negative reactions from others including stigmatisation, fear of confidentiality being breached and fear of being seen as ‘attention-seeking’. Few facilitators of help-seeking were identified. Conclusions: Of the small proportion of adolescents who seek help for their self-harm, informal sources are the most likely support systems accessed. Interpersonal barriers and a lack of knowledge about where to go for help may impede help-seeking. Future research should address the lack of knowledge regarding the facilitators of help-seeking behaviour in order to improve the ability of services to engage with this vulnerable group of young people.

Objectives To determine whether regular use of a spray containing 1,2-octanediol 1%, which has been shown to inhibit survival of head lice, is able to work as a preventive against establishment of new infestations. Setting Randomised, double-blind, cross-over, community study in Cambridgeshire, UK. Participants 63 male and female schoolchildren aged 4–16 years judged to have a high risk of recurrent infestation. Only the youngest member of a household attending school participated. Interventions Participants were treated to eliminate lice, randomised between 1% octanediol or placebo sprays for 6 weeks then crossed-over to the other spray for 6 weeks. Parents applied the sprays at least twice weekly or more frequently if the hair was washed. Investigators monitored weekly for infestation and replenished supplies of spray. Primary and secondary outcome measures The primary endpoint was the time taken until the first infestation event occurred. The secondary measure was safety of the product in regular use. Results Intention-to-treat analysis found a total of 32 confirmed infestations in 20 participants, with 9 of them infested while using both products. In these nine participants the time to first infestation showed a significant advantage to 1% octanediol (p=0.0129). Per-protocol analysis showed only trends because the population included was not large enough to demonstrate significance. There were no serious adverse events and only two adverse events possibly related to treatment, one was a case of transient erythema and another of a rash that resolved after 5 days. Conclusions Routine use of 1% octanediol spray provided a significant level of protection from infestation. It was concluded that this product is effective if applied regularly and thoroughly. Trial registration number ISRCTN09524995.

This paper describes an independent evaluation of a peer-led STD/HIV prevention intervention conducted by Gay Men Fighting AIDS (GMFA) in a public sex environment (PSE). A variety of quantitative and qualitative research methods were employed to collect data on the intervention process as well as its outcomes. The main aim of the intervention was the distribution of condoms and safer sex literature to PSE users. During a five-month period, over 100,000 condoms and 2,200 safer sex information packs were distributed by GMFA volunteers to the PSE users. Condom provision was identified as the most needed health promotion activity in PSEs in a survey of gay and bisexual men (n = 688) conducted by the evaluators. Data collected showed that condoms provided by GMFA, as well as from other sources, were being used in the PSE. The peer-led focus of the intervention was acceptable to the PSE users. In addition, high levels of commitment and input from the volunteers contributed considerable added value to the intervention. The evaluation found that GMFA was successful in reaching the target population and addressing their needs and demands.

To investigate the association between maternal HIV infection and perinatal outcome by a systematic review of the literature and meta-analysis.Appropriate publications were identified using electronic and hand searching of relevant journals from 1983 to 1996. Studies were included in the review if they were prospective cohorts with pregnant women identified as being HIV-infected with a control group of pregnant women who were not infected with HIV. Methodological quality was assessed for each study. Data were extracted for pre-determined outcome measures. Sensitivity analyses were performed to explore the association between HIV infection and an adverse perinatal outcome for the following study characteristics: clinical setting (developed or developing countries), methodological quality (high or poor) and whether studies controlled for potential confounding.Thirty-one studies were eligible to be included in the review. The summary odds ratio of the risk of pre-defined adverse perinatal outcomes related to maternal HIV infection were as follows: spontaneous abortion 4.05 (95% CI 2.75-5.96); stillbirth 3.91 (95% CI 2.65-5.77); fetal abnormality 1.08 (95% CI 0.7-1.66); perinatal mortality 1.79 (95% CI 1.14-2.81); neonatal mortality 1.10 (95% CI 0.63-1.93); infant mortality 3.69 (95% CI 3.03-4.49); intrauterine growth retardation 1.7 (95% CI 1.43-2.02); low birthweight 2.09 (95% CI 1.86-2.35) and pre-term delivery 1 83 (95% CI 1.63-2.06). Sensitivity analyses showed that the association between infant mortality and maternal HIV infection was stronger in studies conducted in developing countries when compared with developed countries [odds ratios (OR) 3.72 (95% CI 3.05-4.54) and 8.6 (95% CI 0.53-141.05), respectively]; studies of higher methodological quality compared with those of poorer quality [odds ratios 14.57 (95% CI 6.93-30.65) and 3.37 (95% CI 2.74-4.14), respectively] and studies which had used restriction or matching to control for potential confounding factors compared with those that had not [OR 11.60 (95% CI 5.71-23.58) and 3.35 (95% CI 2.73-4.12), respectively].The findings of this review have implications for women infected with HIV who are planning a pregnancy or who find themselves pregnant. There appears to be an association, although not strong, between maternal HIV infection and an adverse perinatal outcome. This relationship may be due to bias including uncontrolled or residual confounding. There does, however, appear to be a real and large increase in the risk of infant death in developing countries associated with maternal HIV infection, especially so when there has been an attempt to control for confounding.The association between maternal HIV infection and perinatal outcome was evaluated through a systematic literature review and a meta-analysis of the studies located. The review of the literature for the period 1983-96 identified 31 prospective studies with an appropriate control group (21 conducted in developing countries) on this topic. The summary odds ratios (ORs) of the risk of adverse perinatal outcomes related to maternal HIV infection were as follows: spontaneous abortion, 4.05 (95% confidence interval (CI), 2.75-5.96); stillbirth, 3.91 (95% CI, 2.65-5.77); fetal abnormality, 1.08 (95% CI, 0.7-1.66); perinatal mortality, 1.79 (95% CI, 1.14-2.81); neonatal mortality, 1.10 (95% CI, 0.63-1.93); infant mortality, 3.69 (95% CI, 3.03-4.49); intrauterine growth retardation, 1.7 (95% CI, 1.43-2.02); low birth weight, 2.09 (95% CI, 1.86-2.35); and preterm delivery, 1.83 (95% CI, 1.63-2.06). Sensitivity analyses indicated the association between infant mortality and maternal HIV infection was stronger in studies conducted in developing countries (OR, 3.72; 95% CI, 3.05-4.54) than developed countries (OR, 8.61; 95% CI, 0.53-141.05); studies of higher methodological quality (OR, 14.57; 95% CI, 6.93-30.65) than those of lesser quality (OR, 3.37; 95% CI, 2.74-4.14); and studies that had used restriction or matching to control for potential confounding factors (OR, 11.60; 95% CI, 5.71-23.58) than those that did not attempt such control (OR, 3.35; 95% CI, 2.73-4.12). These results suggest there is an association, although not strong, between maternal HIV infection and adverse perinatal outcome. Most solid is evidence of an association between maternal HIV infection and the risk of infant death in developing countries. Needed, however, are large prospective cohort studies of HIV-positive and HIV-negative pregnant women that attempt to control for confounding. Ideally, these studies would collect data on immune function and HIV disease stage before and during pregnancy, enroll women in the early antenatal stages, and follow-up for at least a year after delivery.

This paper examines the self-reported effects of alkyl nitrite use. The aim of this research into the social contextual use of nitrites was to provide qualitative data to assist with policy-making ...

Information on age- and gender-specific prevalence of herpes simplex virus (HSV) types 1 and 2 infections is crucial to guide genital herpes control strategies. Such data are not available from the newly independent Eastern European countries. We present of study of the age- and gender-specific prevalence of HSV-1 and HSV-2 in low risk populations in Estonia. Serum samples from 1016 children, 794 first trimester antenatal women, and 1036 blood donors (462M, 574F) were tested for HSV IgG antibodies by type-specific HSV-1 and HSV-2 assays. High seroprevalence rates of HSV-1 among children, pregnant women and (non-paid) blood donors were found. HSV-2 infection was not detected among boys. Gender differences in HSV-2 seroprevalence rates among people of reproductive age were observed: higher rates were recorded among pregnant women (23%) and female blood donors (21%), compared to 11% among male blood donors. HSV-1 seroprevalence was high in adults. HSV-2 seroprevalence was higher among females than males and increased substantially with age. HSV-2 prevalence in these non-high risk populations was relatively high, and may indicate a risk for an impending sexually- and STI- driven HIV epidemic.

My Contraception Tool (MCT) applies the principles of multi-criteria decision analysis to the choice of contraceptive method. Its purpose is to make the decision-making process transparent to the user and to suggest a method to them based on their own preferences. The contraceptive option that emerges as optimal from the analysis takes account of the probability of a range of outcomes and the relative weight ascribed to them by the user. The development of MCT was a collaborative project between London School of Hygiene & Tropical Medicine, Brook, FPA and Maldaba Ltd. MCT is available online via the Brook and FPA websites. In this article we describe MCT's development and how it works. Further work is needed to assess the impact it has on decision quality and contraceptive behaviour.

Background/introduction Younger people bear the heaviest burden of sexually transmitted infections (STIs). The acceptability and feasibility of conducting a randomised controlled trial of safer sex support delivered by text message are not known. Aim(s)/objectives To develop a safer sex intervention delivered by text messages for people aged 16–24. To assess the acceptability and feasibility of a randomised controlled trial. Methods The intervention was developed based on evidence, behavioural theory, and user views. It was designed to reduce STIs by increasing correct treatment of STI, partner notification, condom use and STI testing. We conducted a pilot, randomised controlled trial with people aged 16–24 diagnosed with chlamydia or reporting unprotected sex with more than one partner in the last year. We conducted qualitative interviews. Results Two hundred participants were randomised. We fully recruited early and achieved 81% follow up for our proposed primary outcome cumulative incidence of chlamydia at 12 months. Ninety-seven percent of messages sent were successfully delivered to participants’ phones. Recipients reported that the tone, language, content, and frequency of messages was appropriate. Messages reportedly increased knowledge and confidence in how to use and negotiate condom use, and reduced stigma enabling participants to tell a partner about a STI. Discussion/conclusion T he intervention is acceptable and a main trial is feasible. The NIHR have funded a randomised controlled trial to establish the effects of the intervention on sexually transmitted infections at 12 months.

The study objectives were to ascertain behavioural, access-related, health-seeking factors and sexually transmitted infection (STI) prevalence in young men (

Background and methodology Little evidence is available on the extent to which one-stop shops address users9 sexual health needs and the extent to which they identify additional needs users may not have identified. As part of the One-Stop Shop Evaluation, a questionnaire was designed to compare the reasons for users9 visits and the reported outcomes of visits at a one-stop shop with the experiences of users in separate genitourinary medicine (GUM) and contraceptive clinics. Results The difference in the proportions of those attending the one-stop shop and those attending the control sites services for a sexually transmitted infection (STI)-related reason who were diagnosed with an STI was minimal, but those attending for an STI-related reason in the one-stop shop were more likely to receive an additional contraceptive outcome. Women attending for a contraceptive-related reason at the one-stop shop were more likely to have an STI screen than those attending the control sites for the same reason, but there was little difference in the proportions amongst this group receiving an STI diagnosis or receiving treatment. When focusing on women attending for a pregnancy-related reason, one-stop shop users were more likely to have received contraceptive advice or supplies. Discussion and conclusions It was not possible in our evaluation to determine the relative effectiveness of the one-stop shop in comparison to the traditional GUM and contraceptive clinics in improving sexual health status, however the one-stop shop was more likely to address additional sexual health needs that service users may not have previously identified.

BACKGROUND: The purpose of this study was to examine variation in positivity within the English National Chlamydia Screening Programme during 2007/2008. METHODS: Data were analyzed using multivariable logistic regression. The outcome measure was positivity. Funnel plots were used to explore variation in positivity according to screening volume. RESULTS: Three hundred and thirty-four thousand nine hundred and two screening tests were done, 29% of which were in men. Overall positivity was 7.6% in men and 9.3% in women. For men, positivity increased rapidly to plateau from ages 19 to 24. For women, rates peaked at 18 years-those aged 21 being at the same risk of chlamydial infection as 16-year-olds. For men and women, positivity was generally higher for those of black or mixed ethnicity compared with whites, whereas Asians were at lower risk. Similarly, risk of infection for men and women varied by screening venue. Multivariable analysis showed that, for men and women positivity varied significantly with age, ethnicity, screening venue attended, whether the young people had had a new sexual partner in the past 3 months, and whether the patient had had 2 or more sexual partners in the past year. Positivity did not vary significantly with implementation phase. CONCLUSIONS: This is the largest description of testing for Chlamydia trachomatis in healthcare and nonhealthcare settings outside Genitourinary Medicine clinics in England and allowed a detailed analysis of positivity by age and ethnic group. Considerable heterogeneity exists and local health service commissioners need to ensure that the implementation of chlamydial screening reflects these differences.

Purpose: To describe young people's knowledge and use of contraceptive services over initial stages of England's Teenage Pregnancy Strategy, and to investigate factors associated with use of different services.Methods: A random location sample of young people aged 13-21 years (n = 8879) was interviewed in 12 waves over 2000-2004. Individual data were analysed to investigate factors associated with knowledge and use of contraceptive services and to observe trends over time. Area-level data were analyzed to explore differences in key variables.Results: In all, 77% of young women and 65% of young men surveyed knew a service they could use to obtain information about sex. Amongst those who had had vaginal sexual intercourse, the most common source of contraceptive supplies was general practice for young women (54%) and commercial venues for young men (54%). Young women's use of school-based services to obtain supplies increased significantly from 15.4% in Year I to 24.4% in Year 4, p

In the United Kingdom, services for contraceptive consultation and family planning were first opened in the 1960s. Early and relevant information to adolescents is of importance. The aim of this paper was to examine young people's attitudes towards and experiences of consultations with health care providers about contraception, taking account of the context of their contraceptive use. Young people aged 16-21 years were recruited to the study from health services (young people's contraceptive and sexual health clinics and a termination of pregnancy clinic), secondary schools and community projects (a youth club, a young mothers' support group, a community education project and a young women offenders unit). As part of the needs' assessment, in-depth interviews and focus groups were conducted. Thirty-two young male and females were interviewed. Knowledge about contraception, sexually transmitted infections and the risk of pregnancy was often high. Many respondents noted that in a five to ten minute consultation there was not the time to discuss personal factors that may affect contraceptive decision making and effective use of methods. Many described a feeling of being rushed through the service and did not feel they had the opportunity to ask questions. What young people said they wanted from consultations with health care workers and their experiences of the consultation process often conflicted. They wanted the time and opportunity to discuss their options. Often the young men, who were accessing services, described how initially they had gone in to collect condoms, but once they knew the clinic and staff would consider making an appointment. It is concluded that young people want to be given choices and information regarding contraception that fit their lifestyles. Improving the structures of contraceptive and sexual health services for young people will help to remove some of the barriers that prevent some young people from accessing them. However, it is just as important that barriers in the service delivery are tackled to ensure young people receive effective contraceptive advice.

Objective To assess the relative contraceptive effectiveness, tolerability and acceptability of the levonorgestrel-releasing (20 mu g per day) intrauterine system (LNG-20) compared with reversible contraceptive methods in women of reproductive age.Design A systematic review and meta-analysis of randomised controlled trials.Identification Studies were identified through seven databases, and by contacting investigators and organisations working in the contraceptive field.Main outcome measures Unplanned pregnancy and continuation of contraceptive method.Results Five of the seven randomised controlled trials which met the inclusion criteria were included in the meta-analyses; four were comparisons of the LNG-20 intrauterine system with nonhormonal intrauterine devices. LNG-20 intrauterine systems were compared with intrauterine devices divided into two categories, those > 250 mm(3) (Copper T 380 Ag and Copper T 380A intrauterine devices) and those less than or equal to 250 mm(3) (Nova-T, Copper T 220C and Copper 200 intrauterine devices). Pregnancy rates for the LNG-20 intrauterine system users were significantly less likely to become pregnant compared with users of intrauterine devices less than or equal to 250 mm(3), and significantly less likely to have an ectopic pregnancy. LNG-20 intrauterine system users were more Likely to experience amenorrhoea and device expulsion than women using intrauterine devices > 250 mm(3). LNG-20 intrauterine system users were significantly more likely than all the intrauterine device users to discontinue because of hormonal side effects and amenorrhoea. When the LNG-20 intrauterine system was compared with Norplant-2, the LNG-20 users were significantly more likely to experience oligo-amenorrhoea, but significantly less likely to experience prolonged bleeding and spotting.Conclusions The effectiveness of the LNG-20 intrauterine system was similar to or better than other contraceptive methods with which it was compared. Amenorrhoea was the main reason for the discontinuation of the LNG-20 intrauterine system, usually unnecessarily, since this end-organ suppression of bleeding is benign, associated with normal oestrogen levels. Women choosing this method should be informed of potential amenorrhoea when having pre-contraceptive counselling and that absent bleeding may be viewed as a positive outcome.

OBJECTIVES: To assess the contraceptive efficacy, tolerability and acceptability of hormonally impregnated intrauterine systems (IUSs) in comparison to other reversible contraceptive methods. SEARCH STRATEGY: Literature was identified through database searches, reference lists and individuals/organisations working in the field. SELECTION CRITERIA: All randomised controlled trials comparing IUSs with other forms of reversible contraceptives and reporting on pre-determined outcomes in women of reproductive years. The primary outcomes were pregnancy due to method/user failure and continuation rate. DATA COLLECTION AND ANALYSIS: The quality assessment of studies and data extraction were completed independently by two blinded reviewers. A quality checklist was designed to identify general methodological and contraceptive specific factors which could bias results. Events per women months and single decrement life table rates were extracted where possible for pregnancy, continuation, adverse events and reasons for discontinuation. Events per total number of women at follow up were collected for hormonal side effects and menstrual disturbance. When appropriate, data were pooled at the same points of follow up to calculate rate ratios in order to determine the relative effectiveness of one method compared to another. For the single decrement life table rates, the rate differences were pooled to determine the absolute difference in effectiveness of one method compared to another. Interventions were only combined if the contraceptive methods were similar. Non-hormonal IUDs were divided into three categories for the purpose of comparison with IUSs: IUDs >250mm2 (i.e. CuT 380A IUD and CuT 380 Ag IUD), IUDs 250mm2 users. However, women using the LNG-20 IUS were significantly less likely to become pregnant than those using the IUD 250mm2. LNG-20 users were significantly more likely than all the IUD users to discontinue because of hormonal side effects and menstrual disturbance, which on further breakdown of the data was due to amenorrhoea. When the LNG-20 IUS was compared to Norplant-2, the LNG-20 users were significantly more likely to experience amenorrhoea and oligomenorrhoea, but significantly less likely to experience prolonged bleeding and spotting. No other significant differences were observed. Progestasert users were significantly less likely to become pregnant and less likely to continue on the method than non-medicated IUD users after one year, but no significant differences was noted for these two outcomes when Progestasert users were compared to IUD 250mm2 and Norplant-2 users. The LNG-20 IUS was more effective in preventing either intrauterine or extrauterine pregnancies than IUDs

Contemporary health promotion emphasises the concepts of lifestyle, risk, and preventive health behaviour alongside the broader societal concerns of the environment, public policy, and culture.1 The recent green paper Our Healthier Nation stresses a more coordinated approach to health promotion for people who are socially excluded, emphasising behavioural change through targeted interventions at the level of the community.2 There have been extensive reviews of homelessness and health, 3 4 along with calls for urgent action,5–7 but little attention has been paid to the health promotion needs of homeless people, and there is no firm evidence base for practice. One challenge for health promotion is to develop and deliver appropriate initiatives to a heterogeneous population that is not always easy to categorise but has a wide range of needs. The healthcare priorities of a young man sleeping on the streets differ from those of a single mother in temporary accommodation. To be homeless means more than just the absence of secure accommodation. Homelessness has as much to do with social exclusion as with bricks and mortar, and demands a range of health promotion strategies. #### Summary points At one level, the health condition of homeless people is a product of housing policy.3 Over the past two decades in …

To investigate the effect of pregnancy on disease progression and survival in women infected with HIV by a systematic review of the literature and meta-analysis.Appropriate publications were identified using electronic and hand searching of relevant journals from 1983 to 1996. Studies were included in the review if they were cohort studies, either prospective or retrospective, or case-control studies which investigated disease progression of pregnant women infected with HIV and included a control group of non-pregnant women infected with HIV for comparison. Methodological quality was assessed for each study. Data were extracted for predetermined outcome measures. Sensitivity analyses were performed to explore the association between pregnancy and disease progression for the following study characteristics: clinical setting (developed or developing countries), methodological quality (high or poor) and whether studies had controlled for potential confounding.Seven studies, all prospective cohorts, were eligible to be included in the review. The summary odds ratio for the risk of an adverse maternal outcome related to HIV infection and pregnancy were as follows: death 1.8 (85% CI 0.99-3.3); HIV disease progression 1.41 (95% CI 0.85-2.33); progression to an AIDS-defining illness 1.63 (95% CI 1.00-2.67) and fall of CD4 cell count to below 200 x 10(6)/L 0.73 (95% CI 0.17-3.06). Sensitivity analyses showed that HIV progression in pregnancy was significantly more common in a developing country setting (odds ratio 3.71, 95% CI 1.82-7.75) than in developed countries (odds ratio 0.55, 95% 0.27-1.11) and also significantly more common in high quality studies when compared to low quality ones, odds ratios 3.71 (95% CI 1.82-7.57) and 0.55 (95% CI 0.27-1.11), respectively. However, there appears to be less progression of HIV disease and progression to AIDS when studies attempted to control for confounding by matching or restriction techniques, although this was not statistically significant in either case.The findings of this review have implications for women infected with HIV who are pregnant or are considering a pregnancy. There does appear to be an association between adverse maternal outcomes and pregnancy in women infected with HIV, although this association is not strong. The relation may be due to the result of bias including residual confounding. Further large scale observational studies with long term follow up are required before this issue can be fully resolved.The effect of pregnancy on disease progression and survival in HIV-infected women was investigated through a systematic literature review and meta-analysis of the results of eligible studies. The literature search identified seven studies--all prospective cohort analyses--on this topic published in 1983-96. The summary odds ratios (ORs) for adverse maternal outcomes related to HIV infection were as follows: maternal death, 1.8 (95% confidence interval (CI), 0.99-3.3); HIV disease progression, 1.41 (95% CI, 0.85-2.33); progression to an AIDS-defining illness, 1.63 (95% CI, 1.00-2.67); and fall of CD4 cell count to below 200, 0.73 (95% CI, 0.17-3.06). Sensitivity analyses indicated HIV progression during pregnancy was significantly more common in developing countries (OR, 3.71; 95% CI, 1.82-7.75) than developed countries (OR, 0.55; 95% CI, 0.27-1.11) as well as in studies of high methodological quality (OR, 3.71; 95% CI, 1.82-7.57) compared with low-quality studies (OR, 0.55; 95% CI, 0.27-1.11). When studies attempted to control for confounding factors by matching or restriction techniques, there was less progression of HIV disease, but this was not statistically significant. Although this meta-analysis suggests that pregnancy in HIV-positive women may be associated with at least small increases in risk of adverse maternal outcomes, further large-scale observational studies of pregnant and nonpregnant HIV-infected women with long-term follow-up are required. Data on immune function should be available before pregnancy to facilitate determination of the effect of pregnancy on immune status.

Objective: To evaluate the feasibility and effectiveness of a standardized HIV partner notification programme within genitourinary medicine clinics in England. Design: A prospective survey of HIV partner notification activity over a 12-month period. Setting: Nineteen genitourinary medicine clinics in England. Patients and participants: A total of 501 eligible HIV-positive patients (either newly diagnosed or with whom partner notification had not been undertaken previously) seen during the study period. Main outcome measures: The numbers of partners named by patients, and the number of contacts notified, counselled and HIV-tested. Results: Information on overall partner notification activity was obtained by reviewing available medical records of 471 patients; 353 (75%) had discussed partner notification with a health-care worker during the study period and 197 (42%) had undertaken partner notification. Detailed information on outcomes was obtained for only 70 patients who named 158 contacts as being at risk of acquiring HIV. Although 71 (45%) contacts were eventually notified, only 28 were subsequently seen in participating clinics. Almost all contacts (n = 27) requested HIV counselling and testing, and five were diagnosed HIV-positive. Patient referral was the most popular notification method chosen. Conclusions: This study illustrates some of the practical difficulties that limit HIV partner notification within genitourinary medicine clinics. These include health-care workers' misgivings about undertaking partner notification, insufficient locating information to identify contacts, and migration of newly diagnosed patients, which prevents continuity and completion of notification. Nevertheless, HIV partner notification uncovered previously undiagnosed HIV infections. Further work needs to be undertaken in staff training and policy implementation if higher rates of partner notification and outcome measurements are to be achieved.

Background Since May 2004, ten Central and Eastern European (CEE) countries have joined the European Union, leading to a large influx of CEE migrants to the United Kingdom (UK). The SALLEE project (sexual attitudes and lifestyles of London's Eastern Europeans) set out to establish an understanding of the sexual lifestyles and reproductive health risks of CEE migrants. CEE nationals make up a small minority of the population resident in the UK with no sampling frame from which to select a probability sample. There is also difficulty estimating the socio-demographic and geographical distribution of the population. In addition, measuring self-reported sexual behaviour which is generally found to be problematic, may be compounded among people from a range of different cultural and linguistic backgrounds. This paper will describe the methods adopted by the SALLEE project to address these challenges. Methods The research was undertaken using quantitative and qualitative methods: a cross-sectional survey of CEE migrants based on three convenience samples (recruited from community venues, sexual health clinics and from the Internet) and semi-structured in-depth interviews with a purposively selected sample of CEE migrants. A detailed social mapping exercise of the CEE community was conducted prior to commencement of the survey to identify places where CEE migrants could be recruited. A total of 3,005 respondents took part in the cross-sectional survey, including 2,276 respondents in the community sample, 357 in the clinic sample and 372 in the Internet sample. 40 in-depth qualitative interviews were undertaken with a range of individuals, as determined by the interview quota matrix. Discussion The SALLEE project has benefited from using quantitative research to provide generalisable data on a range of variables and qualitative research to add in-depth understanding and interpretation. The social mapping exercise successfully located a large number of CEE migrants for the community sample and is recommended for other migrant populations, especially when little or no official data are available for this purpose. The project has collected timely data that will help us to understand the sexual lifestyles, reproductive health risks and health service needs of CEE communities in the UK.

Background Loss to follow-up in randomised controlled trials reduces statistical power and increases the potential for bias. Almost half of all trials fail to achieve their follow-up target. Statistical methods have been described for handling losses to follow-up and systematic reviews have identified interventions that increase follow-up. However, there is little guidance on how to develop practical follow-up procedures. This paper describes the development of follow-up procedures in a pilot randomised controlled trial of a sexual health intervention that required participants to provide and return questionnaires and chlamydia test samples in the post. We identified effective methods to increase follow-up from systematic reviews. We developed and tested prototype procedures to identify barriers to follow-up completion. We asked trial participants about their views on our follow-up procedures and revised the methods accordingly. Results We identified 17 strategies to increase follow-up and employed all but five. We found that some postal test kits do not fit through letterboxes and that that the test instructions were complicated. After identifying the appropriate sized test kit and simplifying the instructions, we obtained user opinions. Users wanted kits to be sent in coloured envelopes (so that they could identify them easily), with simple instructions and questionnaires and wanted to be notified before we sent the kits. We achieved 92 % (183/200) overall follow-up for the postal questionnaire at 1 month and 82 % (163/200) at 12 months. We achieved 86 % (171/200) overall follow-up for the postal chlamydia test at 3 months and 80 % (160/200) at 12 months. Conclusions By using established methods to increase follow-up, testing prototype procedures and seeking user opinions, we achieved higher follow-up than previous sexual health trials. However, it is not possible to determine if the increase in response was due to our follow-up procedures. Trial registration Current Controlled Trials ISRCTN02304709 Date of registration: 27 March 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1155-1) contains supplementary material, which is available to authorized users.

BACKGROUND: Men who have sex with men (MSM) are at increased risk of HIV infection in both high- and low-income settings. Mass media campaigns have been used as a means of communicating HIV health promotion messages to large audiences of MSM. There is no consensus on which designs are most appropriate to evaluate the process and outcomes of such interventions. METHODS: An exploratory review was conducted to assess research examining awareness, acceptability, effects on HIV testing, disclosure and sexual risk, and cost-effectiveness of HIV mass media campaigns targeting MSM. We searched for quantitative and qualitative studies published between 1990 and May 2011 via the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Psych Info, ISI Web of Science, OpenGrey and COPAC, and contacting experts. No exclusions were made on the basis of study design or methods because our primary aim was to map evidence. We appraised study quality and present a narrative synthesis of findings. RESULTS: Sixteen reports from 12 studies were included. All were from high-income countries and most examined multi-media interventions. Half of the studies were single cross-sectional surveys. Three repeat cross-sectional studies collected data pre and post the campaign launch. The remaining three studies monitored routine data. Three studies included a nested qualitative component. Campaign coverage was the most commonly reported outcome (9 studies). Imagery, tone of language, content and relevance were identified in the qualitative research as factors influencing campaign acceptability. HIV testing rates (or intention to test) were reported by five studies. Two studies reported that testing rates were higher among men who had seen the campaigns compared to men who had not, but this may reflect confounding. Findings were less consistent regarding reductions in sexual risk behaviours (4 studies). None of the studies examined cost-effectiveness. CONCLUSIONS: Campaigns aim to provide MSM with information to help prevent transmission of HIV and to address increasing motivation and changing norms towards precautionary behaviours. However, the limitations of mass media in imparting skills in effecting behaviour change should be recognised, and campaigns supplemented by additional components may be better-suited to achieving these goals.

OBJECTIVES: To evaluate the extent to which larger genitourinary medicine (GUM) clinics in England have established local clinic policies for HIV Partner Notification (PN) and to describe the process of HIV PN within this setting. DESIGN: A cross-sectional survey of HIV PN policies and practices within GUM clinics. SUBJECTS AND SETTING: Senior consultants in 59 GUM clinics in England. MAIN OUTCOME MEASURES: The presence of clinic policies for HIV PN, indicators of HIV PN activity (that is, its initiation, documentation, performance and evaluation) and factors hindering the acceptance of HIV PN into clinical practice. RESULTS: Only 18% (10/57) of respondents stated that their clinics had developed their own local policies for HIV PN. Fifteen percent (9/58) of clinics had audited HIV PN activity, 15% had provided specific HIV PN training for doctors and 47% (27/58) for health advisers. Within GUM clinics, health advisers play a key role in the HIV PN process, being responsible for initiating the discussion of partners, patient follow-up and documenting HIV PN activity in patients9 notes. Notifying partners was primarily seen as the responsibility of the newly diagnosed HIV positive patient. Although 77% (43/56) of responding consultants believed that HIV PN had become an accepted part of their clinics9 practice, the perceived unacceptability of HIV PN to patients and health care workers were seen as important limiting factors. CONCLUSION: In many GUM clinics, local policies on HIV PN have yet to be established and appropriate training for the health personnel provided. Nevertheless, there appears to be wide-spread acceptance of HIV PN in clinical practice with an acknowledgement of its limiting factors. Further research into the acceptability of HIV PN to health care workers and patients in this setting should be undertaken.