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Objective: To determine whether the 2012 Olympic and Paralympic Games were associated with a change in the number of patients attending or diagnosed with a new sexually transmitted infection (STI) at sexual health clinics in London and Weymouth., Methods: We undertook an interrupted time-series analysis of surveillance data from the Genitourinary Medicine Clinic Activity Dataset (GUMCAD) collected at 33 genitourinary medicine (GUM) clinics in London and Weymouth (where Games events were concentrated) between 2009 and 2012. Mixed-effects linear regression models of weekly attendance and diagnoses, incorporating temporal trends, bank holidays, categorical month and clinic closures, were used to test for the effect of the 'Olympic-Paralympic' period. We subdivided the 9-week 'Olympic-Paralympic' period (16 July 2012 to 17 September 2012) into five periods, including three Olympic weeks, two Paralympic weeks, pre-, post- and inter-Games weeks. We also compared characteristics of patients attending during the Olympic-Paralympic period and those attending during the same period in 2011., Results: During the 3 weeks of the Olympics, there was a significant reduction in the number of new episode attendances (2020 fewer, 5.6% reduction (95% CI -8.2 to -2.9)) and the number of patients diagnosed with an STI (267 fewer, 4.8% reduction (95% CI -8.6 to -0.9)) compared to expected. There were no important differences in the profile of patients attending during the 2012 Olympic-Paralympic period and those attending during the same period in 2011., Conclusions: We conclude that a 'business-as-usual' approach to managing local sexual health clinics during the 2012 Olympic and Paralympics would have been appropriate., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Background: Mass gatherings and large sporting events, such as the Olympics, may potentially pose a risk of increased sexually transmitted infection (STI) transmission and increase burden on local STI services. The objectives of this analysis were to assess whether the STI profile of Olympic visitors differed from that of the local STI clinic population and to investigate what impact these visitors had on local STI services., Methods: Self-administered questionnaires (completed by 29,292 patients) were used to determine the visitor status of patients attending 20 STI clinics, between July 20, 2012, and September 16, 2012, in the host cities, London and Weymouth. Using routine surveillance data from the Genitourinary Medicine Clinic Activity Dataset version 2, Olympic visitors were compared with usual attendees (local residents and non-Olympic visitors) in terms of their demographic characteristics, services utilized, and STIs diagnosed using univariate and multivariate methods., Results: Compared with usual attendees, Olympic visitors were more likely to be heterosexual males (56.0% vs. 34.9%, P = 0.001), aged between 15 and 24 years of age (47.1% vs. 34.0%, P = 0.001), of white ethnicity (81.9% vs. 66.4%, P = 0.001), and born in Australasia, Asia, North America, or South America (18.8% vs. 12.0%, P = 0.006). Olympic visitors constituted 1% of new clinic attendances and were less likely to be diagnosed as having a new STI (adjusted odds ratio, 0.69; 95% confidence interval, 0.48-0.98; P = 0.040)., Conclusions: In this first multisite study to examine the effect of Olympic visitors on local sexual health services, the 2012 Olympic Games was found to have minimal impact. This suggests that a "business as usual" approach would have been sufficient.

Introduction: There are few data regarding the tolerability, safety, or efficacy of antenatal atazanavir. We report our clinical experience of atazanavir use in pregnancy., Methods: A retrospective medical records review of atazanavir-exposed pregnancies in 12 London centres between 2004 and 2010., Results: There were 145 pregnancies in 135 women: 89 conceived whilst taking atazanavir-based combination antiretroviral therapy (cART), "preconception" atazanavir exposure; 27 started atazanavir-based cART as "first-line" during the pregnancy; and 29 "switched" to an atazanavir-based regimen from another cART regimen during pregnancy. Gastrointestinal intolerance requiring atazanavir cessation occurred in five pregnancies. Self-limiting, new-onset transaminitis was most common in first-line use, occurring in 11.0%. Atazanavir was commenced in five switch pregnancies in the presence of transaminitis, two of which discontinued atazanavir with persistent transaminitis. HIV-VL < 50 copies/mL was achieved in 89.3% preconception, 56.5% first-line, and 72.0% switch exposures. Singleton preterm delivery (<37 weeks) occurred in 11.7% preconception, 9.1% first-line, and 7.7% switch exposures. Four infants required phototherapy. There was one mother-to-child transmission in a poorly adherent woman., Conclusions: These data suggest that atazanavir is well tolerated and can be safely prescribed as a component of combination antiretroviral therapy in pregnancy.

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.

Objectives: To investigate psychological functioning, relationship factors, stigma perception, disclosure outcomes and regret about the disclosure decision in people being treated for anogenital warts, comparing disclosers and non-disclosers and evaluating the possible predictors of disclosure., Method: A self-completion questionnaire was completed by 54 participants recruited from a London genitourinary medicine clinic. There were 36 disclosers and 18 non-disclosers., Results: Disclosers were significantly less anxious than non-disclosers (p<0.01). Compared with non-disclosers, disclosers also rated their relationships as longer lasting (p<0.001) and closer (p<0.01). Disclosers were less likely to express regret about their disclosure decision than were non-disclosers (p<0.001). There were no significant differences between groups with regard to depression, self-esteem, expected partner response to disclosure, or sexually transmitted infection (STI)-related stigma perception, although there was a trend towards higher stigma perception in disclosers (p = 0.15). The actual partner response to disclosure was significantly more supportive than had been expected (p<0.001). A binary logistic regression model used three variables to predict disclosure status with an accuracy of 83%. Disclosers were predicted by lower anxiety levels, longer relationship duration and higher stigma perception., Conclusions: Relationship factors, in particular duration, were key predictors of partner disclosure of anogenital warts. In terms of individual characteristics, only anxiety was significantly different in disclosers and non-disclosers. Perceptions of stigma and expected outcome of disclosure were not significantly different in the two groups. Of particular relevance to those considering whether or not to disclose, partner response was significantly more supportive than disclosers expected and disclosers expressed significantly less regret about their disclosure decision than did non-disclosers.

Little research has focused specifically on disclosure among HIV+ Black Africans living in the UK; however, the available evidence suggests that this population may be reluctant to disclose to significant others. Forty-five HIV+ Black African men and women were recruited from a London HIV clinic. Semi-structured interviews gathered information on: disclosure, social support, mental and physical health, medication adherence, acculturation and the perceived prevalence of stigma. Both qualitative and quantitative analyses were conducted. The majority of the participants had disclosed to one significant other and there was an inverse association between perceived stigma and disclosure. Disclosure could not be predicted by any of the respondent characteristics identified in the study; rather, disclosure decisions were reasoned, interpersonal in nature and many of the motivations were specific to the individual. There was little evidence to suggest that those who disclosed to more than one other gained additional benefits in physical or mental well-being. Clinicians seeking to assist members of this population to disclose need to assess the specific reasons for and barriers against disclosure for that individual.

In order to determine if antiretroviral prescribing for patients with HIV infection attending the Central Middlesex Hospital is according to current UK guidelines and effective at reducing the serum HIV viral load, 71 case notes were reviewed. All patients eligible for treatment according to the British HIV Association (BHIVA) guidelines were currently being offered triple therapy. The most recent serum HIV viral loads of patients taking at least 3 antiretrovirals were undetectable in 75% of the 20 patients on their first established regimen and 36% of 14 patients who had failed at least one drug according to previous surrogate marker results. Such work allows an individual clinic to monitor its antiretroviral prescribing practices in the face of constantly updated information and guidelines.