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Background Sexually transmitted infections (STIs) and bacterial vaginosis (BV) are associated with increased transmission of HIV, and poor reproductive and sexual health. The burden of STIs/BV among young people is unknown in many high HIV prevalence settings. We conducted an acceptability, feasibility, and prevalence study of home-based sampling for STIs/BV among young men and women aged 15-24 years old in a health and demographic surveillance site (HDSS) in rural KwaZulu-Natal, South Africa. Methods and findings A total of 1,342 young people, stratified by age (15-19 and 20-24 years) and sex were selected from the HDSS sampling frame; 1,171/1,342 (87%) individuals had [greater than or equal to]1 attempted home visit between 4 October 2016 and 31 January 2017, of whom 790 (67%) were successfully contacted. Among the 645 who were contacted and eligible, 447 (69%) enrolled. Consenting/assenting participants were interviewed, and blood, self-collected urine (men), and vaginal swabs (women) were tested for herpes simplex virus type 2 (HSV-2), chlamydia, gonorrhoea, syphilis, trichomoniasis, and BV. Both men and women reported that sample collection was easy. Participants disagreed that sampling was painful; more than half of the participants disagreed that they felt anxious or embarrassed. The weighted prevalence of STIs/BV among men and women, respectively, was 5.3% and 11.2% for chlamydia, 1.5% and 1.8% for gonorrhoea, 0% and 0.4% for active syphilis, 0.6% and 4.6% for trichomoniasis, 16.8% and 28.7% for HSV-2, and 42.1% for BV (women only). Of the women with [greater than or equal to]1 curable STI, 75% reported no symptoms. Factors associated with STIs/BV included having older age, being female, and not being in school or working. Among those who participated in the 2016 HIV serosurvey, the prevalence of HIV was 5.6% among men and 19% among women. Feasibility was impacted by the short study duration and the difficulty finding men at home. Conclusions A high prevalence of STIs/BV was found in this rural setting with high HIV prevalence in South Africa. Most STIs and HIV infections were asymptomatic and would not have been identified or treated under national syndromic management guidelines. A nested STI/BV survey within a HDSS proved acceptable and feasible. This is a proof of concept for population-based STI surveillance in low- and middle-income countries that could be utilised in the evaluation of STI/HIV prevention and control programmes., Author(s): Suzanna C. Francis 1,*, T. Nondumiso Mthiyane 2, Kathy Baisley 1,2, S. Lerato Mchunu 2, Jane B. Ferguson 2,3, Theresa Smit 2, Tania Crucitti 4, Dickman Gareta 2, Siphephelo [...]

The prevalence of sexually transmitted infections in China has increased dramatically over the last 20 years, and heterosexual transmission is rapidly becoming the primary route of HIV transmission. Despite this growing epidemic, little is known about the correlates of sexual behavior in young Chinese women. The objective of this study was to assess family and peer factors related to sexual behavior in Chinese female college students, anonymously completed questionnaires were received from 4, 769 unmarried female college students, recruited using randomized cluster sampling by type of university and students' major and grade. Items captured socio-demographic, family, and peer factors. To examine factors associated with sexual behavior, multiple logistic regression was used, yielding odds ratios and 95% confidence intervals. Over 18% of female students participating reported ever having sexual intercourse, of whom 31.52% had their first sexual intercourse at the age of 18 or younger with more than 50% at an age less than 20 years. Several socio-demographic, family, and peer factors were associated with ever having intercourse. Those more likely to engage in premarital sex were older; majored in art; were from one-child, richer and/or divorced families; had a mother with university or above education; had parents with a strict disciplinary. style;, had middle-school close friends falling in love; and had current close friends living with boyfriends. Interventions to protect young women from sexually transmitted diseases need to target early sex education and address peer and parents influences. KEYWORDS sexual behavior, China, women, students, peer group DOI: 10.1080/03630242.2010.530926

Recent data suggest that the prevalence of HIV/syphilis infections among men who have sex with men (MSM) in China increased rapidly. This cohort study was to assess the correlates of the incident infections for HIV, syphilis, and hepatitis B virus (HBV) among sexually active and HIV--negative MSM in China. A cohort of 507 HIV-seronegative MSM was recruited from November 2006 to February 2007. Sociodemographics, sexual and drug use behaviors, uptake of HIV-prevention services, and HIV, syphilis, and HBV seroconversions were assessed at 6- and 12- month follow-up. The incidence rates were 2.6 per 100 person-years for HIV, 16.9 per 100 person-years for syphilis, and 3.3 per 100 person-years for HBV. Multivariate Cox regression analyses showed that syphilis infection (hazard ratio [HR] = 3.6; 95% confidence interval [CI]: 1.1-11.6) and no perceived risk of HIV infection (HR = 6.0; 95% CI: 1.6-22.7) were independently associated with HIV seroconversion. Predictors for syphilis seroconversion included less education (HR = 1.87; 95% CI: 1.1-3.3), found male sex partners through bathhouses/public washrooms/parks (HR = 2.19; 95% CI: 1.2-4.0), drank alcohol 4 or more times monthly (HR = 1.95; 95% CI: 1.1-3.6), and had sexually transmitted diseases (HR = 2.65; 95% CI: 1.5-4.5). The only predictor for incident HBV seroconvension was having more male sex partners in the past 3 months (HR = 11.8; 95% CI: 1.5-90.4). Alarmingly high incidence rates of HIV, syphilis, and HBV were found among MSM concurrently with high prevalent risky behaviors and low uptakes of health care services. The findings of this study underscore the urgent needs for a comprehensive intervention strategy to curtail the rapid spread of HIV, syphilis, and HBV. DOI: 10.1089/apc.2010.0083

In the third decade of HIV/AIDS in the U.S., African American gay and bisexual men constitute the largest growing part of those testing HIV-positive. Education and prevention efforts are being refocused on this population, but there has been a dearth of research on health promotion efforts specifically tailored for this marginalized group. This project examines HIV prevention media campaigns targeting African American gay and bisexual men through a content analysis and a cultural-critical approach. The researchers found that, among 40 social marketing campaigns, the primary tactics were educational and fear-based to promote HIV-related messaging to African American gay and bisexual men. Keywords: African American; Gay and Bisexual Men; HIV Prevention; Social Marketing DOI: 10.1080/03634521003606202

World War II created a large group of persecuted, homeless or stateless people who came to be united under the term 'displaced persons' (DPs). The United Nations Relief and Rehabilitation Administration (UNRRA) was charged with the care of these individuals in various camps in Germany, although the military governments of the respective zones of occupation had ultimate authority over them. Among the various public health efforts directed toward DPs was a campaign against venereal disease during which compulsory examinations were particularly stressed by the military governments. The controversy resulting from this campaign opens a new window on the complex context of an international organization working under the roof of a national authority to achieve common--or differing--public health goals. (Am J Public Health. 2010;100:993-1003. doi: 10.2105/AJPH.2008.153098.)

Objectives. We sought to determine the association of social-environmental factors with condom use and sexually transmitted infections (STIs) among 420 sex workers participating in an STI/HIV prevention study in Corumba, Brazil, to inform future intervention efforts. Methods. Participants provided urine samples for polymerase chain reaction testing of chlamydia and gonorrhea and responded to multi-item scales addressing perceived social cohesion, participation in networks, and access to and management of resources. We conducted multivariate log-linear and negative binomial regression analyses of these data. Results. Increased social cohesion was inversely associated with number of unprotected sex acts in the preceding week among women (adjusted incidence rate ratio [IRR]=0.80; P Conclusions. The social context within which populations negotiate sexual behaviors is associated with condom use. Future efforts to prevent STI/HIV should incorporate strategies to modify the social environment. (Am J Public Health. 2010;100:S216-S223. doi: 10.2105/AJPH.2008.147462)

The objective of this research was to determine the factors associated with disclosure of three treatable sexually transmitted diseases (STDs). Data were obtained from two intervention trials to determine the ideal means of partner referral. Men diagnosed with urethritis and women diagnosed with trichomoniasis at public clinics in New Orleans, Louisiana were randomly assigned to partner referral (PR), booklet-enhanced partner referral (BEPR), or patient-delivered partner treatment (PDPT). Participants were asked about sex partners at baseline, then whether they disclosed to them at follow-up. The male trial was conducted from December 2001 to March 2004 and the female trial from December 2001 to August 2004. Data on men and women were analyzed separately. Nine hundred seventy-seven men and 463 women--reporting information on 1991 and 521 sex partners--were respectively enrolled in each trial. Disclosure occurred to 57.8% and 87.3% of their partners, respectively. Most men (68.3%) reported having two or more partners and disclosure was more likely to occur in: those who reported only one sex partner (adjusted odds ratio [aOR] 95% confidence interval [CI]: 1.54 [1.10, 2.16]); those in steady relationships (OR [95% CI]: 1.37 [1.08,1.74]); and those assigned PDPT [OR [95% CI]: 2.71 [1.93,3.82]). Most women reported having only one partner (86.8%) and disclosure was more likely to occur in steady relationships (OR [95% CI]: 2.65 [1.24,5.66]), and when sex was reinitiated with partners during the follow-up period (OR [95% CI]: 3.30 [1.54,7.09]). The provision of PDPT was associated with increased STD disclosure among men but not among women. Both men and women were less likely to disclose to casual partners. Women had high rates of disclosure irrespective of intervention arm. DOI: 10.1089/apc.2009.0237

Testing for HIV and other sexually transmitted diseases (STD) remains a cornerstone of public health prevention interventions. This analysis was designed to explore the frequency of testing, as well as health system and personal barriers to testing, among a community-recruited sample of Black men who have sex with men (MSM) at risk for HIV and STDs. Black MSM (n = 197) recruited via modified respondent-driven sampling between January and July 2008 completed an interviewer-administered assessment, with optional voluntary HIV counseling and testing. Logistic regression procedures examined factors associated with not having tested in the 2 years prior to study enrollment for: (1) HIV (among HIV-uninfected participants, n = 145) and (2) STDs (among the entire mixed serostatus sample, n = 197). The odds ratios and their 95% confidence intervals obtained from this analysis were converted to relative risks. (1) HIV: Overall, 33% of HIV-uninfected Black MSM had not been tested for HIV in the 2 years prior to study enrollment. Factors uniquely associated with not having a recent HIV test included: being less educated; engaging in serodiscordant unprotected sex; and never having been HIV tested at a community health clinic, STD clinic, or jail. (2) STDs: Sixty percent had not been tested for STDs in the 2 years prior to study enrollment, and 24% of the sample had never been tested for STDs. Factors uniquely associated with not having a recent STD test included: older age; having had a prior STD; and never having been tested at an emergency department or urgent care clinic. Overlapping factors associated with both not having had a recent HIV or STD test included: substance use during sex; feeling that using a condom during sex is 'very difficult'; less frequent contact with other MSM; not visiting a health care provider (HCP) in the past 12 months; having a HCP not recommend HIV or STD testing at their last visit; not having a primary care provider (PCP); current PCP never recommending they get tested for HIV of STDs. In multivariable models adjusting for relevant demographic and behavioral factors, Black MSM who reported that a HCP recommended getting an HIV test (adjusted relative risk [ARR] = 0.26; p = 0.01) or STD test (ARR = 0.11; p = 0.0004) at their last visit in the past 12 months were significantly less likely to have not been tested for HIV or STDs in the past 2 years. Many sexually active Black MSM do not regularly test for HIV or STDs. HCPs play a pivotal role in encouraging testing for Black MSM. Additional provider training is warranted to educate HCPs about the specific health care needs of Black MSM, in order to facilitate access to timely, culturally competent HIV and STD testing and treatment services for this population. DOI: 10.1089/apc.2009.0086

There is a need to involve sexual partners when addressing sexual behavior of high-risk adolescent women. This study explored men's perceptions of their role in sexual relationships with adolescent women with a history of sexually transmitted infection (STI) and abuse. The AIDS risk reduction model was used to assess sexual risk behaviors of these men for development of cognitive behavioral risk reduction interventions for themselves and partner. Qualitative interviews were conducted with African and Mexican American men (n = 14; ages 18 to 21 years), recruited via adolescent women enrolled in a control-randomized trial of behavioral interventions for reduction of unintended pregnancy, abuse, substance use, and STI. Participants varied in their perceptions of personal susceptibility to STI or HIV, access to informational resources regarding sexual behavior, and level of adult support for safer sexual behavior. These men shared perceptions of inadequate sexual health preparation, including education concerning risk, ultimately contributing to adverse outcomes of sexual behavior. Keywords: mental health; sexuality; health behavior, qualitative methods; adolescence

I examined sociodemographic, sexual, and HIV and other sexually transmitted disease risk differences among homosexual-and nonhomosexual-identified men who have sex with men (MSM) in the United States. Non-Mexican Latino ethnicity, marriage or cohabitation, religiosity, and incarceration history were positively associated with being nonhomosexual identified. Being nonhomosexual identified was associated with some risk (e.g., more sexual intercourse while intoxicated) and protective (e.g., fewer male partners) behaviors. Probabilistic sampling strategies may be useful in future research and intervention efforts. doi: 10.2105/AJPH.2007.125674)

Objectives. We examined the interactive effects of fear of abuse and knowledge of sexually transmitted infections (STIs) on sexual risk behaviors in a sample of young African American women. Methods. We recruited 715 young African American women aged 15 to 21 years from a variety of health clinics and assessed them for fear of abuse because of negotiating condom use, knowledge of STIs, and several sexual risk behaviors. Results. Overall, 75% of young African American women reported inconsistent condom use in the past 60 days. :Surprisingly, under relatively higher levels of fear, young women with high STI knowledge were more likely than were those with low STI knowledge to exhibit inconsistent condom use in the past 60 days (89% vs 80%; [chi square] = 4.32; P [less than or equal to] .04) and during the last sexual intercourse with a main sexual partner (76% vs 70%; [chi square] = 8.06; P [less than or equal to] .01). Conclusions. Most HIV prevention interventions focus on increasing knowledge about the transmission of STIs. However, other contextual factors such as fear of abuse because of negotiating condom use may heighten the risk of HIV infection. Our findings highlight the need for combining dating violence prevention activities with STI and HIV prevention programs targeting young African American women. doi: 10.2105/AJPH.2007.131482)

We interviewed 1038 HIV-positive inpatients in public hospitals in Miami, Florida, and Atlanta, Georgia, to examine patient factors associated with use of HIV care, use of antiretroviral therapy, and unprotected sexual intercourse. Multivariate analyses and multiple logistic regression models showed that use of crack cocaine and heavy drinking were associated with never having had an HIV-care provider, high-risk sexual behavior, and not receiving antiretroviral therapy. Inpatient interventions that link and retain HIV-positive persons in primary care services could prevent HIV transmission and unnecessary hospitalizations. doi:10.2105/AJPH.2008.139931)

HIV continues to be transmitted at unacceptably high rates among African Americans, and most HIV-prevention interventions have focused on behavioral change. To theorize additional approaches to HIV prevention among African Americans, we discuss how sexual networks and drug-injection networks are as important as behavior for HIV transmission. We also describe how higher-order social structures and processes, such as residential racial segregation and racialized policing, may help shape risk networks and behaviors. We then discuss 3 themes in African American culture--survival, propriety, and struggle--that also help shape networks and behaviors. Finally, we conclude with a discussion of how these perspectives might help reduce HIV transmission among African Americans. doi:10.2105/AJPH.2008.140327)

Few HIV prevention interventions have been developed for African American men who have sex with men or who have sex with both men and women. Many interventions neglect the historical, structural or institutional, and sociocultural factors that hinder or support risk reduction in this high-risk group. We examined ways to incorporate these factors into Men of African American Legacy Empowering Self, a culturally congruent HIV intervention targeting African American men who have sex with men and women. We also studied how to apply key elements from successful interventions to future efforts. These elements include having gender specificity, a target population, a theoretical foundation, cultural and historical congruence, skill-building components, and well-defined goals. doi:10.2105/AJ PH.2008.140558)

The HIV/AIDS epidemic has exacted a devastating toll upon Black men who have sex with men (MSM) in the United States, and there is a tremendous need to escalate HIV-prevention efforts for this population. The social context in which Black MSM experience the impact of racism and heterosexism strongly affects their risk for HIV infection; thus, HIV-prevention research focused on Black MSM should focus on contextual and structural factors. There is a pronounced lack of community-level HIV-intervention research for Black MSM, but effective preliminary strategies involve adapting existing effective models and tailoring them to the needs of Black MSM. Future research should develop new, innovative approaches, especially structural interventions, that are specifically targeted toward HIV prevention among Black MSM. doi:10.2105/AJPH.2008.143214)

Studies of detained and incarcerated adolescent offenders in the United States indicate that these juveniles have an elevated risk of sexually transmitted diseases (STDs). However, many more arrestees enter the 'front end' of the juvenile justice system than are detained or incarcerated, and research into the STD risk profiles and service needs of this larger group is lacking. An expansion of STD testing (including of asymptomatic youths), prevention, and treatment is needed, as is improved knowledge about gender-and race-specific services. A pilot program in Florida has shown that juvenile justice and public health systems can collaborate to implement STD testing among new arrestees. With integrated linkages to treatment and prevention after release, this model could greatly reduce the STD burden in this underserved, high-risk population. doi:10.2105/AJPH.2007.122937)

African American women continue to be disproportionately affected by the HIV/ AIDS epidemic, yet there are few effective HIV prevention interventions that are exclusively tailored to their lives and that address their risk factors. Using an ecological framework, we offer a comprehensive overview of the risk factors that are driving the HIV/ AIDS epidemic among African American women and explicate the consequences of ignoring these factors in HIV prevention strategies. We also recommend ways to improve HIV prevention programs by taking into consideration the unique life experiences of adult African American women. doi:10.2105/AJPH.2008.140541)

Although gender-specific theories are often deployed in interventions to reduce women's HIV risks, the same is often not true for interventions among men. Theories of masculinity are not guiding most US research on the risky sexual behavior of heterosexual men or on what can be done to intervene. We first assess the extent to which evidence-based HIV-prevention interventions among heterosexually active men in the United States draw upon relevant theories of masculinity. Next, we introduce a useful framework within masculinity and gender studies that can be applied to HIV-prevention interventions with heterosexually active men. Finally, we make suggestions to improve the gender specificity of HIV-prevention interventions for heterosexually active men in the United States. doi:10.2105/AJPH.2008.149625)

Black men 'on the down low' have been considered prime agents of HIV transmission in the Black community despite little empirical evidence. We assessed the relationship between down-low identification and sexual risk outcomes among 1151 Black MSM. Down-low Identification was not associated with unprotected anal or vaginal sex with male or female partners. Future HIV prevention programs and research should target sexual risk behaviors of Black men, irrespective of identity, and not focus on the 'down low.' (doi:10.2105/AJPH.2007.127217)

Many HIV/AIDS and substance abuse prevention studies in American Indian and Alaska Native communities have been directed by academic researchers with little community input. We examined the challenges in conducting HIV/ AIDS-related research in American Indian and Alaska Native communities and the benefits of changing the research paradigm to a community-based participatory model. The lessons we learned illustrate that the research process should be a cyclical one with continual involvement by community members. Steps in the process include (1) building and sustaining collaborative relationships, (2) planning the program together, (3) implementing and evaluating the program in culturally acceptable ways, and (4) disseminating research findings from a tribal perspective. These steps can enhance the long-term capacity of the community to conduct HIV/ AIDS and substance abuse prevention research. (doi:10.2105/AJPH.2008.134585)

This study examined the association between sexual relationship power, intimate partner violence, and condom use among African American and Hispanic urban girls. In this sample of 56 sexually active girls, 50% did not use condoms consistently and therefore were at higher risk for acquiring HIV or sexually transmitted diseases (STDs). Teens who experienced more intimate partner violence had a significantly higher likelihood of inconsistent condom use and therefore a greater risk for HIV/STDs. Girls' sense of sexual control in their relationships was not directly associated with inconsistent condom use but was inversely related to verbal and emotional abuse. Interventions aimed at reducing HIV/STD risk for adolescent girls need to address patterns of dominance and control in adolescent relationships as well as multiple forms of partner violence. This suggests the need for multilevel intervention approaches that promote girls' agency and multiple ways to keep girls safe from perpetrators of partner abuse. Keywords: adolescents; prevention; condom use; partner abuse; relationship power: intimate partner violence

Our objective was to describe the basic epidemiology of sexually transmitted infections for Arctic and sub-Arctic regions of North America. We summarized published and unpublished rates of chlamydial infection and [...]

This paper employs syndemics theory to explain high rates of sexually transmitted disease among inner city African American and Puerto Rican heterosexual young adults in Hartford, CT, USA. Syndemic theory helps to elucidate the tendency for multiple co-terminus and interacting epidemics to develop under conditions of health and social disparity. Based on enhanced focus group and in-depth interview data, the paper argues that respondents employed a cultural logic of risk assessment which put them at high risk for STD infection. This cultural logic was shaped by their experiences of growing up in the inner city which included: coming of age in an impoverished family, living in a broken home, experiencing domestic violence, limited expectations of the future, limited exposure to positive role models, lack of expectation of the dependency of others, and fear of intimacy. Keywords: Syndemics; Sexually transmitted diseases; Young adults; African American; Puerto Rican; Political economy

New methods are now available, and others are being developed, that could enable women to take the initiative in preventing sexually transmitted infections. However, attempts to capitalize on 'female-controlled' preventive methods thus far have met with limited success. Female-initiated methods were introduced to intervene in the state of gender relations and assist women who are disempowered vis-a-vis their male partners. Paradoxically, however, we underscore that it is the very structure of regional and local gender relations that shapes the acceptability (or lack of acceptability) of these methods. This paper specifically addresses how the structure of gender relations--for better and for worse shapes the promises and limitations of widespread use and acceptance of female-initiated methods. We draw on examples from around the world to underscore how the regional specificities of gender (in)equality shape the acceptance, negotiation, and use of these methods. Simultaneously, we demonstrate how the introduction and sustained use of methods are shaped by gender relations and offer possibilities for reinforcing or challenging their current state. Based on our analyses, we offer key policy and programmatic recommendations to increase promotion and effective use of women-initiated HIV/STI protection methods for both women and men. Keywords: Female-initiated barrier methods; Gender relations and roles; Female condom; Microbicides; Diaphragm; HIV/STI prevention

Data from a convenience sample of 476 detained adolescents were used to examine the relationship between family influences and biologically confirmed sexually transmitted diseases (STDs). Results indicated that frequent parental monitoring was negatively associated with STD infection and that this relationship was modified by age, gender, and race. Findings suggest that STD prevention efforts for detained adolescents (particularly high-risk minority females older than age 16) might focus on increasing monitoring by a parent or parental figure. Keywords: adolescents, detainees, STDs, family influences

A cross-sectional study was conducted on 200 commercial sex workers (CSWs) from two brothel communities in Central Java, Indonesia, to determine the seroprevalence of syphilis and HIV and characterize associated knowledge, beliefs, and risk-taking behaviors. A questionnaire was administered and blood drawn for HIV and syphilis serologies. Focus groups with a total of 20 women were also conducted at both communities to supplement survey data. The mean CSW age was 27.3 years; mean number of clients seen per day was 2.27. The prevalence of syphilis and HIV were 7.5% and 0.5%, respectively. Thirty percent said they and their partners never used condoms during sex, and only 3.0% said they always used condoms. The most common client groups were truck drivers and sailors. While Central Java appears to remain in a pre-epidemic state, there is enormous potential for a significant increase in HIV and STD transmission.

This study examines the subjective side of vulnerability as a social construct rooted in interpersonal relationships and community membership. Analysis is based on a survey of an especially diverse sample of 162 lesbian women, 67 of whom also participated in depth interviews. Another 24 of the original sample also participated in transcribed focus groups. One third were African American, Latina, and Asian, and two thirds were white. This sample reported an overall infection rate of 23%. Three subjective stances, or risk frames, are identified: essentially invulnerable, socially inoculated, and fundamentally vulnerable. Some women describe shifts in their interpretations of their own vulnerability, moving from one stance to another in response to obtaining information, becoming infected, having friends or acquaintances who become infected, and becoming involved with new partners. It is suggested that these shifts comprise a subjective 'vulnerability career'. The significance of lesbian women's constructions of vulnerability is examined, and the implications of this study for a better understanding of their risk for STIs are discussed. Keywords: Lesbian risk; STIs; HIV; USA

Scant population-based U.S. data exist on socioeconomic gradients in sexually transmitted infections (STIs), tuberculosis (TB), and violence, given an absence of socioeconomic data in the public health surveillance systems for […]

Objectives. We examined differences in HIV seroprevalence and the likely timing of HIV infection by birth region. Methods. We analyzed unlinked HIV antibody data on 61120 specimens from 7 public health centers in Los Angeles County from 1993 to 1999. Results. Most (87%) immigrant clients were Central American/Mexican-born. HIV prevalence was similar for US- and foreign-born clients (1.8% [95% confidence interval (CI)=1.7%, 1.9%] and 1.6% [95% CI = 1.5%, 1.8%], respectively). Seroprevalence was high among sub-Saharan African females and low among Asian/Pacific Islander males and females. For HIV-positive immigrants, the average age at and time since immigration were 20.6 years and 12.3 years, respectively. Conclusions. The relatively young age at arrival and long time since arrival for HIV-positive foreign-born clients suggest that most were infected after immigration.