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Opportunities to increase HIV testing among young men of color

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Opportunities to increase HIV testing among young men of color
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  NG and CT suggest that accurate TV testing may be an importantadjunct to STI screening in adolescent females. IMPLEMENTATION OF URINE TESTING FORCHLAMYDIA (CT) AND GONORRHEA (NGC) IN ACOMMUNITY CLINIC  Mariam Chacko, M.D., Courtney Barnes, B.S.,Constance Wiemann, Ph.D., and Ralph DiClemente, Ph.D. BaylorCollege of Medicine, Houston, TX; and Emory University, RollinsSchool of Public Health, Atlanta, GA. Purpose: Urine testing is assumed to be a convenient and superiortest for Chlamydia (CT) and Gonorrhea (NGC) screening. Thepurpose of this study was to compare the challenges of imple-menting urine testing with cervical testing for CT and NGCinfection in young women seeking reproductive health services ina busy community clinic. Methods:  Urine specimens for CT and NGC tested by ProbeTecStrand Displacement Amplification were collected from youngwomen enrolled in a STI behavioral intervention research study ata reproductive health care community clinic. Urine specimens (atleast 30 cc) were collected from research participants at allresearch- and clinic-related visits. For convenience, a single first-catch urine specimen was obtained in a capped plastic containerfor research and clinical (dipstick, pregnancy test) purposes.Research staff performed labeling, crosschecking and packagingof urine specimens for CT/NGC. Urine specimens not transportedthe same day were refrigerated and in transit required a preser-vative pouch. Urine specimens were transported to a local labo-ratory in a medical center hospital where specimens were pro-cessed according to manufacturer’s recommended procedures. Inyoung women who were not research participants, cervical swabspecimens were collected by clinic staff and mailed to a laboratoryin another city. All specimens were picked up by a laboratorycourier service. Results: Between May 2002 and July 2003, of 1140 urine specimensneeded from research subjects, there were no results in 112 (10%):78 (6.8%) specimens were not collected and the laboratory had noresults for 34 (3%). Of 112 urine specimens that needed to bere-obtained only 20 (18%) participants returned to provide speci-mens. Of 1028 specimens with results, 144 (14%) were positive forCT and/or NGC and interfering substances were reported in 4(0.4%). Causes for failure to collect 78 urine specimens includedcommunication problems between subjects and research assistantsin 45 (cup not given/not received/subject refused urine specimen)and communication problems between clinic personnel and re-search assistants in 33 (cups tossed/ no labels). Of 34 specimenswith no laboratory results, inadequate quantity was reported in 4,leaked container in 6, and 24 specimens were not received or couldnot be located. Plastic containers with tight metal screw capshelped to minimize spillage after the initial phase of the project. Of 1994 cervical specimens for Genprobe 4 (0.2%) specimens were notreceived by the laboratory, 14 (0.7%) were reported as unsatisfac-tory (bloody specimen, leakage) and 283/1976 (14.4%) were pos-itive for CT/NGC. Conclusions:  In contrast to cervical testing, urine tests may beconvenient, however, urine testing for CT/NGC in a busy com-munity clinic requires significant attention to collection and trans-portation issues. To improve collection and decrease recall of subjects for urine specimens, improved communication betweensubjects, research and clinical staff and attention to technicaldetails is required. ADOLESCENTS’ KNOWLEDGE ABOUT GENITAL HERPES Brenna C. LeJeune, M.S., Gregory D. Zimet, Ph.D., Matthew C. Aalsma, Ph.D., J. Dennis Fortenberry, M.D., M.A.,Susan L. Rosenthal, Ph.D., and Kenneth H. Fife, M.D., Ph.D.Department of Psychology, Indiana University Purdue UniversityIndianapolis; Departments of Pediatrics and Medicine, IndianaUniversity School of Medicine, Indianapolis, IN. Purpose:  Adolescents’ knowledge about genital herpes has not been adequately studied to date. The current study evaluatedknowledge in this population with regard to the nature, transmis-sion, treatment and morbidities of this infection. Methods: 245 adolescents were recruited via patient records from anadolescent primary health clinic. Participants ranged in age from 14to 20, 47% were female, and 79% were African-American. Eachparticipant completed a questionnaire, which included 12 true/falseitems measuring knowledge about genital herpes. Knowledge itemsaddressed the nature of the virus (including morbidity), treatment,sexual transmission, vertical transmission and the use of condoms inprotecting oneself from contracting the virus. A linear regressionmodel, which included race, gender, and grade in school, was testedinordertodeterminetherelationshipofthesedemographicvariablesto knowledge about genital herpes. Additionally, individual itemanalysis was used to identify those topics about which the adoles-cents were most and least knowledgeable. Results:  The mean knowledge score was 9.9 out of 12 (StandardDeviation    1.6). Multiple regression analysis revealed that race,gender, and grade in school were significant independent predictorsof knowledge regarding genital herpes (R 2   0.10; F    8.46). Allpredictors were significant at the  p    0.05 level. The most knowl-edgeable participants were white females who had achieved highergradelevelsinschool.Withinthesampleasawhole,thehighestratesof correct answers were in response to items concerning the fact thatgenital herpes is an STD (97% responded correctly) and that oneshould use a condom if he or she has the infection (95% respondedcorrectly). The lowest rates of correct answers were in response toitems about the fact that one can have genital herpes and not knowit (30% responded incorrectly), that the infection is recurrent innature (26% responded incorrectly), and that it can be transmittedwhen one is asymptomatic (26% responded incorrectly). In addition,only 64% of the sample knew that vertically transmitted genitalherpes can be lethal to newborns. Conclusions:  Genital herpes is a prevalent infection with signifi-cant morbidity. The current study indicates that most of theparticipants had a good basic level of knowledge about theinfection. However, more than 25% of the sample did not knowseveral important facts about genital herpes. Although African-American participants were less knowledgeable about this infec-tion, other research indicates that they are substantially morelikely to be infected. Therefore, it is especially important that thisgroup is educated about genital herpes. More education duringpre-adolescence and early adolescence on the recurrent nature of the infection and the possibility of asymptomatic transmission will be an important element in future genital herpes control efforts. OPPORTUNITIES TO INCREASE HIV TESTING AMONGYOUNG MEN OF COLOR  Jamal C. Harris, B.A., Sarah A. Stewart, M.P.H., M.Sc.,Babafemi Babawande Pratt, B.A., Michael Rich, M.D., M.P.H.,Elizabeth R. Woods, M.D., M.P.H., andCathryn L. Samples, M.D., M.P.H. Boston HAPPENS, Children’s Hospital Boston, Harvard Medical School, Boston, MA. 146  CLINICAL AND RESEARCH POSTER PRESENTATIONS JOURNAL OF ADOLESCENT HEALTH Vol. 34, No. 2  Purpose:  An estimated one fourth of HIV infected people in theUS are unaware that they are carrying the virus that causes AIDS.HIV-infected young men, especially men of color, are more likelyto be unaware of their HIV status than other populations. Aqualitative study was conducted with Black and Latino youngmen: 1) to assess knowledge and attitudes about HIV risk,treatment, testing benefits, access, and sites; 2) to explore healthcare utilization patterns, perceptions, and preferences; and 3) toexamine alternative approaches to motivate HIV testing and riskreduction counseling and/or health care utilization. Methods:  Between January and April 2003, focus groups andindividual interviews were conducted to explore HIV testingattitudes, beliefs, and behaviors among Black and Latino malesages 15–23 in Boston. Young men were eligible to participate in thestudy if they had a history of any of the following behaviors: sexwith men, recent unprotected sex with women, five or morelifetime sex partners, injection drug use or sharing needles,sexually transmitted infections, participating in commercial orsurvival sex, or sexual activity while using drugs or alcohol.Participants were identified through street outreach and partner-ships with diverse community based organizations. Interviewswere taped and two investigators independently coded the tran-scripts in NVIVO qualitative analysis software using groundedtheory to identify themes. Results:  26 young men participated in focus groups and 13 tookpart in individual interviews (N    39). 38.5% of participantsidentified as gay or bisexual and 51.3% had previously tested forHIV. Participants indicated that the personal decision to test is acomplex combination of awareness of testing, perception of per-sonal risk, opportunity to test, and understanding of the risks vs. benefits of testing. “I had intercourse with a couple girls and Ididn’t know, but it’s always safe to get it done anyway, you know,so I just got it done just for general purposes. . .” “No, I didn’tknow that they were gonna be testing until the end of it, after wewere talking about it.” In spite of infrequent interaction withhealth care providers, youth pointed out that in the appropriatesituation health care providers could facilitate their testing forHIV. “But if a doctor go and tell you, you’d be like, yeah, you gottago check this. And I’m going to listen to that doctor because heknows what he’s talking about.” Many youth, while informedabout HIV transmission, knew less about their personal need totest for HIV or the details of how to test. In addition, participantsoffered insights on how to best advise young women on approach-ing their male partners about HIV testing. Conclusion:  Young men indicate that health care providers canplay an important role in their personal decision to test for HIV.These finding suggests that interventions that increase clinician-provided HIV testing education and recommendations may in-crease rates of testing among young men of color. VAGINAL DOUCHING AND REPRODUCTIVE HEALTHPROTECTION PRACTICES OF UNIVERSITY STUDENTS  M. Kim Oh, M.D., Tina Simpson, M.D., Tina Vazin, Ph.D.,Crystal Spivey, Dr.P.H., Pernell Brown, R.N.C.,Susan Davies, Ph.D., and Karyn Scissum-Gunn, Ph.D. Univ Alabama at Birmingham; and Alabama State University, Montgomery, AL. Purpose:  To determine the characteristics of STI /pregnancyprevention methods preferred by college women, and to examinetheir reproductive health protection method use and vaginaldouching practices. Methods:  A cross sectional and confidential survey of conve-nience samples of female students was conducted in non-clinicalsettings at a Historically Black University (HBU) campus. Results:  Over a period of 4-months beginning 12/02, 222 AfricanAmerican females (18–24 years of age) participated. The mean(  SD) age was 19.7 (  1.5) years, 14% experienced at least onepregnancy, 14% never had sex, none were married but 7% werecohabiting. A majority expressed high levels of concerns forcontracting chlamydia, gonorrhea, genital herpes (60% respec-tively) and HIV (78%).One or more types of birth control methods were used by 80%of participants (91% of sexually experienced and 9% of those whohad never had sexual intercourse): male condoms by 74%, oralcontraceptive pills 32%, injectable hormones 19%, topical vaginalmethods 8%, female condoms 6%, contraceptive patch 6%, emer-gency contraceptive 5%, and diaphragm 1%. The characteristics of a hypothetical new preventive method preferred by the partici-pants included: being effective against both pregnancy and STD/HIV (92%), a female controlled method (84%), oral administration(81%), available without prescription (77%), douche-like adminis-tration (56%), and undetectable by sex partner (54%). A hx of douching was reported by 54%. Of those who douched, 89% didso within the previous 3 months, with the last douching, medianof 15 days ago; 62% douched monthly or more often. 78% knewsomeone who douches regularly, 96% had seen a TV commercialpromoting douching products, and 19% had been asked aboutdouching by a partner. 24% believed that douching preventsinfections and 39% thought that some women believe douchingprevents pregnancy. 44% douched after menstrual period, 16%after sex, and 10% before going to a doctor. Significant correlatesof vaginal douching were a belief that douching prevents STD(  p    .002), being sexually active (  p    .002), use of a BC method(  p    .002), cohabiting (  p    .02) and having been asked aboutdouching by a partner (  p    .03). Those who believed douchingkills germs and prevents infections were more likely to doucheafter sex (  p    .02) and to douche to get rid of vaginal symptoms(  p  .04). Conclusions:  Many HBU female students participating in ourstudy expressed a high level of concern for HIV/STD acquisition,and many have used a variety of currently available products forprotection. Over one half of the participating students reporteduse of vaginal douching, and many seem to have false beliefsregarding the benefits of douching. Though 84% indicated that afemale controlled method is important to them, only 6% have everused female condoms (available free at the student health center).This study highlights needs for reproductive health education forsuch students as our participants, providing facts about adverseeffects of douching, addressing myths on vaginal douching andpromoting female condom use. PELVIC INFLAMMATORY DISEASE IN ADOLESCENTS:HIGH INCIDENCE AND RECURRENCE RATES IN ANURBAN TEEN CLINIC — A NEED FOR BETTERATTENTION TO PARTNER TREATMENT?  Amy M. Kelly, M.D., Marjorie Ireland, Ph.D., andDavid Aughey, M.D. Division of General Pediatrics and Adolescent Health, University of Minnesota; and Children’s Hospitals andClinics, Minneapolis, MN. Purpose:  To determine pelvic inflammatory disease (PID) inci-dence and recurrence rates in an urban teen clinic, and toinvestigate the role of partner treatment in recurrent PID.February 2004 CLINICAL AND RESEARCH POSTER PRESENTATIONS  147
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