Ellen T. Rudy

Sex on demand: geosocial networking phone apps and risk of sexually transmitted infections among a cross-sectional sample of men who have sex with men in Los Angeles county

Background Geosocial networking applications (GSN apps) used for meeting sexual partners have become increasingly popular with men who have sex with men (MSM) since 2009. The current study aimed to determine if self-identified HIV-negative, MSM clinic attendees who used GSN apps have an increased incidence of sexually transmitted infections (STI) compared to self-identified HIV-negative, MSM attendees who met sexual partners via in-person venues, such as bars or clubs or through MSM-specific hook-up websites. Methods Data were collected between August 2011 and January 2013 on all self-identified HIV-negative, MSM clients visiting the L.A. Gay & Lesbian Center for STI screening. A total of 7184 individuals tested for STIs and self-reported behaviours on drug use and social networking methods to meet sexual partners. Multivariate logistic regression models were used to analyse the results. Results Individuals who used GSN apps for meeting sexual partners had greater odds of testing positive for gonorrhoea (OR: 1.25; 95% CI 1.06 to 1.48) and for chlamydia (OR: 1.37; 95% CI 1.13 to 1.65) compared to individuals who met partners through in-person methods only. There were no significant differences in syphilis and HIV incidence between those who met partners via in-person venues only, on the internet or through GSN apps. Conclusions The present study concludes that sexual health clinic MSM attendees who are meeting on GSN apps are at greater risk for gonorrhoea and chlamydia than MSM attendees who meet in-person or on the internet. Future interventions should explore the use of these novel technologies for testing promotion, prevention and education.

HIV vaccine trial participation among ethnic minority communities: barriers, motivators, and implications for recruitment.

Background:Underrepresentation of ethnic minority communities limits the generalizability of HIV vaccine trial results. We explored perceived barriers and motivators regarding HIV vaccine trial participation among low-socioeconomic ethnic minority respondents at risk for HIV. Methods:Six focus group interviews were conducted using a semistructured interview guide. Participants (N = 58, mean age = 36 years, 37% female, and 56% Latino/a and 35% African American) were recruited using venue-based sampling in Los Angeles. Data were analyzed using narrative thematic analysis and Ethnograph qualitative software. Results:Perceived barriers to HIV vaccine trial participation, in rank order, were (1) vaccine-induced HIV infection, (2) physical side effects, (3) uncertainty about vaccine efficacy, (4) uncertainty about other vaccine characteristics, (5) mistrust, (6) low perceived HIV risk, (7) study demands, (8) stigma, and (9) vaccine-induced HIV seropositivity. Motivators were (1) protection against HIV infection, (2) free insurance and/or medical care, (3) altruism, and (4) monetary incentives. Conclusions:Population-specific HIV vaccine trial recruitment and implementation strategies should address trial risks from a family perspective, cultural gender norms, mistrust, low perceived HIV risk, the importance of African-American and Latino/a community participation in HIV vaccine trials, and misconceptions about gaining protection against HIV infection. Increasing the cultural relevance of trial recruitment and implementation should facilitate the participation of Latinos/as and African Americans in HIV vaccine trials.

Posttrial Hiv Vaccine Adoption: Concerns, Motivators, and Intentions Among Persons at Risk For Hiv

Background:Suboptimal uptake of existing vaccines, potential obstacles specific to HIV/AIDS stigma and mistrust, and marked health disparities suggest that it is vital to investigate consumer concerns, motivations, and adoption intentions regarding posttrial HIV vaccines before a vaccine is publicly available. Method:Nine focus groups were conducted with participants (n = 99; median age, 33 years; 48% female; 22% African American, 44% Latino, and 28% white) recruited from 7 high-risk venues in Los Angeles using purposive venue-based sampling. A semistructured interview guide elicited concerns, motivators, and adoption intentions regarding hypothetical U.S. Food and Drug Administration–approved HIV vaccines. Data were analyzed using narrative thematic analysis and Ethnograph qualitative software. Results:Concerns included vaccine efficacy, vaccine-induced infection, vaccine-induced HIV seropositivity, side effects, cost/access, trustworthiness, and relationship issues. Motivators included protection against HIV infection and the ability to safely engage in unprotected sex. Participants expressed reluctance to adopt partial efficacy vaccines and likelihood of increased sexual risk behaviors in response to vaccine availability. Conclusion:Tailored interventions to facilitate uptake of future U.S. Food and Drug Administration–approved HIV vaccines and to prevent risk behavior increases may be vital to the effectiveness of vaccines in controlling the AIDS pandemic.

Hepatitis A and B vaccination in a sexually transmitted disease clinic for men who have sex with men

Background Sexually transmitted disease clinics can deliver hepatitis vaccines to men who have sex with men, but have been reluctant to do so because of perceived low vaccination completion rates. Goal The goal was to evaluate hepatitis A and B vaccination eligibility, acceptance, and completion and the effectiveness of reminder/recall in a sexually transmitted disease clinic serving men who have sex with men. Design Clients self-reported their eligibility for free vaccine. Consenting clients who accepted a first dose of vaccine were systematically assigned to receive telephone reminder/recall or standard follow-up. Results Of 1203 clients, 71.8% were eligible for both vaccines; 62.6% of those eligible accepted both. Reminder/recall was associated with increased receipt of the second dose of hepatitis B vaccine (86.7% versus 80.4% among intervention and control groups, respectively), but not with completion of both vaccine series (55.9% versus 58.8%). Conclusion The majority of clients were eligible for both hepatitis vaccines, and most eligible clients accepted a first dose of both vaccines. Reminder/recall, as delivered at this clinic, failed to increase the proportion of clients who received all vaccine doses. New delivery mechanisms should be explored.

Evaluation of inSPOTLA.org: an Internet partner notification service.

Background: This article presents an evaluation of inSPOTLA.org, a sexually transmitted disease partner notification Web site in Los Angeles County primarily targeting men who have sex with men (MSM). Since its launch in 2005, this Web site has received more than 400,000 visitors and resulted in nearly 50,000 e-mail postcards sent. However, there have been limited quantitative data concerning use of the service for actual partner notification. This study investigated awareness and use of inSPOTLA among MSM, as well as the effect of an advertising campaign. Methods: Data from 2 cross-sectional surveys using time-location samples were used for the evaluation, with a baseline survey conducted in 2007 and a follow-up conducted in 2009. The advertising campaign was implemented between the surveys in 2008. Results: Awareness of inSPOTLA was 15.8% in the baseline survey and 14.4% in the follow-up survey, with no statistically significant difference. Reported use of inSPOTLA for partner notification was less than 2% in both surveys, again with no significant difference. In addition to the surveys, a high-volume sexual health clinic that serves the MSM population in Los Angeles collected data on reason for visit, including referrals from inSPOTLA, from all patients from 2007 through 2009. In 3 years, 2 individuals stated having received an inSPOTLA e-card as the reason for their visit. Conclusions: While website user statistics seemed to indicate an impressive level of use, our evaluation of inSPOTLA found very limited evidence of program effectiveness for the purpose of actual partner notification among MSM in Los Angeles County.

Methamphetamine use and other club drug use differ in relation to HIV status and risk behavior among gay and bisexual men.

This study compared associations between methamphetamine use, drug use other than methamphetamine, and HIV transmission factors among men who have sex with men, attending an sexually transmitted disease clinic. Of 6435 participants, newly recognized HIV status (OR: 3.02 95% CI: 2.30, 3.99) was associated with methamphetamine use compared with nondrug users, an association not found among other club drug users.

Community-embedded disease intervention specialist program for syphilis partner notification in a clinic serving men who have sex with men.

Background/Objectives: We evaluated the effectiveness of a Community-Embedded Disease Intervention Specialist (CEDIS) in providing partner notification (PN) for primary syphilis cases in a high STD morbidity, community-based clinic serving men who have sex with men in Los Angeles. Methods: The CEDIS was trained by the same standards as the local health department Disease Investigator Specialists but was employed by and stationed at the clinic where the primary cases were diagnosed. We compared the CEDIS on specific PN outcomes before and after placement of the CEDIS and among countywide men who have sex with men primary syphilis cases, excluding the cases from the CEDIS clinic. Results: In 2009–2010 after placement of the CEDIS, 100% (87) of primary cases assigned were interviewed; 28% (26) on the same day as their clinic visit and 64% (59) within 7 days. In 2006–2007 before placement of the CEDIS, 67% (43) of primary cases assigned were interviewed; only 2% (1) were interviewed within 7 days. In 2009–2010 countywide, 9% (21) of 252 primary cases assigned were interviewed on the same day as their clinic visit; 18% (45) within 7 days. After placement of the CEDIS, 15% (21) of 140 partners elicited were identified with early syphilis and brought to treatment compared with 0% of 13 partners elicited before placement of the CEDIS, and 15% (25) of 171 partners elicited countywide. Conclusion: The CEDIS program fosters key elements to a successful PN program, such as prompt interviewing of newly diagnosed cases and community trust.