J D Fortenberry

Vaccine characteristics and acceptability of HIV immunization among adolescents

HIV immunization programmes will only be effective if sufficient numbers of persons accept the vaccine. Our aims were to evaluate HIV vaccine acceptability among adolescents and to examine how vaccine characteristics influence acceptability. We recruited 661 adolescents from community health clinics in Indianapolis, Indiana, USA to complete either written or computerized questionnaires, both of which assessed HIV vaccine acceptability as a function of efficacy, cost, type of vaccine, mode of delivery, and parental permission for immunization (required or not required). For both the written and computer methods, efficacy had the strongest effect on acceptability, followed by type of vaccine and cost. Low efficacy, high cost, and live-attenuated vaccines were associated with lower acceptability. These findings suggest that as efforts to develop HIV vaccines continue, it will be important, in parallel, to anticipate potential obstacles to vaccine acceptance, including the belief that a less efficacious HIV vaccine is unacceptable.

Field collection of rectal samples for sexually transmitted infection diagnostics among men who have sex with men

Summary Rectal sexually transmitted infections (STIs) are common in men at risk for urethral infections with these pathogens, particularly men who have sex with men (MSM). However, for those individuals not regularly seen by a clinician, screening for rectal STI is not currently a widespread option. Qualitative data and samples (i.e. self-obtained rectal specimens) were collected from 75 MSM in a variety of venues. Upon completion of the rectal self-sampling, each participant completed a brief interview regarding their overall experience with the process. Participants reported an overall high level of acceptability and comfort-level involved with self-sampling for rectal STI. Of the majority of men who agreed to provide a rectal self-sample, all reported that they would provide a sample again in the future. However, many men also appreciated the interaction with a health-care provider that a clinical setting offered. In conclusion, self-sampling is a feasible and acceptable option when offered to MSM in a range of community-based venues. Further research is needed to determine which combinations of STI testing and treatment methods (including self-sampling) are most appropriate for diverse groups of men.

Association of Chlamydia trachomatis Infection With Redetection of Human Papillomavirus After Apparent Clearance

BACKGROUND Persistent infection with oncogenic human papillomavirus (HPV) is associated with an increased risk of cervical malignancy. Redetection of type-specific HPV after a period of nondetection may be caused by reactivation of a low-level persistent infection. Little is known about factors associated with type-specific HPV redetection. METHODS For a longitudinal cohort of adolescent women with frequent behavioral and sexually transmitted infection (STI) information (every 3 months), Cox proportional hazard models were used to assess the influence of sexual behaviors and STIs on the redetection of oncogenic or high-risk HPV infections. RESULTS A total of 210 type-specific high-risk HPV detection episode periods were identified in this longitudinal cohort; 71 (33.8%) were characterized by a period of nondetection followed by redetection. Chlamydia trachomatis (hazard ratio [HR], 3.14; 95% confidence interval [CI], 1.44-6.86) was associated with redetection; redetection was >2 times more likely with each additional self-reported sex partner in the past 3 months (HR, 2.26; 95% CI, 1.35-3.78). CONCLUSIONS This study demonstrates the role of C. trachomatis and number of recent sexual partners in type-specific HPV redetection. Given that persistent oncogenic HPV infections are associated with cancer-related outcomes, understanding the potential role of such factors in the pathogenesis of HPV-related outcomes is important.

DNA detection and seroprevalence of human papillomavirus in a cohort of adolescent women.

Objectives Human papillomavirus (HPV) infections are common in adolescent women, while the rare cancerous sequelae of HPV infections do not generally occur until the 4th or 5th decades of life. This prospective study of a cohort of adolescent women was performed to further our knowledge of the natural history of incident and prevalent HPV infections. Methods Self-vaginal swabs collected from high-risk, unvaccinated adolescent women in a longitudinal study were analysed for HPV DNA. Sera were collected at enrolment and later tested for HPV antibodies. Statistical analysis was performed to determine the HPV genotype distribution and duration of detection, and to determine rates of seropositivity and seroconversion for HPV types represented in the assays. Results 146 subjects (mean enrolment age=15.4 years; mean duration of follow-up=5.8 years) had samples adequate for analysis of HPV detection, and 95 of these subjects had paired sera available. The cumulative prevalence for high-risk and low-risk HPV types was 95.9% and 91.1%, respectively. HPV types 6, 11, 16 and 18 (HPV types represented in the quadrivalent vaccine) were found at some point in 40.4%, 6.2%, 48% and 24% of participants, respectively. Serological data confirmed exposure to these vaccine-covered types, as well as to other high-risk HPV types. Conclusions In this cohort of adolescent women, high- and low-risk HPV types were frequently detected, and serological data confirmed exposure in most subjects. The high-prevalence HPV types represented in the quadrivalent HPV vaccine further support vaccination of women at an age well before sexual debut.

A longitudinal daily diary analysis of condom use during bleeding-associated vaginal sex among adolescent females

Objective Sex during bleeding is a risk factor for sexually transmitted infection (STI) and other bloodborne viruses, including HIV. We examined daily predictors of adolescent womens male condom use during bleeding-associated vaginal sex. Methods Adolescent females (N=387; 14–17 years) were recruited from primary care clinics for a longitudinal cohort study of STIs and sexual behaviour. Data were daily partner-specific sexual diaries; generalised estimating equation logistic regression assessed the likelihood of condom use during bleeding-associated vaginal sex. Results Less than 30% of bleeding-associated vaginal sex events were condom protected. Condom use during these events was less likely with younger age, higher partner support, higher partner negativity or past week bleeding-associated sex with a given partner; condom use was more likely with high individual mood and past week condom use during bleeding-associated vaginal sex with a given partner. Conclusions Low condom rates during bleeding-associated vaginal sex can increase STI and bloodborne virus risk. Providers should consider integrating partner-specific and behavioural factors when they deliver sexual health messages to young women.

YI.1 Condom Use & Pleasure in a Sample of YMSM: A Conceptual Framework

Purpose Little research addresses sexual pleasure in young men who have sex with men (YMSM). In this qualitative study, we developed a sexual health focused conceptual framework to explore relationships that emerged between condom use and sexual pleasure in sexual relationships among a sample of gay, bisexual, and transgender males. Methods 30 YMSM (ages 18–24 years) were recruited (through advertisements on social networking sites, participant referrals, and flyers posted at local venues frequented by YMSM) to complete a 90-minute, semi-structured interview seeking to better understand partner-seeking behaviours of YMSM. Interviews were transcribed verbatim. Analysis used inductive open coding such that emergent concepts were connected across interviews and major themes identified. Results Median age was 22 years old (M = 21.96; SD = 1.75). Most (N = 18, 60%) of participants self-identified as White, and gay (N = 22, 73%). Over 90% (N = 28) reported having had sex with someone met on a dating website in the past 3 months. Five (17%) participants reported being HIV-positive and 12 (40%) reported a prior history of a sexually transmitted infection. Emotional effects (such as connectedness with others) and physical effects (loss of sensation and erectile difficulties) mediated the relationship between pleasure and condom use during insertive penile-anal intercourse. Specific characteristics of sexual events (e.g., use of lubricant), relationship with the partner, and of the specific sex act (including sexual position) moderated the relationship, with pleasure and satisfaction greater during receptive anal sex without a condom with emotionally intimate or regular partners. Conclusion s Our findings suggest that relationship between sexual pleasure and condom use may be mediated by both emotional and sexual factors. Prevention work with YMSM need to acknowledge the centrality of pleasure in sexual health and focus on modifiable factors that may impact pleasure among YMSM.

P3.031 Condom Use as a Function of New Young Adult Relationship Duration

Objective To find out how condom use in new relationships changes as a function of time, gender, as well as sexual and relationship satisfaction. Method Participants in a larger study who reported at least one new partner during the 12-week study interval (N = 115; 18–29 yrs; 48% women; 75% African American) completed weekly STI testing and 3x/day electronic diary collection assessing individual and partner-specific affect, daily activities, sexual behaviour and condom use. We analysed event-level condom use percentage and subject-level behaviour response effects. Generalized Additive Mixed Models (GAMMs) were used to estimate condom use probability accounting for within-subject and within-nested-partners correlations via random effects. Results The average initial condom use in the new relationships was 62% for men and 46% for women. The plotted smooth shapes of the estimated condom use probabilities fitted using GAMMs were qualitatively similar for both sexes throughout the study period. The initial high condom use percentage was followed by a sharp decline during the first 1.5 weeks to 19% for men and 14% for women. The condom use rates stabilised at around 6% after 4 weeks in a new relationship. Women who reported high levels of relationship satisfaction exhibited marginally significant negative association with condom use probability (p-value = 0.055). Sex satisfaction was not significantly associated with condom use when both the time trends and gender were taken into account. Conclusion Condom use declines sharply for both males and females during the early stages of new relationships. Men use condoms more frequently than women in the early and middle stages of relationships. Relationship characteristics may also influence lower levels of condom use, especially among women.

P3.081 Time to Sexually Transmitted Infections After Negative STI Testing Among Young Adults

Background Recommendations for the frequency of STI screening in high-risk populations are limited by lack of data about when infections occur following a negative screening test. Methods Participants (18–29 years of age; women [N = 192] and men [N = 156]) in a 12-week study of incident STI were recruited from a county STI clinic. Self-collected vaginal samples (women) and urine samples (men) were obtained weekly at participant’s home. Nucleic acid amplification tests (NAAT) were used for diagnosis of C. trachomatis, N. gonorrhoeae, and T. vaginalis infections. Infections diagnosed at enrollment were treated immediately. Based on cumulative diary reports of partner-specific sexual behaviours, an exposure variable was created to indicate vaginal exposure with only one partner, or with more than one partner. Time to infection was modelled using Kaplan-Meier curves; group differences were assessed via logrank test. Logistic regression was used to assess factors associated with infection status at the study completion. Results 146/192 (76%) women and 126/156 (81%) men were uninfected at enrollment. At 4 weeks post-enrollment, 16% of women and 8% of men had at least one STI. At 8 weeks post-enrollment, about 23% of women and 10% of men were infected. Overall, 54/192 (28%) women and 19/156 (12%) men had at least one STI during the 12-week followup. Survival curves differed significantly by gender (p = 0.0003). In a multivariable logistic model, women had significantly higher odds of STI (odds = 3.3, p = 0.004), controlling for infection status at enrollment and monogamy status. Gender remained significant in models including number of partners during the follow-up period. Conclusion In high STI-risk populations, rescreening of initially negative persons identifies high subsequent infection rates, especially among women. Early rescreening (e.g. within 3 months) of any tested person would significantly increase identification of reinfections among initially positive and treated as well as new infections among those previously testing negative.

P3.061 Mycoplasma Genitalium DNA Detected from Adolescent Males in a Longitudinal Cohort

Background Mycoplasma genitalium (MG) causes non-gonococcal urethritis as well as asymptomatic infections although most data on the incidence and natural history of MG is from adults. Methods Participants were 14–17 year old men in a longitudinal study of STI and the urethral microbiome. Urine samples were collected monthly and batch tested retrospectively for MG DNA using PCR. Urine samples were tested in real-time for chlamydia, gonorrhoea, trichomonas and white blood cells (WBC): infections by these organisms were treated. White blood cell count (WBC) was measured by automated cell count of fresh urine. Dysuria and urethral discharge were self-reported on cell phone diaries. Results Among 75 participants (mean age 16.0 at enrollment), 6 (8.0%) men have at least one MG positive sample, with a total of 14 MG positive monthly urine samples. The prevalence of Chlamydia or gonorrhoea infection was 19/75 (25.3%) and 1/75 (1.3%), respectively. All but one participant was positive for at least two consecutive months, and one participant was positive for 4 consecutive months. One participant was positive only once, was co-infected with chlamydia, but treatment could not be confirmed. No other MG positive visits occurred simultaneously with other STI. None of the participants reported symptoms or sexual behaviours within a 15 day window of the positive visit. Average urine WBC was 21.8 WBC/ml urine although only 3/14 MG positive samples were associated with urine WBC > 28.5/ml (commonly used as a diagnostic threshold for pyuria). Conclusions MG in adolescent men is more common than gonorrhoea, persistent without treatment for up to 120 days, and is typically not associated with symptoms or pyuria. These data add to emerging understanding of the prevalence and natural history of sexually transmitted MG and support the importance of more detailed understanding of sexual and reproductive health morbidity associated with these infections.

O1-S11.05 Adolescent sexual intercourse and neighbourhood social disorder

Background Little is known about how and where an adolescent lives and spends time relates to her health-related behaviours. Social disorder, or where crime occurs, is associated with various health outcomes but few have considered its association with adolescent sexual behaviour. Our objective was to assess whether contextual exposure to social disorder is correlated with self-reported sexual intercourse among adolescent girls. Design and Methods Girls (N=48), aged 14–16, were recruited from a single geographic urban area and monitored for 1 week using a GPS-enabled cell phone. Adolescents completed an ACASI survey on self-reported sexual intercourse in the last 30 days. In addition to recorded home and school address, phones transmitted location data every 5 min (travel points). Using ArcGIS, we defined social disorder as aggregated point-level Unified Crime Report data within a 200 metre Euclidian buffer from home and each travel point. Using Stata, we analysed how social disorder exposures differed among girls who reported having sex or not. Results Girls reporting sexual activity spent less time at home (30.9% vs 55.7%, p<0.001) and more time at least 5 km away from home (29.5% vs 12.4%, p=0.01). Girls who reported sex in the last 30 days lived in areas of higher social disorder than girls not reporting sex (p=0.01). There were no significant differences in exposure to social disorder based on travel data among girls reporting sex or not, however. Exposure to social disorder varied by school/non-school day as well as time of day. [Abstract O1-S11.05 figure 1]. Abstract O1-S11.05 Figure 1 Average 200 m crime counts by time of day/day of week and self-reported sexual intercourse in the last 30 days. Conclusions Even within neighbourhoods, social disorder surrounding the home as defined by crime within a 1-block radius correlates with adolescent sexual intercourse behaviour. Although adolescents reporting having sex are less likely to spend time at home and more likely to be further from home than girls not reporting sex, the areas where they travel to are not different in terms of social disorder.