Riley J. Steiner

Introduction of rapid syphilis testing in antenatal care: A systematic review of the impact on HIV and syphilis testing uptake and coverage

Global guidelines recommend universal syphilis and HIV screening for pregnant women. Rapid syphilis testing (RST) may contribute toward achievement of universal screening.

Human rights in health systems frameworks: What is there, what is missing and why does it matter?

Abstract Global initiatives and recent G8 commitments to health systems strengthening have brought increased attention to factors affecting health system performance. While equity concerns and human rights language appear often in the global health discourse, their inclusion in health systems efforts beyond rhetorical pronouncements is limited. Building on recent work assessing the extent to which features compatible with the right to health are incorporated into national health systems, we examine how health systems frameworks have thus far integrated human rights concepts and human rights-based approaches to health in their conceptualisation. Findings point to the potential value of the inclusion of human rights in these articulations to increase the participation or involvement of clients in health systems, to broaden the concept of equity, to bring attention to laws and policies beyond regulation and to strengthen accountability mechanisms.

HIV and Gender-Based Violence: Welcome Policies and Programmes, but is the Research Keeping Up?

Abstract The global HIV policy arena has seen a surge of interest in gender-related dimensions of vulnerability to HIV and violence. UNAIDS and other prominent actors have named gender-based violence a key priority, and there seems to be genuine understanding and commitment to addressing gender inequalities as they impact key populations in the AIDS response. In the quest for evidence-informed interventions, there is usually a strong connection between the research conducted and the policies and programmes that follow. Regarding gender, HIV and violence, is this the case? This discussion paper asks whether the relevant peer-reviewed literature is suitably representative of all affected populations – including heterosexual men, transgender men and women, women who have sex with women, and men who have sex with men – as well as whether the literature sufficiently considers gender norms and dynamics in how research is framed. Conclusions about violence in the context of heterosexual relationships, and with specific attention to heterosexual women, should not be presented as insights about gender-based violence more generally, with little attention to gender dynamics. Research framed by a more comprehensive understanding of what is meant by gender-based violence as it relates to all of the diverse populations affected by HIV would potentially guide policies and programmes more effectively. Résumé Les politiques mondiales sur le VIH s’intéressent de plus en plus aux dimensions sexospécifiques de la vulnérabilité au VIH et à la violence. L’ONUSIDA et d’autres acteurs de premier plan ont fait de la violence sexiste une priorité majeure et il semble exister un accord réel et la volonté de s’attaquer aux inégalités de genre qui ont des répercussions sur des populations clés dans la riposte au sida. Dans la quête d’interventions basées sur des données probantes, il existe habituellement une forte relation entre la recherche menée et les politiques et programmes qui s’ensuivent. S’agissant du genre, du VIH et de la violence, est-ce le cas ? Ce document de synthèse se demande si les publications pertinentes avec comité de lecture sont représentatives de toutes les populations touchées, notamment les hommes hétérosexuels, les hommes et femmes transsexuels, les femmes qui ont des rapports sexuels avec d’autres femmes et des hommes qui ont des rapports sexuels avec d’autres hommes. De plus, les publications tiennent-elles suffisamment compte des normes et de la dynamique de genre dans la manière dont la recherche est cadrée ? Les conclusions sur la violence dans le contexte des relations hétérosexuelles, et en ce qui concerne précisément les hétérosexuelles, ne devraient pas être présentées comme des observations sur la violence sexiste dans son ensemble, sans guère prêter attention à la dynamique de genre. La recherche structurée par une compréhension plus complète de ce que recouvre la violence sexiste, comme phénomène qui concerne toutes les populations touchées par le VIH, a le potentiel de guider plus efficacement les politiques et les programmes. Resumen La arena mundial de políticas referentes al VIH ha visto un repentino aumento de interés en las dimensiones de género relacionadas con la vulnerabilidad al VIH y la violencia. ONUSIDA y otros actores prominentes han nombrado la violencia de género como una prioridad clave, y parece haber un genuino entendimiento y compromiso para abordar las desigualdades de género, ya que afectan a las poblaciones clave en la respuesta al SIDA. En la búsqueda de intervenciones informadas por evidencia, generalmente existe una gran conexión entre las investigaciones realizadas y las políticas y programas subsiquientes. ¿Es éste el caso con respecto al género, el VIH y la violencia? Este artículo de análisis pregunta si la literatura relevante revisada por pares representa adecuadamente a todas las poblaciones afectadas –incluidos los hombres heterosexuales, hombres y mujeres transgénero, mujeres que tienen relaciones sexuales con otras mujeres, y hombres que tienen relaciones sexuales con otros hombres– así como si la literatura considera lo suficiente la dinámica y normas de género en la manera en que se define la investigación. Las conclusiones sobre la violencia en el contexto de las relaciones heterosexuales, y con atención específica a las mujeres heterosexuales, no deben presentarse como algo que nos permitiría comprender mejor la violencia de género de manera más general, con poca atención a la dinámica de género. La investigación definida por un entendimiento más integral de lo que significa violencia de género con relación a todas las diversas poblaciones afectadas por el VIH posiblemente guiaría las políticas y programas con mayor eficacia.

Monitoring knowledge among family, sexually transmitted infections, and sexual partnership characteristics of African American adolescent females.

Among 284 African American girls aged 14 to 17 years, frequent family monitoring knowledge was associated with a reduced likelihood of sexually transmitted infections (STIs) and having a casual sex partner but was not associated with other partnership characteristics. Family monitoring may offer an additional STI prevention opportunity for this vulnerable population.

Contraceptive information on pregnancy resource center websites: a statewide content analysis

OBJECTIVE Most pregnancy resource centers (PRCs) in the US are affiliated with national organizations that have policies against promoting or providing contraceptives, yet many provide information about contraception on their websites. In 2016, the state of Georgia passed a new law to publicly fund PRCs. This study sought to describe the contraceptive information on Georgia PRC websites. STUDY DESIGN We systematically identified all accessible Georgia PRC websites April-June 2016. We downloaded entire websites and used defined protocols to code and thematically analyze content about contraceptives. RESULTS Of the 64 websites reviewed, 20 (31%) presented information about contraceptives. Most of the content was dedicated to emergency contraception. Emphasis on risks and side effects was the most prominent theme. However, no site presented information about the frequency or prevalence of risks and side effects. Sites also emphasized contraceptive failure and minimized effectiveness. We found a high degree of inaccurate and misleading information about contraceptives. CONCLUSIONS Georgia PRC websites presented skewed information that may undermine confidence in the safety and efficacy of contraceptive methods and discourage use. Public funding for PRCs, an increasing national trend, should be rigorously examined. Increased regulation is urgently needed to ensure that online information about contraceptives presented by publicly funded centers is unbiased, complete and accurate. IMPLICATIONS We examined contraceptive information on Georgia PRC websites and found sites minimize benefits and emphasize barriers to use. They contain high levels of medically inaccurate and misleading information that may undermine public health goals. Public funding for PRCs should be rigorously examined; increased regulation is urgently needed.

P4.116 Long-acting reversible contraceptive use and receipt of sexual health services among young women: implications for sti/hiv prevention

Introduction Long-acting reversible contraceptive (LARC) users may be less likely to receive recommended STI prevention services because these methods do not require routine clinic visits for continuation. We compared receipt of services between young women using LARC and other contraceptive methods or no method. Methods Data were from the 2011–2015 U.S. National Survey of Family Growth, a cross-sectional, nationally representative survey. We categorised sexually-active women aged 15–24 years (n=2,018) as: new LARC (initiated ≤12 months prior) or continuing LARC (initiated >12 months) users; moderately (pill, patch, ring, injectable) or less (condoms, withdrawal, diaphragm, rhythm) effective method users; or non-contraceptors. We examined differences in past year chlamydia (CT) testing, HIV testing, and sexual risk assessment (2013–2015 only) by contraceptive type using bivariate statistics and logistic models adjusted for age and race/ethnicity. Results Overall, 41% had been tested for CT, 26% for HIV, and 64% had risk assessed. Compared to moderately effective method users, continuing LARC users had lower odds of HIV testing (18 vs. 30%; AOR=0.4, 95%CI=0.2–0.7) and risk assessment (51 vs. 74%; AOR=0.3, 95%CI=0.2–0.7), but there were no significant differences in CT testing or between new LARC users and moderately effective method users. Compared to less effective method users, there were no differences in service receipt for continuing LARC users; new LARC users had higher odds of CT testing (52 vs. 24%, AOR=1.8, 95% CI=1.0–3.4) but no other differences were observed. Relative to non-contraceptors, new (43 vs. 28%, AOR=2.0, 95%CI=1.1–3.5) and continuing (52 vs. 28%; AOR=2.8, 95%CI=1.6–5.1) LARC users had higher odds of CT testing, and new LARC users had greater odds of risk assessment (72 vs. 55%; AOR=2.4, 95%CI=1.0–5.7). Conclusion Continuing LARC users may be less likely to receive recommended services compared to users of moderately effective methods. STI prevention should be incorporated in efforts to increase access to the full range of contraception.

O09.4 Assessment of clinic and community recruited young african american women for prep eligibility in atlanta, georgia

Introduction HIV disproportionately impacts African Americans (AAs) in the US. Atlanta has been identified as an HIV ‘hot spot’ for AA women and ranks 8th in the US with new infections. Yet little is known about PrEP eligibility or interest among young AA women in Atlanta. Methods 1261 sexually active young AA women (14–24 years) provided baseline data on self-reported sexual behaviour and laboratory-confirmed STI testing (Chlamydia (CT) and gonorrhoea (GC)) prior to participating in an HIV prevention trial in Atlanta. A convenience sample of women were recruited from 2 settings: community venues (n=560, ages 18–24, 2012–2014) and sexual health clinics (n=701, ages 14–20, 2005–2008) from sexual health clinics. An HIV risk index capturing key HIV risk factors for women was calculated from the self-report data. For the clinic sample the index included recent (past 90 days) condomless vaginal sex, condomless anal sex, sex with partner who has had male partners, sex while high (self), sex while high (partner), and intimate partner violence (IPV) (range: 0–6). For the community sample, the index included condomless sex at last sex, exchanged sex for goods and experienced IPV in past 90 days (range: 0–3). A single item assessed PrEP interest in the community sample only. Results Bacterial STI positivity, a primary indicator for PrEP eligibility, was 20.5% (17.1% CT, 6.3% GC) and 20.9% (18.8% CT, 5.2% GC) for the clinic and community samples, respectively. Of the 144 STI positive women from the clinic sample, HIV risk index scores ranged from 0–4, with 21.5% reporting no other HIV risk indicators, 31% had one, 27.8% two, 16.7% three and 2.8% had 4 additional indicators. Of the 117 STI positive women from the community sample, HIV risk index scores ranged from 0–3, with 51.3% reporting no other indicators, 36.8% one, 10.3% two and 1.7% had all 3 additional indicators. Among STI positive women, the most common HIV risk indicator was condomless vaginal sex, but 23.8% and 13.2% (only reported by those >18 years) of the community and clinic samples, respectively, reported recent IPV. 57.8% of the community sample reported they would be likely or very likely to use PrEP if available. Conclusion Our findings indicate that young AA women in Atlanta, whether sampled from community venues or sexual health clinics, are at substantial risk for HIV and meet several PrEP eligibility criteria. Scaling up PrEP among women in Atlanta could have significant implications for HIV in this high burden region.