Contact tracing and sexually transmitted disease among aboriginal men on the Anangu Pitjantjatjara lands.
ABSTRACT Sexually transmitted diseases (STDs) are a major health problem for Pitjantjatjara Aboriginal people, causing considerable morbidity and being implicated in the potential rapid transmission of human immunodeficiency virus (HIV) infection. This paper presents data in relation to STD contact tracing on the Anangu Pitjantjatjara lands. In-depth interviews were conducted with Aboriginal men and non-Aboriginal clinic staff to ascertain their attitudes to and perceptions of contact tracing. The interviews with Aboriginal men also sought more general information in relation to health-seeking behaviour and knowledge of STDs. While contact tracing has proven an effective method of case detection on the Anangu Pitjantjatjara lands (most named contacts are able to be located and a high proportion are found to be infected), the data suggest that important constraining issues are the reluctance of Aboriginal men to consult with particular health workers because of moiety group considerations, concerns about confidentiality, and the low level of knowledge of STDs, particularly of largely asymptomatic infections such as chlamydia, syphilis and HIV.
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ABSTRACT: In the cases of medical patients with sexually transmitted diseases (particularly those with the human immunodeficiency virus), two distinct approaches exist to notifying sexual and/or needle-sharing partners of possible risk. Each approach has its own history (including unique practical problems of implementation) and provokes its own ethical dilemmas. The first approach--the moral "duty to warn"--arose out of clinical situations in which a physician knew the identity of a person deemed to be at risk. The second approach--that of contact tracing--emerged from sexually transmitted disease control programs in which the clinician typically did not know the identity of those who might have been exposed. Confusion between the two approaches has led many to mistake processes that are fundamentally voluntary as mandatory and those that respect confidentiality as invasive of privacy. In the context of the AIDS epidemic and the vicissitudes of the two approaches, we describe the complex problems of partner notification and underscore the ethical and political contexts within which policy decisions have been made.American Journal of Public Health 09/1992; 82(8):1158-64. · 3.93 Impact Factor
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ABSTRACT: We analyzed the association of herpes simplex virus (HSV) infection and syphilis, the two most common causes of genital ulceration in homosexual men, with human immunodeficiency virus (HIV) infection in 200 men enrolled between 1983 and 1986 into a study evaluating the microbial causes of acute proctitis. Infection with HIV was independently associated with a history of syphilis, serologic evidence of syphilis, a history of HSV infection, and antibody to HSV-2. Antibody to HIV was not associated with a history of other genital infections or with antibody to Chlamydia trachomatis or HSV-1. Similar associations were observed in 111 asymptomatic homosexuals seen for HIV screening. Men who presented with primary HSV proctitis had a lower prevalence of HIV antibody than those with preexisting HSV-2 antibody (44% vs 68%); this suggests that HSV-2 infection antedated HIV infection. These data suggest that genital ulcerative diseases are an important risk factor for the acquisition of HIV infection in homosexual men; measures directed at control of these diseases may reduce the transmission of HIV in this population.JAMA The Journal of the American Medical Association 10/1988; 260(10):1429-33. · 29.98 Impact Factor
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ABSTRACT: Despite global similarities between the immunologic and pathogenic properties of HIV infection, there are substantial cultural and geographical variations in the transmission dynamics of HIV infection/AIDS. In the United States and Europe, for example, HIV infection/AIDS is predominantly evident among homosexual men and intravenous drug abusers. However, in Central Africa, the data indicate that HIV infections/AIDS is heterosexually acquired. Thus, the purpose of the present paper is to suggest some basic strategies and raise some critical issues for collecting data on sexual practices relevant to the transmission of HIV infection/AIDS throughout the world. Topics include assessment strategies, language and meta‐language, cross‐cultural and intra‐cultural comparability, general methodological issues, and constraints for the assessment of anal intercourse.Journal of Sex Research - J SEX RES. 01/1990; 27(2):215-232.