Using STD occurrence to monitor AIDS prevention

ArticleinSocial Science & Medicine 38(8):1153-65 · May 1994with4 Reads
DOI: 10.1007/BF01322426 · Source: PubMed
Monitoring the effects of AIDS prevention programmes is increasingly important but methodologically difficult. The use of surveillance derived measures of the occurrence of sexually transmitted diseases as indicators of high risk sexual behaviour, or of HIV incidence, has been widely recognized as a possible approach. This paper first examines the theoretical and empirical basis for this strategy, and highlights, using examples, some of the pitfalls in the interpretation of trends in sexually transmitted disease occurrence. Problems arising in the interpretation of the types of STD surveillance data currently available in countries in Western Europe are discussed. Ways in which STD surveillance systems might be developed so as to enhance their value in monitoring AIDS prevention are proposed. The paper goes on to identify areas of clinical and epidemiological research which might improve our ability to interpret such enhanced STD surveillance data.
    • "A significant decline among men only was also observed more recently in repeated national population-based surveys among young people aged 15– 24 years in South Africa and Tanzania [3,24]. In our study, there was a significant decrease in gonorrhea in men, the latter being considered as a good marker for evaluating recent sexual behavioural risk for HIV transmission [25]. Even if the protective effect of having ever used a condom on HIV risk was not statistically significant, the significant increase in condom use between 1998 and 2008 has certainly played an important role in the gonorrhea and HIV prevalence decline. "
    [Show abstract] [Hide abstract] ABSTRACT: To assess changes in the prevalence of HIV and other sexually transmitted infections, as well as in different proximal and distal factors related to HIV infection, in the general population of Cotonou between 1998 and 2008, while an intensive preventive intervention targeting the sex work milieu was ongoing. A two-stage cluster sampling procedure was used to select the participants in each study. Subjects aged 15-49 who agreed to participate were interviewed and tested for HIV, syphilis, HSV-2, gonorrhoea and chlamydia. We used the Roa-Scott Chi-square test (proportions) and the Student's t test (means) for bivariate comparisons, and adjusted logistic regression models taking into account the cluster effect for multivariate analyses. HIV prevalence decreased significantly in men (3.4% in 1998 versus 2.0% in 2008, p = 0.048), especially in those aged 15-29 (3.0% to 0.5%, p = 0.002). Among men, the prevalence of gonorrhoea decreased significantly (1.1% to 0.3%, p = 0.046) while HSV-2 prevalence increased from 12.0% to 18.1% (p = 0.0003). The proportion of men who reported condom use at least once (29.3% to 61.0%, p<0.0001) and of those having attained a secondary educational level or more (17.1% to 61.3%, p<0.0001) also increased significantly. There was an overall decrease in the prevalence of syphilis (1.5% to 0.6%, p = 0.0003). This is the first population-based study reporting a significant decline in HIV prevalence among young men in an African setting where overall prevalence has never reached 5%. The decline occurred while preventive interventions targeting the sex work milieu were ongoing and the educational level was increasing.
    Full-text · Article · Aug 2012
    • "Until the end of the 1990s the number of HIV infections among the U.S. Forces personnel remained at a relatively low and constant level (Vu et al., 2002). In 1994 in the population of 378,000 active-duty soldiers who were screened, 650 were found to be HIV-positive (Renton & Whitaker, 1994). The rate of HIV seroconversion amounted to 1275 cases in all of the U.S. Forces (Renzullo et al., 2001). "
    Full-text · Chapter · Mar 2012 · International Journal of Drug Policy
    • "Sexually transmitted infections cause significant morbidity and are believed to enhance the transmissibility of HIV infection with significant aggregate level impact on HIV epidemics (Renton, Whitaker, & Riddlesdell, 1998; Rottingen, Cameron, & Garnett, 2001). High levels of occurrence in populations also suggest a significant level of sexual risk behaviour which might support significant epidemics of sexually transmitted HIV infection (Renton & Whitaker, 1994). Like the rest of the FSU, the Central Asian region has experienced major epidemics of syphilis and other sexually transmitted infections following the rapid political and economic changes which commenced in the early 1990s. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: To present a synthetic review and analysis of data describing the epidemics of HIV, syphilis and drug use in Central Asia (except Turkmenistan), and structural factors driving these. Design: Achieving a comprehensive understanding of the co-epidemiology of HIV and STI and the structural factors driving these is key to the development of an effective response. We used a multi-methods situational analysis design to achieve this. Methods: We used three primary methods of data collection during the first 6 months of 2004: interviews with key informants; recording and analysis of government statistics and review of scientific and grey literature. Results: The Central Asian countries are experiencing major epidemics of drug use driven by poor economic circumstances and the transit of at least 35% of global opiate production from Afghanistan through their territories. They are in the early stages of drug injection-associated epidemics of HIV infection, set against a background of high rates of sexually transmitted diseases. The region is one of the poorest in the world and experiences extremely high levels of economic migration, with attendant vulnerability to HIV transmission. Conclusions: Central Asia is highly vulnerable to a crisis of HIV/AIDS, driven by structural factors which require a regional response. Without concerted action, we may expect to see the rapid development over 4-5 years of an HIV epidemic concentrated among IDUs, and achieving very high prevalence levels in this group; followed by a generalising epidemic, developing over 15-30 years with sexual transmission as the predominant mode. The region should be considered a global priority for intervention.
    Full-text · Article · Dec 2006
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