Using STD occurrence to monitor AIDS prevention

Academic Department of Public Health, St Mary's Hospital Medical School, London, U.K.
Social Science & Medicine (Impact Factor: 2.89). 05/1994; 38(8):1153-65. 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.

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    • "). 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
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    • "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. "
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    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 · International Journal of Drug Policy
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    • "Because applicants who are found to be HIV-positive are not allowed to enter the Army, any HIV infections detected among active-duty soldiers are presumably incident cases of infection acquired in the service. The occurrence patterns of other STDs have been used to predict future AIDS trends [24]. Therefore, the high rates of other STDs found among active-duty soldiers at Fort Bragg serve as a marker for the presence of high-risk behaviors for HIV infection in this military population [25]. "
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    ABSTRACT: High rates of sexually transmitted diseases (STDs) have been reported in military populations. However, it remains uncertain whether the incidence of STDs is higher among military personnel than in the civilian population. The annual incidence of gonorrhea and chlamydia from 1985 through 1996 at Fort Bragg, North Carolina, was determined by use of a clinic database and demographic information for the entire installation. A direct standardization for age, sex, and race/ethnicity was performed, and the adjusted annual rates among active duty soldiers were compared with rates among men and women in North Carolina and the United States. Results showed that the adjusted incidence of gonorrhea and chlamydia among Fort Bragg soldiers remained higher overall than comparable state and national rates during the period of analyses. The 1996 adjusted chlamydia rates for male and female active duty soldiers were 3-fold to 6-fold higher than rates for males and females in North Carolina and in the United States as a whole. STDs continue to lead to significant morbidity in this representative military population.
    Preview · Article · May 2000 · Clinical Infectious Diseases
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