STI Prevalence Research Articles

Sexually transmitted infection diagnoses among Hispanic immigrant and migrant men who have sex with men in the United States

Hispanic immigrant/migrant men who have sex with men (MSM) should be at higher risk for sexually transmitted infections/human immunodeficiency virus (STIs/HIV) given individual-level factors associated with the migration process that have been theorised to increase susceptibility to STIs/HIV among migrant populations. However, relatively little is known if these individual level factors are actually associated with the STI prevalence among this population. During 2005-2007, 2576 men and women foreign-born Hispanics were surveyed at three community-based organisations offering services to immigrant/migrant communities in the US. We analysed demographic characteristics, sexual risk behaviours, migration patterns, and factors associated with STI diagnoses (syphilis, chlamydia, and gonorrhoea) in the past 12 months among Hispanic immigrant/migrant MSM. Of 1482 Hispanic immigrant/migrant men surveyed who reported having sex in the past 12 months, 353 (24%) reported sex with a man, and of these, 302 answered questions regarding whether or not they had been diagnosed with a bacterial STI in the past year. Of these 302 men, 25% reported being married; 42% self-identified as being heterosexual and 20% as bisexual. Twenty-nine (9.6%) men reported that they had received an STI diagnosis in the past year. In the multivariate logistic regression model, men who reported receiving money or goods for sex had increased odds of a self-reported STI diagnosis. The prevalence of bacterial STIs among Hispanic immigrant/migrant MSM is lower than the prevalence of bacterial STIs among other MSM in the United States. Nevertheless, receiving money or goods for sex was significantly associated with a self-reported STI diagnosis among Hispanic immigrant/migrant MSM. It is important to understand factors contributing to participation in exchange sex among this population. HIV/STI prevention interventions tailored to non-gay identifying MSM are important for Hispanic immigrant/migrant MSM.

Correlates of Sexually Transmitted Infections among Adolescents Attending Public High Schools, Panama, 2015.

BackgroundSexually transmitted infections (STIs) are common in adolescents worldwide. Vulnerability to STIs increases with risky sexual practices. This study described the sexual practices, estimated the prevalence of STIs, and identified correlates associated with STIs among participants, enrolled in public high schools, in the District of Panama, Panama.MethodsA cross sectional study, using multistage cluster sampling, was conducted among participants, aged 14–18 years, enrolled in public high schools, in the District of Panama, Panama City, Panama, from August to November, 2015. Participants completed a self-administered questionnaire and provided biological samples. The samples of those reporting sexual activity (oral, vaginal, and/or anal intercourse) were tested for STIs. Odds ratios were used to identify correlates of STIs in this population.ResultsA total of 592 participants were included, of whom, 60.8% reported a history of sexual activity, and 24.4% tested positive for least one STI. STIs were more common in female participants, (33.5%). Compared to those without STIs, higher proportions of those with at least one STI reported ≥3 sexual partners in their lifetime (60.0%) and current sexual activity (76.3%). In the multivariable model, correlates of STI included female participants (Adjusted Odds Ratio (AOR) = 5.8, 95% Confidence Interval (CI) 2.3–14.6) and those who engaged in sexual intercourse with casual partners (AOR = 3.0, 95% CI: 1.2–7.5).ConclusionsWe report a high STI prevalence among adolescents attending public high schools, in the District of Panama. Reported risky sexual practices were common and correlated with STIs. Female participants and those reporting sexual intercourse with casual partners were more likely test positive for at least one STI. Our study identified a need for effective interventions to curb future infections in this population.

A cross-sectional study of HIV and STIs among male sex workers attending Australian sexual health clinics

ObjectivesAlthough sex work is frequently characterised as a practice with high risk for HIV and other STIs, little is known about the epidemiology of these infections among men who sell...

Factors associated with consistent condom use and STIs among foreign female entertainment workers: results from a cross-sectional survey in Singapore

ObjectivesWe assessed the prevalence of consistent condom use and laboratory-confirmed STIs among foreign female entertainment workers (FEWs) who engaged in paid or casual sex in Singapore and the factors associated...

P232 Keeping on TOP of BV – an audit of bacterial vaginosis and STI screening in GUM clinic attendees requesting a termination of pregnancy

Background/introduction BASHH guidelines currently recommend universal testing for all GUM clinic attendees and all those undergoing termination of pregnancy (TOP). Screening for and treating bacterial vaginosis (BV) is recommended by BASHH in order to reduce the incidence of post TOP endometritis and PID. Aim(s)/objectives To audit whether STI screening, to include testing for BV, is being carried out in patients attending a GUM service requesting TOP referral. Methods Retrospective case note review of 100 consecutive patients seen requesting TOP referral in an Inner London GUM clinic 1/1/15–1/2/15. Results Case notes of 100 were reviewed. Median age was 25yrs (range 16–49 yrs). 21% of patients (n = 21) were of Black ethnicity. 28/50 (56%) reported previous pregnancy and 19/43 (44%) previous TOP. Sexual histories were documented in 53% (n = 53) of cases. 43% (43/100) of patients were documented to be asymptomatic. 38/100 patients had an STI screen and of the remainder 37% were documented to have declined. STI screening included serology testing for HIV/STS in 68% (n = 26) of cases and microscopy for BV/TV in 42% (n = 16). No asymptomatic patients were screened for BV. STI prevalence in those screened was BV 50% (8/16), Chlamydia 8% (3/37), Gonorrhoea 5% (2/37). Discussion/conclusion Adherence to BASHH guidelines was inconsistent particularly in relation to STI screening and BV screening in asymptomatic women seeking TOP. STI prevalence was relatively high in those screened. A designated clinical proforma may improve documentation and testing rates.

Teenage pregnancy rates and associations with other health risk behaviours: a three-wave cross-sectional study among South African school-going adolescents.

BackgroundTeenage pregnancy still remains high in low and middle-income countries (LMIC), as well as in high-income countries (HIC). It is a major contributor to maternal and child morbidity and mortality rates. Furthermore, it has social consequences, such as perpetuating the cycle of poverty including early school dropout by the pregnant adolescent, especially in sub-Saharan Africa (SSA). Few studies in SSA have investigated the trends in teenage pregnancy and the associated factors, while this is critical in fully understanding teenage pregnancy and for promotion of reproductive health among adolescents at large in SSA.MethodsTo examine the trends in teenage pregnancy and to identify associations with other health risk behaviours in South Africa (SA), a total of 31 816 South African school-going adolescents between 11 to 19 years of age were interviewed in three cross-sectional surveys. Data from the first (2002, n = 10 549), second (2008, n = 10 270) and the third (2011, n = 10 997) nationally representative South African youth risk behaviour surveys (YRBS) were used for this study.ResultsThe overall prevalence of having ever been pregnant among the combined 3-survey sample was self-reported to be 11.0 % and stable across the three surveys. Sexual intercourse among adolescents in SA has decreased from 41.9 % in 2002 to 36.9 % in 2011. However, pregnancy among girls who ever had sex increased from 17.3 % (95 % CI: 0.16–0.19) in 2002, to 23.6 % (95 % CI: 0.21–0.26) in 2008 and decreased to 21.3 % (95 % CI: 0.19–0.23) in 2011. The odds for ever been pregnant were higher for girls who had 2 or more sexual partners (OR: 1.250, 95 % CI: 1.039–1.503), girls who ever used alcohol before sex (OR: 1.373, 95 % CI: 1.004–1.878), practised binge-drinking during the last month (OR: 0.624, 95 % CI: 0.503–0.774), and girls who used mandrax (OR: 1.968, 95 % CI: 1,243–3.117). The odds for never been pregnant were lower for those who used condoms (OR: 0.462, 95 % CI: 0.309–0.691).ConclusionsGirls continue to become pregnant at unacceptably high rates in SA. Sexual intercourse among adolescents in SA has decreased slightly. However, among those who are sexually active pregnancy prevalence rates have increased. More over, this is in the context of high prevalence of HIV and other STI. There is a need to address adolescents’ sexual and reproductive health, and several health risk behaviours, including substance use, that are associated with teenage pregnancy in SA.

Lifetime marijuana use and sexually transmitted infection history in a sample of Black college students

BackgroundSexually transmitted infections (STIs) and marijuana use are more prevalent in African Americans/Blacks (Blacks) than any other ethnicity in the United States. Given the significant health care costs and deleterious health correlates of using marijuana or contracting a STI, it is imperative to examine their association, especially in the vulnerable and underrepresented group of young adult Blacks. PurposeThe current study examines the association between lifetime marijuana use on history of STI diagnosis in a sample of Black college students. ResultsApproximately 81% of the 213 participants were female, with approximately 81% also being 21years of age or younger. Alcohol (88%) led the prevalence of substances ever used, followed by marijuana (75%), and cigarettes (57%). When including demographic and substance use covariates, lifetime marijuana use (AOR=2.51; 95% CIs, 1.01, 6.21) and age (AOR=2.72; 95% CIs, 1.32, 5.64) were associated with history of STI. ConclusionThese findings will inform intervention and prevention methods used to reduce STI prevalence and marijuana use among Black young adults. Both epidemiological and biological foundations will be discussed.

Understanding consumer preferences for care of adolescents with pelvic inflammatory disease.

The objective of this study is to estimate consumers' maximum willingness-to-pay (WTP) for follow-up PID services by physicians and community health nurses (CHNs), differences by consumer type (adolescents versus parents), and the differences in health-provider predicted WTP consumer estimates and actual consumer WTP estimates. In this IRB-approved study, a contingent valuation method was used to collect WTP data regarding co-payments to physicians or nurses for clinical service delivery from the consumers of adolescent PID services (parents and adolescents) and health providers using a national convenience sample. Consumers were recruited from an academic pediatric and adolescent medicine clinic and five health department school-based health clinics in a large urban community with high (sexually transmitted infection) STI prevalence. Participants completed a web-based survey. Data were analyzed using linear regression analyses. Adolescents were willing to pay $36 more (95 % Cl : $27.9-44.3) for community health nursing care and parents were willing to pay $48 more dollars (95 % Cl : $40.3-$57.4) than physician's predicted. There were no significant differences in adolescent and parents WTP for physician or nursing services Consumers (adolescents & parents) WTP for physician PID services were on average $18.50 higher than CHN PID services (p = 0.01). Using physician estimates for WTP as the reference group, adolescents were willing to pay $56 more (95 % Cl : $48.6-$63.4) for physician care and parents were willing to pay $66 more (95 % Cl : $59.0-$72.8) than physician's predicted. Adolescents and parents are willing to pay more for physician follow-up for PID, but they are open to CHN follow-up visits based on the mean WTP for CHN visits. Since WTP also reflects the value that individuals place on a service, our data demonstrate that providers consistently underestimate the value consumers place on clinical services for x adolescents with PID.

‘The full has never been told’: building a theory of sexual health for heterosexual Black men of Caribbean descent

Research on Black sexual health often fails to represent the heterogeneity of Black ethnic groups. For people of Caribbean descent in the USA, ethnicity is a salient cultural factor that influences definitions and experiences of sexual health. Most research on people of Caribbean descent focuses on the relatively high rate of STIs, but sexual health is defined more broadly than STI prevalence. Psychological and emotional indicators and the voice of participants are important to consider when exploring the sexual health of a minority culture. The purpose of this study was to qualitatively explore how heterosexual Black men of Caribbean descent define and understand sexual health for themselves. Eleven men who self-identified as Black, Caribbean and heterosexual participated in three focus groups and were asked to define sexual health, critique behaviours expertly identified as healthy and address what encourages and discourages sexual health in their lives. Findings point to six dimensions of sexual health for heterosexual Black men of Caribbean descent. These include: heterosexually privileged, protective, contextual, interpersonal, cultural and pleasurable dimensions. There were some notable departures from current expert definitions of sexual health. Recommendations for further theory development are provided.

Sexually transmitted infections and sexual behaviour of deploying shipboard US military personnel: a cross-sectional analysis

ObjectivesSexually transmitted infection (STI) prevalence and risk behaviour may differ at different phases of deployment. We examined STI prevalence and sexual behaviour in the predeployment time period (12 months prior)...

High HIV, HPV, and STI Prevalence Among Young Western Cape, South African Women

High HIV, HPV, and STI Prevalence Among Young Western Cape, South African Women

P13.10 Club drug use, sexual behaviour and sti prevalence in sexual health clinic attendees in a uk city

Introduction Club drug (CD) use is increasing, but use in non-swinging heterosexuals and associations with sexual behaviour and STI prevalence is undocumented worldwide. Methods Sexual health clinic attendees aged ≥16 years were invited to complete a questionnaire on sexual behaviour and drug use for two weeks per quarter in 2013–14. CD use was compared with age, sexuality, sexual behaviour and STI rates to determine any associations. Results 2332 questionnaires were analysed; mean age 27 (16–81) years; 52% male; 75% white British; 82.6% heterosexual; 11% MSM. Lifetime CD use was 38%; 36% of these had used in the past 4 weeks (active use). CD use was higher in MSM than heterosexuals, in heterosexual males than females, and in those Self-perceived risky sex was higher in MSM than heterosexuals using mephedrone (OR4.38 p = Lack of condom use in the past 12 months in heterosexual CD users and non-users was the same, but CD users were more likely to have ≥3 partners (OR2.3 p = 0.0001). Heterosexual CD active users were more likely to have had anal sex in the past 4 weeks (OR2.6, p = 0.0001); recent heterosexual anal sex was associated with chlamydia (OR2.41, p = 0.0007). There were no associations between lifetime or active use of CD and STI prevalence in heterosexuals (lifetime OR0.91, p = 0.54; active OR1.02, p = 0.94) or MSM (lifetime OR1.30, p = 0.35; active OR1.21, p = 0.63). Conclusion This is the first sexual health clinic study in the UK to assess CD use in all sexualities. Lifetime use of CD was high. CD use in heterosexuals was associated with higher risk sex but lifetime or recent CD was not associated with a higher prevalence of STIs. STI acquisition is multifactorial and is not solely determined by CD use. Disclosure of interest statement No disclosures of interest.

P09.38 Syphilis prevalence and risk behaviour among people living with hiv in managua, nicaragua: bss-2009, bss-2014 and sti sentinel surveillance (vicits) 2014

Background In Nicaragua, 9,739 HIV cases have been reported during 1987–2014. Two Central American Behavioural Surveillance Survey (BSS) among people living with HIV (PLHIV) to estimate prevalence of STI and risk behaviour have been conducted. Since 2012, the STI Sentinel Surveillance Strategy (VICITS) has offered STI diagnosis/treatment and behavioural intervention for PLHIV in public health sites. We present socio-demographic/behavioural and STI prevalence among PLHIV from BSS (2009 and 2014) and VICITS databases. Methods For the BSS, we used a convenience sample of PLHIV seeking HIV services at Roberto Calderon Hospital (RCH) in Managua, from September–December 2009 and January–March 2014. For VICITS, PLHIV seeking services at RCH during 2014 were included. BSS information was obtained through Audio Computer-Assisted Self-Interview. VICITS data were abstracted from VICITS information system. Blood samples were collected for Syphilis testing according to national guidelines. Data were analysed using STATA v13.0. Results Each BSS survey recruited 200 PLHIV (male 53.5% BSS-2009; 74.0% BSS-2014). VICITS recruited 146 PLHIV (85.7% male). Median age was 34 years old for all three data sources. One-third reported being married/living together in BSS-2009 and VICITS (44%, BSS-2014). Alcohol use in the last month was reported by 33.2% in BSS-2009 and 50% in BSS-2014 and VICITS. Condom use in the last sex with any partner was 60.0% in BSS-2009 and 75.5% in BSS-2014 and VICITS. Prevalence of syphilis was 11.6% (95% CI: 7.5–16.8) in BSS-2009, 10.0% (95% CI: 6.2–15.0) in BSS-2014 and 16.7% (95% CI: 8.1–19.8) in VICITS. Conclusion Although socio-demographic/behavioural data of PLHIV in BSS and VICITS were similar, syphilis prevalence was higher among PLHIV enrolled in VICITS. Our results indicate that VICITS strategy can provide valuable information about sexual behaviour of PLHIV. Our findings suggest the use of programmatic data in lieu of complex and expensive surveys to monitor trends in STI prevalence and sexual behaviour. Disclosure of interest We declare that we have no conflicts of interest.

P04.17 Intravaginal practices among rural malawian women

Introduction Intravaginal practices (IVP) are highly prevalent and commonly performed in many countries for a variety of purposes related to genital health, personal hygiene, and sexual pleasure. However, IVP may also have harmful side effects. Previous research supports an association between IVP and bacterial vaginosis and HIV. Our objective is to understand the prevalence and motivations for IVP among rural Malawian women participating in a community survey on sexual and reproductive health. Methods We used baseline survey data from a community-based cohort study conducted among 650 women in rural Lilongwe District, Malawi. Participants answered questions assessing frequency of use for different types of IVP and reasons for performing IVP. Results Most women reported at least some experience with IVP in the past 30 days: 88% reported internal vaginal cleansing with water, 87% reported cleansing with soap and water, and 84% reported inserting cotton, cloth or tissue. Only 5% of women reported no IVP; most (60%) reported at least three practices. Approximately half of women reported very frequent engagement in at least one type of IVP: among those who inserted cotton, cloth or tissue, 43% did so more than once a day; among those who cleansed internally with soap and water, 51% did so more than once a day. Among IVP engagers, 57% reported sexual- and hygiene-related reasons, 36% only hygiene reasons, 4% neither, and 3% only sexually-related motivations. We found no significant association between motivations for IVP (for hygiene vs. sexual reasons) and frequency of IVP. Conclusion Intravaginal practices are highly prevalent and frequently performed among these rural Malawian women. Women’s motivations for IVP were not associated with IVP frequency, and therefore IVP cessation programs targeted to motivations may be unsuccessful in this population. The next phase of this research program will investigate the association between IVP and STI prevalence. Disclosure of interest statement The authors have no conflicts of interest or financial disclosures to report.

P11.07 The spectrum of sexual behaviours among msm and associations with prevalent sexually transmitted infections and hiv

Introduction “Sex” among men who have sex with men (MSM) encompasses a much broader range of behaviours than just anal intercourse, yet most sexual health research in this population focuses on only this one practice. We undertook this study to more fully characterise the spectrum of sexual behaviours endorsed by MSM seeking care in an urban, public STD clinic and the associations between these behaviours and prevalent STI and HIV. Methods This cross-sectional study of 235 MSM was conducted from July 2012 through October 2013. Participants self-administered a standardised survey assessing several categories of sexual behaviour, including multiple types of receptive/insertive behaviours, venues where sexual activity occurs, and sex while using drugs and alcohol. Men responded about behaviours over their lifetime and within the past three months. We generated unadjusted prevalence ratios (PRs) to characterise associations between recent participation in each behaviour and prevalent STI and HIV. Results Participants’ median age was 26 years. Most were white (57%) and employed (73%). Most, but not all, identified as gay (76%). One-third (35%) had rectal or urethral gonorrhoea or chlamydia, or primary/secondary syphilis. STI prevalence was significantly higher among men who reported using sex slings (PR: 2.04), anonymous sex (PR: 1.81), illicit drugs during sex (PR: 1.77), fisting (PR: 1.74), sex toys (PR: 1.44), and group sex (PR: 1.43). HIV prevalence was 17%, and was significantly higher among men who endorsed fisting (PR: 4.81), felching (PR: 3.92), enemas (PR: 4.04), sex slings (PR: 2.47), drug use during sex (PR: 1.98), and group sex (PR: 1.92). Conclusions Many behaviours other than anal intercourse were significantly associated with prevalent STI and HIV in unadjusted analyses, demonstrating the need for prospective studies to examine causal relationships between specific behaviours and STI or HIV acquisition. Disclosure of interest statement No authors have any conflict to disclose.

P03.02 Sti and hiv knowledge, prevalence and related behaviour among young female traders in an urban slum in lagos nigeria

Background Globally, sexually transmitted infections are responsible for a high burden of morbidity and mortality and the complications of improperly managed infections are felt years after the event. It has also been linked to development of cancers. In sub-Saharan Africa, poverty, gender inequality and unemployment puts young females at risk. This study was carried out to assess STI and HIV knowledge, prevalence and related behaviour among young female traders in Mushin community Lagos, Nigeria Methods A cross-sectional descriptive study was conducted using interviewer-administered questionnaires among female trader’s 15–24 years of age who sell wares in garages in an urban slum. Sample size of 290 was calculated. Simple random sampling was used to select divisions of garages. Data was analysed using Epi info version7, association was established using chi square at p Results The mean age for the females was 21 ± 2.39. Majority were single (63.8%), had at least a secondary school education (82.8%) and had heard of STIs. The main source of information was friends/family (41.9%) and media (41.2%). Approximately half of the respondents had good knowledge regarding transmission, prevention, symptoms and types of STI. 13.8% reported symptoms of STI in the six months preceding the study mainly itching, discharge and painful urination. Most practiced self- medication (85.0%) and did not use condoms while having symptoms (80.0%). Less than 40% had been tested for HIV, mainly to know their status. Among sexually active traders 32.4% tested with their main partner and 44.9% know the HIV status of their sexual partners. Married traders (p = 0.002), older females (0.009) and those with at least a secondary school education (p Conclusion Young female traders in this study had poor knowledge, high prevalence of STI and engage in risky behaviour.

S03.4 Future directions for global sti estimates

Background Estimating STI prevalence and incidence are important for programming and advocacy. Current global and regional estimates are based on meta-analysis of prevalence data of gonorrhoea, chlamydia and trichomoniasis among low-risk populations, and on national surveillance of syphilis sero-prevalence among antenatal care attendees, with adjustment for laboratory test types, geography and age. The precision and utility of these estimates is limited by insufficient, varying, and uncertain data availability and quality, notably on duration of infection and symptoms, representativeness of survey samples, etc. Current estimation methods are not able to incorporate data from high risk populations and are not able to generate national STI estimates. The Spectrum suite of estimation and program planning tools has been developed to support estimation of burdens, trends, service needs and program impact for family planning, HIV/AIDS, tuberculosis and other diseases. The HIV/AIDS, Spectrum is used by over 120 countries every two years to estimate their burden of HIV/AIDS, antiretroviral treatment need and other services. Next generation of estimating STIs A module for estimating burdens and trends of STIs in the Spectrum suite of health modelling tools is being developed, initially for gonorrhoea and syphilis, for which relatively good and abundant country data are available. The Spectrum module will fit STI burdens and trends using standard STI indicators collected routinely by countries and reported annually to the WHO and UNAIDS through the Global AIDS Response Progress Reporting (GARPR) system and STI data on general populations from peer-reviewed literature. By building onto the HIV/AIDS model within Spectrum, the STI estimation tool will benefit from efficiency, expertise, coherence and consistency with estimations of HIV/AIDS. Next steps The development and piloting of the Spectrum STI module is a first phase towards supporting country-level STI estimation and program planning. The STI module will be implemented in selected countries in. two-yearly cycle of country consultations tagged into the UNAIDS HIV/AIDS estimation. A companion module for strategic STI intervention modelling, program planning and costing – as an extension to Spectrum’s current One Health Tool representation of MNCH, family planning and HIV primary/behavioural prevention programs will be designed and developed.

006.6 High prevalence of chlamydia and gonorrhoea among patients with genital ulcer disease in zimbabwe: potential implications for syndromic management

Background Syndromic management of genital ulcer disease (GUD) as recommended by the Zimbabwe Ministry of Health and Child Care, includes antibiotics against Treponema pallidum (TP: benzathine penicillin), Haemophilus ducreyi (HD: erythromycin), and herpes simplex virus (HSV: acyclovir). However, these medications are not recommended to treat co-infections with Neisseria gonorrhoeae (NG: ceftriaxone or kanamycin) and Chlamydia trachomatis (CT: doxycycline or azithromycin) and, unless a person with GUD is simultaneously diagnosed with genital discharge syndromes (GDS), NG and CT co-infections will not be treated according to guidelines. Methods In an ongoing study, we enrolled men and women with GDS or GUD syndromes in 6 clinics with high STI prevalence in Zimbabwe. In addition to testing ulcer secretions for TP, HD, and HSV by multiplex polymerase chain reaction (National Institute of Communicable Diseases, Johanneburg), all patients had urine (males) or vaginal swabs (females) tested for NG and CT by nucleic acid amplification (GeneXpert ® ). Results To date, 302 patients have been enrolled for whom testing is complete, including 106 GUD and 196 GDS patients. NG and/or CT infections were present in 19/52 (36.5%) female GUD patients and 13/54 (24.1%) male GUD patients, compared to 26/96 (27.1%) female GDS patients and 68/100 (68.0%) male GDS patients. Of 32 GUD patients infected with NG (N = 24) and/or CT (N = 17), including 9 dual infections, only 4/18 (22%) of women and 4/14 (29%) of men met objective criteria for simultaneous GDS syndromic management. Conclusion In our study, urethral or vaginal GC and/or CT infections were present in 30% of patients with GUD, of whom three quarters would not have been treated according to recommended syndromic treatment guidelines for sexually transmitted infections. Our study methods and findings should be relevant for Zimbabwe and other countries that are using a syndromic approach to STI control.

P11.21 Characterising the epidemiology of active hepatitis b virus infection among high-risk men who have sex with men and transgender women in lima, peru

Introduction Hepatitis B (HBV) infection is a major cause of chronic liver disease, which is a leading cause of death worldwide. Despite differing epidemiology, HBV infection shares routes of transmission with HIV infection. Therefore we explored factors associated with those infections among high-risk populations in Peru. Methods Men who have sex with men (MSM) and transwomen (TW) recruited from two STI clinics completed a behavioural survey on alcohol use and sexual risk-taking in the last 3 months and received HIV testing. An AUDIT score ≥17 determined the presence of a severe alcohol use disorder. Active hepatitis B infection was determined by detection of HBsAg using EIA UMELISA and HBsAg confirmatory testing (Tecnosuma, Cuba). Self-collected rectal swabs were used to diagnose gonorrhoea/chlamydia by NAAT. Prevalence ratios (PR) were calculated using Poisson regression. Results Among 310 MSM and 89 TW (median age 30 years, IQR: 18–58), 5% (20/399) had active HBV infection. Of the 20 participants with active HBV infection, 50% were HIV co-infected which was significantly more than the HIV prevalence among HBsAg negatives (30%, p-value = 0.053). Rates of recent condomless anal intercourse were similar by HBV infection status (68% among those with active infection vs. 74% among HBsAg negatives p = 0.557). Rectal STI prevalence was 40% among participants with active HBV infection vs. 20% among HBsAg negative participants. (p-value = 0.034). In multivariable regression active HBV infection was associated with severe alcohol use disorders (aPR = 2.54, p-value = 0.008) and HIV diagnosis (aPR = 2.56, p-value = 0.009). Conclusions In the context of South America’s low carrier rate, the prevalence of active HBV infection among this Peruvian sample is high. Our findings emphasise the importance of revising national HBV screening and vaccination guidelines to include HIV-infected individuals and heavy drinkers since both conditions may accelerate liver disease. Educational campaigns to encourage transmission prevention are also needed since condomless anal intercourse was common in this cohort. Disclosure of interest statement This data for this abstract was obtained from an NIH-funded study (1R01AI099727). Hepatitis tests were donated however the donating company did not contribute to the conception of this study or participate in the analysis/interpretation of the data in this abstract.

Covariates of Multiplicity of Risk Behavior Among Injecting Drug Users in Nepal

Drug abuse, needle sharing, and high-risk sexual behaviour are often compounded to increase the risk of human immunodeficiency virus (HIV) transmission. This paper analyzes covariates of multiplicity of risk behavior among injecting drug users (IDUs). Findings are based on data from 1471 IDUs following modified time-location cluster sampling across Nepal in 2010–2011. Among Nepalese IDUs, average duration of injecting drugs is 4.4 years with two-fifths initiating it before age 20. Alcohol use is common with two-fifths reporting its daily consumption. Needle sharing is quite prevalent especially among younger and alcoholic IDUs. Further, IDUs practicing needle sharing exhibit rampant multi-partner behavior. Condom use with non-commercial partners is almost 80 %, whereas with intimate partner it is 41 %. Coexistence of needle sharing and unprotected sex enhances STI prevalence (7 %), which is further pronounced among alcoholics (9 %). Working towards risk reduction for IDUs must deal with multiplicity of risk. Interventions should deal with covariates of risk, addressing youth, substance abuse and risky sexual behavior.