Sexually Transmitted Disease Testing Research Articles

STD Coinfections in The Netherlands: Specific Sexual Networks at Highest Risk

Specific subpopulations infected with multiple bacterial sexually transmitted diseases (STDs) may facilitate ongoing STD transmission. To identify these subpopulations we determined the extent of concurrent incident STD infections and their risk factors among the high-risk population seen at Dutch STD clinics. STD surveillance data submitted routinely by STD clinics to the National Institute for Public Health on demographics, sexual behavior, STD testing, and diagnoses for the period 2004-2007 were analyzed. Bacterial STD coinfections were diagnosed concurrently in 2120 (7%) of the 31,754 incident bacterial STD diagnoses (chlamydia, gonorrhea, infectious syphilis). In univariate logistic regression analyses, coinfections were significantly more often diagnosed in men who have sex with men (MSM, OR = 5.4) than in heterosexuals. Multivariate analyses showed a significant interaction between age and sexual preference. Subsequent stratified analyses by sexual preference showed a linear rise in coinfections with age in MSM. In heterosexuals, by contrast, bacterial coinfections peaked in those aged 19 or less; they had 27% of coinfections, while having only 14% of monodiagnoses and 10% of consultations. Heterosexual STD clinic attendees of Surinamese or Antillean origin were significantly at higher risk for coinfection (OR = 6.5) than all other ethnicities. Attendees belonging to specific sexual networks, such as MSM, ethnic groups, and young heterosexuals were at increased risk for STD coinfections. The different trend with age in MSM versus heterosexuals suggests that these 2 high-risk networks have different determinants of higher risk, such as age-related sexual risk-taking, biologic susceptibility, and insufficient knowledge or compliance with prevention measures. Prevention should therefore be targeted differently towards specific sexual networks.

Unprotected Anal Intercourse and Sexually Transmitted Diseases in High-Risk Heterosexual Women

We examined the association between unprotected anal intercourse and sexually transmitted diseases (STDs) among heterosexual women. In 2006 through 2007, women were recruited from high-risk areas in New York City through respondent-driven sampling as part of the National HIV Behavioral Surveillance study. We used multiple logistic regression to determine the relationship between unprotected anal intercourse and HIV infection and past-year STD diagnosis. Of the 436 women studied, 38% had unprotected anal intercourse in the past year. Unprotected anal intercourse was more likely among those who were aged 30 to 39 years, were homeless, were frequent drug or binge alcohol users, had an incarcerated sexual partner, had sexual partners with whom they exchanged sex for money or drugs, or had more than 5 sexual partners in the past year. In the logistic regression, women who had unprotected anal intercourse were 2.6 times as likely as women who had only unprotected vaginal intercourse and 4.2 times as likely as women who had neither unprotected anal nor unprotected vaginal intercourse to report an STD diagnosis. We found no significant association between unprotected anal intercourse and HIV infection. Increased screening for history of unprotected anal intercourse and, for those who report recent unprotected anal intercourse, counseling and testing for HIV and STDs would likely reduce STD infections.

Efficacy of Sexually Transmitted Disease/Human Immunodeficiency Virus Sexual Risk–Reduction Intervention for African American Adolescent Females Seeking Sexual Health Services

To evaluate the efficacy of an intervention to reduce incident sexually transmitted disease (STD) and enhance STD/human immunodeficiency virus (HIV)-preventive behaviors and psychosocial mediators. A randomized controlled trial of an HIV prevention program. Clinic-based sample in Atlanta, Georgia. African American adolescent females (N = 715), aged 15 to 21 years, seeking sexual health services. Participants completed an audio computer-assisted self-interview and provided self-collected vaginal specimens for STD testing. Intervention Intervention participants received two 4-hour group sessions and 4 telephone contacts over a 12-month period, targeting personal, relational, sociocultural, and structural factors associated with adolescents' STD/HIV risk, and were given vouchers facilitating male partners' STD testing/treatment. Main Outcome Measure Incident chlamydial infections. Over the 12-month follow-up, fewer adolescents in the intervention had a chlamydial infection (42 vs 67; risk ratio [RR], 0.65; 95% confidence interval [CI], 0.42 to 0.98; P = .04) or recurrent chlamydial infection (4 vs 14; RR, 0.25; 95% CI, 0.08 to 0.83; P = .02). Adolescents in the intervention also reported a higher proportion of condom-protected sex acts in the 60 days preceding follow-up assessments (mean difference, 10.84; 95% CI, 5.27 to 16.42; P < .001) and less frequent douching (mean difference, -0.76; 95% CI, -1.15 to -0.37; P = .001). Adolescents in the intervention were also more likely to report consistent condom use in the 60 days preceding follow-up assessments (RR, 1. 41; 95% CI, 1.09 to 1.80; P = .01) and condom use at last intercourse (RR, 1.30; 95% CI, 1.09 to 1.54; P = .005). Intervention effects were observed for psychosocial mediators of STD/HIV-preventive behaviors. Interventions for African American adolescent females can reduce chlamydial infections and enhance STD/HIV-preventive behaviors and psychosocial mediators of STD/HIV-preventive behaviors. Trial Registration clinicaltrials.gov Identifier: NCT00633906.

Health System and Personal Barriers Resulting in Decreased Utilization of HIV and STD Testing Services among At-Risk Black Men Who Have Sex with Men in Massachusetts

Testing for HIV and other sexually transmitted diseases (STD) remains a cornerstone of public health prevention interventions. This analysis was designed to explore the frequency of testing, as well as health system and personal barriers to testing, among a community-recruited sample of Black men who have sex with men (MSM) at risk for HIV and STDs. Black MSM (n = 197) recruited via modified respondent-driven sampling between January and July 2008 completed an interviewer-administered assessment, with optional voluntary HIV counseling and testing. Logistic regression procedures examined factors associated with not having tested in the 2 years prior to study enrollment for: (1) HIV (among HIV-uninfected participants, n = 145) and (2) STDs (among the entire mixed serostatus sample, n = 197). The odds ratios and their 95% confidence intervals obtained from this analysis were converted to relative risks. (1) HIV: Overall, 33% of HIV-uninfected Black MSM had not been tested for HIV in the 2 years prior to study enrollment. Factors uniquely associated with not having a recent HIV test included: being less educated; engaging in serodiscordant unprotected sex; and never having been HIV tested at a community health clinic, STD clinic, or jail. (2) STDs: Sixty percent had not been tested for STDs in the 2 years prior to study enrollment, and 24% of the sample had never been tested for STDs. Factors uniquely associated with not having a recent STD test included: older age; having had a prior STD; and never having been tested at an emergency department or urgent care clinic. Overlapping factors associated with both not having had a recent HIV or STD test included: substance use during sex; feeling that using a condom during sex is "very difficult"; less frequent contact with other MSM; not visiting a health care provider (HCP) in the past 12 months; having a HCP not recommend HIV or STD testing at their last visit; not having a primary care provider (PCP); current PCP never recommending they get tested for HIV or STDs. In multivariable models adjusting for relevant demographic and behavioral factors, Black MSM who reported that a HCP recommended getting an HIV test (adjusted relative risk [ARR] = 0.26; p = 0.01) or STD test (ARR = 0.11; p = 0.0004) at their last visit in the past 12 months were significantly less likely to have not been tested for HIV or STDs in the past 2 years. Many sexually active Black MSM do not regularly test for HIV or STDs. HCPs play a pivotal role in encouraging testing for Black MSM. Additional provider training is warranted to educate HCPs about the specific health care needs of Black MSM, in order to facilitate access to timely, culturally competent HIV and STD testing and treatment services for this population.

Prevalence and Correlates of HIV and Syphilis Infections Among Men Who Have Sex With Men in Chongqing Municipality, China

To examine the prevalence and correlates of HIV/syphilis infections and sexually transmitted diseases (STDs) among men who have sex with men (MSM) in Chongqing, China. Cross-sectional surveys were conducted to provide information, including sociodemographics, sexual and drug use behaviors, HIV knowledge, and HIV-related services in 2006 and 2007, respectively. Multiple methods, including venue-based recruitment, community outreach, Internet advertisements, and peer referral, were used to identify men in Chongqing willing to participate in this study. Of the 1692 participants, 10.8% were HIV-infected (range by district: 7.0%-15.0%), 8.6% were syphilis-infected, and 15.3% self-reported STD-related symptoms. HIV infection was associated with older age, recruitment from bathhouses/saunas, less education, more male sex partners, sex with a woman in the past 6 months, syphilis infection, and STD-related symptoms. Syphilis infection was associated with older age, less education, inconsistent condom use with a man, STD-related symptoms, and HIV infection. STD-related symptoms were associated with older age, being of nonlocal residency, inconsistent condom use with a humans, having ever paid for sex with a humans, HIV infection, and being from District 1. HIV and syphilis infections have reached alarmingly high rates in Chongqing's MSM population. Better targeted, in-depth and comprehensive intervention strategies are needed urgently, including education, condom promotion and distribution, STD control, drug use-related intervention, and advocacy for HIV counseling and testing with bridges to HIV prevention and care services. Widespread testing for HIV, syphilis, and other major STDs in this risk group should be considered as measures for control.

Providing Sexually Transmitted Disease Education and Risk Assessment to Disengaged Young Men Through Community Outreach

This study describes a community outreach project designed to increase access to reproductive health services to young African American men living in low-income urban neighborhoods. The project examined the effectiveness of providing community-based outreach and health education on increasing sexually transmitted disease (STD) screening. Outreach workers provided STD education and risk assessment in community settings, including street corners, parks, schools, and community centers. Data were recorded on outreach contacts, including client demographics, health education topics covered, and risk assessment results. Outreach workers conducted 9,701 contacts in a 176-week period. Most contacts (89%) were with African Americans, and most (84%) were with young men between 15 and 20 years old. Outreach workers discussed each health education item in their protocol at least 85% of the time and each risk assessment item at least 90% of the time. The majority of contacts (94%) reported being sexually active. Compared with the year prior to the project, actual STD testing of the target population doubled at the project clinics. This study suggests that going beyond traditional clinic-based testing to reach young, disenfranchised males constitutes a promising approach to reducing racial disparities in STD infections.

Gonococcal, Chlamydia, and Syphilis Infection Positivity Among MSM Attending a Large Primary Care Clinic, Boston, 2003 to 2004

In the past decade, increases in syphilis and rectal gonorrhea have been reported among men who have sex with men (MSM) in the United States; however, limited sexually transmitted disease (STD) positivity data are available on MSM who receive their healthcare from primary care or general medical clinics. The current study sought to elucidate STD positivity in asymptomatic MSM seen at the largest primary care clinic for MSM in New England and to describe STD test positivity by reason for STD testing. As part of the Centers for Disease Control and Prevention's MSM Prevalence Monitoring Project, all medical visits between 2003 and 2004 (n = 21,927) among MSM attending Fenway Community Health (Boston) were reviewed. The prevalence of positive STD tests (chlamydia, gonorrhea, and syphilis reactivity) was determined and analyzed by demographic characteristics, HIV status, symptoms, and reason for testing. Overall, 23.4% of MSM visits included STD testing during the observation period. Their mean age was 39 years (range: 18-65 years); 84% were white, 5% were black, and 5% were Hispanic. Sixty-five percent of MSM tested were asymptomatic with 7% of asymptomatic MSM testing positive for at least one STD. STD prevalence varied by reason for STD testing: 4.4% of MSM routinely screened had at least one STD, compared to 6.9% of MSM who reported having high risk sex in the preceding 3 months, and 17% of MSM reporting an exposure to an STD. Among all asymptomatic MSM tested, 1.0% had urethral gonorrhea; 1.7% had pharyngeal gonorrhea; 5.6% had rectal gonorrhea; 2.2% had urethral chlamydia; and 4.3% were seroreactive for syphilis. Rectal gonorrhea and syphilis seropositivity were frequently diagnosed in asymptomatic MSM; STD prevalence was highest in MSM tested due to an STD exposure or reporting high-risk sex, underscoring the need to promote routine screening in high risk MSM populations.

Sexually Transmitted Infections Among Patients With Acute HIV in North Carolina

Sexually transmitted infections (STIs) have a well-established synergistic relationship with HIV infection. Co-infection with HIV and an STI can increase the probability of HIV transmission to an uninfected partner by increasing HIV concentrations in genital lesions, genital secretions, or both.[1, 2] STI infection can also increase the likelihood of HIV acquisition by interrupting mucosal barriers, increasing the access to and concentration of HIV receptor cells, and, in women, changing the vaginal microflora to favor HIV infection.[3–6] Among patients with acute HIV (AHI), the 4–6 week interval in the HIV disease course when the virus can be detected in the blood prior to seroconversion, co-infection with an STI may be common.[7] More than 70% of AHI patients had an STI co-infection in a Malawian sexually transmitted disease (STD) clinic in two separate studies.[8, 9] However, little is known about the frequency of STI and acute HIV infection co-infection outside of the STD clinic setting.

Detecting, preventing, and treating sexually transmitted diseases among adolescent arrestees: an unmet public health need.

Studies of detained and incarcerated adolescent offenders in the United States indicate that these juveniles have an elevated risk of sexually transmitted diseases (STDs). However, many more arrestees enter the "front end" of the juvenile justice system than are detained or incarcerated, and research into the STD risk profiles and service needs of this larger group is lacking. An expansion of STD testing (including of asymptomatic youths), prevention, and treatment is needed, as is improved knowledge about gender- and race-specific services. A pilot program in Florida has shown that juvenile justice and public health systems can collaborate to implement STD testing among new arrestees. With integrated linkages to treatment and prevention after release, this model could greatly reduce the STD burden in this underserved, high-risk population.

Individual and community risk factors and sexually transmitted diseases among arrested youths: a two level analysis.

High rates of infection for chlamydia and gonorrhea have been noted among youths involved in the juvenile justice system. Although both individual and community-level factors have been found to be associated with sexually transmitted disease (STD) risk, their relative importance has not been tested in this population. A two-level logistic regression analysis was completed to assess the influence of individual-level and community-level predictors on STD test results among arrested youths processed at a centralized intake facility. Results from weighted two level logistic regression analyses (n = 1,368) indicated individual-level factors of gender (being female), age, race (being African American), and criminal history predicted the youths' positive STD status. For the community-level predictors, concentrated disadvantage significantly and positively predicted the youths' STD status. Implications of these findings for future research and public health policy are discussed.

Screening for Chlamydia trachomatis and Neisseria gonorrhoeae Among Adolescents in Family Court, Philadelphia, Pennsylvania

To evaluate the use of the Family Court System as a venue for screening adolescents, especially males for sexually transmitted diseases (STD). To identify, treat, and describe the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infections among adolescents on probation under the jurisdiction of the Family Court System of Philadelphia from April 2004 through December 2006. We analyzed data from the first several years of this program, which offered education and voluntary noninvasive screening for CT and GC to adolescents adjudicated delinquent and placed on probation through the Family Court of Philadelphia. Between April 1, 2004 and December 31, 2006, 2270 adolescents were counseled about STDs, of whom 1605 voluntarily submitted a urine specimen for STD testing. Among the 1594 unique individuals with a valid test result, 13.9% (44 of 317) of females, 7.0% (90 of 1277) of males, and 8.4% overall (134 of 1594) were found to be positive for either or both STD. In total, treatment was confirmed for 93.3% (84/90) of males and 100% (44/44) of females testing positive. Noninvasive STD testing was well accepted by adolescents in the Family Court System. Over several years of study, infection rates were found to be persistently high in both males and females. The Family Court is an effective venue to identify and treat adolescent males and females with chlamydia and/or gonorrhea infection.

Drug use and sexually transmitted diseases among female and male arrested youths.

Knowledge of the rates and correlates of juvenile offenders' sexually transmitted diseases (STD) has been limited to samples of incarcerated youths comprised mostly of males. Data collected on 442 female and 506 male youths processed at a centralized intake facility enabled us to study this important public health problem among a sample of juvenile offenders at the front end of the justice system. Female-male, multi-group latent class analyses identified two subgroups, High Risk and Lower Risk, of youths described by a latent construct of risk based on drug test results, STD test results, and a classification for the seriousness of arrest charge. The results found: (1) a similar classification distinguished High Risk and Lower Risk male and female youths, and (2) important gender group differences in sexual risk related factors (e.g., substance use during sexual encounters). Among the youths in this sample who tested positive for an STD, 66% of the girls and 57% of the boys were released back into the community after arrest. Overall, our findings raise serious public health and social welfare concerns, for both the youths and the community. Prevention and intervention implications of these findings are also discussed.

Self-reported syphilis and gonorrhoea testing among men who have sex with men: national HIV behavioural surveillance system, 2003–5

Objectives:The Centers for Disease Control and Prevention provides guidance on sexually transmitted disease (STD) testing specifically for men who have sex with men (MSM) in STD treatment guidelines to address...

Factors Associated With Newly Diagnosed HIV Among Persons With Concomitant Sexually Transmitted Diseases

We evaluated Illinois and Chicago Departments of Public Health surveillance databases to determine risk factors associated with newly diagnosed HIV among persons with bacterial sexually transmitted diseases (STDs). Test results for Chlamydia, gonorrhea, early syphilis (primary, secondary, and early latent), and HIV from public health clinics in Illinois in 2002 were merged with demographic and behavioral survey data collected during patient visits. STD was defined as any positive non-HIV result. Among 43,517 patient encounters, 5814 (13.4%) had positive STD test results. There were 308 (0.7%) positive new HIV test results, of which 71 (23.1%) had concomitant infection with an STD. Compared with STD-positive, HIV-negative cases, age >30 years (OR = 1.9, 95% CI, 1.0,4.4), men who have sex with men (MSM) (OR = 22.2, 95% CI 11.3-43.7), and bisexual male (OR = 22.4, 95% CI 7.8-64.8) were independently associated with STD and HIV coinfections. Among distinct STDs, syphilis (n = 438) was the least frequent (7.5%), but was reported in the highest proportion (10.1%) of all new HIV infections and conferred the greatest risk (OR = 11.0, 95% CI 7.7-15.8) for newly diagnosed HIV. MSM were at increased risk for newly diagnosed HIV with STD coinfection. Persons with a concomitant STD and HIV were older than US populations that generally constitute the greatest proportion of STD cases. These results highlight the role in particular of syphilis among populations at high risk for HIV transmission. Public health interventions targeting MSM and older adults for effective testing and prevention strategies are critically needed within high-risk networks for cotransmission of STDs and HIV.

Recently Arrested Adolescents are at High Risk for Sexually Transmitted Diseases

Adolescent offenders may be at high risk for sexually transmitted diseases (STDs). With previous research and interventions focused on incarcerated adolescents, data are needed on STD prevalence and risk factors among newly arrested youth released to the community, a far larger subgroup. Participants were recruited from all arrested youth processed at the Hillsborough County, Florida Juvenile Assessment Center during the last half of 2006 (506 males, 442 females). Participants voluntarily providing urine samples for drug testing as part of standard protocol were also consented to having their specimens split and tested for chlamydia and gonorrhea, using an FDA-approved nucleic acid amplification test. STD prevalence was similar to those previously reported among incarcerated adolescents: 11.5% tested positive for chlamydia, 4.2% for gonorrhea, and 13.2% for either or both infections. Prevalence was significantly higher among females: 19.2% of females had either or both infections compared with 10.5% of males. Prevalence was higher for 17 to 18 year olds (15.2% of males, 25.5% of females), blacks, detained youths, drug users, and those engaged in sexual risk behaviors. Previous STD testing experience was limited. The study indicated that a voluntary STD screening protocol is feasible for arrested youth entering the juvenile justice system, and these offenders are at high risk for STDs. Because most arrested youths are released back to the community, routine testing and treatment of recently arrested youths, and expanded access to risk reduction and prevention programs, can yield substantial public health benefits.

Association of Sexually Transmitted Disease-Related Stigma With Sexual Health Care Among Women Attending a Community Clinic Program

The objective of this study was to assess the association of sexually transmitted disease (STD)-related stigma on sexual health care behaviors, including Papanicolaou smears and STD testing/treatment, among women from a high-risk community. Descriptive statistics were used to assess the association of demographics, sexual and drug-related risk behaviors, and 3 measures of STD-stigma (internal, social, and tribal stigma, the latter referring to "tribes" of womanhood) with sexual health care in the past year. Pearson's chi-square test and Mann-Whitney test were used to assess significance. Multivariate logistic models were used to determine the association of STD-stigma with sexual health care after controlling for other factors. Lower internal stigma score was marginally associated with reporting an STD test in the past year [median score (interquartile range) for those reporting and not reporting an STD test were 0.79 (0.30-1.59) and 1.35 (0.67-1.93), respectively]. In an adjusted model, internal stigma retained a negative association with reporting of STD testing in the past year (adjusted odds ratio, 0.92; 95% confidence interval, 0.85-0.99). Most women had received a Papanicolaou smear in the past year, and none of the STD-stigma scales were associated with reporting this behavior. Internal stigma retained an association with not having any STD test or treatment. Although sexual stigma is a deeply rooted social construct, paying attention to how prevention messages and STD information are delivered may help remove one barrier to sexual health care.

Nucleic-Acid Amplification Testing of Urine vs. Patient Complaint-Driven Evaluation

The present pilot study compared the ability of a conventional patient complaint-driven approach to that of nucleic-acid amplification testing (NAAT) of urine to identify those individuals among an adult, urban, Emergency Department (ED) population infected with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV). Urine for NAAT was collected for testing after individuals had completed a questionnaire and before being seen by a physician. A total of 614 subjects were enrolled, and complete physical examinations were performed on 348 (56.6%) individuals, with women being significantly more likely to receive such an evaluation (odds ratio [OR] 3.09; 95% confidence interval [CI] 1.96-4.86); p < 0.001). A total of 153 (24.9%) of the study cohort tested positive for a least one sexually transmitted disease (STD), and only a reported history of STD (OR 1.74; 95% CI (1.18-2.57); p = 0.005) and a history of a new sexual partner in the last 3 months (OR 1.79; 95% CI 1.13-2.82); p = 0.012) were predictive of a positive STD test. NAAT of urine samples on patients who did not receive a complete physical examination resulted in a 33% (51/153) increase in diagnostic yield in this cohort of ED attendees.

Health Issues in Prisons and Jails

Health Issues in Prisons and Jails

The Adult Film Industry: Time to Regulate?

The United States adult film industry produces 4,000–11,000 films and earns an estimated $9–$13 billion in gross revenues annually [1]. An estimated 200 production companies employ 1,200–1,500 performers [2]. Performers typically earn $400–$1,000 per shoot and are not compensated based on distribution or sales. Los Angeles County is the largest center for adult film production worldwide. In 1988 the California Supreme Court, in People v. Freeman, found adult film production to be protected as free speech under the First Amendment, since such films were not considered obscene based on prevailing community standards. Unlike other legal but highly regulated activities such as gambling and commercial sex work in Nevada, the adult film industry was legalized in California through case law, not by statute, and has for the most part escaped governmental oversight. Regulation of the industry has been limited to prevention of child pornography. Title 18, Section 2257 of the United States Code of Regulations explicitly prohibits performers under age 18 and provides for civil and criminal prosecutions for any violation [3]. Adult film production companies are required to have a Custodian of Records to document and retain records of the age of all performers, to enforce the age entry restriction. Adult film performers engage in prolonged and repeated sexual acts with multiple sexual partners over short periods of time, creating ideal conditions for transmission of HIV and other sexually transmitted diseases (STDs). All the more concerning, high-risk practices are on the rise [4]. These practices include sex acts that involve simultaneous double penetration (double-anal and vaginal–anal intercourse) and repeated facial ejaculations. At the same time, condom use is reportedly low in heterosexual adult films—approximately 17% for adult performers [5]. In 2004, only two of the 200 adult film companies required the use of condoms for all penile–anal and penile–vaginal penetration [2]. Performers report that they are required to work without condoms to maintain employment. These practices lead to high transmission rates of STDs and occasionally HIV among performers. After four performers contracted HIV in 1998, Sharon Mitchell, a former adult film performer, founded Adult Industry Medical (http://www.aim-med.org), a clinic to counsel and screen performers monthly for HIV using a PCR test (Figure 1). It was expanded later to include other STD testing. The testing program began as an effort to reduce transmission of infections through early diagnosis, treatment, and “quarantine” should a performer test positive for HIV. Performers are required in most cases to pay for all screening tests, and to sign a consent form that permits disclosure of their test results to other performers and producers before filming. Both of these practices are explicitly prohibited under California Occupational Safety and Health Administration (Cal/OSHA) regulations. HIV-positive female performers are permanently excluded from participating in adult films. Figure 1 Screenshot of the Web site of Adult Industry Medical Health Care Foundation

Services for men at publicly funded family planning agencies, 1998-1999.

Men's reproductive health needs are receiving increased attention, but most family planning clinic clients are female, and clinics have reported barriers to serving men. A 1999 survey of publicly funded agencies that administer family planning clinics asked several questions about current policies and services and the number of men served in 1998. Data on 17 services were collected, as well as the proportion of clients who were male and agencies' barriers to serving men. The services most commonly offered to men in 1999 were condom provision and sexually transmitted disease (STD) counseling (95% of all agencies), contraceptive counseling (93%), and STD treatment (90%) and testing (89%). The proportions offering various male reproductive health services were lowest among hospital-based clinics. Eighty-seven percent of agencies served some male contraceptive or STD clients in 1998; those that did served a mean of 255 men and a median of 50. The male client caseload increased between 1995 and 1998 at 53% of agencies, and four out of five agencies were interested in serving more men in the future. The most commonly reported barriers to serving men were men's unawareness that services were available (58%) and inadequate agency funding (55%). Although most clients of publicly funded family planning agencies are women, a nonnegligible number are men. Additional efforts are needed to determine the best way to deliver reproductive health services to men.