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Item Differences in risk behaviours, HIV/STI testing and HIV/STI prevalence between men who have sex with men and men who have sex with both men and women in China(SAGE, 2016-09) Davis, Alissa; Best, John; Luo, Juhua; Van Der Pol, Barbara; Dodge, Brian; Meyerson, Beth; Aalsma, Matthew; Wei, Chongyi; Tucker, Joseph D.; Department of Epidemiology, Richard M. Fairbanks School of Public HealthDifferences in risk behaviours between men who have sex with men (MSM) and men who have sex with both men and women (MSMW) have important implications for HIV and sexually transmitted infection (STI) transmission. We examined differences in risk behaviours, HIV/STI testing, self-reported HIV/STI diagnoses, and linkage to HIV care between MSM and MSMW across China. Participants were recruited through three MSM-focused websites in China. An online survey containing items on socio-demographics, risk behaviours, testing history, self-reported HIV/STI diagnosis, and linkage to and retention in HIV care was completed from September to October 2014. Chi square tests and logistic regression analyses were conducted. MSMW were less likely to use a condom during last anal sex (p ≤ 0.01) and more likely to engage in group sex (p ≤ 0.01) and transactional sex (p ≤ 0.01) compared to MSM. Self-reported HIV/STI testing and positivity rates between MSM and MSMW were similar. Among HIV-infected MSM, there was no difference in rates of linkage to or retention in antiretroviral therapy when comparing MSM and MSMW. Chinese MSM and MSMW may benefit from different HIV and STI intervention and prevention strategies. Achieving a successful decrease in HIV/STI epidemics among Chinese MSM and MSMW will depend on the ability of targeted and culturally congruent HIV/STI control programmes to facilitate a reduction in risk behaviours.Item Exploring the Bacterial Diversity of the Male Urethra During Idiopathic Urethritis(2020-08) Farrell, Rowan Micah; Nelson, David E.; Bauer, Margaret; Spinola, StanleyIdiopathic urethritis (IU) comprises up to 50% of symptomatic cases of male urethritis in clinical settings. The syndrome is of an unknown etiology but may be due to an as yet unidentified bacterial pathogen(s). We were interested in identifying pathogens that could cause IU using multiple methods. Shotgun metagenomic sequencing or 16S rRNA sequencing methods can provide rich datasets but are limited by the completeness of the corresponding sequence reference databases. We generated metagenomic and 16S datasets from DNA extracted from urethral swabs of men with IU to determine the composition of their urethral microbiome. In order to enrich the corresponding reference databases used to identify the reads in the sequence datasets, I cultivated bacteria from the first void urine (FVU) of men with IU. My goal was to grow and whole genome sequence bacterial isolates that are not currently represented in the reference databases. Of the 216 men we enrolled at the Bell Flower STD clinic in Indianapolis, IN, 59 men had IU. I grew a total of 802 isolates from the FVU of the IU patients and identified those isolates using colony-based 16S rRNA PCR. Based on % sequence similarity to the nearest type strain, I sorted the 16S alleles into four categories: Species (≥98 % identity) (N=264), Genus (≥95 % identity) (N=407), Closest Match (<95 % identity) (N=95), and No Hit (0 % identity) (N=22). There were 24 genera represented in the isolate collection. Of these, the six most abundant genera were Streptococcus, Staphylococcus, Corynebacterium, Haemophilus, Gardnerella, and Prevotella. These six genera composed nearly 80% of all IU-associated isolates. All sequences below 98% sequence similarity represent potentially novel strains of bacteria. We will proceed with whole genome sequencing of bacterial isolates with the goal of improving genome database coverage of bacterial diversity in the male urethra.Item Integrating Individual and Contextual Factors to Explain Disparities in HIV/STI Among Heterosexual African American Youth: A Contemporary Literature Review and Social Ecological Model(Springer, 2020-08) Banks, Devin E.; Hensel, Devon J.; Zapolski, Tamika C. B.; Psychology, School of ScienceHeterosexual African American youth face substantial disparities in sexual health consequences such as HIV and STI. Based on the social ecological framework, the current paper provides a comprehensive, narrative review of the past 14 years of literature examining HIV/STI risk, including risky sexual behavior, among heterosexual African American youth and a conceptual model of risk among this population. The review found that individual psychological and biological factors are insufficient to explain the sexual health disparities faced by this group; instead, structural disadvantage, interpersonal risk, and community dysfunction contribute to the disparity in HIV/STI outcomes directly and indirectly through individual psychological factors. The conceptual model presented suggests that for African American youth, (1) HIV/STI risk commonly begins at the structural level and trickles down to the community, social, and individual levels, (2) risk works in a positive feedback system such that downstream effects compound the influence of structural risks, and (3) contextual and individual risk factors must be considered within the advanced stage of the epidemic facing this population. Despite advanced HIV and STI epidemics among heterosexual African American youth, multisystemic interventions that target structural risk factors and their downstream effects are posited to reduce the disparity among this high-risk population.Item Prevalence and behavioral risk factors for STIs/HIV among attendees of the Ministry of Health hospitals in Saudi Arabia(2015-04) Filemban, Sanaa M.; Yasein, Yasser A.; Abdalla, Magdy H. H.; Al-Hakeem, Raafat; Al-Tawfiq, Jaffar A.; Memish, Ziad A.; Department of Medicine, IU School of MedicineIntroduction: Sexually transmitted infections (STI) are a major public health, social, and economic problem leading to morbidity, mortality, and stigma. This study was conducted to determine the prevalence of STIs, investigate behavioral risk factors and the relationship between the STIs/HIV and demographic factors. Methodology: A cross-sectional survey was conducted between 2013 and 2014 among attendees of the Ministry of Health hospitals. Results: The total number of participants was 3,994 (2,441 males and 1,553 females), with a mean age of 31.95 ± 9.45 years (range 12 to 77 years). The prevalence of STIs and HIV was 6.2% and 0.05% respectively. The mean age for infected people with STIs was 29.42 ± 7.51, vs. 32.12 ± 9.55 for non infected (p < 0.05). There was no diffference between infected and non infected people regarding gender, occupation and marital status. The prevalence of STIs was more commonly reported among non-Saudi (10.9%). Drug use (OR = 4.74; 95%; CI: 3.47–6.48), intravenous drug use (OR = 4.51; 95% CI: 1.45–13.12), illegal sex (OR = 10.7; 95% CI: 7.62–13.32), sex for money (OR = 6.36; 95% CI: 4.52–8.93), sex for pleasure (OR=9.76; 95% CI: 7.29–13.07) were significantly associated with STIs. Conclusion: The prevalence of STIs including HIV in Saudi Arabia is low compared to other countries in the region and globally.Item Sexually transmitted diseases and infertility(Elsevier, 2017-01) Tsevat, Danielle G.; Wiesenfeld, Harold C.; Parks, Caitlin; Peipert, Jeffrey F.; Obstetrics and Gynecology, School of MedicineFemale infertility, including tubal factor infertility, is a major public health concern worldwide. Most cases of tubal factor infertility are attributable to untreated sexually transmitted diseases that ascend along the reproductive tract and are capable of causing tubal inflammation, damage, and scarring. Evidence has consistently demonstrated the effects of Chlamydia trachomatis and Neisseria gonorrhoeae as pathogenic bacteria involved in reproductive tract morbidities including tubal factor infertility and pelvic inflammatory disease. There is limited evidence in the medical literature that other sexually transmitted organisms, including Mycoplasma genitalium, Trichomonas vaginalis, and other microorganisms within the vaginal microbiome, may be important factors involved in the pathology of infertility. Further investigation into the vaginal microbiome and other potential pathogens is necessary to identify preventable causes of tubal factor infertility. Improved clinical screening and prevention of ascending infection may provide a solution to the persistent burden of infertility.