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Introduction Sexual orientation minorities have worse health outcomes than the heterosexual majority. In 2023, Aotearoa New Zealand (NZ) added sexual and gender identity items to the Census, offering actionable data for improving sexual identity and gender identity (SOGI) community health. However, this also raises questions about individuals' willingness to provide such information to Government and their comfort with data privacy and governance. Methods Using data from gay, bisexual, and other men who have sex with men (GBM) participants of the Gay Auckland Periodic Sex Survey and Gay Men's Online Sex Survey 2014 cross-sectional surveys, the study question examined comfort having their sexual orientation recorded in official databases. A logistic regression model was used to identify independent predictors of comfort, including sociodemographic and behavioural variables. Results Of 3173 participants who completed the question, 63.1% were comfortable with recording sexual orientation. Adjusted odds ratios showed less comfort among those identifying with an 'Other' ethnicity (AOR: 0.64, 95% CI: 0.43-0.96), identifying as bisexual (AOR: 0.45, 95% CI: 0.35-0.56), and those who did not believe their GP to be aware of their sexuality (AOR: 0.32, 95% CI: 0.26-0.40). No sexual behaviours were independently associated with comfort. Discussion The majority of GBM participants reported comfort with having their sexual orientation recorded on official databases, but some are not, and this is patterned by sociodemographic variables. Officials should improve the safety and perceived relevance of sexual orientation data collection efforts to increase their representativeness and utility for sexual minority populations.

Introduction: New Zealand has a unique illicit drug market, gay cultures and drug use patterns. Minimal attention has been given to how drug use shapes sexual practice, especially in the era of biomedical HIV prevention among gay and bisexual men (GBM)., Methods: An online cross-sectional study of GBM ('Flux NZ') adapted from an Australian study was undertaken to explore connections between drug use, sexual practice, health and community. We describe drug use patterns, then identify three discrete groups determined by intensity of recent (past 6 months) sexual practice: no recent sex, recent sex and recent sexualised drug use. We examine factors associated with these groups and identify factors independently predicting sexualised drug use., Results: Of 739 participants, almost a third had engaged in group sex (29%), 17.5% were taking pre-exposure prophylaxis (PrEP), 6.5% were HIV positive. Overall, 59.5% had recently used illicit drugs (16.9% methylenedioxymethamphetamine, 6% methamphetamine, 3.3% gamma-hydroxybutyrate acid, 1.4% ketamine). Sexualised drug use was common (35.7%). Those engaged in sexualised drug use were connected to gay community and had a high uptake of biomedical HIV prevention. Independent predictors of sexualised drug use included being sexually adventurous, knowing their HIV status, having more than 10 recent sexual partners, engaging in group sex and sex at a sex-on-site venue., Discussion and Conclusions: Many GBM engaging in sexualised drug use manage HIV transmission risks through regular testing, PrEP and HIV treatment. HIV prevention efforts should target GBM with less intensive sexual behaviour but who may be at comparatively higher risk of HIV transmission., (© 2023 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

This study was performed to validate a dried blood spot (DBS) method for the serological screening of HIV, syphilis, hepatitis B and C. It included 250 paired DBS and serum samples and 116 unpaired DBS samples from 366 unique patients from two laboratories between 8 October and 2 November 2021. As determined by original test request, these were tested using a DBS method for HIV Ag/Ab (n=216), anti-treponemal Ab (n=166), hepatitis B sAg (n=100), and hepatitis C Ab (n=100) Elecsys assays on the Roche Cobas automated platform. Using the manufacturer's (serum) cut-off for reactivity ('positivity'), the sensitivity and specificity of DBS testing compared with serum were: for HIV Ag/Ab 100% and 100%, for anti-treponemal Ab 68.3% and 100%, for hepatitis B sAg 95.9% and 100%, and for hepatitis C Ab 84.0% and 100%, respectively. Adjusting the assay cut-off using receiver operator curve analysis increased sensitivity of DBS testing for anti-treponemal Ab to 90.0%, hepatitis B sAg to 97.9% and hepatitis C Ab to 94.0% whilst maintaining specificity of 98.8%, 100% and 100%, respectively. With optimisation of assay cut-off, DBS can perform comparably with serum for serological testing for HIV, syphilis, hepatitis B and C and may be a valuable tool in increasing access to testing in New Zealand., (Copyright © 2023 Royal College of Pathologists of Australasia. Published by Elsevier B.V. All rights reserved.)

Background: Chlamydia, gonorrhea, and syphilis are common sexually transmitted infections that disproportionately affect specific groups in New Zealand (NZ). Predictors of reinfection are not well studied in NZ but could inform public health strategies to decrease sexually transmitted infection (STI) incidence., Methods: New Zealand-wide chlamydia, gonorrhea, and syphilis cases during 2019 were identified using nationally collected data. Cases were followed-up to identify reinfection with the same STI within 12 months of initial infections. Logistic regression models were used to identify predictors for each STI reinfection., Results: Determinants identified for increased odds of chlamydia reinfection were age groups 16-19 and 20-24 years, females, Māori and Pacific peoples, cases in the Northern region, and cases with at least one test before the initial infection. Age 40 years and older was associated with lower odds of gonorrhea reinfection, as was being of Asian ethnicity, living in Midland or Southern regions, and reporting heterosexual behavior. Region was the only statistically significant predictor for syphilis reinfection, with higher odds of reinfection for people living in the Central region., Conclusions: Our findings reflect disproportionate STI rates for some groups in NZ, with younger age groups, Māori and Pacific peoples, men who have sex with men, and people living in the Northern region experiencing higher odds of reinfection. Groups identified with higher odds for reinfection require increased access to culturally responsive health services to treat, understand, and prevent possible reinfection. Changes to current public health strategies could include culturally specific behavioral counseling, and improvements to and adherence to effective contract tracing., Competing Interests: Conflict of Interest and Sources of Funding: The authors declare no conflicts of interest. This work was supported by funds from the New Zealand Ministry of Health STI Surveillance. P.S. was supported by a Burnett Foundation Aotearoa Fellowship., (Copyright © 2023 American Sexually Transmitted Diseases Association. All rights reserved.)

Introduction Queer-identifying (non-heterosexual) men report higher rates of tobacco and e-cigarette use than the general population. The advent of e-cigarettes as a commercial product in Aotearoa New Zealand has been accompanied by aggressive marketing and a sharp uptake in use, especially among young people. Recent evidence suggests that e-cigarettes are widely used for purposes other than smoking cessation. Aim This study investigated how vaping is perceived and the role e-cigarettes play in the daily lives of young queer users. Methods Using focus groups with a semi-structured interview proforma, we interviewed twelve young queer men between July and August 2021. Interviews were queer-led, conducted via Zoom, and lasted up to 2 h. Interviews were audio-recorded and transcribed verbatim for subsequent inductive and thematic analysis. Results Of the twelve participants, 10 were daily users, and two described themselves as 'social vapers'. We found strong evidence for minority and intra-minority stress as a driver to uptake and continued use of e-cigarettes. E-cigarettes were also used to navigate new social and cultural spaces and as currency for integration into various social milieux, including both mainstream and gay community spaces. There was little support for queer-targeted cessation initiatives. Discussion Vaping is highly socially acceptable within queer communities where it is a facilitator of social integration, managing stress and quitting tobacco.

Gay, bisexual, and other men who have sex with men (GBM) have developed community norms for regular HIV/STI testing. We investigated factors associated with self-reported COVID-19 testing in response to reported COVID-19 cases and public health restrictions. Participants responded to weekly cohort surveys between 10th May 2021 and 27th September 2021. We used the Andersen-Gill extensions to the Cox proportional hazards model for multivariable survival data to predict factors influencing COVID-19 testing. Mean age of the 942 study participants was 45.6 years (SD: 13.9). In multivariable analysis, GBM were more likely to report testing during periods of high COVID-19 caseload in their state of residence; if they were younger; university educated; close contact of someone with COVID-19; or reported coping with COVID-19 poorly. COVID-19 testing was higher among men who: were more socially engaged with other GBM; had a higher proportion of friends willing to vaccinate against COVID-19; and were willing to contact sexual partners for contact tracing. Social connection with other gay men was associated with COVID-19 testing, similar to what has been observed throughout the HIV epidemic, making community networks a potential focus for the promotion of COVID-19 safe practices., (© 2022. The Author(s).)

Although many studies reported on decreases in sexual partner numbers among gay and bisexual-identifying men in the early period of the COVID-19 pandemic, few studies have explored COVID-19 risk-reduction strategies. Drawing on free-text responses in an online survey (from April to July 2020), we describe the ways in which men sought to minimise the risk of COVID-19 in sexual encounters. Partner selection was an important strategy, in particular, restricting sex to men they already knew. Accounts also indicate how participants assessed risk from potential sex partners based on symptoms, residential location, recent travel, work role, and number of other sexual contacts. Less common were in situ practices, such as avoiding kissing. Participants' responses provide insight into creative community-based responses in the early months of the pandemic, some of which have resonances with early responses to HIV. Findings are discussed in relation to the concepts of 'lay epidemiology' and 'counterpublic health'. In particular, we examine how risks and health are experienced and valued in relation to local knowledges, meanings, and practices; and how practices emerge in response to dominant public health discourses that produce an idealised public based on (hetero)normative assumptions.

Introduction: COVID-19 related lockdowns have impacted the sexual activity of gay and bisexual men (GBM). We investigated trends in sexual behaviors and the COVID-19 context in which they occurred (COVID-notification rates and jurisdictional restrictions) to understand changes in the duration and severity of periods of lockdown on the sexual behavior of Australian GBM., Methods: In an online, prospective observational study of 831 GBM from May 2020 to May 2021, we investigated associations between changes in sexual behavior among Australian GBM, lockdowns, and COVID-19 notification rates through weekly surveys from May 2020 to May 2021., Results: The mean age was 45.71 years (SD: 13.93). Most identified as gay (89.0%) and 10.2% were living with HIV. There was an overall increase in the mean weekly number of non-committed relationship partners (0.53-0.90, p  < 0.001). The state of Victoria experienced a significant extended COVID-19 outbreak, accompanied by severe lockdown restrictions. In response, Victorian men's partner numbers shifted three times, while elsewhere there was an overall gradually increasing trend., Conclusions: Less severe outbreaks with shorter lockdown periods, involving fewer and geographically contained, COVID-19 notifications were accompanied by non-significant changes in sex with non-relationship partners than more severe outbreaks over extended periods and larger geographical areas., Supplementary Information: The online version contains supplementary material available at 10.1007/s13178-022-00733-8., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s) 2022.)

Sexual orientation and gender identity change efforts (SOGICE) are harmful practices, yet who suggests them to young people and what impacts are associated with these suggestions have received limited attention in the literature. The present study explored whether certain suggesters, and the frequency of categories of suggesters (including religious leaders, family members, and health professionals), were associated with suicidality and non-suicidal self-injury (NSSI). The study also explored whether particular demographics of young people were more likely to report SOGICE experiences. Data were collected through an online survey of New Zealand gender- and sexuality-diverse youth. The sample (n = 3948) had an age range of 14-26 (mean age = 18.96), and approximately half (52.4%) were transgender or gender-diverse. Odds of suicidality and NSSI were highest when religious leaders suggested SOGICE and when more than one type of suggester was reported. SOGICE was more likely to be reported by transgender and gender-diverse youth, statutory care- and homelessness-experienced youth, and young people reporting current material deprivation. Implications for targeted mental health services and education for young people and the community are discussed., (© 2022. The Author(s).)

Background and Objectives: Gay and bisexual men (GBM) are deferred from donating blood in many countries. Perceptions by GBM that blood donor deferral policies are unjustifiably discriminatory, especially due to advances in HIV prevention, could contribute to non-compliance and need to be understood. We explore blood donation interest and history among GBM and attitudes towards donor deferral policies for the first time in New Zealand (NZ)., Materials and Methods: Data from a cross-sectional online survey of GBM in NZ were examined. We constructed three groups: (1) never donated blood and not interested; (2) never donated but expressed interest; and (3) previously donated blood. We tested these for association with demographic and behavioural variables, as well as attitudes towards blood donation policy., Results: A total of 607 GBM were eligible for the study, of whom 32.9% reported having donated blood previously, 44.3% had never donated blood but expressed interest and 22.7% expressed no interest in donating. Among previous donors, a third (8.6% of the total sample) reported non-compliance with the deferral policy. Most participants found the 12-month deferral policy to be too strict (81.8%), unfair (75.4%) and homophobic (68.8%)., Conclusion: We estimate that, for the first time in NZ, almost 10% of the sample did not report compliance with the 12-month deferral policy for men who have sex with men (MSM). Negative attitudes towards the deferral policy were common and could potentially increase the risk to the blood supply if compliance reduces. Further work is needed to inform a deferral policy that is accepted by GBM while maintaining the safety of NZ's blood supply., (© 2022 The Authors. Vox Sanguinis published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion.)

Successful use of biomedical forms of HIV risk-reduction may have predisposed many gay and bisexual men (GBM) to vaccination against COVID-19, which may, in turn, affect their sexual behavior. A total of 622 Australian GBM provided weekly data on COVID-19 vaccination history and sexual behaviour between 17 January 2021 and 22 June 2021. We identify factors associated with COVID-19 vaccination, and compare sexual behavior before and since vaccination. Mean age was 47.3 years (SD 14.0). At least one-dose vaccination coverage had reached 57.2%, and 61.3% reported that the majority of their friends intended to be vaccinated. Vaccinated men reported a mean of 1.11 (SD 2.10) weekly non-relationship sex partners before vaccination and 1.62 (SD 3.42) partners following vaccination. GBM demonstrated high confidence in COVID-19 vaccines. Their sexual activity increased following vaccination suggesting that greater sexual freedom may be a specific motivation for vaccine uptake among some men., (© 2022. The Author(s).)

We examined depression and anxiety prior to and during COVID-19 restrictions in Australian gay and bisexual men (GBM). In an online cohort, a COVID-19-focused survey was conducted in April 2020. During 2019 and in April 2020, 664 GBM completed the Patient Health Questionnaire (PHQ-9, measuring depression) and Generalized Anxiety Disorder Assessment (GAD-7, measuring anxiety). Increased depression and anxiety were defined as a ≥ 5 point increase on the respective scales. Mean PHQ-9 and GAD-7 scores increased between 2019 and 2020 (PHQ-9: from 5.11 in 2019 to 6.55 in 2020; GAD-7: from 3.80 in 2019 to 4.95 in 2020). The proportion of participants with moderate-severe depression (PHQ-9 ≥ 10) increased from 18.8% (n = 125) to 25.5% (n = 169), while the proportion of participants with moderate-severe anxiety (GAD-7 ≥ 10) increased from 12.7% (n = 84) to 17.3% (n = 115). Almost one-quarter of participants (n = 158, 23.8%) had increased depression; in these men, mean PHQ-9 increased from 2.49 in 2019 to 11.65 in 2020 (p < 0.001). One-in-five (20.6%) participants (n = 137) had increased anxiety; among these men, mean GAD-7 increased from 2.05 in 2019 to 10.22 in 2020 (p < 0.001). Increases were associated with concerns about job security, reduction in social and sexual connections and opportunities, and being personally concerned about COVID-19 itself. COVID-19 appeared to have a sudden and pronounced impact on depression and anxiety in Australian GBM, with a significant minority showing sharp increases. Ongoing monitoring is required to determine longer-term impacts and GBM need access to appropriate and sensitive supports both during and after the COVID-19 pandemic., (© 2022. The Author(s).)

Few studies have examined changes in sexual behaviour following HIV pre-exposure prophylaxis (PrEP) initiation among gay, bisexual and other men who have sex with men (GBM) in relationships. In a national, online, prospective study of GBM in Australia, we compared sexual behaviours prior to and after PrEP initiation among HIV-negative and unknown-HIV-status men (recruited 2014-2017) not taking PrEP at baseline and who completed at least one six-monthly follow-up by July 2018. Among men in relationships who did not initiate PrEP (n = 339), we compared their most recent survey to their prior one, while among men in relationships who initiated PrEP (n = 81), we compared follow-ups before and after PrEP initiation. Among the 81 PrEP-initiators who were in a relationship both before and after initiation, the proportion reporting their regular partner was on PrEP increased from 8.3 to 44.4% (p < 0.001) and the proportion reporting receptive CLAIC increased from 27.2 to 44.4% (p = 0.009). Overall, men who initiated PrEP were more likely to be in a relationship with a partner on PrEP, and it appeared they started PrEP around the same time. Receptive CLAIC also became more common., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: In response to the novel coronavirus disease (COVID-19) pandemic, Australia introduced public health and physical distancing restrictions in late March 2020. We investigated the impact of these restrictions on HIV preexposure prophylaxis (PrEP) use among Australian gay and bisexual men (GBM)., Methods: Participants in an ongoing online cohort study previously reported PrEP use from 2014 to 2019. In April 2020, 847 HIV-negative and untested participants completed questionnaires assessing changes in PrEP use as a result of COVID-19 public health measures. Binary logistic multiple regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) to compare changes in PrEP use behaviors., Results: Among 847 men, mean age was 44.1 years (SD: 12.7). PrEP use rose from 4.9% in 2015 to 47.2% in 2020. Among those, 41.8% (n = 167) discontinued PrEP use during COVID-19 restrictions. Discontinuing PrEP during COVID-19 restrictions was independently associated with being less likely to have recently tested for HIV (aOR: 0.17; 95% CI: 0.09 to 0.34; P < 0.001) and less likely to report sex with casual partners (aOR: 0.28; 95% CI: 0.14 to 0.54; P < 0.001)., Conclusions: By April 2020, following the introduction of COVID-19 restrictions, GBM dramatically reduced PrEP use, coinciding with a reduction in sexual activity. Longer-term impacts of COVID-19 restrictions on sexual behaviors among GBM need to be monitored because they may foreshadow fluctuations in prevention coverage and risk of HIV infection. Our findings indicate a potential need for clear, targeted information about resumption of PrEP and on-demand optimal dosing regimens in response to ongoing changes in restrictions.

Introduction: In March 2020, Australian state and federal governments introduced physical distancing measures alongside widespread testing to combat COVID-19. These measures may decrease people's sexual contacts and thus reduce the transmission of HIV and other sexually transmissible infections (STIs). We investigated the impact of physical distancing measures due to COVID-19 on the sexual behavior of gay and bisexual men in Australia., Methods: Between April 4, 2020, and April 29, 2020, 940 participants in an ongoing cohort study responded to questions to measure changes in sexual behaviors during the COVID-19 pandemic. Men reported the date they become concerned about COVID-19 and whether they engaged in sexual behavior with regular or casual partners or "fuckbuddies" in the 6 months before becoming concerned about COVID-19 (hereafter referred to as "before COVID-19"), and following the date, they become concerned about COVID-19 (hereafter referred to as "since COVID-19"). Before and since COVID-19 was based on individual participants' own perceived date of becoming concerned about COVID-19., Results: The mean age of was 39.9 years (SD: 13.4). Most participants (88.3%) reported sex with other men during the 6 months before COVID-19. Of the 587 men (62.4%) who reported sex with casual partners before COVID-19, 93 (15.8%) continued to do so in the period since COVID-19, representing a relative reduction of 84.2%., Conclusion: Gay and bisexual men in Australia have dramatically reduced their sexual contacts with other men since COVID-19. These behavioral changes will likely result in short-term reductions in new HIV and STI diagnoses. If sexual health screenings are undertaken before resuming sexual activity, this could present a novel opportunity to interrupt chains of HIV and STI transmission.

Background: Men who have sex with men in Australia are currently ineligible to donate blood (are "deferred") for 12 months since last oral or anal sexual contact with another man. In Australia and overseas, there has been limited research on attitudes and perceptions related to blood donation in this population., Study Design and Methods: Questions on blood donation histories and attitudes toward the deferral policy were included in the questionnaire of an online prospective cohort of gay and bisexual men (GBM) living in Australia., Results: In 2018, 1595 GBM responded to the survey. In this sample, 28.7% reported previously donating blood. Among the remaining men who had never donated blood, 64.5% expressed an interest in doing so. Nearly all men indicated they were not willing to abstain from sex with another man for 12 months in order to donate, and the vast majority believed the rule was unfair, too strict, and homophobic. Three-quarters (77.7%) said that if the policy changed, they would likely donate blood. Age and openness about one's sexuality were independently associated with one's willingness to donate blood in the absence of the deferral., Conclusion: There was a high level of willingness and desire to donate blood among GBM. However, rather than abstaining from sex in order to donate, many men comply with the deferral policy and do not donate. A less conservative deferral policy may increase donations from GBM., (© 2020 AABB.)

Use of crystal methamphetamine (crystal) among gay and bisexual men (GBM) has been associated with condomless anal intercourse with casual partners (CLAIC) and HIV infection. Pre-exposure prophylaxis (PrEP) and undetectable viral load (UVL) are important biomedical HIV prevention strategies. We investigate the relationship between crystal use and HIV sexual risk behaviours in the context of PrEP and UVL. In 2018, 1367 GBM provided details about crystal use and HIV prevention strategies. Binary logistic regression was used to estimate associations between crystal use and behaviour. Recent crystal use was independently associated with greater social engagement with gay men and having more sexual partners. Crystal use was also independently associated with use of PrEP and UVL among GBM who engaged in CLAIC. Although GBM who used crystal were more likely to have engaged in CLAIC, they were also more likely to use biomedical HIV prevention which mitigates against the risks of HIV infection.

Background: Many gay and bisexual men (GBM) experience HIV anxiety, particularly around condomless anal intercourse. HIV pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy that may reduce HIV anxiety among GBM., Methods: The Following Lives Undergoing Change (Flux) Study is a national, online, open-prospective observational study of licit and illicit drug use among GBM in Australia. In 2018, participants responded to newly included items regarding anxiety about HIV transmission. Stratifying GBM as high or low risk as determined by the Australian PrEP Guidelines, we assess whether PrEP use is associated with lower levels of HIV anxiety. Multivariate logistic regression was used to compare factors associated with PrEP use among GBM at high risk (PrEP-eligible) and low risk (PrEP-ineligible) of HIV infection. Results are reported as adjusted odds ratios and corresponding 95% confidence intervals., Results: Among 1547 men, the mean age was 37.1 years (SD 13.1). Men aged 25 years or younger had higher HIV anxiety scores than older men. Among PrEP-eligible men, men who use PrEP reported lower levels of HIV anxiety (adjusted odds ratio = 0.92; 95% confidence interval = 0.87 to 0.99; P < 0.001). No differences were observed on HIV anxiety among PrEP-ineligible men., Conclusions: Among PrEP-eligible men, PrEP use was independently associated with lower levels of HIV anxiety. In addition to avoiding HIV infection, PrEP use may help reduce anxiety among men at risk of HIV. This feature of PrEP could be promoted as part of demand creation initiatives to increase PrEP uptake.

Background and Aims: Gay, bisexual and other men who have sex with men (GBM) use alkyl nitrites ('poppers') at higher rates than other populations to functionally enhance sexual experiences. Their use has been associated with HIV sexual risk behaviours including receptive anal sex. We investigate the prevalence, frequency, and motivations for poppers use and their relationship with HIV risk. We also discuss the implications of the recent scheduling changes to poppers by the Australian Therapeutic Goods Administration., Methods: Data were drawn from the Following Lives Undergoing Change (Flux) study, a prospective observational study of licit and illicit drug use among GBM. Between 2014 and 2018, 3273 GBM enrolled in the study. In 2018, 1745 GBM provided data relating to frequency of and motivations for poppers use and were included in this analysis., Results: Median age was 33 years (IQR 25-46) and 801 GBM (45.9%) had used poppers in the previous six months ('recent use'). Among these men, 195 (24.3%) had used them weekly or more frequently. Most recent users (77.4%) reported using poppers for a 'buzz' during sex or to facilitate receptive anal intercourse (60.8%). The majority (57.7%) of HIV-negative men reporting recent poppers use were concurrently taking HIV pre-exposure prophylaxis. Recent poppers use was independently associated with receptive anal intercourse with casual partners (aOR 1.71; 95%CI 1.35-2.16) and chemsex (aOR 4.32; 95%CI 3.15-5.94). Poppers use was not associated with anxiety, depression, or drug-related harms. Only 15.4% of current users indicated they would stop using poppers if they were criminalised; 65.0% said they would 'find other ways' to obtain them., Conclusions: Poppers are commonly used by Australian GBM to functionally enhance sexual experiences, particularly to facilitate receptive anal intercourse. Few men experienced drug-related harms from poppers use. Regulatory changes must ensure potential harms from popper use are minimised without increasing barriers to access or perpetuating stigma., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: New Zealand has experienced a rise in HIV diagnoses in recent years and new interventions are required to address this., Methods and Analysis: NZPrEP (A demonstration project of HIV preexposure prophylaxis in Aotearoa New Zealand) is an open-label, single-arm treatment evaluation study to investigate feasibility, retention, adherence, and clinical and behavioural outcomes of HIV pre-exposure prophylaxis (PrEP) provision to gay and bisexual men (GBM) in a publicly funded secondary sexual health service in Auckland, New Zealand. The sample size is 150 GBM. Inclusion criteria were specific behavioural risk factors indicating an increased risk of HIV infection. Exclusion criteria were hepatitis B infection, any medical contraindications to prescribing tenofovir/emtricitabine or factors limiting ability to adhere to the study protocol. Eligible participants will be screened for HIV and other sexually transmissible infections (STIs) and for any medical contraindications to PrEP, and enrolled for a maximum follow-up period of 96 weeks. They will be required to attend for 3-monthly testing for HIV and STIs and monitoring for renal and liver toxicity. Participants will also be required to complete an online behavioural survey after each study visit. The outcomes of interest are feasibility of PrEP provision in a sexual health clinic setting, PrEP acceptability, and adverse medical and behavioural effects of PrEP. The study sample is limited to 150 participants due to funding and service constraints. Statistical analysis of all primary and secondary outcomes will be performed using Stata V.14 at the University of Auckland. Results for primary and secondary endpoints will be reported after the conclusion of the study in March 2019., Ethics and Dissemination: The study was approved by the Health and Disability Ethics Committee on 15 September 2016 (16/NTA/112). Key findings will be submitted to peer-reviewed journals. A summary report will be circulated to the study and community stakeholders, and to the Auckland District Health Board, Ministry of Health and Pharmac., Trial Registration Number: ACTRN12616001387415; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Kenyon (2019) is correct to suggest that there is limited evidence of longer term effectiveness.[...].

Gonorrhea is a major global public health problem with emergence of multiple drug-resistant strains with no effective vaccine. This retrospective cohort study aimed to estimate the effectiveness of the New Zealand meningococcal B vaccine against gonorrhea-associated hospitalization. The cohort consisted of individuals born from 1984 to 1999 residing in New Zealand. Therefore, it was eligible for meningococcal B vaccination from 2004 to 2008. Administrative datasets of demographics, customs, hospitalization, education, income tax, and immunization were linked using the national Integrated Data Infrastructure. The primary outcome was hospitalization with a primary diagnosis of gonorrhea. Cox's proportional hazards models were applied with a Firth correction for rare outcomes to generate estimates of hazard ratios. Vaccine effectiveness estimates were calculated as 1-Hazard Ratio expressed as a percentage. There were 1,143,897 eligible cohort members with 135 missing information on gender, 16,245 missing ethnicity, and 197,502 missing deprivation. Therefore, only 935,496 cohort members were included in the analysis. After adjustment for gender, ethnicity, and deprivation, vaccine effectiveness (MeNZB™) against hospitalization caused by gonorrhea was estimated to be 24% (95% CI 1⁻42%). In conclusion, the data suggests vaccination with MeNZB™ significantly reduced the rate of hospitalization from gonorrhea. This supports prior research indicating possible cross protection of this vaccine against gonorrhea acquisition and disease in the outpatient setting.

HIV pre-exposure prophylaxis (PrEP) is a daily pill that prevents HIV acquisition. In March 2018, New Zealand became one of the first countries in the world to publicly fund PrEP for individuals at high risk. PrEP promises significantly improved HIV control but is unfamiliar to most health practitioners here, compromising its potential. In this article we review the rationale for PrEP and identify barriers to rapid implementation. The latter include: consumer and health practitioner awareness; acceptability; scale-up targets; prescribing and pharmacy bottlenecks; service capacity to manage follow-up; primary care training; monitoring systems for uptake and quality; equity; eligibility; risk compensation and policy. Many of these areas are ripe for research and innovation. By addressing these obstacles we can realise the potential of PrEP and move closer to ending HIV in Aotearoa/New Zealand., Competing Interests: Gilead Sciences has funded study medication, extra laboratory costs and a research nurse on the separate NZPrEP demonstration project at Auckland Sexual Health Service (lead PI Dr Azariah). PHARMAC has provided salary support for behavioural analysis on NZPrEP (Dr Saxton).

Introduction and Aims: Data are lacking on drug use among gay and bisexual men (GBM) in New Zealand. We establish a baseline estimate of drug use and investigate associations with sexual health and HIV risk., Design and Methods: A cross-sectional survey of GBM was conducted in gay community settings and online. Participants were asked their frequency of using nine drugs (poppers, cannabis, ecstasy, methamphetamine, amphetamine, cocaine, LSD, gamma hydroxybutyrate and ketamine) in the previous 6 months. We examined associations between selected drugs and number of recent partners, unprotected anal intercourse with a casual partner and sexually transmitted infections using adjusted odds ratios (AOR)., Results: Overall, 3211 participants provided information of whom 55.8% reported any drug use, and 37.9% cannabis, 36.7% poppers, 16.5% ecstasy, 10.5% amphetamine, 7.4% methamphetamine, 6.6% LSD, 6.1% cocaine, 5.3% gamma hydroxybutyrate and 4.4% ketamine use. A quarter of all respondents (25.6%) reported using one drug, 22.8% two to four and 7.4% five or more drugs (polydrugs). Methamphetamine and polydrug use was independently predictive of reporting >20 recent partners (AOR 1.6 and 7.0, respectively), unprotected anal intercourse with a casual partner (AOR 1.8 and 3.2, respectively) and a sexually transmitted infection (AOR 1.6 and 4.3, respectively)., Discussion and Conclusions: Drug use was common in this sample of GBM. Polydrug and methamphetamine users had especially high sexual health needs, but risks remained elevated among GBM consuming other drugs. Drug harm reduction programs and HIV prevention should target GBM with problematic drug use. Limitations include an inability to attribute causation. [Saxton P, Newcombe D, Ahmed A, Dickson N, Hughes A. Illicit drug use among New Zealand gay and bisexual men: Prevalence and association with sexual health behaviours. Drug Alcohol Rev 2017;00:000-000]., (© 2017 Australasian Professional Society on Alcohol and other Drugs.)

Background: Gonorrhoea is a major global public health problem that is exacerbated by drug resistance. Effective vaccine development has been unsuccessful, but surveillance data suggest that outer membrane vesicle meningococcal group B vaccines affect the incidence of gonorrhoea. We assessed vaccine effectiveness of the outer membrane vesicle meningococcal B vaccine (MeNZB) against gonorrhoea in young adults aged 15-30 years in New Zealand., Methods: We did a retrospective case-control study of patients at sexual health clinics aged 15-30 years who were born between Jan 1, 1984, and Dec 31, 1998, eligible to receive MeNZB, and diagnosed with gonorrhoea or chlamydia, or both. Demographic data, sexual health clinic data, and National Immunisation Register data were linked via patients' unique personal identifier. For primary analysis, cases were confirmed by laboratory isolation or detection of Neisseria gonorrhoeae only from a clinical specimen, and controls were individuals with a positive chlamydia test only. We estimated odds ratios (ORs) comparing disease outcomes in vaccinated versus unvaccinated participants via multivariable logistic regression. Vaccine effectiveness was calculated as 100×(1-OR)., Findings: 11 of 24 clinics nationally provided records. There were 14 730 cases and controls for analyses: 1241 incidences of gonorrhoea, 12 487 incidences of chlamydia, and 1002 incidences of co-infection. Vaccinated individuals were significantly less likely to be cases than controls (511 [41%] vs 6424 [51%]; adjusted OR 0·69 [95% CI 0·61-0·79]; p<0·0001). Estimate vaccine effectiveness of MeNZB against gonorrhoea after adjustment for ethnicity, deprivation, geographical area, and sex was 31% (95% CI 21-39)., Interpretation: Exposure to MeNZB was associated with reduced rates of gonorrhoea diagnosis, the first time a vaccine has shown any protection against gonorrhoea. These results provide a proof of principle that can inform prospective vaccine development not only for gonorrhoea but also for meningococcal vaccines., Funding: GSK Vaccines., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Aim: To investigate whether changes in rates of genital warts diagnosis at Auckland Sexual Health Service (ASHS), pre and post the quadrivalent human papillomavirus (4vHPV) vaccine introduction in late 2008, differed between clients vaccine-eligible and not eligible., Method: All new clients attending ASHS from 2007 to 2013 were categorised as having genital warts or not. Generalised linear mixed models were used to compare differences in rates of change in diagnoses., Results: Overall, 43,480 were seen with genital warts diagnosed in 13.1%. The difference in rate of change over time in diagnosis pre- to post-vaccine differed in females vaccine-eligible to not (p=0.004). The relative risk of diagnosis per year pre-vaccine was 0.98 (0.84, 1.13) and post-vaccine 0.77 (0.74, 0.81) in those eligible compared to 0.87 (0.80, 0.95) and 0.95 (0.91, 0.98), respectively, in those not eligible. This difference in change, between vaccine eligible or not, differed between males and females (p=0.02), with males considered eligible if the same aged female would have been. In males, no difference in rate change pre- to post-vaccine could be shown in those eligible or not (p=0.53)., Conclusion: In this study a population effect for women of the 4vHPV vaccine was demonstrated., Competing Interests: Dr Oliphant reports a grant from Seqirus, following the completion of the study.

Objectives: Our objectives were to investigate demographic and behavioural factors associated with condom use and to examine how habitual condom use was across partner types and sexual positions among younger men who have sex with men (YMSM), aged 16-29, surveyed in New Zealand., Methods: We analysed the 2006-2011 national HIV behavioural surveillance data from YMSM who reported anal intercourse in four scenarios of partner type and sexual position: casual insertive, casual receptive, regular insertive and regular receptive. For each, respondents' condom use was classified as frequent (always/almost always) or otherwise, with associated factors identified with multivariate mixed-effect logistic regression. Habitual condom use across scenarios was examined using a latent variable technique that estimated the intraclass correlation coefficient (ICC)., Results: Frequent condom use was reported for 63.6% of 5153 scenarios reported from 2412 YMSM. Frequent use increased from boyfriend to fuckbuddy to casual partners. Infrequent use was associated with online recruitment, Pacific ethnicity, less education, HIV positivity, sex with women, having ≥20 sexual partners versus 1 and reporting insertive and receptive sexual positions. Frequent condom use was associated with having two to five sexual partners versus one and shorter regular partnerships. The ICC=0.865 indicated highly habitual patterns of use; habitual infrequent condom use was most prevalent with regular partners (53.3%) and habitual frequent condom use was most prevalent with casual partners (70.2%) and for either sexual position (50.5% and 49.1%)., Conclusions: Habitual condom use among YMSM highlights the value of early, engaging and sustained condom promotion. Public health should provide better and more compelling condom education, training and promotion for YMSM., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

During 2012, Christchurch experienced a dramatic increase in cases of infectious syphilis among men who have sex with men. This was accompanied by some novel trends; notably, the acquisition of infection in a younger age group, with local sexual contacts, commonly via the use of social media. This study is a report on an approach to case identification and public health communication as a component of a multifaceted outbreak response. Enhanced syphilis surveillance data on public health responses to outbreaks of sexually transmissible infections was collated and reviewed, alongside clinical records and literature. Reported outbreak response methods were adapted for the Christchurch cohort. A Facebook page was created to raise awareness of infectious syphilis, the importance of screening and where to get tested. Twenty-six males were diagnosed with infectious syphilis in 2012, an increase from previous years, of which 22 reported only male sexual contact. High use of social media used to find potential sexual contacts was reported. Enhanced syphilis surveillance characterised in detail an infectious syphilis outbreak in Christchurch. Index cases were identified, contact tracing mapping was used to identify transmission networks and social media was also used to educate the risk group. There was a decrease in infectious syphilis presentations, with no cases in the last 3 months of 2012.

Objectives: To determine the incidence of self-reported sexually transmitted infections (STIs) and sexual health checks in community and internet samples of New Zealand gay, bisexual and other men who have sex with men (MSM) and factors associated with these., Methods: We analysed anonymous self-completed data from 3138 MSM who participated in the location-based Gay Auckland Periodic Sex Survey (GAPSS) and the internet-based Gay Online Sex Survey (GOSS) undertaken in February 2011., Results: Overall 8.2% of the participants reported at least one STI in the previous 12 months, which did not differ significantly by demographic factors or HIV status. While having anal sex and more partners were associated with more STI, after adjustment for the number of partners, the type of partner (regular or casual) was not. Medium and low condom users reported STIs more than high condom users, regardless of partner type. Overall 40% had a sexual health check-up without an STI diagnosed in the past year, with similar numbers attending general practice and sexual health clinics. Having a check-up was lower among Pacific and Asian men, those identifying as bisexual and recruited online. While those with more partners, having anal intercourse and diagnosed with HIV were more likely to go for a check-up, those using condoms less often were not., Conclusions: STIs are commonly reported in this community sample of MSM but will underestimate the true incidence due to asymptomatic infection. Screening for STIs outside sexual health clinics should be normalised for MSM and made accessible, safe and relevant., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Repeated behavioural surveillance should sample all epidemiologically relevant subgroups to provide a complete picture of trends in HIV risk behaviours. Web-based recruitment has been mooted but little empirical data exist on country experiences. We describe who is omitted from three rounds of a conventional offline-only surveillance programme among men who have sex with men (MSM) 2006-2011, but recruited subsequently on Internet dating sites, and the implications of this for understanding trends. The latter were younger, less gay identified and less gay community attached. Importantly, they reported different partnering patterns, lower condom use with casual and fuckbuddy-type male partners, and lower rates of HIV testing, compared to MSM routinely captured in offline surveillance. The replacement of offline socio-sexual activity by the Internet among many MSM means that current venue-based surveillance systems may underestimate risk behaviours, overlook trends among unsampled online MSM, and misinterpret trends observed in sampled MSM due to "sample drift" of most-at-risk MSM.

Eribulin mesylate (E7389), a tubulin and microtubule inhibitor, has been approved to treat metastatic breast cancer in certain patient populations. A liposomal formulation of E7389, E7389-LF, aims to increase the therapeutic profile of E7389. As determining the free drug concentration is crucial for the assessment of efficacy and toxicity of liposomal drug, in this study, an ultracentrifugation method coupled with LC-MS/MS was developed to separate the free E7389 from liposomal and protein bound E7389. The pharmacokinetics of the free E7389 after dosing either E7389 or E7389-LF was characterized. The concentration ratio of E7389 in ultracentrifuged mice plasma (UCM) vs E7389 in plasma after a 2mg/kg i.v. of E7389 ranged from 54.19% to 65.41%, which was similar to the free fraction in the mouse plasma. The respective concentration ratio of E7389 in UCM vs E7389 in plasma after a 2mg/kg i.v. of E7389-LF ranged from 0.07% to 0.59%, and the exposure, expressed as AUC, of UCM/plasma ratio was determined to be 0.2%. Pharmacokinetic modeling was performed to estimate the release kinetics of E7389 from E7389-LF, and the release was best described by a first order rate constant k(rel) 0.078 h(-1). Sensitivity analysis demonstrated that further decrease the release rate constant by adjusting liposome formulation would lead to decreased C(max) and much longer half-life of UCM E7389, which might result in better efficacy and lower toxicity., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Annual population-based estimates of the number of men who have sex with men (MSM) with diagnosed HIV infection (HIV prevalence pool), and the proportion of all MSM this represents (HIV prevalence), have been insufficiently described over the long term. We investigated the dynamic effects of ongoing HIV diagnoses, lower mortality due to treatment and growth in the MSM population over time on these two epidemic indicators using national HIV/AIDS surveillance data in New Zealand, 1985-2009. The diagnosed HIV prevalence pool rose 79% between 1989 and 1999, and 137% between 1999 and 2009. Estimates of diagnosed HIV prevalence as a proportion of MSM were 0.2% of MSM in 1985, and were between 1.5% and 5.0% of MSM by 2009. New Zealand continues to have a relatively low-prevalence HIV epidemic among MSM; however, the number of MSM living with diagnosed infection is growing rapidly 25 years after HIV testing was introduced.

Eribulin mesylate is a newly approved treatment for locally advanced and metastatic breast cancer. We targeted oral bioavailability and efficacy against multidrug resistant (MDR) tumors for further work. The design, synthesis and evaluation of novel amine-containing analogs of eribulin mesylate are described in this part. Attenuation of basicity of the amino group(s) in the C32 side-chain region led to compounds with low susceptibility to PgP-mediated drug efflux. These compounds were active against MDR tumor cell lines in vitro and in xenograft models in vivo, in addition to being orally bioavailable., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Novel second generation analogs of eribulin mesylate, a tubulin agent recently approved for the treatment of breast cancer, are reported. Our recent efforts have focused on expanding the target indications for this class of compounds to other tumor types. Herein, we describe the design, synthesis and evaluation of eribulin analogs active against brain tumor cell lines in vitro and corresponding brain tumor models in mice. Attenuation of basicity of the amino group(s) in the C32 side-chain region led to compounds with lower susceptibility to P-gp mediated drug efflux, allowing these compounds to permeate through the blood-brain barrier. In preclinical in vivo studies, these compounds showed significantly higher levels in the brain and cerebrospinal fluid as compared to eribulin. In addition, analogs within this series showed antitumor activity in an orthotopic murine model of human glioblastoma., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

An LC/MS/MS method was developed to quantify carboplatin and eribulin mesylate (E7389) in human plasma and urine. For carboplatin, sample clean-up by protein precipitation and supernatant injection into a Waters Spherisorb((R)) S5 SCX column was used. Liquid-phase extraction and reverse-phase chromatography on a Polaris C18 column were used for eribulin. Quantitation involved LC/MS/MS with positive electrospray ionization. Accuracy, precision, linearity, range, specificity, recovery and stability were also evaluated. Both compounds were stable in human plasma (>or=80 days at -80 degrees C), at room temperature (>or=4h), following three freeze-thaw cycles and in 50/50 methanol/H(2)O (<4 degrees C for >or=252 days).

Laulimalide is a cytotoxic natural product isolated from marine sponges. It is structurally distinct from taxanes. However, like paclitaxel, laulimalide binds to tubulin and enhances microtubule assembly and stabilization. It exhibits potent inhibition of cellular proliferation with IC50 values in the low nM range against numerous cancer cell lines. In contrast to paclitaxel, however, laulimalide is also very potent against multidrug-resistant (MDR) cancer cell lines which overexpress P-glycoprotein (PgP). It has unique structural and biological properties, and attempts at synthesis have attracted considerable effort in recent years, resulting in more than ten published total syntheses. Despite this extensive attention, there have been no reported in vivo evaluations of laulimalide to date, probably due to the structural complexity of laulimalide and the scarcity of natural material. In our studies to explore the therapeutic potential of laulimalide, a total synthesis capable of producing gram quantities of laulimalide was designed, which enabled both in vitro and in vivo evaluation. Our in vitro results with synthetic material confirmed the previous reports that laulimalide is a mitotic blocker that can inhibit the growth of a variety of both non-MDR and MDR human cancer cell lines. However, despite demonstrating promise in cell-based and pharmacokinetic studies, laulimalide exhibited only minimal tumor growth inhibition in vivo and was accompanied by severe toxicity and mortality. The unfavorable efficacy to toxicity ratio in vivo suggests that laulimalide may have limited value for development as a new anticancer therapeutic agent.

Aim: This paper characterises the health and wellbeing of HIV-positive people in New Zealand., Methods: The HIV Futures New Zealand Survey is a self-complete anonymous questionnaire distributed in a variety of ways. Data were collected on health, clinical, and social variables., Results: There were 226 responses, estimated to be approximately 25% of the HIV positive population. Respondents were aged between 18 and 68, and 56% were homosexual men. Most (68%) reported a viral load on most recent test of below 500 copies/mL and 59% had a CD4 lymphocyte count on most recent test of over 250 cells/mcL. However, 28% reported a major health condition in addition to HIV and 21% had a mental health condition. Most respondents (64%) were currently using antiretroviral therapy. Many (84%) knew other people with HIV and had contact with an HIV/AIDS organisation (77%). Forty-two percent of respondents had stopped working because of HIV, and 47% reported their main source of income as a Government benefit., Conclusions: This research has demonstrated that, while the HIV-positive population of New Zealand generally has improved health as a result of antiretroviral therapy, there are still significant social and economic barriers to their quality of life.

The pharmacokinetics of a series of novel cyclic, non-peptide inhibitors of HIV protease were studied in rats or dogs after intravenous and oral administration. Six symmetrically substituted cyclic urea compounds (XK234, XM311, XM320, XM321, XM323, and XM412), which effectively inhibited HIV virus replication, with IC90 values of 0.03-1.0 microM (0.017-0.76 microgram mL-1), were evaluated. Plasma concentrations were measured in rats and dogs using specific and sensitive HPLC methods. In rats, the maximum plasma concentrations of 0.21-1.88 micrograms mL-1 were detected within 1 h of oral administration of 10 mg kg-1 of the compounds. The elimination half-lives ranged from 1.25 to 3.3 h in rats and the absolute oral bioavailability ranged from 18 to 100%. In dogs, the maximum plasma concentration and absolute oral bioavailability were 4.37 micrograms mL-1 and 48%, 1.07 micrograms mL-1 and 16%, and 1.48 mg ML-1 and 38% for XK234, XM311, and XM323, respectively. The data demonstrated that the maximum plasma concentrations of these cyclic ureas were several times higher than the IC90 for inhibition of viral replication after single doses of 10 mg kg-1 in rats and dogs. With this combination of high potency against virus replication and good oral bioavailability, these cyclic ureas represent a new class of compounds that are suitable for development as therapeutic agents for the treatment of HIV-associated diseases.

DMP 323 is a symmetrically substituted cyclic urea compound with demonstrated activity against human immunodeficiency virus (HIV) in vitro. DMP 323 has been measured in rat and dog plasma via liquid-liquid extraction and HPLC. The limit of quantitation is 10 ng/ml using 0.5 ml plasma. Following an intravenous dose of 5 mg/kg to rats, DMP 323 exhibited an apparent volume of distribution at steady-state of 6.36 liters/kg and clearance of 7.12 liters/hr/kg. The same dose administered intravenously to dogs resulted in apparent volume of distribution at steady-state and clearance values of 2.28 liters/kg and 1.48 liters/hr/kg, respectively. Elimination half-lives were 0.95 hr in rats and 1.80 hr in dogs. DMP 323 was rapidly absorbed from oral solution doses in rats (3, 5, and 10 mg/kg) and dogs (5 and 10 mg/kg), achieving maximum plasma concentrations in 1 hr or less in both species. Absolute bioavailability of DMP 323 from oral doses ranged from 15 to 27% in rats and from 37 to 38% in dogs. Pharmacokinetics were unchanged in rats and dogs over 8-day t.i.d. and 5-day b.i.d. multiple oral dose regimens, respectively. Oral doses administered to fed animals resulted in lower plasma concentrations of DMP 323 than the same doses administered to fasted animals. Because of its in vitro high potency and acceptable pharmacokinetics, DMP 323 seems to be a worthy candidate for further study in the effort to develop an inhibitor of HIV protease for use in the therapy of AIDS.

A selective high-performance liquid chromatographic (HPLC) assay for a sigma receptor antagonist, DuP 734 (I), in rat plasma has been developed. Compound I and internal standard, XC031 (I.S.), were first extracted from plasma into an ethyl acetate-toluene mixture (3:7, v/v) and then back-extracted into freshly prepared phosphoric acid (0.03 M). Separation of I and I.S. with no interference from endogenous substances was achieved on a reversed-phase octyl column and detection was by UV at 229 nm. The mobile phase consisted of acetonitrile-glacial acetic acid-triethylamine-0.05 M ammonium acetate (670:4:2:2000, v/v). Using 0.5 ml of rat plasma for extraction, the limit of quantitation was 43 ng/ml and the assay was linear from 43 to 8536 ng/ml. The intra- and inter-day coefficients of variation ranged from 0.7 to 3.0%, and from 1.4 to 14.5%, respectively, over the entire concentration range. The accuracy was within 16.1% of the spiked concentrations. I was stable in frozen plasma at -20 degrees C for at least 68 days.

In flaxedilized cats, visual cortex evoked potentials (VEPs) to an intensity series of brief light flashes were recorded differentially using either a screw over frontal sinus or an insect pin in neck muscle as the reference electrode. At the same time EPs from the cornea (the ERG) and frontal sinus were recorded differentially against the neck muscle electrode. The EP recorded from the frontal sinus screw was a miniature of the ERG recorded from the cornea, with the same latencies and shape as the ERG but only 10-30% of its amplitude. At a fast presentation rate (1/sec) the amplitude of the ERG, and consequently the frontal sinus potential, decreased with increasing intensity of light flash, whereas at a slow presentation rate (1/3 or 1/5 sec) the ERG and frontal sinus potential increased in response to all but the highest intensities. The location of the reference electrode and the rate of light flash presentation had the following effects on visual cortex EP amplitudes. A frontal sinus reference increased the amplitudes of early components (less than 100 msec) of the VEP. Also, VEP amplitudes as a function of flash intensity yielded slopes which tended to be positive at a slow presentation rate and negative at a fast presentation rate. This effect is in accord with the rate dependent slopes of the frontal sinus potential.

To maximize the availability of platelet concentrates (PC) and minimize their outdate, competing criteria, a computer simulation model of platelet production and distribution was developed. Based on 2 years of actual platelet orders placed with a regional blood center, the simulation program generated daily platelet orders, and also calculated mean demand and standard deviation of demand for each day of the week. The number of PC to be produced on a given day was calculated from: PC to be produced = (mean demand for that day of the week) + Tx (standard deviation of demand for that day of the week)-(PC in inventory on the given day), where T is a selected multiple of the standard deviation. As T increases, availability is maximized, but outdating is expected to increase. Conversely, lower T is associated with less availability, but lower outdate. At the simulated platelet demand level (about 735 PC per week), with 3-day platelet storage life, 99% availability is associated with 1% outdate and distribution of PC of less than 1 day average age. 100% availability, with no outdate is predicted for a 5-day storage life, with no further improvement in logistics with 7-day storage life, at this level of demand. Although logistics of platelet production and distribution vary from center to center, the simulation analysis is generally applicable, and a formal plan has the great advantage of predictive, rather than reactive, platelet production.

Following the detection of two cases of leishmaniasis in The Gambia, the possible vectors and animal reservoirs were studied. A total of 5, 158 phlebotomine sandflies, in 20 species and subspecies were captured, including 98 males and 61 females of Phlebotomus duboscqi. This species is a vector of cutaneous leishmaniasis in Senegal and must be suspected as a vector in The Gambia; it was captured close to the dwellings of both patients and from rodent burrows, including those of Mastomys erythroleucus, a known reservoir of cutaneous leishmaniasis in Senegal. We report the first finding in The Gambia of visceral leishmaniasis in a dog captured near the house of the patient with visceral leishmaniasis. This strongly suggests that dogs could be a reservoir of this infection in this area. The vector was not determined.

A repeatable post-soldering technique for a nonprecious alloy has been described. With proper metal design, nonprecious alloy crowns can be soldered in a standard vacuum porcelain furnace. Scanning electron micrographs and EDXA confirm that a good union has taken place between the gold solder and nickel alloy.