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Objectives: Despite a growing HIV threat, there is no definition and characterisation of key populations (KPs), who could be the major drivers of the epidemic in Turkey. We used programmatic mapping to identify locations where KPs congregate, estimate their numbers and understand their operational dynamics to develop appropriate HIV programme implementation strategies.Methods: Female and transgender sex workers (FSWs and TGSWs), and men who have sex with men (MSM) were studied in İstanbul and Ankara. Within each district, hot spots were identified by interviewing key informants and a crude spot list in each district was developed. The spot validation process was led by KP members who facilitated spot access and interviews of KPs associated with that spot. Final estimates were derived by aggregating the estimated number of KPs at all spots, which was adjusted for the proportion of KPs who visit multiple spots, and for the proportion of KPs who do not visit spots.Results: FSWs were the largest KP identified in İstanbul with an estimate of 30 447 (5.8/1000 women), followed by 15 780 TGSWs (2.9/1000 men) and 11 656 MSM (2.1/1000). The corresponding numbers in Ankara were 9945 FSWs (5.2/1000 women), 1770 TGSWs (1/1000 men) and 5018 MSM (2.5/1000 men). Each KP had unique typologies based on the way they find and interact with sex partners. MSM were mostly hidden and a higher proportion operated through internet and phone-based applications. Night time was the peak time with Friday, Saturday and Sunday being the peak days of activity in both İstanbul and Ankara.Conclusions: This study has highlighted the presence of a substantial number of FSWs, TGSW and MSM in İstanbul and Ankara. The information obtained from this study can be used to set priorities for resource allocation and provide HIV prevention services where coverage could be the highest. [ABSTRACT FROM AUTHOR]

Objective: Condom use behaviours are proximal to recent STI increases in the USA, yet it remains unclear whether the use of condoms has changed over time among unmarried, non-cohabiting young men who have sex with women (MSW) and how this variability is influenced by STI risk factors.Methods: To examine condom use over time among MSW aged 15-29, we used three cross-sectional surveys from the 2002, 2006-2010 and 2011-2017 National Survey of Family Growth. We estimated weighted percentages, adjusted prevalence ratios (APRs) and 95% confidence intervals (CI) to assess changes in condom use, stratified by whether MSW reported any STI risk factors in the past 12 months (ie, perceived partner non-monogamy, male-to-male sex, sex in exchange for money or drugs, sex partner who injects illicit drugs, or an HIV-positive sex partner).Results: We observed a divergence in trends in condom use at last sex between men aged 15 -29 with STI risk factors in the past 12 months and those without such history. We saw significant declines in condom use from 2002 to 2011-2017 among men with STI risk factors (APR=0.80, 95% CI 0.68 to 0.95), specifically among those aged 15-19 (APR=0.73, 95% CI 0.57 to 0.94) or non-Hispanic white (APR=0.71, 95% CI 0.54 to 0.93). In contrast, trends in condom use among men with no STI factors remained stable or increased. Across all time periods, the most prevalent STI risk factor reported was perception of a non-monogamous female partner (23.0%-26.9%). Post-hoc analyses examined whether condom use trends changed once this variable was removed from analyses, but no different patterns were observed.Conclusions: While STIs have been increasing, men aged 15-29 with STI risk factors reported a decline in condom use. Rising STI rates may be sensitive to behavioural shifts in condom use among young MSW with STI risk factors. [ABSTRACT FROM AUTHOR]

Objectives: Within the context of rising rates of reportable STIs in the USA, we used national survey data to examine temporal trends in high-risk factors that indicate need for STI/HIV preventive services among key subpopulations with disproportionate STI rates.Methods: We used data from the 2002 (n=12 571), 2006-2010 (n=22 682) and 2011-2015 (n=20 621) National Survey of Family Growth (NSFG). NSFG is a national probability survey of 15-44 year olds living in US households. We examined STI risk factors among sexually active men who have sex with men (MSM) and Hispanic, non-Hispanic black, 15-19 year old, 20-24 year old, and 25-29 year old women who have sex with men (WSM) and men who have sex with women (MSW). Risk behaviours included: received money or drugs for sex, gave money or drugs for sex, partner who injected drugs, partner who has HIV, non-monogamous partner (WSM, MSW only) and male partner who had sex with other men (WSM only). Endorsement of any of these behaviours was recoded into a composite variable focusing on factors indicating increased STI risk (yes/no). We used chi-squares and logistic regression (calculating predicted marginals to estimate adjusted prevalence ratios (aPRs)) to examine STI risk factors over time among the key subpopulations.Results: From 2002 to 2011-2015, reported STI risk factors did not change or declined over time among key subpopulations in the USA. In adjusted analyses comparing 2002 to 2011-2015, we identified significant declines among WSM: Hispanics (aPR=0.84 (0.68-1.04), non-Hispanic blacks (aPR=0.69 (0.58-0.82), adolescents (aPR=0.71 (0.55-0.91) and 25-29 year olds (aPR=0.76 (0.58-0.98); among MSW: Hispanics (aPR=0.53 (0.40-0.70), non-Hispanic blacks (aPR=0.74 (0.59-0.94) and adolescents (aPR=0.63 (0.49-0.82); and among MSM (aPR=0.53 (0.34-0.84).Conclusions: While reported STIs have increased, STI risk factors among key subpopulations were stable or declined. Condom use related to these risk factors, sexual mixing patterns and STI testing should be examined. [ABSTRACT FROM AUTHOR]

Development of efficacious interventions is only the first step in achieving population level impact. Efficacious interventions impact infection levels in the population only if they are implemented at the right scale. Coverage must be prioritised across subpopulations based on the diversity and clustering of infections and risk in society, and expanded rapidly without delay. It is important to prioritise those who are most likely to transmit infection first. [ABSTRACT FROM AUTHOR]

Objectives: To determine how patterns of non-monogamy influence prevalences of sexually transmitted infections (STIs) in individuals and their cohabitating sex partners. METHODS A 2002 survey in 24 Peruvian cities enrolled men and women aged 18-29 years from random household samples. The cohabiting sex partner of each enrolee was also enrolled until approximately 100 couples per city were recruited. Men provided urine and women vaginal swabs or urine for molecular testing for Chlamydia trachomatis and Trichomonas vaginalis; both genders provided blood for serological testing.Results: Among 2099 females and 2052 males providing specimens and behavioural data, 18.2% of males and 2.5% of females reported non-monogamy during the past year. C trachomatis was detected in 121 females (5.8%) and 80 males (4.1%) and T vaginalis in 87 females (4.2%) and 26 males (1.3%). Multivariate analyses showed that C trachomatis infection in females was significantly associated with her male partner's non-monogamy (OR 2.02, CI 1.32 to 3.08) but not significantly with her own non-monogamy; T vaginalis was associated with her own non-monogamy (OR 3.11, CI 1.25 to 7.73) and with her partner's non-monogamy (OR 2.07, CI 1.26 to 3.42). For males, both C trachomatis (OR 2.17, CI 1.29 to 3.69) and T vaginalis (OR 2.49, CI 1.06 to 5.87) were significantly associated only with his own non-monogamy.Conclusions: Among cohabiting couples, male non-monogamy was common and was associated with C trachomatis and T vaginalis infection in himself and in his female partner, whereas female non-monogamy was reported infrequently and was significantly associated only with her own T vaginalis infection. Patterns of non-monogamy may guide public health interventions. [ABSTRACT FROM AUTHOR]

Background and Objectives: Understanding the time course of sexual partnerships is important for understanding sexual behaviour, transmission risks for sexually transmitted infections (STI) and development of mathematical models of disease transmission.Study Design: The authors describe issues and biases relating to censoring, truncation and sampling that arise when estimating partnership duration. Recommendations for study design and analysis methods are presented and illustrated using data from a sexual-behaviour survey that enrolled individuals from an adolescent-health clinic and two STD clinics. Survey participants were queried, for each of (up to) four partnerships in the last 3 months, about the month and year of first sex, the number of days since last sex and whether partnerships were limited to single encounters. Participants were followed every 4 months for up to 1 year.Results: After adjustment for censoring and truncation, the estimated median duration of sexual partnerships declined from 9 months (unadjusted) to 1.6 months (adjusted). Similarly, adjustment for censoring and truncation reduced the bias in relative risks for the effect of age in a Cox model. Other approaches, such as weighted estimation, also reduced bias in the estimated duration distribution.Conclusion: Methods are available for estimating partnership duration from censored and truncated samples. Ignoring censoring, truncation and other sampling issues results in biased estimates. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue, including one on Sexually Transmitted Diseases (STD)/Human Immunodeficiency Virus (HIV) epidemiology and the targets of its prevention.

The article provides a major overview of trends in sexually transmitted infections in the U.S. It reports on the interesting differences between infections, and ethnic and geographic differences which remain stark. Syphilis and gonorrhoea rates among whites and African-Americans are also discussed. It also highlights the future challenges of implementing and evaluating preventive efforts.

An introduction to the journal is presented in which the editors discuss various reports published within the issue, including one on the absolute and relative sizes of key populations in Pakistani cities and the implications for HIV transmission dynamics, one on the efficient allocation of HIV prevention programme resources, and another on the prevalence of HIV among injection drug users in Pakistan.

In this article, the authors describe the Program Science initiative in detail, discuss some of its recent accomplishments and explore its significance and timeliness in light of the HIV prevention challenges. The authors also describe the Program Science series being launched and present a preview of future articles. [ABSTRACT FROM AUTHOR]

The article reports on the expanded use of behavioural interventions to prevent and reduce sexually transmitted infections (STIs) in 2011. Effectivity evidence is reportedly based on self-reported behaviour, the assessment and reporting of which is subject to bias. The article states that specific behaviours like condom use and sexual frequency have limited effect on the chances of acquiring STI and that to achieve impact, behavioural interventions must be mixed correctly at the right scale.

The authors reflect on the issue of inadequate prevention programmes for HIV and other sexually transmitted infections. They suggest that a new paradigm should be considered for proper planning, implementation and evaluation of the programmes. They endorse an approach by J. Parkhurst and colleagues, Program Science, a systematic application to improve programmes and encourage the right strategy in such resolve.

Background Despite remarkable progress in the scientific understanding of the biological characteristics of the pathogens, pathogenesis and immunology, human sexual behaviour and population transmission dynamics, there are still considerable knowledge gaps regarding the heterogeneity and determinants of epidemics of sexually transmitted infections (STI) and HIV. To understand more fully the causes of STI and HIV epidemics it is necessary to reconcile individual and population approaches and bring together sociological and biomedical streams of research. Methods This study examined the implications of approaching the study of STI and HIV epidemics from the perspective that individual and population-level characteristics and interactions result in emergent properties and structural patterns that cannot be easily predicted. In addition to offering examples from the research literature, female sex work is analysed as an example of a complex adaptive system and the implications for STI and HIV epidemics are examined in that context. Results Previous research in this field has provided compelling examples of how the complex interplay of individuals and resulting structural patterns including sexual networks can influence the patterns of emergence and the trajectory of STI and HIV epidemics. Conclusions Approaching the study of STI and HIV epidemics as emergent phenomena arising from complex interactive systems with diverse structural patterns offers a promising avenue for developing a more coherent understanding of these epidemics. It would also promote consilience between sociological, population and biomedical disciplines that could open new vistas for the science of public health. [ABSTRACT FROM PUBLISHER]

Background The concept of concurrent partnerships, while theoretically appealing, has been challenged at many levels. However, non-monogamy may be an important risk factor for the acquisition and transmission of sexually transmitted infections (STI). One's own non-monogamy is a risk factor for transmitting STI to others, partners' non-monogamy is a risk factor for acquiring STI and, most importantly, mutual non-monogamy is a population level determinant of increased STI spread. This study describes the levels, distribution and correlates of non-monogamy, partners' non-monogamy and mutual non-monogamy among adult men and women in the USA. Methods Data from the National Survey of Family Growth (NSFG) Cycle 6 were used. NSFG is a national household survey of subjects aged 15–44 years in the USA. Cochran–Mantel–Haenszel tests and χ tests were used in the analysis. Results Among sexually active adults, 17.6% of women and 23.0% of men (an estimated 19 million) reported non-monogamy over the past 12 months in 2002. An estimated 11 million Americans (1 in 10) reported partners' non-monogamy and an estimated 8.4 million (7% of women and 10.5% of men) reported mutual non-monogamy. All three types of non-monogamy were reported more frequently by men than women. Younger age, lower education, formerly or never married status, living below the poverty level and having spent time in jail were associated with all three types of non-monogamy in general. Conclusions The three types of non-monogamy may be helpful in tailoring prevention messages and targeting prevention efforts to subgroups most likely to spread infection. [ABSTRACT FROM PUBLISHER]

Objective To examine the frequency of three sexual behaviours from the most active to the least active members of the population in various subpopulations using measures of inequality. Methods Data from a US national probability sample of the population aged 15–44 years (National Survey of Family Growth) were used. Gini coefficients and Lorenz curves were calculated in order to examine the concentration of three sexual behaviours: vaginal sex acts (past 4 weeks) and number of opposite-sex partners (past 12 months; lifetime). Analyses were conducted separately for men and women and subpopulations of interest (by age, race/ethnicity, educational level and poverty level). Results The sexual behaviours examined were concentrated within the most active members of the population. This concentration was most pronounced for vaginal sex acts in the past 4 weeks and lifetime opposite-sex partners, with the top 5% of each population accounting for more of the sexual behaviour than the bottom 50% of the population. Sexual behaviours were most concentrated among adolescents, the least educated and the most impoverished. Some subpopulations had similar mean or median numbers of sex acts (or sex partners), but had different degrees of concentration of these behaviours. Finally, the most impoverished men and women had the highest concentration levels for two of the three sexual behaviours (vaginal sex acts, opposite-sex partners in past 12 months). Conclusion Given that sexual behaviours tended to be highly concentrated in subpopulations that are often at the highest risk of sexually transmitted infections, targeted interventions may be the most efficient method to reduce risk in these groups while minimising potential unintended consequences. [ABSTRACT FROM PUBLISHER]

Objectives To examine the distribution of chlamydia, gonorrhoea and syphilis in the USA through the use of Lorenz curves and Gini coefficients. Methods The distribution of three sexually transmitted diseases (STD; chlamydia, gonorrhoea and primary and secondary syphilis) was examined across states and counties in the USA in 2007, based on reported case numbers. Gini coefficients, which can range from 0 (equality in STD rates across geographical units) to 1 (complete inequality such that all STD occur in one geographical unit) were calculated. Results Overall, chlamydia was the most evenly distributed and syphilis was the most concentrated of the three STD examined. The Gini coefficients for chlamydia, gonorrhoea and syphilis were 0.121, 0.255 and 0.334, respectively, when examined across states, and 0.319, 0.494 and 0.630, respectively, when examined across counties. Differences in Gini coefficients were observed when the STD distributions were examined by sex, race/ethnicity and age group. Conclusions The use of Lorenz curves and Gini coefficients can help to assess inequalities in the distribution of STD, to gauge the suitability of geographically targeted interventions, and to help in determining the epidemic phase of STD. Having a better understanding of the disparities in the distribution of STD across states and counties by sex, race/ethnicity and age group might help in understanding why disparities in STD rates exist across different groups and in developing interventions to address these disparities. [ABSTRACT FROM PUBLISHER]

Objectives To examine changes over time in the distribution of primary and secondary syphilis cases across states, using Lorenz curves and Gini coefficients. Methods For each year from 1985 to 2007, the Gini coefficient for the state-level distribution of male and female syphilis cases was calculated. The Gini coefficient can range from 0 (indicating equality in syphilis rates across states) to 1 (indicating complete inequality such that all syphilis cases occur in one state). Results The Gini coefficients for men are notably lower (indicating more equality in the distribution of syphilis across states) in recent years (in which men who have sex with men (MSM) account for most syphilis cases) than in the heterosexual epidemic of the late 1980s and early 1990s. Although syphilis rates in men were similar in 1995 and 2007 (6.7 and 6.6 per 100 000, respectively), the Gini coefficient for male syphilis decreased from 0.523 in 1995 to 0.333 in 2007. For syphilis in women, Gini coefficients have not shown the same degree of decline. Conclusions The spread of MSM syphilis cases to urban areas across the nation is likely to be a main cause of the decreased concentration of male syphilis cases across states from 1995 to 2007. [ABSTRACT FROM PUBLISHER]

The authors reflect on the association between recruitment of sex partners and the causation of sexually transmitted infections (STIs). Results of a survey show indications that sex partner recruitment vary from one place to another and through different channels and it is directly associated with the risk of acquiring STI. Technological developments also paved way to more improved and faster recruitment of sex partners including the Internet and personal advertisement in newspapers.