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When traveling internationally, HIV serodisclosure and knowledge of partners' serostatus were hampered by the lack of a common language. Condomless anal intercourse was less likely to occur in partnerships where HIV serostatus was not disclosed or known. Taken together, these observations suggest that language barriers may affect sexual decision making.

Introduction: The purpose of the study was to measure national prescribing patterns for hydrocodone/acetaminophen among veterans seeking emergency medical care, and to see if patterns have changed since this medication became a Schedule II controlled substance.Methods: We conducted a retrospective cohort study of emergency department (ED) visits within the Veterans Health Administration (VA) between January 2009 and June 2015. We looked at demographics, comorbidities, utilization measures, diagnoses, and prescriptions.Results: During the study period, 1,709,545 individuals participated in 6,270,742 ED visits and received 471,221 prescriptions for hydrocodone/acetaminophen (7.5% of all visits). The most common diagnosis associated with a prescription was back pain. Prescriptions peaked at 80,776 in 2011 (8.7% of visits), and declined to 35,031 (5.6%) during the first half of 2015 (r=‒0.99, p

BackgroundInternational travel poses potential challenges to HIV prevention. A number of studies have observed an association between travel and behavioural disinhibition. In the present study, we assessed differences in sexual behaviour while travelling internationally and within the USA, compared with being in the home environment.MethodsA probability-based sample of men who have sex with men (MSM) from the San Francisco Bay Area who had travelled internationally in the previous 12 months was recruited through an adapted respondent-driven sampling methodology (N=501). Participants completed interviewer-administered, computer-assisted surveys.ResultsDetailed partner-by-partner behavioural data by destination type were collected on 2925 sexual partnerships: 1028 while travelling internationally, 665 while travelling within the USA and 1232 while staying in the San Francisco Bay Area. The proportion of partnerships during international travel that involved unprotected anal intercourse (UAI) was lower compared with during domestic travel and staying locally. International travel was associated with decreased odds of receptive UAI (AOR=0.65, p=0.02) compared with staying locally and there was a trend towards decreased odds of insertive UAI (AOR=0.70, p=0.07).ConclusionsMSM engaged in proportionately fewer sexual activities which present a high HIV transmission risk when travelling internationally, namely unprotected receptive and insertive anal intercourse and particularly with HIV serodiscordant partners. The lower sexual risk-taking during international travel was robust to controlling for many factors, including self-reported HIV serostatus, age, relationship status and type of partnership. These findings suggest that when travelling internationally, MSM may experience behavioural disinhibition to a lesser extent than had been described previously.

IntroductionRespondent-driven sampling (RDS) offers a recruitment strategy for hard-to-reach populations. However, RDS faces logistical and theoretical challenges that threaten efficiency and validity in settings worldwide. We present innovative adaptations to conventional RDS to overcome barriers encountered in recruiting a large, representative sample of men who have sex with men (MSM) who travel internationally.MethodsNovel methodological adaptations for the "International Travel Research to Inform Prevention" or "I-TRIP" study were offering participants a choice between electronic and paper coupons referrals for recruitment and modifying the secondary incentives structure from small cash amounts to raffle entries for periodic large cash prize raffle drawings. Staged referral limit increases from 3 to 10 referrals and progressive addition of 70 seeds were also implemented.ResultsThere were 501 participants enrolled in up to 13 waves of growth. Among participants with a choice of referral methods, 81% selected electronic referrals. Of participants who were recruited electronically, 90% chose to remain with electronic referrals when it was their turn to recruit. The mean number of enrolled referrals was 0.91 for electronic referrals compared to 0.56 for paper coupons. Median referral lag time, i.e., the time interval between when recruiters were given their referrals and when a referred individual enrolled in the study, was 20 days (IQR 10-40) for electronic referrals, 20 days (IQR 8-58) for paper coupons, 20 days (IQR 10-41) for raffle entries and 33 days (IQR 16-148) for small cash incentives.ConclusionsThe recruitment of MSM who travel internationally required maximizing known flexible tools of RDS while at the same time necessitating innovations to increase recruitment efficiency. Electronic referrals emerged as a major advantage in recruiting this hard-to-reach population who are of high socio-economic status, geographically diffuse and highly mobile. These enhancements may improve the performance of RDS in target populations with similar characteristics.