In addition to providing millions of men with lifelong lower risk for HIV infection, voluntary medical male circumcision (VMMC) also provides female partners with health benefits including decreased risk for human papillomavirus (HPV) and resultant cervical cancer (CC).We modeled potential impacts of VMMC on CC incidence and mortality in Uganda as an additional benefit beyond HIV prevention.HPV and CC outcomes were modeled using the CC model from the Spectrum policy tool suite, calibrated for Uganda, to estimate HPV infection incidence and progression to CC, using a 50-year (2018-2067) time horizon. 2016 Demographic Health Survey data provided baseline VMMC coverage. The baseline (no VMMC scale-up beyond current coverage, minimal HPV vaccination coverage) was compared with multiple scenarios to assess the varying impact of VMMC according to different implementations of HPV vaccination and HPV screening programs.Without further intervention, annual CC incidence was projected to rise from 16.9 to 31.2 per 100,000 women in 2067. VMMC scale-up alone decreased 2067 annual CC incidence to 25.3, averting 13,000 deaths between 2018 and 2067. With rapidly-achieved 90% HPV9 vaccination coverage for adolescent girls and young women, 2067 incidence dropped below 10 per 100,000 with or without a VMMC program. With 45% vaccine coverage, the addition of VMMC scaleup decreased incidence by 2.9 per 100,000 and averted 8000 additional deaths. Similarly, with HPV screen-and-treat without vaccination, the addition of VMMC scaleup decreased incidence by 5.1 per 100,000 and averted 10,000 additional deaths.Planned VMMC scale-up to 90% coverage from current levels could prevent a substantial number of CC cases and deaths in the absence of rapid scale-up of HPV vaccination to 90% coverage.
In Brief Background: Episodic acyclovir therapy has been added to genital ulcer disease (GUD) syndromic management guidelines in several sub-Saharan African countries with human immunodeficiency virus (HIV) epidemics. We examined the correlates of health care seeking in men with GUD and its relationship to HIV-1 and herpes simplex virus type 2 outcomes. Methods: Men with GUD (n = 615) were recruited from primary health care clinics in Gauteng province, South Africa for a randomized controlled trial of episodic acyclovir therapy. We used baseline survey and sexually transmitted infection/HIV-testing data to examine delay in health care seeking (defined as time from ulcer recognition to baseline study visit). Results: Median delay in health care seeking for GUD was 5 days, and one-quarter of men had previously sought care for the current ulcer. Previous care seekers were older, had more episodes of ulceration in the past year, and were more likely to test seropositive for HIV-1 and HSV-2. Delay in health care seeking was significantly associated with age, education level, and sex during the ulceration episode. Delays in care seeking were related to poorer HIV-1 outcomes; these findings were valid after controlling for advanced HIV. Conclusions: Interventions to help shorten the duration between ulcer recognition and health care seeking for men with GUD are needed. In a study of men with genital ulcer disease in South Africa, delays in care seeking were associated with sex during ulceration and poorer human immunodeficiency virus 1 outcomes.
Background About 19 million new STDs occur each year in the USA, almost half of which are among youth. Lack of information, misconceptions and stigma prevent many from getting tested. To normalise conversations around sexual health and destigmatize testing, the GYT Campaign was launched in April 2009, with the goal of promoting STD testing among youth ages 15–25 years. Methods GYT was developed as part of It's Your (Sex) Life, a public information partnership of MTV and the Kaiser Family Foundation, together with the Centers for Disease Control and Prevention and Planned Parenthood Federation of America (PPFA). The campaign uses on-air, online, on-the-ground, and mobile components to increase STD testing and spark an empowering youth movement. It has expanded each year, reaching over 4,000 health centers nationwide, including school- and college-based health centers. Efforts to evaluate the campaign's reach and impact include media/materials tracking, national surveys, patient intake surveys at partnering clinics and schools, and the monitoring of STD test/positivity rates. Results At campaign launch, GYT was among the most-searched terms on Google, the most-tweeted terms on Twitter, and the most discussed videos on YouTube. As of January 2010, GYT had produced >60 public service ads and original programs, airing 3200 times on MTV stations (18 h of airtime), and had 1.5 million visitors to www.itsyoursexlife.com . A national survey suggests that campaign awareness among teens (13–19 years; n=766) reached 18% in 2010, with 10–20% reporting that they talked to a friend (21%), family member (18%), partner (11%) or provider (17%) about STDs/testing; and 10% reporting having visited a doctor as a result of the campaign. Available data from participating PPFA clinics revealed a 71% increase in patients presenting for STI testing from April 2008 (pre-campaign) to April 2010, with a 25% increase from April 2009–2010. Chlamydia positivity was 6% among women and 9% among men during campaign promotion periods, indicating that GYT did not simply motivate the worried well. Conclusions Research suggests that GYT is effectively reaching youth and impacting sexual-health discussions and STD-testing behaviours. The public-private partnership may serve as a model for other sexual health promotion programs. Creative ways for mobilising youth and lessons learnt about campaign branding, celebrity recruitment, and evaluation will be shared.
Background Several common global definitions of sexual health refer to physical, emotional and social well-being, with respect to sexuality, and also to the need for this well-being to be reflected for all individuals in relationships. How well sexual health definitions fit US youths’ attitudes to sexual health, and associations between these attitudes, sexual behaviours and sexual health care were assessed. Methods: In total, 4017 youth aged between 15 and 25 years via an online survey panel, weighted to be representative of the US population, were surveyed. Respondents reported their attitudes towards seven dimensions of sexual health that we abstracted from existing global definitions (emotional fulfillment, social connectedness, spirituality, overall pleasure, physical intimacy, mental fulfillment, reciprocal benefits). Respondents also reported on sexual health-related discussions with partners, sexual behaviours, and their use of sexual health care. Outcomes through weighted frequency estimates and ordinal regression models were reported. Results: Youth generally construed all seven dimensions as important to sexual health, with the emotional dimension rated most favourably. Attitudes to the dimensions of overall pleasure, physical intimacy and spirituality were most consistently related to sexual health discussions and behaviours. The behaviours most consistently related to sexual health attitudes were going for a sexual health check-up, discussing birth control/pregnancy and discussing risk before sex without a condom. Conclusions: Youth construal of sexual health fits well with global sexual health definitions. Attitudes to dimensions of sexual health were related to some sexual health-related behaviours, especially healthcare use and complex discussions.
Access to school health clinics and nurses has been linked with improved student achievement and health. Unfortunately, no studies have examined how many students report using school clinics or nurses and for which services. This study addressed this gap with data from a nationally representative sample of 15- to 25-year-olds. Respondents who reported being in high school were provided a list of services and asked whether they had gone to a school nurse or clinic for any of the listed services. Nearly 90% reported having access to a school clinic or nurse. Among students with access, 65.6% reported using at least one service. Non-White students and younger students were more likely to report having access to a clinic or nurse. These results show many students have access to clinics or nurses and are using these services, although not uniformly for all services.
We examined expedited partner therapy for chlamydia and gonorrhea in college and university health centers by institutional and policy characteristics. Expedited partner therapy awareness and use was low (44.1% used), did not differ by institutional characteristics, and differed by policy environment. Our findings suggest missed opportunities for sexually transmitted disease prevention in college and university health centers.
As increased attention and proposed funding are being directed toward community colleges, it is important to consider the sexual and reproductive health care needs of this growing population. Existing data suggest there are significant sexual health needs among this population and often insufficient provision of services. Some community college students are more likely than students at 4-year colleges to test positive for sexually transmitted diseases (STDs). Given resource constraints, creative solutions are required. These may include campus-wide policies addressing STD/HIV (human immunodeficiency virus) prevention, referral systems to connect students to care in the community, and partnerships with local health departments, Federally Qualified Health Centers, or community-based organizations to assist with the provision of services. Colleges have the unique opportunity to provide students with valuable information about sexual health and services. Community colleges, in particular, are uniquely positioned to reach at-risk community members for STD testing and sexual health care who might otherwise be lost to care. More research is needed on the sexual health needs of community college students, especially on factors such as geographic location, how embedded the school is into the community, social norms around sexual health on college campuses, and health services offered. New and innovative ways to promote linkage to care for testing and counseling could offer potential health benefits to this growing at-risk population.
