Faculty Bibliography

OBJECTIVES/OBJECTIVE:To determine infection patterns of sexually transmitted infections that facilitate HIV transmission among HIV-discordant couples. METHODS:112 initial respondents were recruited in an impoverished neighbourhood of Brooklyn, New York. Their sexual (and injection) partners were recruited in up to four additional network sampling waves for a final sample of 465 persons aged 18 years or older. After separate informed consent had been obtained, blood and urine were collected and tested for HIV, type-specific antibodies to herpes simplex virus (HSV-2), syphilis, chlamydia and gonorrhoea. RESULTS:Of 30 HIV-discordant partnerships, five were same-sex male partnerships and 25 were opposite-sex partnerships. No subjects tested positive for syphilis or gonorrhoea. Two couples were chlamydia-discordant. For HSV-2, 16 couples were double-positive, eight discordant, four double-negative, and two comprised a HSV-2-negative with a partner with missing herpes data. CONCLUSIONS:HSV-2 was present in 83% of the HIV-discordant couples, chlamydia in 7%, and syphilis and gonorrhoea in none. HSV-2 is probably more important for HIV transmission than bacterial sexually transmitted diseases because it is more widespread. Even given the limited generalisability of this community-based sample, there seems to be an important HIV-prevention role for herpes detection and prevention activities in places where HIV-infected people are likely to be encountered, including sexually transmitted disease clinics, HIV counselling and testing programmes, prisons, needle exchanges, and drug abuse treatment programmes. The effects of HSV-suppressive therapy in highly impacted groups should also be investigated.

OBJECTIVES/OBJECTIVE:To describe: (a) the prevalence and individual and network characteristics of group sex events (GSEs) and GSE attendees; and (b) HIV/sexually transmitted infection (STI) discordance among respondents who said they went to a GSE together. METHODS AND DESIGN/METHODS:In a sociometric network study of risk partners (defined as sexual partners, persons with whom respondents attended a GSE, or drug injection partners) in Brooklyn, NY, we recruited a high-risk sample of 465 adults. Respondents reported on GSE attendance, the characteristics of GSEs, and their own and others' behaviors at GSEs. Sera and urines were collected, and STI prevalence was assayed. RESULTS:Of the 465 participants, 36% had attended a GSE in the last year, 26% had sex during the most recent of these GSEs, and 13% had unprotected sex there. Certain subgroups (hard drug users, men who have sex with men, women who have sex with women, and sex workers) were more likely to attend and more likely to engage in risk behaviors at these events. Among 90 GSE dyads, in which at least 1 partner named the other as someone with whom they attended a GSE in the previous 3 months, STI/HIV discordance was common [herpes simplex virus (HSV-2): 45% of dyads, HIV: 12% of dyads, and chlamydia: 21% of dyads]. Many GSEs had 10 or more participants, and multiple partnerships at GSEs were common. High attendance rates at GSEs among members of large networks may increase community vulnerability to STI/HIV, particularly because network data show that almost all members ofa large sociometric risk network either had sex with a GSE attendee or had sex with someone who had sex with a GSE attended. CONCLUSIONS:Self-reported GSE attendance and participation were common among this high-risk sample. STI/HIV discordance among GSE attendees was high, highlighting the potential transmission risk associated with GSEs. Research on sexual behaviors should incorporate measures of GSE behaviors as standard research protocol. Interventions should be developed to reduce transmission at GSEs.