Investigating the relationship between HIV testing and risk behaviour in Britain: National Survey of Sexual Attitudes and Lifestyles 2000.

OBJECTIVES: To estimate the prevalence of, and identify factors associated with, HIV testing in Britain. DESIGN: A large, stratified probability sample survey of sexual attitudes and lifestyles. METHODS: A total of 12,110 16-44 year olds completed a computer-assisted face-to-face interview and self-interview. Self-reports of HIV testing, i.e. the timing, reasons for and location of testing, were included. RESULTS: A total of 32.4% of men and 31.7% of women reported ever having had an HIV test, the majority of whom were tested through blood donation. When screening for blood donation and pregnancy were excluded, 9.0% of men and 4.6% of women had had a voluntary confidential HIV test (VCT) in the past 5 years. However, one third of injecting drug users and men who have sex with men had a VCT in the past 5 years. VCT in the past 5 years was significantly associated with age, residence, ethnicity, self-perceived HIV risk, reporting greater numbers of sexual partners, new sexual partners from abroad, previous sexually transmitted infection diagnosis, and injecting non-prescribed drugs for men and women, and same-sex partners (men only). Whereas sexually transmitted disease clinics were important sites for VCT, general practice accounted for almost a quarter of VCT. CONCLUSION: HIV testing is relatively common in Britain; however, it remains largely associated with population-based blood donation and antenatal screening programmes. In contrast, VCT remains highly associated with high-risk (sexual or drug-injecting) behaviours or population sub-groups at high risk. Strategies to reduce undiagnosed prevalent HIV infection will require further normalization and wider uptake of HIV testing

Increasing prevalence of male homosexual partnerships and practices in Britain 1990-2000: evidence from national probability surveys.

OBJECTIVES: To estimate the prevalence and timing of homosexual experience among British men; to explore the patterns of sexual practices and partnerships in 2000, and behavioural and attitudinal changes between 1990 and 2000 among men who have sex with men (MSM). DESIGN: Two large, stratified probability sample surveys of the general population. METHODS: Trained interviewers administered a combination of face-to-face and self-completion questionnaires to men aged 16 to 44 years resident in Britain (n = 6000 in 1990 and n = 4762 in 2000). RESULTS: In 2000, 2.8% of British men reported sex with men in the past 5 years. 46.0% of MSM reported five or more partners in the past 5 years, and 59.8% reported unprotected anal intercourse in the past year. A total of 33.0% of MSM reported one or more female partner(s) in the past year. In comparison with 1990, there was a significant increase in the proportion of MSM in the population in 2000, and among these men, in the proportion reporting receptive anal intercourse in the past year [age-adjusted odds ratio (OR), 2.08; 95% confidence interval (CI), 1.08-4.00], but no significant change in self-perceived HIV-risk (age-adjusted OR, 1.11; 95% CI, 0.49-2.51) or HIV testing in past 5 years (age-adjusted OR, 1.14; 95% CI, 0.57-2.25). CONCLUSIONS: Evidence of increasing prevalence of homosexual intercourse among the British male population coupled with increases in some HIV-risk behaviours among MSM suggests overall increasing numbers at risk in the population. Although these changes may partly reflect an increased willingness to report these behaviours, our results are consistent with increasing incidence of sexually transmitted infections and behavioural surveillance data

A scoping umbrella review to identify anti-racist interventions to reduce ethnic disparities in health and care

Objectives: To identify anti-racist interventions which aim to reduce ethnic disparities in health and care. / Eligibility criteria for selecting studies: Only studies reporting systematic reviews of anti-racist interventions were included. Studies were excluded if no interventions were reported, no comparators reported, or the paper was primarily descriptive. / The following databases were searched: Embase, Medline, Social Policy and Practice, Social care online and Web of Science. Quality appraisal (including risk of bias) was assessed using the AMSTAR-2 tool. Due to the nature of the selected reviews, the lack of meta-analyses and heterogeneity of included studies, a narrative synthesis using an inductive thematic analysis approach was conducted to integrate and categorise the evidence on anti-racist interventions for health and care. / Results: A total of 18 systematic reviews are included in the final review. 15 are from the healthcare sector and three are from education and criminal justice. 17 reviews are focused on interventions and one focused on implementation. All 18 reviews described interventions which targeted individuals and their communities, and 11 reviews described interventions targeting both individuals and communities, and healthcare organisations. On an individual level, the most promising interventions reviewed include group-based health education led by professional staff and providing culturally tailored or adapted interventions. On a community level, participation in all aspects of care pathway development that empowers ethnic minority groups may provide an effective approach to reducing ethnic health disparities. Targeted interventions to improve clinician patient interactions and quality of care for conditions with disproportionately worse outcomes in ethnic minority groups show promise. / Discussion: Many of the included studies were low or critically low quality due to methodological or reporting limitations. The heterogeneity of intervention approaches, study designs, and limited reporting of cultural adaptation, implementation and lack of comparison with White ethnic groups limited our understanding of the impact on ethnic health inequalities. In summary, for programme delivery, different types of pathway integration and providing a more person-centred approach with fewer steps for patients to navigate can contribute to reducing disparities. For organisations, there is an overemphasis on patient education and individual behaviour change rather than organisational change, and recommendations should include a shift in focus and resources to policies and practices that seek to dismantle institutional and systemic racism through a multi-level approach

Ethnic variations in sexual behaviour in Great Britain and risk of sexually transmitted infections: a probability survey.

BACKGROUND: Ethnic variations in the rate of diagnosed sexually transmitted infections (STIs) have been reported in many developed countries. We used data from the second British National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) to investigate the frequency of high-risk sexual behaviours and adverse sexual health outcomes in five ethnic groups in Great Britain. METHODS: We did a stratified probability sample survey of 11161 men and women aged 16-44 years, resident in Great Britain, using computer-assisted interviews. Additional sampling enabled us to do more detailed analyses for 949 black Caribbean, black African, Indian, and Pakistani respondents. We used logistic regression to assess reporting of STI diagnoses in the past 5 years, after controlling for demographic and behavioural variables. FINDINGS: We noted striking variations in number of sexual partnerships by ethnic group and between men and women. Reported numbers of sexual partnerships in a lifetime were highest in black Caribbean (median 9 [IQR 4-20]) and black African (9 [3-20]) men, and in white (5 [2-9]) and black Caribbean (4 [2-7]) women. Indian and Pakistani men and women reported fewer sexual partnerships, later first intercourse, and substantially lower prevalence of diagnosed STIs than did other groups. We recorded a significant association between ethnic origin and reported STIs in the past 5 years with increased risk in sexually active black Caribbean (OR 2.74 [95% CI 1.22-6.15]) and black African (2.95 [1.45-5.99]) men compared with white men, and black Caribbean (2.41 [1.35-4.28]) women compared with white women. Odds ratios changed little after controlling for age, number of sexual partnerships, homosexual and overseas partnerships, and condom use at last sexual intercourse. INTERPRETATION: Individual sexual behaviour is a key determinant of STI transmission risk, but alone does not explain the varying risk across ethnic groups. Our findings suggest a need for targeted and culturally competent prevention interventions

A Strategic Approach to Public Health Workforce Development and Capacity Building

In February 2010, CDC’s National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease (STD), and Tuberculosis (TB) Prevention (NCHHSTP) formally institutionalized workforce development and capacity building (WDCB) as one of six overarching goals in its 2010–2015 Strategic Plan. Annually, workforce team members finalize an action plan that lays the foundation for programs to be implemented for NCHHSTP’s workforce that year. This paper describes selected WDCB programs implemented by NCHHSTP during the last 4 years in the three strategic goal areas: (1) attracting, recruiting, and retaining a diverse and sustainable workforce; (2) providing staff with development opportunities to ensure the effective and innovative delivery of NCHHSTP programs; and (3) continuously recognizing performance and achievements of staff and creating an atmosphere that promotes a healthy work–life balance. Programs have included but are not limited to an Ambassador Program for new hires, career development training for all staff, leadership and coaching for mid-level managers, and a Laboratory Workforce Development Initiative for laboratory scientists. Additionally, the paper discusses three overarching areas—employee communication, evaluation and continuous review to guide program development, and the implementation of key organizational and leadership structures to ensure accountability and continuity of programs. Since 2010, many lessons have been learned regarding strategic approaches to scaling up organization-wide public health workforce development and capacity building. Perhaps the most important is the value of ensuring the high-level strategic prioritization of this issue, demonstrating to staff and partners the importance of this imperative in achieving NCHHSTP’s mission

Application of Unmanned Aerial Vehicles in Emergency Medical Situations

Introduction One of the significant impacts on patient outcome in emergency medical situations is the response time taken for trained personnel and equipment arrival on scene. The National EMS Information System states the average response time to reach adult patients in the United States is 9.4 minutes (1). We are exploring the whether the application of Unmanned Aerial Vehicle (UAV) technology in emergency situations would shorten response time and subsequently could improve patients’ outcome In this reported on first phase (Phase 1) of an envisioned multi-stage project, we tested the ability of a UAV to properly, efficiently transport a a portable ECG device to a mock emergency site and successfully take an ECG reading when used by an untrained personnel on hand. MethodsOur UAV was a DJI Phantom 2 Vision model, a quadcopter equipped with a 14 Megapixel camera and HD video recording capabilities. The onboard camera allows for real time transmission of patient status and appearance, while the quadcopter model allows for maximum weight to lift ratio. In order to record a portable ECG, we equipped an iPhone 5 with an AliveCor Kardia mobile ECG monitor. We included an easy to use protocol for the AliveCor so that a layperson would be able to operate the machine. DataThe total flight time for 100 yards across an open field was two and a half minutes , or approximately 2 feet/second. This data shows a chi-squared distribution of 5.065, with a p-value of .01 (df=1, p\u3c.05). DiscussionDue to the statistically significant p-value, Phase 1 data demonstrates that our UAV was capable of traversing an appropriate distance in an amount of time that drastically improves upon the emergency response call time taken by traditional methods. In addition to our flight data, we were also able to properly operate the ECG and apply it to a mock patient in under 90 seconds, showing that our protocol, with instructions for usage, was clear and precise. Conclusion: This study is considered Phase 1 of a multi-stage investigation. Moving forward, we hope to improve the efficacy of our UAV, while expanding its the technological and medical capabilities, allowing it to not only carry ECG but also possibly AEDs and pharmaceuticals. Ultimately, We hope to apply such technology to emergencies in both rural and urban environments, as well as adapt it for use within the military

Control Measures Used during Lymphogranuloma Venereum Outbreak, Europe

The degree of preparedness may affect the ability to respond quickly and to control an outbreak