Exploring partner communication and patterns of sexual networking: qualitative research to improve management of sexually transmitted diseases

This ethnographic research among rural South African men and women seeking care for STDs explores constraints to communication among partners and defines predominant patterns of sexual networking. A series of fifteen open-ended interviews explored topics related to sexual networking and partner communication. Patterns of sexual networking showed clear gender variation, with men more likely to discuss multiple partners. Both men and women believed they should tell one partner about their STD, most often a steady partner. Strong distinctions were made between regular and casual partners, with an emphasis on the role of trust in a steady relationship. Men and women expressed anxiety about telling their partners of their illness, but women more often expressed fear whereas men felt embarrassed. Multi-partnered sexuality is common and is widely accepted for men. While the importance of regular partnerships is clear for both men and women, sexual relationships appear to be highly unstable. Communication among partners could be facilitated by stronger health promotion messages, such as the importance of telling a partner about an STD. Prevailing patterns of communication and sexual networking have profound implications for the STD epidemic

On-site HIV testing in resource-poor settings : is one rapid test enough?

Objective: To determine the feasibility, accuracy and cost-effectiveness of a rapid, on-site, HIV testing strategy in a rural hospital, and to assess its impact on test turnaround time and the proportion of patients post-rest counselled. Design: Prospective comparison of two testing strategies [double rapid test on-site versus central enzyme-linked immunosorbent assay (ELISA)-based testing], and an economic evaluation. Setting: Hlabisa Hospital, a rural South African district hospital. Patients: A total of 454 consecutive adult inpatients requiring and consenting to HIV testing as part of their clinical management. Main outcome measures: Concordance between rapid tests, and between the rapid and ELISA strategies, test turnaround time, proportion of patients post-test counselled, and cost-effectiveness. Results: HIV seroprevalence was 49.6%. Both rapid rests were concordant in all patients [one-sided 95% confidence interval (CI) of probability, 99.3-100]. The rapid strategy was 100% sensitive (95% CI, 97.9-100) and 99.6% specific (95% CI, 97.2-100) compared with the ELISA strategy. The mean interval between ordering a test and post-test counselling fell from 21 days prior to the introduction of the rapid test strategy to 4.6 days after its introduction (P < 0.00001). The proportion of patients post-lest counselled increased to 96% from 17% after the introduction of the rapid test strategy (P < 0.00001). By using a double rapid test strategy the cost per patient post-test counselled was almost halved to US$11. Accuracy of the rapid strategy was not substantially increased by performing two tests. Conclusion: In high prevalence, resource-pool settings, rapid, on-site HIV testing is feasible, accurate and highly cost-effective, substantially increasing the number of patients post-test counselled. A single rapid lest may be sufficient.5 page(s