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Sexual health assessment is essential to comprehensive health care. A sexual history provides information that may indicate human immunodeficiency virus and sexually transmitted infection testing. Detection and treatment of human immunodeficiency virus and sexually transmitted infections will break the chain of infection and improve quality of life.

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Sexually Transmitted Disease Surveillance Network clinics served populations with high STI rates. Given experience with diagnoses of both nonreportable and reportable STIs and extragenital chlamydia and gonorrhea testing, STI clinics comprise a critical specialty network in STI diagnosis, treatment, and prevention.

Over the last 30 years, expectations for the quality, validity, and objectivity of the outcome measures used to assess the impact of behavior change interventions related to HIV have steadily increased. At this point (mid-2014 at this writing), biological evidence or biomarkers of the incidence of HIV and other sexually transmitted infections [STI] in a target population is clearly preferable to self-reports of behavior. This kind of evidence is, however, much more expensive to collect than participants’ reports of behavior change (e.g., increased condom use, reduced substance use or abstinence from substance use, and high levels of medication adherence). In addition, while potentially less subject to reporting bias, biomarkers and biological outcomes have their own flaws. In this paper we review the literature on the validity of self-reports of outcomes most relevant to HIV behavior change interventions, sexual behavior (ever having had sex and condom use), substance use, and medication adherence. We note the extent to which they may be adequate outcome measures without biological data, and the conditions under which they may be most likely to be sufficient. We also argue, like many others, that where possible, both self-report and biological measures should be collected.

Objective Women living with HIV experience higher risk of cervical cancer, but screening rates in the U.S. are lower than recommended. The purpose of this study was to examine whether an intervention using self-sampling of cervico-vaginal cells for human papillomavirus (HPV) with results counseling would increase cervical cytology ("Pap") testing among women with HIV. Methods This was a randomized controlled trial to test the effectiveness of an intervention of self-sampling for HPV and results counseling. Participants were 94 women over age 18, with HIV infection, attending an HIV Clinic for a primary care visit, whose last cervical cancer screening was 18 months or more before baseline. Women were assigned to the intervention or information-only group. The primary outcome was completion of cervical cytology testing within 6 months of baseline. The secondary outcome was the women's perceived threat of developing cervical cancer. Results A total of 94 women were enrolled and analyzed in the study. The cytology completion rate overall was 35% by 6 months from baseline. There were no differences comparing HPV positive with HPV negative women, nor comparing them with the information-only group. In the intervention group, a positive HPV test increased perceived threat of cervical cancer. Conclusions The intervention did not improve cytology test attendance, though education about HPV and cervical cancer risk as part of study procedures was associated with testing for 35% of this group of women whose previous cytology occurred an average 3.6 years prior to the baseline appointment. Self-sampling for HPV testing was feasible.

In this low-prevalence population, the positive predictive value of the Focus HSV-2 ELISA test was low. This finding, together with those reported elsewhere, indicates that caution is warranted when recommending HSV screening in low-prevalence or heterogeneous populations. Consideration should be given to raising the cutoff index value for defining a positive test result.