This paper describes the frequency of women's disclosure of their HIV status, examines the extent to which they experience adverse social and physical consequences when others learn they are infected, and analyzes correlates of these negative outcomes. There were 257 HIV-positive women between the ages of 18 and 44, recruited from HIV/AIDS primary care clinics and from community sites, who completed a faceto-face interview. Women in the sample were 33 years old on average; 92% were AfricanAmerican; 54% had less than 12 years of education; 56% had used intravenous drugs; and 30% knew they were HIV positive for 5 or more years. There were 97% who disclosed their HIV status; 64% told more than 5 people. Negative consequences associated with others knowing they were HIV-positive were reported by 44%, most commonly the loss of friends (24%), being insulted or sworn at (23%), and being rejected by family (21%). There were 10 women (4%) who reported being physically or sexually assaulted as a result of their being HIV positive, and 16% reported having no one they could count on for money or a place to stay. Violence was widespread in this sample, with 62% having experienced physical or sexual violence, including sexual abuse or rape (27%), being beaten up (34%), and weapon-related violence (26%). Logistic regression analysis indicated that women with a history of physical and sexual violence were significantly more likely to experience negative social and physical consequences when their infection became known to others, adjusting for age and the number of people women had disclosed to, both of which were only marginally significant. Partner notification policies and support programs must be responsive to the potential negative consequences associated with others learning that a woman is HIV positive. The high rates of historical violence in the lives of women living with HIV underscore the need for routine screening and intervention for domestic violence in all settings that provide health care to HW-positive women.Drs. Gielen, Fogarty, and Faden are from Johns

The objective of this study was to investigate the potential use of bacteriophage in preventing Escherichia coli mastitis on dairies. A cocktail consisting of 4 distinct bacteriophages was generated by screening against 36 E. coli isolates from dairy cows in Washington State with clinical mastitis. The bacteriophage significantly inhibited growth of 58% of the Washington State isolates and 54% of E. coli mastitis isolates from New York State, suggesting that the cocktail of phages had a relatively broad spectrum of action against relevant strains from 2 distinct geographies. The ability to suppress bacterial growth of these isolates in a liquid growth medium was not affected by the ratio of bacteriophage particles to bacterial cells (multiplicity of infection, MOI). For those E. coli that were completely inhibited by the phage cocktail, an MOI as low as 10 had the same effect as 10 µg/mL of ceftiofur on the growth rate of E. coli over a 12-h period using optical density measurements. A 3.3- to 5.6-log reduction of growth was achieved when E. coli was co-incubated with our phage cocktail in raw milk over a 12-h period at physiologic temperature. A modified gentamicin protection assay using bovine mammary epithelial cells provided a model to test whether bacteriophage could prevent cell attachment and invasion by chronic coliform mastitis strains. Pretreatment of cell cultures with the phage cocktail significantly reduced adhesion and intracellular survival of E. coli compared with controls. When combined with a bismuth-based teat sealant, the phage cocktail was able to inhibit bacterial growth when challenged with 1.6 × 10(3) cfu/mL of a clinical mastitis E. coli strain. In vitro results show bactericidal activity by our phage in raw milk and mammary tissue culture systems. Before a bacteriophage-based dry-cow treatment becomes a potential option for dairies, in vivo studies must be able to demonstrate that a specific dose of bacteriophage can protect cows from experimentally induced E. coli mastitis without inducing an inflammatory reaction.

Microbial testing is an essential element in validation of critical limits identified within a hazard analysis critical control point (HACCP) plan. Without appropriate validation there is no assurance that the plan will control the hazards of concern. Once critical control points have been validated to effectively prevent, reduce, or eliminate hazards, application of routine testing for pathogens in finished product becomes an ineffective means to assure process control and therefore safety of the product. The occurrence of a pathogen in a product produced under an effective HACCP plan is so rare that sampling protocols are not capable of finding the needle in the haystack. Quantitative indicators can provide a much more effective tool for verifying that HACCP is properly implemented. Choice of appropriate indicators is product and process specific. In certain applications, finished product testing for even indicator organisms provides no meaningful data for verification of HACCP (e.g., canned products). Tests chosen should provide meaningful information that directs resources toward prevention and improvement of the system.

Outbreaks in 1989 of staphylococcal food poisoning linked to the consumption of imported canned mushrooms indicated that staphylococcal enterotoxins (SE) may survive a commercial retort process. To examine this possibility, fresh mushrooms were blanched in boiling water for 5 min and cooled 5 min in sterile water inoculated with enterotoxigenic type A Staphylococcus aureus strain 743, to yield approximately 1.3 ×103 staphylococci per g. Inoculated mushrooms were incubated 20 h at 30°C to simulate time-temperature abuse prior to canning. Mushrooms were sealed in 211 × 212 cans and thermally processed in a still retort to F values of 7, 12, and 18 min at 121 and 127°C. Pre- and post-thermal process staphylococcal enterotoxin A (SEA) serological activity was estimated from a standard curve with purified SEA using a commercial enzyme-linked immunosorbent assay (ELISA) kit. SEA was chromatographically separated from 4-can composite extracts of each F value and temperature. A feline emetic assay was used to determine the biological activity. The dose, administered on a body-weight basis, was equivalent to approximately 0.5 servings of mushrooms and brine for humans. The presence of SEA in the samples was confirmed by Western blotting using anti-SEA immunoglobulin G (IgG). The pre-thermal-process concentration of SEA was about 58 ng/g of mushrooms. Serological and biological activities were detected after all sterilizing values tested at 121 and 127°C. The inactivation of serological activity occurred in two phases, with a rapid initial rate and a distinctly slower rate at higher F values. Attenuation of biological activity, noted by a reduction in the number of emetic episodes and an increase in time to an emetic response, was observed with increasing F values of the processes.