Abbreviations: (ACIP) Advisory Committee on Immunization Practices, (anti-HBc) total antibody to hepatitis B core antigen, (BRFSS) Behavioral Risk Factor Surveillance System, (CDC) Centers for Disease Control and Prevention, (CI) confidence interval, (EIP) Emerging Infections Program, (HBsAg) hepatitis B surface antigen, (HBV) hepatitis B virus, (HepB) hepatitis b vaccine, (HIV) human immunodeficiency virus, (HIVRISK) human immunodeficiency virus infection risk, (IDU) injection drug use, (LTC) long-term care, (MSM) male sex with another male,

San Diego, California shares the world's busiest land border crossing with Tijuana, Mexico-a city where 95 % of injection drug users (IDUs) test hepatitis C virus (HCV) antibody-positive. Yet, little is known about the prevalence and risk behaviors for HCVamong IDUs in San Diego. In 2009-2010 IDUs in San Diego County completed a risk assessment interview and serologic testing for HCV and HIV infection. Recruitment involved respondent-driven sampling, venue-based sampling at a syringe exchange program, and convenience sampling. Correlates of HCV infection were identified by multivariable logistic regression. Among 510 current IDUs, 26.9 % (95 % CI 23.0-30.7 %) and 4.2 % (95 % CI 2.4-5.9 %) had been infected with HCVand HIV, respectively. Overall, median age was 28 years; 74 % were male; 60 % white and 29 % Hispanic; and 96 % were born in the U.S. Median years of injecting was 6; 41 % injected daily; 60 % injected heroin most often; 49 % receptively shared syringes and 68 % shared other injection paraphernalia; and only 22 % reported always using new syringes in the past 3 months. Two thirds had ever traveled to Mexico and 19 % injected in Mexico. HCV infection was independently associated with sharing injection paraphernalia (adjusted odds ratio [AOR]= 1.69) and SEP use (AOR=2.17) in the previous 3 months, lifetime history of drug overdose (AOR=2.66), and increased years of injecting (AOR=2.82, all P values G0.05). Controlling for recruitment method did not alter results. HCV infection prevalence among IDUs in San Diego was modest compared to other US cities and much lower than Tijuana. Given that known individual-level HCV risk factors were common in San Diego, the city's lower HCV prevalence might be due to differences in social and structural factors between the cities.

Female exotic dancers are an important, yet understudied group of women who may engage in drug- and sex-related HIV/STI risk behaviors through their work. The study objective was to identify co-occurring indicators of vulnerability (e.g., housing, income, incarceration) associated with HIV/STI risk behavior among female exotic dancers in Baltimore, Maryland. Surveys administered during July 2008–February 2009 captured socio-demographic characteristics, drug use, and sexual practices among dancers (N=101) aged ≥18 years. Multivariate logistic regression was used to assess the relationship between vulnerability and risk behavior. Dancers with a high vulnerability score (i.e., 2 or more indicators) were more likely to report sex exchange (AOR: 10.7, 95% CIs: 2.9, 39.9) and multiple sex partnerships (AOR: 6.4, 95% CIs: 2.3, 18.3), controlling for demographics and drug use, compared to their less vulnerable counterparts. Findings point to primacy of macro-level factors that need to be addressed in HIV/STI prevention efforts targeting this and other high-risk populations.

Background Sex partner meeting places may be important locales to access men who have sex with men (MSM) and implement targeted human immunodeficiency virus (HIV) control strategies. These locales may change over time, but temporal evaluations have not been performed. Methods The objectives of this study were to describe the frequency of report of MSM sex partner meeting places over time, and to compare frequently reported meeting places in the past five years and past year among newly HIV diagnosed MSM in Baltimore City, Maryland. Public health HIV surveillance data including partner services information was obtained for this study from the Baltimore City Health Department from May 2009 to June 2014. Results 869 sex partner meeting places were reported, including 306 unique places. Bars/clubs (31%) and internet-based sites (38%) were the most frequently reported meeting place types. Over the five year period, the percentage of bars/clubs decreased over time and the percentage of internet-based sites increased over time. Among bars/clubs, 4/5 of those most frequently reported in the past five years were also most frequently reported in the most recent year. Among internet-based sites, 3/5 of those most frequently reported in the past five years were also in the top five most frequently reported in the past year. Conclusion This study provides a richer understanding of sex partner meeting places reported by MSM over time and information to health departments on types of places to access a population at high risk for HIV transmission.

ICERs may inform decision makers as they decide whether the added cost of the preexposure strategy provides sufficient value in preventing infections.

outcomes, and interviewer-administered alcohol consumption questions, at age 26, 32 and 38 years. Results Response level was >90% at each assessment. At 38, drinking before or during sex in the previous year was common (8.2% of men; 14.6% of women reported "usually/always"), and unwanted consequences were reported by 13.5% of men and 11.9% of women, including regretted sex or failure to use contraception or condoms. Frequent heavy drinkers were more likely to "use alcohol to make it easier to have sex" and regret partner choice, particularly women. Heavy drinking frequency was strongly associated with partner numbers for men and women at 32, but only for women at 38. Significantly higher odds of STIs amongst the heaviest drinking men, and TOPs amongst the heaviest drinking women were seen at 32-38. Conclusion Alcohol involvement in sex continues beyond young adulthood where it has been well documented, and is common at 38. Women appear to be more affected than men, and heavy drinking is associated with poorer outcomes for both. Improving sexual health and wellbeing throughout the life course needs to take account of the role of alcohol in sexual behaviour.

Places with active HIV transmission may serve as key locations for targeted control. In 2008–2009, heterosexual sex partner venues in Baltimore, MD were identified using a three-phase process and characterized by the presence or absence of HIV cases. 1,594 participants aged 18–35 years were enrolled at 87 venues. The study yielded an overall HIV prevalence of 3.7%; 42% of venues had ≥1 case of HIV (i.e., HIV positive venues). In final age-adjusted models, HIV positive venues had 10% more high HIV-risk sexual partnering (95% CI: 1.01, 1.19) and more than twice as much drug market activity (95% CI: 1.04, 6.46) compared to HIV negative venues. Commercial sex work, parenteral risk behavior and venue-level sex market activity were not significantly associated with HIV status of the venues. This study highlights characteristics of venues, such as drug market activity, that may be important in identifying places with active HIV transmission.

This study explored the relationship between the social organization of neighborhoods including informal social control and social cohesion and a current bacterial sexually transmitted infection (STI) among adolescents and young adults in one U.S. urban setting. Data for the current study were collected from April 2004 to April 2007 in a cross-sectional household study. The target population included English-speaking, sexually-active persons between the ages of 15 and 24 years who resided in 486 neighborhoods. The study sample included 599 participants from 63 neighborhoods. A current bacterial STI was defined as diagnosis of a chlamydia and/or gonorrhea infection at the time of study participation. Participants reported on informal social control (i.e. scale comprised of 9 items) and social cohesion (i.e. scale comprised of 5 items) in their neighborhood. In a series of weighted multilevel logistic regression models stratified by gender, greater informal social control was significantly associated with a decreased odds of a current bacterial STI among females (AOR 0.53, 95% CI 0.34, 0.84) after controlling for individual social support and other factors. The association, while in a similar direction, was not significant for males (AOR 0.73, 95% CI 0.48, 1.12). Social cohesion was not significantly associated with a current bacterial STI among females (OR 0.85, 95% CI 0.61, 1.19) and separately, males (OR 0.98, 95% CI 0.67, 1.44). Greater individual social support was associated with an almost seven-fold increase in the odds of a bacterial STI among males (AOR 6.85, 95% CI 1.99, 23.53), a finding which is in contrast to our hypotheses. The findings suggest that neighborhood social organizational factors such as informal social control have an independent relationship with sexual health among U.S. urban youth. The causality of the relationship remains to be determined.