Background The emergence of social emergency medicine—the incorporation of social context into the structure and practice of emergency care—has brought forth greater embracement of the social determinants of health by medical professionals, yet workforce practices and training have remained elusive. Academic literature particularly in the field of pediatric emergency medicine (PEM) fellowship training is lacking relative to general pediatrics and adult emergency medicine. Methods The primary objective of this study was to assess the social care knowledge, perspectives, and training of PEM program directors (PDs) and fellows across a national cross‐sectional sample. A secondary aim was to uncover key actionable areas for the development of social care curricula in PEM training programs. A social care practices assessment tool was developed via snowball sampling interviews among clinician researcher experts and disseminated to PEM PDs and fellows nationally in accredited academic PEM training institutions. Results A total of 153 participants—44 PDs (49% response rate) and 109 fellows (28%)—completed the assessment tool. Responses among PDs and fellows were highly concordant. Only 12% reported regular use of a standardized social needs screening tool. The majority felt unprepared to assist families with social needs and less than half felt comfortable talking to families about social need. At the same time, social care was highly valued by 73% of participants. All participants felt that providing social care training during PEM fellowship would be beneficial. PDs and fellows identified five priority areas for PEM curricular development. Conclusions PEM PDs and fellows have an overall favorable perception of social care yet report significant deficits in current practice organization and training. This study is part of a larger national collaborative advocacy project to organize and advance social care delivery across academic PEM training institutions through evidence‐based approaches, best practices, and expert consensus.

We explored to whom rural men who have sex with men (MSM) disclose their sexual identity and HIV status in Mpumalanga, South Africa. Participants were recruited using a modified snowball sampling method in order to complete a questionnaire. Descriptive and logistic regression analyses were conducted. There were 47 participants of whom 22 self-reported as HIV-positive. Most participants disclosed their sexuality and HIV status to immediate family members and gay-identified friends. We found that the longer someone had identified as MSM, the more likely they were to be HIV-positive and not go to clinic. Education and employment modified these findings. This study presents a broader picture of MSM in this rural African setting: that they do disclose their sexuality and HIV status to others in their community. However, more research is needed to develop these measures. We need to assess how long participants identify as MSM, how long they have been HIV-positive, and to whom they have disclosed these aspects of their lives to inform HIV prevention and treatment interventions for MSM in rural settings.

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Introduction PrEP awareness in Latin America has been poorly characterized, with studies in Brazil, Mexico, and Peru highlighting awareness of 65% among gay, bisexual and other men who have sex with men (MSM). We assessed the association between higher risk of HIV infection, indicative of PrEP eligibility, and PrEP awareness among MSM from these countries. Methods This was a secondary analysis of a web-based survey advertised on social media platforms from March-June 2018 in Brazil, Mexico and Peru. Eligible individuals were cisgender MSM, ≥18 years old, HIV negative or of unknown status, who lived in these countries, and provided informed consent. Higher risk of HIV infection was defined as having 10 or more points in the HIV Risk Index for MSM (HIRI-MSM). We used multivariable Poisson regression models to calculate adjusted prevalence ratios (aPR) testing the association between higher risk for HIV and PrEP awareness. Results After exclusions, 19,457 MSM were included in this analysis. In Brazil, 53.8% were classified as higher risk for HIV, 51.9% in Mexico, and 54.2% in Peru. Higher risk for HIV was minimally associated with PrEP awareness among those in Brazil (aPR 1.04, 95% CI 1.01, 1.06), but no such association was observed in Mexico or Peru. Having more than a high school education, high income, daily use of geosocial networking (GSN) applications, and substance use were associated with PrEP awareness. Conclusion Higher risk of HIV infection was associated with increased PrEP awareness in Brazil. However, this association was weak indicating that PrEP awareness could be strengthened with further prevention efforts. In the remaining countries, results were non-conclusive between risk and awareness. Interventions to increase PrEP awareness are paramount to increase PrEP willingness and uptake and in turn prevent new HIV infections. Social media platforms could play an important role to achieve this goal.

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ObjectiveCurrent guidelines for women do not include extragenital screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) and do not mention anal sex behaviour. The objective of this cross-sectional study was to determine the number of potentially missed CT and NG cases by relying on urogenital screening and self-reported anal sex behaviour among women.MethodsDemographic and clinical data of 4658 women attending a community health centre in Los Angeles, California, USA from 2015 to 2018 were examined. CT and NG were detected using nucleic acid amplification test (APTIMA Combo 2, Hologic Gen-Probe, San Diego, California). Demographic and behavioural factors were also examined to assess potentially missed NG/CT cases. Multivariable regression analyses were used to determine whether reported anal sex behaviour predicts NG/CT rectal infection.ResultsA total of 193 NG cases and 552 CT cases were identified; however, 53.9% of NG cases and 25.5% of CT cases were identified exclusively through extragenital screening. Of all positive cases of rectal CT, 87.0% did not report anal sex without a condom and 91.3% did not report any anal sex with their last sexual partner. Of all positive cases of rectal NG, 78.9% did not report anal sex without a condom and 76.3% did not report any anal sex with their last sexual partner. Anal sex with last partner was not predictive of NG/CT rectal infection.ConclusionsRelying solely on urogenital screening and reported behaviour misses NG/CT cases. Extragenital NG/CT screening should be conducted in all women regardless of reported anal sex behaviour.

ObjectivesPharyngeal and rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are often undiagnosed due to their asymptomatic nature. This study aims to determine (1) the prevalence of CT/NG infections by anatomical site among cisgender men; (2) the proportion of missed CT/NG rectal/pharyngeal infections if urogenital testing alone was performed or screening depended on self-reported behaviour alone; and (3) the predictive probability of self-reported behaviours for rectal CT/NG.MethodsThis cross-sectional study used electronic health records collected at a sexual health clinic in Los Angeles from 18 November 2018 until 28 February 2020. The included patients were ≥18 years of age cisgender men who received CT/NG testing at least once during the study period. We calculated the proportion of missed pharyngeal/rectal CT/NG infections if only urogenital testing had been done and if testing was based only on self-reported anal sex. Separately, we ran logistic regressions for predictive probability of self-reported anal sex on CT/NG rectal infections.ResultsOverall, there were 13 476 unique patients with 26 579 visits. The prevalence of any extragenital CT/NG infection was 37.28%. Over 80% rectal/pharyngeal CT cases and over 65% rectal/pharyngeal NG cases would be missed if urogenital testing alone was performed. Likewise, over 35% rectal CT/NG cases would be missed had testing relied on self-reported sexual behaviours alone.ConclusionsThe proportion of missed rectal and pharyngeal CT/NG infections is high. Our data from a sexual health clinic lend support to three-site opt-out testing for cisgender men attending a sexual health/Lesbian, Gay, Bisexual, Transgender, Queer/Questioning (LGBTQ+) specialty clinic regardless of their sexual orientation or reported sexual behaviours.

IntroductionPrEP awareness in Latin America has been poorly characterized, with studies in Brazil, Mexico, and Peru highlighting low awareness. We assessed the association between higher risk of HIV infection, indicative of PrEP eligibility, and PrEP awareness among men who have sex with men (MSM) from these countries. MethodsMSM were recruited to complete an online survey via advertisements on Facebook, Grindr, and Hornet from March-June 2018. Eligible individuals were cisgender MSM, ≥18 years old, HIV negative or of unknown status, lived in these countries, and provided informed consent. Higher risk was defined using a CDC score indicating an increased risk of HIV infection and the suggested cutpoint of 10. We used Poisson regression models to calculate adjusted prevalence ratios (aPR) testing the association between higher risk and PrEP awareness; socio-demographics and other risk variables were considered potential confounders. Separate models were conducted for Brazil, Mexico, and Peru. ResultsAfter exclusion, 19,457 MSM were available for analysis. Overall PrEP awareness was 64.9%, with those from Brazil reporting highest awareness (68.8%), followed by Mexico (64.1%), and Peru (46.6%). In Brazil, 53.8% were classified as higher risk for HIV, 51.9% in Mexico, and 54.2% in Peru. Higher risk for HIV was associated with PrEP awareness among those in Brazil (aPR 1.04, 95% CI 1.01, 1.06), but no association was seen in Mexico or Peru. Additionally, having more than high school education, high income, daily use of gay social networking (GSN) applications, and substance use were associated with PrEP awareness in each country. ConclusionHigher risk of HIV infection was associated with increased PrEP awareness in Brazil. However, this association was weak indicating that MSM at higher risk, who would benefit from PrEP, are often not aware of this prevention strategy. In the remaining countries, there was no association between risk and awareness, highlighting a disconnect between need and knowledge. As PrEP is introduced, awareness should increase, as in Brazil where PrEP has been available longer. Interventions to increase PrEP awareness are paramount to increase PrEP uptake and prevent HIV infections. GSN applications and social media could play an important role to achieve this goal.