I njection drug users (IDUs) are at risk for acquiring blood-borne pathogens (BBP), such as human immunodefiency virus (HIV) and hepatitis C virus (HCV), through the use of contaminated drug equipment. HIV (and to a far lesser extent, HCV) may also be acquired through sexual transmission routes, which place IDUs at additional risk for infection. Illicit drug use is associated with highrisk sexual behaviours, such as the exchange of sex for drugs or money, 1-3 and a greater likelihood of exposure to social and sexual networks with high HIV (and HCV) prevalence. In 2006, the rate of positive HIV test reports among Canadian adults was 9.4/100,000 and IDUs represented 19.1% of all such reports. In the province of Alberta, the rate of new adult HIV case reports was 7.2/100,000 with 21.8% of all cases being identified as IDU. 4 Nationally, the rate of newly reported HCV cases in 2004 was 44.7/100,000. 5 In Alberta, the rate of newly reported HCV cases in 2006 was 41.7/100,000 of which approximately 68% were attributed to IDU (Alberta Health and Wellness, 2008). The objective of this research was to determine the seroprevalence and correlates of HIV and HCV and associated risk behaviours for a cohort of IDUs recruited in Edmonton, Alberta. METHODS Edmonton was selected as one of multiple sites for a national, crosssectional survey (I-Track Study) developed by the Public Health Agency of Canada (PHAC) to describe drug and sexual risk behaviours, and HIV/HCV prevalence among IDUs. 6 This study was approved by the
A retrospective chart review was conducted for one year to determine cervical cytological abnormalities and their distribution among women attending a STD clinic, and to analyse cervical cytologies by STD diagnosis and history or presence of genital warts. Analysis was performed on 790 Pap smears. Most (60%) cytologies were benign. Prevalence of STD among CIN-1 cytologies (78%) was significantly higher (P = 0.02) than among benign cytologies (46%). Commonest cytologies presenting among youngest age groups were CIN-1/condyloma, CIN-1, CIN-2. Women with preceding or concurrent clinical HPV infection had significantly more HPV associated changes on cytology (P < 0.001) than women with no such history. The presentation of cytological abnormalities considered to be precursors to cervical cancer among sexually active young women demonstrates the importance of Pap smear testing of STD clinic populations.
BackgroundEdmonton, Canada has been experiencing a rise in infectious syphilis cases since 2003, attributed to individuals engaging in transactional sex and substance use. As well, Aboriginal people had disproportionately higher rates of the infection. The results of a case study of primary syphilis cases were shared with community organisations serving vulnerable populations to ascertain their suggestions on strategies to increase testing for syphilis among this population. Agencies suggested that compensating clients for syphilis screening at a community organisation would increase testing rates. We sought to determine if more cases among the target population were diagnosed through outreach testing that provided financial compensation than by routine screening methods by other healthcare professionals.MethodsA data extract containing demographics, ethnicity, and risk behaviours for infectious syphilis cases in Edmonton between April 2007 and November 2008 was obtained from the provincial STI database. An additional database, which held demographic and risk group information on participants in the project, was also analysed. Client demographics and risk behaviours were compared using χ2or Fisher's exact test for categorical variables and Mann–Whitney for continuous variables.ResultsA total of 931 testing visits were completed with 877 individuals. Three-quarters of individuals reported a history of substance use (77.1%; n=676) with more than one-quarter of individuals involved in transactional sex, either as a sex worker (n=204) or contact with a sex worker (n=110). Over half of the individuals (51.3%; n=450) were Aboriginal. Ten newly diagnosed infectious syphilis cases were found. The proportion of cases detected among female sex workers was 2.9% (6 cases out of 209 testing visits) and was 2.0% (2 cases out of 98 testing visits) among male sexual contacts of sex workers. Female cases were more likely to be a sex worker when tested through outreach (75%) than by routine testing sites (23.5%, p=0.006) see Abstract P5-S4.05 table 1.Abstract P5-S4.05 Table 1Comparison of characteristics of infectious syphilis cases (N=155)FactorNumber of casesOutreach cases,n=10(%)Routine testing casesn=145 (%)Total,N=155 (%)p ValueGender Female8 (80.0)68 (46.9)76 (49.00.05 Male2 (20.0)77 (53.1)79 (51.0)Ethnicity Aboriginal7 (70.0)58 (40.0)65 (41.9)0.10 Non-aboriginal3 (30.0)87 (60.0)90 (58.1)Median age (IQR)32.5 (21.25–37.5)32 (24–43)32 (24–42)0.71Risk behaviour Heterosexual10 (100.0)107 (83.6)117 (84.8)0.16 Injection drug use2 (20.0)11 (7.6)13 (8.4)0.20 Sex with an IDU08 (5.5)8 (5.2)1.00Sex worker Female6 (75.0)16 (23.5)22 (28.9)0.006 Male01 (1.3)1 (1.3)1.00 Sex with a sex worker (males only)2 (100.0)22 (28.6)24 (30.4)0.09ConclusionsBy offering testing at community agencies with financial compensation to individuals, a higher rate of cases were found among sex workers than through routine testing methods. By treating cases among individuals linked to high transmission activity, we aim to reduce the transmission of infectious syphilis.
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