16 May, 12 | by Leslie Goode, Blogmaster
We’re inviting contributions for two special themed issues:
Trichomonas vaginalis - deadline 31st October 2012
Further information >>
Criminalizing contagion - deadline 14th December 2012
Further information >>
10 May, 12 | by Leslie Goode, Blogmaster
Does hormonal contraception raise the risk of HIV transmission? Contraceptive choice may have an impact on sexual risk-taking behaviour, of course; but there has also been a concern that vaginal epithelium thinning arising from a progesterone-induced anovulatory state may reduce the efficacity of the vaginal barrier (Mitchell & Stephens, 2004).
Now a retrospective analysis of statistical data from an HIV-microbicide trial completed three years ago (HPTN 035) claims to offer reassuring evidence that injected forms of hormonal contraception are not associated with higher rates of HIV transmission. Researchers from the Microbicides Trials Network (MTN) were reporting to the International Microbicides Conference (M2012), which met in Sydney 15th – 18th April.
These findings could hardly be more topical. Last October a study published in the Lancet (Heffron, 2011) and subsequently reported in the New York Times, sent a wave of anxiety through the global health protection community with the claim that HIV-negative women might face a two-fold increased risk of acquiring the infection from their HIV-positive partners, and that HIV-positive women could have a two-fold increased risk of passing it on to the non-infected partners. The issue has enormous implications given the wide-scale use of injected hormonal contraception in areas of high HIV prevalence. Around 12 million of all women in sub-Saharan Africa between the ages of 16 and 49, 6% of all women in this age-group, use this method. Research, published in this journal and elsewhere, has emphasized, among its many advantages, the potential value of contraception as a prevention tool to combat vertical HIV transmission (mother to child) (Wilcher, Petruney, Reynolds & Cates, 2008; Reynolds, Janowitz, Wilcher, Cates, 2008; Reynolds, Steiner & Cates, 2005). Should the results of the Heffron study be even partially confirmed through further research, it is unclear how public health authorities would go about squaring the benefits of injectable hormonal contraception with increased HIV transmission risk. In the meantime the World Health Organization and UNAID have not recommended any change in public health practice.
In such a context this report can hardly fail to make an impact, and the global public health community will no doubt be awaiting with interest the publication of the study.
H.S. Mitchell & E. Stephens, “Contraception Choice for HIV positive women”, Sexually Transmitted Infections 2004:80;3
R. Wilcher, T. Petruney, H.W. Reynolds, W. Cates, “From effectiveness to impact: contraception as an HIV prevention intervention”, Sexually Transmitted Infections 2008:84;Suppl. 2
H.W. Reynolds, B. Janowitz, R. Wilcher, W. Cates, “Contraception to prevent HIV-positive births: current contribution and potential cost savings in PEPFAR countries”, Sexually Transmitted Infections 2008:84 suppl.2
H.W. Reynolds, M.J. Steiner, W. Cates, “Contraception’s proved potential to fight HIV” (Letter), Sexually Transmitted Infections:81;2
Renee Heffron, Jared Baeten et al., “Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study”, The Lancet Infectious Diseases, Vol. 12, Issue 1
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70247-X/abstract
For M2012 report see:
http://www.news-medical.net/news/20120418/No-added-HIV-risk-with-hormonal-contraceptives.aspx
10 May, 12 | by Leslie Goode, Blogmaster
What sort of impact does HIV testing (Voluntary Testing and Counselling: VCT) have on an individual’s subsequent sexual behaviour?
A number of studies of VCT clients in sub-Saharan Africa, and published in STI journal, suggest a significant preventative effect. A two-year cohort study of 401 clients of Kenyan government health centres (Arthur & Gilks, 2007) points to a significant reduction at 7.5 months both in the proportion of clients with multiple partners (from 16% to 6%) and in the numbers reporting symptoms of STIs (16% to 6%). A more recent study of attendees at health-centre affiliated VCTs in two Zambian mining villages involving serial interviews (Sikasote & Murray, 2011) serve to consolidate pre-test decisions concerning sexual risk behaviour and reflect clients’ desire to “regain control of their lives”.
In the view of the support these studies lend to the preventative aspect of VCT, it is encouraging to note the comparable behavioural changes reported in a recent study of a very different client group of 1,038 cocaine and heroin users taking up base-line VCT at a US Emergency Department (Bernstein and Madico, 2012). The study involved secondary analysis of data from a randomized control trial of a motivational intervention (ineffective, as it turned out), which included behaviour change at six and twelve months, notably: a sustained decrease in the proportion of unprotected sex acts (OR 0.7 at 6 months; 0.69 at 12 months), and a sustained drop off – from a high base-line, admittedly – in the number of sex acts (OR 3.1; 0.25). Given the screening took place during visits to an ED, this effect cannot, as in the African cases, be attributed to a pre-test decision.
These recent findings seem to endorse once again, albeit in the relation to a very different client group, the preventative impact of VCT. It is interesting, in this regard, that the Zambian study (Sikasote and Murray, 2011) raises the issue of VCT impact for those testing negative, and the importance of post-test support for this group. They even recommend the de-linking of counselling from testing to encourage earlier attendance.
G. Arthur, C. Gilks et al., “Sexual behaviour change in clients of health centre-based voluntary HIV counselling and testing services in Kenya”, Sexually Transmitted Infections 2007: 83;7
Janet Sikasote, Scott A. Murray et al., “Voluntary counselling and testing for HIV in a Zambian mining community: serial interviews with people testing negative”, Sexually Transmitted Infections 2011:87;5
Edward Bernstein, Guillermo Madico et al., “Long-term Follow-up After Voluntary Human Immunodeficiency Virus/Sexually Transmitted Infection Counseling, Point-of-service Testing, and Referral to Substance Abuse Treatment From the Emergency Department, Academic Emergency Medicine, Volume 19, Issue 4, April 2012
27 Apr, 12 | by Leslie Goode, Blogmaster
How effective is HAART (highly active antiretroviral therapy) in preventing HIV transmission among MSM (men who have sex with men)? The recent HPTN (HIV Prevention Trials Network) 052 clinical trial demonstrated, to great acclaim, that with heterosexual sero-discordant couples early initiation of HAART is associated with 96% reduction in HIV transmission. Yet there are reasons why we might expect that for MSM the preventive effect would be less. We know for example that rectal intercourse is an especially effective route of HIV transmission due to the thinness of the rectal epithelial membrane; high prevalence of urethritis and other STDs in this group could also increase vulnerability. There is little or no evidence, however. Given this ignorance, the possibility that HIV- infected MSM may be using HAART status in their sexual decision-making is a matter of concern. How important is it that sexually-active HIV-infected MSM should use condoms and other risk-reduction strategies through all stages of HIV disease regardless of HIV treatment status?
A US study (Politch, Anderson et al.) published in AIDS has attempted to cast some light on this difficult area, by assessing HIV levels in paired semen and blood samples from 101 HIV-infected MSM who had been on stable ART regimens for at least 3 months. Given the impracticability of undertaking anything like HPTN 052 on an MSM population, prevalence of HIV viral shedding in blood may offer the best approach to determining the relative infectivity of this group.
Of the 83 men with undetectable HIV in blood plasma, 25% proved to have HIV in semen with copy numbers ranging from 80-2,560 (median 200), as against 50% of those with HIV in blood plasma. Large recent studies of blood plasma in HIV positive men on HAART (not MSM) have reported levels of viral shedding in semen of 2-3%. In attempting to quantify the real infectivity risk associated with this higher level of compartmentalized shedding, the authors refer to a theoretical paper (Chakraborty, Eron et al., “Viral burden in genital secretions determines male-to-female sexual transmission of HIV-1: a probabilistic empiric model”, AIDS 2001:15:621-627) and a clinical study (Baeten, Nakku-Joloba, et al., “Genital HIV-1RNA Predicts Risk of Heterosexual HIV-1 Transmission”, Sci Transl Med 2011:3:77ra29) which both conclude that <1000 copies of HIV RNA pose a low but real risk of male-to-female HIV transmission. Thus, reckoning on a five-fold reduction in this copy number for rectal transmission among MSM, our authors place the threshold of significant risk at <200 – which is well within the range of values reported in their own study.
All this may seem speculative. In the absence of any more reassuring evidence, however, readers will no doubt agree that “it would be prudent to advise sexually active HIV-infected MSM to use condoms, … regardless of HIV treatment status”.
Joseph A. Politch, Deborah J. Anderson et al., “Highly active antiretroviral therapy does not completely suppress HIV in semen of sexually active HIV-infected men who have sex with men”, AIDS 2012:26
Papers on related issues published in STI journal:
For a sceptical view of the influence of perceptions of ART status on sexual risk taking, see:
J. Cox, J. Beauchemin, and R. Allard, “HIV status of sexual partners is more important than antiretroviral treatment related perceptions for risk taking by HIV positive MSM in Montreal, Canada”, 2004:80:518-523
http://sti.bmj.com/content/80/6/518.abstract?sid=cf57e9d8-2698-4361-8290-d88035309990
22 Apr, 12 | by Leslie Goode, Blogmaster
A meta-analysis in The Lancet Infectious Diseases offers a global picture of the heightened risks of HIV borne by female sex workers in low- and middle-income countries. The analysis includes 112 papers and national reports, extracted from 19,180 relevant studies, and covers 50 low- and middle-income nations. A table gives, for each of the 50 countries, an estimate of the relative burden of HIV disease in the female population that is borne by sex workers, expressed as an odds ratio, and the percentage of HIV infections that occur among female sex workers. In addition, pooled figures are given for regions, where sufficient data is available: i.e. for Asia, Latin America and sub-Saharan Africa (though not for Eastern Europe or the Middle East, for which sufficient data was lacking).
Globally, the odds ratio for a female sex worker being infected as against any female is 13.5, and the overall HIV prevalence for female sex workers is 11.8%. Discussion is devoted largely to the differences between regions (i.e. Asia etc.) and the possible impact of recent and ongoing programs.
Asia is distinguished by a relatively large pooled odds ratio: 29.2 as opposed to 12 and 12.4 for Latin America and sub-Saharan Africa respectively, indicating a remarkably heavy burden of female HIV borne by sex-workers Asia. The cases of Latin America and sub-Saharan Africa differ from each other in respect to the general prevalence of HIV in the population, though female sex-workers appear to bear a similar proportion of it (OR 12 and OR 12.4 respectively). Thus, the prevalence of 5.2% for sex workers in Latin American has to be set against relatively low background prevalence in the female population as a whole, while the figure of 36.9% for sub-Saharan Africa reflects vastly higher levels of general prevalence.
There is some rather piecemeal discussion of recent interventions affecting female sex-workers in these regions. The authors point out the effects of such interventions could take time to show up in the data. Nevertheless the overall impression is given of a problem that has in all the regions so far proved extremely refractory in the face of a number of serious and large-scale interventions. For example, following the scale-up of the Avahan and Sonagachi HIV prevention programs across India, female sex workers still carry more than a 50-times increased odds of HIV infection.
Needless to say, the authors recommend a scale-up of access to quality HIV-prevention programming and services among female sex workers on account of their heightened burden of disease, and the likelihood of onward transmission through high numbers of sexual partners.
Stefan Baral, Deanna Kerrigan et al., “Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis”, The Lancet: Infectious Diseases, published online 15th March, 2012
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(12)70066-X/abstract
Papers on related issues published in STI journal:
Michele R. Decker, Stefan D. Baral, Chris Beyrer et al., “Injection drug use, sexual risk, violence and STI/HIV among Moscow female sex workers”, published Online First: 27th January 2012
C. T. Bautista, J. K. Carr et al., “Seroprevalence of and risk factors for HIV-1 infection among female commercial sexworkers in South America”, 2006:82:311-316
N. Makyao, S. Kamazima et al., Oral Sessions epidemiology: oral session 8: STIs and HIV in female sex workers: 01-S08.01: High HIV prevalence within a generalised epidemic; condom use, violence, and sexually transmitted infections among female sex workers in Dar es Salaam, Tanzania, 2011:87:A40-A41
Nurholis Majid, Robert Magnani et al., “Syphilis among female sex workers in Indonesia: need and opportunity for intervention”, published online first: 3rd June 2012
26 Mar, 12 | by Leslie Goode, Blogmaster
At 120,000 cases in a population of 42m, the prevalence of HIV in Myanmar is not enormous by global standards. Yet with ART coverage among the lowest in the world, the death rate from HIV is estimated at 15,000-20,000 per year. Add to this an epidemic of multi-drug resistant (MDR) TB of three times the global average, considerably exacerbated by this HIV, and one can understand the sense of urgency with which a recent report by Médecins Sans Frontières (MSF) pleads the case for additional funding for HIV and TB programs in Myanmar.
For all these depressing figures, some considerable progress has been made thanks to the recommencement, following a five-year absence, of financial support (Round 9) from the Global Fund to Fight AIDS, Tuberculosis and Malaria. This has enabled levels of enrolment for ART to reach 29,000 as of 2012. Expected funding from Round 11 of Global Fund support was to have paid for 46,500 additional patients ART, helping to bring the coverage to 100,000 by 2018.
Sadly, Round 11 never arrived. In an unprecedented move by the Global Fund, it was cancelled when donor countries failed to contribute at the replenishment conference of 2010 even to the level of the lowest scenario.
The report describes the predicament of MSF workers who must refuse ART to patients whose CD4 count has yet to fall below 150. It also conveys a sharp sense of the opportunity that will be missed, if the resources are not made available for scale-up. With low-ish HIV prevalence and a related MDR TB epidemic, the arguments for a prompt intervention seem overwhelming. Furthermore, recognition of these needs is now reflected in the encouraging efforts of the Myanmar government to increase its health budget. There is ”acknowledgement, willingness and commitment for scale-up” in the country. Yet tragically the financial carpet is in the process of being drawn from under the feet of program providers.
In the light of this MSF pleads for increased funding by international donors for HIV and TB programs in Myanmar, and, above all, for adequate additional funding of the Global Fund in 2012.
Médecins Sans Frontières, Lives in the Balance: the Urgent Need for HIV and TB Treatment in Myanmar, 22nd Febrary, 2012
OF RELATED INTEREST from our journal:
M.J. Toole, N. Chanlivong et al., “Understanding male sexual behaviour in planning HIV prevention programmes: lessons from Laos, a low prevalence country”, Sex Transm Infect 2006;82:135-138 doi:10.1136/sti.2005.016923
http://sti.bmj.com/content/82/2/135.full?sid=ede79323-e743-4a05-907e-d4f33c483b98
23 Mar, 12 | by Leslie Goode, Blogmaster
In the face of 340 million incident cases of STI worldwide each year, UNAIDS in a recent statement deemed the male latex condom “… the single most efficient, available technology to reduce the sexual transmission of HIV and other sexually transmitted infections”. Sadly, though the condom may be effective in vitro, this potential proves hard to realize use in real life. Sustained condom use requires levels of commitment such that, even in the case of discordant heterosexual HIV couples, studies indicate fewer than half of participants report regular use. In the light of this, the Australian journal Sexual Health has devoted a special issue to condom use – recognizing it to be a “complex behaviour embedded in the fabric” of social relationships. Attention is given both to data regarding the behaviour itself (including errors and problems of condom use), and to the methodological problems affecting its evaluation by recent research.
Individual reviews cover China, Central and Eastern Europe and Sub-Saharan African. There are also papers on the female condom and on the issue of “risk compensation” – i.e. where the introduction of one preventative method (e.g. vaginal microbicides) impacts on the use of another (e.g. condoms).
Two systematic review papers, reflecting the two-fold concern of this special issue with the behaviour itself and methodological issues around its evaluation, offer a global perspective on condom use. The first of these – a review of the literature regarding condom use errors and problems (Stephanie A. Sanders et al.) – leaves the reader with a bewildering sense of the disparity in the importance assigned by studies to the various causes of “condom failure”. Statements abound such as that “breakage rates ranged from 0.8% to 40.7% of participants across 15 studies”. The reader may wonder what there is to learn from such data, other than that condom use is indeed a complex behaviour and difficult to evaluate scientifically.
The other systematic review paper (Richard A. Crosby & Sarah Bounse) is complementary to this. It deals specifically with the methodological problems of evaluating the link between condom use and STI, focussing exclusively on prospective studies. Forms of misclassification bias are rife, the authors claim. The most serious derive from the difficulty of determining, when infection takes place within the recall period, whether events of condom-protected sex occurred before infection, or after infection. Other sources of misclassification bias involve failing, where figures are given for number of infections for a given level of condom use, to control for “use errors” such as breakage, slipping, or incomplete use.
Ultimately the critical question facing policy formers is this: whether protective effect of condom use warrants the full support of public health efforts to keep condoms to the forefront of STI prevention? It should be borne in mind that all the potential forms of study bias regarding condom use tend towards the nul hypothesis (i.e. they underestimate the effectiveness of condoms). In the light of this, the authors affirm that the threshold for sufficient protective effect has probably already been crossed. Yet clearly more definitive findings would greatly assist the cause of deploying condoms as part of public health efforts. To this end, the paper seeks to explain, and thereby avert, the causes of “error variance” between studies of condom effectiveness (variance not determined by real differences of the relation between condom use and STI).
Sexual Health 9: 1, 2012
http://www.publish.csiro.au/nid/164/currentissueflag/1.htm
Stephanie A. Sanders, Robin R. Milhausen et al., Condom Use Errors and Problems: A Global View, pp.81-95
Richard A. Crosby and Sarah Bounse, Condom Effectiveness: Where are we Now, pp.10-17
FOR FURTHER DISCUSSION OF THIS ISSUE in this journal, see:
R. Crosby, W.L. Yarber et al., ”Two heads are better than one: the association between condom decision-making andcondom use errors and problems”, Sex Transm Infect 2008;84:198-201 doi:10.1136/sti.2007.027755
http://sti.bmj.com/content/84/3/198.full?sid=cae33837-335c-4d59-bb95-439830fe5e00
And for a perspective on promoting condoms through religious leadership, Willms et al in Sex Transm Infect 2011;87:611-615 doi:10.1136/sextrans-2011-050045
http://sti.bmj.com/content/87/7/611.abstract?sid=d4d99386-88d5-4037-a7a1-64be1f1c1751
26 Feb, 12 | by Leslie Goode, Blogmaster
Can we put a figure on the infectivity of HIV infection per coital act, and on the relative importance of the various determinants of transmission?
Estimates are needed in order to plan effective interventions. A recent paper, published in the Journal of Infectious Diseases (Hughes, Celum et al.), discussed by an editorial (Gray & Wawer) of the same issue, represents the latest attempt at estimating infectivity and its determinants for sub-Saharan Africa. The study was conducted on the back of a large randomized trial of HSV-2 suppression for prevention of HIV transmission between sero-discordant couples, and involved 3,293 couples at 14 sites in S and E Africa over a period of 24 months.
First the figures. Transmission per coital act was estimated at 0.0019 for male-to-female, and 0.001 for female-to-male. The major driver of transmission was HIV load in the infected partner: each log10 increment in viral load produced a 2.9 fold adjusted risk of transmission. Condom use reduced risk by 82%.
On the whole, these findings provide reassuring corroboration of the findings of earlier, smaller studies. The figure for overall infectivity is similar to that reported during the latent stage of HIV infection in low-income countries. Such a figure does not explain the rapid spread of the infection in many sub-Saharan settings – because, as Gray and Wawer point out, a study of this kind, involving stable sero-discordant couples, is unable to factor in the vastly higher levels of infectivity associated with early and late stage disease.
The figure of 2.9 for the multiplication of risk with log10 viral load increment is higher than prior estimates, and may reflect more precise estimates enabled in this study by quarterly viral load measurements (Lingappa, Hughes, Wang et al.).
Numerous earlier attempts to establish HIV infectivity and its determinants are surveyed in a recent meta-analysis (Boily, Baggaley and Wang et al.). Two things distinguish the present paper. The first is sheer scale: at 3,293 couples, the number of recruits exceeds considerably that of the next largest study (Fideli, Aldrovandi et al.), and far exceeds participation in previous studies (generally placed at <200 participant couples). The size of a study like this is an important factor because it enhances its ability to reliably estimate co-factors of transmission. The second distinguishing feature is the seriousness of the effort to estimate the number of sexual events: participant couples were interviewed about their sexual activity every month – a frequency that greatly exceeds the frequency of interviews in comparable studies. These factors, along with frequency of quarterly viral load measurements, seem to mark a considerable gain in reliability, as against earlier attempts to place a figure on latent HIV infectivity.
James P. Hughes, Connie Celum et al., “Determinants of Per-Coital-Act HIV-1 Infectivity Among African HIV-1- Serodiscordant Couples”, Journal of Infectious Diseases 205:3, January 2012
http://jid.oxfordjournals.org/content/205/3/358.full
Ronald H. Gray and Maria J. Wawer, “Probability of Heterosexual HIV-1 Transmission per Coital Act in Sub-Saharan Africa” (Editorial), Journal of infectious Diseases 205:3, January 2012
http://jid.oxfordjournals.org/content/205/3/351.full
J. R. Lingappa, J.P. Hughes, R.S. Wang et al., “Estimating the impact of plasma HIV-1 RNA reductions on herosexual HIV-1 transmission risk”, PLoS One 2010,10.1371/journal.pone.0012598
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0012598
M. C. Boily, R.F. Baggaley, L. Wang et al. “Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies, Lancet Infectious Diseases 2009; vol. 9, no.2, Feb. 2009
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(09)70021-0/fulltext
U. S. Fideli, S. A. Allen, R. Musonda et al., “Virologic and immunologic determinants of heterosexual transmission of human immunodeficiency virus type 1 in Africa”, AIDS Res Hum Retroviruses 2001; 17 (10): 901-10
26 Feb, 12 | by Leslie Goode, Blogmaster
A recent paper (Qiao et al.) – Journal of National Cancer Institute (JNCI) 104:3 – reports the findings of a series of 5 population-based studies of self-screening for cervical cancer in rural China, involving 13,140 participants. They are particularly relevant to STI readers on account of issues they raise about the effectiveness of screening programs in low-resource settings. An editorial in the same issue of JNCI (Patrick Petignat) provides an interesting discussion of these issues.
While a seventh of the world’s cases of cervical cancer (the third most common type of cancer in women) occur in China, a high proportion of these will be in low-resource rural settings where access to healthcare is very limited, and the kind of screening (smear or pap test) conducted in developed countries is not feasible. The last few years have seen the development of a promising alternative to the smear test, which involves screening for the strains of Human Papilloma Virus (HPV) that can lead to cervical cancer (HPV DNA). So far as low-resource settings are concerned, the latter test has the notable advantage that it can be administered by patients on themselves, and need not require significant medical resources and laboratory infrastructure.
Could self-administered HPV DNA testing provide a practicable mode of screening in areas, like rural, China where trained medical practitioners are scarce? Petignat, in his JNCI editorial, helpfully distinguishes between the issue of diagnostic performance, and the wider issue of the likely efficacy of self-testing interventions outside the research setting.
The paper (Qiao et al.) addresses the first issue. Participants in the five studies were all tested with HPV DNA administered by physician and with self-administered HPV DNA, as well as with two other tests – liquid-based cytology (LBC) and visual inspection with acetic acid (VIA) (a test that has been proposed for low-resource settings). Sensitivity and specificity of self-administered HPV DNA in detecting biopsy-confirmed cervical intraepithelial neoplasia grade 2 or more severe (CIN2+) proved to be 86.2% and 80.07% respectively as against 97% and 82.7% for HPV DNA performed by physician. Sensitivity of self-administered HPV DNA at 86.2% was actually superior to sensitivity of LBC at 80.7% and VIA at 50.3%. So far so good. The real problem with HPV DNA, whether self-administered or administered by physician, proved to be its relatively low specificity of 80.7%. Without further triage, screening with HPV DNA would result in an altogether unfeasible 15.6% of women being referred for colposcopy. A combination of self-HPV with triage using LBC or VIA might offer the most feasible solution. Computer models for the impact of these combinations were developed in the course of the study, and produced levels of referral for colposcopy of 4.8% and 4.5% respectively. Given LBC requires laboratory facilities and a medical infrastructure not likely to be achievable in a low-resource context, self-HPV combined with VIA comes out as the most feasible option.
There remains, however, the issue of the likely feasibility of self-testing interventions outside the research setting. The authors comment on the willingness of participants (70% of those invited) and the almost 100% compliance of participants with instructions. This is promising. But compliance on the part of volunteer participants is one thing: likely take-up of self-testing interventions outside such a framework is quite another, and would no doubt depend on the delivery of the intervention, as well as on a range of cultural factors. The authors refer to a relatively inexpensive testing kit – care HPV. Ultimately, however, cost-effectiveness will depend on take-up. Petignat concludes with a salutary note of warning: “Self-HPV per se is only a part of a secondary prevention program, and obstacles to program participation might not only result in program failure but also be harmful for women”. In view of this, further research seems called for.
Fang-Hui Zhao, You-Lin Qiao et al., “Pooled Analysis of a Self-Sampling HPV DNA Test as a Cervical Cancer Primary Screening Method”, Journal of the National Cancer Institute, 104:3, 8th Feb., 2012
Patrick Petignat, Pierre Vassilakos, “Is It Time to Introduce HPV Self-Sampling for Primary Cervical Cancer Screening?” (Editorial) Journal of the National Cancer Institute, 104:3, 8th Feb., 2012
31 Jan, 12 | by Jackie Cassell, Editor of STI
The BMJ Group journals Sexually Transmitted Infections (impact factor 3.029) and the Journal of Medical Ethics (impact factor 1.391), in conjunction with academics at the Centre for Social Ethics and Policy (University of Manchester) and the Health Ethics and Law Network (University of Southampton), would like to publish a collection of articles on the criminalization of disease and sexually transmitted infections. We invite article contributions to be published as part of this themed collection.[1]
Themes
The use of criminal law to respond to infectious disease transmission has far-reaching implications for law, policy and practice. It presupposes co-operation between clinicians and criminal justice professionals, and that people who infect others can be effectively and fairly identified and brought to justice. There is a potentially difficult relationship between criminal justice and public health bodies, whose priorities do not necessarily coincide. We are interested in receiving papers of broad interest to an international readership of medical ethics scholars and practicing clinicians on any of the following topics:
Publication
1. Up to eight articles will published in a special section in an issue of Sexually Transmitted Infections in 2013.
2. Two articles will be published in a special section in an issue of Journal of Medical Ethics in 2013.
All articles will be blind peer reviewed according to each individual journal’s editorial policies. Final publication decisions will rest with the Editors in Chief: Professor Jackie Cassell (STI) and Professor Julian Savulescu (JME).
Important Dates
Please submit your article to either journal no later than December 14th 2012.
Submission Instructions
For Sexually Transmitted Infections:
Articles for STI should be a maximum of 2,500 words and submitted via the journal’s website: http://sti.bmj.com/. Please choose the special issue ‘Criminalizing Contagion’ during the submission process.
For Journal of Medical Ethics:
Articles for JME should be a maximum of 3,500 words, and submitted via the journal’s website: http://jme.bmj.com/. Please choose the special issue ‘Criminalizing Contagion’ during the submission process.
Further submission instructions are on the journals’ respective websites. If you would like to discuss any aspect of your submission, including possible topics and the journals involved, please contact the guest editors in the first instance: Dr David Gurnham (David.Gurnham@manchester.ac.uk), Dr Catherine Stanton (Catherine.Stanton@manchester.ac.uk) or Dr Hannah Quirk (Hannah.Quirk@manchester.ac.uk).
