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Biomedical subjects

C H Mercer

Publications and source records attributed to C H Mercer.

At least 19 recordsLinked to original sources
PubMed2006

A comparison of the population diagnosed with chlamydia in primary care with that diagnosed in sexual health clinics: implications for a national screening programme.

OBJECTIVES: To compare demographic, behavioural and HIV testing characteristics of individuals diagnosed with chlamydia infection in primary care with those in genitourinary medicine clinics, in the absence of a screening programme. The aim was to explore the current and potential contribution of primary care to the control of chlamydia. STUDY DESIGN AND METHODS: We analysed data on individuals who reported one or more chlamydia diagnoses in the past 5 years in a large probability sample survey of the resident, UK general population aged 16-44 years. Estimates were weighted and odds ratios calculated. RESULTS: Women diagnosed in primary care reported fewer sexual partners, and were less likely to have had an HIV test in the past 5 years than their counterparts diagnosed in genitourinary medicine clinics. Age, ethnicity, social class, educational attainment and urbanization of area of residence did not differ between the two groups. Too few men were diagnosed in primary care to allow for such a comparison. CONCLUSIONS: Primary care already diagnoses a large number of women with chlamydia infection, who may perceive themselves as low risk through age or sexual behaviour, yet are likely to comprise a substantial proportion of all infections. Few men are diagnosed in primary care. These groups need to be strategically targeted in the context of a future chlamydia screening programme, which will focus on the screening of younger women at high risk, and in which the role of primary care is still in development.

Adolescent↗
PubMed2006

Is the cultural context of MMR rejection a key to an effective public health discourse?

OBJECTIVES: (1) To explore the social and cultural influences, and health beliefs associated with low uptake of MMR (measles, mumps and rubella vaccine). (2) To describe and explore the prevalence of health beliefs associated with non-compliance with MMR, with a view to improving the personal relevance and impact of information for parents, in the context of persisting low uptake following public controversy. METHODS: We undertook a survey of mothers' experiences of and attitudes to the MMR, developed through ethnographic study, which was linked to maternal and child information on the Child Health Database in Brighton, England. RESULTS: Mothers interpret MMR risk through concepts of child health embedded in family health history, with a majority both of compliers and non-compliers holding that each child's immune system is unique. Cultural 'risk factors' for non-compliance relate strongly to the use of complementary healthcare, such as homeopathy, with evidence that rejection of vitamin K is associated with MMR non-compliance. Forty per cent, both of compliers and non-compliers, did not consider the possible benefits to other children of MMR. CONCLUSIONS: These findings have paradoxical and challenging consequences for the promotion of immunization in the policy context of increasing emphasis on healthy choices. They demonstrate the need for immunization information that acknowledges and addresses lay concepts of immunity.

Adolescent↗
PubMed2006

The social shaping of childhood vaccination practice in rural and urban Gambia.

Improving childhood vaccination coverage is a key health policy objective in Africa, and as availability increases, it will depend on addressing issues of demand and timely schedule completion. This paper explores vaccination demand in urban and rural areas of The Gambia as shaped by prevailing local vaccination cultures (comprising maternal knowledge and understandings, socio-cultural contexts and interactions with health providers). A survey of 1,600 mothers constructed on the basis of prior ethnography finds a high level of social demand for vaccination, based on lay theories of the general value of immunization in complementing traditional child protection practices. For most rural mothers, strong social networks encourage routine clinic attendance and vaccination 'default' arises only through day-to-day problems and contingencies. However, more pervasive patterns of schedule non-completion are found amongst poorer urban mothers, including recent immigrants, who experience social exclusion at infant welfare clinics. These findings point to the need for health education dialogue grounded in mothers' own understandings and for particular policy attention to improving the clinic experiences of vulnerable social groups in rapidly expanding urban areas.

Data Collection↗
PubMed2006

Factors associated with heterosexual transmission of HIV to individuals without a major risk within England, Wales, and Northern Ireland: a comparison with national probability surveys.

OBJECTIVE: To compare the prevalence of HIV risk behaviours reported by heterosexuals without major risks for HIV acquisition diagnosed with HIV in England, Wales, and Northern Ireland, with those of the heterosexual general population. METHODS: Demographic and sexual behaviour data for heterosexuals (without major risks for HIV) aged 16-44 from the British National Surveys of Sexual Attitudes and Lifestyles in 1990 and 2000 were compared to 139 HIV infected individuals without major risks for HIV aged 16+ at diagnosis, interviewed between December 1987 and March 2003. Comparisons were made overall and separately for the early and late 1990s. RESULTS: HIV infected heterosexual men without major risks were significantly more likely to report first heterosexual intercourse before age 16 (adjusted odds ratio (AOR): 2.75; 95% confidence interval (CI),1.65 to 4.57), while both HIV infected heterosexual men and women reported greater partner numbers (AOR: men 2.44; CI, 1.4 to 4.05; AOR women 2.17; CI, 1.28 to 3.66) and never using condoms (AOR: men 7.97; CI,4.78 to 13.3; AOR women 3.95; CI, 2.30 to 6.80) than the heterosexual general population. There is evidence to suggest that the two groups were more similar in their reporting of partner numbers in the late 1990s relative to the early 1990s. CONCLUSION: Heterosexual HIV infected individuals without major risks for HIV acquisition in England, Wales, and Northern Ireland are significantly more likely to report high risk sexual behaviours relative to the British heterosexual general population. However, these differences may have decreased over time, at least for the number of partners. Effective sexual health promotion, including the continued promotion of condom use, would impact on the rising rates of STI diagnoses and also prevent HIV transmission among the heterosexual general population.

Adolescent↗
PubMed2006

Refocusing health promotion for syphilis prevention: results of a case-control study of men who have sex with men on England's south coast.

BACKGROUND: Prevention interventions have had little impact on syphilis outbreaks among men who have sex with men (MSM) and diagnosis rates continue to rise rapidly. Detailed studies of the determinants of syphilis transmission are needed to inform new prevention interventions. OBJECTIVE: To investigate factors associated with recent syphilis diagnosis and recommend strategies for improved prevention interventions. METHODS: A case-control study of MSM attending genitourinary medicine (GUM) and HIV outpatient clinics. Cases were MSM testing positive for early syphilis, based on either laboratory or microscopy results, with those testing negative being controls. All participants completed the same anonymous questionnaire covering demographics, lifestyle, sexual behaviour, and sexual partnerships. RESULTS: 50 cases and 108 controls returned questionnaires. Syphilis diagnosis was significantly associated with sexually transmitted infection history, recent recreational drug use, receptive anal sex practices, but not insertive ones, higher numbers of oral sex partners, but not specific oral sex practices. Overall, there were no differences between HIV positive and HIV negative/untested men in reporting of sexual behaviours or partnership combinations. The use of public sex settings (backrooms, saunas, "cruising grounds," etc) was reported by 68% of all participants and not significantly associated with syphilis diagnosis. CONCLUSIONS: Many key behavioural and partnership risk factors for syphilis are also risk behaviours for HIV transmission and point to the need for integrated strategies that tackle the two infections together. Simplified procedures for syphilis screening should be available in GUM clinical settings, along with targeted community outreach prevention interventions.

Adult↗
PubMed2006

Men who have sex with men: a comparison of a probability sample survey and a community based study.

We compared characteristics of men who have sex with men (MSM) in a probability sample survey with a community based study in London. The majority of men in both surveys reported male sex partner(s) in the last year but MSM recruited through the population based survey had lower levels of HIV risk behaviour, reported fewer sexually transmitted infections and HIV testing than those recruited from gay venues. Community samples are likely to overestimate levels of risk behaviour among all MSM.

Adolescent↗
PubMed2006

Who uses condoms with whom? Evidence from national probability sample surveys.

OBJECTIVES: To explore the changing pattern of condom use from 1990 to 2000; to identify sociodemographic and behavioural factors associated with condom use; and reasons for condom use in 2000. METHODS: Large probability sample surveys administered among those resident in Britain aged 16-44 (n = 13 765 in 1990, n = 11 161 in 2000). Face to face interviews with self completion components collected sociodemographic, behavioural, and attitudinal data. RESULTS: Condom use in the past year among sexually active 16-24 year old men increased from 61.0% in 1990 to 82.1% in 2000 (p<0.0001), and from 42.0% to 63.2% (p<0.0001) among women of the same age, with smaller increases among older age groups. Among individuals reporting at least two partners in the previous 4 week period, approximately two thirds reported inconsistent or no condom use (63.1% (95% CI 55.9% to 69.8%) of the men and 68.5% (95% CI 57.6% to 77.7%) of the women). CONCLUSIONS: Rates of condom use increased substantially between 1990 and 2000, particularly among young people. However, inconsistent condom use by individuals with high rates of partner acquisition may contribute significantly to the recent resurgence in STIs. This group is an important target for intensive and specific sexual health interventions.

Adolescent↗
PubMed2006

Estimating adult HIV prevalence in the UK in 2003: the direct method of estimation.

BACKGROUND: Estimates of the total number of prevalent HIV infections attributable to the major routes of infection make an important contribution to public health policy, as they are used for planning services. METHODS: In the UK, estimates were derived through the "direct method" which estimated the total number of diagnosed and undiagnosed HIV infections in the population. The direct method has been improved over a number of years since first used in 1994, as further data became available such as the inclusion of newly available behavioural survey data both from the National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) and community surveys of men who have sex with men (MSM). These data were used to re-estimate numbers of people unaware of their infection and provided ethnic breakdowns within behavioural categories. The total population was divided into 10 mutually exclusive behavioural categories relevant to HIV risk in the UK-for example, MSM and injecting drug users. Estimates of the population size within each group were derived from Natsal 2000 and National Statistics mid-year population estimates. The total number of undiagnosed HIV infections was calculated by multiplying the undiagnosed HIV prevalence for each group, derived from the Unlinked Anonymous HIV Prevalence Monitoring Programme surveys (UAPMP), by the population size. These estimates were then added to the prevalent diagnosed HIV infections within each group derived from the national census of diagnosed HIV infections, the Survey of Prevalent HIV Infections Diagnosed (SOPHID). The estimates were then adjusted to include all adults in the UK. Because undiagnosed HIV prevalence estimates were not available for each of the behavioural categories, the UAPMP prevalence estimates were adjusted using available data to provide the best estimates for each group. RESULTS: It is estimated that 53,000 individuals are infected with HIV in the UK in 2003, of whom 27% were unaware of their infection. Of the total of 53,000, an estimated 26,000 were among heterosexually infected and 24,500 among MSM. CONCLUSION: The direct method uses an explicit framework and data from different components of the HIV surveillance system to estimate HIV prevalence in the UK, allowing for a comprehensive picture of the epidemic.

Adolescent↗
PubMed2005

Community based syphilis screening: feasibility, acceptability, and effectiveness in case finding.

OBJECTIVES: To investigate the feasibility and acceptability of implementing community based syphilis screening using different sample collection techniques, and its effectiveness in screening at-risk populations and identifying new syphilis cases. METHODS: Two phases of syphilis screening were conducted in venues frequented by men who have sex with men (MSM). Phase 1 used venepuncture and phase 2 a validated saliva test. Evaluation used quantitative data from testers, venues and the local genitourinary medicine (GUM) clinic, and qualitative data from venue and programme staff. RESULTS: 1090 MSM were tested over 7 weeks. 62% of testers had not attended a GUM clinic in the past year. 64% of testers reported > or = 2 sexual contacts in the past 90 days and 11% reported > or = 10. Similar diagnosis rates were recorded for phase 1 (1.4%) and phase 2 (1.8%). There was greater uptake of testing with the saliva test in saunas during phase 2. CONCLUSIONS: Syphilis screening in gay venues is feasible and acceptable to at-risk MSM, and reaches a group not routinely accessing GUM services. The low case detection for syphilis suggest this approach, while unlikely to contain outbreaks, may be more useful if combined with screening for other sexually transmitted infections and effective health promotion strategies.

Adult↗
PubMed2005

Who pays for sex? An analysis of the increasing prevalence of female commercial sex contacts among men in Britain.

BACKGROUND: In the United Kingdom the incidence of sexually transmitted infections (STI) and risky sexual behaviours is increasing. The role of commercial sex in this trend is poorly understood. Little is known about the men who pay for sex. We examined the epidemiology of female commercial sex contacts reported by men in 1990 and 2000. METHODS: National probability sample surveys of sexual attitudes and lifestyles (Natsal) of men aged 16-44 resident in Britain in 1990 (n = 6000) and 2000 (n = 4762). RESULTS: The proportion of men who reported paying women for sex in the previous 5 years increased from 2.0% (95% CI 1.6 to 2.5) in 1990 to 4.2% in 2000 (95% CI 3.6 to 4.9). In both surveys, paying for sex was more frequent in men aged between 25 years and 34 years, who were never or previously married, and who lived in London. There was no association with ethnicity, social class, homosexual contact, or injecting drug use. Men who paid for sex were more likely to report 10 or more sexual partners in the previous 5 years; only a minority of their lifetime sexual partners (19.3%) were commercial. They were more likely to meet partners abroad and to report previous STI. Only 15% reported having had an HIV test. CONCLUSION: The proportion of men who reported paying for heterosexual sex has increased, and these men have multiple commercial and non-commercial partners. Their higher rates of STI and low level of HIV testing suggest the need for prevention interventions for clients as well as sex workers.

Adolescent↗
PubMed2005

Who reports sexual function problems? Empirical evidence from Britain's 2000 National Survey of Sexual Attitudes and Lifestyles.

OBJECTIVE: To identify sociodemographic, sexual, and health behavioural and attitudinal factors associated with reporting sexual function problems. METHODS: A probability sample survey of 11 161 men and women aged 16-44 years resident in Britain in 2000. Data collected by a combination of computer assisted face to face and self interviewing. Outcomes were self report of a range of sexual function problems, considered as "any problems" (1+ lasting 1+ months in the past year) and "persistent problems" (1+ lasting 6+ months in the past year), and associations with sociodemographic, behavioural, and attitudinal variables. RESULTS: Both "any" and "persistent" sexual function problems were more commonly reported by women than men. A variety of sociodemographic factors were associated with both measures but differed by gender. For example, the adjusted odds ratio (AOR) for reporting any problems for married v single respondents was 0.70 (95% confidence interval (CI) 0.57 to 0.87) v 1.31 (95% CI 1.10 to 1.56) for men and women, respectively. Sexual behaviours significantly associated with reporting sexual function problems included competence at first sex, paying for sex in the past 5 years, number of occasions of sex and masturbation, both in the past 4 weeks. For men (only), reporting STI diagnosis(es) was significantly associated with reporting "any" problems (AOR 2.1, 95% CI 1.4 to 3.2) and "persistent" problems (AOR 2.1, 95% CI 1.1 to 3.9). Both measures were significantly more likely among men and women who reported communication difficulties with their partners, with AORs in excess of 1.9. CONCLUSIONS: Sexual fulfilment is an important part of sexual health. Understanding factors associated with reporting sexual problems, and recognising that such factors maybe partnership specific, is an important step towards improving our understanding of sexual function and thus improving the provision of care and support available.

Adolescent↗
PubMed2003

Maintaining patient access to GUM clinics: is it compatible with appointments?

OBJECTIVES: To determine whether a planned change from a walk-in service to a system in which 35% of appointments were prebooked and 65% obtained on the day, preserved access to the service for patients with, or at risk of, STIs. To describe patients' attitudes and behaviours in relation to accessing the clinic, and relate these to disease status and other epidemiological factors. To evaluate the effect of the change on clinical outcomes. To develop a tool for evaluating access to services. METHOD: A natural experiment was studied, in which a cohort of patients attending just before the change in appointments policy (phase 1) was compared with a cohort following the change (phase 2). A questionnaire was administered to all new patients, and linked to disaggregated epidemiological and demographic data and case notes. RESULTS: The age, ethnic, symptom status, and disease mix of the clinic did not change significantly, and more patients were seen in phase 2. Time from telephoning to being seen did not change. Under 25s and Afro-Caribbeans used prebooked appointments less than others. Partner notification improved and HIV testing rates increased, while staff preferred the new system. CONCLUSION: This specific appointment system in a GUM clinic preserved access for high risk groups. However, this may not generalise to systems with a higher proportion of prebooked appointments.

Adult↗
PubMed2003

Treating sexually transmitted infections in primary care: a missed opportunity?

OBJECTIVES: To explore patterns of primary care attendance, barriers to the use of primary care, and views on services in a population of first time genitourinary medicine (GUM) clinic attenders. METHOD: A cross sectional survey of new patients attending a mainly walk-in outer London GUM clinic, in which responses were linked to clinical data. RESULTS: 40.5% of all patients and 39.9% of those with an STI had already seen a GP for their current problem. This did not vary with age or symptom status. Duration of symptoms was highly significantly longer in patients who had attended a GP than in patients who attended a GUM clinic in the first instance. When patients who had not seen a GP were asked the reason for this, a third of responses cited the convenience of a GUM clinic or difficulty in accessing primary care services, while only 3% cited embarrassment and only 2% examination or gender issues. CONCLUSION: Many patients initially attend GP services for STIs, and primary care is therefore already an important setting with potential for STI control. However, delay in treatment through attendance at primary care, and barriers in access to primary care, need to be addressed in the planning of future services.

Adult↗
PubMed2002

The accuracy of reported sensitive sexual behaviour in Britain: exploring the extent of change 1990-2000.

OBJECTIVES: The 1990-1 British national probability sample survey of sexual attitudes and lifestyles (Natsal 1990) was repeated in 1999-2001 (Natsal 2000) to update population estimates of risk behaviours, and assess change over time. We examine whether changes in prevalence estimates may partly result from changes in measurement accuracy. METHODS: Taking Natsal 2000 (11 161 respondents) and Natsal 1990 (13 765 respondents aged 16-44) we compared the response rate, sample representativeness, reporting of abortion last year (relative to official statistics), and selected attitudes. Among the common birth cohort eligible for both surveys (aged 16-34 Natsal 1990, 26-44 Natsal 2000), we compared reporting of experiences before 1990. RESULTS: The response rate (66.8% Natsal 1990, 65.4% Natsal 2000) and completeness of reporting abortion were unchanged (84% Natsal 1990, 86% Natsal 2000). Attitudes were significantly changed in Natsal 2000 relative to Natsal 1990--for example, increased tolerance of male homosexual sex, OR (95% CI) 2.10 (1.93-2.29) men and 2.95 (2.74 to 3.18) women. In the common birth cohort reporting of heterosexual intercourse before 16 (OR 1.15 (1.02 to 1.29) men, 1.49 (1.31 to 1.69) women), and homosexual experience (OR 1.80 (1.46 to 2.21) men, 2.00 (1.61 to 2.48) women) were significantly increased. CONCLUSIONS: The results are consistent with improved reporting accuracy for some sensitive behaviours in Natsal 2000, in line with greater social tolerance and improved survey methodology. However, the evidence is not conclusive, and may not be generalisable to all such behaviours. The increase found in the reported prevalence of STI risk behaviours between Natsal 1990 and Natsal 2000 is likely to be somewhat overstated.

Adolescent↗
PubMed2001

Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours.

BACKGROUND: Sexual behaviour is a major determinant of sexual and reproductive health. We did a National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) in 1999-2001 to provide population estimates of behaviour patterns and to compare them with estimates from 1990-91 (Natsal 1990). METHODS: We did a probability sample survey of men and women aged 16-44 years who were resident in Britain, using computer-assisted interviews. Results were compared with data from respondents in Natsal 1990. FINDINGS: We interviewed 11161 respondents (4762 men, 6399 women). Patterns of heterosexual and homosexual partnership varied substantially by age, residence in Greater London, and marital status. In the past 5 years, mean numbers of heterosexual partners were 3.8 (SD 8.2) for men, and 2.4 (SD 4.6) for women; 2.6% (95% CI 2.2-3.1) of both men and women reported homosexual partnerships; and 4.3% (95% CI 3.7-5.0) of men reported paying for sex. In the past year, mean number of new partners varied from 2.04 (SD 8.4) for single men aged 25-34 years to 0.05 (SD 0.3) for married women aged 35-44 years. Prevalence of many reported behaviours had risen compared with data from Natsal 1990. Benefits of greater condom use were offset by increases in reported partners. Changes between surveys were generally greater for women than men and for respondents outside London. INTERPRETATION: Our study provides updated estimates of sexual behaviour patterns. The increased reporting of risky sexual behaviours is consistent with changing cohabitation patterns and rising incidence of sexually transmitted infections. Observed differences between Natsal 1990 and Natsal 2000 are likely to result from a combination of true change and greater willingness to report sensitive behaviours in Natsal 2000 due to improved survey methodology and more tolerant social attitudes.

Adolescent↗