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Biomedical subjects

T A Peterman

Publications and source records attributed to T A Peterman.

At least 19 recordsLinked to original sources
PubMed1996

Opportunities for targeting publicly funded human immunodeficiency virus counseling and testing.

We wished to identify opportunities for improving the yield of positive HIV test results from federally funded HIV counseling and testing programs. We reviewed client records from 1992 and 1993 for targeting opportunities at the site level based on site type (i.e., family planning clinic) and the seropositivity in the past and at the client level based on the client's history of a past negative test, demographics, and risk history. We studied 1,281,606 records from 1992. The number of tests and opportunities for site-level targeting varied by project area. Seropositivity varied by site type, but the best predictor of seropositivity was seropositivity at that site in the past. Of 1,102 sites with <1% of tests positive in 1992, only five had >3% positive in 1993. Sites with no positive tests in 1992 performed 99,468 tests in 1993, and only 292 (0.3%) were positive. Clients with a past negative test had a slightly lower seropositivity (1.5%) than clients with no previous test (2.0%). In sites with a low (0.1-2.0%) seropositivity, clients with no transmission risk by history were unlikely to be infected (0.8% for black men). However, in sites with high (> or =5%) seropositivity, clients without risk were often infected (5.7% for black men). Opportunities for targeting were identified. They vary considerably by project area and testing site. These opportunities for targeting should be considered by sites as AIDS prevention strategies evolve.

AIDS Serodiagnosis↗
PubMed1995

Decreasing prevalence hides a high HIV incidence: Miami.

OBJECTIVE: Study methods of assessing HIV trends in sexually transmitted disease (STD) clinics where blinded seroprevalence has been among the highest in the United States. DESIGN: Cross-sectional and retrospective cohort. METHODS: Reviewed computerized records of the four Miami STD clinics for 1987-1992. RESULTS: A total of 53,403 persons had 70,793 tests. When testing began, 13% were HIV-positive. By 1992, 35% of all tests were performed on previously HIV-negative persons. This caused a faster decline in overall seroprevalence (to 7%) compared with seroprevalence among persons tested for the first time (to 9%). The percentage of tests performed for previously HIV-negative persons varied among age, race and sex subgroups, causing confounding if overall seroprevalence was used to compare groups. Seroconversion occurred in 514 patients. Black women were most likely to be positive on retesting (4.3%). Incidence rates did not change much over time, remaining at 2.5% per year. CONCLUSIONS: When using a routine HIV-testing data to analyze trends, separate analyses should be undertaken for patients who were (or were not) previously tested. In these patients, the prevalence decreased slightly but incidence remained high, particularly among black women.

Adult↗
PubMed1995

HIV-1 seroconversion and risk behaviors among young men in the US army. The Seroconversion Risk Factor Study Group.

OBJECTIVES: This study sought to examine risk factors associated with human immunodeficiency virus type 1 (HIV-1) seroconversion among active-duty men in the US Army. METHODS: One hundred twenty-eight men with documented HIV-1 seroconversion between 1988 and 1991 were matched to control subjects on demographic variables. Risk factor information was collected for the seroconversion period. RESULTS: Forty-nine case subjects and no control subjects reported same-gender sex; this includes 34 case subjects who also reported sex with women. Seventy case and 118 control subjects reported no risk factors other than heterosexual intercourse. Among heterosexuals, excess risk was noted for men who had sex with women in risk categories defined by the Centers for Disease Control and Prevention (odds ratio = 10.0; 95% confidence interval = 1.3, 78.1). Significant trends of increasing risk for seroconversion were found with increasing numbers of female partners, nonsteady partners, and partners with whom sex occurred on the first day of acquaintance. CONCLUSIONS: In this population, the major risk factor for HIV-1 seroconversion was same-gender sex. Among heterosexuals, sex with anonymous or causal partners increased this risk. Intervention programs should emphasize the risk of indiscriminate partner selection in addition to "safe sex" practices.

Adult↗
PubMed1995

Routine hepatitis B vaccination in a clinic for sexually transmitted diseases.

Patients were assigned to one of two vaccine schedules to assess the feasibility of vaccinating a sexually transmitted disease clinic population against hepatitis B virus. Of 1386 patients entering an inner-city clinic between June and July 1990, 611 (44%) accepted a first dose of vaccine. Twenty-one percent of all susceptible patients received at least two doses of vaccine. Annualizing these findings shows that an ongoing program could prevent 636 hepatitis B virus infections per year. Although a significant proportion of sexually transmitted disease clinic patients can be successfully vaccinated, strategies for preventing hepatitis B virus infections in this high-risk population must consider patient behavior as well as vaccine efficacy.

Adolescent↗
PubMed1995

Syphilis and gonorrhea in Miami: similar clustering, different trends.

During the second half of the 1980s, Miami had a syphilis epidemic while gonorrhea rates decreased. To determine whether the direction of these trends truly differed within all population subgroups or whether they resulted from aggregating groups within which trends were similar, records from four sexually transmitted disease clinics from 1986 to 1990 and census data from 1990 were used to compare race-, sex-, age-, and zip code-specific groups. Syphilis and gonorrhea clustering was similar; 50% of cases occurred in the same zip codes, representing 10% of the population. In all groups, gonorrhea decreased (aggregate 48%) while syphilis first increased (aggregate 47%) and then decreased. Determining reasons for these different trends may facilitate controlling these diseases.

Adolescent↗
PubMed1995

Kaposi's sarcoma. How can epidemiology help find the cause?

Kaposi's sarcoma (KS) remains the most commonly diagnosed cancer in AIDS patients. Neither the cause nor a cure for AIDS-related KS is known. KS serves as a striking example of how epidemiologists seek the cause of any disease. Epidemiologic analysis of reported KS cases is revealing but not definitive. The leading hypotheses for the cause of AIDS-related KS are an as-yet-unidentified sexually transmitted infectious agent and exposure to inhalant alkyl nitrites, often called poppers. Epidemiology suggests that persons can reduce their risk of KS by avoiding nitrite inhalants and changing behavior to reduce the risk of sexually transmitted infections.

AIDS-Related Complex↗
PubMed1994

Incubating syphilis in patients treated for gonorrhea: a comparison of treatment regimens.

Dade County sexually transmitted disease clinic records were reviewed to estimate the relative effectiveness of gonorrhea treatment regimens for eradicating incubating syphilis. Records were searched to see if persons treated for gonorrhea returned with primary syphilis 3-45 days after treatment or secondary syphilis 15-90 days after treatment. The number of persons treated was adjusted for the prevalence of syphilis in the year of treatment. Between 1985 and 1992, 98,441 persons were treated for gonorrhea. Syphilis was diagnosed in an interval that suggested it was incubating at the time of the treatment for 5.6/10(4) (adjusted number) persons treated with spectinomycin alone (a regimen not expected to eradicate syphilis); 2.9/10(4) persons treated with spectinomycin plus tetracycline, doxycycline, or erythromycin; and 2.1/10(4) persons treated with ceftriaxone plus tetracycline, doxycycline, or erythromycin (P > .1). Incubating syphilis was rare despite a syphilis epidemic. The effectiveness of a regimen for eradicating incubating syphilis should not be a major consideration when choosing gonorrhea therapy.

Ceftriaxone↗
PubMed1994

Seroconversion in patients attending sexually transmitted disease clinics.

OBJECTIVES: To characterize recent HIV seroconverters in a sexually transmitted disease (STD) clinic population, and examine changing transmission patterns. METHODS: We conducted a case-control study nested within a retrospectively defined cohort of individuals attending Baltimore STD clinics between January 1988 and July 1990. Seroconverters, who tested HIV-positive after having a negative test, were compared to both HIV-negative controls, who were also tested twice, and a second, prevalent HIV-positive control group. Controls were matched 2:1 by sex, clinic, and month of HIV test. RESULTS: Forty-nine out of 6175 (0.79%) patients tested at least twice had documented HIV-1 seroconversion. On multivariate analysis, seroconversion was significantly associated with self-reported injecting drug use [odds ratio (OR), 7.3; 95% confidence interval (CI), 2.3-23)], with being a man who has had sex with other men (OR, 3.5%; 95% CI, 1.2-10), or with having sex with a known HIV-infected person (OR, 11; 95% CI, 1.3-96). Thirty-five per cent of seroconverters did not report a risk for HIV infection, and a higher proportion of recent seroconverters also reported no risk. Compared to the prevalent positive control group, more seroconverters reported no risk and a lower proportion reported recognized risks. A diagnosis of gonorrhea was also significantly associated with seroconversion (OR, 2.5; 95% CI, 1.1-5.7). CONCLUSIONS: These data suggest increasing heterosexual transmission of HIV in this inner-city STD clinic population. Incident STD, in particular gonorrhea, may increase a patient's risk for HIV infection, suggesting that patients with STD should be targeted aggressively for HIV prevention activities.

Adult↗
PubMed1994

High rate of HIV seroconversion among patients attending urban sexually transmitted disease clinics.

OBJECTIVE: To study rates of documented HIV seroconversion and syphilis as a cofactor for seroconversion in sexually transmitted disease (STD) clinics. In the main clinic the HIV seroprevalence rate was 12% and most infections had been shown to be acquired by heterosexual contact. METHODS: We analyzed computer records of patients who had at least two HIV-antibody tests between 1 December 1987 and 31 December 1990, at STD clinics in Dade County (Miami), Florida. RESULTS: Of 5164 individuals with two HIV tests, 208 (4.0%) seroconverted. The overall seroconversion rate was 3.1 per 100 person-years. Among blacks, who accounted for 77% of seroconversions, the rate was higher for women (4.8) than for men (2.7). The highest rate was in 15-19-year-old black women (7.1 per 100 person-years). The HIV seroconversion rate was 12.8 for patients with primary or secondary syphilis diagnosed between two HIV tests, 3.1 for patients who acquired syphilis before their first HIV test, and 2.3 for patients who had never had syphilis. Eighteen per cent of all HIV seroconversions were attributable to syphilis acquired in the interval between two HIV tests. CONCLUSIONS: We found high HIV seroconversion rates, especially among black teenagers and black women, in an STD clinic population in which the majority of HIV infections were shown previously to have been acquired heterosexually. Syphilis was a marker for HIV seroconversion and syphilitic ulcers may facilitate HIV transmission. Innovative prevention programs directed towards women and adolescents should be developed and evaluated.

Adolescent↗
PubMed1993

A method for identifying persons at high risk for sexually transmitted infections: opportunity for targeting intervention.

OBJECTIVES: The purpose of this study was to develop a method to identify persons at high risk for acquiring new sexually transmitted infections. METHODS: Computerized medical records from sexually transmitted disease clinics in Dade County, Florida, were used to conduct a retrospective cohort study. For all patients who visited in 1987, risk factors were identified for returning to the clinics within a year with a new sexually transmitted infection. Predictor variables were derived from the index visit and any visits in the year prior to the index visit. Logistic regression was used to develop a model that was applied to all patients who attended in 1989. RESULTS: Of 24,439 patients attending in 1987, 18.5% returned within a year with a new infection. Return rates were highest for 15- to 19-year-old Black males (31.8%). The highest odds ratios for returning were a diagnosis or treatment for an infection in the previous year and a diagnosis or treatment for infection at the index visit. The patients predicted to be at highest risk had a 39% return rate. There were as many new infections among the 2893 patients at highest risk as there were among the 13,326 patients at lowest risk. CONCLUSIONS: We developed a model that identifies persons at very high risk for sexually transmitted infection. These persons should be targeted for intensive intervention to reduce their risk.

Adolescent↗
PubMed1993

Changes in sexually transmitted disease rates after HIV testing and posttest counseling, Miami, 1988 to 1989.

OBJECTIVES: The effects of posttest counseling on acquisition of sexually transmitted diseases in patients at a large urban sexually transmitted disease clinic were studied. METHODS: Comparisons were made of the percentage of patients who had a positive gonorrhea culture (or any sexually transmitted disease) in the 6 months before and after human immunodeficiency virus (HIV) counseling and testing. RESULTS: For 331 patients counseled about a positive HIV test, the percentage with gonorrhea was 6.3 before and 4.5 after posttest counseling (29% decrease). For 666 patients counseled about a negative test, the percentage with gonorrhea was 2.4 before and 5.0 after posttest counseling (106% increase). With any sexually transmitted disease as the outcome, patients who tested positive for HIV had a 12% decrease and patients who tested negative had a 103% increase after counseling. CONCLUSIONS: HIV counseling and testing was associated with a moderate decrease in sexually transmitted diseases among patients who tested positive for the virus, but risk increased for patients who tested negative. This suggests a need to improve posttest counseling in this clinic and to assess the effects of counseling and testing in other clinics.

AIDS Serodiagnosis↗
PubMed1993

Defining behavioral methods to prevent sexually transmitted diseases through intervention research.

This article focuses on efforts to use behavioral interventions to prevent STDs. Presented is a history of attempts to prevent and control STDs through behavior change and a summary of the main theoretic approaches to human behavior that have provided the scientific base for behavioral public health interventions. The authors also review the important behavior intervention studies, most of which have addressed chronic disease prevention. They specify the differences between behaviors that are associated with chronic disease and those that increase risk for STDs, as well as the implications of these differences for behavioral prevention of STDs. Finally, a review of the accumulating empiric evidence in the area of behavioral prevention of STDs is presented and a strategy for the development of methods to help change risk behaviors for STDS (including AIDS) is proposed.

Counseling↗
PubMed1992

AIDS in bisexual men in the United States: epidemiology and transmission to women.

BACKGROUND: Homosexual and bisexual men with acquired immunodeficiency syndrome (AIDS) differ, and bisexual men play an important role in the sexual transmission of human immunodeficiency virus (HIV) to women. METHODS: To describe AIDS in these groups, we examined AIDS cases reported nationally through June 1990. RESULTS: Among 65 389 men who reported having had sex with men since 1977, 26% were bisexual. More Black (41%) and Hispanic men (31%) than White men (21%) reported bisexual behavior. Bisexual men were twice as likely to report intravenous drug use (20%) as were homosexual men (9%), regardless of race or ethnicity. Among 3555 women with heterosexually acquired AIDS, 11% reported sexual contact with a bisexual man and no other risk factor, although in some states approximately half reported such contact. In 1989, the AIDS rate due to sex with a bisexual man was three and five times higher among Hispanic and Black women, respectively, than among White women. CONCLUSIONS: Differences between bisexual and homosexual men with AIDS and the relative importance of AIDS in women due to sexual contact with bisexual men should be considered in the development of HIV prevention programs.

Acquired Immunodeficiency Syndrome↗
PubMed1991

The aetiology of Kaposi's sarcoma.

The aetiology of KS remains unknown, but recent evidence suggests that the disease is caused by the presence of an infectious agent in an immunosuppressed host. Although there are a variety of clinical presentations, the putative infectious agent is likely to be the same in all cases. The pathophysiology of the lesions, the types of immunosuppression that facilitate disease expression, the response to therapy and the distribution of disease within immunosuppressed populations provide important clues to the nature of the unidentified infectious agent.

Humans↗