Background Approximately 15% of HIV-infected MSM engaged in HIV primary care have been diagnosed with an STI in the past year, yet STI testing frequency remains low. Methods We sought to quantify STI testing frequencies at a large, urban HIV care clinic, and to identify patient- and provider-related barriers to increased STI testing. We extracted laboratory data in aggregate from the electronic medical record to calculate STI testing frequencies (defined as the number of HIV-infected MSM engaged in care who were tested at least once over an 18-month period divided by the number of MSM engaged in care). We created anonymous surveys of patients and providers to elicit barriers. Results Extra-genital gonorrhea and chlamydia testing were low (29%–32%), but the frequency of syphilis testing was higher (72%). Patients frequently reported high-risk behaviors, including drug use (16.4%) and recent bacterial STI (25.5%), as well as substantial rates of recent testing (>60% in prior 6 months). Most (72%) reported testing for STI in HIV primary care, but one-third went elsewhere for “easier” (42%), anonymous (21%) or more frequent (16%) testing. HIV primary care providers lacked testing and treatment knowledge (25–32%), and cited lack of time (68%), discomfort with sexual history taking and genital exam (21%), and patient reluctance (39%) as barriers to increased STI testing. Conclusion STI testing in HIV care remains unacceptably low. Enhanced education of providers, along with strategies to decrease provider time and increase patient ease and frequency of STI testing, are needed.

Although the physical and emotional impact of surgical removal of partial or complete removal of the breast as well as effects of breast cancer treatment on the individual have been well documented, little research is available on sexuality and sexual health of breast cancer survivors in a relationship context. Sexual health concerns of breast cancer survivors remain an unmet need for many. The present study consisted of qualitative interviews with 135 racially diverse, female breast cancer survivors who completed treatment to better understand their perspectives on sexual health and management of sexual problems in their potential and existing relationships after breast cancer. Key thematic findings include that breast cancer survivors have to (1) adapt to the physical and emotional traumas of breast cancer surgery and treatment, (2) navigate complicated sexual communications with potential and existing partners, and (3) negotiate intimacy and closeness without sexual intercourse with existing partners. This study demonstrates the need for healthcare providers to discuss sexual health after breast cancer with all of their patients as it is a concern that faces single and partnered breast cancer survivors months and years after treatment.

Background Rates of screening for bacterial sexually transmitted infections (STI) among men who have sex with men in HIV care settings remain low despite high prevalence of these infections. STI self-testing may help increase screening rates in clinical settings. Methods We implemented an STI self-testing program at a large, urban HIV care clinic, and evaluated its effectiveness and acceptability. We compared measures obtained during the first year of the STI Self-testing Program (Intervention Year, April 1, 2013 – March 31, 2014) to Baseline Year (January 1, 2012 – December 31, 2012) to determine: 1) overall clinic change in STI testing coverage and diagnostic yield and; 2) program-specific outcomes including appropriate anatomic site screening, and patient-reported acceptability. Results Overall, testing for gonorrhea and chlamydia increased significantly between Baseline and Intervention year, and 50% more gonococcal and 47% more chlamydial infections were detected. Syphilis testing coverage remained unchanged. Nearly 95% of 350 men who participated in the STI Self-testing program completed site-specific testing appropriately based on self-reported exposures, and 92% rated their self-testing experience as “good” or “very good”. Conclusions STI Self-testing in HIV care settings significantly increases testing coverage and detection of gonorrhea and chlamydia, and the program is acceptable to patients. Additional interventions to increase syphilis screening rates are needed.