With regard to your concerns about losing the human touch and confidentiality issues with your patients, our full text article explains the following:
1. All patients are given a preference on how they would like us to communicate results to them, by phone, text or letter. We found the majority preferred text message as the patients believed it led to the
highest degree of confidentiality and ens...
With regard to your concerns about losing the human touch and confidentiality issues with your patients, our full text article explains the following:
1. All patients are given a preference on how they would like us to communicate results to them, by phone, text or letter. We found the majority preferred text message as the patients believed it led to the
highest degree of confidentiality and ensured any messages reached them directly.
2. The text is an initial generic contact message only through which they are asked to contact the clinic at their convenience. On contacting us, their diagnoses are given
and discussed with them by experienced clinic nurses, with an appointment made to deliver treatment or other appropriate follow-up,face-to-face.
There are other practical issues to consider. Your comment that "I still have a doctor who takes the time to call me with my test results" implies you are able to receive calls at any time. For many people at work this is
not so and that receiving phone calls in the work place risks loss of confidentiality. Also,for some, voicemail is perceived as an unnecessary expense whereas receiving a text is free. This is an important distinction when trying to contact someone who is unable to answer their phone. It has been our experience that patients have expressed a high degree of satisfaction with our service. For up to 50% of our population, including vulnerable youth, mobile phones are their only point of contact. Technology is a link that
allows us to effectively communicate and therefore give
individualised care. Don't be afraid to use it to achieve the best outcomes for your patients.
We read Rana et al’s (1) paper entitled “Sexual behaviour and condom
use among individuals with a history of symptomatic genital herpes” with
interest, and find any paper which helps to describe patient’s behaviours
and beliefs useful.
There appears to be one particular flaw in this paper, and that is
the authors’ assumption that people with a history of herpes should use
condoms at all...
We read Rana et al’s (1) paper entitled “Sexual behaviour and condom
use among individuals with a history of symptomatic genital herpes” with
interest, and find any paper which helps to describe patient’s behaviours
and beliefs useful.
There appears to be one particular flaw in this paper, and that is
the authors’ assumption that people with a history of herpes should use
condoms at all times.
The authors justify this statement by referencing three papers. The
first paper (2) highlights that condoms seem to be protective against HSV
transmission in vitro, but is more pessimistic about evidence in vivo, and
limits its recommendations of ‘consistent and correct condom use’ to
pregnant women at risk of HSV-2. The second paper (3) relates to reducing
HIV transmission in developing countries, and makes little mention and no
recommendations about condom use. The third reference (4) does state that
“condom use should be recommended during sexual intercourse when lesions
or symptoms are not present.” But acknowledges “, the data supporting
condom use for the prevention of genital herpes transmission are weak”.
Indeed in the parent paper of this article (5), the same authors,
analysing the same data in the same population demonstrate that increased
risk of transmission of HSV-2 occurred in those who engaged in vaginal sex
during episodes or ‘never’ used condoms, but failed to demonstrate that
condom use between attacks (“always” used condoms) was protective.
As the participants of this study were all in monogamous
relationships, the assertion that they should use condoms at all times
seems unnecessarily punitive. Indeed, 35% of partners were unknowingly
already HSV-2 Positive, a little higher but consistent with international
prevalence estimates (6) and so protected from further infection. As 80%
of HSV-2 infections are asymptomatic or unrecognised (7), and as
transmission rates in discordant couples seem relatively low (2.2% over 8
months for symptomatic infection, 3.6% for serologically proven infection
(8)) then it might be very reasonable for discordant monogamous couples to
choose not to use condoms, reassured in the knowledge that transmission
between attacks can occur but is less likely than transmission during an
attack; that most transmission results in asymptomatic infection; and that
although symptomatic herpes can be troublesome, it is rarely sinister or
dangerous.
In our view, the medicalisation of genital herpes in these
circumstances is overwhelmingly detrimental to sexual health. Advice that
individuals with genital herpes in monogamous relationships should use
condoms regularly and consistently “during both symptomatic and
asymptomatic periods” seems unfounded in the literature, and unnecessarily
stigmatising. The ongoing medicalisation and stigmatisation of herpes will
not, of course, harm sales of Valaciclovir, and we worry about conflicts
of interest in this paper.
Bibliography
______________________
1. Rana RK, Pimenta JM, Rosenberg DM, Warren T, Sekhin S, Cook SF, et
al. Sexual behaviour and condom use among individuals with a history of
symptomatic genital herpes. Sex Transm Infect 2006;82(1):69-74.
2. Casper C, Wald A. Condom use and the prevention of genital herpes
acquisition. Herpes 2002;9(1):10-4.
3. O'Farrell N. Increasing prevalence of genital herpes in developing
countries: implications for heterosexual HIV transmission and STI control
programmes. Sex Transm Infect 1999;75(6):377-84.
4. Stanberry L, Cunningham A, Mertz G, Mindel A, Peters B, Reitano M,
et al. New developments in the epidemiology, natural history and
management of genital herpes. Antiviral Res 1999;42(1):1-14.
5. Rana RK, Pimenta JM, Rosenberg DM, Tyring SK, Paavonen J, Cook SF,
et al. Demographic, behavioral, and knowledge factors associated with
herpes simplex virus type 2 infection among men whose current female
partner has genital herpes. Sex Transm Dis 2005;32(5):308-13.
6. Barton SE. Reducing the transmission of genital herpes. Bmj
2005;330(7484):157-8.
7. Miyai T, Turner KR, Kent CK, Klausner J. The psychosocial impact
of testing individuals with no history of genital herpes for herpes
simplex virus type 2. Sex Transm Dis 2004;31(9):517-21.
8. Corey L, Wald A, Patel R, Sacks SL, Tyring SK, Warren T, et al.
Once-daily valacyclovir to reduce the risk of transmission of genital
herpes. N Engl J Med 2004;350(1):11-20.
Lyerla et al (August 2008 issue) conclude that there
is a general overall weakness in the surveillance system of most low and middle income countries in their article on the quality of sero-surveillance. This may well be the case. However, the paper has some important inaccuracies and some of their assertions can be challenged.
Their assessment that Jamaica has a poorly functioning surveillance syste...
Lyerla et al (August 2008 issue) conclude that there
is a general overall weakness in the surveillance system of most low and middle income countries in their article on the quality of sero-surveillance. This may well be the case. However, the paper has some important inaccuracies and some of their assertions can be challenged.
Their assessment that Jamaica has a poorly functioning surveillance system is erroneous.
The rating methodology is based on the classification of countries as generalized, concentrated or low-level epidemics. A concentrated epidemic is defined by the authors as having an estimated HIV prevalence consistently over 5% in at least one subpopulation at highest risk of
infection, and a prevalence below 1% in the general adult population (age 15–49 years) in urban areas. Misclassification results in inappropriate
application of the rating tool devised. For example, Jamaica and Guyana are classified as having a concentrated epidemic in the article. Yet the 2007 AIDS epidemic update published by UNAIDS2 reports an estimated HIV
prevalence of 1.6% in Guyana and 1.5% for Jamaica. The classification of these countries as having a concentrated epidemic is not consistent with the UNAIDS own publications on the status of the epidemic. Several other Caribbean countries previously classified as having a generalized epidemic in a similar assessment between 1995 and 2002 by Garcia-Calleja et al,3 are also misclassified here.4 The authors give no justification for classifying only one country in the Caribbean (Haiti) as having a generalized epidemic. Such confusion about the nature of the epidemic will lead to inaccurate assessments of surveillance systems.
The authors assess surveillance of 4 high risk groups (MSM, SW, IDU, and clients of SW) for countries now considered to be having a concentrated epidemic. However, IDU is not an indigenous transmission route of HIV for most Caribbean countries and therefore regular surveillance of this population is not conducted.4 Assuming that all
countries have the same risk groups or risk groups of equal importance in the HIV epidemic is inaccurate. In some countries like Jamaica public STI clinic attendees are included in sentinel surveillance however no provision is made for this in the rating scheme. 4,5
Finally, the authors assess several elements of surveillance systems including consistency of reporting. A maximum score of 7 is assigned to represent the number of times that national surveillance is conducted between 2001 and 2007 suggesting that this activity should optimally be
conducted annually. This is contrary to the 2006 guidance issued for UNGASS reporting, which recommends biennial surveillance for ANC attendees and high risk groups.6 In addition, as surveillance of pregnant women increased to more than 90% in some countries, sentinel surveillance of ANC attendees is increasingly no longer relevant. In countries with limited resources the persons involved in surveillance may be the same staff who are involved in HIV prevention. It can therefore be counterproductive to
conduct annual surveillance because prevention activities will be compromised.
There are other sources of HIV testing that can provide important insights into the HIV epidemic within countries that the rating system does not take into account. These include HIV testing of seasonal migrant
workers, US permanent visa applicants, life insurance medicals, persons being admitted to hospital, blood donors, and outreach testing, all of which Jamaica does. It is difficult to take all of this into account in a broad assessment as conducted by the authors.
However, publications from UN bodies must be accurate and reliable. The use of generic tools to assess country systems emphasize the need for in-depth understanding of country systems in order to produce accurate assessments that can be used for decision-making. It would be far more
meaningful, accurate and constructive to carry out these kinds of assessments on a regional basis in partnership with the countries than trying to make broad generic assessments that frequently miss the mark and contribute little to strengthening the systems being assessed.
References
1. The quality of sero-surveillance in low- and middle incomecountries: status and trends through 2007.
R Lyerla,1 E Gouws,2 J M Garcia-Calleja3,
Sex Transm Infect 2008;84(Suppl I):i85–i91. doi:10.1136/sti.2008.030593
2. UNAIDS (2007). Caribbean AIDS epidemic update Regional Summary: December 2007. UNAIDS, Geneva 2007. Available at http://www.data.unaids.org/pub/Report/2008/jc1528_epibriefs_caribbean_en.pdf
3. Garcia-Calleja JM, EZaniewski E, Ghys PD, et al. A global analysis of trends in the quality of HIV sero-surveillance.
Sex Transm Infect 2004;80(Suppl 1):i25–30.
4. Figueroa JP. The HIV Epidemic in the Caribbean: Meeting the challenges of achieving universal access to prevention, treatment and care.
West Indian Med J 2008; 57(3):195-203.
5. Figueroa JP, Duncan J, Byfield L, Harvey K, Gebre Y, Hylton-Kong T, Hamer F, Williams, Carrington D, Brathwaite AR.
A comprehensive approach to the HIV/AIDS epidemic in Jamaica: a review of the past 20 years. West Indian Med J in press.
6. UNAIDS (2005). Guidelines on construction of core indicators, 2006 reporting. Geneva, UNAIDS.
We read with interest the article by Clarke et al1 regarding
assessing demand for access to sexual health services in a community where
a closed appointment system operates1. The genitourinary medicine (GUM)
clinic in North Worcestershire has been operating this closed system for
at least 3 years whereby, patients are offered an appointment either on
the day or the day after and asked to phone back...
We read with interest the article by Clarke et al1 regarding
assessing demand for access to sexual health services in a community where
a closed appointment system operates1. The genitourinary medicine (GUM)
clinic in North Worcestershire has been operating this closed system for
at least 3 years whereby, patients are offered an appointment either on
the day or the day after and asked to phone back if appointments are
unavailable. The BASHH/HPA surveys have demonstrated that the latest
routine waiting times for patients to be seen within 48 hours in this GUM
clinic was 72% (62% unadjusted). Previously figures have varied from 43
to 62%2. However, this figure has not correlated with patient’s
experiences of obtaining an appointment. To analyse this we have
instituted telephone call logging for appointments over a 1 year period
focussing on the availability of routine appointments. Data referring to
emergency appointments or advice calls, although recorded were excluded
from this study. Furthermore call logging was subdivided by sex as in
Clarke’s study and by days of the week to assess areas of maximum demand
for appointments. These measures had fewer implications for workforce
planning than Clarke’s study as this GU clinic sees around 5000 patients a
year with a new and rebook follow up ratio of 2.31:1.
Table 1 shows the average number of routine appointments offered,
appointments requested by patients but not available and appointments
offered to patients but declined as inconvenient. For the purposes of
this correspondence, the logging of calls according to gender has been
grouped together, monthly data aggregated and the mean sum total
represented. Initial data was first presented at the BASHH/BHIVA Spring
meeting of 20053.
Critically, the average data fails to capture the full range recorded
over the last 12 months, for example: appointments unavailable on Monday
varied from 58-127.
As Clarke correctly points out, to avoid incorrect assumptions that
the 48 hour target is being met, the collection of telephone data from
clinics operating closed appointment systems is essential. Furthermore it
remains unclear whether those who are unsuccessful when they first ring
for an appointment are successful thereafter.
In view of the many pressures on “Choosing Health“monies it is
essential that commissioners are presented with an accurate representation
of the demand for GUM services.
References
1) Clarke J, Christodoulides H and Taylor Y. Sexually Transmitted
Infections 2006; 82: 45-48
3) Bhaduri S, Gosling C. Poster 9-Does a closed appointment system
improve access? 11th Annual Conference of BHIVA (British HIV Association)
and BASHH (British Association for Sexual Health and HIV) 2005: 20-23
April
From this paper we get a good idea on the medical and nursing costs for managing warts but a major cost for the NHS is the building, furnishings, equipment, phones, all other satffing i.e secretaries, reception, managers, finance, personnel etc. This is estimated at about 20% to 25% and should have been mentioned. Some detail about what drugs were used would have been good. In my clinic we treat 800 new...
From this paper we get a good idea on the medical and nursing costs for managing warts but a major cost for the NHS is the building, furnishings, equipment, phones, all other satffing i.e secretaries, reception, managers, finance, personnel etc. This is estimated at about 20% to 25% and should have been mentioned. Some detail about what drugs were used would have been good. In my clinic we treat 800 new warts per year and HPV drug costs are about £35,000 giving about £44 per patient. Using payment by results (PBR)calculations our cost per case is above £400 per case.
Recently, French et al reported the first cases of lymphogranuloma
venereum (LGV) in the United Kingdom.1 One year further, the LGV outbreak
first noticed in 2003 among MSM has spread beyond the first countries
affected (the Netherlands, Belgium, Germany, France, the UK, Sweden and
the United states) to other European countries like Spain, Italy,
Switzerland, Poland, and outside the continent to A...
Recently, French et al reported the first cases of lymphogranuloma
venereum (LGV) in the United Kingdom.1 One year further, the LGV outbreak
first noticed in 2003 among MSM has spread beyond the first countries
affected (the Netherlands, Belgium, Germany, France, the UK, Sweden and
the United states) to other European countries like Spain, Italy,
Switzerland, Poland, and outside the continent to Australia, USA and
Canada. Moreover, some of the questions raised in the publication of
French et al can now been answered partially.
A retrospective study performed on anal swabs from STI clinic
visitors in Amsterdam and San Francisco has learned us that the LGV strain
which seems to be responsible for the current outbreak (L2b) can be traced
back to at least 1981 in the United States and to 2000 in Europe.2,3 So it
seems more appropriate to speak of a slow epidemic rather than an outbreak
of LGV. What has caused LGV to spread unnoticed within the MSM community
worldwide for many years? In part, this can be attributed to the routine
chlamydia test procedures for MSM before 2003. Anal swabs positive for
chlamydia were recorded as chlamydia proctitis. Since the occurrence of
LGV outside the traditionally epidemic countries was unknown additional
testing for LGV was not performed.
Who should be screened for LGV? Most LGV patients reported
unprotective sex and a history of multiple STI’s. In a retrospective study
we have tried to unravel other clinical and epidemiological criteria for
LGV management in MSM.4 HIV status, proctoscopic findings and results of
Gram stained anorectal smears proof helpful in predicting LGV . LGV
specific tests and syndromic treatment are recommended in MSM with
anorectal chlamydia in combination with either clinical signs of
proctitis, HIV seropositivity or an elevated white blood cell count in
Gram stained anorectal smears. Moreover, it appears that part of the LGV
infections do not cause severe clinical symptoms. This may delay the
diagnosis and hamper screening and prevention measures.
Gőtz et al described a group of 15 LGV patients of whom 6
seroconverted for Hepatitis C (HCV) coinciding with the moment they
contracted LGV.5 It was speculated that sexual techniques that lead to
mucosal damage like fisting and use of sex toys, and a concomitant
ulcerative STI like LGV facilitate the sexual transmission of HCV. Raised
diagnostic problems can now be tackled more easily with a recently by our
group developed fast molecular biological diagnostic test (realtime PCR)
designed specifically for LGV Chlamydia trachomatis strains.6 This test
can be performed under routine microbiological laboratory conditions and
will hopefully facilitate the propagation of LGV screening programmes.
During the last International Society for Sexual Transmitted Disease
Research meeting, July 2005 in Amsterdam, The Netherlands a LGV satellite
workshop was organised under the supervision of the European Surveillance
of Sexually Transmitted Infections (ESSTI) network in order to tackle
urgent LGV related research questions in a multilateral joint effort
(www.isstdr.nl/sat_meet.htm). Supranational collaborations will have to
prove their benefit to increase our understanding of this LGV epidemic.
References
1. French P, Ison CA, Macdonald N. Lymphogranuloma venereum in the
United Kingdom. Sex Transm Infect 2005;81:97-8.
2. Spaargaren J, Fennema HS, Morré SA, de Vries HJ, Coutinho RA. New
lymphogranuloma venereum Chlamydia trachomatis variant, Amsterdam. Emerg
Infect Dis 2005;11:1090-2.
3. Spaargaren J, Schachter J, Moncado J, Fennema HS, de Vries HJ,
Coutinho RA, Morré SA. Slow Epidemic of Lymphogranuloma Venereum L2b
Strain. Emerg Infect Dis 2005;11:1787-8
4. van der Bij AK, Spaargaren J, Morré SA, Fennema HS, Mindel A,
Coutinho RA, de Vries HJ. Predictors for lymphogranuloma venereum in men
having sex with men: diagnostic implications. Clin Infect Dis 2006;42:186-
94.
5. Götz HM, van Doornum G, Niesters HG, den Hollander JG, Thio HB, de
Zwart O. A cluster of acute hepatitis C virus infection among men who have
sex with men--results from contact tracing and public health implications.
AIDS 2005;19:969-74.
6. Morré SA, Spaargaren J, Fennema JS, de Vries HJ, Peña AS. Real-
time polymerase chain reaction to diagnose Lymphogranuloma Venereum. Emerg
Infect Dis 2005;11:1311-2
Although lymphogranuloma venereum (LGV) as a cause of severe proctitis is well known amongst genitourinary and gastroenterological specialists, it remains absent from a common list of causes of rectal bleeding amongst General Practitioners and Surgeons. An example is a case of a homosexual man who presented as a 2 week rule urgent referral to the Colorectal clinic with painless rectal bleeding and went on...
Although lymphogranuloma venereum (LGV) as a cause of severe proctitis is well known amongst genitourinary and gastroenterological specialists, it remains absent from a common list of causes of rectal bleeding amongst General Practitioners and Surgeons. An example is a case of a homosexual man who presented as a 2 week rule urgent referral to the Colorectal clinic with painless rectal bleeding and went on to have endoscopy and biopsies for proctitis. It would not have been unreasonable
to start this patient on steroids or mesalazine enemas for symptom control while awaiting the results of biopsies. In this instance, however, it was only after telephone consultation with an HIV specialist and referral to
the Genitourinary Medicine clinic that a diagnosis of LGV proctitis was reached several weeks later. Steroids’ would almost certainly have made this condition worse and may even have resulted in a rectal perforation.
The article by Waalboer and colleagues (STI 2006;82:207-211)
precipitated a déjà vu experience for me- albeit along with something new.
They describe a bimodal presentation of chlamydial proctitis in MSM- some
with more severe rectal symptoms caused by LGV serovars and the rest with
much milder rectal disease caused by the D-K serovars.
In 1975 as part of my MD thesis undertaken at The Londo...
The article by Waalboer and colleagues (STI 2006;82:207-211)
precipitated a déjà vu experience for me- albeit along with something new.
They describe a bimodal presentation of chlamydial proctitis in MSM- some
with more severe rectal symptoms caused by LGV serovars and the rest with
much milder rectal disease caused by the D-K serovars.
In 1975 as part of my MD thesis undertaken at The London Hospital I
looked at MSM who had non gonococcal proctitis. I defined this as mucosal
hyperaemia and/ or an excess of polymorphs in rectal exudate. Chlamydial
isolation was by inoculation of irradiated McCoy cells by John Treharne at
London’s Institute of Ophthalmology
Chlamydia was isolated in only 2 of 48 MSM with low grade proctitis
(none had LGV clinically) but in none of 35 control MSM who did not have
proctitis. Another 3 of the men with proctitis had a significant rise in
Micro IF antibody levels (1 in 8 or greater).
All 28 of the 48 men whose Micro IF antibodies were positive showed
serovars in the D-K groups only. No antibodies to LGV were found.
I understand this to mean at least in one large GU clinic in London
in the mid 1970s I saw no MSM who had current or past LGV, in spite of the
fact that unsafe sex was very common in those pre HIV times.
Helen Ward (3) ask the question about the extent of the Lymphogranuloma venereum (LGV) in the wider population than that of men who have sex with men (MSM). A rospective sentinel survey set up in France following the European alert in January 2004 tried to answer this question.
From April 2002 to December 2008, rectal samples from MSM were collected by the French National Reference Centre for Chlamydia infec...
Helen Ward (3) ask the question about the extent of the Lymphogranuloma venereum (LGV) in the wider population than that of men who have sex with men (MSM). A rospective sentinel survey set up in France following the European alert in January 2004 tried to answer this question.
From April 2002 to December 2008, rectal samples from MSM were collected by the French National Reference Centre for Chlamydia infections from mainly 3 labs in Paris and some labs in France. All the C. trachomatis-positive rectal samples were genotyped. Over 1041 positive specimens
genotyped, 725 L2 serovars and 316 non-LGV associated serovars (mainly Da,G, and J) were identified.
Simultaneously, C. trachomatis-positive genital specimens were tested for the presence of LGV strains by a specific genovar L Taqman Real-time PCR (2). A total of 2662 urogenital specimens (1095 urethral or male urine
specimens and 1567 vaginal, cervical or female urine specimens) were tested. These specimens were obtained between 2004 and 2008 in Paris, Bordeaux, and from Pasteur Cerba laboratory, a central French laboratory
that received specimens from all over the country. No LGV strain was found except one in the urethral male sample of one HIV(+) gay man. This is the second case of urethritis due to a C. trachomatis genovar L2 in France,
the first one having been already published in 2006 (1). We can conclude that, in France, LGV remains essentially a rectal infection in MSM.
Acknowledgments: we thank Dr Georges Kreplack, Patrice Sednaoui, Catherine Scieux Sabine Trombert, for providing C. trachomatis-positive specimens from Paris and Cerba laboratory.
References
1. Herida, M., G. Kreplack, B. Cardon, J. C. Desenclos, and B. de Barbeyrac. 2006. First case of urethritis due to Chlamydia trachomatis genovar L2b. Clinical Infectious Diseases 43:268-269.
2. Morre, S. A., J. Spaargaren, J. S. A. Fennerna, H. J. C. de Vries, R. A. Coutinho, and A. S. Pena. 2005. Real-time polymerase chain reaction to diagnose lymphogranuloma venereum. Emerging Infectious Diseases 11:1311-
1312.
3. Ward, H., and R. F. Miller. 2009. Lymphogranuloma venereum: here to stay? Sex Transm Infect 85:157.
HIV/AIDS is a viral Sexual Transmission Diseases (STDs) which
threatens life expectancy and, with it, development, social cohesion,
political stability and food security. It imposes a devastating economic
burden on countries. Behaviours that bring the highest risk of infection in
Bangladesh are unprotected sex between sex workers and their clients,
needle sharing and unprotected sex between men....
HIV/AIDS is a viral Sexual Transmission Diseases (STDs) which
threatens life expectancy and, with it, development, social cohesion,
political stability and food security. It imposes a devastating economic
burden on countries. Behaviours that bring the highest risk of infection in
Bangladesh are unprotected sex between sex workers and their clients,
needle sharing and unprotected sex between men.
HIV incidence is rising faster in India that is the neighboring
country of Bangladesh. In India rates of sexually transmitted infections
and injecting drug use are also on the rise. Drug trafficking, along with
the economic and psychological consequences of recent conflicts, is
increasing the likelihood that HIV epidemics will emerge in this region.
The Human rights organizations in Bangladesh estimate that more than
20,000 women and children were trafficked annually for the purpose of
prostitution, and more than 50,000 women and children were estimated to
have been trafficked into India annually, most for the sex trade. The
situation of Bangladesh like that trafficking of women or children for
sexual exploiting is a high profitable business. The system of
constitution & low almost every time fever of trafficking criminal as
like Brazil. This criminal group thinks that some time this crime has risk
but less, but it has great profit, no any possible of loss, invest is
nothing size of the profit. Every trafficking event there is several
people work behind the incident. It is group work. They are more
organize and committed. But it is harmful to the thousands of women and
children exploited in slavery-like situation in the global sex industry.
Several social norms and immature behavior fueled of this disease to
scatter rapidly. There are several social components link to develop this
harmful situation. Poverty-behind to force it, gender discrimination plays
a vital role; frustration and risk behaviour help to sink humanity
resulting in infection. The link between poverty and gender discrimination
are help to decline socio economic prosperity. This link creates several
anti social poisonous issues also. Such as trafficking to prostitute, sell
sex for earn or living, break down family norm to create frustration and
driven drug point. We notice easily that Illiteracy is the main watchword
of all circumstance. So it is not easy to remove it from the society,
several programs and strategy are needed to gain sustainable position
Day by day it is mounting evidence that the trafficking of women and
children for sexual exploitation, is a significant problem in every
country. Usually commercially sex trafficking is more than an issue of
crime or migration; it is an issue of gender discrimination and the worse
status of women. Around the world most trafficked people are adolescent
girls, women and children of low socio-economic status, and the primary
trafficking flows are from poor of developing countries to more wealthy
countries.
Rainbow Nari O Shishu Kallyan Foundation found, Trafficking is strong
link HIV pandemic, if we see; globally of those HIV epidemic region,
trafficking & sex exploitation is regular feature of there. Mostly
trafficking victim are used commercial sex industry in other geographical
area, they stay in there, as like in prison, they have no rights of speak
out themselves. They are forced to sexual conduct with multiple partners,
but they have no ability to insist upon condom use or safe sex and are
vulnerable to HIV/STIs transmission. Some time they have to face physical
attack, but they don’t get health care facilities.
Mohammad Khairul Alam
AIDS Researcher
Rainbow Nari O Shishu Kallyan Foundation
rainbowngo@gmail.com
www.plusbangla.com
Reference:
UNICEF, World Bank, Rainbow Nari O Shishu Kallyan
Foundation.
Dear Editor,
With regard to your concerns about losing the human touch and confidentiality issues with your patients, our full text article explains the following:
1. All patients are given a preference on how they would like us to communicate results to them, by phone, text or letter. We found the majority preferred text message as the patients believed it led to the highest degree of confidentiality and ens...
Dear Editor,
We read Rana et al’s (1) paper entitled “Sexual behaviour and condom use among individuals with a history of symptomatic genital herpes” with interest, and find any paper which helps to describe patient’s behaviours and beliefs useful.
There appears to be one particular flaw in this paper, and that is the authors’ assumption that people with a history of herpes should use condoms at all...
Dear Editor,
Lyerla et al (August 2008 issue) conclude that there is a general overall weakness in the surveillance system of most low and middle income countries in their article on the quality of sero-surveillance. This may well be the case. However, the paper has some important inaccuracies and some of their assertions can be challenged. Their assessment that Jamaica has a poorly functioning surveillance syste...
Dear Editor,
We read with interest the article by Clarke et al1 regarding assessing demand for access to sexual health services in a community where a closed appointment system operates1. The genitourinary medicine (GUM) clinic in North Worcestershire has been operating this closed system for at least 3 years whereby, patients are offered an appointment either on the day or the day after and asked to phone back...
Dear Editor,
From this paper we get a good idea on the medical and nursing costs for managing warts but a major cost for the NHS is the building, furnishings, equipment, phones, all other satffing i.e secretaries, reception, managers, finance, personnel etc. This is estimated at about 20% to 25% and should have been mentioned. Some detail about what drugs were used would have been good. In my clinic we treat 800 new...
Dear Editor,
Recently, French et al reported the first cases of lymphogranuloma venereum (LGV) in the United Kingdom.1 One year further, the LGV outbreak first noticed in 2003 among MSM has spread beyond the first countries affected (the Netherlands, Belgium, Germany, France, the UK, Sweden and the United states) to other European countries like Spain, Italy, Switzerland, Poland, and outside the continent to A...
Dear Editor,
Although lymphogranuloma venereum (LGV) as a cause of severe proctitis is well known amongst genitourinary and gastroenterological specialists, it remains absent from a common list of causes of rectal bleeding amongst General Practitioners and Surgeons. An example is a case of a homosexual man who presented as a 2 week rule urgent referral to the Colorectal clinic with painless rectal bleeding and went on...
Dear Editor,
The article by Waalboer and colleagues (STI 2006;82:207-211) precipitated a déjà vu experience for me- albeit along with something new. They describe a bimodal presentation of chlamydial proctitis in MSM- some with more severe rectal symptoms caused by LGV serovars and the rest with much milder rectal disease caused by the D-K serovars.
In 1975 as part of my MD thesis undertaken at The Londo...
Dear Editor,
Helen Ward (3) ask the question about the extent of the Lymphogranuloma venereum (LGV) in the wider population than that of men who have sex with men (MSM). A rospective sentinel survey set up in France following the European alert in January 2004 tried to answer this question. From April 2002 to December 2008, rectal samples from MSM were collected by the French National Reference Centre for Chlamydia infec...
Dear Editor,
HIV/AIDS is a viral Sexual Transmission Diseases (STDs) which threatens life expectancy and, with it, development, social cohesion, political stability and food security. It imposes a devastating economic burden on countries. Behaviours that bring the highest risk of infection in Bangladesh are unprotected sex between sex workers and their clients, needle sharing and unprotected sex between men....
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