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TEXAS HIV/STD E-UPDATE
Information from the Bureau of HIV and STD Prevention,
Texas Department of Health
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IN THIS ISSUE:
-TDH Releases RFP for HIV PCPE Training
-TDH Posts New Prevention Case Management Standards
-CDC Proposes Revisions to Educational Materials Review Requirements
-Bureau Studies Risk Assessment for STDs Among Private Practitioners
-Applications for HIV Prevention Leadership Institute Now Being Accepted
-Upcoming Events


TDH RELEASES RFP FOR HIV PCPE TRAINING

The Texas Department of Health (TDH) Bureau of HIV and STD Prevention
announces the expected availability of fiscal year (FY) 2005 funding for
Risk Reduction Specialist (RRS) and quality assurance training and technical
assistance. This includes but is not limited to the TDH Prevention
Counseling and Partner Elicitation (PCPE) and related training courses. The
Request for Proposals (RFP) for this funding can be viewed at:
www.tdh.state.tx.us/hivstd/grants/default.htm.

Please note that letters of intent for this RFP are due July 15. The
deadline for submission of proposals is August 20.


TDH POSTS NEW PREVENTION CASE MANAGEMENT STANDARDS

TDH has released new HIV prevention case management (PCM) standards to
augument the Centers for Disease Control and Prevention's (CDC) September
1997 "Guidance for HIV Prevention Case Management" and TDH's "Program
Operating Guidelines and Procedures." The new standards are online at
www.tdh.state.tx.us/hivstd/guidelines/pdf/pdf_PCM_standards.pdf. Contracting
organizations should view these standards as minimum requirements for
program excellence, and must develop local protocols to expand upon the
guidance offered in all of these documents.


CDC PROPOSES REVISIONS TO EDUCATIONAL MATERIALS REVIEW REQUIREMENTS

On June 16, CDC published two notices in the Federal Register seeking public
comment on proposed revisions to the "Interim Revision of Requirements for
Content of AIDS-Related Written Materials, Pictorials, Audiovisuals,
Questionnaires, Survey Instruments, and Educational Sessions in Centers for
Disease Control Assistance Programs" published on June 15, 1992. One notice
describes proposed revisions to the 1992 Guidelines for regional, state,
territorial, local and community-based assistance programs. The second
notice describes newly separated HIV Guidelines for school-based assistance
programs.

CDC is proposing these revisions to (1) address advances in technology since
1992 (mainly the advent of the Internet and the World Wide Web) (2) increase
grantee accountability (3) be consistent with new public law and (4) provide
clarification for school-based assistance programs.

Public comments on these proposed revisions will be accepted through August
16. Comments may be sent to CDC in the following ways - 1) by email to
HIVComments@... 2) by fax to 404-639-3125 and 3) by U.S. mail to: HIV
Content Guidelines Comments, Centers for Disease Control and Prevention,
1600 Clifton Road N.E., MS E-56, Atlanta, GA 30333. Copies of the current
1992 Guidelines, proposed Guidelines as revised, and public comments
received by CDC may be accessed through www.cdc.gov.

CDC anticipates publishing final Guidance documents within 120 days of the
conclusion of the comment period.


BUREAU STUDIES RISK ASSESSMENT FOR STDs AMONG PRIVATE PRACTITIONERS

Traditionally, public health STD clinics have provided care for individuals
with STDs, but a substantial proportion of STD cases receive care from
private practitioners. A study conducted by the TDH Bureau of HIV and STD
Prevention among private primary care providers in Texas describes the STD
risk assessment of these practices. The study will be published in the June
issue of Texas Medicine under the title "Risk assessment for sexually
transmitted diseases among private practitioners in Texas".

Providers were classified into five geographic regions encompassing the
cities of Dallas, Fort Worth, San Antonio, Austin, El Paso, Houston and
counties in east Texas. Specialties included family practice, internal
medicine, obstetrics and gynecology (OB/GYN), and pediatrics. A category of
HIV-care providers was created to identify those practices that had seen
more that six patients infected with HIV in the six months previous to the
survey. The Texas Medical Association physician directory, the Internet and
telephone information services were used to obtain telephone numbers for
providers.

A questionnaire about STD risk assessment and screening was developed by the
Bureau. The survey was pilot tested and conducted by the Office of Survey
Research (OSR) at the University of Texas. The OSR obtained 376 completed
responses. The telephone interviews took place from August to December 2001.


The majority of practices interviewed were general practitioners (45%),
followed by OB/GYNs (28%), internal medicine doctors (22%) and pediatricians
(4%). The survey was answered predominantly by nurses (42.8%), followed by
physicians (17.6%) and advanced medical practitioners (14.4). Solo practices
constituted more than half (55%) of the practices while group practices
accounted for 38% of them. The remaining few practices were hospital,
student health center or community health center based.

Most practices (92%) used a direct interview with a physician to gather the
health history of the patient, but other means were also employed: nurse
interview (71%) and self administered form (67%). Sexual history elicitation
was not universal when gathering the health history of the patient. Overall,
40% of the practices reported conducting a risk assessment for STD with all
of their patients. This proportion increased for at risk patients and
patients with a previous STD diagnosis. But while a patient with a previous
STD diagnosis would be assessed most of the time, this was not the case for
other patients such as adult and adolescent females, including pregnant
females. In general, OB/GYN practices (55%), physicians providing care for
HIV-infected persons (58%), and female physicians (84%) were more likely to
indicate that they assess all of their patients for risks of STDs.

The study reports variations among specialties among the reasons for not
performing an STD risk assessment. OB/GYN practices were less likely than
internists, family practitioners and pediatricians to say that risk
assessment was not important for the typical patient cared for. None of the
OB/GYN practices said they do not have enough time to conduct the
assessment. Trends indicated that OB/GYN practices were also less likely
than the other practices to report that the staff does not perceive the
patient to be at risk or that the patient would be offended as reasons for
not performing a risk assessment

During the risk assessment process more than 90% of the practices asked
whether or not the person was sexually active and has had a history of STDs.
Other questions about risk behavior which may help identify individuals at
high risk, such as sexual preference and their partners' social behavior,
were less commonly asked.

Although 72% of the practices indicated that the staff was comfortable
asking patients about their sexual behavior, sexual history elicitation was
not universal when gathering the health history of the patient. Evidence
that not all the practices were at ease when dealing with the sexual
behavior of the patients was revealed in the following answers: 22% of the
practices indicated that staff at the practice worry about offending the
patient in taking sexual history; 18% answered that office staff felt
uncomfortable taking a sexual history with a patient of the opposite sex;
and 25% responded that their staff did not feel comfortable talking with a
homosexual patient about his or her sexual behavior.

Consistent with the results obtained in a recent national study, our
findings corroborate that private physicians in Texas provide care for a
large proportion of individuals afflicted with STDs. These health care
providers thus have an important role in identifying cases and providing
treatment for them. This study suggests, however, that the frequency with
which private providers conduct STD risk assessments points to a
considerable gap in public health practice. Further, while over 90% of
providers conduct risk assessment with those patients they perceive to be a
risk, the criteria for determining those patients who are at risk varied
greatly among providers. The findings raise concerns about the lack of
uniformity among the practices in the process of initiating STD prevention
and identifying patients with STDs. Many STDs, including chlamydia, genital
herpes and genital warts, are broadly distributed throughout several
populations. Targeting discussion of STDs to patients with certain
characteristics may miss significant numbers of patients.

The full citation is: Sharon K. Melville,Sonia I. Arbona, Cheryl L. E.
Jablonski, Lois I. Kantor, James H. Lee, Caeli Paradise, Debra Bement
Seamans. Risk assessment practices of Texas private practitioners for
sexually transmitted diseases. Texas Medicine, 2004, Vol. 100, No. 6, pp.
60- 64.


APPLICATIONS FOR HIV PREVENTION LEADERSHIP INSTITUTE NOW BEING ACCEPTED

Applications are now being accepted for participation in the 2005 CDC/ASPH
Institute for HIV Prevention Leadership. Applications must be postmarked by
July 16.

The Institute is offered through a cooperative agreement between the Centers
for Disease Control and Prevention and the Association of Schools of Pubic
Health. Currently in its fifth year of operation, the Institute offers a
proven effective training curriculum to enhance HIV/AIDS prevention and
strategic management capacity in community-based organizations (CBOs).

HIV prevention program personnel who work CBOs funded directly or
indirectly through their health departments or other organizations by CDC
and/or serve as CPG co-chairs are eligible to apply. Other eligibility
criteria also apply.

For more information on the Institute and to download application materials
go to www.ihpl.org If you have questions after reviewing the application
materials contact Kim Nichols Dauner at kndauner@... or call her at
803-777-4174.


UPCOMING EVENTS

July 23, 2004
Deadline for 14th Texas HIV/STD Conference call for presentations and
scholarship applications.

July 31, 2004
HIV, the Future and Your Choices: Hepatitis C (HCV) and HIV Co-Infection,
Houston. Sponsored by the National AIDS Treatment Advocacy Project (NATAP).
To register, call NATAP at 212-219-0106 between 9am-5pm, Monday through
Friday.

August 9-13, 2004
Training Institute in Sexual Health Education (TISHE), Blairstown, NJ.
Sponsored by the Network for Family Life Education at Rutgers University.
For more information, go to www.tishe.org, or contact Nora Gelperin at
norag@..., or 732-445-7929.

November 11-14, 2004
5th Annual National Harm Reduction Conference, New Orleans, LA. Sponsored by
the Harm Reduction Coalition. Go to
www.harmreduction.org/conf2004/index.html, or call 212-213-6376, ext. 15 for
more information.

December 1, 2004
World AIDS Day

December 13-17, 2004
14th Texas HIV/STD Conference, Austin. Sponsored by TDH. A separate clinical
update will be held on December 17-18, 2004 for an additional fee. For more
information, visit www.tdh.state.tx.us/hivstd/conf/2004/default.htm.

December 17-18, 2004
14th Texas HIV/STD Conference Clinical Update, Austin. Sponsored by TDH,
Center for Health Training, Texas/Oklahoma AIDS Education and Training
Center (TX/OK AETC), and Texas Department of Mental Health and Mental
Retardation (MHMR). Targeted to physicians, nurses, pharmacists and other
clinicians working with HIV/STD affected communities. For more information,
visit www.tdh.state.tx.us/hivstd/conf/2004/default.htm.


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The Texas HIV/STD E-Update mailing list is maintained by the Bureau of HIV
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your name from the mailing list, send a message to dan.warr@....

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Back issues of the Texas HIV/STD E-Update going back to 2002 are available
online at the following URL:
www.tdh.state.tx.us/hivstd/pie/e-update/default.htm
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TDH Electronic Publication Number E13-11720
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Texas HIV/STD E-Update
Greg Beets, Editor
Texas Department of Health
HIV/STD Comprehensive Preventive Services Division
1100 West 49th Street
Austin, Texas 78756-3199
Phone: 512-490-2500, ext. 2671
Fax: 512-490-2538
E-mail: greg.beets@...