• Antibiotic Resistance Prompts Changes in CDC's Treatment Guidelines for Gonorrhea
• Limited Spending: An Analysis of Correctional Expenditures on Antiretrovirals for HIV-Infected Prisoners
• Substance Use and Sexual Behavior During Incarceration Among 18- to 29-Year-Old Men: Prevalence and Correlates

Antibiotic Resistance Prompts Changes in CDC's Treatment Guidelines for Gonorrhea

In the April 13th issue of MMWR, the CDC released an updated recommendation of the Sexually Transmitted Diseases Treatment Guidelines, 2006, which no longer recommends treating gonorrhea with fluoroquinolones antibiotics such as Cipro, Floxin, and Levaquin. Instead of fluoroquinolones, the CDC recommends the cephalosporin class of antibiotics. The CDC has recommended fluoroquinolones as a gonorrhea treatment option since 1993. At first the class of drugs was extremely effective, but fluoroquinolone-resistant gonorrhea has increased in recent years -- first in Hawaii, then California, and then nationwide among men who have sex with men. As a result, the CDC recommended in 2000 and 2002 that fluoroquinolones not be used to treat gonorrhea infections acquired only in Hawaii and California. In 2004, they recommended that fluoroquinolones no longer be used to treat gonorrhea in men who have sex with men across the U.S. The CDC now recommends the use of cephalosporins for treatment of all gonorrhea cases. The CDC based its recommendations on preliminary 2006 data showing that fluoroquinolone-resistant gonorrhea is present nationwide and is continuing to rise among heterosexual men and among men who have sex with men. For more information on the updated treatment recommendations including drug regimens visit: www.cdc.gov/STD/treatment/2006/updated-regimens.htm

CDC. Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2006: Fluoroquinolones No Longer Recommended for Treatment of Gonococcal Infections. Morb Mortal Wkly Rep. 2007;56(14):332-36.

Limited Spending: An Analysis of Correctional Expenditures on Antiretrovirals for HIV-Infected Prisoners

A substantial proportion of persons with HIV infection are incarcerated. As such, jails and prisons are important venues for the provision of HIV therapy. In an effort to determine whether HIV therapy is being adequately provided to inmates, researchers from Brown Medical School performed an analysis comparing national correctional system antiretroviral expenditures to the projected cost of such treatment based on the number of inmates who are HIV-infected. Utilizing known HIV prevalence estimates from the U.S. Bureau of Justice Statistics (BJS), average HIV treatment costs, and national data on pharmaceutical sales to correctional institutions, the authors were able present real correctional expenditures as a percentage of estimated total expenditures to determine the unmet need within the incarcerated population.

The results, published in Public Health Reports, indicate that there is a substantial unmet need for antiretrovirals in correctional health care, as total antiretroviral sales represented only 29% of the funds estimated to be required to treat all inmates eligible for such treatment. By end of 2003, there were just over 23,600 state and federal prisoners with known HIV infection -- 1.9% of the incarcerated population. Based on Centers for Disease Control and Prevention (CDC) data on antiretroviral therapy usage among HIV-infected patients, 86% of inmates should be receiving such therapy. Multiplying the number of inmates expected to be on antiretrovirals with the estimated cost of HIV therapy, the authors arrived at a total anticipated correctional antiretroviral expenditure of over $454 million. However, prisons only spent $52.5 million on antiretroviral medications.

In assessing the many limitations of the study, the investigators note their reliance on BJS HIV prevalence data, which is drawn from only 19 prisons that routinely test for inmates for HIV entry upon entry into the facility and reports only those inmates with known HIV infection. Additionally, differing protocols regarding initiation of HIV therapy and the use drugs other than antiretrovirals may have contributed to inaccuracy in the estimate of HIV-positive individuals eligible for HIV therapy. Despite the many barriers to care, the authors underscore the need for treatment of HIV-infected prisoners, emphasizing the reduced costs associated with HIV-related complications and linkage to HIV care in the community.

Limited Spending: An Analysis of Correctional Expenditures on Antiretrovirals for HIV-Infected Prisoners. Zaller, N. et al. Public Health Reports. 2007 Jan-Feb; 122(1):49-54.

Substance Use and Sexual Behavior During Incarceration Among 18- to 29-Year-Old Men: Prevalence and Correlates

In this study, a supplement to a larger multi-site intervention trial, investigators conducted an audio-computer assisted self-interviewing (ACASI) survey of 197 men with a history of incarceration, ages 18-29 years, in order to assess substance abuse and sexual behavior during incarceration. The findings support previous studies, revealing that 50% and 17% of participants, respectively, engaged in substance use or had consensual sex while incarcerated. These behaviors were correlated and both were associated with the following: being older, having spent more years incarcerated, being sexually abused, and involvement in gangs and violence while incarcerated.

Significantly, multiple regression analysis demonstrated that behavior practices during incarceration may reflect behavior practices in the community. This relationship is manifested in the observation that men were more likely to have had sex during incarceration if they reported having a male partner in the community. Likewise, men were more likely to use illegal substances during incarceration if they reported hard drug use prior to incarceration. Limitations of the study include a reliance on self-reported behavior from a small convenience sample of men and recall bias. Nonetheless, the authors assert that these findings emphasize the need for future longitudinal research to explore the extent to which men's experiences pre-to-post incarceration are directly linked, not only to examine the ways that pre-incarceration experience influences behavior during incarceration, but also to study the ways that incarceration experiences affect behavior in the community following release from a correctional facility. Such research, the authors suggest, might inform the development of novel or improved risk reduction interventions.

Substance Use and Sexual Behavior During Incarceration Among 18- to 29-Year-Old Men: Prevalence and Correlates. Seal, DW et al. AIDS Behavior. 2007 March 8.