Consistent with most prior studies, the highest rates were observed for students of EA origin, the lowest among Asian students, with an intermediate rate for Hispanic individuals. This pattern of the number of ARBs persisted after controlling for maximum drinks and the prevention group in which a person participated in the larger study. While fluctuations in ARBs across the year were fairly similar for the three ethnic groups , rates of ARBs were different across ethnicities. As suggested by several recent papers and predicted in the first part of Hypothesis 2, women had higher ARB rates. However, contrary to the second half of that hypothesis, the relationship of ethnicities to ARBs over time was different in females and males. The expected pattern of highest ARBs in EA students and lowest in Asian individuals was most obvious for females and less prominent for males. The mixed-design ANOVA in Table 4 demonstrated significant sex main effects, as well as ethnicity by sex by time and sex by LR by time interactions. The key role of sex in the rates of ARBs over 55 weeks and the interactions of sex with ethnicity might reflect several mechanisms. First, women develop higher BACs per drink , which may translate into higher risks for ARBs. The differences across ethnicities may be especially strong in women vs. men as Asian and Hispanic women may also have stronger culture-based prohibitions against heavier drinking than seen in EA cultures . Also, while more research is needed, considering recent documentation of potentially genetically-related physiologic characteristics that may relate to the BAC required for ARBs ,slide grow tables higher rates of ARBs in EA women might reflect some sex-related biological mechanisms that contribute directly to the ARB risk. The first part of Hypothesis 3 was also supported in that a low LR was related to higher ARB rates in these subjects.

However, the data in Figure 3 indicate that the relationships of ethnicity to ARBs differ in high- and low-LR subjects. It is possible that greater differential in ethnicity-related ARB risks might be observed primarily in subjects with higher LRs where drinking quantities are not already elevated by a low sensitivity to alcohol. Finally regarding hypotheses, the prediction that the ethnic group status will interact with sex and LR to predict ARB propensity was partially supported. Table 4 demonstrates significant 3-way interactions for ethnicity by sex by time and sex by LR by time, but the overall 4-way interaction was not significant . Still, the findings underscore the contention that there is more to ARBs than just how much a person drinks, and support the prediction that ethnicity, sex and LR all relate to ARB patterns. The optimal understanding of how ARBs develop requires considering a range of characteristics, preferably in a prospective study . The complex relationships with which multiple factors relate to ARB risks may indicate opportunities for more focused and efficient prevention by identifying subgroups most likely to experience ARBs and who are most likely to gain from programs aimed at decreasing heavy drinking. The larger study from which these data were extracted and a smaller investigation at another university indicated that active education about alcohol-related risk factors are associated with less intense future drinking. In the current study, the significant active education group vs. control group main effect in Table 4 supports the conclusion that decreases in maximum drinks seen with participation in the educational videos were also associated with lower levels of ARBs over time . Thus, universities and other institutions interested in decreasing the risk for ARBs and associated problems might consider developing similar education programs and focusing their efforts on subgroups of subjects with the highest ARB risk. As is true for all research, it is important to recognize caveats regarding the current work. The data were extracted from a larger study evaluating different ways of decreasing heavy drinking among students, and consistent with a prior report focusing on heavy drinking , exposure to active intervention affected ARB rates, a factor that complicates interpretation of results.

However, as shown in Table 4, the current results remained robust when prevention group assignment was used as a covariate in the mixed design ANOVA. The relationships among ethnicity, LR and changes in drinking over time are the focus of several other papers and, due to space constraints, are not discussed in detail here . Also regarding the larger study, the subjects were from a single California university, and the generalizability of results to other settings needs to be established, including gathering data on additional ethnic minorities as our analyses were limited to EA, Hispanic and Asian individuals. Next, the data were gathered on-line rather than in person by research staff with whom students had no personal contact, a step that might have affected the veracity of the responses, but the level of impact or direction of effect cannot be determined. Also regarding the larger study from which these data were extracted, to maximize the number of students receiving educational videos only 13% of the subjects were controls, and differences in numbers of subjects across groups may have impacted on current results. While the time frame for the current study was 55 weeks and the proportion of subjects reporting ARBs during this interval approached 50% in females, ARBs occur over many years and longer term follow ups are needed. In addition, the short time frame of reporting for the prior month for each assessment resulted in relatively low numbers of ARBs per individual per evaluation. Additional caveats are worth noting. All information about ethnic identity and blackouts involved self-reports, which may underestimate ARBs because heavy drinking can interfere with accurate recognition of whether an ARB occurred. It is also important to recognize that while the SRE has proven to be a robust predictor of future heavy drinking and alcohol problems, the present analyses did not control for years of drinking, the type of beverage consumed or other covariates. However, prior studies demonstrated that the relationship of SRE scores to heavy drinking and related consequences remained robust even after controlling for sex, weight, marijuana use or smoking histories and operated similarly in 12- year-old subjects with recent drinking onsets and in young adults.

Finally, there are important subgroups among EA, Asian and Hispanic populations, which, reflecting our sample size, could not be evaluated, and additional risk factors associated with ARBs were not included in analyses. These caveats aside, the present findings indicate that the propensity toward ARBs goes beyond the amount of alcohol consumed and is related to interrelationships among ethnicities, sex, and the sensitivity to alcohol. There are important differences among subgroups of students regarding how characteristics contribute to the ARB risk. Understanding how these interrelationships operate can be important in identifying who carries the highest risk and in creating focused and efficient prevention programs. Universal HIV testing is a cornerstone in efforts to achieve epidemic control as HIV-infected and unaware people are associated with the majority of HIV transmission events. In particular, during acute and early HIV infection , people who are unaware of their HIV status represent a subgroup with a disproportionate risk of HIV transmission due to high HIV viral loads,sliding grow table ongoing sexual risk behaviors and greater per-contact infectivity.The CDC recommends provision of confidential partner services to provide HIV risk reduction education and HIV testing to the recent sex or needle-sharing partners of newly HIV diagnosed people. By linking recently exposed persons to testing and treatment, this public health intervention has been used to limit the spread of sexually transmitted infections , such as syphilis and gonorrhea, since the early 20th century. In the setting of HIV, however, partner services has had its limitations. In 2006, Katz et al. estimated that fewer than half of newly HIV-diagnosed persons received partner services at public health departments across the United States. Reasons include that partner services is not mandated by law for HIV infection and more importantly that HIV remains a highly stigmatizing condition with significant implications for direct or indirect disclosure. Not only is partner services underutilized, but it can be limited in finding HIV unawares in the setting of newly diagnosed chronic HIV infection in which persons are often required to recall partners from several years prior. In 2007, the Task Force on Community Preventive Services, in reviewing the efficacy of partner services, showed that 20% of all referred partners were newly diagnosed with HIV. Persons with AEH likely represent a group particularly appropriate for partner services, as recall of recent sexual or needle-sharing partners may be more likely to identify putative transmission partners . Studies of partner services in the setting of recent HIV infection are limited, but demonstrate a greater yield of new HIV diagnoses in the setting of newly diagnosed acute HIV infection as compared with partner services provided to chronically HIV-infected persons. We examined the yield of HIV partner services provided to persons newly diagnosed with AEH in San Diego for identification of HIV-unaware persons, individuals with AEH, genetically linked partners and HIV-uninfected individuals at high risk for acquiring HIV infection.

Adults and adolescents were offered confidential and free-of-charge screening for acute, early and established HIV infection at multiple community-based sites in San Diego as part of the San Diego Primary Infection Resource Consortium from 1996 to 2014. Before 2007, a quantitative HIV RNA was performed in HIVantibody–negative persons presenting with signs or symptoms of AEH and behavioral risks for HIV infection . Beginning in 2007, HIV nucleic acid testing was provided to all HIV antibody–negative persons regardless of symptoms and exposures. AHI was defined by a negative or indeterminate HIVantibody test in the presence of detectable HIV-1 RNA, corresponding to Fiebig stages I–II. Early HIV infection was characterized by using one of the available assays to estimate recency Less-Sensitive or Detuned Vitros anti-HIV 1þ2 assay and limiting antigen and defined as HIV antibodyþ/detuned HIV antibody consistent with infection less than 170 days. Consenting antiretroviral -naive individuals with AEH were offered enrollment and longitudinal follow-up in the observational SD PIRC study.Routine clinical laboratories and HIV drug resistance testing were performed at baseline; demographic and behavioral risk data were collected for all individuals. Longitudinal follow-up included visits at weeks 2, 4, 8, 12 and every 24 weeks thereafter. HIV partner services were offered to all AEH clients and included education and counseling to elicit information about recent sex or needle-sharing partners. Index cases were offered ‘self-disclosure’ , ‘dual-disclosure’ and ‘third-party notification’ for recruiting their recent sex or needle-sharing contacts. Study staff providing partner services received structured partner services training by the California Department of Public Health or Centers for Disease Control and Prevention. These structured trainings were repeated by our study staff every 5 years. The trainings included how to elicit partners from index cases, including prompts and reinterviews, and delivering exposure notifications to partners. Privacy concerns were taken very seriously, in particular when an index case chose third-party notification . Partners successfully contacted were offered free-of-charge HIV testing and counseling through SD PIRC or a testing facility of their choice and linkage to prevention and treatment services. Those with positive HIV test results who reported unknown or negative HIV serostatus before HIV testing were defined as newly HIV diagnosed, whereas those who reported positive serostatus or found to have been diagnosed previously were defined as previously diagnosed. All recruited partners who underwent HIV testing and counseling with the SD PIRC provided behavioral risk information, and recruited partners identified with AEHwere also offered enrollment into SD PIRC as index clients . Partnerships were characterized as genetically linked if the HIV population sequence from an index case and their recruited partner were less than or equal to 1.5% genetically different using the Tamura-Nei model. The study focused on sex or needle sharing partners recruited within 6 months of diagnosis of the index case. Statistical analysis was performed using SPSS version 22 and SAS 9.3 . The efficacy of partner services provided to AEH clients was assessed by the number of index cases needed to interview to identify recruited partners: for HIV/STI testing, newly diagnosed with HIV infection, AEH infection and genetically linked index and recruited partners.