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Sexual Health publishes contributions on sexual health from the widest perspectives including HIV/AIDS, STIs, issues of sexuality, and reproductive health. More

Editors: Christopher Fairley and Roy Chan

 
 
 

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Published online 04 February 2016
Survey of partner notification practices for sexually transmissible infections in the United States 
Fidel A. Desir, Jessica H. Ladd and Charlotte A. Gaydos

Partner notification services for chlamydia, gonorrhea, HIV, and syphilis are widely available throughout a convenience sample of testing sites in the United States. Anonymous service availability is relatively low compared to non-anonymous services.

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Published online 04 February 2016
Cross-cultural integration affects attitudes towards people with HIV/AIDS in Australia 
Hassan Hosseinzadeh and Ann Dadich

The stigma associated with HIV/AIDS represents a significant issue – this is partly influenced by culture. To better understand this influence, this study determined the effect of cross-cultural integration on the tendency to stigmatise people living with HIV/AIDS (PLWHA). Survey results from 236 Australian–Iranian adults reveal the benefits afforded by an individualist culture, particularly for PLWHA.

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Published online 01 February 2016
How do outcomes compare between women and men living with HIV in Australia? An observational study 
Michelle L. Giles, Marin C. Zapata, Stephen T. Wright, Kathy Petoumenos, Miriam Grotowski, Jennifer Broom, Matthew G. Law and Catherine C. O'Connor

This article evaluates outcomes for men and women living with HIV in Australia. No significant differences between males and females were found for all-cause mortality, new AIDS illnesses or virological response to treatment.

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Published online 01 February 2016
Ability to detect high-grade squamous anal intraepithelial lesions at high resolution anoscopy improves over time 
Richard J. Hillman, Manoji P. W. Gunathilake, Fengyi Jin, Winnie Tong, Andrew Field and Andrew Carr

For a given cohort, histological high-grade squamous intraepithelial lesions may be more frequently diagnosed as an anoscopist becomes more experienced with the procedure. This may effect has the potential to impact clinical service delivery and the interpretation of clinical trial data.

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Published online 18 January 2016
High rates of chlamydia found among 12- to 16-year-olds attending a rural sexual health clinic: implications for practice 
Jane Elizabeth Tomnay, Lauren Coelli and Jane Simone Hocking

Little is known about chlamydia rates in sexually active 12–16 year olds in Australia. This retrospective clinical audit shows high rates of chlamydia in these young asymptomatic patients where contraception advice and fear of unwanted pregnancies are the main impetus for seeking health care. The current Australian chlamydia testing guidelines should be amended to include all sexually active people under the age of 30 years.

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Published online 18 January 2016
Does place of service matter? A utilisation and cost analysis of sexually transmissible infection testing from 2012 claims data 
Kwame Owusu-Edusei, Chirag G. Patel and Thomas L. Gift

Utilisation and cost analyses of STI tests from 2012 health insurance outpatient claims data showed that the majority (over 93%) of STI tests were performed in three service venues –‘Independent Laboratories’, ‘Office’ and ‘Outpatient hospital’. Test costs from ‘Independent Laboratory’ and ‘Office’ were 30–69% lower (P < 0.01) than those from ‘Outpatient Hospital’. Additionally, tests performed in ‘Emergency Room – Hospital’ were 15–80%, (P < 0.01) higher than those from the other service venues, except those from ‘Outpatient hospital’.

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Published online 18 January 2016
Prevalence of chlamydia, gonorrhoea, syphilis and trichomonas in Aboriginal and Torres Strait Islander Australians: a systematic review and meta-analysis 
Simon Graham, Lucy Watchirs Smith, Christopher K. Fairley and Jane Hocking

This review highlights that the prevalence of the four STIs (chlamydia, gonorrhoea, syphilis and trichomonas) is highly variable among Aboriginal people and that it varies considerably by sex, geographical location, population subgroup and by clinic vs community-based studies. Future community-based studies that include asymptomatic young people are needed to more accurately estimate the prevalence of STIs so that local testing and management protocols can reflect the local context.

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Published online 22 December 2015
‘Most young men think you have to be naked in front of the GP’: a qualitative study of male university students’ views on barriers to sexual health 
Cameron Ewert, Archibald Collyer and Meredith Temple-Smith

Although sexually transmissible infection rates among young men are rising in Australia, young men rarely present to the general practitioner (GP) for a sexual health consultation. This study explored the barriers which prevent young male University students from seeking sexual health advice from a GP, and discusses alternative means of sexual health education.

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Published online 18 December 2015
Community and clinic-based screening for curable sexually transmissible infections in a high prevalence setting in Australia: a retrospective longitudinal analysis of clinical service data from 2006 to 2009 
Bronwyn Silver, John M. Kaldor, Alice Rumbold, James Ward, Kirsty Smith, Amalie Dyda, Nathan Ryder, Teem-Wing Yip, Jiunn-Yih Su and Rebecca J. Guy

In a high prevalent setting, the population characteristics of two different screening approaches (community based and routine clinic) are compared. Using retrospective longitudinal data, the predictors of the first test occurring in the community screen, positivity and repeat testing are also investigated. Both screening approaches reached high numbers of young people; the community screen reached more young men and the routine clinic testing reached more young women. Options to improve screening coverage in remote Aboriginal communities are also discussed.

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Published online 30 November 2015
Estimating human papillomavirus vaccination coverage among young women in Victoria and reasons for non-vaccination 
Julia M. L. Brotherton, Leonard S. Piers and Loretta Vaughan

As part of the Victorian Population Health Survey 2011–2012, we surveyed 956 women who would have been age-eligible (age 18–26 years in 2007) for the catch-up component of Australia’s National HPV Vaccination Program. Women reported HPV vaccination status and, where applicable, were asked their reasons for failure to complete the vaccine course or for not initiating the course. Self-reported vaccination coverage was higher than Register based coverage estimates.

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Published online 30 November 2015
Love moderates the relationship between partner type and condom use among women engaging in transactional vaginal sex 
Alexis M. Roth, Joshua G. Rosenberger, Devon J. Hensel, Sarah E. Wiehe, J. Dennis Fortenberry and Karla D. Wagner

Women engaging in transactional sex were enrolled in a 4-week digital diary study of their sexual health. These analyses assess the impact of multi-level predictors of condom use during paid/traded sex events. There was a significant interaction between affective state (being in love) and condom use; when women reported love they were less likely to use condoms with romantic partners but more likely to use condoms with non-romantic partners (e.g. stranger, regular trick, drug dealer or friend). Implications for behavioural interventions to reduce HIV/STI risk are discussed.

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Published online 25 November 2015
Topical anaesthetics for premature ejaculation: a systematic review and meta-analysis 
Marrissa Martyn-St James, Katy Cooper, Kate Ren, Eva Kaltenthaler, Kath Dickinson, Anna Cantrell, Kevan Wylie, Leila Frodsham and Catherine Hood

Topical anaesthetics were compared with placebo and oral agents for the treatment of premature ejaculation in a systematic review and meta-analysis. Topical anaesthetics are significantly more effective than placebo, sildenafil or paroxetine at increasing intra-vaginal ejaculatory latency time. Topical Eutectic-like Mixture for Premature Ejaculation spray is associated with erectile dysfunction, numbness and burning. More systemic adverse events are reported with tramadol, sildenafil and paroxetine than with lidocaine gel.

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blank image Sexual Health
Volume 13 Number 1 2016

 
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Table of Contents 
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Young people from culturally diverse backgrounds and their use of services for sexual and reproductive health needs: a structured scoping review 
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Jessica R. Botfield , Christy E. Newman and Anthony B. Zwi
pp. 1-9

Sexual and reproductive health are global health, development and human rights priorities, essential to the wellbeing of individuals, couples and families. Despite widespread recognition of this, young people, including those from culturally diverse backgrounds in wealthy nations such as Australia, remain largely hidden to, and underserved by, sexual and reproductive healthcare services. A scoping review was undertaken to describe the range of research on sexual and reproductive health among culturally diverse young people in Australia, in order to identify gaps in the literature. Two gaps were identified: (1) the perspectives of culturally diverse young people regarding sexual and reproductive health and health care; and (2) the engagement of culturally diverse young people with sexual and reproductive health services. New directions for a research agenda on sexual and reproductive health care for culturally diverse young people in Australia are proposed.

 
    | Supplementary Material (65 KB)
 

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Penises not required: a systematic review of the potential for human papillomavirus horizontal transmission that is non-sexual or does not include penile penetration 
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Zhiyue Liu , Tasnuva Rashid and Alan G. Nyitray
pp. 10-21

Previous studies have suggested that human papillomavirus (HPV) can be transmitted in ways other than penetrative sex. We systematically reviewed articles that suggest evidence of non-sexual or non-penetrative sexual transmission HPV. HPV DNA was detected in the genital tract of female virgins with a prevalence up to 51.1%.

 
    | Supplementary Material (44 KB)
 

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Identifying types of sex conversations in adolescent health maintenance visits 
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Stewart C. Alexander , Sharon L. Christ , J. Dennis Fortenberry , Kathryn I. Pollak , Truls Østbye , Terrill Bravender and Cleveland G. Shields
pp. 22-28

Using latent class analysis, we identified four types of physician–adolescent sexuality discussions that differed in terms of emphasis, topics addressed as part of the sexual history and risk assessment, and topics addressed in anticipatory guidance. The presence of sexuality conversations in the majority of these visits suggests that physicians consider sexuality to be an important issue and part of their responsibility in caring for their adolescent patients. However, the substantial variability in the types of sexuality conversations, particularly the notable omissions of many key topics, supports the importance of teaching sexual health interview skills in medical school and residency, and as part of continuing medical education and quality improvement.

 
    | Supplementary Material (30 KB)
 

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Sexually transmissible infections in middle and high school students: experience rates, risk factors and relationship with mental health – results from the Korean youth risk behaviour web-based survey 
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Hanna Kwon , Hee Cheol Kang and Jun Ho Lee
pp. 29-34

The rate of ever having a sexually transmissible infection in Korean adolescents with experience of sexual intercourse was 10.0%. Ever having a sexually transmissible infection was significantly and independently associated with sexual debut at elementary school and contraceptive methods other than condoms. Additionally, ever having a sexually transmissible infection was significantly and independently associated with depressive mood, suicidal ideation and suicide attempts.

 
  
 

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Sexual health among female Aboriginal university students in the Maritime Provinces of Canada: risk behaviours and health services use 
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Kevin Wilson , Audrey Steenbeek , Mark Asbridge , Amber Cragg and Donald B. Langille
pp. 35-42

This study examined associations of being Aboriginal and sexual risk behaviours as well as use of health services in female Canadian university students. Aboriginal students were more likely not to not have used a condom or effective contraception at last intercourse than non-Aboriginal students, and they had a higher lifetime prevalence of ever having had a pregnancy or STI test. Health services providers should be aware of this greater level of risk-taking among university students of Aboriginal ethnicity.

 
  
 

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Pelvic inflammatory disease associated with Chlamydia trachomatis but not Mycoplasma genitalium in New Zealand 
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Jeannie Oliphant and Sunita Azariah
pp. 43-48

Mycoplasma genitalium was almost as commonly diagnosed as Chlamydia trachomatis in women attending a sexual health service. C. trachomatis was the only infection that was significantly associated with a diagnosis of pelvic inflammatory disease (PID). The cost-effectiveness of routine screening for M. genitalium in women with PID in our population remains unclear.

 
  
 

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Potential impact of the human papillomavirus vaccine on the incidence proportion of genital warts in French women (EFFICAE study): a multicentric prospective observational study 
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Philippe Judlin , Anne-Carole Jacquard , Xavier Carcopino , François Aubin , André Dahlab , Frédéric Mistretta , Didier Not , Pierre-Yves Boelle , Olivier Aynaud and Benoît Soubeyrand
pp. 49-54

A study among 15- to 26-year-old women found a trend for a not significant decreased incidence proportion of genital warts among women younger than 20 years who are more frequently vaccinated against human papillomavirus (HPV).

 
  
 

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Previous and future use of HIV self-testing: a survey of Australian gay and bisexual men 
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Garrett Prestage , Iryna Zablotska , Ben Bavinton , Andrew Grulich , Phillip Keen , Dean Murphy , Graham Brown , Jack Bradley , Martin Holt and Rebecca Guy
pp. 55-62

This cross-sectional survey of 559 non-HIV-positive Australian gay and bisexual men found that the majority, particularly those at increased risk, would be likely to use HIV home self-testing.

 
  
 

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Costs of pleasure and the benefits of pain: self-perceived genital sensation, anatomy and sexual dysfunction 
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Nina Callens , Guy Bronselaer , Petra De Sutter , Griet De Cuypere , Guy T’Sjoen , Piet Hoebeke and Martine Cools
pp. 63-72

Women with self-described female sexual dysfunction (FSD) reported significantly decreased genital sensation (pain and pleasure) at most genital sites when compared to a group of age-matched control women displaying normal levels of sexual function. For the clitoral site, sensitivity was more decreased with partner stimulation than with self-stimulation, in contrast to findings in women without FSD. Furthermore, perceived or expected discomfort in the vaginal area was a significant risk factor of concomitant FSD. These results combined suggest that a disturbed or otherwise suboptimal subject–partner (sexual) interaction may be a main determinant of sexual difficulties in women, underlining the need for further research on the interpersonal effects of genital pain and pleasure.

 
  
 

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The impact of a chlamydia education program on practice nurse’s knowledge and attitudes in relation to chlamydia testing: a cross-sectional survey 
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Rebecca Lorch , Rebecca Guy , Meredith Temple-Smith , Alaina Vaisey , Anna Wood , Belinda Ford , Carolyn Murray , Chris Bourne , Jane Tomnay , Jane Hocking and on behalf of the ACCEPt Consortium
pp. 73-80

A cross-sectional survey was conducted at baseline and following delivery of a chlamydia education program with practice nurses (PNs) participating in the Australian Chlamydia Control Effectiveness Pilot. The education program led to improved knowledge and attitudes to chlamydia, and could be made available to PNs working in general practice. Future analyses will determine if the education program plus other initiatives can increase testing rates.

 
  
 

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Frequent condom use with casual partners varies by sexual position among younger gay and bisexual men in New Zealand: national behavioural surveillance 2006–2011 
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Nathan J. Lachowsky , Peter J. W. Saxton , Anthony J. Hughes , Nigel P. Dickson , Robin R. Milhausen , Cate E. Dewey and Alastair J. S. Summerlee
pp. 81-86

National HIV behavioural surveillance data were analysed to examine condom use with casual partners among younger gay, bisexual and other men who have sex with men (YMSM) in New Zealand. Three-quarters of YMSM reported frequent condom use during insertive (76.0%) and receptive (73.8%) anal intercourse, which varied by demographic, behavioural and relational factors. These findings demonstrate that condom norms can be actively established and maintained among YMSM. Condom promotion efforts must increase YMSM’s capacity, agency and skills to negotiate condom use, especially for the receptive partner.

 
  
 

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Prescription rates of the contraceptive implant in Australia 2008–2012: impact of patient age and area of residence 
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Amie L. Bingham , Cameryn C. Garrett , Anne M. Kavanagh , Louise A. Keogh , Rebecca J. Bentley and Jane S. Hocking
pp. 87-90

Uptake of the sub-dermal contraceptive implant (SDI) in Australia is thought to be low, despite it being a highly effective form of contraception. Comprehensive data regarding use of the device in Australia and factors that affect this are scarce. This paper reports on an analysis of prescriptions of the SDI made through the Pharmaceutical Benefits Scheme between 2008 and 2012, finding that uptake is significantly associated with younger age and residence in a regional area.

 
  
 

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Favourable attitudes towards serosorting are associated with overall less frequent condom use among young Black men having sex men 
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Richard A. Crosby , Leandro Mena and Angelica Geter
pp. 91-92

Favourable attitudes toward serosorting were assessed among a clinical sample of young Black MSM (YBMSM) residing in the United States. Findings suggest that YBMSM having favourable attitudes toward serosorting may be more likely to report condomless sex than their counterparts without favourable attitudes. Those with more favourable attitudes were no less likely to report having sex with multiple partners compared to those without such favourable attitudes.

 
  
 

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Measuring exposure to sexually explicit media among young men who have sex with men: a pilot study 
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Kimberly M. Nelson , Matthew R. Golden and Sara Nelson Glick
pp. 93-95

The prevalence and frequency of sexually explicit media (SEM) consumption as well as associations with contextual and sexual risk characteristics among 61 young men who have sex with men (YMSM) were estimated. Results indicate that SEM use among YMSM is extremely common. Future research should clarify potential relations between SEM and sexual risk-taking with larger samples of YMSM and specific measures, including SEM content and amount.

 
  
 

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As good as it gets? Retention in care of people newly diagnosed with HIV at the Sydney Sexual Health Centre 
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Dominic Rowley , Amel Ahmed , Anna McNulty , Lynne Wray and Vickie Knight
pp. 96-98

The spectrum of engagement in HIV care, known as the HIV care cascade, is a relatively new concept in HIV medicine. Retention in care (RIC) is an important component of the cascade as it aims to reduce HIV viral load at both an individual and population level. This study aimed to determine retention in care rates in HIV-positive patients attending a large Australian urban sexual health clinic. At 6 months post-diagnosis, 63 (66%) patients were RIC while 33 (34%) were not retained in care. Within those not retained in care, 17 (18%) were lost to follow-up and 16 (17%) were known to have been referred to other services. Overall the clinic performed well compared to international standards but the efforts to improve the lost to follow up rate can be improved upon.

 
  
 

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These articles have been peer reviewed and accepted for publication. They are still in production and have not been edited, so may differ from the final published form.

    SH15193  Accepted 04 February 2016
    Is the risk for sexually transmitted infections different for women with same-sex sexual behaviour compared to heterosexual women? A retrospective study based on attendees at a Norwegian STI clinic from 2004-2014
    Sol-Britt Molin, Birgitte de Blasio, Anne Olaug Olsen
    Abstract


    SH15218  Accepted 29 January 2016
    An initial typology of contexts of dyadic sexual encounters between men and associations with sexual risk and pleasure: findings from an observational study
    G.J. Melendez-Torres, Ford Hickson, David Reid, Peter Weatherburn, Chris Bonell
    Abstract


    SH15186  Accepted 15 January 2016
    HIV post-test practices: an online survey examining perceived delivery of HIV test results, post-test discussion and referral in health care settings across the WHO European Region
    Stephen Bell, Jordi Casabona, Nino Tsereleti, Dorthe Raben, John de Wit
    Abstract


    SH15034  Accepted 09 January 2016
    Perceptions and correlates of pubic hair removal and grooming among college-aged women: a mixed methods approach
    Andrea DeMaria, Beth Sundstrom, Stephanie McInnis, Emily Rogers
    Abstract


    SH15175  Accepted 08 January 2016
    Duration of infection of gonorrhoea and chlamydia at the pharynx and rectum among men who have sex with men: a systematic review
    Eric Chow, Shayne Camilleri, Christopher Ward, Sarah Huffam, Marcus Chen, Catriona Bradshaw, Christopher Fairley
    Abstract


    SH15205  Accepted 06 January 2016
    Sexual health related information delivery-are patient information leaflets still relevant ?
    Rick Varma, Charles Chung, Amanda Townsend, Melissa Power
    Abstract


    SH15192  Accepted 30 December 2015
    The prevalence of human herpesvirus 8 among HIV-infected patients, intravenous drug users, and the general population in Iran
    Rezvan Kakavand-Ghalehnoei, Zabihollah Shoja, Alireza Najafi, Mostafa Haji Mollahoseini, Shohreh Shahmahmoodi, Sayed Mahdi Marashi, Ahmad Nejati, Somayeh Jalilvand
    Abstract


    SH15209  Accepted 18 December 2015
    What would be missed if we didn’t screen men who have sex with men for oral chlamydia trachomatis? – a cross sectional study
    Priya Loomba, Vickie Knight, Anna McNulty
    Abstract


    SH15092  Accepted 06 November 2015
    Parents’ reaction to HSV-2 biomarker testing of junior secondary school students in Botswana
    Haddi Cham, Sarah Lasswell, Kim Miller
    Abstract


9


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Rank Paper Details
1. Published 10 March 2015
Barriers and facilitators of sexually transmissible infection testing in remote Australian Aboriginal communities: results from the Sexually Transmitted Infections in Remote Communities, Improved and Enhanced Primary Health Care (STRIVE) Study

Belinda Hengel, Rebecca Guy, Linda Garton, James Ward, Alice Rumbold, Debbie Taylor-Thomson, Bronwyn Silver, Skye McGregor, Amalie Dyda, Janet Knox, John Kaldor and Lisa Maher

2. Published 21 April 2015
Syphilis transmission: a review of the current evidence

Juliet E. Stoltey and Stephanie E. Cohen

3. Published 11 June 2015
Sexual risk and healthcare seeking behaviour in young Aboriginal and Torres Strait Islander people in North Queensland

Robert Scott, Regina Foster, Lisa N. Oliver, Anna Olsen, Julie Mooney-Somers, Bradley Mathers, Joanne M. Micallef, John Kaldor and Lisa Maher

4. Published 11 June 2015
Sexual behaviour, drug use and health service use by young Noongar people in Western Australia: a snapshot

Robyn Williams, Chris Lawrence, Edward Wilkes, Maurice Shipp, Barbara Henry, Sandra Eades, Bradley Mathers, John Kaldor, Lisa Maher and Dennis Gray

5. Published 21 April 2015
Public health interventions to control syphilis

Thomas A. Peterman and Bruce W. Furness

6. Published 21 April 2015
Increasing trends of syphilis among men who have sex with men in high income countries

Phillip Read, Christopher K. Fairley and Eric P. F. Chow

7. Published 10 March 2015
Chlamydia and gonorrhoea point-of-care testing in Australia: where should it be used?

Lisa Natoli, Rebecca J. Guy, Mark Shephard, Basil Donovan, Christopher K. Fairley, James Ward, David G. Regan, Belinda Hengel and Lisa Maher

8. Published 21 April 2015
Evolution of the syphilis epidemic among men who have sex with men

Marc M. Solomon and Kenneth H. Mayer

9. Published 10 March 2015
A field evaluation of a new molecular-based point-of-care test for chlamydia and gonorrhoea in remote Aboriginal health services in Australia

Louise M. Causer, Belinda Hengel, Lisa Natoli, Annie Tangey, Steven G. Badman, Sepehr N. Tabrizi, David Whiley, James Ward, John M. Kaldor and Rebecca J. Guy

10. Published 21 April 2015
Management of syphilis in HIV-positive individuals

Fiona V. Cresswell and Martin Fisher

11. Published 11 June 2015
‘It’s always just there in your face’: young people’s views on porn

Shelley Walker, Meredith Temple-Smith, Peter Higgs and Lena Sanci

12. Published 21 April 2015
A review of recent advances in rapid point-of-care tests for syphilis

Claire C. Bristow, Elysia Larson, Marjan Javanbakht, Emily Huang, Louise Causer and Jeffrey D. Klausner

13. Published 11 June 2015
Young people’s perceptions of sexual and reproductive health in regional and rural Queensland: capturing the views of adolescents through reference groups and a user-friendly electronic survey

Paula Matich, Caroline Harvey, Priscilla Page, Karen Johnston, Clare Jukka, Jane Hollins and Sarah Larkins

14. Published 11 June 2015
Sexual health literacy of the student population of the University of Tasmania: results of the RUSSL Study

Steve Simpson, Christine Clifford, Kaz Ross, Neil Sefton, Louise Owen, Leigh Blizzard and Richard Turner

15. Published 24 November 2015
Dr Google, porn and friend-of-a-friend: where are young men really getting their sexual health information?

Amy Litras, Sarah Latreille and Meredith Temple-Smith

16. Published 21 April 2015
A novel response to an outbreak of infectious syphilis in Christchurch, New Zealand

Edward Coughlan, Heather Young, Catherine Parkes, Maureen Coshall, Nigel Dickson, Rebecca Psutka, Peter Saxton, Ramon Pink and Katharine Adams

17. Published 21 April 2015
The molecular epidemiology of Treponema pallidum subspecies pallidum

Daphne Y. Ma, Lorenzo Giacani and Arturo Centurión-Lara

18. Published 10 March 2015
Increased testing for Neisseria gonorrhoeae with duplex nucleic acid amplification tests in Australia: implications for surveillance

Basil Donovan, Wayne Dimech, Hammad Ali, Rebecca Guy and Margaret Hellard

19. Published 24 November 2015
Demographic and behavioural correlates of six sexting behaviours among Australian secondary school students

Kent Patrick, Wendy Heywood, Marian K. Pitts and Anne Mitchell

20. Published 4 August 2015
Reasons for delays in treatment of bacterial sexually transmissible infections in remote Aboriginal communities in Australia: a qualitative study of healthcentre staff

Belinda Hengel, Lisa Maher, Linda Garton, James Ward, Alice Rumbold, Debbie Taylor-Thomson, Bronwyn Silver, Skye McGregor, Amalie Dyda, Janet Knox, John Kaldor, Rebecca Guy and on behalf of the STRIVE Investigators


      
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