title: Discrepancy between sex- and water-associated risk behaviors for cryptosporidiosis among HIV-infected patients in San Francisco.
abstract: OBJECTIVE
  Potential transmission of cryptosporidiosis through drinking water supplies has been highly publicized; however, it is unknown whether this reporting has increased patient awareness or reduced other risk behaviors for exposure to this organism, such as high-risk sexual behavior.
  
  
  METHODS
  Consecutive patients presenting for initial evaluation to the Gastroenterology AIDS Clinic completed a questionnaire that assessed knowledge about cryptosporidiosis, perceived risk of infectious diarrhea, drinking water sources, and high-risk sexual behavior.
  
  
  RESULTS
  Fifty-one patients completed the questionnaire (82% male; 86% homosexual; mean age, 38 years; median CD4 count, 136 x 10(6) cells/L). Most respondents (31 of 44; 70%) believed they were at risk for infectious diarrhea. Awareness of cryptosporidiosis was high (31 of 45; 69%) as was avoidance of tap water (26 of 51; 51%) and exclusive or frequent use of bottled or boiled water (40 of 51; 78%). Respondents who used bottled water reported spending an average of $331.76 U.S. annually. However, high-risk sexual behavior remained common: 21 (41%) of the 51 subjects reported unprotected anal intercourse or oral-anal sexual contact. High-risk sexual behavior was prevalent even among subjects who drank exclusively boiled or bottled water.
  
  
  CONCLUSIONS
  Awareness of risk for infectious diarrhea and cryptosporidiosis is high among patients infected with HIV in San Francisco. Patients perceive drinking water to be a substantial risk factor for infectious diarrhea and incur significant expense to avoid tap water. However, high-risk sexual behaviors remain prevalent in this population and should be the focus of future education efforts.
authors.affiliation: San Francisco General Hospital, Department of Medicine, University of California, 94110, USA.
authors.forename: L S
authors.initials: LS
authors.lastname: Kim
authors.forename: J
authors.initials: J
authors.lastname: Stansell
authors.forename: J P
authors.initials: JP
authors.lastname: Cello
authors.forename: J
authors.initials: J
authors.lastname: Koch
mesh_terms: D000328:Adult; D001727:Bisexuality; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003457:Cryptosporidiosis / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology; D004326:Drinking; D005260:Female; D015658:HIV Infections / Q000150:complications*; D007722:Health Knowledge, Attitudes, Practice; D006716:Homosexuality; D006801:Humans; D008297:Male; D012307:Risk Factors; D012309:Risk-Taking; D012495:San Francisco / Q000453:epidemiology; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D014881:Water Supply / Q000592:standards*