Human Immunodeficiency virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) is rapidly spreading in the whole world and many adolescents start relationships at a younger age without knowing the danger of the sexually transmitted diseases. Parents should involve themselves in imparting knowledge about HIV/AIDS related information. It is imperative that parents and adolescents should have that relationship of discussing about the dangers of HIV/ AIDS. Adolescents should be taught about the importance of relationships and how to protect themselves against the dreaded disease. The research took the form of a qualitative interpretive case study focusing on a study sample of twenty parents and twelve members of a focus group. Data was collected through semi-structured interviews, document analysis and observations. The study examined the hidden issues or underlying the involvement of parents in imparting HIV/AIDS related information to their adolescents. The study revealed that many parents are aware of the pandemic and they felt it is imperative to discuss with their adolescents. Family life education is very much important even if their adolescents are taught about the HIV/AIDS related information at schools. Government is also involved in ensuring that there are preventative measures against the killer disease. This should be a collective effort by both the parents and teachers. The study further recommends the establishment of a library in order to enhance the literacy levels of parents and educators. It will be very much significant to educate or train the trainers in order to educate even our future generation. HIV/AIDS is incurable, therefore, it is imperative for the Department of education to ensure the literacy levels so that even the department of Health contributes its information to inform everybody about the danger of incurable diseases more specifically HIV/AIDS.

In 1981, a number of reports of death from immune system failure began to cause alarm in medical circles. The Human Immunodeficiency Virus (HIV) was identified as the cause of a condition known as Acquired Immune Deficiency Syndrome (AIDS). To date, there is no cure for AIDS, and as a result it is perceived as the deadliest medical condition of the century. While intensive research remains focused on development of a vaccine, there has been a strong move toward a more preventative approach that is holistic in nature, and encompasses behavioural and social components as being of equal importance. Going hand in hand with HIV/AIDS are Sexually Transmitted Infections (STIs). STIs are increasing around the world and in South Africa at a remarkable rate. Like HIV/AIDS, STIs are also transmitted during sex, more specifically through body contact during sex. Research has identified adolescents as a group that is particularly vulnerable to HIV and STI infection. Life-skills programmes use experiential learning to engage learners and are particularly popular because they empower individuals to make responsible, well thought out decisions based on well developed values and beliefs. There are however, various variables and agents that impact upon the success of HIV/AIDS and STI education. It is therefore suitable to adopt a biopsychosocial approach to underlie a HIV/AIDS and STI life-skills programme. Health models, such as the AIDS Risk Reduction Model, based on this approach should take into consideration important psychological variables to cope with changes in behaviour, as well as prepatory behaviours inclined towards preventing risky behaviour. The Ubuntu Education Fund is a non-government, international organisation that offered a life skills programme in HIV/AIDS, STIs, Rape and Child Abuse to learners in Grades 6 - 9. This study focused on HIV/AIDS and STIs. The sample size was 260 learners from the Nelson Mandela Metropolitan Region. A quasiexperimental one group pre-and post-test design was used to determine if there was a difference between the knowledge of these learners pre- and post- the life skills programme. The results of the study indicate that there was a small increase in knowledge after the life-skills programme intervention. In some schools there was even a decrease in knowledge. This study suggests that the life-skills programme was flawed and that it needs to be reviewed. The implications of these findings are discussed with suggestions for future interventions.

Background: Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) is an urgent public health issue in Mexico. Mexico has witnessed a 122% increase in reported prevalence of HIV since 2001 (Holtz et al., 2014). Country estimates suggest there are between 140,000-230,000 individuals living with HIV in Mexico (CENSIDA, 2014). While approximately 50% of individuals living with HIV in Mexico are unaware that they are living with the virus (CENSIDA, 2014). Despite a federal universal HIV program implemented in 2011, HIV in Mexico has not reached a chronic infectious disease status as seen in other regions of the globe (Deeks, 2013). The mortality rate among individuals with HIV/AIDS in Mexico is 4.2 per 100,000 (CENSIDA, 2014). There is a paucity of findings regarding social and epidemiological data focused on populations outside traditional at risk populations of HIV in Mexico (Martin-Onraët et al., 2016). Analyzing aggregate country level data for Mexico provides necessary insights to better understanding previously unconsidered social factors that are informing sexual and reproductive health trends influencing HIV health patterns. Methods: Secondary analyses were performed on Mexico's Encuesta Nacional de Salud y Nutrición 2012 (ENSANUT). Mexico’s ENSANUT is a probabilistic aggregate national dataset with a multistage stratified cluster sampling design (Janssen et al., 2013). ENSANUT is Mexico’s equivalent to the National Health and Nutrition Examination Survey (NHANES) in the United States. Data is collected via self-report interviews conducted at the participant's home. A structured questionnaire was administered to individuals 20 years of age and older (≥ 20) where sexual and reproductive data was collected from participants. The ENSANUT adult study sub-sample (n=46,227) is comprised of 42.75% men and 57.25% women. A general linear model (GLM), principal component analysis (PCA), chi-squares (χ²), and logistic regressions were applied to the study adult subsample to disentangle social factors associated with sexually transmitted infections (STIs) in the population. Quantitative analyses were conducted on SAS 9.4. Findings: Men were more likely to have a STI diagnosis (OR=3.60; 95% CI 3.00, 4.32, p=<0.001). Previous HIV testing was found to be protective for STI diagnosis across both genders (OR=0.82, 95% CI 0.72, 0.94, p=<0.001). Co-infections of HIV/gonorrhea and HIV/syphilis (n=20) were the highest in the study population. The latent variable model indicates mental health and access to health care resources are critical for positive sexual and reproductive health outcomes in Mexico. Mental health was found to be non-protective for STI risk among the study population (OR=1.59, 95% CI 1.41, 1.81, p=<0.0001). Policy recommendations: 1. Increased access and utilization of HIV resources and mental health services would benefit the study population. Further qualitative research is needed to better understand the barriers to health care access and utilization in these two domains; 2. Increase in preventative programs and health initiatives that encourage established strategies for positive sexual and reproductive health outcomes. These strategies include: universal human papillomavirus (HPV) vaccines, wide availability of Pre-Exposure Prophylaxis (PrEP), and routine HIV/STI screenings; 3. Alternative data collection strategies for ENSANUT which are culturally appropriate for sexual and reproductive health constructs.

Thesis (M.Pharm.(Pharmacology)) --University of Limpopo, 2014. / Management of Sexually Transmitted Infections (STIs) in Private Pharmacies in Limpopo Province: Practice and Knowledge of Pharmacists Background: In 2001, the South African Pharmacy Council (SAPC) developed a strategic plan, which recognised the crucial role that pharmacists could play in controlling sexually transmitted infections (STIs) and the spread of HIV infection. In South Africa, patients seek and receive treatment for STIs from pharmacies despite a legal restriction (Ward, Pharm, Butler, Mugao, Klausner, Mcfarland, Chen & Schwarcz, 2003). Current legislation bars people to seek treatment from the pharmacists for certain acute illnesses, thus significantly influencing the spread of some infections with the view that the longer infections remain untreated, the more opportunities for transmissions to occur. The perceived lack of treatment options in private pharmacies may even prevent patients from accessing advice or preventative measures at the pharmacy level (Gupta, Sane, Gurbani, Bollinger, Mehendale & Godbole, 2010). It is against this background that the study was carried out with the aim of assessing the knowledge and practice of private pharmacists in management of sexually transmitted infections (STIs) in the Limpopo Province and ultimately assist in the reduction of the spread of HIV infections. Objectives: The objectives of the study were; to identify areas of weakness in services provided by pharmacists in management of STIs in private pharmacies; to identify possible pharmaceutical care of HIV; to determine the level of use of Department of Health Standard Treatment Guidelines of sexually transmitted infections by private pharmacy; to determine the availability of sexually transmitted infection drugs for treatment of STIs; and to identify the type of information given to clients with STI. Method: A cross-sectional design was used in this study. The study was carried out in the Limpopo Province, South Africa. Out of the population of 130 pharmacies registered with the SAPC in Limpopo, a sample of 23 was selected. The pharmacies were stratified according to where they were located. This study used a questionnaire designed as an instrument of data collection. The data was collected through a face-to-face interview with the responsible pharmacist in each pharmacy outlet. This study used Simulated Client Method to evaluate the practice. In this method, simulated male and female clients visited randomly selected Pharmacies. Two scenarios were developed for a male patient with urethral discharge and a female patient with vaginal discharge. The simulated clients on a standardised reporting form, outside the pharmacy, carefully recorded all observations made during the simulated scenario. Data analysis: The data were analysed using cross-tabulation techniques and chi-square test was used to check existence of association. Compliance with Standard Treatment Guidelines in terms of treating STI syndrome was used as dependent variable. Location (Rural and urban) of private pharmacies, the gender of the client in the simulated client method, treating genital ulcer syndrome (GUS), treating male urethritis syndrome (MUS) and treating female vaginal discharge syndrome were used as independent variables. The existence of association between the dependent and variable was tested using the Chi-square test of independence. Result: The results showed that 27% of private pharmacies in Limpopo treated and managed STIs clients in accordance with Standard Treatment Guidelines. The structured interviews results showed that 78% of private pharmacists in Limpopo knew the linkage between HIV and STIs. Only 39% of the private pharmacists knew about the existence of Standard Treatment Guidelines and used them in daily client consultations. Cross tabulation of data on compliance with Standard Treatment Guidelines in terms of treating STI syndrome (the dependent variable) and the location of private pharmacies (the independent variable) produced a Chi-square value of 1.31. This showed that the dependent variable had no association with location of independent private pharmacies. The study found that the treatment and management of GUS, MUS and female discharge varied according to location of the private pharmacies. The medicines stocked were in line with the Standard Treatment Guidelines in both rural and urban pharmacies in the Limpopo Province. There was very high demand for STI medication without a prescription averaging of 150 clients per week. Private pharmacies in both areas gave the necessary information to their clients focused on use condom with 54%, partner notification with 38% and only 27% of pharmacists advised client to consult the physician. The simulated client visits showed the discrepancy between knowledge and actual practice of the private pharmacists. Conclusion: The majority of private pharmacies operating in the Limpopo Province do not comply with the Standard Treatment Guidelines for treatment and management of STIs due to inadequate knowledge. While there is a need to train some pharmacists in the provision of primary health care for syndromic STI treatment in order to reduce STIs and HIV transmission, the lifting of current legal restriction in South Africa that prevents pharmacists from prescribing STI medication may be necessary. The knowledge and practice of incidence of specific infections in communities served by the specific pharmacy should be part of the pharmaceutical care provision.

BACKGROUND: Human Papillomavirus (HPV) is the most common sexually-transmitted infection in the U.S. and is associated with a number of cancers. A vaccine that can prevent 90% of HPV-associated cancers has been available since 2006, yet millions of young adults remain unvaccinated. Low vaccination uptake has been observed in cisgender sexual minority communities and less is known about HPV vaccination among transgender and gender nonbinary (TGNB) people. The aims of this dissertation were: (a) to identify facilitators for and barriers to HPV vaccination among gender minority people; (b) to compare HPV vaccination rates, HPV risk and situational factors like barriers to care, access to care, preventive care, HPV knowledge and Internet use in a sample of TGNB people and cisgender sexual minority people; and (c) to explore the association of online health information and HPV vaccination receipt among TGNB people compared to cisgender sexual minority people and determine if eHealth Literacy or general health literacy moderate this relationship. METHODS: The dissertation comprised three studies. First, an integrative review of the literature included searches of three electronic databases to identify and appraise studies that explore patient-, provider- and system-level HPV vaccination barriers among gender minority people. Second, guided by the Integrative Model of eHealth Use, a cross-sectional secondary analysis of The Population Research in Identities and Disparities for Equality (PRIDE) Study Annual Questionnaire 2018-19, compared the rate of HPV vaccination among TGNB and cisgender sexual minority people and described situation factors (e.g., barriers to care, access to care, preventive care), Internet use, HPV knowledge, HPV risk, and HPV vaccination among these communities. Third, a novel cross-sectional online survey of TGNB and cisgender sexual minority participants recruited from The PRIDE Study, also guided by the Integrative Model of eHealth Use, explored the association between online health information seeking and receipt of HPV vaccine, and whether eHealth literacy and/or general health literacy moderate this relationship. Statistical methods for the cross-sectional studies included prevalence ratios (PR) using robust Poisson statistics and multivariable logistic regression with post hoc Bonferroni-Holm correction. RESULTS: The integrative review identified six cross-sectional studies and one qualitative study that explored HPV vaccine barriers and facilitators among gender minority people. The majority of the studies included <10% gender minority participants. Key barriers to vaccination identified were misperceptions of risk at patient-level, bias towards vaccinating female assigned individuals at the provider-level and population effects of recommendations for girls-only at the policy-level. The cross-sectional secondary analysis of The PRIDE Study 2018-19 Annual Questionnaire and included N = 5,500 responses and found that: (a) the prevalence of ever receiving HPV vaccine was 1.2 times greater among TGNB participants than cisgender participants (PR 1.2; 95% CI, 1.1-1.3); (b) the prevalence of ever receiving HPV vaccine was 2.4 times greater among transgender men who were assigned female at birth compared to transgender women who were assigned male at birth (PR 2.4; 95% CI, 2.0-2.8); and (c) no differences in vaccination initiation and vaccination completion based on gender identity, sex assigned at birth, sex organs born with, or current sex organs. The cross-sectional novel online survey of PRIDE participants yielded N = 3,258 responses (response rate 19.6%). After controlling for covariates including age, race/ethnicity and educational attainment, we found that TGNB as compared to cisgender participants had increased odds (aOR=1.5=; 95% CI, 1.1-2.2) of reporting receipt of HPV vaccine ever and decreased odds (aOR=0.7; 95% CI, 0.5-0.9) of ever receiving of HPV vaccine when they looked for info on vaccines in the past year. Conversely, TGNB participants had over twice the odds (aOR=2.4; 95% CI, 1.1-5.6) of ever receiving HPV vaccine if they visited a social networking site like Facebook or Instagram in the past year. There were no moderating effects observed from eHealth or general health literacy. CONCLUSIONS: TGNB communities are understudied in terms of HPV vaccination and the existing literature shows misperceptions about the need of HPV vaccination among TGNB communities at both the patient and provider level. TGNB participants were more likely to have ever received HPV vaccine compared to cisgender sexual minority participants in the cross-sectional secondary analysis of The PRIDE Study 2018-19 Annual Questionnaire which may be attributed to high primary engagement in the cohort. Finally, online health information seeking about vaccines was associated with decreased receipt of HPV vaccine (ever) whereas social media use increased HPV vaccine receipt (ever) among TGNB participants compared to cisgender sexual minority participants. These conflicting findings suggest that the quality of online health information relating HPV vaccines, how, when and why TGNB people search for health information online may affect health behaviors like HPV vaccination. More research is warranted to explore how online health information seeking may influence personal health decision-making among TGNB communities.

In 2011 the National Academy of Medicine identified research gaps related to transgender populations and suggested a research agenda that included, among other goals, investigating health outcomes related to transition related care. The overarching goal of this dissertation therefore is to add to the body of knowledge about the state of health of transgender individuals, including utilization of gender-affirming care, preventive care and screening practices for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). This dissertation includes three manuscripts. The first is a retrospective chart review including 1670 transgender patients, aged 18 and up (mean age 35.57 years), at a community health center to examine utilization of gender-affirming procedures as well as investigate the prevalence of smoking and uptake of colon cancer screening compared to New York City benchmarks using data from the New York City Community Health Survey (NYC CHS). The results revealed transgender individuals had high uptake of gender affirming hormones (81.9%) but fewer had undergone gender-affirming surgeries (31.5%). Transgender individuals had almost double the rate of current cigarette smoking compared to adults aged 18 and up in the New York City Community Health Survey (OR=1.92, 95% CI=1.61, 2.28) and also had suboptimal colon cancer screening rates compared to New Yorkers aged 50 and older (OR=0.16, 95% CI=0.11, 0.23). The second paper is a scoping review of the literature to investigate postoperative outcomes related to vaginoplasty procedures in transgender women. One hundred and three articles met inclusion criteria and provided information on immediate as well as long term health outcomes. The review demonstrated many inconsistencies in the timing of follow-up as well as how outcomes were measured, but provided invaluable information on the many types of postoperative issues that may be seen after vaginoplasty surgery. Lastly, the third paper examined the prevalence of HIV and STI testing behavior and prevalence of HIV infection among transgender people in a community health center setting. This analysis demonstrated that HIV screening rates were lower than expected (55.7%) given the elevated HIV prevalence in the population. In the multivariate analysis the odds of HIV screening among transmasculine individuals was higher in those who had undergone gender affirming surgeries (OR=1.67, 95% CI= 1.08, 2.58), had a substance use history (OR=5.18, 95% CI=1.41, 18.99) and a history of genital warts (OR=4.64, 95%CI=1.24, 17.34). Among transfeminine individuals the odds of HIV screening were higher in those with only cisgender male partners (OR=2.18, 95% CI=1.52, 3.11), gender affirming surgery (OR=2.56, 95% CI=1.53, 4.31), substance use history (OR=2.76, 95% CI=1.23, 5.78) and genital warts (OR=2.69, 95% CI=1.20, 6.02). HIV prevalence was higher among transfeminine compared to transmasculine individuals (28.1% vs. 2.8%, p<.001). In the multivariable analysis having only cisgender male sex partners increased the odds of HIV infection among transmasculine individuals (OR=10.58, 95% CI=1.33, 84.17), while having at least a high school diploma reduced the odds of infection (OR=0.08, 95% CI=0.01, 0.72). Among transfeminine individuals increased odds of HIV-infection were seen in those who were unemployed (OR=1.7, 95% CI=1.1, 2.64) and those who had a history of genital warts (OR=2.54, 95% CI=1.37, 4.70). White individuals had a lower likelihood of HIV infection (OR=0.40, 95%CI=0.21, 0.73). Overall these three studies provide important information about transition-related, primary and preventive healthcare for transgender populations. The findings of elevated cigarette smoking, underutilization of colorectal cancer screening and low HIV and STI screening rates occurred in this study despite the fact that transgender people were engaged in medical care. Clinics and other health settings that provide transgender health services should include robust metrics for monitoring uptake of preventive health care services and work to improve uptake of services when disparities are evident.

Indiana University-Purdue University Indianapolis (IUPUI) / The emergence and development of electronic health records have contributed to an abundance of patient data that can greatly be used and analyzed to promote health outcomes and even eliminate health disparities. However, challenges exist in the data received with factors such as data inconsistencies, accuracy issues, and unstructured formatting being evident. Furthermore, the current electronic health records and clinical information systems that are present do not contain the social determinants of health that may enhance our understanding of the characteristics and mechanisms of disease risk and transmission as well as health disparities research. Linkage to external population health databases to incorporate these social determinants of health is often necessary. This study provides an opportunity to identify and analyze health disparities using geographical information systems on two important sexually transmitted diseases in chlamydia and gonorrhea using Marion County, Indiana as the geographical location of interest. Population health data from the Social Assets and Vulnerabilities Indicators community information system and electronic health record data from the Indiana Network for Patient Care will be merged to measure the distribution and variability of greatest chlamydia and gonorrhea risk and to determine where the greatest areas of health disparities exist. A series of both statistical and spatial statistical methods such as a longitudinal measurement of health disparity through the Gini index, a hot-spot and cluster analysis, and a geographically weighted regression will be conducted in this study. The outcome and broader impact of this research will contribute to enhanced surveillance and increased effective strategies in identifying the level of health disparities for sexually transmitted diseases in vulnerable localities and high-risk communities. Additionally, the findings from this study will lead to improved standardization and accuracy in data collection to facilitate subsequent studies involving multiple disparate data sources. Finally, this study will likely introduce ideas for potential social determinants of health to be incorporated into electronic health records and clinical information systems.

Thesis (MPH.) -- University of Limpopo, 2020 / Background of the study: Cervical cancer is a disease that is described as the state of overgrowth of tissue resulting from the disorganisation of cell division that is preceded by several earlier cervical changes, especially at the squamocolumnar junction of the cervix. Factors such as HPV, which is a sexually transmitted infection (STI), low socioeconomic status (SES), intercourse at a very early age, numerous childbirths, poverty and limited access to health care, are some of the contributing risk factors for cervical cancer. Most women in developing countries only seek professional help once the malignancy is already at an advanced stage. Purpose of the study: The aim of the study was to investigate the determinants of cervical cancer in patients seen in the gynaecology clinic at Mankweng hospital. And the objectives were: to profile the sociodemographic characteristics; to profile the contributory risk factors; and, to determine the association of risk factors for cervical cancer with the socio-demographic characteristics of the patients seen in the gynaecology clinic at Mankweng hospital. Research methodology: A quantitative, cross-section descriptive study, which has been validated and used in several studies globally, was conducted at Mankweng hospital, which is a tertiary referral academic hospital in the Limpopo Province, following all cervical cancer patients consulting at gynaecology outpatient clinic during the study period. Data were collected using a structured questionnaire and entered into computer software and analysed. Research findings: Thirty-seven percent of the women who participated in this study were single, 27% were married, 27% widowed and only 9% were divorced. Nearly half (46%) of the participants had secondary education and only 8% had tertiary education. The majority (91%) of the women were unemployed and only 9% were employed. The majority (40%) of the women were at stage II cervical cancer. Nearly two-thirds (62%) had had multiple partners. At the time of the study, 94% of the participants did not have multiple partners. Nearly two-thirds (64%) of the participants had heard about Pap smears before their current diagnosis and 62% of the participants had had a Pap smear before the current results. Few participants smoked cigarette (2%) or used contraceptive (3%). The young age group, single, divorced, with secondary and v tertiary education were more likely to be HIV positive. And the elderly, divorced, widowed and less educated were more likely to have high parity. Recommendations and conclusions: Information about the risk factors for developing cervical cancer, specifically the transmission of HPV, needs to be disseminated to young people. Rather than initiating cervical screening by age group, which may result in young women being refused screening irrespective of their risk, cervical screening guidelines should stipulate the initiation of cervical screening and HPV vaccine from the age of 15 onwards. Present study suggests that young women may be more prone to HPV and HIV due to the fact that young women who are single or divorced, with tertiary education were more likely to have multiple partners, which places them in a risk-based cervical screening target group. A final recommendation and conclusion is that a long-term, in-depth study on cervical cancer in young women in relation to the presence of the risk-factors should be carried out. Attempts should be made to reach women who rarely visit health care services.

Community service projects have consistently been an effective means of community involvement and an avenue in which improvement in an area may be measured. Although the roles each participant assumes may differ, the ultimate accomplishment of the project is paramount to each person involved. This paper will explore the Governor's Task Force on Venereal Disease to determine both the effectiveness of the Task Force and the methods utilized to accomplish the task force goals. Primarily, this group of selected individuals will be reviewed to determine whether they were effective due to their ability to influence others, or simply through a great deal of hard work and co-operation. Data for this work was collected from individual written responses from Task Force participants, the Governor's Commission on Youth, various medical professionals, several works of other authors (see bibliography), data gathered by me as participant-observer, and through interviews from selected Task Force participants. Upon compiling the data, several concepts were revealed. I found that the influence that each participant enjoyed in the community was a primary factor of the effectiveness of the Task Force. Moreover, it was the influence of the particular individual with others who could assist with this particular problem which created a positive response, and thus effective results. This paper also explores the Task Force as a politically appointed group chosen to complete a specific project. The goals, operations, and accomplishments are detailed in an effort to measure the significance of the Task Force in the community.

Trichomonas vagina/is, one of the most common sexually transmitted diseases, has been shown to increase patients' susceptibility to HIV infection and cervical cancer; moreover, resistance to metronidazole is increasing, and new drug targets must be identified in order to combat resistant strains. T vagina/is expresses cysteine proteases that have been implicated in vaginal epithelial apoptosis as well as immune system evasion. In the past the various cysteine proteases have been studied as a group, and the following work examines, one specific protease, TvCP2, in detail through Western blot analysis, immunofluorescent staining, and recombinant expression. The experiments 5 presented here suggest that aT l-CP2 over-expressing transfectant line processes CP2 and sequesters it in cellular compartments. Previous data gives strong evidence of the secretion of cysteine protease CP4 and hints at the possibility of CP2 secretion as well; however, our results show no co-localization between CP2 and CP4 in T l-CP2 over expressing transfectants, suggesting separate trafficking and different roles. To better characterize CP2 function, we attempted to express active, recombinant protein. Although Pichia pastoris serves as a reliable expression vehicle, a processing event following translation ofTvCP2 appears to have cleaved the pro-domain and, along with it, the a-secretion signal, trapping active TvCP2 within the cellular pellet. A thioreoxintagged version ofTvCP2 has been expressed in E. coli, and preliminary experiments show it may auto-activate under certain conditions, but further experimentation is required to confirm the presence of active CP2 within the fraction purified from these cells.