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Landon Myer

Publications and source records attributed to Landon Myer.

16 recordsLinked to original sources
PubMed2005

Microbicide acceptability research: current approaches and future directions.

With growing recognition of the potential value of microbicides for HIV/STI prevention, the importance of the acceptability of this brand-new technology has been widely acknowledged. We review the current body of microbicide acceptability research, characterize the limitations in assessment approaches, and suggest strategies for improvement. Electronic databases and abstracts of recent meetings were searched for acceptability data regarding vaginal and rectal products that may be used for HIV prevention. Of the 61 studies reviewed, more than half assessed acceptability based primarily on the description of a hypothetical microbicide, or with the demonstration of a spermicide or lubricant. Physical characteristics of microbicidal products, their effects after insertion, and their effects on sensation during intercourse (for both partners) were the dimensions most frequently assessed (measured in 77%, 49% and 49% of studies, respectively). Attention to the social context of use was inadequate. As acceptability is likely to be a key determinant in the use-effectiveness of microbicides, in-depth understanding of the social processes that shape microbicide acceptability across diverse populations will become increasingly valuable. This includes exploring the effects that sexual partners, health care providers, and key opinion leaders have on the acceptability of microbicides among women and men, including youth and people living with HIV. Future research will benefit from studies of the acceptability of other contraceptive-barrier methods (especially the female condom), use of an agreed-upon operationalization of acceptability, use of acceptability assessments within clinical trials, expansion of measurement domains, and assessment of changes in perceptions of acceptability and use over time. Failure to understand the key factors associated with microbicide acceptability is likely to hinder the adoption and continued use of products that are effective in preventing HIV infection.

Anti-Infective Agents, Local↗
PubMed2004

Intravaginal practices, HIV and other sexually transmitted diseases among South African women.

BACKGROUND AND OBJECTIVES: Intravaginal practices, including wiping, douching, or inserting substances into the vagina, have been hypothesized to increase women's risk of HIV infection. However, data on the prevalence of these practices, and associations with HIV and other sexually transmitted diseases (STD), are limited. STUDY DESIGN: We interviewed 2,897 women participating in a gynecologic screening study in Cape Town, South Africa, about their intravaginal practices. After clinical examination, cervical and blood samples were collected and tested for HIV and other STD [corrected]. RESULTS: Of the 831 (29%) women reporting some type of intravaginal practice, 48% reported using only water and cloth to clean inside the vagina, whereas 17% reported using antiseptics or detergents. Most women (53%) reported practices as part of regular hygiene. Intravaginal practices were strongly associated with behavioral risk factors, and recent multiple sexual partners [corrected]. Intravaginal practices were associated with prevalent HIV infection (adjusted odds ratio, 1.74; 95% confidence interval, 1.37-2.20), but were not associated with other STDs. CONCLUSION: Prospective studies that include detailed measurements of correlated sexual risk behaviors are required to discern whether this association is causal in nature; if so, these behaviors could represent an important area for future HIV prevention interventions.

Adult↗
PubMed2004

Treatment of maternal syphilis in rural South Africa: effect of multiple doses of benzathine penicillin on pregnancy loss.

OBJECTIVES: Despite few data, the treatment of syphilis in pregnant women using a single dose of benzathine penicillin is the standard of care in many resource-poor settings. We examined the effect of various doses of benzathine penicillin on pregnancy loss among women with a positive Rapid Plasma Reagin (RPR) test result in a rural South African district. METHODS: All pregnant women making their first antenatal care visit during pregnancy were screened for syphilis using the RPR test. Those testing positive were counselled to receive three weekly doses of benzathine penicillin, and received a partner notification card. Pregnancy outcomes were determined from facility records or home visits where necessary. RESULTS: Of 8917 women screened, 1043 (12%) had reactive syphilis serology; of those with titre data available, 30% had titres of 1:8 or greater. While 41% (n = 430) of women received all three doses as counselled, 30% (n = 312) received only one dose, and 20% (n = 207) did not return to the clinic to receive treatment. Among the 947 women with pregnancy outcome data available, there were 17 miscarriages and 48 perinatal deaths observed. There was a strong trend towards reduced risk of pregnancy loss among women receiving multiple doses of penicillin (adjusted OR for perinatal mortality for each additional dose received, 0.63; 95% CI, 0.48-0.84). CONCLUSIONS: While this association requires further investigation, these results suggest that there may be substantial benefit to providing multiple doses of benzathine penicillin to treat maternal syphilis in this setting.

Abortion, Spontaneous↗
PubMed2002

Condom use and sexual behaviors among individuals procuring free male condoms in South Africa: a prospective study.

BACKGROUND: Although the South African government has increased the number of male condoms distributed free to the public, there is no understanding of whether these are being used effectively to prevent the spread of sexually transmitted diseases, including HIV infection. GOAL: The study goal was to determine sexual behaviors and barriers to condom use among individuals procuring condoms distributed free to the public sector. STUDY DESIGN: In a prospective study, individuals who procured condoms from 12 public health facilities across South Africa were recruited and observed for the next 5 weeks. RESULTS: The 384 successfully observed subjects reported 3262 sexual contacts, of which 2637 (81%) involved protection with a condom. In multivariate analysis, alcohol consumption and use of other contraceptives were associated with unprotected sexual intercourse. CONCLUSION: The levels of condom use are relatively high in this population, but these data highlight several important barriers to condom use that may be targeted by future interventions.

Adult↗
PubMed2002

The Jaipur paradigm.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Barriers to accessing free condoms at public health facilities across South Africa.

OBJECTIVES: Lack of access to public sector condoms still presents a fundamental barrier to condom use in most of South Africa. This study investigated the determinants of condom procurement at public health facilities in order to inform improved public sector condom distribution and promotion strategies. DESIGN: Cross-sectional study. SETTING: Twelve health facilities in four health regions of South Africa: Boland/Overberg, Empangeni/Jozini, Kimberley, and Pretoria. SUBJECTS: Consecutive individuals procuring condoms and a sample of individuals not procuring condoms were interviewed on their recent sexual behaviour and condom-related knowledge and attitudes. OUTCOME MEASURES: Factors associated with condom procurement. RESULTS: Across all facilities, 554 individuals procuring condoms and a comparison group of 261 individuals not procuring condoms were interviewed. Eighty-three (33%) of those interviewed who were not procuring condoms stated that they would like to do so. Several potential barriers to condom procurement, including female gender and perceived risk of HIV, showed substantially different associations in different study regions. Only two factors, negative partner attitudes towards condoms and the use of other forms of contraception, were consistently associated with a decreased probability of condom procurement across all regions. CONCLUSIONS: These results suggest that the barriers to condom procurement may vary considerably across South Africa. This heterogeneity suggests that national-level interventions to promote condom procurement and use may be less appropriate than specialised interventions addressing locally relevant factors, including those identified here.

Adolescent↗
PubMed2002

Willingness to participate in South African HIV vaccine trials--concerns of medical professionals in the Western Cape.

OBJECTIVES: To evaluate the willingness of medical doctors working at a tertiary hospital to participate in HIV vaccine trials, their perceptions of patients' willingness to participate, and the major reasons underlying these views. DESIGN: A self-administered, anonymous postal survey conducted in two rounds between May and July 2001. SETTING: A tertiary care hospital in the Western Cape. SUBJECTS: All medical doctors listed on the hospital's staff directory. OUTCOME MEASURES: Willingness to participate in, and to recruit patients into, HIV vaccine trials, and the reasons for this. RESULTS AND CONCLUSIONS: Of the 289 individuals surveyed, 80% stated either that they would not be willing to participate in HIV vaccine trials or that they were unsure about their participation. Meanwhile, 37% stated that they would be willing to recruit patients into vaccine trials. The most common concerns with trial participation were the possibility of vaccine-induced infection and the possibility of testing positive for antibodies to HIV. The surprisingly low level of willingness to participate in trials in this sample of medical professionals highlights the importance of preparatory work to overcome substantial barriers to HIV vaccine trial participation.

AIDS Vaccines↗
PubMedDate not supplied

Why do women seek antenatal care late? Perspectives from rural South Africa.

Despite the widespread availability of free antenatal care services, most women in rural South Africa attend their first antenatal clinic late in pregnancy and fail to return for any followup care, potentially leading to avoidable perinatal and maternal complications. Using interviews with pregnant women from the rural Hlabisa district of South Africa, we documented perceptions of health and health care during pregnancy and investigated factors shaping the utilization of antenatal care. Our findings indicate that most women in this setting do not perceive significant health threats during pregnancy, and in turn view more than one antenatal care visit as unnecessary. In contrast, women perceive labour and delivery as a time of significant health risks that require biomedical attention, and most women prefer to give birth in a health facility. This paradox, in which health care is important for childbirth but not during pregnancy, is embodied in most women's primary reason for seeking antenatal care in this setting: to receive an antenatal attendance card that is required to deliver at a health facility. Health education programs promoting antenatal care are required to explain the importance of effective antenatal care toward maternal and child health.

Adolescent↗