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Impact of HIV infection on mortality and accuracy of AIDS reporting on death certificates.

To assess the impact of HIV infection on mortality and the accuracy of AIDS reporting on death certificates, we analyzed data from 6704 homosexual and bisexual men in the San Francisco City Clinic cohort. Identification of AIDS cases and deaths in the cohort was determined through multiple sources, including the national AIDS surveillance registry and the National Death Index. Through 1990, 1518 deaths had been reported in the cohort and 1292 death certificates obtained. Of the 1292 death certificates, 1162 were for known AIDS cases, but 9% of the AIDS cases did not have HIV infection or AIDS noted on the death certificate. Only 0.7% of the decedents had AIDS listed as a cause of death and had not been reported to AIDS surveillance. AIDS and HIV infection was the leading cause of death in the cohort, with the highest proportionate mortality ratio (85%) and standardized mortality ratio (153 in 1987), and the largest number of years of potential life lost (32,008 years). The devastating impact of HIV infection on mortality is increasing and will require continued efforts to prevent and treat HIV infection.

Abstracting and Indexing↗

Changing men's attitudes and behavior: the Zimbabwe Male Motivation Project.

A multimedia communication campaign was conducted between 1988 and 1989 to promote family planning among men in Zimbabwe. The campaign consisted of a 52-episode semiweekly radio soap opera, about 60 motivational talks, and two pamphlets about contraceptive methods. Changes over time were measured by comparing a subset of a follow-up survey conducted from October to December 1989 to a baseline survey conducted from April to June 1988. Men exposed to the campaign were also compared to men who were not exposed. The follow-up survey revealed that the campaign reached 52 percent of men aged 18 to 55. Among married Shona-speaking men, use of modern contraceptive methods increased from about 56 percent to 59 percent during the campaign. Condom use increased from about 5 percent to 10 percent. Awareness and current use of modern contraceptives was also higher among men exposed to the campaign, primarily because of their greater awareness of condoms. Men exposed to the campaign were significantly more likely than other men to make the decision to use family planning and to say that both spouses should decide how many children to have.

Adolescent↗

Sources of sexual information and sexual attitudes and behaviors of Anglo and Hispanic adolescent males.

A survey of Anglo and Hispanic adolescent males' sources of sexual information and their attitudes and practices was conducted. A comparison of attitudes and behaviors revealed little difference by ethnicity; however, a more detailed analysis of sources of information resulted in some interesting findings. The relationship between completing a sex education class and condom use was statistically significant in a positive direction. In addition, this relationship was much stronger for Hispanic youth. The important implications of this finding are discussed.

Adolescent↗

Adolescent sexuality and public policy.

In recent decades, various attempts have been made to determine the level of sexual activity among adolescents. This information has been used in the planning and evaluation of sex-related programs. However, there is a flaw in using only the initial estimates of the behavior--that a sexually active person is defined as one who has had sexual intercourse. This narrow definition distorts the perception of adolescent sexual behavior. Sexual activity can more accurately be designated by focusing on the actual frequency with which teenagers have sex. In this research report, adolescents were considered sexually active if they had had sex within the last four weeks. Using this definition, adolescents were found to be substantially less sexually active than has been previously reported. This finding was then used to look at various policy decisions in the areas of sex education, family planning, and sexually transmitted disease prevention.

Adolescent↗

Oral contraceptives and cervical carcinoma in situ in Chile.

A case-control study of cervical carcinoma in situ was conducted in Santiago, Chile, to determine whether risk of this condition is altered by use of oral contraceptives. Responses to a standardized questionnaire were compared in 133 hospitalized cases and 254 age-matched controls selected from the same screening program through which the cases were detected. After controlling for the possible confounding influence of a variety of indices of sexual behavior, socioeconomic status, and prior cytological smears, no increase in risk was found in women who ever used oral contraceptives. No trend of increasing or decreasing risk was seen in relation to duration of use, up to more than 6 years of exposure, or with the passage of time from either initial or most recent exposure. An observed increase in risk in current users of oral contraceptives was not considered likely to represent a causal relationship.

Abortion, Spontaneous↗

Knowledge, attitude and beliefs amongst inhabitants of high density informal settlements with regard to sexuality and AIDS in Alexandra township.

OBJECTIVE: The main purpose of this study was to gain information on the knowledge that people living in squatter conditions have about AIDS, their attitude towards this disease and their sexual practices. METHOD: The study had two parts, in-depth interviews and a survey. The in-depth interviews were held with 68 male informal settlement dwellers to obtain information on the type of questions to ask in the quantitative part of the study, taking into account the sensitivity of the information we were seeking, and how best to phrase these questions. For the survey, the 300 male informal settlement residents who were interviewed, were located by means of systematic sampling techniques. RESULTS: The results of the survey showed that most of the respondents were living in squalid conditions, without recreation facilities. They were also likely to have had more than one partner (54%). Most of the respondents (90%) had heard about AIDS as a disease. Even though they were aware of AIDS as an epidemic in the country as a whole, they were not convinced that the disease exists in their community, the main reason being that they have never heard about nor seen a person with AIDS in the township. CONCLUSION: There is an urgent need for AIDS education. But this education cannot take place as a separate activity from other upliftment activities in squatter areas.

Acquired Immunodeficiency Syndrome↗

The dynamics of young men's condom use during and across relationships.

According to data from the 1991 National Survey of Adolescent Males, condom use is likely to be highest at the beginning of relationships and to decline as the relationship continues. The proportion of sexually active men aged 17-22 who used a condom with their most recent partner declined from 53% the first time they had intercourse with that partner to 44% at the most recent episode. Condom use also decreases with age; 59% of 17-18-year-olds used a condom the first time they had intercourse with their most recent partner, compared with 56% of 19-20-year-olds and 46% of 21-22-year-olds. However, the probability that the female partner used the pill the first time that the couple had sex increased with the man's age--from 21% among 17-18-year-olds to 35% among 21-22-year-olds. Young men were more likely to have used a condom if they thought their partner was sexually inexperienced, and less likely to have done so if they suspected their partner was at high risk for an STD.

Adolescent↗

Female patients and male nursing students.

Male nursing students, just like their female counterparts, are expected to give quality, professional nursing care to all patients. The sex of the patient assignment should not prevent learning opportunities. Cultural attitudes, however, perceive nursing to be a female profession. Role confusion occurs when a female patient and a male nurse are paired. Because of this stereotypical behavior, men in nursing sometimes face barriers in providing quality care to female patients. The cause and possible solutions to this issue are addressed.

Attitude of Health Personnel↗

Drinking-driving and health lifestyle in the United States: Behavioral Risk Factors Surveys.

National patterns of self-reported drinking-driving were examined using aggregated Behavioral Risk Factor Survey data. Drinking-driving is reported by 6.1% of U.S. adults, is almost three times more prevalent among men than women and is most prevalent in 18-24-year-old men (15.4%). Sociodemographic characteristics of self-reported drinking drivers correspond with those characteristics based on alcohol-associated motor vehicle accident and arrest data. Heavy smokers and those who fail to use seatbelts are more likely to drink and drive than those without these health-risk behaviors. Men reporting stress in interpersonal relationships are more likely to drink and drive. Individuals who drink or smoke in response to stress are more likely to drink and drive than those who exercise in response to stress. The concurrent practice of drinking-driving with lack of seatbelt use, use of alcohol in response to stress and smoking probably contributes substantially to the risk of accident and serious injury among drinking drivers and has implications for both prevention and treatment programs.

Accidents, Traffic↗

Psychological factors that predict AIDS high-risk versus AIDS precautionary behavior.

Men (N = 526) who patronized gay bars in three cities completed measures of sexual behavior covering the previous 3 months and psychological measures theoretically pertinent to AIDS risk. Thirty-seven percent of the sample reported engaging in unprotected anal intercourse, the behavior most strongly associated with transmission of human immunodeficiency virus (HIV) infection. Perceived peer norms concerning the acceptability of safer sex practices, AIDS health locus of control scores, risk behavior knowledge, age, and accuracy of personal risk estimation, but not personal HIV serostatus knowledge, were associated with high-risk and precaution-taking behavior.

Acquired Immunodeficiency Syndrome↗

Predicting male and female contraceptive behavior: a discriminant analysis of groups high, moderate, and low in contraceptive effectiveness.

An exploratory, multivariate study was carried out to assess (a) whether three contraceptive-effectiveness groups (high, moderate, and low) could be differentiated on the basis of variables that have been theoretically and empirically associated with contraceptive behavior and (b) whether an identified set of discriminating variables could accurately classify sexually active college students into these groups. Three hundred sixty-five sexually active, never-married college students (211 males and 154 females) completed instruments measuring variables related to contraception. Four separate discriminant analyses were performed, one for each sex for both their initial sexual encounter and their current sexual interactions. Discrimination and classification of the three contraceptive groups for both males' and females' initial sexual experience was not very successful. Moderate discrimination was achieved for the female current sexual activity subsample and good discrimination and classification was made for the currently sexually active male subsample. The results are discussed in terms of the implications of the findings for understanding contraceptive behavior of males and females, problems with the dependent variable of contraceptive use, and the mounting evidence that emotional orientation to sexuality influences contraceptive behavior.

Adult↗

A description of the gender differences in risk behaviors in young adults with genital herpes.

The purpose of this paper is to describe gender differences in risk behaviors--substance use and sexual behavior--in young adults with genital herpes. Two-hundred fifty-two young adults with genital herpes were recruited into the study via newspaper advertisements in a West Coast metropolitan area. As a part of a large randomized clinical trial, participants completed questionnaires measuring demographic characteristics and the risk behaviors of substance use and sexual behavior. Participants had a mean age of 27.1 years and were largely Caucasian, employed, college-educated, and heterosexual. Women were two years younger than men and had less income. Gender differences were found in both substance use and sexual behavior. Men were more likely to report current use of illicit drugs than were women. Men were also more likely to report a history of gonorrhea, and urethral discharge. Women reported initiating sex at an older age and having fewer sexual partners over their lifetimes than men. There were no gender differences in use of condoms or spermicides specifically to prevent transmission of genital herpes. Further study is needed of these young adults as they are at high risk for transmission of the disease and also for contracting other sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection. Sensitive interventions are needed with this high-risk population.

Adolescent↗

Psychiatrists' and non-physician psychotherapists' beliefs about gender-appropriate behavior: a comparison.

We adapted the Bem Sex-Role Inventory to survey therapists' beliefs about gender-appropriate behavior for hypothetical patients. We previously studied psychiatrists, finding that women were more likely to choose masculine or androgynous (high masculine and high feminine) traits as optimal for female patients while men were more likely to choose the undifferentiated (low masculine and low feminine) category for patients of either sex. In this study we used the same measure to compare psychologists and social workers to the psychiatrists, to determine the effect of medical education on these attitudes. We found that regardless of educational background, women were more likely to choose the androgynous category and men were more likely to choose the undifferentiated category. Women psychiatrists were more likely to choose masculine traits as optimal than were women non-physician therapists. Male therapists of all backgrounds were least likely to choose masculine traits as optimal for either male or female patients. Medical education per se does not seem to determine attitudes about gender-appropriate behavior. Men entering professions in which they are concerned about others' emotional well-being may have less stereotypically masculine beliefs about gender-appropriate behavior than women entering the same fields. Possible reasons for this difference are discussed.

Adult↗

The twain meet: empirical explanations of sex differences in health and mortality.

Health statistics routinely show higher morbidity and health services use for women, while mortality rates are higher for men. This analysis empirically identifies reasons for women's poorer health. It is based on retrospective (interview) and prospective (health diaries) data from the Health In Detroit Study. Three kinds of risk factors, which may help explain females' excess, are considered: acquired risks, psychosocial aspects, and health-reporting behavior. Men and women differ markedly in acquired risks: smoking and job hazards are higher for men, but inactivity, nonemployment, stress, and many other factors are higher for women. Psychosocial aspects predispose women to more illness and health care. Women also had keener interest in the survey. When all of the risk factors are controlled, the morbidity gap narrows considerably. In fact, indicators of general and chronic health reverse to reveal higher morbidity for men. Similarly, females' excesses for therapeutic care (short- and long-term disability, medical visits, lay consultation, drug use) diminish when risks and morbidity level are controlled. They actually reverse to a male excess for disability and medical care. Though most of the unveiled male excesses are statistically nonsignificant, their pattern allows a reasonable interpretation. Our results are closely compatible with recent analyses of sex mortality differences in several California sites, which could not eliminate men's mortality excess by controlling for social factors. In conclusion, contemporary women's poorer health profile stems largely from their roles and stress (acquired risks), and to a smaller degree from their health attitudes. When social factors are taken into account, health data suggest a disadvantage for men, and mortality data maintain men's disadvantage. Do the reasons lie in biology?

Female↗

[Sexual behavior patterns in old age].

Existing studies on sexual behavior of the aged show earnest deficiencies: false sampling, insufficient interviewing instruments and little interest in theory development. As a consequence all results must be taken as preliminary: most elderly reduce their sexual activities and change from genital to tenderness behavior. Men and women experience sexuality differently. Those who live in institutions report of few sexual interest and complain of lacking privacy. Several theories are applied to sexual behavior of the aged: disuse, exchange, role, communication theories and the concept of developmental tasks. Some consequences for research, for the elderly, for the social environment, for sex education and for institutions are discussed.

Aged↗