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Heterosexual transmission of HIV in Haiti.

BACKGROUND: Despite the importance of human immunodeficiency virus (HIV) transmission through heterosexual contact, the incidence of HIV infection in heterosexual cohorts has not been well studied, particularly in the developing world. OBJECTIVE: To 1) determine the incidence of HIV infection in discordant heterosexual couples (couples in which one partner had HIV infection and the other did not) in Haiti and 2) assess risk factors for and methods of preventing HIV infection. DESIGN: Prospective study. SETTING: National Institute for Laboratory Research, Portau-Prince, Haiti. PARTICIPANTS: 475 HIV-infected patients and their noninfected regular sex partners. MEASUREMENTS: Patients and their partners were evaluated at 3- to 6-month intervals for HIV infection, sexually transmitted diseases, and sexual practices. The efficacy of counseling and provision of free condoms was also evaluated. RESULTS: Among the 177 couples who remained sexually active during the prospective study period, 20 seroconversions to HIV positivity occurred, for an incidence rate of 5.4 per 100 person-years (95% CI, 5.16 to 5.64 per 100 person-years). Thirty-eight couples (21.5%) discontinued sexual activity during the study. Only 1 seroconversion occurred among the 42 sexually active couples (23.7% of the 177 sexually active couples) who always used condoms. In contrast, the incidence in sexually active couples who infrequently used or did not use condoms was 6.8 per 100 person-years (CI, 6.49 to 7.14 per 100 person-years). Transmission of HIV was associated with genital ulcer disease, syphilis, and vaginal or penile discharge in the HIV-negative partner and with syphilis in the HIV-infected partner. CONCLUSION: Counseling and the provision of free condoms contributed to the institution of safe sex practices or abstinence in 45% of discordant heterosexual couples. However, 55% of couples reported that they continued to have unprotected sex, resulting in an incidence of HIV infection of 6.8 per 100 person-years.

Condoms↗

Sexual risk behavior among female army recruits.

This tri-service study was an initial effort to develop an explanatory model of sexual risk behavior among young women in the military. Demographic, cognitive (problem-solving), and affective factors (self-esteem) were evaluated in relation to sexual risk behaviors (more than one sex partner, a new partner within 6 months, and not using a condom) among female Army recruits (n = 105) training at a large southeastern Army post. Participants demonstrated high self-esteem and good problem-solving abilities, yet more than two-thirds were at risk for STDs based on sexual risk behaviors. The relationship between self-esteem (affective) and problem-solving (cognitive) (r = 0.67, p = 0.0001) suggested that an emotional rather than a cognitive response may have influenced sexual risk behaviors. No relationships were observed between problem-solving or self-esteem and sexual risk behaviors. Implications for research and clinical practice are delineated.

Adolescent↗

Partner influences and gender-related factors associated with noncondom use among young adult African American women.

We examined the partner influences and gender-related correlates of noncondom use among African American women. The prevalence of noncondom use was 45.3%. Women whose sexual partners were noncondom users were four times more likely to believe that asking their partner to use a condom implied he was unfaithful, three times as likely to have a partner who resisted using condoms, three times more likely to receive AFDC, twice as likely to be sexually nonassertive, three times more likely to believe that it was not difficult to find an "eligible" African American man, and three times as likely to have had one sexual partner. HIV prevention tailored towards African American women should address these partner influences and gender-related factors.

Adult↗

Underlying reasons for sexual conduct and condom use among expatriates posted in AIDS endemic areas.

Among people who work abroad, sexual activity and therefore the risk of HIV infection appear to be relatively high. Little is known about the factors that influence sexual conduct when staying abroad, separated from their usual social environment. This is why 55 expatriates who had been sexually active in AIDS endemic areas were selected for an in-depth interview from the original sample of 864 Dutch expatriates participating in a study on sexual behaviour and HIV infection. The social and cultural context in which the sexual contacts took place was addressed in these interviews. Qualitative analysis of the data led to the identification of four styles with regard to the meaning of and motivations for having sex abroad: 'the unprepared', 'the fanatical', 'the unaffected' and 'the slightly accessible'. These styles are described separately and attention is paid to the association of these styles with protection behavior.

Acquired Immunodeficiency Syndrome↗

Factors associated with sexually transmitted diseases among prostitutes in Singapore.

From June to December 1990, 806 prostitutes registered with the STD programme in Singapore for regular screening for sexually transmitted diseases (STD) were investigated for factors associated with STD incidence in the preceding year. The majority were foreigners (92.7% Malaysians and 3.1% Thais). Anal sex (0.4%) and intravenous drug use (0.9%) were rare. The overall STD incidence rate was 47.7 per 100. None was human immunodeficiency virus (HIV) positive. The crude and age-adjusted risk of STD was found to increase significantly with client load. An inverse relationship between condom use and STD risk was also observed. Mean condom use among clients was reported as 56.1% for spontaneous use and estimated as 75.4% following negotiation for condom use by prostitutes. Although the prostitutes negotiated for condom use with majority of the clients (85.5%) who did not use condoms spontaneously, they were successful with only about half of them (54.4%). Health education should be targeted at clients on the protective effects of condom use and at the prostitutes on skills in negotiating condom use.

Adult↗

Casual sex, extramarital sex, condom use and alcohol intake among heterosexual patients attending an STD clinic in Norway.

A study excluding homosexuals was performed to study casual sex, extramarital sex, the use of a condom with a casual sexual partner and the combination of alcohol intake and casual sex among patients attending a clinic for sexually transmitted diseases (STDs). Heterosexual patients (467) received a questionnaire, and 458 were included. Men reported more (94%) casual sexual partners than did women (76%). According to a multiple logistic regression analysis a condom was used significantly less frequently in "old" respondents, those having a permanent sexual partner, those having low education, those infected with STDs (earlier STDs), those who had had more than 4 sexual partners over the last year, and those combining alcohol intake and casual sex. Intravenous drug users/prostitutes used a condom more often than did men with paid sex and "other heterosexuals". To have an effect on STD patients, innovative forms of health education may be necessary, and greater emphasis should be placed on more informal means of information, including interactive health education and communication strategies to promote positive attitudes regarding condom use.

Adolescent↗

Determinants of intentions of Junior High School students to become sexually active and use condoms: implications for reduction and prevention of AIDS risk.

The purpose of this study was to examine factors associated with young adolescents' increased risk for AIDS. A multiethnic sample of 303 seventh-grade students in three schools in the greater New York area completed questionnaires assessing their basic demographic characteristics (gender and ethnicity), AIDS knowledge, substance use (cigarette smoking, alcohol use), and decision-making skills. AIDS knowledge, substance use, decision-making skills, gender, and ethnicity predicted intentions to engage in sexual behavior in the future. Relevant knowledge of AIDS was associated with lower intentions to engage in sexual behavior in the future. More frequent substance use, less frequent use of decision-making skills, and being male increased intentions to engage in sexual behavior in the future. Our findings are discussed in terms of their implications for education and prevention of adolescent sexual activity and AIDS-risk reduction.

Acquired Immunodeficiency Syndrome↗

Can condom users likely to experience condom failure be identified?

A study based on a convenience sample of 177 couples who each used 11 condoms found that 103 condoms (5.3%) broke before or during intercourse and 67 condoms (3.5%) slipped off during sex. Couples who had not used a condom in the past year were almost twice as likely to experience condom failure as were couples who had used at least one during that period (p < .001). Of the couples who had used a condom in the previous year, the failure rate among those who reported at least one condom break during that period was more than twice the failure rate among those who reported no breaks (p < .001). Among couples who had used condoms in the past year without breaking any, those who did not live with their partner and those who had a high school education or less were at increased risk of condom failure (adjusted odds ratios of 3.2 and 2.7, respectively).

Adolescent↗

The association between substance use, condom use and sexual risk among low-income women.

Substance use is frequently assumed to be associated with higher levels of sexual risk-taking and lower levels of condom use. An analysis of 668 black, Hispanic and white low-income women at public health and public assistance facilities in Miami show that 19% engaged in risky sexual behavior over the preceding six months, 24% in substance use and 31% in condom use. Overall, substance users are nearly four and one-half times more likely to take sexual risks than nonusers, but are about half as likely to have relied on condoms. When the probability of condom use is considered in the context of both substance use and sexual risk, substance users who take sexual risks appear just as likely to rely on condoms as are nonusers who take sexual risks and those who do not (odds of 0.43-0.49). However, substance users who do not take sexual risks are much less likely to use condoms (odds of 0.15). This pattern holds among black, Hispanic and white women, and suggests that perceptions of risk and the risks that partners bring to sexual encounters may be more important determinants of condom use than substance use per se.

Adolescent↗

The efficacy of the health belief model for predicting condom usage and risky sexual practices in university students.

This investigation examined the ability of the health belief model (HBM) to predict condom usage and risky sexual practices in 122 white heterosexual college students (ages 17 to 33 years). The HBM did not significantly explain condom usage in the 58 men and 64 women surveyed; rather it partially explained the variance in sexual risk behaviors. Results were not consistent for men and women. The HBM components significantly explained 18% of the variance in multiple sexual partnerships in men and 22% of the variance in this behavior in women. The HBM constructs also explained 9% of the variance in the likelihood of women being intoxicated or high during sex and 18% of the variance in the number of sexual risk behaviors endorsed by women. These findings suggest that the HBM has differential and limited utility for predicting sexual practices in university students. Future research is needed to examine more comprehensive models of behavior change.

Acquired Immunodeficiency Syndrome↗

A comparison of the performance of male and female CBD distributors in Peru.

This report presents the results of an operations research project to increase male involvement in family planning in Peru. Two community-based distribution (CBD) programs, PROFAMILIA of Lima and CENPROF of Trujillo, Peru, recruited male contraceptive distributors and compared their performance to that of female distributors recruited at the same time. Both programs found it harder to recruit men than women as distributors. Program supervisors, who were women, were less comfortable with men than with other women, even though there were no differences in distributor compliance with program norms. Male distributors were more likely to serve male clients and sell male methods (condoms), while female distributors were more likely to serve female clients and sell female methods (pills). Men sold as much or more total couple-years of protection than did women, and they recruited as many or more new acceptors. Gender was found to exert an impact on method mix independent of other distributor characteristics, such as age, education, marital status, and number of living children. The study suggests that family planning programs can influence method mix and client characteristics by recruiting men as CBD distributors.

Contraceptive Devices, Male↗

Intra-couple communication dynamics of HIV risk behavior among injecting drug users and their sexual partners in Northern Vietnam.

This paper elucidates the social context of HIV risk behavior and intra-couple risk communication among injecting drug users (IDUs) and their main sex partner. Data on shared injection equipment, unprotected sex with multiple partners, unprotected sex with a main partner and couples' dynamics and risk communication were gathered through separate in-depth interviews with 11 active male IDUs and 11 of their primary female sex partners in Northern Vietnam. The majority of IDUs' sex partners does not inject drugs and is monogamous. In contrast, most IDUs reported a wide range of risky practices including needle sharing and unprotected sex with multiple, often concurrent, sex partners. Men rarely used condoms with primary partners. Many IDUs worried about their HIV-status, but none disclosed their injecting or sexual practices to their sex partners, leaving their partners unaware of their HIV risk. Among women who worried about HIV/AIDS, the vast majority was unable to influence their partner's needle sharing or extramarital affairs and most would not initiate condom use because they feared their partner's reaction. Couple-based interventions to facilitate risk communication combined with programs to promote condom use among male IDUs, may help to reduce HIV transmission from IDUs to their primary partners.

Adult↗

Psychological distress, drug and alcohol use as correlates of condom use in HIV-serodiscordant heterosexual couples.

OBJECTIVE: To investigate the relationship between psychological distress, alcohol, drug and condom use in HIV-serodiscordant heterosexual couples. METHODS: Structured interviews were conducted to collect demographic information, detailed data on psychological distress, drug and alcohol use and sexual behavior. RESULTS: Analyses were based on 106 pairs of sexually active discordant couples. Significant differences among heterosexual condom users and non-users varied according to gender and HIV serostatus. Affect domains of interpersonal sensitivity and hostility were significant, as were the variables of regular drug or alcohol use and combining sex with drugs or alcohol. Employment was strongly associated with condom use in HIV-negative women whose regular sexual partners were HIV-positive men. CONCLUSION: The risk of vaginal sex without condoms in HIV-serodiscordant heterosexual couples may be reduced by specific psychological counseling and attention to drug and alcohol use as risk factors. Further research on the effect of employment of HIV-negative women is required.

Adolescent↗

Correlates of HIV risk and preventive behaviors in Armenian female sex workers.

This study describes HIV risk and preventive behaviors and their correlates among Armenian female commercial sex workers (CSWs) as a prerequisite to developing gender and culturally appropriate interventions. Ninety-eight CSWs from three Armenian cities were interviewed using a structured questionnaire. Quantitative findings were further elaborated by focus group discussions (N = 25) and key informant interviews (N = 8). Inconsistent condom use with all types of sexual partners was reported, as were condom tear/slippage, alcohol and drug use, and sex with drug injecting clients. Prominent misconceptions regarding HIV transmission, prevention and disease manifestations were noted. Correlates of condom use intentions included history of substance use, attitudes regarding condom use, risk perception, and comfort negotiating condom use. Intentions to use condoms were strongly associated with recent frequency of condom use. Understanding the relationship between condom use and its determinants is critical in the design and implementation of effective prevention programs tailored for Armenian CSWs.

Adolescent↗