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PubMed1990

Abnormal Papanicolaou smear. A population-based study of risk factors in Greenlandic and Danish women.

Possible risk factors for abnormal Papanicolaou smear were investigated in a population-based cross-sectional study. From Nuuk (Greenland) and Nykøbing Falster (Denmark), random samples of 800 women aged 20-39 years were drawn. Totals of 586 and 661 women were included in Greenland and Denmark, respectively. All women went through a personal interview, and had a gynecologic examination including a PAP smear and cervical swab for HPV analysis. A blood sample was taken for analysis of HSV type specific antibodies. Multiple sexual partners was the most important risk factor for abnormal cervical cytology (OR = 4.2). An infectious etiology was also indirectly supported by a relatively protective effect of barrier contraceptive methods (OR = 0.6). The simultaneous finding of HPV 16/18 as a significant risk factor (OR = 2.4) cannot be taken uncritically as support for a causal effect of this HPV type, since such a relationship between cytological changes of the cervix and HPV infection could also emerge if the positive PAP smear was not just a measure of intra-epithelial neoplasia but also an expression of the infection itself on the cervix.

Adult↗
PubMed1998

Objective markers of condom failure.

BACKGROUND: Studies of condom efficacy rely on self-reported behavior. Objective markers of exposure to semen may provide a more valid assessment of condom failure and failure to use condoms. GOALS OF THIS STUDY: To compare three semen biomarkers: acid phosphatase (AP) activity, prostate specific antigen (PSA), and the human seminal plasma antigen (MHS-5). STUDY DESIGN: Twenty women were intravaginally inoculated with six measured, increasingly larger amounts of their partners' semen. Vaginal fluid was collected by the participant using swabs and tested. RESULTS: Background levels of PSA were low (0.00-1.25 ng/ml), background levels of AP were variable (0-350 U/l), and all preinoculation samples were negative for MHS-5. All postinoculation samples were positive for PSA, 64 of 117 (55%) for AP, and 14 of 120 (12%) for MHS-5. CONCLUSION: The PSA immunoassay was the best semen biomarker under these sampling and testing conditions.

Acid Phosphatase↗
PubMed1998

Influence of HIV positive status on sexual behavior among males.

OBJECTIVE: To compare HIV seronegative (HIV-) and HIV seropositive (HIV+) males in terms of sexual behavior with female and male partners of different types. METHOD: Cross-sectional study. From August 1994 to February 1995, a sample of 236 respondents (150 HIV- and 86 HIV+) recruited from public health centers in the State of S. Paulo (Brazil), answered a questionnaire, including questions on demographic aspects, HIV and AIDS related knowledge, sexual orientation, use of alcohol and other drugs, sexual behavior with regular and casual female and male partners, and perceived risk of HIV infection. Sexual behavior with regular and casual female and male partners within the previous three months, was investigated. RESULTS: A lower proportion of HIV+ engaged in sexual contact with regular female partners (p < .01) and in vaginal intercourse with this type of partner (p < .01). A lower proportion of HIV+ engaged in overall sexual activity (p < .001) and reported lower frequency of penetrative sexual practices (p < .05). A high level of condom use with female and male partners was identified with no significant differences being found between the two serostatus groups. Some risky sexual behavior was identified, however, especially with regular partners, suggesting that some men were continuing to practice unsafe sex. CONCLUSIONS: The high level of condom use identified suggests that safer sex advice has been taken up. Condom use was not universal, however, and some men continue to place themselves at risk, especially with regular partners. Prevention programs should strive not only to encourage HIV- to practice safer sex, but also to encourage HIV+ to do so in order to prevent further transmission of the virus.

Acquired Immunodeficiency Syndrome↗
PubMed1991

AIDS in Africa.

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Acquired Immunodeficiency Syndrome↗
PubMed1998

Factors associated with changes in sex behaviour among drug users in Puerto Rico.

Despite available strategies to prevent sex risk behaviours in Puerto Rico, heterosexual transmission of HIV continues to increase. Since 1990, heterosexual contact has been the fastest growing infection risk category among the island's general population, and the primary transmission route for women and children. To understand change in sex risk behaviours and factors related to change, 911 drug injectors and 359 crack smokers were recruited from the San Juan metropolitan area following a stratified cluster design. This study comprised a total of 1,004 (79.1%) drug users who were assessed at follow-up. Abstinence from sex behaviour increased from 54.6% to 61.1% (p < 0.01), use of condoms during vaginal sex also increased from 26.4% to 36.9% (p < 0.01). In multivariate analysis, significant predictors of abstinence were gender, injection drug use, HIV seropositivity and not having a steady partner. Predictors of using condoms during vaginal sex were HIV seropositivity, STD diagnosis and participation in an HIV preventive programme. These findings indicate that additional HIV preventive efforts are needed to reduce sex risk behaviours among drug users who have a steady sex partner, as well as among drug users who are HIV-negative.

Adult↗
PubMed2003

Delivering equitable care: comparing preventive services in Manitoba.

OBJECTIVES: This study examined preventive care delivered in Manitoba during the 1990s by 3 different methods -childhood immunizations (by physicians and public health nurses under a government program), screening mammography (through a government program introduced in 1995), and cervical cancer screening (no program). METHODS: Longitudinal administrative data, an immunization monitoring system, and Canadian census databases were used. RESULTS: Cervical cancer screening rates remained static and showed strong socioeconomic differences; childhood immunization rates remained high with small socioeconomic gradients. The introduction of the Manitoba Breast Screening Program resulted in rising rates of screening and vanishing socioeconomic gradients. CONCLUSIONS: Manitoba government programs in childhood immunization and screening mammography actively helped the provision of preventive care. Organized programs that target population groups, recognize barriers to access, and facilitate self-evaluation are critical for equitable delivery.

Adult↗
PubMed2002

Current status of prophylactic use of antimicrobial agents for cesarean section in Thailand.

AIMS: To evaluate actual practices and physician reasons for variation in prophylactic use of antimicrobial agents for cesarean section (CS). METHODS: The study combined a survey of 2726 medical records and an interview of 50 practicing physicians at the obstetric departments of a university, a regional and a general hospital in Songkhla Province, Southern Thailand. RESULTS: Practices that were consistent with systematic reviews were use in 94%, prescription after cord clamping in 86%, and choosing ampicillin in 91%, because physicians believed in the advantages of these practices. Indications for prophylactic use ranged from routine use for all cases to selective use for indicated cases such as ruptured membranes, vaginal examinations, labor, maternal obesity, or unplanned CS. Single-dose practice was varied greatly across hospitals, from 9% to 84%. The reasons given by physicians for a multiple-dose regimen were personal experience in this regimen and belief in its superiority under their local conditions. This practice was less common where the hospital had practice recommendations. CONCLUSIONS: Not all evidence-based knowledge is adopted in practice. The prophylactic use of antimicrobial agents for CS varies among physicians. Past experience and personal beliefs in the limitation of research generalizability are the barriers to such adoption.

Adult↗
PubMed1994

Knowledge, attitudes and activities of male clients of female sex workers: risk factors for HIV.

AIMS: To examine HIV related knowledge, attitudes and practices amongst male clients of female sex workers in New Zealand. METHODS: A sample of 30 clients were contacted in the commercial sex areas of the three main urban centres. A brief structured interview was undertaken by a fully trained interviewer who was herself a sex worker. RESULTS: The respondents were aged between 20 and 60 and came from a range of occupations. A third of them were married. Most visited sex workers quite frequently and vaginal sex was the most common service purchased. Condoms were consistently used with sex workers whereas they were less commonly used with casual partners and almost never used with regular partners. Clients rarely carried condoms and took a passive role in their use with sex workers. Knowledge about HIV transmission was high but perception of HIV risk or fear of infection were low. Many of the respondents travelled both within and outside New Zealand and most used commercial sex services on their travels. CONCLUSIONS: The findings suggest that clients may be a source of HIV infection of both sex workers and their other sex partners. More detailed research is necessary to explore clients' perceptions of HIV risk and the barriers to their wider use of condoms.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[The nonoxynol content in condoms is insufficient to inhibit the human immunodeficiency virus (HIV)].

The seven makes of condom which are marketed in Denmark were examined for the nonoxynol content with the object of assessing whether the content of nonoxynol in the condoms is sufficient to present HIV spread in connection with use of the condom and assessed in relation to the defects in effectivity (tearing, holes, overflow of semen, sliding off). Compared with the declared content of nonoxynol of 40 mg (100%) per condom, the following nonoxynol quantities could be demonstrated by methanol/water extraction and subsequent high-performance liquid chromatography: One make of condom contained 65%, two 50-55% and four 25-33%. The nonoxynol content was found to be evenly distributed between the outer and inner surface of the condoms. With a theoretical distribution volume of 6 ml (tearing during vaginal coitus), it was found that three of the makes of condoms examined did not achieve the HIV-inhibiting nonoxynol concentration of 0.05%, by means of measuring the quantity of nonoxynol on the distal 5 cm of the condoms. In anal sex, the distribution volume is greater resulting in lower nonoxynol concentrations and thus increased risk for HIV infection. It is concluded that the nonoxynol content in the condoms marketed in Denmark should be increased in order to inactivate HIV in case of condom failure.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Attitude of women towards early cancer detection and estimation of the compliance to a screening program for cervix and breast cancer.

Before the start of a feasibility study for cervical and breast cancer screening in two towns (Genoa and Rome) in Italy, a random sample (N = 349) of the target population was interviewed with the aim of evaluating (i) the degree of knowledge as to the purpose of the screening tests; (ii) the attitude towards early detection of these cancers; and (iii) the potential compliance to the program. Pap test: 48.7% of women were correctly informed about the object of the test; information was associated with the degree of education (p < 0.0001). Periodic Pap test was reported by 77.9% of women: the proportion was higher among younger (p = 0.013) and married women (p = 0.001). A 1-year interval between two tests was more frequently reported by younger women (p < 0.001). Estimated participation in the cervical cancer screening program was 63.3%. Increasing age (OR = 0.78; CI = 0.6-1.0), the married status (OR = 0.39; CI = 0.18-0.83) and lack of knowledge of the object of the test (OR = 0.47; CI = 0.25-0.87) hindered participation in the program. Mammography: 53.3% of women reported that it is a method used for early detection of breast cancer. Well-educated women were more likely to be correctly informed (p < 0.0001). Previous mammography was reported by 49.3% of women aged 50 to 69 years who never experienced breast cancer symptoms; married women more frequently reported having had the test (p = 0.02). Estimated participation in the breast cancer screening program was 59%. Women aged 60 years and over were less prone to participate (OR = 0.44; CI = 0.22-0.89). Increasing age was the most relevant barrier to participation in screening programs, and strong efforts should be made to involve older women, due to their greater chance of getting cancer.

Adult↗
PubMed1994

Barrier methods of contraception, spermicides, and sexually transmitted diseases: a review.

OBJECTIVE: To understand whether barrier methods of contraception (BMC) and/or spermicides lower the risk of acquiring sexually transmitted disease (STD) and to quantify the protection. DESIGN: Review of published experimental studies, in vitro and in vivo evidence on the issue. SUBJECTS: We reviewed 22 papers that examined the impermeability of BMC in vitro against STD agents or the effect of spermicides, and 60 papers reporting results of epidemiological studies on the risk of STD in users of BMC. RESULTS: There was in vitro evidence that both BMC and spermicides were effective against most sexually transmissible agents. Doubts remain on the effectiveness of BMC and spermicides in normal conditions of use, particularly against human papilloma virus. Natural membrane condoms are not impermeable and pores are seen by electron microscopy. Epidemiological studies show a consistent reduction in the risk for use of condoms against gonococcal (most studies giving relative risk, RR, estimates around 0.4 to 0.6) and HIV infection (RRs between 0.3 and 0.6 in most studies). Spermicides protect women against gonorrhoea and trichomoniasis; their role against other STDs is less clear and there is some indication of an irritative effect on the vaginal mucosa that is likely to be dose-dependent. CONCLUSIONS: A large amount of evidence indicates that BMC reduce the risk of gonorrhoea and HIV transmission, but the results are--at least in quantitative terms--less consistent for other diseases. Implications for individual choices and public health approaches should relate to frequency of exposure and severity of the disease too.

Cohort Studies↗
PubMed2004

Examination of population-wide trends in barriers to cancer screening from a diffusion of innovation perspective (1987-2000).

BACKGROUND: Barriers to cancer screening may change over time as screening becomes more widespread. METHODS: Using 1987, 1992, and 2000 National Health Interview Survey data, we examined population-wide trends in barriers to Pap, mammography, and colorectal screening (n =66,452). RESULTS: Lack of awareness was the most common barrier for all screening tests; it decreased by 13.5 percentage points for mammography and by 4.6 percentage points for colorectal screening, but increased by 3.0 percentage points for Pap test from 1987 to 2000. Decreases in not recommended by a doctor were observed for mammography (from 20.5% to 3.7%) and colorectal screening (from 22.3% to 14.2%). Examination of trends in barriers among sociodemographic and health care access subgroups revealed disparities for each screening test. CONCLUSIONS: Although population-wide progress has been made in reducing barriers to screening, lack of awareness, and not recommended by a doctor remain important barriers, especially among traditionally underserved populations.

Adult↗
PubMed1998

Does additional lubrication affect condom slippage and breakage?

The risk of condom slippage (1.94%) and breakage (0.89%) among 3607 condoms was analysed with respect to the use of additional lubricant. Whether or not lubricant was used, the site at which it was applied and the type of lubricant used were all found to vary significantly with the type of sexual act(s) for which the condoms were used. Little evidence was found for differing effects of type of additional lubricant (water-based, saliva or other) or site of lubricant use (on penis/inside condom, on condom, in vagina/anus). The use of lubricant more than doubles the risk of slippage for vaginal sex. While anal sex is associated with much higher risks of slippage the use of lubricant for this practice actually reduces the risk of slippage to that similar for vaginal sex where lubricant is used. No significant effect of additional lubricant on condom breakage was observed. It is recommended that education messages concerning the use of additional lubricant may need to change to take into account the varied nature of lubricant use practices and the differential effects of lubricant with respect to sexual practices. Specifically, if the use of additional lubricant has little or no impact on condom breakage but increases condom slippage then encouraging its use may be counterproductive if condom users consider slippage to be a reason not to use condoms.

Adult↗
PubMed1999

Prostate-specific antigen in vaginal fluid as a biologic marker of condom failure.

Forty women participated in three clinic visits during which they were exposed to their partner's semen (10 microL, 100 microL, and 1 mL). At each visit they took vaginal fluid samples before exposure to their partner's semen, immediately after, and at 1, 24, and 48 h after exposure. PSA was measured with an enzyme-linked immunoassay. The mean PSA level for preexposure swabs ranged between 0.43 and 0.88 ng/mL. The mean PSA levels were 193 immediately after exposure to 10 microL, 472 after 100 microL, and 19,098 after 1 mL. The PSA levels declined within 1 h, and returned to background at 48 h. The findings confirm that our procedure is a sensitive and specific method for detecting recent semen exposure, and indicate that PSA levels depend on exposure intensity and time since exposure. Application of this method in condom efficacy studies provides objective evidence of condom failure that enhances the interpretation of self-report.

Adult↗
PubMedDate not supplied

College students' reasons for nonuse of condoms within dating relationships.

Two hundred ten heterosexual undergraduates in dating relationships were surveyed about reasons for not using condoms every time for vaginal and anal sex and for increasing or decreasing condom use during their relationships. Half of the respondents reported consistent condom use in the first month of their relationships, while only 34% reported consistent condom use in the past month. Subjective assessments of partner safety and the belief that sufficient measures were being taken to avoid pregnancy were important reasons for condom nonuse. Study results suggest that interventions should emphasize the importance of objectively assessing HIV/STD risk before reducing condom use within relationships. Interventions also need to provide additional information on the riskiness of heterosexual anal sex.

Adolescent↗
PubMed1993

Condom use with primary partners among injecting drug users in Bangkok, Thailand and New York City, United States.

OBJECTIVE: To determine factors associated with likelihood or failure to use condoms with primary sexual partners among injecting drug users (IDU) in two cities. DESIGN AND METHODS: Interviews were conducted with 601 IDU in Bangkok in 1989 and with 957 IDU in New York City in 1990-1991. Subjects were recruited from drug-use treatment programs and a research storefront. Informed consent was obtained and a World Health Organization standardized questionnaire about AIDS risk behaviors administered by a trained interviewer. RESULTS: A substantial minority (37%) of IDU in Bangkok and a majority (55%) of IDU in New York City reported penetrative intercourse (vaginal, anal or oral) with a primary partner in the 6 months before the interview. Of those reporting penetrative intercourse with a primary partner, only 12% in Bangkok and 20% in New York reported that they always used condoms. Parallel bivariate and multiple logistic regression analyses were conducted to distinguish between subjects who reported always using condoms and subjects who reported unsafe sexual activity with primary partners. The same two factor--knowing that one is HIV-seropositive and talking about AIDS with sexual partners--were most strongly associated with always using condoms with primary partners in both cities. CONCLUSIONS: Programs to prevent sexual transmission of HIV among IDU should provide voluntary and confidential/anonymous HIV counseling and testing, and should facilitate discussions of AIDS and sexual transmission of HIV between IDU and their sexual partners. That the same two factors were associated with always using condoms with primary partners among IDU in these two cities suggests that these factors may also be important in other groups at high risk for HIV.

Adult↗
PubMed2003

Cervical cancer and Pap smear screening in Botswana: knowledge and perceptions.

BACKGROUND: Cervical cancer is the most common cancer in Botswana. Little is known about women's use of Papanicolaou (Pap) cervical smear tests. AIM: The study is to explore knowledge and beliefs of 30 women about cervical cancer and Pap smear tests using the Health Belief Model. METHOD: Women were recruited from all income levels using network sampling. Data were collected using a demographic questionnaire and semi-structured interview guide. Data analysis included descriptive statistics for demographic data and content analysis for interview data. FINDINGS: Knowledge of cervical cancer and the Pap smear test was inadequate among women with low incomes. Pap smear utilization was also limited among low-income women. Of the 18 women who had at least one Pap smear test in their lifetime, eight (44%) had opportunistic testing as a result of having gynaecological symptoms. Twelve women (40%) had never had Pap smear tests. Major barriers to Pap smear screening included inadequate knowledge about Pap smear testing, providers' negative attitudes, and limited access to doctors. CONCLUSION: The study has implications for health education and health policy and for nurses' involvement in both.

Adult↗
PubMed1995

Cross-cultural comparison of US and Nigerian adolescents' HIV-related knowledge, attitudes, and risk behaviour: implications for risk reduction interventions.

Attitudes towards AIDS prevention, AIDS-related knowledge, and sexual behaviour of Nigerian adolescents and their African-American counterparts in two geographic regions of the United States were compared to assess cross-cultural similarities and differences between the adolescents. This study was conducted as the first in a programmatic sequence of activities leading toward the adaptation of a risk reduction intervention that was developed in the US for implementation with Nigerian youths. Subjects (n = 511) completed self-report measures of AIDS-related knowledge, attitudes towards condoms, attitudes towards AIDS prevention, sexual behaviour over the past two months, self- and response efficacy, and perceived vulnerability. Between-group comparisons revealed that US adolescents were more knowledgeable, held more favourable attitudes towards prevention and toward condoms, reported more sex partners, engaged in higher frequencies of unprotected vaginal intercourse, and became sexually active at later age than Nigerian adolescents. The findings are discussed with respect to their implications for translating risk reduction interventions developed in the US for African-American adolescents for later cross-cultural implementation with adolescents in developing countries where such risk reduction efforts are urgently needed.

Adolescent↗