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PubMed2001

Childhood sexual abuse, adolescent sexual coercion and sexually transmitted infection acquisition among homeless female adolescents.

OBJECTIVE: To examine the relationship between childhood experiences of sexual abuse, sexual coercion during adolescence, and the acquisition of sexually transmitted infections (STIs) in a population of homeless adolescents. METHOD: Homeless adolescent females (N = 216) from a northwestern United States city were recruited by street outreach workers for a longitudinal study of STI epidemiology. Baseline data on childhood abuse and recent history of sexual coercion were used to predict physiologically confirmed STI acquisition over the subsequent 6 months. RESULTS: About 38% of all girls reported a history of childhood sexual abuse (CSA). Girls with a history of CSA were more likely to report recent sexual coercion. In turn, sexual coercion in the last three months was significantly associated with a higher number of sexual partners (but not with a greater frequency of intercourse or with lower rates of condom use). Number of sexual partners significantly predicted the future acquisition of an STI within 6 months. CONCLUSIONS: Interventions to reduce risky sexual behaviors in homeless adolescent females may need to consider the impact of CSA, particularly on the number of sexual partners during adolescence. However, it also should be noted that engagement in intercourse often results from coercion and is not voluntary in this population.

Adolescent↗
PubMed1989

Transmission of HIV to heterosexual partners of infected men and women.

Future heterosexual spread of HIV will in part depend on the efficiency of transmission from men to women and from women to men. We studied seventy-eight female sexual partners of men infected with HIV and 18 male sexual partners of infected women. Participants were interviewed concerning sexual practices, use of contraception and other risk factors for HIV infection. Fifteen out of 78 (19.2%) female partners and one out of eighteen (5.5%) male partners were seropositive for HIV antibody. All couples had practised vaginal intercourse. Seropositive female partners did not differ significantly from seronegative partners with regard to length of relationship, number of acts of vaginal intercourse, other sexual practices, stage of clinical disease in the index case, or numbers of other sexual partners in the last five years. In two women, seroconversion was documented after one act of unprotected sexual intercourse. The majority of infected female partners (eight out of 15) had sexual relationships with men who were asymptomatic and did not practice anal intercourse. Biological factors such as variability in infectivity of the index case and susceptibility of the contact, as well as behavioural variables may be important in determining transmission.

Adolescent↗
PubMed2002

Ineffective use of condoms among young women in managed care.

Condoms must be used effectively in order to prevent pregnancy and the spread of HIV/STD. This study investigated two types of ineffective condom use, delayed condom use (initiated after penetration has occurred) and condom slippage and/or breakage. We estimated prevalence and identified predictors of ineffective condom use among young women at risk of STDs. The study used baseline survey data from a randomized trial of women 18-24 years old at two managed care sites; 779 participants who were recent condom users were included in this analysis. Forty-four per cent of the sample reported delayed condom use in the past three months and 19% reported condom slippage and/or breakage. In multivariate logistic regression, younger age, primary partner, lack of partner support, multiple recent sexual partners and using condoms for contraception were positively associated with delayed condom use. Correlates of condom slippage and/or breakage were non-white race/ethnicity and history of any STD. Greater frequency of condom use independently predicted both outcomes. Ineffective condom use was common in this sample of experienced condom users and predictors were different for each outcome. HIV/STD prevention interventions must address more specific aspects of condom use than have previously been their focus, especially when condom use is already high.

Adolescent↗
PubMed1988

Main routes of transmission of human immunodeficiency virus (HIV) infection in a family setting in Palermo, Italy.

A cross-sectional seroepidemiologic study was carried out on household contacts and sexual partners of human immunodeficiency virus (HIV) antibody-positive intravenous drug abusers in Palermo, Italy, in 1985 to evaluate factors that influenced HIV transmission. A total of 43 index cases, 36 spouses or heterosexual partners, 28 children, and 55 adult household members were enrolled. None of the household members without sexual contact, who had shared items and facilities and had interacted with the index cases, contracted HIV infection. However, six of 36 sexual partners had antibodies to HIV. It was observed that the risk of HIV infection was significantly associated with the frequency of sexual intercourse with the seropositive partner. Four children were also found to be infected: two had acquired immunodeficiency syndrome-related complex, and the other two were clinically and immunologically normal. Furthermore, one other child had evidence of passive transfer of maternal antibodies. The infection was confined to the younger children (ranging in age from eight months to three years). The data support a high rate of vertical transmission from mother to infant, an intermediate rate of transmission to sexual partners, and no transmission attributable to household contact.

AIDS-Related Complex↗
PubMed2004

Deconstructing the relationship between intimate partner violence and sexual HIV risk among drug-involved men and their female partners.

This study, based on data from a random sample of 322 men on methadone, examines whether traditional male gender role beliefs, male substance use, and couple drug-involvement lead to male psychological dominance, which in turn leads to perpetration of intimate partner violence (IPV) and sexual HIV risk behavior. Structural equation modeling indicated that male psychological dominance is directly associated with perpetrating both physical IPV and sexual HIV risk; however, physical IPV did not lead to sexual HIV risk as predicted originally. Stronger endorsement of traditional male gender role beliefs was associated with male psychological dominance. Couple drug-involvement was also directly associated with male psychological dominance as well as sexual HIV risk. Male substance use led to couple drug-involvement, but not to physical or sexual HIV risk as hypothesized. Study findings highlight the significance of couple drug-involvement and male psychological dominance as pathways leading to physical IPV and sexual HIV risk behavior. Implications for HIV prevention efforts targeting drug-involved men and their sexual partners are discussed.

Adult↗
PubMed1992

Effect of HIV antibody testing and AIDS education on communication about HIV risk and sexual behavior. A randomized, controlled trial in college students.

OBJECTIVE: To evaluate the effects of human immunodeficiency virus (HIV) antibody testing and education about HIV infection on communication about sexual risk behaviors for HIV transmission. DESIGN: Randomized, controlled trial with three arms. SETTING: University student health center. PATIENTS: Of 2196 heterosexual university students attending the student health clinic for medical care, 435 were interested in education about HIV and HIV testing and were randomly assigned to three groups. Follow-up at 6 months was done in 370 subjects (85%): 90 control subjects, 144 subjects who received education alone, and 136 subjects who received education plus HIV testing. MEASUREMENTS AND RESULTS: Subjects who received HIV testing plus education questioned sexual partners about their HIV status more than subjects receiving education alone or those in the control group (56%, 42%, and 41% of subjects, respectively; P = 0.01). No consistent differences among groups in the number of sexual partners or in the use of condoms were found at follow-up. CONCLUSIONS: Heterosexual university students who received education about HIV infection plus HIV testing had increased communication with sexual partners about the risk for HIV infection after 6 months. Further reduction in risk behaviors for HIV transmission may require additional interventions in this population.

AIDS Serodiagnosis↗
PubMed1993

History of circumcision, medical conditions, and sexual activity and risk of penile cancer.

BACKGROUND: Epidemiological evidence suggests lack of neonatal circumcision as the strongest risk factor for penile cancer, but the role of sexually transmitted diseases in the etiology of penile cancer has remained unclear. PURPOSE: To further clarify risk factors for penile cancer, we examined the role of circumcision, personal characteristics and habits (such as smoking), sexually transmitted diseases, past sexual activity, and medical conditions of the penis. METHODS: A population-based, case-control study was conducted in western Washington state and in the province of British Columbia. We interviewed 110 men with penile cancer diagnosed from January 1979 to July 1990 and 355 control subjects from the general population, frequency matched to case subjects on age and date of diagnosis. Tumor tissue from 67 case subjects was tested for human papillomavirus (HPV) DNA by polymerase chain reaction. Results of blood tests from 69 case subjects and 208 control subjects were available for study. STATISTICALLY SIGNIFICANT RESULTS: Relative to men circumcised at birth, the risk for penile cancer was 3.2 times greater among men who were never circumcised and 3.0 times greater among men who were circumcised after the neonatal period. For current smokers, the risk was 2.8 times that of men who never smoked. The risk among men reporting a history of genital warts was 5.9 times that of men reporting no such history. Of 67 tumors tested for HPV DNA, 49% were positive; the majority of these positive tumors (70%) were type 16, which has been associated with anogenital carcinoma. Relative risks (RRs) associated with a reported history of penile rash or penile tear were 9.4 and 3.9, respectively. Among men not circumcised at birth, RRs associated with presence of smegma and difficulty in retracting the foreskin were 2.1 and 3.5, respectively. Twenty-eight percent of case subjects, compared with only 10% of control subjects, reported 30 or more sexual partners, and men with HPV-positive tumors were more likely to report a greater number of sexual partners. CONCLUSIONS: These results suggest that the absence of neonatal circumcision and potential resulting complications are associated with penile cancer. Additionally, medical conditions of the penis, sexual activity, infection with HPV, and smoking may increase the risk for penile cancer. IMPLICATIONS: A larger study would allow examination of interrelationships of circumcision, infection with HPV, and smoking as risk factors.

Aged↗
PubMed1992

Prevalence of human papillomavirus infection in men. Comparison of the partners of infected and uninfected women.

Men were checked for the presence of genital human papillomavirus (HPV)-associated lesions. The evaluation included acetic acid-guided, high-magnification examination of the penis and scrotum employing a colposcope and biopsy confirmation of HPV-associated lesions in the genital area. The men were in a high-risk group if they were sexual partners (for at least six months) of women known to harbor genital condyloma. The men were in a low-risk group if they were sexual partners of women with no known genital condyloma. Seventy-eight of 113 men (69%) in the high-risk group had genital HPV-associated lesions, while 31% did not. Two of the 94 men (2%) in the low-risk group had genital HPV-associated lesions, while 98% did not. The differences were highly statistically significant (P less than .01). The male sexual partners of women with HPV infection had a significantly higher risk of harboring genital HPV infection as compared to partners of uninfected women.

Adolescent↗
PubMed1996

The lifetime occurrence of sexually transmitted diseases among a cohort aged 21.

AIMS: To determine the lifetime occurrence of sexually transmitted diseases (STDs) among a cohort aged 21. METHODS: Participants were interviewed at aged 21 as part of a multidisciplinary health and development study. Questions on STDs and sexual behaviour were presented by computer. RESULTS: Of the cohort members known to be alive, 92% responded. Among the sexually experienced 8.6% of the men and 17.3% of the women reported ever having had an STD. Genital warts and chlamydial infection were the commonest STDs among the men, and chlamydial infection, genital warts, and genital herpes among the women. General practice was the commonest place for treatment, and only a minority of people were treated at sexual health clinics. The risk of having an STD increased steeply with the lifetime number of sexual partners. CONCLUSIONS: STDs are common problems among young New Zealanders, especially women. The rate was as high as the US. Prevention should be directed at increasing the use of condoms, but education aimed at reducing the number of sexual partners and delaying the onset of sexual involvement should be considered seriously. A more coordinated approach to treatment is required to take into account the diversity of settings where STDs are treated. Surveillance of STDs needs to be extended, as currently the only data are from sexual health clinics.

Adult↗
PubMed2001

Factors associated with HIV testing: results from an Italian General Population Survey.

BACKGROUND: HIV testing, with appropriate counseling, can help prevent the spread of HIV infection. This study is the first national survey in Italy that examines factors associated with serotesting among Italian heterosexuals and is part of a European Concerted Action. METHODS: In 1998, a cross-sectional telephone survey was conducted on a random sample (n = 2,603) of the Italian population ages 18-49 years. Associations between HIV testing and risky sexual behaviors (multiple sexual partners in the past 5 years, intercourse with prostitutes, not always using condoms with a new sexual partner) and sociodemographic variables are examined separately for men and women using multiple logistic regression. RESULTS: The prevalence of having ever been tested for HIV, whether voluntarily or not, among heterosexual men and women is 27.0 and 32.8%, respectively. Voluntary testing is reported by 8.4% of heterosexual men and 6.1% of heterosexual women. Multivariate analysis shows that having multiple sexual partners significantly increases the odds of testing (Men: OR = 2.10; 95% CI: 1.3-3.4. Women: OR = 3.03; 95% CI: 1.7-5.4). Multiple logistic regression, controlling for risky behavior, shows also that persons ages 30-39 years have significantly higher probability of being tested than younger subjects (Men: OR = 3.30; 95% CI: 1.4-7.9. Women: OR = 2.61; 95% CI:1.1-6.4). Better educated women tend to have a higher probability of testing, but this increase is not significant at the 5% level. CONCLUSIONS: The prevalence of voluntary serotesting in Italy is lower than in other countries. Risky sexual behavior is associated with higher odds of testing; however, a high proportion of at-risk heterosexuals never sought testing. Particular attention should be dedicated to younger persons and to less educated women.

AIDS Serodiagnosis↗
PubMedDate not supplied

The Wheel Project. Women Helping to Empower and Enhance Lives.

The Women Helping to Empower and Enhance Lives (WHEEL) Project focused on female sexual partners of injection drug users (i.d.u.s). It was conducted in five sites, three within and two outside the continental United States. The study's two main intervention goals were to (a) reduce HIV-related sexual risk behaviors and (b) reduce HIV-related drug risk behaviors. The Project also featured needs assessment, planning, and staff training components. Baseline data were collected on 2,794 women, which made this the largest study of noninjecting female sexual partners of i.d.u.s in the United States. Six-month follow-up data were obtained on 1,953 women. The Wheel Project tested two interventions: an individual intervention and a group intervention. The study found significant reductions in drug use and risky sexual behaviors for the 6-month follow-up sample for both interventions. These changes were substantial and point to the viability of both interventions for this population of sexual partners of injection drug users.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Factors associated with HIV infection in adolescent females in Zimbabwe.

PURPOSE: To identify factors associated with human immunodeficiency virus (HIV) infection among adolescent females in Zimbabwe and appropriate prevention strategies for this vulnerable population. METHODS: A total of 1807 females aged 15-19 years completed a questionnaire and provided a blood sample for HIV testing as part of a nationally representative survey. Associations between HIV infection and factors operating at the individual, household, partner and community levels, as well as sexual behavior, were explored through bivariate and multivariate logistic regression analyses. Two multivariate models were fitted: the first model considered sexual risk behaviors and contextual variables, whereas the second model considered only contextual variables. RESULTS: Of 1807 adolescent females, 192 (10.6%) were HIV positive, and 41% of HIV-positive adolescent females reported no sexual risk behaviors. In the first multivariate model, the risk associated with number of lifetime sexual partners was increased for 1 partner (odds ratio [OR] = 2.4, 95% confidence interval [CI] = 1.57-3.6), 2 partners (OR = 4.4, 95% CI = 2.22-8.55), and 3 or more partners (OR = 6.3, 95% CI = 2.56-15.7) as compared with having 0 partners. Believing that people with HIV have many sexual partners (OR = 1.71, 95% CI = 1.14-2.57) and that the man should take the initiative to have sex (OR = 1.55, 95% CI = 1.03-2.32) were also risk factors. In the second model, increased risk was associated with having ever married or lived with a man (OR = 1.99, 95% CI = 1.18-3.35) as well as the attitudes above. Decreased risk of HIV infection was associated with having a job (OR = .39, 95% CI = .18-.88), main activity in past 12 months was as a student (OR = .39, 95% CI = .19-.80), participation in school-based lectures on sexual health (OR = .49, 95% CI = .27-.87), and perceiving that AIDS is a somewhat serious problem in the community (OR = .55, 95% CI = .33-.92). CONCLUSIONS: Adolescent females in Zimbabwe who are married, not attending school and/or are unemployed, are at heightened risk for HIV infection. Interventions that improve their educational and employment opportunities, strengthen school-based prevention services, foster more equitable gender attitudes, and make marriage safer by, for example, promoting knowledge of partners' serostatus before marriage, may reduce their risk. Future research priorities are proposed.

Adolescent↗
PubMed1996

Risk factors for hepatitis B virus infection among heterosexuals attending a sexually transmitted diseases clinic in Italy: role of genital ulcerative diseases.

The seroprevalence and risk factors for hepatitis B virus (HBV) infection were determined among 1,497 heterosexuals with no history of intravenous drug use (median age 32, range 15-78) treated at a sexually transmitted disease clinic in Rome. A total of 329 (22.0%) had antibodies to HBV core antigen (anti-HBc), a rate nearly four times as high as the 5.8% found recently in a national sample of young male adults, ages 18-26 years. Multiple logistic regression analysis showed that the risk of anti-HBc positivity was independently associated with male sex, increasing age, lower level of education, three or more sexual partners in the previous year, and positive syphilis serology. Lack of condom use, history of nonulcerative sexually transmitted diseases, and genital herpes were not associated with anti-HBc positivity. These findings confirm that heterosexual exposure plays an important role in the spread of HBV infection. Furthermore, these data indicate that individuals with more than two sexual partners a year and those with positive syphilis serology should be immunised against HBV.

Adolescent↗
PubMedDate not supplied

Characteristics of women by smoking status in the San Francisco Bay Area.

To better understand why smokers are more likely to develop cervical cancer than nonsmokers, we investigated laboratory and demographic differences between the two groups. Women between the ages of 18 and 49 who attended eleven community clinics in the San Francisco Bay Area were studied to investigate differences between smokers and nonsmokers. The 332 smokers and 365 nonsmokers were queried about smoking habits, sexual and reproductive history, and recent diet. Cervical mucus specimens were cultured for yeast, lactobacillus, and other microorganisms. Results showed that white Hispanic women were less likely to smoke than white non-Hispanic women. Smokers, when compared to nonsmokers, consumed larger quantities of coffee, soft drinks, liquor, and beer in the 24 h prior to the interview. Women who smoked were more likely than those who did not smoke to have had first sexual intercourse before age 16, had a greater number of lifetime sexual partners, and were more likely than nonsmokers to have been pregnant. After controlling for number of sexual partners, smokers reported a history of chlamydia, gonorrhea, and/or pelvic inflammatory disease more often than did nonsmokers, and cervical mucus of smokers was more likely than that from nonsmokers to contain greater than 8500 microorganisms/ml.

Adolescent↗
PubMed1984

Chancroidal ulcers that are not chancroid. Cause and epidemiology.

Hemophilus ducreyi was isolated from the ulcer of one of 33 patients in whom chancroid had been diagnosed clinically. Herpes simplex virus was isolated from 16 of these patients. A presumptive diagnosis of chancroid was made in one of three sexual partners of the only index patient with culture-proved chancroid. No chancroidal lesions were found in any of 39 sexual partners of the other 32 index patients. Genital cultures for herpes simplex virus were positive from four of 14 sexual partners of index patients with genital herpes simplex infection. The differential diagnosis of chancroidal genital ulcers is facilitated by herpes simplex virus cultures and a new selective H ducreyi culture medium.

Chancroid↗
PubMed2001

An outbreak of hepatitis A among young men associated with having sex in public venues.

An increase in hepatitis A virus (HAV) infection was noted among young men in the former Thames regions during 1997. A retrospective case-control study, using a standardised questionnaire at interview, was conducted in the area most affected (London and East Sussex) to investigate the hypothesis that this increase was mainly among homosexual men and to establish the risk factors associated with transmission. Forty-eight cases and 161 controls completed questionnaires. Forty-one cases (85%) described their sexuality as homosexual (p < 0.0001). Cases were more likely than controls to have eaten shellfish (Odds Ratio (OR) 2.4; 95% Confidence Interval (CI) 1.16, 5.04) during the two months before onset of illness. Cases had more sexual partners (p = 0.015), and more casual sexual partners (p = 0.007) than controls. Cases were more likely to have had sex in a gay sauna (OR 3.5; 95% CI 1.53, 8.30), or in a gay club, pub or disco (OR 2.9; 95 CI 1.29, 6.63) than controls. After adjusting for confounding factors, cases were more likely to have eaten shellfish (adjusted [adj] OR 3.0; 95% CI 1.33, 6.59) and to have had sex in a gay sauna (adj OR 3.9; 95% CI 1.42, 10.59). Public health messages need to inform homosexual men about recognised risk factors such as eating shellfish and travel abroad to endemic areas, as well as sexual risks. Homosexual men can benefit from hepatitis A vaccine. We would suggest that in an outbreak situation men who have multiple anonymous partners and have sex in public venues should be targeted as a priority for health education and immunisation.

Adolescent↗
PubMed1988

Human immunodeficiency virus infection, hepatitis B virus infection, and sexual behaviour of women attending a genitourinary medicine clinic.

During the six months immediately after a public information campaign about the acquired immune deficiency syndrome 1115 women who attended a genitourinary medicine clinic in west London were tested for antibodies to the human immunodeficiency virus (HIV). Three women (0.27%) were positive, and all three were regular sexual partners of men with high risk lifestyles--two intravenous drug users and one bisexual. A consecutive series of 647 women from the cohort was tested for antibodies for hepatitis B core antigen: 27 were positive, of whom six had been born in the United Kingdom and were not known to have been at risk. The two women who were seropositive for HIV who completed a questionnaire on their sexual behaviour before they were tested reported both anal and oral receipt of semen and were in the upper fifth percentile for lifetime sexual partners. More than half (53%) of 424 women who reported that they had non-regular sexual partners never used a condom. It is concluded that heterosexual women in London are at a low risk of becoming infected with HIV.

Acquired Immunodeficiency Syndrome↗
PubMed1992

[Epidemiological study on mycoplasmas colonization and infection in the female genital tract].

1309 cervical or vaginal specimens from females in various physiological periods and women with multiple sexual partners were examined for Ureaplasma urealyticum and Mycoplasma hominis from Feb. to May, 1990. Significantly, low carriage rates of U.urealyticum were found in the neonatal (28.57%), puerperium (26.51%) and postmenopause (30.00%) groups, whereas, pregnant women (more than 36 weeks) showed the highest incidence (73.20%). The recovery rate of U. urealyticum in girls with no history of sexual contact was significantly lower (38.30%) than that in married nonpregnant women (48.98%) and women with multiple sexual partners (71.74%). The incidence rate of the genital mycoplasmas was significantly affected by the type of contraception, the number of sexual partners, socioeconomic states, degree of cultural traditional, as well as hormonal status. Possible modes of transmission of genital mycoplasmas were also discussed.

Adolescent↗