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PubMed1999

Drug and alcohol consumption and sexual risk behaviour among young adults: results from a national survey.

To study the association of the consumption of alcohol and other psychoactive drugs with sexual risk behaviour for HIV infection, data from a representative sample of the Spanish population aged 18-39 years were analysed. A national household survey was carried out in 1996 using a combination of face-to-face interviews and self-administered questionnaires. The survey included 5253 subjects aged 18-39 years who provided information on alcohol and drug consumption, number of sexual partners and condom use with the steady partner and with casual partners in the 12 months before the survey. Of those surveyed, 27.4% had been drunk at least once and 20.5% had consumed drugs. Both behaviours were associated with male sex, younger age, higher educational level, being single and having had more than one sexual partner. In the logistic regression analysis adjusting for the sociodemographic variables, the greater frequency of drunkenness and cannabis use were associated with having more than one sexual partner. Regular condom use was significantly less frequent among cocaine users and more frequent among opiate users, but was not associated with the use of other drugs. Sexual risk behaviour (i.e. more than one partner and failure to use a condom regularly) was more frequent among persons who had been drunk or used cannabis or cocaine. Excessive consumption of alcohol, and cannabis and cocaine use are independently associated with sexual behaviour involving greater risk of HIV infection or transmission.

Adolescent↗
PubMed1986

Characteristics of women under 20 with cervical intraepithelial neoplasia.

The relationship between risk of cervical neoplasia and various sociodemographic, reproductive and sexual characteristics was studied in 126 women (cases) with an abnormal Papanicolaou test finding and 1914 controls seen at the same clinic in which cases were detected but showing no evidence of cervical neoplasia. All the subjects of this study were under the age of 20. Number of sexual partners and clinical occurrence of genital warts emerged as the most important determinants of the risk of cervical intraepithelial neoplasia (CIN) in these very young women (Relative Risk (RR) for three or more sexual partners = 2.45, 95% Confidence Interval (CI) 1.63-3.70, RR for occurrence of genital warts, adjusted for number of sexual partners = 9.15, 95% CI: 5.06-16.26). Also having grown up in a 'problem' family seemed to increase the probability of developing CIN (RR adjusted for number of partners = 1.64, 95% CI 1.06-2.52). For all other investigated characteristics, cases and controls were remarkably similar. These include socioeconomic status, parity, smoking habits, use of various contraceptive methods and also indicators of sexual activity such as age of first having sexual intercourse, and duration and frequency of intercourse. Although this group of women under 20 only allows the study of less severe precursors of cervical cancer, it helps to highlight the earliest effect of purported risk factors for cervical neoplasia, chiefly sexual habits, at a time very close to their being established.

Adolescent↗
PubMed2004

Seeking and engaging in internet sex: a survey of patients attending genitourinary medicine clinics in Plymouth and in London.

We conducted a survey of patients attending two GUM clinics to evaluate the use of the internet for seeking sexual partners and for seeking on-line sexual health information. Prevalence of internet sex-seeking (ISS) was 11% (57/500) in Plymouth and 21% (50/237) in London. ISS was more common among men who have sex with men (MSM) (43/92 = 47%) than men who have sex with women (MSW) (38/280 = 14%, P < 0.0001) and more common amongst MSW than women who have sex with men (WSM) (25/350 = 7%, P = 0.007). In both samples, accessing sexual health information online was associated with ISS (Plymouth, P = 0.05 and London, P = 0.001), as was reporting more than 10 sexual partners per year (Plymouth and London, P < 0.001). It remains to be seen whether the potential sexual health promotion benefits of the internet could balance potential risks of STI acquisition.

Adult↗
PubMed2006

Disclosure of HIV status to sex partners and sexual risk behaviours among HIV-positive men and women, Cape Town, South Africa.

BACKGROUND: The HIV epidemic continues to amplify in southern Africa and there is a growing need for HIV prevention interventions among people who have tested HIV positive. METHODS: Anonymous surveys were completed by 413 HIV-positive men and 641 HIV-positive women sampled from HIV/AIDS services; 73% were <35 years old, 70% Black African, 70% unemployed, 75% unmarried, and 50% taking antiretroviral treatment. RESULTS: Among the 903 (85%) participants who were currently sexually active, 378 (42%) had sex with a person to whom they had not disclosed their HIV status in the previous 3 months. Participants who had not disclosed their HIV status to their sex partners were considerably more likely to have multiple partners, HIV-negative partners, partners of unknown HIV status and unprotected intercourse with non-concordant sex partners. Not disclosing their HIV status to partners was also associated with having lost a job or a place to stay because of being HIV positive and feeling less able to disclose to partners. CONCLUSIONS: HIV-related stigma and discrimination are associated with not disclosing HIV status to sex partners, and non-disclosure is closely associated with HIV transmission risk behaviours. Interventions are needed in South Africa to reduce the AIDS stigma and discrimination and to assist people with HIV to make effective decisions on disclosure.

Adult↗
PubMed1990

Sexual transmission of hepatitis C virus and its relation with hepatitis B virus and HIV.

OBJECTIVE: To determine the extent of transmission of hepatitis C virus in sexual partners of intravenous drug misusers and to examine the relation between the prevalences of HIV, hepatitis B virus, and hepatitis C virus infections in homosexual men and intravenous drug misusers and their sexual partners. DESIGN: Serum samples collected between 1984 and 1988 were tested for hepatitis B virus markers and antibodies against hepatitis C virus by enzyme linked immunosorbent assay (ELISA) and for HIV antibody by enzyme immune analysis and western blotting. SETTING: Large referral university hospital with an external AIDS clinic in the metropolitan area of Barcelona, Spain. SUBJECTS: 243 Intravenous drug misusers, 143 of their regular heterosexual partners, and 105 homosexual men. MAIN OUTCOME MEASURES: Prevalences of hepatitis C virus, hepatitis B virus, and HIV infections. RESULTS: In all, 178 of the 243 (73%) intravenous drug misusers, 16 out of 143 (11%) of their partners, and 17 of the 105 (16%) homosexual men had antibodies against hepatitis C virus. The presence of hepatitis C virus infection was unrelated to sex, age, the presence of HIV or hepatitis B virus infections, or the Centers for Disease Control stage of HIV. In sexual partners of intravenous drug misusers there were strong correlations between the presence of hepatitis C virus infection and that of HIV (p = 0.001) and hepatitis B virus (p = 0.013) infections. CONCLUSIONS: Intravenous drug misusers have a high risk of acquiring hepatitis C virus, hepatitis B virus, and HIV infections, but the presence of hepatitis C virus infection seems to be unrelated to the presence of the other two viruses. Homosexual men have a high prevalence of HIV and hepatitis B virus infections with a low prevalence of hepatitis C virus infection, the presence of which is not related to that of the other two infections. Conversely, heterosexual partners of intravenous drug misusers have low prevalences of the three virus infections, but the presence of hepatitis C virus infection correlates significantly with the presence of HIV and hepatitis B infections. The rate of sexual transmission of hepatitis C virus seems to be low, even in partners of people known to be seropositive for this virus.

Adolescent↗
PubMed1992

Second generation heterosexual transmission of HIV-1 infection.

Reports of 217 HIV-1 infected persons have been investigated. Initially, 122 were described as having no identified risk of HIV infection and 95 were described as probably infected through heterosexual intercourse. The sexual partners of 34 of these 95 cases were reported as having acquired their infection heterosexually in the UK but information on the risk status of the sexual partners of the remaining 61 cases was lacking. Telephone follow-up through microbiologists and clinicians resulted in the recategorisation of 132 cases. Interviews were conducted with 22 HIV infected heterosexuals without a major risk for HIV infection, either in themselves or their sexual partners, and who had no evidence of heterosexual exposure outside the UK. Interviews confirmed the categorisation of 15 cases (9 male, 6 female) as due to second generation HIV-1 infection ie, infection acquired through heterosexual intercourse in the UK with a partner who also became infected through heterosexual intercourse. A possible chain of transmission is described involving three of these 15 cases.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Spontaneous and induced abortion among resident physicians.

Female resident physicians are believed to be at an increased risk for a variety of third-trimester pregnancy complications. However, early pregnancy complications have been less well studied. This report compares spontaneous and induced abortions in a nationally representative sample of 5096 female medical school graduates (who experienced 1284 pregnancies) and of the sexual partners of 5000 of their male classmates (who experienced 1481 pregnancies). The response to the survey was 86.1%. The life-table probability of spontaneous abortion was 14.8% for female residents compared with 12.6% for the sexual partners of male residents. However, female residents were more likely than the male residents' sexual partners to terminate a pregnancy voluntarily (8.2% vs 2.7%). The increased risk of voluntary termination persisted when only married women were studied (3.6% vs 1.4%). However, female residents' pregnancies were at approximately half the risk of voluntary termination compared with pregnancies among the general US population of women aged 25 to 34 years. These results provide reassurance to those residents who would like to become pregnant but are concerned about the possible effect of their occupation on the course of the pregnancy.

Abortion, Induced↗
PubMed1993

Adolescent sexual behavior and condom use in Ile-Ife, Nigeria.

A study to identify risky sexual behaviors related to condom use was conducted in a Yoruba-speaking urban area of Nigeria. The subjects were 256 randomly selected male high school students, 15-19 years of age, who completed a self-administered questionnaire. The majority (79%, or 194) reported having had heterosexual intercourse in the previous 12 months, 9 (4.6%) with prostitutes and 107 (55.4%) with more than one sexual partner. Three subjects who had more than one sexual partner and 1 of the 9 who had sexual intercourse with a prostitute had used a condom. Condoms were reported to be used only for the prevention of unwanted pregnancy by 61.3% of the students. Implications of these findings for adolescent AIDS education in Africa are discussed.

Adolescent↗
PubMed1991

The lack of transmission of NANB/C hepatitis between acute and chronically infected patients and their heterosexual partners.

In order to study the risk of heterosexual transmission of non-A, non-B/C (NANB/C) hepatitis, 34 spouses and/or sexual partners to 34 index patients (13 women, 21 men; median age 39 years) with acute NANB/C hepatitis (anti-HCV positive 13/34) were repeatedly tested for antibodies to hepatitis C virus (anti-HCV) and serum alanine aminotransferase (S-ALAT) values. Spouses and/or sexual partners to 13 patients with chronic NANB/C hepatitis (11/13 anti-HCV positive) were also studied by determining anti-HCV and S-ALAT levels. No conclusive evidence of heterosexual transmission of NANB/C hepatitis was found.

Acute Disease↗
PubMed1980

Psychophysiological aspects of male sexual inadequacy: results of an experimental study.

Forty-two male patients and their sexual partners were studied: 16 patients with "psychogenic" erectile failure (eight each with the primary and secondary forms), 16 premature ejaculators, and 10 patients with diabetes-related impotence. Due to the higher mean age of the diabetics, an age-matched older control group (eight healthy males and their sexual partners) and an age-matched younger control group (16 healthy males and their sexual partners) were also studied. In an experimental situation various psychophysiological parameters were evaluated. The viewing of films depicting sexual behavior produced psychophysiological reactions in all subjects. The patient groups and the controls differed on the following five parameters: amount of increase in systolic blood pressure, amount of increase in number of spontaneous fluctuations in skin resistance, erection amplitude, latency of erection, and duration of erection. In the diabetic group the three erection parameters were very depressed. In the group with primary psychogenic erectile impotence all five parameters were lower than in the controls, with the greatest difference in spontaneous fluctuations in skin resistance. The psychophysiological profile of the group of patients with secondary psychogenic erectile impotence was surprisingly similar to the profile of the diabetics, with a sharp increase in systolic blood pressure and in spontaneous fluctuations in skin resistance, but very depressed erection parameters. There were no marked differences between the controls and the premature ejaculators. There were only a few correlations between self-rated sexual arousal and psychophysiological measures of sexual stimulation and these were not very high. They were found mainly in the patient groups.

Adult↗
PubMed2006

Promoting female condom use to heterosexual couples: findings from a randomized clinical trial.

CONTEXT: The female condom remains the only female-initiated method for preventing pregnancy and STDs, including HIV. Innovative methods for promoting its use, and for involving male partners in its use, are needed. METHODS: A sample of 217 women and their main male sexual partners were randomly assigned to one of three study conditions: a six-session relationship-based STD prevention intervention provided to the couple together, the same intervention provided to the woman only or a single-session education control provided to the woman only. Assessments were conducted at baseline and three months postintervention. Contrast coding was used to examine whether the effects of the two active interventions differed from those of the control intervention, and whether the effects of the two active interventions differed from each other. Regression analyses were used to estimate treatment effects. RESULTS: During follow-up, participants in either active intervention were more likely to use a female condom with their study partner and with all partners, and used female condoms at a higher rate with all partners, than individuals assigned to the control intervention; at the end of three months, they were more likely to intend to use the condom in the next 90 days. No significant differences in outcomes were found between the active intervention groups. CONCLUSIONS: Focusing on both a woman and her main male sexual partner is efficacious in increasing female condom use and intention to use among heterosexual couples at risk for HIV and other STDs.

Adolescent↗
PubMed1999

Establishing efficient partner notification periods for patients with chlamydia.

OBJECTIVES: To delineate chlamydia partner notification periods with high proportions of infected, untreated sexual partners, and to evaluate relevant Centers for Disease Control (CDC) recommendations. METHODS: Disease Intervention Specialists (DIS) offered contact tracing services to all chlamydia patients (N = 1,309) reported in Colorado Springs between July 1996 and June 1997. Patients were asked to identify sexual partners during the 180 days preceding treatment. Partners were actively sought by DIS and offered DNA amplification testing. RESULTS: Of 1,309 patients, 1,109 were interviewed, resulting in 2,293 named partners. Two fifths of eligible partners were located; inability to examine partners was related to time of last exposure and to frequency of sexual exposure. Of located partners, 95% were tested with DNA amplification technology. Adherence to CDC criteria identified 88% of infected, untreated partners; the other 12% consisted mainly of epidemiologically important asymptomatic men whose infection is seldom identified by current public health interventions. CONCLUSIONS: The chlamydia partner notification recommendations of the CDC are adequate, but miss men with long-standing infection. These men contribute to entrenched chlamydia endemicity; targeted programs to screen high-risk men merit serious consideration.

Adult↗
PubMed2003

A partner's drug-using status impacts women's drug treatment outcome.

The role that male sexual partners play in the treatment outcome of drug dependent pregnant women deserves greater attention. Pregnant women enrolled in a comprehensive treatment program with drug-free (n=85) or drug-using (n=82) male sexual partners completed a relationship survey and were compared on partner and psychosocial variables. Compared with male drug-free partners, male drug-using partners had more unemployment and more current legal involvement, less education, were less likely to be supportive of the pregnant woman's recovery efforts and were more likely to give them money to buy drugs. Male drug-free partners also had fewer medical, dental, legal and transportation needs than male drug-using partners. Data from treatment retention suggests that women with male drug-using partners are retained in a comprehensive treatment for a shorter time than women with male drug-free partners. A male partner's drug-using status should be considered when treating pregnant drug dependent women.

Adult↗
PubMed1995

Pulmonary function tests in HIV-infected patients without AIDS. Pulmonary Complications of HIV Infection Study Group.

To determine the prevalence, incidence, and types of lung diseases that occur in association with HIV infection, 1,353 subjects, including HIV-seropositive homosexual men, injection drug users, female sexual partners of HIV-positive men, and HIV-seronegative control subjects from the first two transmission categories were evaluated prospectively in a multicenter study. Patients with AIDS at the time of initial evaluation were excluded. One thousand two-hundred ninety-four subjects who had no AIDS-defining diagnosis within 3 mo of enrollment had measurements of FVC, FEV1 and DLCO at the time of enrollment. As a group, all subjects had mean values of FVC and FEV1 close to 100% predicted. Those with CD4 counts below 200/mm3 had slightly reduced DLCO compared with the others. Subjects with a history of HIV-associated symptoms (thrush, weight loss, herpes zoster) also had a reduced DLCO compared with those without symptoms. Injection drug users had reduced FVC, FEV1 and DLCO compared with homosexual men and female sexual partners of HIV-infected men, with DLCO more substantially reduced. Part of the reduction in DLCO in drug users was attributable to factors other than HIV infection, especially cigarette smoking and race. Using predicted values that take cigarette smoking into account, the prevalence of abnormality in DLCO was higher among injection drug users (33.3%) than among homosexual men (11.2%) and female sexual partners (12.7%). These results show that advanced HIV infection, characterized by CD4 count < 200/mm3 or HIV-associated symptoms, and factors unrelated to HIV infection, including race, cigarette smoking, and injection drug use, are all associated with reductions in DLCO measurements.

Bisexuality↗
PubMed2004

Re-infection of Chlamydia trachomatis in patients presenting to the genitourinary medicine clinic in Portsmouth: the chlamydia screening pilot study - three years on.

Chlamydia trachomatis is the most common bacterial sexually transmitted infection (STI) in the UK. The Department of Health set up an opportunistic screening programme for genital chlamydia infection, focusing on sexually active 16-24-year-old women and some men. This study identified those patients re-attending the genitourinary medicine (GUM) clinic and followed them up until September 2002. We examined the reasons for attendance and re-infection with chlamydia. Two hundred and eighty-five patients re-attended the clinic. Two-thirds of these had changed their sexual partners in the follow-up period. Fifty-six patients were diagnosed with genital chlamydia infection in subsequent clinic visits. The majority of them had changed their sexual partners, suggesting new acquisition of infection. This suggests that in this age group re-screening should be offered at a year interval. Patients diagnosed with genital chlamydia infection should be referred to the GUM clinic for further STI screening and partner notification.

Adolescent↗
PubMed1989

Infection with Chlamydia trachomatis and Neisseria gonorrhoeae in women with lower abdominal pain admitted to a gynaecology unit.

One hundred and sixty-five women admitted to a gynaecology unit with lower abdominal pain were screened for infection with Neisseria gonorrhoeae and Chlamydia trachomatis by members of a department of genitourinary medicine. C. trachomatis alone was detected in 21 patients. N. gonorrhoeae alone was isolated from five patients, and dual infection was present in six patients, giving a total of 32 (19%) patients in whom a sexually transmitted disease (STD) was diagnosed. The combination of an endocervical swab placed in Amies transport medium for gonococcal isolation and an endocervical slide for immunofluorescent detection of chlamydiae proved to be a simple and accurate method of screening for STD. As a result of contact tracing, 16 sexual partners of women in whom STD was detected were examined. Three cases of gonococcal and nine cases of non-gonococcal urethritis were diagnosed. None of the sexual partners had symptoms suggestive of genitourinary infection.

Abdomen↗
PubMed1992

Some aspects of sexual behaviour and the potential demographic impact of AIDS in developing countries.

This review examines recent research on the influence of heterogeneity in sexual behaviour on the transmission dynamics of the human immunodeficiency virus (HIV), the aetiological agent of AIDS. Attention is focused on the potential demographic impact of AIDS in developing countries and how this is influenced by the structure of networks of sexual contacts (who mixes with whom), age-dependency in rates of sexual partner change and differences in the ages of female and male sexual partners. Analyses based on the construction of simple and complex mathematical models of the spread of HIV via heterosexual contact serve as a template for the interpretation of observed pattern and as a guide to the major aspects of sexual behaviour that govern the transmission dynamics of the virus. It is argued that much greater attention must be addressed to the quantification of patterns of sexual behaviour in defined communities, despite the many practical problems that surround data collection and interpretation.

Acquired Immunodeficiency Syndrome↗
PubMed2006

HIV seroconversion among public sexually transmitted disease clinic patients: analysis of risks to facilitate early identification.

OBJECTIVES: We identified risks for HIV seroconversion among public sexually transmitted disease (STD) clinic patients. DESIGN: This was a retrospective cohort study conducted January 1993 through October 2002 of STD clinic attendees aged > or =12 years in Baltimore, Maryland. METHODS: A negative HIV enzyme immunoassay (EIA) test was required for staggered cohort entry. Observation time was 30 days to 3 years. The outcome for multivariate Poisson regression was HIV seroconversion (positive EIA and/or Western blot test) compared among patients with or without sexual risk behaviors, drug use, an STD diagnosis, and signs and symptoms at an initial HIV test. RESULTS: One hundred twenty-five HIV seroconversions occurred among 10,535 individuals and 13,693 person-years of observation, for an incidence of 0.91 HIV seroconversions per 100 person-years (95% confidence interval [CI]: 0.76 to 1.09). Median time to HIV seroconversion was 1.54 years (95% CI: 1.11 to 1.73). In multivariate analysis, increased HIV seroconversion risk was associated with older age, drug use, a sexual partner with syphilis or HIV, genital ulcers, and gonorrhea. HIV incidence per 100 person-years was 4.86 for subjects with an HIV-positive sexual partner, 3.06 for those with injection drug use, and 2.40 for those with genital ulcers. CONCLUSIONS: We found a high rate of HIV seroconversion among STD clinic patients with specific risks. Algorithms with HIV RNA testing targeted to patients at the highest risk for seroconversion may optimize prevention and resource utilization.

Adolescent↗