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PubMedDate not supplied

Human papillomavirus testing as an optional screening tool in low-resource settings of Latin America: experience from the Latin American Screening study.

Hybrid capture II (HC II) test for oncogenic human papillomaviruses (HPV) was carried out in a cohort of 4284 women at their first clinical visit. Overall prevalence of HPV was 17.1%, decreasing with age from 33.9% among women below 20 years to only 11.0% among those older than 41 years. HPV prevalence was significantly higher among current smokers (odds ratio [OR] = 1.31; 95% CI 1.1-1.6), in women with two or more lifetime sexual partners (OR = 1.9; 95% CI 1.6-2.4), and those women with two or more sexual partners during the past 12 months prior to examination (OR = 1.6; 95% CI 1.2-2.2). HPV detection increased in parallel with increasing cytologic abnormality, being highest in women with high-grade squamous intraepithelial lesion (P= 0.001). Specificity of the HPV test in detecting histologically confirmed cervical disease was 85% (95% CI 83.9-86.1). Sensitivity of the HPV test in detecting histologic abnormalities increased in parallel with disease severity, ranging from 51.5% for cervical intraepithelial neoplasia (CIN) 1 to 96.5% for CIN 3 and 100.0% for cancer, with respective decline of positive predictive value. These data suggest that HPV testing with HC II assay might be a viable screening tool among this population with relatively high prevalence of cervical disease.

Adult↗
PubMed2000

Human immunodeficiency virus-related risk behavior among African-American females.

This study draws attention to the demographic shift in the population of HIV-infected African Americans from young, low-income, unmarried homosexual, and injecting drug users to female, heterosexual, higher income, and older persons. We used data from the 1995 Survey of Family Growth, sponsored by the National Center for Health Statistics, to examine the patterns of HIV-related risk behavior (consistent condom use, number of sexual partners, sex education in birth control methods) among African-American females. We found that only 33.3% of the African-American females had indicated that their partners always used condoms; 23.8% had seven or more lifetime sexual partners; and nearly 30% did not have any sex education in birth control methods, sexually transmitted diseases, or abstinence. In addition, African-American females who had partners who had not used condoms in the last 12 months were less likely than those who reported occasional condom use to perceive that they were infected with HIV (21.1% vs. 33.1%). These risk factors were prevalent among low-income African-American females with low socioeconomic status (SES) as well as black women with higher SES who lived in smaller cities and suburbs. These results highlight the need for HIV prevention strategies that cut across socioeconomic class, gender, sexual orientation, and place of residence.

Adolescent↗
PubMed2001

Disclosure of serostatus by HIV infected youth: the experience of the REACH study. Reaching for Excellence in Adolescent Care and Health.

PURPOSE: To describe disclosure of HIV serostatus by infected youth to parents and sexual partners and to examine the association of disclosure with subject characteristics. METHODS: Baseline data on 317 HIV infected adolescents in national 15 site study were examined. Data sources included direct and computer-assisted interview, laboratory studies, and chart reviews. Examination of parental disclosure was restricted to subjects without parental permission requirements. Concordance in parental disclosure/support used McNemar's test. Associations between disclosure to parent(s) and subject characteristics were examined using logistic regression analysis. Repeated measure analysis was used for sexual partner disclosure. RESULTS: Subjects of both genders more often disclosed their HIV infection status to mothers than to their fathers (77% vs. 47%, p < .001). With disclosure, perceived support from either parent was high. In multivariate analyses, factors associated with maternal disclosure were length of time since diagnosis (OR = 1.43; 95% CI: 1.06-1.92), and Hispanic ethnicity (OR = .37; 95% CI: .15-.95). No factors were significantly associated with paternal disclosure in multivariate analysis, although length of time since diagnosis showed a trend (OR = 1.31; 95% CI: 1.00-1.74). Factors associated with disclosure to sexual partners were partner's HIV+ status (OR = 2.09; 95% CI: 1.11-3.93) and "main partner" status (OR = 3.17; 95% CI: 1.84-5.46). CONCLUSIONS: Although subjects were more likely to reveal their status to their mothers, parental support was perceived as high after disclosure to either parent. Since "time since diagnosis" was associated with parental disclosure, support systems are necessary for youth until such a disclosure can occur.

Adolescent↗
PubMed1996

Religiosity, gender, and the double standard.

Scottish teenagers (N = 690) participated in a survey concerning the relationship between religiosity, gender, and social judgments of sexual activity. Respondents estimated the number of sexual partners of 20-year old men and women and made evaluative judgments of sexually active men and women on positive and negative dimensions. On both tasks, evidence was obtained for the operation of a double standard. Women were expected to have fewer sexual partners than men, and their sexual activity was judged more negatively on evaluatively negative dimensions. Contrary to findings of previous studies in this area, gender differences in endorsement of the double standard were not found. Only moderate support was found for the view that religiosity contributes to different standards of sexual behavior for men and women, although religiosity had significantly greater influence on judgments made by women than on judgments made by men.

Adolescent↗
PubMed1998

Variations in HIV risk behaviors of incarcerated juveniles during a four-year period: 1989-1992.

OBJECTIVE: To retrospectively monitor over several years change in incarcerated juveniles' human immunodeficiency virus (HIV) risk behaviors. METHODS: From 1989 to 1992, detainees who volunteered after an HIV class or were referred by a health care provider were counseled individually and privately by health educators using a standardized questionnaire and counseling form developed from an instrument used to counsel prostitutes in Los Angeles, California. RESULTS: The number counseled each year was 1045, 1745, 2354 and 1428 from 1989 to 1992, respectively. Those agreeing to HIV testing rose from 72% of total participants in 1989 to 84% of total participants in 1992. Eight of those youth tested as HIV positive. Four blind seroprevalence studies during the same time yielded one case in 1000 for 1988, one case in 1005 for 1989, two cases in 751 in late 1989 (2.7/1000), and one case in 1214 for 1990 (1.25/1000). The number worrying about AIDS and considering themselves vulnerable to AIDS increased, but protective behaviors did not. Sexual partners per year were 2.1 regardless of the age of first sexual activity. Alcohol was associated with an increased number of sexual partners (2.6/year) and higher rates of sexually transmissible infections (STIs) and pregnancy. Although 96% of boys and girls were sexually active, only 4% used a condom consistently during the first 3 years, and only 7% in 1992. Those reporting having used condoms with the intention to prevent both STIs and pregnancy had a higher rate of use. Those carrying condoms all the time used condoms more often. Males having sex with both males and females rarely used condoms, and 45% had one or more STIs. CONCLUSIONS: Although the rate of HIV infection remains low in juveniles detained by the County of Los Angeles, their rates of risky behaviors place them at high risk for HIV acquisition.

Adolescent↗
PubMed1997

Changes in attitude, sexual behaviour and the risk of HIV/AIDS transmission in southwest Nigeria.

This pilot study was carried out in southwest Nigeria to determine the current trends in sexual behaviours known to be associated with HIV transmission in Nigeria. Knowledge of AIDS in general and as an incurable disease was high (91.4% and 79.4% respectively). Knowledge of the means of AIDS transmission was also very high among both men and women. Overall, condom use was consistent at 25%, inconsistent at 55% and non-existent at 20% for all sexually active respondents. Over 60 per cent of sexually active respondents had two or more sexual partners, with significantly more males than females having this number of sexual partners (p < 0.01). Eighteen per cent of sexually active respondents had a history of sex with commercial sex workers while 25% had a history of at least one sexually transmitted disease. Using multiple logistic regression, the significant determinants of condom use among the sexually active group were: being in a stable sexual relationship, history of sex with commercial sex workers, self-perception of testing positive for HIV and self-perception of HIV/AIDS risk in Nigeria. Prevalence of condom use in this study was much higher than those reported in previous studies, suggesting a probable decline in high risk sexual behaviours among inhabitants of urban Southwest Nigeria since the advent of AIDS. Most sexually active respondents aged 19 years or below (adolescents) who perceived themselves at a high risk of testing positive for HIV had never used condoms. The non usage of condoms among this group of adolescents is disturbing, since they are at greatest risk of spreading the disease. Health education and promotion of safe sex practices need to be extensively targeted at adolescents.

Adolescent↗
PubMed1990

Derivation and validation of a clinical diagnostic model for chlamydial cervical infection in university women.

We developed and prospectively tested a logistic regression model for chlamydial cervical infection. Study subjects included 2271 women receiving gynecologic care in our student health clinic. Clinical data were collected in a standardized fashion. We identified cell culture--isolated Chlamydia trachomatis from 133 (9%) of 1458 subjects in the derivation set and 73 (10%) of 729 subjects in the validation set. Model variables included a new sexual partner within 2 months or more than one sexual partner within 6 months; cervical ectopy; cervical friability; at least 20 polymorphonuclear leukocytes per high-power field in cervical secretions; white blood cells in vaginal secretions; and use of an antibiotic active against C trachomatis within a month. This model can distinguish women with low, medium, and high risks of chlamydial infection (on derivation set: receiver operating characteristic curve area, 0.710; SE, 0.026; on validation set: area, 0.698; SE, 0.035) using simple clinical information obtained in the office.

Adolescent↗
PubMed1996

A case-control study of risk factors for seropositivity to human T-lymphotropic virus type I (HTLV-I) in Jamaica.

BACKGROUND: We investigated behavioural and environmental risk factors for seropositivity to human T-lymphotropic virus type I (HTLV-I). METHODS: A nested case-control study of 201 HTLV-I seropositive subjects and 225 age- and sex-matched seronegative controls was performed using questionnaire data from the enrollment visit of a cohort study in 1987-1988. HTLV-I serostatus was confirmed using enzyme-linked immunosorbent assay (ELISA) and Western blot. RESULTS: Among women, the number of lifetime sexual partners (P < 0.05, chi 2 trend) and the number of different men fathering a child by the woman (P < 0.06, chi 2 trend) were associated with HTLV-I seropositivity. Use by the female subject of an intrauterine device (IUD) was associated with an increased risk of seropositivity (odds ratio (OR) = 2.67, 95% confidence interval (CI): 1.13-6.23); condom use was rare in this population. Among male subjects, a larger number of lifetime sexual partners was also associated with HTLV-I seropositivity (P < 0.05, chi 2 trend). No association was found between HTLV-I seropositivity and educational attainment, income, or occupation. Having been breastfed as a child or receipt of a blood transfusion had elevated but imprecise OR due to very high and low prevalence of the risk factors, respectively. Several variables relating to insect or animal exposure showed no association with HTLV-I seropositivity. CONCLUSIONS: These data confirm that heterosexual intercourse is a major route of HTLV-I transmission, but do not support suggestions of insect or environmental vectors.

Adult↗
PubMedDate not supplied

Chlamydia trachomatis infection in sexually active adolescents and young women.

BACKGROUND: The prevalence of Chlamydia trachomatis infections among Polish teenagers is unknown. Sexually active adolescents are at a greater risk for sexually transmitted infections, including Chlamydia trachomatis (ChT). Most inflections are asymptomatic and therefore untreated. Early detection and treatment of cervical chlamydial infections can prevent pelvic inflammatory disease and has a strong protective effect against infertility. AIM: To determine the prevalence and risk factors of Chlamydia trachomatis infections among sexually active female adolescents attending the outpatient gynaecological clinic of the Institute of Mother and Child in Warsaw. MATERIALS AND METHODS: 249 sexually active girls, 16-19 years old, attending the outpatient clinic of the Institute of Mother and Child in Warsaw were enrolled in this study from December 2002 to May 2004, The participants filled out a questionnaire containing informations on age, purpose of the visit, level of education, age of the first intercourse, number of lifetime sexual partners, number of current partners (in the last 3 months), number of sexual partners in the past (patients' partner), contraceptive methods, use of condoms at the first and the last intercourse, past history of STD and obstetric history at first visit. Pelvic examination was done for the following reasons: checking vaginal discharge, presence of abnormalities of the cervix such as ectopy, erythroplakia and uterine tenderness and taking a Pap smear and a cervical swab for Chlamydia trachomatis detection. Cervical swabs for Chlamydia trachomatis were tested by Polymerase Chain Reaction (PCR). RESULTS: The prevalence of ChT genital infection in the studied group was 3.2%. Adolescent females infected by ChT less frequently reported the use of condom and more often did not use any contraception in comparison with the girls without ChT genital infections (42.8% and 42.8% vs. 49% and 12.8%), The existence of other STDs was more frequently noted in adolescents with Chlamydial infection in comparison to healthy girls (14.2% vs. 8.3%). There were no statistically significant differences in results of the Pap smears and the incidence of cervical ectopy between the two groups.

Adolescent↗
PubMed1999

Sexual practices in a cohort of US women with and without human immunodeficiency virus. HERS Study. HIV Epidemiology Research Study.

OBJECTIVES: To compare the frequency and pattern of sexual activities of women infected with human immunodeficiency virus (HIV) relative to uninfected women at the time of enrollment into a multisite cohort study. METHODS: The HIV Epidemiology Research Study (HERS) is a prospective study following 873 HIV-infected and 438 HIV-uninfected women. The baseline protocol included interviews about sexual practices, sociodemographic information, and drug and alcohol use, as well as clinical and laboratory studies. Multiple logistic regression models estimated differences between infected and uninfected women in relation to sexual activity and practice. RESULTS: 77% of infected women and 89% of uninfected women reported at least one sexual partner in the six months before study entry. Among sexually active women, specific practices varied little by HIV serostatus, with the exception of oral sex, which was more frequently performed and received by uninfected women. Despite the high prevalence of sexual activity, infected women were 2.5 times as likely not to have had any recent sexual partners as uninfected women (95% CI = 1.77-3.44). CONCLUSIONS: Women who decrease or altogether stop engaging in sexual partnerships may benefit from direct counseling in relation to underlying loss of sexual affection.

Adolescent↗
PubMed1988

Sexual and reproductive life events in relation to duration of oral contraceptive use.

In order to disclose differences between users and non-users of oral contraceptives (OC), 620 women aged 15-54 were invited to participate in an in depth interview about sexual, contraceptive, and reproductive life events. Of the 585 women who participated, 459 were consecutive gynecological in- or outpatients, and 126 were selected from visitors in general practice. Data was analysed by multivariate test statistics. After correction for present age and social class, the duration of use of OC (DOC) among women 15-34 years of age correlated negatively to age at menarche and coital debut and positively to number of sexual partners, oral-genital sexual practice, and number of pelvic inflammatory diseases. Among women over 35, DOC was positively associated only to cigarette smoking. No correlation was found to coital frequency (whether earlier, present or during pregnancy or menstruation), number of births and abortions, or to social classification. In epidemiological research on benefits and risks of oral contraceptives, confounding influence of one or more variables is of crucial importance. The present findings point at sexual and life-style habits as potential confounders in the study of OC and associated diseases.

Adolescent↗
PubMed1991

Effects of a peer-led AIDS intervention with university students.

Acquired immune deficiency syndrome (AIDS) has become a major health threat to university students. This study evaluated a peer-led AIDS intervention program with university students (1) increase knowledge of human immunodeficiency virus (HIV) transmission and infection; (2) change attitudes to reflect scientific information on AIDS-related facts; and (3) change behavioral intentions to correspond with safer sexual practices. Subjects were students (N = 142) from four undergraduate classes and were predominantly female (65%), white (82%), and sexually active (86%). A non-equivalent control group design was used, with two classes receiving the intervention and two classes receiving no information. For the intervention, peer educators presented AIDS-related information, modeled ways to use condoms safely and ways to discuss condom use with sexual partners, and led discussions on HIV infection and use with sexual partners, and led discussions on HIV infection and AIDS, relationships, sexuality, and condom use. A questionnaire was administered to assess differential changes in AIDS-related knowledge, attitudes, and behavioral intentions between the intervention and control groups. The results showed significant improvements among intervention subjects on the knowledge, attitudes, and behavioral intentions scales compared with the control group.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Evaluation of single whole inclusion serum test for IgG antibody to Chlamydia trachomatis in asymptomatic women.

IgG antibody titres against Chlamydia trachomatis were measured using a whole inclusion assay (Electro-Nucleonics Laboratories, Bethesda, Maryland, USA) in single serum samples of patients who presented for termination of pregnancy with evidence of infection with this organism (case group) and of 30 women with no evidence of infection (control group). Case and control patients were matched for age, race, marital status, history of sexually transmitted diseases, number of lifetime sexual partners, and whether they had had a new sexual partner in the preceding month. Fifty eight of 60 (97%) serum samples tested had chlamydial antibodies present at a titre of 1/8 or more. There was no significant difference between the geometric mean titres of the 30 case patients and the 28 controls with chlamydial antibodies (1/161.3 and 1/77.4 respectively). Significantly more case patients than controls, however, had a titre of 1/128 or more (p less than 0.01). The sensitivity, specificity, and positive and negative predictive values of a single serum antibody titre of 1/128 or more as an indicator of recent infection compared with isolation of the organism in cycloheximide treated McCoy cells or antigen detection by Chlamydiazyme (Abbot Laboratories; North Chicago, Illinois, USA), or both, were each 67%. The value of the antibody assay seems to be questionable as high levels of antibodies failed to correlate with isolation or antigen detection results, or both, in our population.

Adult↗
PubMed1991

Evaluation of I-C papaverine in patients with psychogenic and organic impotence.

Forty men with organic or psychogenic impotence, who were highly motivated for treatment, were offered instruction in the intracavernosal (I-C) self-injection of papaverine and regular ongoing supervision by the investigator. Twenty declined immediately, citing a number of reasons, notably qualms about pain of the injection, side-effects and the unnaturalness of the method. Eleven patients discontinued the drug within 11 months; nine used it for at least one year, and all were continuing with it albeit less frequently at the time of assessment. Those who discontinued treatment differed significantly from those who did not; the latter initially used the drug less frequently (less than once per month), did not have a regular sexual partner or had a poor relationship with their sexual partner, and reported a decline in libido during use of the drug. The findings suggest that I-C papaverine, although effective in treating impotence, is not a panacea, and a large percentage of users (55% in our study) are likely to discontinue the drug within a relatively short period of time.

Adult↗
PubMedDate not supplied

Internet sex and dating sites need warnings.

For this issue's Commentary column, Peter L. Tenore, MD, discusses risk for infection with HIV or acquisition of sexually transmitted diseases associated with the use of the Internet to find sexual partners and presents results of an informal survey to determine whether Internet sites used to find sexual partners provide warnings about sexually transmitted diseases and HIV. He also calls for the operators of such sites to add warnings to their sites.

Disease Transmission, Infectious↗
PubMed1996

Determinants of smoking behaviour in random samples of Greenlandic and Danish women 20-39 years of age.

BACKGROUND: The prevalence of smoking among young women is of particular concern in most countries as it does not decline as in men. We studied smoking behaviour in Greenlandic and Danish women over a 2 year period to provide information on the social and behavioural determinants of smoking in women. METHODS: In 1986, samples of 800 women aged 20-39 years were drawn at random from Nuuk/Godthåb (Greenland) and Nykøbing Falster (Denmark). A total of 586 and 661 women were interviewed in Greenland and Denmark, respectively. In 1988, new random samples of 150 women were drawn from the same areas. Totally, 129 Greenlandic and 126 Danish women were included in this study. In 1987, a sample of 732 women aged 20-49 years from Copenhagen was randomly drawn from the computerized Central Population Register. Of these, 623 women completed a questionnaire. RESULTS: Smoking behaviour was almost the same among women in Nykøbing Falster and Copenhagen (54% smoked) while a significantly higher percentage of smokers was observed among women in Greenland (88% smoked). Heavy smoking was most prevalent among Danish women and associated with early debut of smoking. Among Danish women, smoking was associated with use of oral contraceptives, early age at first intercourse, and multiple sexual partners. In Greenland, smoking was associated with early sexual debut and multiple sexual partners. In an extended analysis on a subgroup of Danish women, smoking was also associated with low education and infrequent intake of vegetables. The study showed no development in smoking behaviour in any age group over the two year period between the two studies, neither in Nykøbing Falster nor in Nuuk. CONCLUSION: The high prevalence of moderate smoking among women in Greenland suggests that broad anti-smoking initiatives are urgently needed. The high prevalence of heavy smoking and a social gradient among Danish women may indicate that a strategy focusing on restrictions of smoking may be more relevant than merely continuing a pure anti-smoking information strategy.

Adult↗
PubMed1993

Clinico-epidemiological study of donovanosis in Durban, South Africa.

OBJECTIVE: To describe the epidemiological and clinical features of donovanosis and their relevance to the possible coincident risk of HIV-1 transmission in patients attending an STD clinic. DESIGN: Assessment of patients with donovanosis diagnosed by the detection of Donovan bodies on tissue smears stained by the RapiDiff technique. SETTING: City Health STD Clinic, King Edward VIII Hospital, Durban, South Africa. PARTICIPANTS: One hundred and seventy one patients with donovanosis. RESULTS: Donovan bodies were detected in 171 (130 men, 41 women). Ulcers were present for longer than 28 days in 72 (55.4%) men and 19 (46.3%) women. Ninety five (55.6%) came from rural areas. Lesions were ulcero-granulomatous in 162, hypertrophic in eight and necrotic in one. Anal lesions were detected in one woman. Only one of 21 regular sexual partners examined was infected with donovanosis. Complete healing was observed in 41 (24%) who attended for follow up. Extensive lesions were sometimes observed in pregnant women. Serological tests for syphilis were positive in 40 (23.4%). HIV-1 antibodies were detected in 4/48 men and 0/15 women who underwent HIV testing. Donovanosis ulcers in three HIV-1 seropositive men were cured by standard antibiotic therapy. CONCLUSIONS: Delay in presentation, extensive areas of genital ulceration and lack of co-existent infection with donovanosis among sexual partners were notable features. Primary health care facilities in rural areas do not appear to be providing an adequate service for patients with donovanosis. HIV control programmes should consider specific measures aimed at eradicating donovanosis in areas where the condition is prevalent.

Adolescent↗
PubMed1983

Partner reaction following ostomy surgery.

This study was conducted to obtain information regarding sexual adjustment following ostomy surgery and to explore the spouse/partner's reaction upon resuming sexual activities following surgery. Home interviews were conducted with 40 subjects who had a permanent stoma, where the mean length of time since surgery averaged 4.6 years. Retrospective perceptions of the spouse/partner's reactions were varied. A majority reported that their spouses reacted positively to the first sexual experience following ostomy surgery. However a substantial number of subjects stated that their sexual partner reacted with caution ("fear of hurting me") or in a negative manner. This and previous studies indicate that the sexual partner plays a key role in helping the person adjust following ostomy surgery.

Adaptation, Psychological↗