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Sexual behavior among employed male rural migrants in Shanghai, China.

A study of sexual behavior in migrant men was conducted in construction sites, markets, and factories in Shanghai, the largest city in China. An anonymous, self-administered questionnaire was completed by the migrants. Among 986 sexually active men, 14% had had more than one sexual partner in their lifetime, 31% premarital sex, 3.3% oral sex, and 11.5% commercial sex. Seventy-eight percent never used condoms. Risk-taking was similar in different working venues but increased with decreasing age. Younger men initiated sexual intercourse earlier and had more premarital sex and sexual partners as well as more frequent sexual encounters. Risk-factors that correlate with having multiple sex partners included having seen pornography, early age at initiating sexual intercourse, premarital sex, and a desire for legalization of commercial sex. Sexually transmitted diseases and HIV are likely to increase among migrants, particularly those who are young. Intervention strategies should target younger migrants, and must accommodate a low literacy level.

Adolescent↗

Alcohol use, perceptions of the effects of alcohol use, and condom use in urban minority youth.

This study examined the relations between alcohol use, perceived effects of alcohol use, and condom use in three different types of sexual partners in African American and Hispanic youth. Data were drawn from a household probability sample of minority youth (N = 1435) living in Detroit. Relationships were examined among three types of sexual partners: "married/lived with" partners, "knew well" partners, and "casual" partners. The effects of alcohol on condom use and perceived effects of alcohol on condom use were investigated using multiple regression with controls for demographic variables and sexual history. The quantity of alcohol consumed with partners was negatively related to condom use in all types of partners. The quantity of alcohol use was also negatively related to the perceived effect of alcohol use on condom use only with "knew well" partners.

Adolescent↗

Time of exposure and risk of HIV infection in homosexual partners of men with AIDS.

We interviewed, and tested for HIV antibody, 117 homosexual men who had been regular sexual partners of men who developed acquired immunodeficiency syndrome (AIDS); 85 tested seropositive. Receptive anal intercourse with the index AIDS case and number of different sexual partners with whom subjects were anally receptive were both risk factors. Controlling for the number of partners with whom subjects were anally receptive, we found that the odds ratio of receptive anal intercourse with the case was infinite (95% confidence intervals, 3.3-infinity) if sexual contact continued up to or beyond the time of diagnosis, while the odds ratio was 1.0 (95% CI 0.3-3.2) if contact ceased before the case's AIDS diagnosis. Risk was not associated with the duration or frequency of contact. Our data suggest that the potential for sexual transmission from an HIV-infected person may be greater close to or after the onset of disease.

Acquired Immunodeficiency Syndrome↗

Hepatitis B markers in men seeking human immunodeficiency virus antibody testing in Mexico City.

OBJECTIVES: To estimate the prevalence and associated risk factors of hepatitis B virus (HBV) serologic markers in 1,377 men with high-risk sexual behavior attending a center for human immunodeficiency virus (HIV) detection in Mexico City. METHODS: The study population consisted of all men who were tested for HIV from March to September, 1992. Study participants responded to a standardized questionnaire and provided a blood sample for serology. RESULTS: A total of 1.9% of the population were hepatitis B surface antigen (HBsAg) carriers, and there was a significant difference in HBsAg prevalence between HIV-negative (0.8%) and HIV-positive individuals (7.9%). Sexual preference was associated with HBsAg prevalence; only 0.3% of men who had female sexual partners exclusively were HBsAg carriers, compared with 4.8% of men who had male sexual partners exclusively. Prevalence of antibodies to hepatitis B core antigen (anti-HBc) was 15.4%. However, men who reported only female partners had a 4.6% prevalence, whereas men who had only male partners had a 30.4% prevalence. Logistic regression analysis demonstrated an association of anti-HBc prevalence with age, marital status, sexual preference, seropositivity for HIV, and antibodies to herpes simplex virus type 2. CONCLUSIONS: These data demonstrate that coinfection with HBV is common in the HIV-positive men studied. The highest prevalences of HBsAg and anti-HBc were observed among homosexual men. These results highlight the need to intensify safe-sex education campaigns and to promote hepatitis B vaccination especially among this population group.

AIDS Serodiagnosis↗

Nonrandom mating in Drosophila melanogaster laboratory populations derived from closely adjacent ecologically contrasting slopes at "Evolution Canyon".

Ecological differentiation of natural populations of Drosophila melanogaster, Drosophila simulans, and another drosophilid, Zaprionus tuberculatus, in "Evolution Canyon," Mount Carmel, Israel, is well established. The fitness complex of D. melanogaster includes oviposition temperature preferences, tolerance to high temperature, drought stress and starvation, and different longevity patterns. This remarkable differentiation has evolved despite small interslope distances (only 100-400 m), within easy dispersal distance. The differences between populations are those expected from genetic adaptation to local microclimates. How such differentiation could evolve and be maintained despite the likelihood of genetic exchange between populations is a challenging question. We hypothesized that interslope microclimatic differences caused strong differential selection for stress tolerance, accompanied by behavioral differentiation (habitat choice and reduced migration rate), reinforced by sexual isolation. Here we report highly significant mate choice by flies from different slopes of the canyon, with preference for sexual partners originating from the same slope. No preferences were found when the sexual partners belonged to different isofemale lines from the same slope.

Animals↗

Prevalence of antibodies to human papillomavirus (HPV) type 16 virus-like particles in relation to cervical HPV infection among college women.

A human papillomavirus type 16 (HPV-16) virus-like particle (VLP)-based enzyme-linked immunosorbent assay (ELISA) was used to measure serum antibody to capsid proteins in 376 sexually active college women who were also screened for the presence of genital HPVs by PCR and interviewed for demographic and behavioral risk factors for HPV infection. The seroprevalence was 46% in women with HPV-16 DNA in the genital tract. The corresponding values for women who harbored other HPV types or no HPV in the genital tract were 30 and 19%, respectively (HPV-16 group versus no-HPV group; odds ratio [OR], 3.7; 95% confidence interval [CI], 1.5 to 8.9). The antibody response was significantly higher among women with a high viral load than among those with a low viral load (median optical density value, 0.838 versus 0.137, P = 0.009). Comparable levels of seroreactivity were observed among women infected with HPV types distantly or closely related genetically to HPV-16. Seroreactivity was significantly associated with an age of 25 to 30 years (OR, 2.3; 95% CI, 1.2 to 4.4), three or more lifetime sexual partners (OR, 2.9; 95% CI, 1.1 to 10), and history of a sexually transmitted disease other than HPV (OR, 3.1; 95% CI, 1.5 to 6.3). The percent seropositivity increased linearly with number of lifetime sexual partners until reaching a plateau at 35% for women with more than six partners (chi for linear trend, P < 0.001). The low sensitivity of HPV-16 VLP-based ELISA may limit the usefulness of the assay as a diagnostic test for HPV-16 infection. However, the assay appears to have adequate specificity and should be useful as an epidemiological marker of HPV-16 infection and sexual behavior.

Adolescent↗

Women and AIDS: social determinants of sex-related activities.

Female sexual partners of injection drug users are at risk for AIDS because of their association with street drug cultures and all their concomitant risks, including their own non-injecting drug use. This study examines a model of the social determinants of HIV-associated sexual risk behaviors. Multiple linear regression analysis was used to analyze the data for 207 female sexual partners who had never injected drugs. The findings show that crack cocaine use is the strongest contributor to the model, which explains fourteen percent of the variance of sexual risk behavior. The findings suggest that the risks associated with sexual practices are much greater for crack cocaine users than among non users of crack.

Acquired Immunodeficiency Syndrome↗

Cigarette smoking and cervical cancer: meta-analysis and critical review of recent studies.

The objective of this study is to investigate the strength of the epidemiological evidence for a relationship between smoking and cervical cancer by analysis of recent literature. I conducted a meta-analysis of all eligible case-control studies published in English from 1977 to July 1990, with the primary intent of examining the relationship between smoking and cervical cancer. I identified nine eligible studies. Data pooled from eight studies using similar definitions for cervical cancer and classification of smoking showed a significant effect on cervical cancer of ever having smoked, with a crude odds ratio (OR) of 1.46 (95% confidence interval [CI] 1.34-1.58). And, from those studies which adjusted for age and number of sexual partners, a weighted OR of 1.42 (95% CI 1.33-1.51) was obtained. A significant association between smoking and cervical cancer emerges. Data from these studies suggest a 42%-46% increase in cervical cancer among smokers, even after controlling for age and number of sexual partners.

Adult↗

Risk factors for HIV-1 infection among women in the Arusha region of Tanzania.

Risk factors for HIV-1 infection among women were assessed through a population-based cross-sectional study in the Arusha region of northern Tanzania. The study participants were obtained by randomly selecting 10-household clusters from Unga limited, the town of Babati, and the roadside village of Matufa, which are urban, semi-urban, and rural communities, respectively. Informed verbal consent for participation in an interview and in HIV-1 testing was sought from each respondent. Blood samples were collected from each consenting individual for HIV-1 antibody testing using enzyme-linked immunosorbent assay (ELISA), and all positive sera were confirmed using repeated ELISA tests. Information of risk factors was obtained through the interview process using a structured questionnaire. Of the 567 women who gave blood samples, 48 (8.5%) were HIV-1 positive. The HIV-1 seroprevalence rates among women in the urban area, the semi-urban area, and the rural village were 14.4%, 6.9% and 2.3%, respectively. Factors associated with significantly higher HIV-1 seroprevalence were urban residence; history of having traveled out of the Arusha region within Tanzania, as well as having traveled abroad; having multiple sex partners; and having sexual intercourse under the influence of alcohol. Women who reported ever having used condoms had significantly higher probability of being infected with HIV-1 than those who had never used condoms, suggesting that condom use may be a marker of high-risk sexual behavior and that condom use is probably not adhered to in a way that consistently protects against HIV-1 infection. These results suggest the need for health education interventions aimed at increasing appropriate and consistent condom use and reduction of the number of sexual partners.

Adolescent↗

Sexual lifestyle of women attending inner-city general practices for cervical smears.

Despite high prevalences of sexually transmitted infections, little is known about the sexual lifestyles of women attending inner-city general practices. Responses from a 1996 questionnaire showed that age at first intercourse and numbers of sexual partners were similar to the national survey five years earlier. However, only 49% of women reporting > or = 2 sexual partners in the past year said their partner had used a condom at the last sexual intercourse.

Adolescent↗

Risk factors for hepatitis C virus infection in blood donors: a case-control study.

OBJECTIVE: To investigate risk factors for hepatitis C virus (HCV) infection in Sydney blood donors. DESIGN: Blood donors confirmed to be positive for HCV antibodies were compared with blood donors with a positive result of a screening assay, but whose HCV antibody status had not been confirmed. A questionnaire on sexual, parenteral and other potential risk factors was administered to both groups. SETTING: Blood Transfusion Service in Sydney. PARTICIPANTS: The study enrolled 220 donors who had confirmed HCV infection, and 210 donors who did not. RESULTS: The relative risk associated with injecting drug use was 63 (95% confidence interval, 19-260) when comparison was made with all other donors. Among donors who did not report injecting drug use, a significant, independent increase in risk was found in association with having had a tattoo. Among donors who did not give a history of parenteral exposure, there was a significantly greater risk in people with more than one life-time sexual partner than in those with at most one partner. CONCLUSION: A history of injecting drug use was elicited as the most important risk factor in Sydney blood donors with antibodies to hepatitis C. Having had a tattoo, and an increased number of lifetime sexual partners were also independently associated with HCV infection.

Adult↗

AIDS awareness and sexual behaviour in a high HIV prevalence area in rural northern Kwazulu-Natal, South Africa.

The objective was to assess AIDS awareness and sexual behaviour in a rural South African community with a high HIV prevalence. One hundred clinic attenders underwent a structured interview using a standard questionnaire. Although the 64 female and 36 male patients, mean age 22 (range 13-45), had good knowledge of AIDS-related issues, only 50 perceived HIV/AIDS as a common problem. Of the 75 patients who were sexually active only 30 (40%) used condoms (men 16; 55% vs women 14; 30%, P=0.033) despite being better informed about the protective effect of condoms (active 61; 81% vs abstinent 14; 56%, P=0.011). More men than women admitted to multiple sexual partners (17; 47% vs 7; 11%, P<0.0001). In conclusion, despite a high level of awareness of HIV/AIDS issues, self-perceived risk was low, condom use was infrequent and especially men continued to have multiple sexual partners. Awareness has yet to translate into reduction of risk behaviour.

Acquired Immunodeficiency Syndrome↗

Recidivism among patients with gonococcal infection presenting to a venereal disease clinic.

We studied the incidence of gonorrhea, gonococcal recidivism and related factors in venereal disease clinic patients. A sample of 2029 records, which were selected randomly, were reviewed. Gonorrhea and gonococcal recidivism were more common in nonwhite patients, particularly in nonwhite men. Gonorrhea occurred more than once in 23% of the patients with gonorrhea and those patients accounted for 48% of all cases of gonorrhea. We also interviewed 627 new patients attending the venereal disease clinic. Gonococcal recidivism was reported more often by older men and younger women. Use of contraceptives was less frequent among white women who were gonococcal recidivists. However, contraception was not used by 40% of the patients or their partners. Gonococcal isolation rates were lowest in men who used condoms. The number of sexual partners did not correlate with age, use of contraceptives or results of cultures for gonococci. Men had more sexual partners than women and white women had more partners than non-white women. Nine percent of patients took oral antibiotics prior to their visit to the clinic; antibiotic ingestion did not correlate with the patients' race or the results of their cultures.

Adult↗

Intracavernosal drug-induced erection therapy versus external vacuum devices in the treatment of erectile dysfunction.

OBJECTIVES: To determine if there is a significant difference between intracavernosal self-injection and external vacuum devices when compared directly for satisfaction, effectiveness and side-effects. PATIENTS AND METHODS: Fifty men were randomised into two groups and received either instruction on the use of the Osbon ErecAid system or self-injection therapy. After 15 uses, each group completed a questionnaire detailing efficacy, satisfaction and side-effects, and then changed to the other modality after appropriate instruction. A questionnaire was completed by study participants and their sexual partners after using both methods. Patients were followed for 18-24 months using telephone interviews. RESULTS: Forty-four patients (mean age 62.3 years, range 38-84) completed the study. Patients and their partners reported a superior quality of erections with the injection method but the difference did not reach statistical significance. The ability to attain orgasm and the overall satisfaction of the patient and partner with the sexual experience was significantly better when using injections. Side-effects were similar between the modalities. Subgroups analysed for age, duration and aetiology of impotence showed that younger patients (< 60 years), those with a shorter duration of impotence (< 12 months) and those impotent secondary to radical prostatectomy strongly favoured injection therapy (P < 0.05). Overall, of the 44 couples, the final preferences of the patients were 25 (57%), 12 (27%), six (14%) and one (2%) for the injection, vacuum device, both or neither, respectively, and of the partners were 22 (50%), 12 (27%), six (14%) and four (9%), respectively. At 18-24 months, 80% of patients were still using either the vacuum device, injections, or both. CONCLUSION: Both the vacuum device and injections are effective treatment modalities for impotence and are associated with good long-term success. Overall, there was a trend favouring injection therapy over the vacuum device which was most significant in younger patients, those with a shorter duration of impotence, and those impotent secondary to radical prostatectomy.

Adult↗

The influence of different sexual-contact patterns between age classes on the predicted demographic impact of AIDS in developing countries.

A model is developed to describe the spread of HIV within heterosexual communities and the demographic impact of AIDS. The model combines epidemiologic and demographic processes and is designed to mirror the impact of AIDS in sub-Saharan Africa. Refinements on past work in this area include unequal probabilities for transmission from females to males and from males to females, the inclusion of an age- and sex-dependent sexual-partner choice function and distributed incubation plus infectious periods. Numerical studies suggest that unequal transmission probabilities (weighted to a greater probability from males to females than vice versa), and the tendency of males to choose sexual partners of the opposite sex younger than themselves, both act to increase the demographic impact of AIDS over that predicted with equal transmission between the sexes and partner choice restricted within given age classes. Analyses support the conclusions of past work that the epidemic will only have a small detrimental impact on the dependency ratio of a population (the ratio of dependents to working adults) even when a weighting is added to take account of the extra burden imposed by the care of adult AIDS patients. However, a small increase in the ratio can imply a significant rise in the number of dependents within the population. Stimulation studies of the impact of changes in behavior to reduce transmission highlight to the need to induce such changes as early as possible in the course of the epidemic in order to minimize its impact. Directions for future research are discussed emphasizing the need to acquire quantitative data on sexual habits and to construct models to represent heterogeneity in sexual behavior.

Acquired Immunodeficiency Syndrome↗

Changes in the injecting risk behaviour of injecting drug users in London, 1990-1993.

OBJECTIVE: To describe changes in the injecting risk behaviour of injecting drug users (IDU) in London between 1990 and 1993. DESIGN: Injecting risk behaviour was measured over 4 years (1990-1993) in a serial point HIV prevalence study of 2062 IDU recruited in both drug treatment and non-treatment community-based settings within greater London. The study used a structured questionnaire and common sampling and interview strategy developed by a World Health Organization technical group and implemented in 13 cities. METHODS: Log-linear models were used to assess patterns of change over years and of differences in injecting risk behaviour, including syringe sharing and syringe hygiene between 1990 and 1993. The log likelihood chi 2 statistic, G2, was used to test statistical significance. Changes in the mean values were assessed first using parametric tests assuming normality and the results were compared with Kruskal-Wallis (non-parametric) tests. Pearsons chi 2 was used to measure differences in frequency of sharing occasions and partner selectivity. RESULTS: An overall reduction in injecting risk behaviour was observed during the first 2 years of this study, including a decline in syringe sharing (both accepting and passing on used syringes), the number of sharing partners and the frequency of sharing occasions. Most sharers restricted sharing to sexual partners and close friends. The majority of sharers reported always cleaning injecting equipment. Main source of sterile equipment was pharmacies and syringe exchanges. Indirect sharing (of spoons, filters, and by front- or backloading) was reported. Since 1991 there has been a stabilization in risk behaviour. CONCLUSIONS: The data indicate that IDU in London have made positive reductions in risk behaviour. Levels of syringe sharing were substantially lower than those reported up to 1987 before AIDS awareness and the introduction of HIV prevention measures. The majority did not share syringes or confined their sharing to close friends and sexual partners, and if shared, cleaned their syringes. Continuation of indirect sharing indicates the need for more detailed prevention messages. While the initial decline in syringe-sharing rates may be attributed to the wide availability of sterile injecting equipment and other preventive measures, it may now be necessary to look beyond current intervention initiatives to develop interventions which seek to change the social etiquette of sharing and move towards the long-term maintenance of low levels of injecting risk behaviour.

Adult↗

The sexual and reproductive behavior of American women, 1982-1988.

Comparison of 1988 data from the National Survey of Family Growth with 1982 data reveals that the proportion of U.S. women who have had sexual intercourse rose slightly, from 86 percent to 89 percent. Among teenagers, the proportion sexually active rose from 47 percent to 53 percent; most of the change is attributable to increases occurring among white and nonpoor teenagers, thus narrowing racial and income differences. Among women aged 15-44 in 1988 who have ever had intercourse, 67 percent reported that they had had two or more sexual partners in their lifetime. The proportion was highest among women aged 20-34 (about 70 percent), but 58 percent of sexually active teenage women reported having had two or more sexual partners. About 67 percent of women of reproductive age in 1988 were exposed to the risk of unintended pregnancy, up from 63 percent in 1982. Among these women, 35 percent rely on contraceptive sterilization to prevent pregnancy and 55 percent use reversible methods, while 10 percent use no method. Poor women are much more likely than nonpoor women to be using no method of contraception (15 vs. eight percent); among poor teenagers, this proportion reaches 25 percent. The level of contraceptive use at first intercourse among teenage women improved substantially between 1982 and 1988, however, rising from 48 percent to 65 percent. During 1984-1988, almost four in 10 births and almost six in 10 pregnancies among American women were unintended; most of these were mistimed, but 12 percent of births were unwanted ever.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Determinants of genital human papillomavirus infection in young women.

Carcinoma of the cervix has several well-established epidemiologic risk factors, including multiple sexual partners and early age at first intercourse. Human papillomavirus (HPV) infection appears to have an etiologic role in the development of cervical neoplasia, but evidence linking HPV infection to known risk factors for cervical cancer has been inconsistent. The lack of expected correlations may be due to the inaccuracy of HPV assays previously used. A polymerase chain reaction DNA amplification method for the detection of HPV was used to investigate the determinants of genital HPV infection in a cross-sectional sample of 467 women attending a university health service. In contrast to studies using less accurate detection methods, the risk factors for HPV infection found here were consistent with those for cervical neoplasia. The risk of HPV infection was strongly and independently associated with increasing numbers of sexual partners in a lifetime, use of oral contraceptives, younger age, and black race. Age at first intercourse, smoking, and history of a prior sexually transmitted disease were correlated with, but not independently predictive of, HPV infection. These results demonstrate that the key risk factors for cervical carcinoma are strongly associated with genital HPV infection. This correlation suggests that HPV has an etiologic role in cervical neoplasia and reaffirms the sexual route of HPV transmission.

Adolescent↗