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PubMed2003

Characteristics of HIV-infected childbearing women in Barbados.

OBJECTIVE: To describe the demographic profile, social and family characteristics, and lifestyle traits of HIV-infected childbearing women in the Caribbean nation of Barbados in comparison to a control group of HIV-negative women. METHODS: Data for this report were drawn from the Pediatrics HIV Surveillance Program of the Queen Elizabeth Hospital in Barbados. The data covered all HIV-infected women in the country who delivered between 1986-2000, with similar data coming from a control group of HIV-negative childbearing women. Routine information recorded during antenatal care was obtained from the women's case records. Additional data were collected from interviews with the women. RESULTS: There were 182 HIV-infected women who delivered during the study period, and a group of 202 childbearing women served as controls. In comparison to the control group, the HIV-infected women were younger, more often multiparous, and more likely to have been unemployed at the time of their pregnancy. The HIV-infected women also had had an earlier onset of sexual activity, had had more sexual partners during their lifetime, and were more likely to be involved with an older sexual partner. At the time of giving birth most of the HIV-infected women were asymptomatic for AIDS and were living with either their parents (mother or father or both) or the baby's father. In addition, at the time of their six-weeks-postnatal visit, the large majority of the HIV-infected women were involved in caring for their children. The proportion of HIV-infected women who were diagnosed prior to childbirth increased significantly over the study period, rising from 25% during 1986-1990 to 82% during 1996-2000. Slightly over one-fifth of the HIV-infected women had had one or more subsequent pregnancies after they had learned that they were infected. CONCLUSIONS: The early age of sexual activity as well as repeated pregnancies, especially from different and older partners, may have contributed significantly to both vertical and horizontal HIV transmission in Barbados. Future studies of HIV incidence and its trend among childbearing women could be important for monitoring the HIV epidemic in this country. Many of the HIV-infected childbearing women in our study were unemployed, sick, and had multiple children. Therefore, to help them to plan for and cope with the disease and also the care of their children beyond the perinatal period, there is a need to provide the women with repeated counseling with continued follow-up and, where necessary, additional economic, social, and medical support.

Adolescent↗

PubMed1992

Effects of communication with important social referents on beliefs and intentions to use condoms.

Data from a 1989 survey using the condom attitude and belief instrument with 310 clients from two sexually transmitted disease clinics identified significant social referents who influence condom-use intentions. They are sexual partner, father and friends. The present study found that communication with these referents had a positive net effect on beliefs about and intentions to use condoms. Implications applicable for intervention programmes to increase condom use are to promote talking about condoms between the sexual partners and important social referents and to develop such communication skills.

Adolescent↗

PubMed2004

A prospective study of intraindividual and peer influences on adolescents' heterosexual romantic and sexual behavior.

Theories and empirical studies of adolescent sexual behavior have identified the contributions of personal attributes and social experiences; however, it is rare that models have clarified developmental pathways to adolescent sexual behavior that include (1) factors assessed prior to and early in adolescence and (2) dyadic experiences in adolescence that provide the opportunity for sexual behavior (i.e., dating). Using data from a prospective study, structural equation modeling was used to test a model predicting adolescent sexual behavior at age 19, denoted by the number of lifetime sexual partners. Predictors examined were sociability and impulsivity assessed at 30 months of age, physical characteristics and experiences with peers measured at age 12-13, the age of first romantic relationship, and frequency of alcohol use at age 16. The pathway to greater sexual involvement was marked by some desired personal attributes (e.g., sociability) and peer experiences (e.g., higher quality friendships). These associations were mediated, however, by earlier initiation of romantic relationships and more frequent use of alcohol in middle adolescence. Earlier initiation of romantic relationships and more frequent alcohol use were predicted by greater sociability and less impulsivity in childhood, higher quality friendships and greater peer acceptance in early adolescence, and a more mature appearance and physical attractiveness (among females) at age 13. The findings imply a complex pathway that leads to a greater accumulation of sexual partners by age 19. This pathway begins in childhood and includes individual qualities, peer acceptance, romantic relationships, and alcohol use.

Adolescent↗

PubMed2006

A population-based and longitudinal study of sexual behavior and multidrug-resistant HIV among patients in clinical care.

BACKGROUND: Population-based and longitudinal information regarding sexual risk behavior among patients with multidrug resistant (MDR) HIV and their sexual partners is of great public health and clinical importance. OBJECTIVE: To characterize the HIV sexual risk behaviors of patients with and without drug-resistant HIV in the clinical care setting over time. MEASUREMENTS: 393 HIV-positive patients completed questionnaires of self-reported sexual risk behaviors at approximate 6-month intervals extending over 24 months. HIV viral load and genotypic drug resistance obtained during the same time points were matched to the behavioral data. Multidrug resistance was defined as having resistance to 2 or 3 antiretroviral (ARV) drug classes. RESULTS: In serial cross-sectional analyses, 393 patients (44% female and 79% heterosexual) contributed 919 matched behavioral and virologic results over the 24 months of data collection. Of these, 250 patients (64%) reported having sex during at least 1 survey period resulting in greater than 10,000 sexual events with more than 1000 partners. Unprotected sexual behavior was reported by 45% of sexually active patients, resulting in 34% of all sex events that exposed 29% of all partners. Of these patients with unprotected sexual events, 31% had HIV drug resistance--11.6% with resistance to 2 classes of ARVs (2-class), and 1.8% with 3-class ARV resistance at the time of a sexual risk event. Close to 1000 or 28% of all unprotected sexual events involved resistant strains (11% of these with resistance to 2 classes and 0.2% with 3-class resistance, exposing 20% of unprotected sexual partners to resistant HIV (8% to 2-class and 0.6% to 3-class resistance). In longitudinal analysis among the 78 patients who reported a cumulative total of 12 months of sexual history and had resistance testing, 38% reported engaging in unprotected sexual behavior. There was substantial and complex variation in the distribution of unprotected sexual events and in the detection of resistance over time. CONCLUSION: In this study of HIV sexual risk and resistance over time among HIV-infected patients in clinical care, a substantial proportion engaged in unprotected sex and had drug-resistant HIV, frequently exposing partners to 1- or 2-class resistant HIV strains. However, relatively few exposures involved 3-class resistance. The dynamics of sexual risk behavior and HIV drug resistance are complex and vary over time and urgently require both general and targeted interventions to reduce transmission of resistant HIV.

Adult↗

PubMedDate not supplied

Students' sexual behavior, knowledge, and attitudes relating to the acquired immunodeficiency syndrome.

Five hundred ninety students receiving primary care in a university health service were surveyed anonymously in 1985-86 to study their self-reported sexual behavior and knowledge and attitudes about acquired immunodeficiency syndrome (AIDS). Most students (75%) were heterosexual; 3% were homosexual, 3% bisexual, and 15% had never been sexually active. Many students (32%) had greater than or equal to 2 sexual partners in the past year, but only 23% of these had changed their sexual practices because of concern about AIDS. Some students with high-risk sexual behavior were not very knowledgeable: among homosexual or bisexual men, those with greater than or equal to 6 recent sexual partners knew less than others (P less than 0.001). Overall, less knowledgeable students had more personal concerns about AIDS, favored limiting the social activities of people infected with human immunodeficiency virus (HIV), and favored screening for HIV-antibody; these associations between knowledge and attitudes were significant even when controlling for demographic characteristics and sexual behavior with multiple linear regression. The authors conclude that many students receiving primary care reported sexual behavior that could spread HIV, and that less knowledgeable students had particular concerns and attitudes about AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Acculturation, sexual behavior, and alcohol use among Latinas.

We explored the relationship of alcohol use to unsafe sex in Latinas. Telephone interviews were conducted with 523 currently sexually active Latinas aged 18-49 years. Only 7.5% of these women used alcohol half of the time or more prior to sex. "Regular" alcohol users had more sexual partners, but also had more experience with condom use, used condoms with primary partners as frequently as nonusers of alcohol, and used condoms more with secondary partners. While Latinas who use alcohol prior to sex more often have multiple sexual partners, alcohol use does not appear to interfere with condom use.

Acculturation↗

PubMed2003

Risk-taking sexual behaviour and self-reported depression in middle adolescence--a school-based survey.

BACKGROUND: Early sexual activity has been widely studied in the context of pregnancies, substance use and antisocial behaviour, but the aspects of psychosexual health have received less attention. AIM: To study the associations of early sexual activity and self-reported depression. SETTING: A school survey in Finland in 1999 and 2000 in the eighth and ninth grades. METHODS: Adolescents with experience of sexual intercourse were studied (11,793 girls and 10,443 boys, mean age 15.5 years). Scores of 8 or more in the Beck Depression Inventory were regarded as indicative of self-reported depression. Associations with sexual behaviour variables were analysed using logistic regression models. RESULTS: In both genders, self-reported depression increased in proportion to the number of sexual partners and with the non-use of contraception. A higher number of coital experiences correlated with depression only among boys. Adjusting for age and age at menarche/oigarche did not affect the associations detected. In stepwise logistic regression, an increasing number of partners increased the risk for self-reported depression [for boys with at least five partners odds ratio (OR) 2.5, 95% confidence intervals (CI) 2.2-3.0, and for girls OR 2.7, 95% CI 2.3-3.2]. Boys and girls who did not use contraception showed roughly twice as high a risk as contraceptive users. However, girls with five or more coital experiences had a significantly lower risk for depression compared to girls with only one sexual intercourse. CONCLUSIONS: Multiple sexual partners and non-use of contraception may reflect a depressive disorder in both genders. While adolescent health service providers should be aware of the risk for depression among sexually active adolescents, the sexual health of depressed adolescents also warrants special attention.

Adolescent↗

PubMed1960

Early infectious syphilis. Male homosexual relations as a mode of spread.

Homosexual relations play an important part in the transmission of infectious syphilis. A preponderance of the males with infectious syphilis treated in Los Angeles City Health Department clinics in 1959 admitted to exclusively homosexual relations during the period in which they became infected. In the interviewing of males with infectious syphilis, inquiry should routinely be made relative to possible homosexual relations, for investigation of the sexual partners of homosexual males is particularly productive in terms of new case finding. The practicing physician's awareness of the epidemiological significance of homosexual activity will influence his degree of clinical suspicion, his attitude in the physician-patient relationship and his concept of the opportunity and responsibility of bringing to examination the infected patient's sexual partners.

Attitude↗

PubMed2000

Sexual molestation of men: interviews with 224 men attending a genitourinary medicine service.

Prevalence studies of sexual molestation in men attending genitourinary medicine (GUM) clinics have concentrated on experiences in adulthood or as a child, or on men who report male sexual partners only. Use of questionnaires in such studies can lead to under-reporting of 'sensitive' events. Our aim is to identify the lifetime prevalence of sexual molestation in men attending a GUM clinic using a self-administered, computerized interview via a cross-sectional survey. Eighteen per cent of respondents reported sexual molestation as an adult and 12% reported child sexual abuse (CSA). Sexual molestation in adulthood was more common in men who reported male sexual partners and in men reporting child sexual abuse. Fourteen per cent of victims reported being infected with a sexually transmitted infection (STI) after adult sexual molestation. In conclusion, a significant proportion of men attending GUM services report sexual molestation. Further research is required into effective ways of addressing this unmet need.

Adolescent↗

PubMed1998

Preventive counseling of HIV-positive men and self-disclosure of serostatus to sex partners: new opportunities for prevention.

This study examined whether preventive counseling of HIV-positive men (N = 255) was associated with self-disclosure of serostatus to sex partners. Men who reported being counseled at posttest and at their current HIV clinic to disclose their serostatus to partners were more likely to have done so than men counseled only at posttest, only at the HIV clinic, or not counseled at either site. Disclosure increased with the number of times counseled at the HIV clinic. These patterns held for HIV-negative partners, but not for HIV-positive or HIV-unknown partners. Disclosure to HIV-negative partners was associated with safer sexual practices. The findings suggest that counseling interventions for HIV-positive men, when delivered by multiple sources, may provide an effective means of increasing disclosure to sexual partners.

Adult↗

PubMed2003

The reliability and validity of the Modified Condom Outcome Expectancy Scale (MCOES) among an international sample of HIV-negative partners of people living with HIV/AIDS.

Safer sexual behaviour is vital in curbing the HlV epidemic in many developing countries where the epidemic is primarily transmitted through heterosexual sex. Reliable and valid assessment of factors related to HIV risk behaviours are important in testing behavioural theories as well as informing effective AIDS prevention programmes. The current study tests the reliability and validity of a modified version of the Condom Outcome Expectancy Scale (COES) among a sample of HI'-negative sexual partners (n = 100) of HIV-infected individuals in Pune, India, Chang Mai,Thailand and Kampala, Uganda. Internal consistency reliability was measured using Cronbach's alpha coefficient, which had a value of 0.80 for the entire sample, with site-specific values of. 0.78 for India; 0.75 for Thailand; and 0.79 for Uganda. Test-retest reliability was conducted to test the scale's stability over time with 60% of the sample, resulting in a Cronbach's alpha coefficient of 0.70. The scale's structure was explored by analyzing response scores on the items using principal components analysis, which yielded a two-factor solution. The study indicates the utility of a modified version of the widely tested COES across international settings. Such research is necessary in understanding intervention targets across international settings.

Acquired Immunodeficiency Syndrome↗

PubMed1995

Sexual behaviour and risk of exposure to HIV among 18-25-year-olds in Scotland: assessing change 1988-1993.

OBJECTIVE: To study changes in sexual behaviour related to HIV transmission in young people between 1988 and 1993. DESIGN: Data collected by computer-assisted telephone interview with 4081 individuals aged 18-25 years resident in central Scotland. The data were collected on a monthly basis between 1988 and 1993 and aggregated into 11 6-month periods. The data were examined for changes relating to condom use, numbers of sexual partners and perceived risk of contracting HIV. METHODS: The statistical significance of observed changes over time in reported behaviours was assessed using a general linear modelling programme. RESULTS: Increasing numbers of young men and women reported behaviour change because of HIV, using condoms, and concern that they or someone close to them would get AIDS. There is no evidence of a reduction in the number of sexual partners reported by men or women or a change in the number of individuals perceiving that they are at risk of HIV infection. CONCLUSIONS: Significant changes in sexual behaviour related to HIV transmission are taking place among young people in the general population; most notably an increase in the reported use of condoms by both men and women.

Adolescent↗

PubMed1989

Condom use by heterosexuals attending a department of GUM: attitudes and behaviour in the light of HIV infection.

The use of condoms to prevent the further spread of human immunodeficiency virus (HIV) infection is one of the main themes of the government's health education campaign against AIDS. A study of the use of and attitudes towards condoms in 222 heterosexual men and women attending a department of genitourinary medicine (GUM) in central London showed that 55% (50/91) to 59% (41/70) of men or women never, and 6% (6/95) to 15% (14/91) always, used condoms with their regular or non-regular sexual partners. No major differences were found in the use of or attitudes to condoms according to age, sex, social class, or civil status. Attitudes towards the use of condoms were generally negative. These attitudes, in combination with the infrequent use of condoms with regular (and even more with non-regular) sexual partners, must be a cause for concern if the further spread of HIV is to be avoided.

Acquired Immunodeficiency Syndrome↗

PubMed1984

Preventing complications of sexually transmitted disease. New treatment guidelines for an expanded spectrum of problems.

Newly recognised sexually transmitted diseases have combined with the traditional venereal diseases to present clinicians with a demanding management challenge. Besides the increases in incidence of some of these diseases, many of the associated organisms are becoming more resistant to commonly used antimicrobial drugs. Predictably, accompanying this trend are increasing numbers of serious complications affecting men, women and infants. Timely and appropriate management of patients presenting with sexually transmitted diseases are imperative to stem the swelling tide of these conditions and prevent their insidious consequences. Clinicians must therefore remain knowledgeable about the effective therapies (and regimens) that are available. An update of the treatment guidelines for sexually transmitted diseases is provided in this article. As well as selecting appropriate antimicrobial regimens, it is equally important that clinicians educate their patients about their disease and its probable course, explain the administration of medications clearly to patients, and follow them up appropriately to detect resistant cases and non-compliers, and ultimately ensure effective treatment. In addition, no patient should be considered appropriately managed until his or her sexual partners have been properly dispositioned. For most patients, this will entail examining their sexual partners and treating them immediately. Execution of these treatment guidelines and management principles will help protect the reproductive capability of many women by preventing pelvic inflammatory disease, ectopic pregnancy, and infertility.

Chlamydia Infections↗

PubMed2003

Sexual behaviour and social class in Australian women.

Sexual behaviour is determined by social, cultural and personal factors. Sexual behaviour studies have been conducted in many countries. However, information from Australia is limited. This study was conducted in Obstetrics Department, Westmead Hospital, Sydney. Questionnaire-derived demographic and behavioural characteristics for public and private patients were compared using bivariate and logistic regression analyses. Of the patients, 3036 were public, and 595 private. On bivariate analysis some significant differences were private patients more likely to be born in Australia and have a higher education level whereas public patients were more likely to have had a greater number of lifetime sexual partners and younger age at first sex. Public patients were more likely to be herpes simplex virus type 2 (HSV-2) antibody positive (12%) than private patients (6%). On logistic regression significant variables included country of birth, being HSV-2 antibody positive, and age at first sex. A number of sexual and social variables were significantly different, comparing patients in the public and private sectors. Evaluation of interventions to reduce the sexual risk to women in the public sector should be considered, including encouraging young women to delay their sexual debut, and reducing the number of sexual partners.

Adolescent↗

PubMed1994

AIDS, HIV infection, and illicit drug use within inner-city families and social networks.

OBJECTIVES: Drug use is commonly depicted and treated as an individual problem. This study describes the extent of drug use, human immunodeficiency virus (HIV) infection, and acquired immunodeficiency syndrome (AIDS) among drug users' sexual partners and family and household members in order to broaden considerations of risk. METHODS: Social network charts and structured interviews were administered to 126 women (predominantly African American and Latino) enrolled in methadone treatment. The charts elicited the prevalence of drug use and HIV infection among subjects' family and household members. RESULTS: Drug use and HIV/AIDS permeated subjects' sexual, familial, and household relationships. More than half of the women who resided with a sexual partner reported that their partners currently used drugs. Almost one third of the subjects' siblings were drug users. Of the 715 total siblings (all subjects plus their siblings), 69 (9.7%) were known to be HIV positive or to have an AIDS diagnosis. CONCLUSIONS: The sexual, familial, and household expressions of drug use underscore the notion that drug use and attendant risks, including but not limited to HIV infection, might be usefully viewed and treated as an inter- and intracommunity problem rather than as an exclusively individual one.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Uganda study found that death reduced HIV prevalence; did the public take home the wrong message?

Uganda has had a remarkable decline in HIV prevalence, and the question of what caused this decline is controversial. An intensive study of the Rakai region of Uganda from 1994 - 2003 found that much of the decreased prevalence resulted from death of people with HIV. But the incidence of new HIV infections was low throughout this study and did not change greatly, suggesting that the real cause of the success was a large reduction in new infections before the study began. The early data presented at the February 2005 Retroviruses conference also showed increasing use of condoms, and some backsliding on reducing the number of sexual partners. But neither change was big enough to greatly affect the incidence of new infections, at least in the aggregate data across the 50 villages studied. In summary, the big reduction in HIV prevalence occurred because of changes that happened before this study, not those measured within it. Therefore the new information does not contradict reduction in the number of sexual partners as a major cause of Uganda's success.

Adolescent↗

PubMed1997

Effectiveness of the 40 adolescent AIDS-risk reduction interventions: a quantitative review.

OBJECTIVE: (1) To review evaluations of Acquired Immunodeficiency Syndrome (AIDS) prevention interventions targeting adolescents to determine whether these efforts have been effective in reducing risk behaviors. (2) To examine the relation between intervention design issues and outcomes measures. METHOD: A systematic review of five electronic databases and hand-searches of 11 journals, were undertaken for articles published from January 1983 through November 1995 that reported evaluations of adolescent AIDS risk-reduction interventions conducted in the United States. Outcomes examined include: improved attitudes about AIDS risk and protective behaviors, increased intention to abstain from sexual intercourse or to use condoms, and reduced sexual risk behaviors. RESULTS: Forty studies that met preestablished inclusion criteria were found. For each outcome assessed, a majority of studies found a positive intervention impact (88% of studies assessing changes in knowledge; 58% changes in attitude, 60% changes in intention to use condoms, 73% in condom use, and 64% in decreasing number of sexual partners). Interventions that demonstrated an increase in intention to use a condom were significantly more likely to be theory-based than those that did not show any significant changes in intention (100% vs. 0%, p = .048). Interventions that increased condom use and decreased the number of sexual partners were longer in duration than those that did not improve these outcomes. CONCLUSIONS: AIDS risk reduction interventions can be effective in improving knowledge, attitudes, and behavioral intentions and in reducing risk practices. The positive relationship between improved outcomes and several elements of intervention design underscores the need for increased focus on intervention design in future studies.

Acquired Immunodeficiency Syndrome↗