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PubMed2007

A comparison of on-line and off-line sexual risk in men who have sex with men: an event-based on-line survey.

OBJECTIVE: To assess whether men who have sex with men (MSM) are more likely to report unprotected anal intercourse (UAI) with partners met on-line compared with those met off-line. METHODS: A total of 6122 individuals consented to participate in an anonymous behavioral survey on-line. This event-based analysis is limited to the 1683 men from the United States and Canada who had sex in the 3 months before the study and reported that their last sexual encounter included a new or casual male partner or partners. Prevalence and predictors of UAI were analyzed separately for the 386 men reporting more than 1 partner (multiple) and the 1297 men reporting only 1 (single) partner in their last encounter. RESULTS: Of the 1683 MSM recruited on-line, 51% met their partner(s) in their last sexual encounter on-line and 23% reported UAI. No difference in risk for UAI was found for partners met on-line versus off-line in the bivariate or multivariate analyses. In a multivariate analysis of men with multiple-partner encounters, UAI was significantly associated with being HIV-seropositive (adjusted odds ratio [OR] = 2.87; P = 0.02) in a model that included age; education; whether partners were met on-line or off-line; and use of crystal methamphetamine, sildenafil, or alcohol before sex. Using the same model, significant predictors of UAI in men reporting a single-partner encounter were use of crystal methamphetamine (adjusted OR = 5.67; P = 0.001) and no college degree (adjusted OR = 1.63; P = 0.01). CONCLUSIONS: MSM recruited on-line who reported a new or casual sex partner(s) in the prior 3 months are at considerable risk of HIV or other sexually transmitted infections, but they are equally likely to report UAI whether sex partners were met on-line or off-line. The Internet may be an ideal venue for reaching high-risk MSM.

Adolescent↗
PubMed1989

Prevalence of HIV antibody in high and low risk groups in England. Public Health Laboratory Service Working Group.

Most studies of the spread of HIV infection have centred on homosexuals and intravenous drug users. To estimate the extent of infection in different groups, including heterosexuals, the prevalence of HIV antibody was studied in 34,222 subjects tested with consent between October 1986 and December 1987 in England. These included subjects in high risk groups for HIV infection, heterosexuals with partners in the high risk groups and heterosexuals with multiple partners or with no identifiable risk factors. The prevalence was highest in homosexual or bisexual men in London (15.1%; 213/1412), being 4.0% (146/3607) outside London. The yearly incidence of infection in 632 homosexual or bisexual men without HIV antibody when retested during the study period was 3%. Among intravenous drug users the prevalence of HIV antibody was 5.7% (36/633) in London and 1.5% (39/2562) outside. Of 3272 heterosexual subjects tested, whose partner was in a risk group, eight of 515 (1.6%) in London and six of 2757 (0.2%) outside were positive for the antibody. Among 20,455 heterosexuals with a history of multiple partners or with no declared risk, only six subjects with HIV antibody were identified, two of whom had been infected abroad. Heterosexual spread of infection in England is evidently still largely confined to subjects whose partner has an identifiable risk.

Cross-Sectional Studies↗
PubMed2006

The economics of mutualisms: optimal utilization of mycorrhizal mutualistic partners by plants.

Can choice of mutualistic partners and the degree of their utilization determine (1) mutualistic partner coexistence, (2) relative abundance of mutualistic partners, and (3) environment-dependent changes in relative abundance? We investigate these questions in the context of the plant-mycorrhizal fungal mutualism by building a biological market model potentially applicable to other mutualisms as well. We examine the situation where a single plant selectively utilizes member(s) of a group of ectomycorrhizal potential trading partners. Under biologically realistic circumstances, the plant may simultaneously utilize multiple partners, its degree of utilization determining the community structure of the fungi. If utilization of multiple partners is optimal, the marginal cost of acquiring additional nitrogen from every trading partner must be equal while the marginal cost of acquiring it from any unutilized partner must be larger. Because the plant's nitrogen demand is light dependent, the composition of the fungal species among its trading partners changes along light-availability gradients. We discuss the design of an experiment to test the key prediction of our model, the equalization of marginal cost.

Models, Theoretical↗
PubMed1989

Sexual behaviour of injecting drug users and associated risks of HIV infection for non-injecting sexual partners.

The sexual behaviour of 142 clients of syringe-exchange schemes was measured using a questionnaire interview based survey method. Two to four months later the questionnaire was repeated to provide measures of behavioural change. The majority of these clients were sexually active, 77% having one or more sexual partners in the 3 months prior to the first interview. Many of these clients (46% of those sexually active) had sexual partners who did not inject drugs. There is evidence that this group modified their sexual behaviour towards reducing their own risk of HIV infection, with more having no sexual partners (from 23% to 31%), a reduction in those having multiple partners (from 26% to 21%) and a slight increase in those with regular partners (from 49% to 52%). Not all clients in this group reduced their risk of infection by modifying their sexual behaviour. Some clients continued to engage in high risk sexual behaviour, having multiple partners (21%) and not using condoms (79%). Whilst overall there is evidence of changes in the sexual behaviour of the clients towards a reduced risk of infection, we have identified an associated increase in risk of transmission from them to their sexual partners. Drug injectors who continued to have sexual partners were more likely to have sexual partners who did not inject drugs.

Adult↗
PubMed1999

Reaching homosexual men for HIV surveillance through a gay magazine.

HIV surveillance in homosexual men is poor in most countries, as this risk group is difficult to sample. The aim of this study is to test the feasibility of reaching homosexual men for national HIV surveillance using gay community media. In 1989, a questionnaire on general gay issues, with a section on AIDS, was included in a widely sold gay magazine in the Netherlands. Among 17,700 sold copies, 1134 responses were obtained from males (6%). Of these, 669 men (59%) gave their address, of which in turn 84% responded to a questionnaire on risk behaviour in 1990. In 1991/1992, the 669 men were asked to participate in an HIV serosurvey, in which eventually 308 participated with a blood test (46%) and 147 without (total 68%). Participation in the serosurvey with blood test was associated with reporting multiple partners in 1989. Twenty participants were infected (6.5%). In logistic regression analysis, risk factors for infection were recent unprotected receptive anal intercourse with multiple partners (odds ratio (OR): 10.7; 95% confidence interval (CI): (2.18-52.2); one partner 1.17 (0.31-4.48); none 1) and living in Amsterdam (OR: 3.92; 95% CI: (0.99-15.5); urbanised western Netherlands 2.15 (0.57-8.03); elsewhere 1), while a high educational level was protective (OR: 0.29 (0.08-0.96); middle 0.41 (0.11-1.54); low 1). Among those who participated in 1991/1992, risk behaviour increased between 1989 and 1991/1992 (reporting multiple casual partners rose from 55% to 64%; reporting inconsistent condom use with receptive anal sex from 58% to 71%). Using a predictive model which included self-reported serostatus in 1989, the HIV prevalence rate in 1991/1992 among all male responders to the 1989 questionnaire was estimated to be 5.3% (95% CI: 3.1 7.7%). In conclusion, unless initial response is improved, recruitment through a gay magazine may not allow reliable estimates of HIV prevalence in homosexual men. However, it can be useful at the national level for monitoring changes in prevalence and risk behaviour over time, geographical differences and risk factors for infection.

Adolescent↗
PubMed2004

Having a good relationship with their mother: a protective factor against sexual risk behavior among adolescent females?

STUDY OBJECTIVE: To assess whether having a good relationship with their mother was a protective factor against risky sexual behavior for female adolescents and whether it was independent of family structure. DESIGN: Cross-sectional survey of in-school adolescents aged 14-19 years. SETTING: Catalonia, in northeast Spain. PARTICIPANTS: A total of 3677 females divided according on whether they had a good (n=3335) or a bad (n=342) relationship with their mother. MAIN OUTCOME MEASURES: Rates of sexual activity and sexual behavior. RESULTS: Adolescents in the good relationship group were significantly younger, more likely to live in an intact family, to have a good relationship with their father and siblings, and to talk about sexuality and their partner with their mother. They were also less likely to have ever had sexual intercourse. Among those sexually experienced, they were significantly older at first intercourse and less likely to have multiple partners or a history of STI. After adjusting for potential confounders, females in the good relationship group were less likely to be sexually active and to have had multiple partners, independently of family structure. CONCLUSIONS: Having a good relationship with their mother is a protective factor against sexual intercourse and having multiple sexual partners independently of family structure. Communication between generations and having a good relationship with their father and siblings also play an important role.

Adolescent↗
PubMed1993

Risks of human immunodeficiency virus infection among adolescents attending three diverse clinics.

This study was performed to identify specific high-risk behaviors, such as unprotected oral, anal, and vaginal intercourse and substance abuse, associated with human immunodeficiency virus infection among adolescents attending three diverse clinics located in a localized geographic area: a university-based clinic, a Planned Parenthood clinic, and an inner-city public health clinic (PHC). Six hundred seventy-one female and 207 male adolescents attending one of the three clinics completed a structured questionnaire. Similarities among patients at the clinic sites included high rates of anal intercourse (21%), unprotected vaginal sex (95%), oral sex (73%), and poor communication skills (42%). Some differences appeared as well, including higher rates of homosexual experiences, no birth control use, and having multiple partners among adolescents attending the PHC (p < 0.001). In contrast, adolescents attending either the university-based clinic or the Planned Parenthood Clinic had higher rates of substance abuse around sexual activity than those who attended the PHC (p < 0.001). We conclude that adolescents attending general medical clinics in the San Francisco Bay area engage in high-risk behaviors that place them at risk for transmission of human immunodeficiency virus even though many have had previous education about acquired immunodeficiency syndrome and sexually transmitted disease. Specific risk factors include unprotected receptive anal intercourse, unprotected vaginal intercourse with new and unknown partners, experience in homosexual behavior, high rates of oral sex, multiple partners, poor communication skills, and frequent use of illicit substances in conjunction with sex. The differences found among sites indicate the need for health care providers and prevention programs to provide emphasis on practices specific to the adolescents in their service area.

Acquired Immunodeficiency Syndrome↗
PubMed2002

The encounter with family violence and risky sexual activity among young adolescent females.

In this article, we analyze the relationship between family violence and risky sexual activity for female adolescents (age 14 to 17). We examine two forms of family violence: experience (receiving physical abuse from a parent or parent-figure) and exposure (witnessing interparental physical violence). We hypothesize that either form of violence will predict greater odds of engaging in risky sexual behavior. We define risky sexual activity as any of the following: having multiple partners within the last 12 months or having sex with partners who are themselves engaging in risky behavior (e.g., having multiple partners of either sex, injecting unprescribed drugs, sharing unprescribed needles for injecting drugs). We analyzed data from 710 respondents taken from the National Survey of Family Growth, Cycle V, living with at least one biological parent. Results showed that experiencing violence from a parent greatly increased the likelihood of risky sex, even when controlling for the experience of forced sex, age, mother's age at first birth, race, socioeconomic status, and religiosity. Female adolescents who had experienced forced sex, those who were older (especially 17-year-olds), non-Hispanic Blacks (but not Hispanics), those living in a family with low educational attainment (less than a high school diploma), and those for whom religion was not or only somewhat personally important were more likely to report risky sex compared to others. These effects were not modified by whether the respondents lived in single- or two-parent families. An interaction between the two forms of physical violence suggests that either form is sufficient to increase significantly the odds of risky sex; an analysis in which respondents were differentiated by their experience of either form of violence showed a strong effect of experience on risky sex, net of the control variables.

Adolescent↗
PubMed2006

Gender differences in self-rated and partner-rated multiple intelligences: a Portuguese replication.

The authors examined gender differences and the influence of intelligence quotient (IQ) test experience in the self and partner estimation of H. Gardner's (1999) 10 multiple intelligences. Portuguese students (N = 190) completed a brief questionnaire developed on the basis of an instrument used in previous research (A. Furnham, 2001). Three of the 10 self-estimates yielded significant gender differences. Men believed they were more intelligent than were women on mathematical (logical), spatial, and naturalistic intelligence. Those who had previously completed an IQ test gave higher self-estimates on 2 of the 10 estimates. Factor analysis of the 10 and then 8 self-estimated scores did not confirm Gardner's 3-factor classification of multiple intelligences in this sample.

Adult↗
PubMed1999

Risk awareness of HIV/AIDS among commercial farm workers in Zimbabwe.

OBJECTIVE: To determine levels of perceived risk of HIV infection and the determinants of these perceptions among commercial farm workers. DESIGN: Cross sectional. SETTING: Commercial farms in Manicaland, Mashonaland Central, Mashonaland West and Mashonaland East provinces of Zimbabwe. SUBJECTS: 406 male and 411 female adults. MAIN OUTCOME MEASURES: Perceived risk of HIV infection. RESULTS: Out of 33 female respondents aged less than 20 years, 19 (57.6%) reported that they had no chance of acquiring the HIV infection. The majority (15) of these 19 teenagers indicated that they had no chance of being HIV infected because they had sex only with their spouses. Of the respondents aged 20 years or more, 235 (64.6%) males and 182 (55.3%) females reported that they had no chance of being HIV infected (OR = 1.47, 95% CI 1.07 to 2.02, p = 0.016). Most males (57.0%) and females (59.9%) of age 20 years or more said that they had no chance of being HIV infected because they had sex with only their spouses. Among the respondents of age 20 years or more who indicated they had a moderate to high chance of being infected or were already infected, 35 (33.3%) of the males reported that they had multiple partners and 41 (40.6%) of the females reported that their spouses had multiple partners. CONCLUSION: In general, despite high seroprevalence rates in Zimbabwe, many individuals do not perceive themselves at risk. Future health education intervention studies should seek to increase the general perception of low risk so that adequate precaution can be taken against being infected.

Adolescent↗
PubMed1997

[A survey on sexual awareness and behaviour of residents of a provincial city].

For better understanding of the sexual behaviours that are high-risk in terms of HIV infection, a random sample of 200 people aged above 20 and below 60 years, from a population of 23,700, was selected in the provincial city of Nagano and surveyed by visitation. The responses of 156 people (a rate of response of 78%) were collected and the results were statistically analyzed. The methods employed in conducting a survey on sexual behaviour were also evaluated. The number of sexual partners is an indicator of high-risk sexual behaviour for HIV infection. The data reveals that 65.3% of the men and 37% of the women had two or more partners in the past, with 37.5% of the men and 12.5% of the women having two or more partners in the last 5 years, and 19.1% of the men and 4.2% of the women having two or more partners in the last year, revealing that a higher percentage of men than women have multiple partners. Comparison by age group reveals that young men and women in their 20s have the highest percentage of multiple partners. For both men and women first sexual intercourse before the age of 18, for men self-employment, being a craftsmen or in agriculture, and for women, higher education, were all factors in having greater numbers of partners. In conducting a survey on sexual behaviour the following should be kept in mind. 1) The psychological background of the respondent; Sex counseling skills are required on the part of the interviewer when taking a survey on sex since it is a very private and personal topic for people. Respondents have a tendency to be those who are open-minded about sex and are active in life, and these factors can exaggerate the survey results. 2) Conduct of a survey on sexual behaviour; The survey should be taken only after the purpose of the survey has been fully explained to the respondents and trust has been established. In principle, therefore, mailing of a letter of request and the actual questions should not be the method utilized prior to the collection of responses.

Adult↗
PubMed2003

Assessing sexual health behaviors of resident physicians and graduate students.

OBJECTIVE: To compare the sexual practices of 44 resident physicians with those of 88 nonmedical graduate students, including law students and master's-level social work students, by using the Safe Sex Behavioral Questionnaire (SSBQ). METHODS: In a cross-sectional survey, the SSBQ, used to assess the sexual practices of these two groups, was distributed to participants at a state university via their campus mailboxes, along with a return address envelope, to help ensure anonymity. RESULTS: The educational cohorts did not differ. Overall, participants reported engaging in high-risk sexual behaviors. Women with multiple partners were more likely to engage in increased risky behaviors, whereas men with multiple partners were more likely to use condoms. CONCLUSIONS: Physicians, although educated about healthy sexual behaviors, are still engaging in unsafe safe. The reasons for the discrepancy between knowledge and practice need to be explored.

Adult↗
PubMed1985

Cancer of the cervix. Some aspects of epidemiology, screening, risk factors and survival.

Early statistics on the occurrence of cancer of the cervix are unreliable. What is certain is that between 1950 and 1965 incidence rates (IRs) and mortality rates (MRs) fell considerably in most Western populations. Recently, however, rates in the 15-35-year age group of some populations have risen two- to threefold. In some developing populations, especially in South America and Africa, rates are very high--up to eight times those in most Western populations. Risk factors include early age at first intercourse, low socio-economic state, having multiple partners, smoking, being widowed or divorced, and having a husband who has had multiple partners. The modus operandi of carcinogenesis is not known. Screening, using the Papanicolaou test, has markedly reduced the IRs and MRs, particularly in certain Scandinavian populations. In Western populations 40-60% of patients attain 5-year survival. Understandably, in individual patients the crucial regulating factor is the stage of disease when diagnosed. Among those at stage I, 70-90% survive for 5 years or more, whereas only 0-25% of patients diagnosed at stage IV do. In Soweto, Johannesburg, length of survival in a series of black patients whose staging pattern did not markedly differ from that in Western series was less than half that in the latter. Undoubtedly, as repeatedly urged, appropriate selective screening and health education could effectively reduce the toll of mortality, especially in high-risk developing populations.

Adolescent↗
PubMed2006

Intimate partner violence against women in eastern Uganda: implications for HIV prevention.

BACKGROUND: We were interested in finding out if the very low antenatal VCT acceptance rate reported in Mbale Hospital was linked to intimate partner violence against women. We therefore set out to i) determine the prevalence of intimate partner violence, ii) identify risk factors for intimate partner violence and iii) look for association between intimate partner violence and HIV prevention particularly in the context of the prevention of mother-to-child transmission of HIV programme (PMTCT). METHODS: The study consisted of a household survey of rural and urban women with infants in Mbale district, complemented with focus group discussions with women and men. Women were interviewed on socio-demographic characteristics of the woman and her husband, antenatal and postnatal experience related to the youngest child, antenatal HIV testing, perceptions regarding the marital relationship, and intimate partner violence. We obtained ethical approval from Makerere University and informed consent from all participants in the study. RESULTS: During November and December 2003, we interviewed 457 women in Mbale District. A further 96 women and men participated in the focus group discussions. The prevalence of lifetime intimate partner violence was 54% and physical violence in the past year was 14%. Higher education of women (OR 0.3, 95% CI 0.1-0.7) and marriage satisfaction (OR 0.3, 95% CI 0.1-0.7) were associated with lower risk of intimate partner violence, while rural residence (OR 4.4, 95% CI 1.2-16.2) and the husband having another partner (OR 2.4, 95% CI 1.02-5.7) were associated with higher risk of intimate partner violence. There was a strong association between sexual coercion and lifetime physical violence (OR 3.8, 95% CI 2.5-5.7). Multiple partners and consumption of alcohol were major reasons for intimate partner violence. According to the focus group discussions, women fear to test for HIV, disclose HIV results, and request to use condoms because of fear of intimate partner violence. CONCLUSION: Intimate partner violence is common in eastern Uganda and is related to gender inequality, multiple partners, alcohol, and poverty. Accordingly, programmes for the prevention of intimate partner violence need to target these underlying factors. The suggested link between intimate partner violence and HIV risky behaviours or prevention strategies calls for further studies to clearly establish this relationship.

Adolescent↗
PubMed1989

Mathematical formulation and studies of the risk parameters involved in HIV transmission.

The probability of becoming infected with HIV is formulated in terms of the total number of sexual contacts (N), the probability that a sexual act is infectious (r) and the prevalence (p). Using the appropriate equations we studied the effect of reducing each of the risk factors on lowering the probability of infection. We show that for many realistic situations the probability of becoming infected by multiple partners is equal to the probability of becoming infected by one partner in a monogamous relationship given that the prevalence is the same in both cases; however if the multiple partners are chosen over time from a pool of a growing prevalence, then one is better off in a monogamous relationship where that partner is chosen early in the epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Transmission of cervical human papillomavirus infection by sexual activity: differences between low and high oncogenic risk types.

Not all studies have proven that cervical human papillomavirus (HPV) infection is a sexually acquired condition. Determinants of HPV infection were analyzed in a survey of 718 asymptomatic women in northeastern Brazil. HPV DNA was detected and typed by polymerase chain reaction. HPV types were classified into low- and high-risk groups on the basis of their association with cervical carcinomas. Overall HPV prevalence (18.3%) was moderately associated with age at first intercourse (P = .111, trend) and number of lifetime sex partners (P = .005, trend). However, separate analyses by risk revealed different degrees of association with sexual activity. Except for a positive association with multiple partners among women < 40 years old (P = .034, trend), infection with low-risk types (9.7%) was not correlated with sexual behavior. On the other hand, infection with high-risk HPV types (11.6%) was strongly and independently associated with both multiple partners (P = .009, trend) and age at first intercourse (P = .007, trend) in all age groups.

Adult↗
PubMed1994

Longitudinal changes in injection behaviors in a cohort of injection drug users.

To determine how the injecting behaviors of injection drug users (IDUs) change over time in the context of the epidemic of acquired immunodeficiency syndrome (AIDS) and what factors may be associated with such changes, a cohort of IDUs (n = 313) initially in treatment provided structured interviews regarding drug injecting behaviors. Repeat interviews in 18 months assessed behavior change in subjects who could be contacted for follow-up (n = 220, 70.3%). The study occurred in a state where sterile syringes can be purchased without prescription in drug stores. Injection drug use occurred for 180 (81.8%) of the 220 subjects in the 12 months prior to the initial interview but in only 121 (55.0%) in the 10 months prior to the follow-up interview (p < 0.0001). Similarly, sharing of equipment decreased from 63.1% to 31.8% (p < 0.0001). Sharing with multiple partners declined from 41.9% to 10.6% (p < 0.0001). Factors associated with ongoing risk included use of injected and non-injected psychoactive substances, less time in drug dependence treatment during follow-up interval, having a sexual partner who was an IDU and not using a drug store as the primary source of syringes. Factors associated with multiple-partner sharing included use of psychoactive substances, younger age and nonwhite race.

Cohort Studies↗
PubMed2002

The association between substance use and risky sexual behaviors among incarcerated adolescents.

OBJECTIVES: The purpose of this study is to examine the relationships between substance use and risky sexual behaviors and having acquired a sexually transmitted disease. METHODS: The sample consisted of 210 incarcerated adolescents ages 12-17. Data were collected through 40-min interviews administered by trained research assistants. Multivariate analysis was used to examine the relationship between risky sexual behaviors and substance use when adjusting for other covariates. RESULTS: Almost three-quarters (70.6%) of these incarcerated adolescents regularly use one or more substances. Inconsistent condom use and sex with multiple partners (>2) was reported by approximately 70% of those surveyed. The regular use of substances elevated the odds of having sex with multiple partners (OR = 11.88), exchanging sex for money or drugs (OR = 4.64). and inconsistent condom use (OR = 3.06). CONCLUSION: Given strong associations between risky sexual behavior and substance use, interventions should be more multiproblem-focused. Health interventions should attempt to address common causes of both behaviors. Effective interventions will be those that can successfully demonstrate effects on outcomes that measure both the intervention effects on substance use and risky sexual behaviors.

Adolescent↗