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PubMed2006

The silent HIV epidemic among pregnant women within rural Northern Tanzania.

BACKGROUND: Many national antenatal clinics (ANC) based HIV surveillance systems in sub-Saharan Africa have limited coverage of remote rural sites, a weakness that compromises adequate estimation, monitoring and development of effective preventive and care programmes. To address this void in rural Manyara and Singida within Northern Tanzania, we conducted antenatal clinic-based sentinel surveillance. METHODS: We consecutively enrolled 1377 counselled and consenting pregnant women attending ANC clinics for the first time during the current pregnancy. The study was conducted in six antenatal clinics, within three divisions of rural Manyara and Singida regions in 2003/2004. Interviews were conducted and blood samples for routine purposes were collected and tested for anti-HIV IgG antibody anonymously, using Bionor HIV-1 & 2 assay. RESULTS: Among enrollees, 94% (1296/1377) participated fully. The overall prevalence of HIV was 2.0% (95%CI: 1.34-2.97). The highest HIV prevalence was among women aged between 15-19 years in both rural and remote rural populations. The odds of HIV infection was 4.3 (95%CI: 1.42-12.77) times among women reporting more than one lifetime sexual partners compared with those with one partner. HIV infection was associated with history of genital sores or foul smelling discharge, OR 6.8 (95%CI: 2.78-16.66) and age at first pregnancy (2.5 times higher likelihood of infection if before the age of 18 years versus at a later age). CONCLUSION: Including rural remote sites, as part of the national ANC routine surveillance, is crucial in order to discover imminent silent epidemics such as the one described in this paper. Scaling up HIV prevention efforts is mandatory to prevent the imminent escalation of the HIV epidemic highly associated with a history of sexually transmitted infections (STIs), multiple sexual partners and pregnancies at a younger age. Ignorance of relevant knowledge and low utilisation of condoms underscores the urgency for large-scale preventive efforts. Research to capture a wider representation of the risk factors in the general population should be a priority to enable further customised HIV prevention efforts.

Adolescent↗
PubMed1995

Predictors of unprotected male-to-male anal intercourse with casual partners in a national sample.

The focus of the paper is the predictors of unprotected anal intercourse with casual partners among a national Australian sample of homosexually active men. We interviewed by telephone 2583 homosexually active men (sex with a man within the last five years) about their sexual practice, type of sexual partners, human immunodeficiency virus (HIV) test status, attachment to the gay community, knowledge of HIV and acquired immune deficiency syndrome (AIDS) and a range of demographic variables. Logistic regression analyses were used to distinguish men who practised unprotected anal intercourse with casual partners from those who practised safe sex with casual partners. Men who practised unprotected anal intercourse with casual partners were less likely to have a regular male sexual partner than men who practised safe sex with their casual partners. They were less likely to be tertiary educated, more likely to be employed in trade and manual occupations and to live in Tasmania and the Northern Territory. They were less likely to be culturally or politically attached to the gay community. Knowledge of HIV/AIDS also distinguished the men: men with an accurate knowledge of HIV transmission were less likely to engage in unprotected anal intercourse with their casual partners. Several other variables, including age and HIV test status, did not distinguish those who practised safe sex with casual partners from those who practised unprotected anal intercourse with casual partners.

Australia↗
PubMed1999

A Markov model for measuring vaccine efficacy for both susceptibility to infection and reduction in infectiousness for prophylactic HIV vaccines.

We use a discrete-time non-homogeneous Markov chain to model data from augmented human immunodeficiency virus (HIV) vaccine trials. For this design, the study population consists of primary participants some of whom have steady sexual partners who are also enrolled to augment the trial. The state space consists of the infection status of primary participants without steady partners and the infection status of both persons in the steady partnerships. The transition probabilities are functions of the two parameters: vaccine efficacy for susceptibility (VES) and infectiousness (VEI). We use likelihood methods to estimate VES and VEI from time-to-event data. We then use stochastic simulations to explore the bias and precision of the estimators under various plausible conditions for HIV vaccine trials. We show that both the VES and VEI are estimable with reasonable precision for the conditions that may exist for planned HIV vaccine trials. We show that exams conducted every six months will likely provide sufficient information to estimate the VE parameters accurately, and that there is little gain in precision for more frequent exams. Finally, we show that joint estimation of the VES and VEI will likely be feasible in a currently planned HIV vaccine trial among injecting drug users in Bangkok, Thailand, if one augments the information about the primary participants in the trial with information about their steady sexual partners.

AIDS Vaccines↗
PubMed1993

[Contact tracing of genital Chlamydia infection].

The present study evaluates two strategies for partner notification among young women with genital Chlamydia trachomatis infection. The study included 443 women, aged 14-21 years, who visited one of 20 youth clinics during a two months period in 1991. The youth clinics were randomized to use patient referral or provider referral. In the latter group, 11 of 14 women with genital Chlamydia infection revealed their sexual partners. Only five of 24 sexual partners were notified by a letter, and six of 24 partners turned up for examination. In the patient referral group, 16 of 34 women asked to notify their partner, and ten of 31 partners were examined. Partner notification in young women with genital Chlamydia infection seems to be difficult.

Adolescent↗
PubMed2005

Cervical dysplasia in HIV infected women in Maiduguri, Nigeria.

The human immunodeficiency virus (HIV) infection has been shown to be a risk factor for premalignant and malignant conditions of the cervix. Patients attending the gynaecological clinic of the University of Maiduguri Teaching Hospital received voluntary counselling and testing (VCT) for HIV. All patients who were screened for HIV also had their pap smear taken. Cervical dysplasia was significantly commoner among HIV infected women than those that were HIV negative (31.3% vs 7.8%, respectively). The incidence of cervical dysplasia was also proportional to the degree of immunosuppression as women with low CD4 count had higher incidence of cervical dysplasia. The population studied was generally promiscuous irrespective of their HIV status, with over 90% of them having multiple sexual partners. It is recommended that health education in this population should be aimed at discouraging multiple sexual partners. Gynaecologists should be co-care providers to all HIV+ women in view of the menace of cervical dysplasia.

Adolescent↗
PubMed2001

Population-based HIV testing and counseling in rural Uganda: participation and risk characteristics.

OBJECTIVES: To assess self-selection in a population-based voluntary HIV testing and counseling (VTC) program by comparing the HIV risk characteristics of users and nonusers of VTC in rural Uganda. DESIGN: A 1994 to 1995 community-randomized trial in the Rakai District of Uganda enrolled adults aged 15 to 59 years and ascertained their HIV status, sociodemographic characteristics, risk behaviors, and AIDS-associated symptoms. All subjects were offered confidential individual VTC at no cost. METHODS: We compared users and nonusers of VTC among 10,950 participants (4764 male and 6186 female) enrolled at baseline using multivariate logistic regression. RESULTS: Women were significantly less likely to receive VTC than men (31.5% vs. 34.8%, p <.001). In multivariate analysis, younger age, HIV-positive status, and having no sexual partners in the past 5 years (and, significant for women only, having 2 or more sexual partners) were associated with lower VTC participation for both men and women. Among women, higher VTC participation was associated with symptoms suggestive of AIDS and other illnesses and shopkeeper occupations. CONCLUSIONS: During the initial phase of a population-based free VTC program in rural Uganda, certain high-risk groups were underrepresented among VTC recipients. There is a need to target VTC to ensure participation by high-risk individuals most in need of services.

AIDS Serodiagnosis↗
PubMed2004

Bacterial vaginosis in lesbians and bisexual women.

OBJECTIVE: To determine whether bacterial vaginosis (BV) is associated with sexual activity between women. STUDY DESIGN: Cross-sectional survey of 708 new patients attending 2 sexual health clinics for lesbians and bisexual women in London, U.K. Questionnaire for demographic, sexual history, and sexual practice data linked with the results of genitourinary examination. RESULTS: BV was common (31.4%). The odds of BV was significantly associated with larger numbers of female sexual partners (odds ratio [OR], 1.6; confidence interval [CI], 1.05-2.44 for > or = 11 compared with 1-5 partners) and with smoking (OR, 1.43; CI, 1.01-2.03), but not with sex with men or vaginal douching. CONCLUSIONS: BV is common in women who have sex with women (WSW). The increasing odds of BV with larger numbers of female sexual partners suggest that BV may be sexually transmitted between women.

Adolescent↗
PubMed1999

A behaviour risk factor survey in Jamaica.

A population based probability sample of 958 persons (454 males and 504 females) aged 15 to 49 years was surveyed in Jamaica in late 1993 for lifestyle and behaviour risk factors. Demographic characteristics of the sample were comparable to the general population, 60% of persons visited a private doctor the last time that they were ill. Based on self-reporting, 18% of the women and 8% of the men were hypertensive and 4.8% of the women and 3.3% of the men were diabetic. 26% of the men and 8% of the women had never had their blood pressure taken. 40% of the women had never had a Papanicolaou smear, 29% had never had a breast examination and 33% said that they were overweight compared with 18% of men. Smoking cigarettes and marijuana was more common among men (36%) than women (11%), as were drinking alcohol (79% of men, 41% of women) and heavy alcohol use (30% of men, 9% of women). Injuries requiring medical attention in the previous five years were reported by 40% of the men and 15% of the women. 34% of the men and 12% of the women regularly carried a weapon and 18% of the sample had participated in or witnessed at least one violent act in the previous month. Most of the people interviewed used a contraceptive method; 10% were not sexually active. Significantly more men than women had two or more sexual partners in the previous year (54% vs 17%, p < 0.001) or reported ever having a sexually transmitted disease (29% vs 9%, p < 0.001). Younger persons were more sexually active and more likely to use condoms during their most recent sexual intercourse. Higher socio-economic status and educational level generally had a more positive effect on health behaviour. This survey provides vital information relevant to planning health promotion campaigns and assessing their success.

Adolescent↗
PubMed1995

[1st sexual intercourse and 1st pregnancy in puerperal women at a hospital of the metropolitan area].

One thousand women hospitalized at a maternity were surveyed after their delivery or abortion about their first sexual intercourse and pregnancy. Mean age at the first sexual intercourse was 18.7 years and only 9.2% used a contraceptive method in spite that 20% were not willing to become pregnant. The mean age of sexual partners was 22 years old. Women of less than 32 years old generally had older sexual partners, but among those older than 25 years old the proportion of younger partners increased. The first pregnancy occurred at 20 years old as a mean, 62% of women were single, only 1.3% used a contraceptive method, and 27.3% of resultant pregnancies were not desired.

Adolescent↗
PubMed2002

[Female juvenile prostitution and AIDS prevention programs in Brazil].

OBJECTIVE: To investigate perception of AIDS and to obtain information for developing AIDS prevention programs targeting female juvenile prostitution. METHODS: Thirteen young women aged 18 to 21 years working as prostitutes in the city of Ribeirão Preto, Brazil, were interviewed using semi-structured interviews. The questionnaire focused on sociodemographic aspects, HIV-related knowledge, sexual behavior, relations with clients and other sexual partners, and suggestions for sexually transmitted diseases (STD) and AIDS prevention programs. RESULTS: Though all subjects demonstrated knowledge of safe sex and HIV transmission, this contrasted with their belief that destiny determines who gets infected and their search for affection in their relationships with partners and clients. These contradictions act as possible factors preventing safe sex behavior. CONCLUSIONS: The strategies of HIV/AIDS prevention should incorporate the need of allowing room for discussion in order to clarify this group's social imaginary beliefs and concepts about AIDS. In addition, discussions about the belief in the safety of affective relationships should take place since this encourages unsafe sexual practices. Another key issue is how to approach this group and strategies sensitive to their individualities should be applied.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Intersubtype recombinant HIV type 1 involving HIV-MAL-like and subtype H-like sequence in four Norwegian cases.

Suspected epidemiological links between three cases of human immunodeficiency virus type 1 (HIV-1) infection were verified by the finding of a shared unique virus genotype. A probable male index case was not available for testing. Case 1 was a female sexual partner of the index case. Case 2 was an adult son of case 1. Case 3 was a female sexual partner of case 2. The link to the index case was substantiated by the subsequent finding of another female sexual contact of the index case, harboring the same HIV-1 genotype as the three other cases. To characterize the genotype further, the complete provirus nucleotide sequence was obtained directly from blood cell DNA of case 3. HIV cultivated from case 3 demonstrated CCR5 dependence, an extreme slow-low phenotype, and some genotypic features not present in its directly sequenced counterpart. Most of the gag, pol, and vif genes of these viruses clustered with one of the earliest African HIV-1 strains, MAL, previously classified as a recombinant between the subtypes A, D, and I. Most of the rest of the genome was related to subtype H, albeit with less than 90% identity in most regions. These viruses are the only ones shown to display extensive similarity with MAL in the gag-pol region and among the first HIV-1 recombinants described involving subtype H. We postulate that the gag-pol genes of MAL and these viruses are derived from a common ancestor that is not necessarily intersubtype recombinant in the pol region.

Adult↗
PubMedDate not supplied

[Sexual functioning of patients with major depression. Pilot study].

Disturbances in sexual functioning in patients with endogenous mental disorders are frequently reported. The aim of the study was to estimate the occurrence of sexual disfunctions in patients hospitalised for major depression (unipolar affective disorder). The investigations covered 53 persons remaining in stable partnership. Apart from the assessment of psychological state, depressive symptoms and the course of treatment, we analysed the quality of relations with the partner, sexual satisfaction, willingness to and frequency of sexual intercourse, satisfaction with oneself as a sexual partner. The obtained results indicate that sexual problems must not be neglected in treatment of depressive patients.

Adult↗
PubMed2006

Analysis of the influence of therapy and viral suppression on high-risk sexual behaviour and sexually transmitted infections among patients infected with human immunodeficiency virus in Taiwan.

This study examined the effects of certain characteristics of human immunodeficiency virus (HIV)-infected patients related to the risks of practising unprotected sex (UPS) among 919 HIV-infected patients who attended the sexually transmitted disease (STD) clinic of the Taipei City STD Control Center, Taiwan, during the period January-July 2004. After learning that they were HIV-positive, 517 (56%) subjects had practised UPS, 476 (52%) had a new STD diagnosis, and 106 (12%) had used some form of injected drug. UPS was reported by 76% of homosexual/bisexual males, 19% of heterosexual males and 5% of females, and was reported more often by those individuals with casual sexual partners (p < 0.001). According to multivariate logistic regression analyses, UPS was associated with male-to-male sexual intercourse (OR 2.46; 95% CI 1.26-4.86, p < 0.001), with casual sexual partners (OR 2.82; 95% CI 1.62-4.88, p < 0.001), and with an individual's knowledge of his/her HIV status for > 11 years (OR 2.06; 95% CI 1.02-4.18, p < 0.05). Although using anti-retroviral therapy to prevent sexual transmission of HIV is rational, the avoidance of at-risk sexual behaviour should also be a priority among HIV-seropositive individuals. Ongoing risk-reduction counselling related to HIV transmission is needed to reduce certain sexual behaviours associated with HIV transmission.

Adult↗
PubMed2001

Protective role of health values in adolescents' future intentions to use condoms.

PURPOSE: To examine the protective role of health values in adolescents' intentions to use condoms. METHODS: Two hundred thirty-six sexually active adolescents who were attending a municipal sexually transmitted diseases clinic were interviewed, using standardized and constructed instruments, regarding their previous condom use, health values, condom attitudes, social norms regarding condoms, self-efficacy regarding condoms, and intentions to use condoms in the future. Correlations and hierarchical multiple regression analyses were conducted to examine the direct and indirect effects of health values on intentions to use condoms. RESULTS: Health values were significantly correlated with intentions to use condoms with main and casual sexual partners, and accounted for a significant amount of variance in intentions to use condoms with casual sexual partners, after controlling for demographic variables, past condom use, and constructs from the Theory of Planned Behavior. Health values were also found to moderate the relationship between condom attitudes and intentions to use condoms with casual partners. CONCLUSIONS: Efforts to include health values as a protective factor in health behavior theory and risk-reduction interventions are warranted.

Adolescent↗
PubMed2003

Delayed selfing as an optimal mating strategy in preferentially outcrossing species: theoretical analysis of the optimal age at first reproduction in relation to mate availability.

The evolution of mating systems and that of life history have usually been modeled separately. However, they may be to some extent coupled in natural situations because they rely on the same phenotypic traits. Here, we focus on one of these traits, the age at first reproduction, in a species able to self- and cross-fertilize. When inbreeding depression is strong, self-fertile species preferentially cross-fertilize. However, outcrossing is not always possible when the availability of sexual partners is limited. The optimal reproductive strategy in this case would be to wait for a sexual partner for a certain period of time (the waiting time) and then switch to selfing if no mates have been encountered (reproductive assurance strategy). We predict the evolution of an optimal waiting time depending on the efficiency of resource reallocation to late fecundity, on the inbreeding depression, and on the instantaneous probability of encountering a partner versus dying. As a consequence of reduced mate availability, intermediate selfing rates can be generated in preferentially outcrossing populations, but they are lowered by the existence of a waiting time. Our model may thus explain low selfing rates observed in natural populations of many self-fertile, preferentially outcrossing plants or animal species.

Age Factors↗
PubMed2000

The determinants of safe sex behaviors of junior college students with sexual experience.

The purpose of this study was to explore the safe sex behavior and related factors of junior college students with sexual experience in southern Taiwan. This study used a cross-sectional design, in which data from a sample of 187 junior college students with sexual experience were collected by an anonymous and self-administered questionnaire. For a conceptual framework, the study used constructs from the PRECEDE (Predisposing, Reinforcing, and Enabling Causes in Educational Diagnosis and Evaluation) model. Two predisposing factors (AIDS-prevention self-efficacy, AIDS related knowledge), one enabling factor (school resources in AIDS prevention), one reinforcing factor (perception of peers' AIDS prevention behavior), demographic characteristics (gender, parents' educational level), substance use (cigarette and alcohol use) and sexual history (age of first sexual intercourse, number of sexual partners) were examined for their ability to influence safe sex behavior of junior college students with sexual experience. The results showed that gender, fathers' educational level, age of first sexual intercourse, number of sexual partners, cigarette use and alcohol use were significant factors for difference in safe sex behavior. AIDS prevention self-efficacy, AIDS-related knowledge, and perception of peers' AIDS prevention behavior were all positively related to safe sex behavior. AIDS prevention self-efficacy, fathers' educational level accounted for 49.8% of the variance in safe sex behavior.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Learning about sex: conditioning of partner preference: theoretical comment on Coria-Avila et Al. (2005).

Sexual partner preference in female rats has been difficult to establish experimentally because the vaginocervical stimulation the female receives during the preference test can be rewarding or aversive depending on the context. G. A. Coria-Avila, A. J. Ouimet, P. Pacheco, J. Manzo, and J. G. Pfaus (2005) reported that female rats can be conditioned to show partner preference for a male that is scented with a sexually neutral odor if they are mated repeatedly with that male in a paced mating test. These results suggest that establishment of a partner preference depends on rewarding characteristics of the vaginocervical stimulation the female receives during an initial mating and that selection of a sexual partner can be determined by olfactory stimuli associated with that stimulation. These results are discussed within the context of the appetitive-consummatory construct of sexual behavior and the evolutionary significance of conditioned partner preference.

Animals↗
PubMed1999

Project neighborhoods in action: an HIV-related intervention project targeting drug abusers in Washington, DC.

Project Neighborhoods in Action was a human immunodeficiency virus (HIV) outreach and intervention program that was conducted with injection drug users and crack users in several inner-city neighborhoods in the District of Columbia. Study participants were placed randomly in either a standard intervention or an enhanced intervention condition, with more than 800 persons being assigned to each group. Drug use frequency dropped from 15.2 days to 12.4 for alcohol (P<.0001), 2.1 days to 1.6 for marijuana (P<.003), 13.0 days to 8.8 days for crack (P<.0001), 2.4 days to 1.5 days for cocaine (P<.0001), 19.7 days to 15.6 for heroin (P<.0001), and 5.2 days to 3.4 for speedball (P<.0001). Drug injecting decreased from an average of 90.8 times to 66.9 (P<.0001), with both direct sharing and indirect sharing rates decreasing significantly as well (from 2.4 to 1.1 times for the former [P<.002] and from 12.0 to 8.1 times for the latter [P<.0004]). The number of sexual partners dropped from a mean of 1.6 to 1.1 (P<.0001). The number of drug-injecting sexual partners went from 0.3 to 0.2 (P<.01). Having sex while high decreased from 11.2 times to 7.9 (P<.0001). Trading sex for drugs and/or money declined from 1.9 times to 1.3 (P<.001). Protected sex increased from 29.5% to 63.7% (P<.0001), and the number of unprotected sexual acts dropped from 9.6 to 7.2 (P<.0001). Only a few differences were observed for standard versus enhanced intervention respondents, with no particular pattern formed. We were left with the impression that the standard intervention and enhanced intervention used in this program were about equally effective at reducing the involvement of drug abusers in HIV-related risky behaviors.

Adult↗