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PubMed1994

The high prevalence of unsafe sexual behaviors among acute psychiatric inpatients. Implications for AIDS prevention.

We conducted a study to determine the prevalence and sociodemographic distribution of unsafe sexual behaviors among psychiatric inpatients and to investigate an association between crack cocaine use and these behaviors. Two hundred thirty-nine patients admitted to two Philadelphia hospitals during a 12-month period were interviewed to obtain a detailed sexual history and substance abuse history. A history of multiple sex partners was reported by 42.6% of male patients and 13.0% of female patients (p < .01). A history of receptive anal intercourse in the past 6 months was reported by 11.6% of females and 2.1% of males (p < .05). Only about half the study subjects who were sexually active reported ever using a condom during the past 6 months. Crack cocaine use among males and cocaine use among females was statistically significantly associated with a history of having sex with a high risk partner. This study draws attention to the role of crack cocaine and other types of cocaine in the spread of human immunodeficiency virus infection in this population and the need for intensive acquired immunodeficiency syndrome prevention programs on inpatient psychiatric units.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Assessing behavioral risk for HIV infection in family-planning and STD clinics: similarities and differences.

Four hundred fifty-five women in family-planning and sexually transmitted disease (STD) clinics were surveyed to determine the degree of participation in behaviors known to be associated with increased risk of human immunodeficiency virus (HIV) infection. A previous history of STD (20%) and multiple sexual partners (73%) were shown to be the high-risk behaviors most prevalent in these populations. Sexual intercourse with persons in high-risk groups (6%) and intravenous (IV) drug use (3.7%) were less prevalent. Differences between the populations from each type of clinic and between races were noted. Overall, almost one third of family-planning clinic clients and nearly half of STD clinic clients reported participation in at least one risk behavior, emphasizing the need for educational efforts toward disease prevention in these settings.

Adolescent↗
PubMedDate not supplied

High-risk behaviors for transmission of syphilis and human immunodeficiency virus among crack cocaine-using women. A case study from the Midwest.

This study examines the drug use patterns, sexual practices, condom use, knowledge and attitudes toward sexually transmitted diseases (STD)s and AIDS, and seroprevalence of human immunodeficiency virus (HIV) and syphilis among women who use crack in Dayton, Ohio. In 1990, two indigenous outreach workers recruited 150 participants who were not in drug treatment programs, who were 18 years of age or older, and had used crack in the previous 3 months. Structured interviews revealed that 90% of the sample were black, 78% used crack "daily," 93% had multiple sexual partners, and 49% had 10 or more male sexual partners in the last 3 months. A majority (67%) of the women felt they were in need of drug treatment. No reactive syphilis serologies were detected in 138 serum samples; 2 women (1.4%) were HIV seropositive. This case study provides insight into the high-risk sexual behaviors of crack users in a medium-sized, midwestern city. The study demonstrates the value of indigenous outreach prevention and STD screening initiatives in reaching this segment of our society, which has a high risk of acquiring STDs.

Adolescent↗
PubMedDate not supplied

Patterns of condom use and sexual behavior among never-married women.

BACKGROUND AND OBJECTIVES: Use of condoms is one of the main methods sexually active persons may choose to prevent infection with sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). Little is known about patterns of condom use among women in the United States. We provide a conceptualization of patterns of condom use and factors associated with these patterns. GOAL OF THIS STUDY: To examine patterns of condom use and associated characteristics among sexually active, never-married women in the United States. STUDY DESIGN: Analysis of data from the 1988 National Survey of Family Growth, which is a nationally representative sample of women in their childbearing years. RESULTS: Only a minority of sexually active, never-married women report using condoms, and even fewer report using them consistently. Women with characteristics traditionally associated with increased risk of infection with STD and HIV appear to be less likely to report using condoms and to report using them consistently. Women who report use of condoms to prevent STDs are more likely to report consistent condom use; less likely to cease using condoms; and more likely to initiate consistent condom use. CONCLUSION: Findings suggest the need for innovative programming targeted for specific sexually active populations to promote both initiation and maintenance of use of condoms.

Adolescent↗
PubMedDate not supplied

Prevalence of genital Chlamydia trachomatis infection in selected populations in China.

BACKGROUND: Chlamydia trachomatis is an important pathogen of the urogenital tract. Numerous epidemiologic studies have reported on the prevalence of chlamydia world wide. However, the prevalence of Chlamydia trachomatis in China has not been widely studied. GOAL OF THIS STUDY: To identify Chlamydia trachomatis in three distinct populations in China. Urogenital specimens were collected from men with no prior history of sexual intercourse (virgin), men seen at a sexually transmitted disease clinic, and female prostitutes. STUDY DESIGN: Two-hundred urethral swabs were collected from group one, and 100 urethral swabs from group two, and 109 cervical swabs from group three. All specimens were tested for chlamydia by tissue culture isolation using McCoy cells and an iodine stain. RESULTS: Chlamydia trachomatis was not isolated from the virgin males. The prevalence of chlamydia in men seen at a sexually transmitted disease clinic was 13% (13/100) and in female prostitutes, 37.6% (41/109). CONCLUSION: The prevalence of chlamydia seen in these three groups is similar to rates found in previous studies done in the United States and Europe in similar populations. Patients with multiple sex partners in China need to be screened for C. trachomatis.

Adult↗
PubMed1997

Zenilman's anomaly reconsidered: fallible reports, ceteris paribus, and other hypotheses.

BACKGROUND AND OBJECTIVES: In the January-February, 1995 issue of Sexually Transmitted Diseases, Zenilman and colleagues reported a null association between incident sexually transmitted diseases (STDs) and self-reported condom use. That anomalous finding generated a flurry of letters to the editor, some of which were quite heated. This article reconsiders the Zenilman team's results. STUDY DESIGN: New statistical analyses were conducted to test two hypotheses that sought to account for the null association: (1) deviation from study protocol, and (2) differential risks of acquiring an incident STD among segments of the study population that varied by reported level of condom use. RESULTS: No support was found for hypotheses concerning deviation from study protocol and differential risk of acquiring an incident STD by level of condom use. Indeed, for respondents who reported multiple sexual partners, the analyses found increased rates of infection among those who reported more consistent condom use. CONCLUSIONS: Two of the most promising hypotheses for explaining Zenilman's anomalous findings are unsupported by reanalysis of the available empirical evidence. It is still possible that respondents who reported that they used condoms consistently differed from self-reported nonusers or inconsistent users in some way that altered their risk of acquiring an STD and thus obscured the protective effects of properly used condoms. Nonetheless, as Zenilman and others suggest, fallibility in self-reports of condom use remains the primary suspect as the cause of these anomalous results. Such fallibility may be particularly pronounced when self-reported behavioral data are collected in contexts that include strong educational campaigns or other norm-setting interventions.

Bias↗
PubMed1997

Sexual factors associated with cytomegalovirus seropositivity in human immunodeficiency virus-infected men. The Seroco Study Group.

BACKGROUND: Many people infected by human immunodeficiency virus (HIV) acquire severe cytomegalovirus (CMV) diseases. Factors associated with CMV seropositivity are poorly documented in sexually active HIV-infected men. GOAL: To study CMV seroprevalence in HIV-infected men according to sexual behavior before the diagnosis of HIV seropositivity. STUDY DESIGN: Cross-sectional study. CMV seroprevalence was studied at enrollment in a prospective cohort of homosexual and heterosexual men infected by HIV through sexual contact. RESULTS: In the study population (n = 723), age, sexual preference, previous lifetime history of sexually transmitted diseases, and multiple sexual partners were independently related to CMV seropositivity. Furthermore, routine condom use during the 6 months before diagnosis of HIV seropositivity was significantly related to CMV seropositivity (adjusted odds ratio [OR]: 0.4, 95% confidence interval [CI]: 0.1-1.0), occasional condom use being of borderline significance [adjusted OR: 0.5, CI: 0.2-1.3]. CONCLUSIONS: This study confirms the importance of sexual factors in the acquisition of CMV infection by HIV-infected men and suggests a protective effect of condom use.

AIDS-Related Opportunistic Infections↗
PubMed1998

Reductions in STD infections subsequent to an STD clinic visit. Using video-based patient education to supplement provider interactions.

BACKGROUND AND OBJECTIVES: Video-based patient education has been effective in a variety of clinical settings. The authors studied the efficacy of a video-based educational intervention in an inner-city public sexually transmitted diseases (STD) clinic. GOAL: To evaluate the efficacy of video-based patient education in reducing STD infections subsequent to a clinic visit. DESIGN: African-American and Hispanic men attending a large public STD clinic were assigned at random to either an experimental video-based educational intervention or a control condition in which they received regular clinic services. Patients in the experimental group were exposed to video-based interventions that provided information about STDs and their prevention, portrayed positive attitudes about condom use, and modeled appropriate strategies for encouraging condom use in different sexual relationships. During 1992, 2,004 subjects were tracked for an average of 17 months through the New York City STD surveillance database for the occurrence of new STD infections. RESULTS: The overall rate of new infection among male STD clinic patients was 24.2%. Rate of new infection was significantly lower among those exposed to video-based prevention education than among controls (22.5% compared with 26.8%, p < .05). Subjects reporting multiple sex partners had a significantly higher new infection rate but also experienced the greatest impact of educational intervention. There was a 32.2% new infection rate among high-risk controls compared with a 24.8% rate among high-risk intervention groups (p < 0.025). CONCLUSION: Results of this randomized clinical trial indicate that using video-based patient education to supplement regular STD clinic services and provider interactions can be effective in reducing rates of new STD infection, particularly among those at greatest risk.

Adult↗
PubMed1999

Sexual experiences and condom use of heterosexual, low-income African American and Hispanic youth practicing relative monogamy, serial monogamy, and nonmonogamy.

BACKGROUND AND OBJECTIVES: To describe (a) demographic characteristics, (b) sexual history, (c) perceived HIV susceptibility, and (d) current sexual behavior, condom use, and alcohol and marijuana use of heterosexual, low-income African American and Hispanic youth categorized as relatively monogamous (n = 577), serial monogamous (n = 171), or nonmonogamous (n = 278). STUDY DESIGN: Data were drawn from personal interviews with a probability sample of low-income youth, age 15 to 24 years, conducted in Detroit in 1991. RESULTS: Many group differences were found. For example, relatively monogamous youth were most likely to be female and Hispanic and to have engaged in unprotected intercourse. Serial monogamous youth were younger and most likely to have used condoms at last intercourse. Nonmonogamous youth initiated intercourse earlier and were most likely to have experienced oral and anal intercourse and to have used alcohol and marijuana. CONCLUSION: Risk reduction programs may need to be tailored differently to accommodate the needs of these three distinct subgroups of youth.

Adolescent↗
PubMed2002

Prevalence and determinants of sexually transmitted diseases: an analysis of young Jamaican males.

BACKGROUND: Jamaican adolescents have high rates of sexually transmitted diseases (STDs). GOALS: Since the sexual behaviors that put an individual at risk for HIV are the same as for other STDs, the prevalence and determinants of STD symptoms among a sample of young Jamaican males were examined. STUDY DESIGN: As part of the 1997 Reproductive Health Survey, male adolescents and young adults in Jamaica were surveyed about symptoms of STDs and related sex behaviors. RESULTS: Overall, 9% of the sample reported symptoms of STDs in the year before the interview. Rates of high-risk sexual behaviors were high. Logistic regression analyses indicated that being older and having multiple sex partners were associated with having symptoms of STDs. CONCLUSIONS: Prevention programs should recognize that various factors can increase the risk of contracting and transmitting STDs, including HIV. Interventions should be targeted to those with high-risk behaviors that are conducive to continued participation in high-risk sexual behaviors.

Adolescent↗
PubMed2002

Three surveys of HIV-1 prevalence and risk factors among men working at a sugar estate in Malawi.

BACKGROUND: HIV-1 surveys in defined populations identify underlying risks and trends useful to mount interventions. GOAL: The goal of the study was to determine HIV-1 prevalence and risk factors among men working at a Malawian sugar estate. STUDY DESIGN: Three independent surveys were conducted in 1994, 1997, and 1998. Procedures included obtaining informed consent, interviewing, and drawing blood for HIV and syphilis testing. Analyses determined prevalence of HIV and associated risk factors. RESULTS: HIV prevalence was 24.3% in 1994 (n = 1691), 22.8% in 1997 (n = 615), and 20.9% in 1998 (n = 1354; P < 0.03). From 1994 to 1998, the percentage of subjects with a history of sexually transmitted disease (STD) decreased from 43.6% to 29.5% (P < 0.0001), accompanied by a substantial rise in STDs confirmed by physical examination (from 7.5% to 16.8%; P < 0.0001) and by laboratory testing for syphilis (from 6.5% to 10.4%; P < 0.0001). The percentage with multiple sex partners declined (from 62.0% to 35.2%; P < 0.0001), and condom use rose (from 10.9% to 18.9%; P < 0.0001). STDs were significantly associated with prevalent HIV infection each year. CONCLUSIONS: The prevalence of HIV has remained relatively stable and high in this cohort.

Adult↗
PubMed2003

Outbreak of Neisseria gonorrhoeae in Northern Alberta, Canada.

BACKGROUND: In January 2001 we investigated an outbreak of Neisseria gonorrhoeae in a northern region of Alberta, Canada, and here we report on the epidemiology of the outbreak. GOAL: The goal was to examine the outbreak etiology and make recommendations for strengthening regional STD programs. STUDY DESIGN: Provincial STD notification forms were reviewed to identify cases, and a case-control study was undertaken to identify risk factors for infection. RESULTS: Gonorrhea was reported among 81 individuals, aged 15 to 60 years, between January 1999 and March 2001 in 8 neighboring communities. Attendance at a public bar in one community was associated with infection (P < 0.01). Cases were predominantly Aboriginal (96.3%) and aged less than 30 years (77.6%), and at least 39% of cases reported multiple sex partners. Casual partnering and extended sexual networks are believed to have influenced the spread of infection. CONCLUSION: This study emphasizes the importance of site-specific health interventions to effectively target at-risk individuals at high-risk locations, with preventive measures aimed at members of high-risk sexual networks. Effective interventions must ensure the availability of and access to appropriate health services for all residents of northern regions in Alberta.

Adolescent↗
PubMed1997

Cervical cancer screening in the Flemish region (Belgium): measurement of the attendance rate by telephone interview.

In November and December 1995 a computer assisted telephone interview (CATI) was organized in order to measure the rate of participation in cervical cancer screening among a sample of 1,477 women between 18 and 69 years old, residing in the Flemish Region and selected by random digit dialling. Associations between screening status and a set of explanatory variables (demographic, socioeconomic determinants and exposition to primary risk factors for cervical cancer) were studied by logistic regression modelling. The screening coverage meaning the percentage of women screened less than 3 years ago, increases sharply up to 25 years and remains higher than 85% up to 40 years; from then it decreases progressively. Socioeconomically deprived groups and single women are less likely to have a smear taken. Notable regional differences exist. Over-screening (interval between Papanicolaou smears less than 3 years) is an important phenomenon among screened women especially within the younger age groups. The prevalence of risk factors (sexual intercourse at young age, multiple sex partners, contraceptive pill use, smoking) has increased over time but women at higher risk are generally better screened. This survey provides useful baseline information necessary to monitor the achievement of some main objectives, formulated by the Europe Against Cancer programme and also included in Flemish public health policy.

Adolescent↗
PubMed1996

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↗
PubMed1997

Risk behavior for HIV infection in participants in preventive HIV vaccine trials: a cautionary note.

We conducted a longitudinal study of participants in phase I and II HIV vaccine safety and immunogenicity trials to examine changes in sexual risk behavior that are associated with risk of HIV transmission. The participants were 48 HIV-negative men and women enrolled in one of two placebo-controlled HIV vaccine trials conducted at San Francisco General Hospital. There was a significant increase in insertive unprotected anal intercourse (UAI) from 9% at baseline (trial entry), to 13% at the month 6 assessment, to 20% at the month 12 assessment (p = .02). The primary predictor of either insertive or receptive UAI during the vaccine trials was having engaged in this behavior prior to entry (p = .001). Higher-risk behavior was also seen among participants who were younger and had multiple sexual partners (each, p = .06) and who indicated that one of their reasons for participation in the vaccine trial was hope of protection from HIV infection (p = .07). These findings indicate that despite instructions otherwise, participants with a history of high-risk behavior or who express hope of protection from HIV infection by enrolling in vaccine trials may be candidates for more intensive risk-behavior counseling prior to and during their participation.

AIDS Vaccines↗
PubMed1997

The association of herpes simplex virus type 2 (HSV-2), Haemophilus ducreyi, and syphilis with HIV infection in young men in northern Thailand.

To evaluate the association between sexually transmitted diseases that commonly may cause genital ulceration and prevalent and incident HIV infections, we conducted three case control studies in a cohort of 21-year-old male military conscripts in northern Thailand. The men were evaluated at baseline in 1991 and semiannually until their discharge 2 years later. Serologic evidence of infection with herpes simplex virus type 2 (HSV-2), Haemophilus ducreyi, and HIV were more frequent at baseline in 83 men with a history of genital ulcer than in 97 men without such a history. Seropositivity to H. ducreyi (odds ratio [OR] = 3.46), HSV-2 (OR = 3.83), and syphilis (OR = 1.53) were more common in HIV-positive than HIV-negative men. Men (N = 45) who seroconverted to HIV while in the military were more often seropositive for H. ducreyi and HSV-2 before HIV seroconversion and also were more likely to seroconvert to HSV-2 and H. ducreyi during the same interval as their HIV seroconversion compared with men who remained HIV-negative. These data suggest that HSV-2 and H. ducreyi may be both markers for high-risk sexual behavior and risk factors for HIV infection among young men in Thailand.

AIDS-Related Opportunistic Infections↗
PubMed2000

Association between crack cocaine use and high-risk sexual behaviors after HIV diagnosis.

OBJECTIVE: To describe the prevalence of crack cocaine use in an HIV-infected population and to examine the association between crack use after HIV diagnosis and high-risk sexual behaviors for heterosexual men, heterosexual women, and men who have sex with men (MSM). METHODS: Analysis of cross-sectional interviews conducted from January 1995 through December 1998 with HIV infected adults in 12 states. RESULTS: Of 10,415 persons with HIV or AIDS, 66.6% never used crack, 10.7% used crack before HIV diagnosis but not after, and 22.7% used crack after diagnosis. High-risk sexual behaviors were more prevalent among those who had ever used crack and were most prevalent among those who used crack after diagnosis. In multivariable analyses, crack use after diagnosis was associated with having multiple sex partners and trading sex for drugs/money in all three groups: heterosexual men, heterosexual women, and MSM. For heterosexual women and MSM, crack use after diagnosis was associated with unprotected sex with a main partner, and among heterosexual men and MSM, with unprotected sex with casual partners. CONCLUSIONS: Crack use after HIV diagnosis was associated with high-risk sexual behaviors. Treatment programs to assist people in quitting crack are needed to help reduce the risk of HIV transmission from this population.

Adolescent↗
PubMed1999

Detection of early HIV infection and estimation of incidence using a sensitive/less-sensitive enzyme immunoassay testing strategy at anonymous counseling and testing sites in San Francisco.

Timely estimates of HIV incidence are needed to monitor the epidemic and target primary prevention but have been difficult to obtain. We applied a sensitive/ less-sensitive (S/LS) enzyme immunoassay (EIA) testing strategy to stored HIV-positive sera (N = 452) to identify early infections, estimate incidence, and characterize correlates of recent seroconversion among persons seeking anonymous HIV testing in San Francisco from 1996 to 1998 (N = 21,292). Sera positive on a sensitive EIA but negative on a less-sensitive EIA were classified as early HIV infections; sera positive on both EIA were classified as long standing. Seventy-nine sera were from people with early HIV infection. Estimated HIV incidence was 1.1% per year (95% confidence interval [CI], 0.68%-1.6%) overall and 1.9% per year (95% CI, 1.2%-3.0%) among men who have sex with men (MSM). Early HIV infection among MSM was associated with injection drug use, unprotected receptive anal sex, and multiple sex partners in the previous year. No temporal trend in HIV incidence was noted over the study period. The S/LS strategy provides a practical public health tool to identify early HIV infection and estimate HIV incidence in a variety of study designs and settings.

Adult↗