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PubMed1995

The HIV/AIDS epidemic in Jamaica.

OBJECTIVE: To describe the HIV/AIDS epidemic in Jamaica. METHODS: Data from the national surveillance system for HIV infection and AIDS based in the Epidemiology Unit, Ministry of Health, were reviewed. These include case reports; HIV screening of blood donors, migrant farmworkers and US visa applicants; sentinel surveillance among antenatal clinic (ANC) attenders and sexually transmitted disease (STD) clinic attenders; and various serosurveys. RESULTS: A total of 669 AIDS cases were reported in Jamaica from December 1993 representing a cumulative AIDS case rate of 28 per 100,000 population. Since 1987 the annual AIDS case rate doubled every 2 years with 69% of individuals having died with AIDS. Heterosexual transmission predominates with the cumulative adult AIDS male-to-female case ratio declining from 2.8:1 in 1988 to 1.9:1 in 1993. A total of 55 children with AIDS account for 8.2% of all cases. The HIV infection rate per 1000 in 1993 was 3.8 among blood donors, 1.4 among ANC attenders and significantly higher among STD clinic attenders (men 6%, women 2.7%), homosexuals (9.6%), female prostitutes (12%) and individuals with repeat STD infections (10%). Consistent condom use increased from 27% in 1989 to 47% in 1993. CONCLUSIONS: HIV infection was introduced into Jamaica from abroad through several different routes including the Jamaican homosexual community, migrant farmworkers, female prostitutes, and informal commercial importers. HIV transmission is well established locally and is spreading more rapidly in Western Jamaica and along the North Coast, which may reflect increased sexual activity associated with tourism. Although awareness of AIDS and HIV is high and condom use has increased considerably, there are no grounds for complacency concerning the HIV/AIDS epidemic in Jamaica.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Management of sexually transmitted diseases and HIV prevention in men at high risk: targeting clients and non-paying sexual partners of female sex workers in Benin.

OBJECTIVES: Male clients of female sex workers have rarely been specific targets for HIV/sexually transmitted diseases (STD) interventions in sub-Saharan Africa. We assessed the effectiveness of outreach methodology for contacting sexual partners of female sex workers for purposes of HIV/STD prevention in Cotonou, Benin. DESIGN AND METHODS: In collaboration with owners/managers, outreach personnel and female sex workers, 404 clients were recruited on-site at prostitution venues, and provided urine samples for leukocyte esterase dipstick (LED), STD and HIV testing before having sex with female sex workers. After having sex they underwent an interview and physical examination. No payment was made for study participation. Prostitution site personnel (n = 41) and boyfriends of female sex workers (n = 56) were also recruited. RESULTS: In all 68% of the clients approached agreed to participate. On-site LED testing and free STD treatment were important factors in participation. HIV-1 prevalence was several-fold higher than in the general population in Cotonou, at 8.4, 12.2 and 16.1% in clients, personnel and boyfriends respectively, and was associated with increasing age and lack of condom use with female sex workers. Condom use rates by clients with female sex workers were non-negligible but sub-optimal, and low with regular partners. Approximately one-third of clients with regular partners also had other non-female sex worker sex partners. Boyfriends of female sex workers are of particular concern due to high numbers of partners, very low condom use rates and high HIV prevalence. CONCLUSIONS: Study findings indicate that male sex partners of female sex workers form a 'bridging population' for HIV/STD transmission both to female sex workers, as well as from female sex workers to the general population of women, particularly regular female partners.

Adult↗
PubMed2001

High prevalence of syphilis and other sexually transmitted diseases among sex workers in China: potential for fast spread of HIV.

OBJECTIVES: In China, in the early 1980s, sexually transmitted diseases (STD) started to increase steeply. Sex workers and their clients appeared to play an important role in the spread of STD. Prostitution is illegal in China, and therefore no specific services exist for sex workers unless they are arrested and detained in re-education centres. Staff of a maternal and neonatal hospital in Guangzhou felt the need for an STD care and prevention programme for sex workers outside detention, and started a programme within their hospital, which was unique in the Chinese context. METHODS: From March 1998 to mid-October 1999 sex workers were recruited through various outreach methods, and were interviewed, counselled and examined for the presence of STD/HIV. RESULTS: A total of 966 women, originating from all over China but working in Guangzhou, entered the programme. The median duration of prostitution was one year, and the median number of clients was seven per week. Antibodies to HIV were present in 1.4%. The prevalence of STD was very high: syphilis 14%, Chlamydia trachomatis 32%, gonorrhoea 8% and trichomoniasis 12.5%. Knowledge about STD/HIV transmission and condom use was poor. CONCLUSION: Given the high prevalence of STD, the potential for the further spread of HIV is clearly present. STD care and prevention programmes for these women, outside detention, are urgently needed, and appear also to be feasible in China.

Adult↗
PubMed1992

The influence of mental health problems on AIDS-related risk behaviors in young adults.

This paper explores how symptoms of mental health problems influence acquired immune deficiency syndrome-related risk behaviors, and how changes in those symptoms relate to risk behaviors engaged in by young adults. Repeated interviews with 602 youths since 1984 provide a history of change in behaviors. Mental health symptoms during adolescence (alcohol/drug [r = .28]; conduct disorder [r = .27]; depression [r = .16]; suicide [r = .14]; anxiety [r = .16]; and posttraumatic stress [r = .09]) are associated with higher numbers of risk behaviors (specifically, prostitution, use of intravenous drugs, and choice of a high-risk sex partner) during young adulthood. Changes in mental health symptoms between adolescence and young adulthood are related to the number of risk behaviors engaged in by young adulthood (total number of symptoms [B = .10], alcohol/drug abuse or dependence [B = .34], depression [B = .20], suicidality [B = .35], anxiety [B = .13], and posttraumatic stress [B = .14]). Changes in symptoms of mental health problems are associated specifically with those risk behaviors that are initiated primarily in young adulthood: intravenous drug use, prostitution, and choice of risky partners. The findings show that prevention and treatment of mental health problems are important components of preventive interventions for human immunodeficiency virus infection in high-risk teens and young adults.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The recovery of Neisseria gonorrhoeae from clinical specimens: effects of different temperatures, transport times, and media.

Factors influencing the recovery of Neisseria gonorrhoeae from patients were studied. By comparison of the survival times of N. gonorrhoeae in Amies and modified Thayer-Martin media at different temperatures, it was found that the organism survived better at low temperature in the former medium, but at higher temperature on the latter. Even at 4 C, N. gonorrhoeae showed a loss of viability in Amies medium. Culture plates inoculated with cervical specimens can be kept in a CO2-enriched environment at high ambient temperature (approximately 24-30 C) for 18-24 hr before incubation with only a slight loss in isolation rate. Urine specimens are unsuitable for recovery of N. gonorrhoeae from female prostitutes, and urine specimens from male patients should not be kept overnight. Non-penicillinase-producing N. gonorrhoeae isolates from prostitutes not only had fewer colonies on culture plates but also required more time for growth to be visible.

Culture Media↗
PubMedDate not supplied

Sexually transmitted diseases in females in a juvenile detention center.

Of 37 female adolescent prostitutes and 63 other females held in the King County, Washington, juvenile detention facility, 81 (81%) complained of vaginal discharge, and only eight (8%) had no genitourinary symptoms. The prevalence of genital infections among prostitutes and nonprostitutes was similar. Neisseria gonorrhoeae was found in 18 (18%) of 98 detainees tested, and Chlamydia trachomatis was found in 17 (20%) of 86 detainees tested; either organism was found in 27 (32%) of 85 tested for both organisms. Also, 38 (48%) of 80 tested had trichomoniasis. No detainees had syphilis. Sixty-seven (68%) of 98 responding detainees used no contraception. Such populations deserve the attention of public programs for control of sexually transmitted diseases and for family planning.

Adolescent↗
PubMedDate not supplied

Incidence and risk factors for acquisition of sexually transmitted diseases in heterosexuals with multiple partners.

BACKGROUND AND OBJECTIVES: The incidence of four STDs that are mainly transmitted during vaginal intercourse, and risk factors for acquisition during follow-up were studied in a cohort of heterosexuals with multiple partners in Amsterdam, the Netherlands. These heterosexuals with > or = 5 different sexual partners in the preceding 6 months were recruited from an STD clinic and participated voluntarily in a longitudinal HIV study between 1987 and 1991. STUDY DESIGN: Using survival techniques, the authors analyzed data on general characteristics, sexual behavior, reported and diagnosed STDs of 155 men and 234 women participating at least twice in the HIV study and returning regularly. RESULTS: The majority of women were prostitutes and the majority of men were clients of prostitutes. For men and women, the 2-year cumulative incidence were 2.7% (95% confidence interval [95% CI] 0.9-8.3) and 0.8% (95% CI 0.1-5.8), respectively, for syphilis, 8.5% (95% CI 3.9-18.0) and 5.3% (95% CI 2.6-10.8) for gonorrhea, 20.2% (95% CI 12.5-31.9) and 31.9% (95% CI 23.7-42.2) for Chlamydia trachomatis infection, and 24.5% (95% CI 17.3-34.2) for trichomoniasis (examination in women only). Among men, STD(s) diagnosed at entry was found to be an independent predictor of infection with any of these STDs during follow-up (relative hazard (RH) = 2.58, 95% CI 1.18-5.64). Among women, risk factors were age < or = 25 years (RH = 1.82, 95% CI 1.13-2.19) and current report of commercial unprotected vaginal contacts (RH = 2.19, 95% CI 1.11-4.13). Among women, trichomoniasis during follow-up was predicted by current report of commercial contacts (RH = 2.59, 95% CI 1.16-5.79). C. trachomatis infection in women was associated with native country outside the Netherlands (RH = 2.47, 95% CI 1.38-4.43), reported history of STDs in the 4 months before the study (RH = 2.92, 95% CI 1.39-6.14) and age < or = 25 years (RH = 1.90, 95% CI 1.06-3.40). CONCLUSIONS: This study shows that STDs were common among this group of heterosexuals, despite regularly participating in the HIV study in which consistent condom use was promoted. Prevention efforts should be intensified for men and women having commercial sexual contacts, young women, and individuals with a history of STDs.

Adult↗
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

Antibody to Haemophilus ducreyi among trucking company workers in Kenya.

BACKGROUND AND OBJECTIVES: To determine the prevalence, correlates, and incidence of Haemophilus ducreyi antibodies, a cohort of East African trucking company employees was evaluated. STUDY DESIGN: Human immunodeficiency virus (HIV)-1-seronegative men working in six trucking companies in Mombasa, Kenya, were evaluated with a questionnaire and serologic testing for antibodies to H. ducreyi and other sexually transmitted pathogens. Men who were initially H. ducreyi seronegative were retested at 1 year of follow-up. RESULTS: The H. ducreyi seroprevalence among 501 men at enrollment was 26.5%. Seropositivity was significantly associated with older age, married status, years of active sex life, number of sex partners in the past year, history of unprotected sex with a prostitute in the past year, and history of alcohol intake (all P values < 0.01). Occupational travel for more than 14 days per month was also significantly associated with H. ducreyi seropositivity (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.3-3.2). Using multivariate analysis, H. ducreyi seropositivity was independently associated with age, married status, history of sex with a prostitute, and history of alcohol intake. Presence of H. ducreyi antibodies was significantly associated with seropositivity to the other major genital ulcerative pathogens, Treponema pallidum (OR 4.3, 95% CI 2.2-8.3), herpes simplex virus type 2 (OR 4.9, 95% CI 2.0-11.5), and Chlamydia trachomatis (OR 3.2, 95% CI 1.5-6.9). These associations remained significant after adjusting for demographic and exposure variables. The incidence of seroconversion to H. ducreyi antibodies was 3.6 per 100 person years. CONCLUSIONS: Serologic evidence of H. ducreyi infection was common among male trucking company employees. H. ducreyi seropositivity is an objective marker of high-risk behavior and is associated with serologic evidence of other ulcerative sexually transmitted diseases.

Adolescent↗
PubMed2002

Human herpesvirus 8 seroprevalence in an STD clinic in Paris: a study of 512 patients.

BACKGROUND: Human herpesvirus 8 (HHV-8) is thought to be possibly sexually transmitted in some populations, but few data are available on this mode of transmission. GOAL The goal was to study HHV-8 seroprevalence in patients attending a sexually transmitted disease (STD) clinic and to search for predictive factors of HHV-8 seropositivity. STUDY DESIGN: Five hundred twelve consecutive patients attending the STD clinic of Hôpital Saint-Louis (Paris) were tested for HHV-8 antibodies (immunofluorescence assay using two cell lines, BCP-1 and ISI n. butyrate [3 mmol/l]). A standardized questionnaire was used to obtain demographic, behavioral, and clinical data. Predictive factors of HHV-8 seropositivity were considered in univariate and multivariate analysis with use of logistic regression models. RESULTS: In testing of the patients for HHV-8 antibodies, 67/512 (13.1%) tested positive: 53/346 (15.3%) of men and 14/166 (8.4%) of women ( = 0.03). The predictive factors of HHV-8 seropositivity for men were the country of origin (Central Africa, odds ratio [OR]: 7.5; North Africa, OR: 5.5), homosexuality (OR: 3.7), and visiting prostitutes (OR: 7.1). For women they were country of origin (Central Africa, OR: 8.3) and presence of HSV-2 antibodies (OR: 6.5, tendency). CONCLUSION: Our study does not show clear relationships between HHV-8 seropositivity and sexual behavior, apart from homosexuality, but visiting prostitutes (for men) and HSV-2 seropositivity (for women) could be subtle clues supporting the hypothesis of heterosexual transmission.

Antibodies, Viral↗
PubMed2002

Prevalence of preinvasive and invasive lesions of the cervix in sexual workers.

OBJECTIVE: To determine the prevalence of preinvasive and invasive lesions of the cervix in sexual workers. MATERIALS AND METHODS: A total of 438 prostitutes were analyzed. Each prostitute had a clinical history, gynecological examination, Pap smear, and a colposcopic examination of the cervix. A cervical biopsy was taken under colposcopic guidance when there was abnormal epithelium. RESULTS: The sexual workers' mean age was 32.2 + 8 years (mean + SD), age of first sexual intercourse was 15.9 + 2 years, parity mean was 4.1 + 2, births were 3 + 3, and age of first delivery was 16.6 + 4.7 years. Cervical biopsies were taken from 84 patients because of atypical epithelium under colposcopic examination. Sixty-four (76.2%) patients had preinvasive and invasive lesions: 41(64%) had cervical intraepithelial neoplasia (CIN) 1, 12 (18.8%) had CIN 2, 8 (12.5%) had CIN 3, 2 (3.2%) had microinvasive carcinoma (Ca), and 1 (1.5%) had invasive Ca 1. Sexual workers with cervical pathology were younger (p < .05) and had their first sexual intercourse experience earlier than those sexual workers who did not have lesions (p < .02).Preinvasive lesions were found in sexual workers in their 30s, and invasive lesions were found in sexual workers under the age of 40. CONCLUSIONS: Preinvasive lesions of the cervix have increased 2-fold in Venezuelan sexual workers and the invasive lesions are stable but found in younger sexual workers.

Journal Article↗
PubMed2004

HIV/AIDS risk among brothel-based female sex workers in China: assessing the terms, content, and knowledge of sex work.

BACKGROUND: Sexual transmission of HIV in China is rapidly increasing, in part driven by commercial sex work. GOAL: This article examines variations in occupational control among one type of brothel-based prostitutes in China, and the relationship between the terms and content of this work and the risk of HIV/AIDS. Organizational factors are discussed as part of the current political, economic, and social context of sex work in China. STUDY: The analysis is based on ethnographic observation and in-depth interviews conducted in south China in 2000 and 2001 involving 158 female prostitutes from 45 brothels in 4 red light districts. Qualitative analysis of interview and observational data used development of thematic codes measuring occupational control. RESULTS: Brothel-based female sex workers in China are a heterogeneous population, displaying considerable variability in the organization of life and work, relationships with managers and clients, ability to negotiate condom use, knowledge of sexually transmitted diseases and HIV, and occupational identity, all of which may result in different risks of acquiring HIV. CONCLUSION: HIV prevention activities in China must focus on sociocultural aspects of sex work. Such interventions depend on detailed knowledge of its organization. The results of this study demonstrate the importance of prevention activities directed at the brothel managers and clients, as well as the sex workers.

Adolescent↗
PubMed1998

Characterization and phylogenetic analysis of a novel hepatitis D virus strain discovered by restriction fragment length polymorphism analysis.

The hepatitis D virus (HDV) genotypes in 46 HDV-infected patients and 12 prostitutes were screened with Xhol restriction fragment length polymorphism (RFLP) analysis of reverse transcription PCR products of viral genomes and verified by phylogenetic analysis. The amplificates of three (6.5%) patients and two (17%) prostitutes showed a novel RFLP pattern different from those of the three known genotypes. Complete HDV genomic sequence identities between isolates with a novel RFLP and the HDV genotypes I, II and III were 72.3, 77.2 and 63.0%, respectively. Importantly, divergence was mostly seen in various regions related to replication or packaging. The novel isolates formed a monophyletic group (P < 0.05) and were most closely related to genotype II.

Amino Acid Sequence↗
PubMedDate not supplied

AIDS, policy and bioethics: ethical dilemmas facing China in HIV prevention: a report from China.

The present situation of the HIV/AIDS epidemic is very grim in China. The probability of China becoming a country with a high prevalence of HIV/AIDS cannot be excluded because there have been factors which promote the wide spread of HIV if we fail to take timely action to prevent it at the opportune moment. However, China's HIV prevention policy is inadequate. Health professionals and programmers believed that they could take a conventional public health approach to cope with the HIV epidemic. They simply ignored the fact that HIV infection is an epidemic so special that their approach is not effective to deter the epidemic. Many health professionals and programmers bypassed ethical issues that had emerged in the prevention of the HIV epidemic. Even some health educators, sexologists and officials believe that 'AIDS is the punishment for promiscuity', and this belief has led to discrimination and stigmatization of AIDS patients, HIV positive people, their family members and high risk groups. Although homosexuality is not illegal, the police can always find any reason to detain homosexuals. A difficult ethical issue is about the laws prohibiting prostitution and drug use in China which force prostitutes and intravenous drug users underground, giving them no chance to access information, education and the services needed to protect them. The dilemma facing China is whether to stay with a restrictive policy for the reason of ideology cleansing or to turn to a more supportive policy. It is necessary to have some change in the ethical framework to evaluate the action in HIV prevention. Tolerance should be the first ethical principle.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Seroepidemiology of herpes simplex virus in Yogyakarta, Indonesia.

Sera from 487 individuals in Yogyakarta, Indonesia, were tested for antibodies to herpes simplex virus (HSV) by a passive hemagglutination method. Age-specific incidence rates for antibodies to HSV were calculated. For sera from persons other than prostitutes, in the age group from 10 to 19, the positive rate was 48% but in the age group higher than 20, it was more than 87%. Fifty of 59 pregnant women (85%) were positive. The positive rate and the distribution of antibody levels in prostitutes were higher than in the general population.

Adolescent↗
PubMedDate not supplied

Incidence of chancroid in Vienna from 1980 to 1988.

The authors report on a retrospective study of the occurrence of chancroid in the city of Vienna during the past 10 years. After identifying two patients at the authors' department with chancroid in March 1988, the authors investigated the frequency with which this disease presented during the last 10 years. Of 32 patients, six presented between 1977 and 1980, and one patient in 1987. The remaining 25 patients were diagnosed within a 4-month period in 1981, suggesting a limited outbreak. The source of this infection could be traced to Turkey; infected prostitutes contributed to further spread in Vienna. All patients were treated successfully with sulfamethoxazole/trimethoprim. Efficient control of this outbreak can be attributed to inpatient treatment of the prostitutes. Appropriate and timely treatment must be preceeded by careful and exact diagnosis of this disease whose clinical picture is constantly diverging from its classical form.

Austria↗
PubMed2000

Prevalence of human papillomavirus infection and its correlation with cervical lesions in commercial-sex workers in Japan.

OBJECTIVE: To investigate the prevalence of the human papillomavirus (HPV) infection and its correlation with cervical lesions in commercial-sex workers (CSWs) who attended a sexually transmitted disease (STD) clinic in an entertainment area in Tokyo. METHODS: Surveys were conducted on 546 prostitutes and 233 control subjects. In all subjects, HPV detection was performed by the hybrid capture method. A cervical cytological examination was performed on 247 prostitutes and 233 control subjects. RESULTS: The HPV-positive rates in the two periods of study were higher (p < 0.01) in CSWs than in the control subjects. When the cytological grades were examined according to HPV-positive rates, the proportion of cytologic Class IIIa to Class IV was significantly higher (p < 0.01) in the HPV-positive CSWs than in the HPV-negative CSWs or in the normal subjects. CONCLUSION: The high frequencies of HPV infection and cervical dysplasia in the CSWs in the present series might predict a higher risk of cervical cancer in this group of subjects.

Adolescent↗
PubMed1991

[Epidemiological study on Chlamydia trachomatis infection in obstetrics and gynecology field in Tokyo].

In conjunction with the Tokyo Branch of Japan Association for Maternal Welfare, we have been carrying out examinations of Chlamydial infection on women, especially pregnant women, living in Tokyo. Specimens were collected from 212 gyneco-obstetric clinics in Tokyo during 4 years from January 1987-December 1990. A total of 13,925 swab specimens from patients who were suspected of sexually transmitted diseases from clinical findings and pregnant women who requested the examination were tested for the presence of antigen to C. trachomatis with EIA (Chlamydiazyme). Epidemiological analysis based on the results and case cards that were described sex, age, occupation and clinical findings were conducted. The results obtained are briefly summarized as follows. 1) C. trachomatis antigen was detected in 12.8% (1,237/9,657) of the female patients, 31.0% (124/400) of the male patients and 6.8% (10/168) of the infants. The detection rates of C. trachomatis antigen in the male patients was significantly higher than that in the female and the infants patients. C. trachomatis antigen was detected in 6.1% (226/3,683) of pregnant women. 2) The detection rates of C. trachomatis antigen were compared by occupation of female patients. Most high rate was 26.6% (53/199) in bar hostess , subsequently 20.1% (102/508) in students, 19.8% (59/298) in prostitutes, 13.6% (455/3,348) in office girls and 7.2% (471/6,573) in house-wives. It was noteworthy that the detection rates of C. trachomatis antigen in students was as similarly high as that in prostitutes. 3) The detection rates of C. trachomatis antigen was also compared by age groups. The detection rate had a tendency to be high in younger people.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗