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PubMed2005

An examination of knowledge, attitudes and practices related to HIV/AIDS prevention in Zimbabwean university students: comparing intervention program participants and non-participants.

OBJECTIVES: This study represents a comprehensive assessment of differences between participants in an HIV/AIDS prevention program (SHAPE: Sustainability, Hope, Action, Prevention, Education) and non-participants in knowledge, attitudes and practices with a focus on cultural, sociological and economic variables. METHODS: We developed an eight-page questionnaire that was administered to 933 randomly selected students at the University of Zimbabwe. Survey items addressed sexual decision-making, condom use, limiting sexual partners, cultural power dynamics and access to HIV testing. RESULTS: Results show participants are statistically more likely to report being sexually abstinent, and understand the prevention benefits of condom use. SHAPE members had fewer sexual partners in the previous year than non-SHAPE members (1.4 vs. 2.2). SHAPE members were significantly more likely (67%) than non-SHAPE respondents (48%) to indicate that they knew their HIV sero-status and to state that they knew their status because they had been tested (85% vs. 71%). DISCUSSION: Though we found differences between the groups suggesting that program participation increases awareness concerning gender equity, there continue to be many intractable cultural attitudes in this age group. Findings suggest that the attitudes and practices of young men and women are changing, but that progress in some areas does not assure progress in all areas.

Acquired Immunodeficiency Syndrome↗
PubMed1981

Case-control study of the husbands of women with dysplasia or carcinoma of the cervix uteri.

The husbands of married women with cervical dysplasia, carcinoma-in-situ, or invasive carcinoma of the cervix who, in an earlier study, had claimed to have had no sexual partner other than their husband, were interviewed to determine whether the risk of cervical epithelial abnormalities in the women could be related to their husband's sexual background. Of 322 women previously studied, 57 were eligible for this study and the husbands of 31 of them were interviewed together with the husbands of a control group, matched for age and age at first intercourse. The number of sexual partners reported by the husband was found to be a significant risk factor, with a relative risk of 7.8 for 15 or more partners outside marriage. The relative risk for women who smoked was 7.0, and this was independent of any of the sexual risk factors. The findings for subgroups of women with invasive carcinoma and with dysplasia or carcinoma-in-situ were similar. The data strongly support the view that an infectious agent is involved in the aetiology of cancer of the cervix and suggest that smoking may have an independent carcinogenic action.

Adult↗
PubMed2005

HIV/STD risk reduction interventions for African American and Latino adolescent girls at an adolescent medicine clinic: a randomized controlled trial.

BACKGROUND: Adolescent girls in the United States and around the world are at a heightened risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). OBJECTIVE: To determine the efficacy of a skill-based HIV/STD risk-reduction intervention in reducing self-reported unprotected sexual intercourse among African American and Latino adolescent girls. DESIGN: Randomized controlled trial with 3-, 6-, and 12-month follow-ups. SETTING AND PARTICIPANTS: Sexually experienced African American and Latino adolescent girls recruited from the adolescent medicine clinic of a children's hospital serving a low-income inner-city community (N = 682, mean age, 15.5 years); 88.6% were retained at the 12-month follow-up. INTERVENTIONS: Three 250-minute interventions based on cognitive-behavioral theories and elicitation research: an information-based HIV/STD intervention provided information necessary to practice safer sex; a skill-based HIV/STD intervention provided information and taught skills necessary to practice safer sex; or a health-promotion control intervention concerned with health issues unrelated to sexual behavior. MAIN OUTCOME MEASURES: Primary outcome measure was self-reported frequency of unprotected sexual intercourse; secondary outcomes included the frequency of sexual intercourse while intoxicated, the number of sexual partners, biologically confirmed STDs, and theoretical mediator variables, including the intention to use condoms, beliefs about using condoms, and condom-use knowledge. RESULTS: No differences between the information intervention and the health control intervention were statistically significant. Skills-intervention participants (mean [SE], 2.27 [0.81]) reported less unprotected sexual intercourse at the 12-month follow-up than did information-intervention participants (mean [SE], 4.04 [0.80]; P = .03), or health control-intervention participants (mean [SE], 5.05 [0.81]; P = .002). At the 12-month follow-up, skills-intervention participants (mean [SE], 0.91 [0.05]) reported fewer sexual partners (P = .04) compared with health control-intervention participants (mean [SE], 1.04 [0.05]) and were less likely to test positive for STD (mean [SE], 10.5% [2.9%]) than were health control-intervention participants (mean [SE], 18.2% [2.8%]; P = .05). No differences in the frequency of unprotected sexual intercourse, the number of partners, or the rate of STD were observed at the 3- or 6-month follow-up between skill-intervention participants and information-intervention or health control-intervention participants. CONCLUSION: Skill-based HIV/STD interventions can reduce sexual risk behaviors and STD rate among African American and Latino adolescent girls in clinic settings.

Adolescent↗
PubMed1987

Epidemiology of cervical cancer by cell type.

A multicenter case-control study of 481 invasive cervical cancer patients and 801 population controls enabled comparison of risk factors for squamous cell tumors (n = 418), adenosquamous cancers (n = 23), and adenocarcinomas (n = 40). The epidemiology of the squamous cell tumors resembled that found in other studies, with the major risk factors being absence of Pap smear screening (relative risk = 3.6 to 4.8 for those not screened within 5 yr), multiple sexual partners (relative risk = 2.9 for over ten partners), and history of genital infections or sores (relative risk = 2.3). Although based on small numbers, adenosquamous tumors appeared to share some of these risk factors, notably number of sexual partners, years since last Pap smear, and level of education. Adenocarcinomas were not similarly affected, although sexual practices were marginally predictive. Obesity increased the risk of adenocarcinoma, but no other similarities to endometrial adenocarcinoma were observed. Smoking was a significant predictor of squamous cell tumors but did not affect adenocarcinomas. Extended use of oral contraceptives was a risk factor for all tumor types, especially adenocarcinoma, and a familial tendency to cervical cancer was also observed for all cell types.

Adenocarcinoma↗
PubMed2006

Sexual identity formation and AIDS prevention: an exploratory study of non-gay-identified Puerto Rican MSM from working class neighborhoods.

As a subgroup of men who have sex with men (MSM), non-gay-identified (NGI) behaviorally bisexual Latino MSM are associated with heightened probabilities of HIV transmission, yet they have eluded HIV/AIDS interventionists. This exploratory study of Puerto Rican MSM drug users employed multi-session qualitative interviews to examine early life experiences related to gender identity and sexual orientation, and the place of risky drug and sexual behaviors in the process of sexual identity formation. NGI participants experienced sexual debut between ages 13 and 20, and most were recruited to prostitution as young teens by NGI age mates who were also members of drug use networks. Participants emphasized their role as insertive sexual partners and that they maintained relationships with pasivo biological males. It is feasible to recruit NGI MSM through primary male sexual partners and drug use networks. HIV/AIDS prevention based on awareness of developmental histories holds promise for intervening before NGI youth engage in male prostitution or injection drug use.

Adolescent↗
PubMed1988

Bacterial vaginosis.

Bacterial vaginosis (nonspecific vaginitis) is a polymicrobial, superficial vaginal infection caused by an increase in anaerobic organisms and a concomitant decrease in lactobacilli. Gardnerella vaginalis, once thought to be the sole etiologic agent, is probably one of several endogenous members of the vaginal flora that overgrow in women with bacterial vaginosis. Whether the growth of anaerobes or a primary decrease in lactobacilli is the initial pathogenic event remains unclear. Epidemiological studies have revealed that current or previous infections caused by Trichomonas organisms, increased sexual activity, and intrauterine device use are risk factors for this condition. Studies have indicated that bacterial vaginosis, previously thought to be a benign illness, is associated with some morbidity in pregnant women. Symptoms remain unreliable in the diagnosis of bacterial vaginosis. Diagnostic efficacy is best achieved by utilizing clinical signs. Assessment of cure is best accomplished by Gram stain, not clinical criteria. Metronidazole, 500 mg orally for seven days, remains the treatment of choice; however, a 2-g single dose of metronidazole represents a reasonable alternative if cost and compliance issues predominate in a clinical situation. Although a recent study supports the contention that treatment of the male sexual partner of women with bacterial vaginosis is effective, a general recommendation cannot be made with confidence on the issue of sexual partner treatment until other supporting work is done.

Bacterial Infections↗
PubMed2006

Adolescents' sexual self-disclosure on the internet: deindividuation and impression management.

This study examined the effect of anonymity on adolescents' sexual self-disclosure on the Internet and the impact of topic intimacy on their reply intent for sexual disclosure by conducting a survey with 1,347 adolescents. It was found that male participants were more likely than females to engage in sexual self-disclosure and to correspondingly respond to cyber partners' sexual disclosure. Results showed that the greater the anonymity, the greater the intent for sexual self-disclosure. Participants exhibited greater reply intent when cyber partners self-disclosed sexual topics with greater intimacy, and the effect of topic intimacy was more pronounced in male participants. The findings suggest that male adolescents tend to adopt a reciprocal strategy in responding to partners' sexual disclosure on the Internet, whereas females tend to employ a conservative strategy. It was concluded that male and female adolescents revealed differential self-presentation and impression management for their sexual self-disclosing and responding on the Internet.

Adolescent↗
PubMed1995

Bacterial vaginosis in lesbians: a sexually transmitted disease.

Sexual transmission of bacterial vaginosis (BV), a common syndrome in sexually active women, has not been previously established. Because no male counterpart for BV has been found, a population of lesbians is an ideal one in which to test the hypothesis that BV is sexually transmitted. We studied 103 homosexual women (lesbians) who sought gynecologic care at a community clinic and in a private gynecology practice in New York City. Participants were asked to refer their sexual partners for evaluation. In this cross-sectional prevalence study, all participants were evaluated for the presence of BV, and pairs of monogamous sexual partners were analyzed for concordance of their vaginal secretions. Twenty-nine (28.7%) of the 101 participants from whom satisfactory vaginal wash samples were available had BV. There were 21 pairs of monogamous partners. Of 11 index women who had BV, eight (72.7%) had partners who also had BV. Of 10 index women who did not have BV, only one (10%) had a partner with BV. The likelihood of a partner's having BV was 19.7 times greater if the index case had BV (P < .008; 95% CI, 2.1-588.0). We conclude that with respect to BV, lesbians in monogamous relationships usually have concordant vaginal secretions. This concordance probably reflects the sexual transmission of BV between lesbians.

Female↗
PubMed2001

Determinants of HIV prevalence amongst female IDU in Madrid.

OBJECTIVE: To explore the multitude possible factors associated with HIV in a population of female injecting drug users (IDUs) in Madrid, Spain. DESIGN: A cross-sectional study was undertaken and because of the lack of sampling frame in this population, a convenience sample was recruited from drug treatment, methadone services and street settings. METHODS: Face to face interviews were conducted with 304 female IDUs during October 1995-March 1996. HIV status was determined from antibody testing of blood samples or from written confirmation of HIV test results from a physician. A hierarchical logistic regression model was used to identify direct and indirect relationships with HIV prevalence. RESULTS: HIV prevalence in the sample of female IDUs for which HIV status was known (n = 262) was 63%. Factors independently associated with HIV prevalence in the regression analysis included: having a regular HIV positive sexual partner [odds ratio (OR): 12.2], age over 34 years (OR: 3.4), no fixed address (OR: 2.9), co-infection with a sexually transmitted infection (STI) in the last year (OR: 2.8) and ever shared needles (OR: 2.6). CONCLUSIONS: The documentation of the context of risk behaviour in female IDU is important to predict the course of the epidemic and to develop prevention strategies. The sexual partners of female IDUs in Spain are important components in explaining the HIV epidemic in this population as other risk factors, including high risk drug taking behaviour. The findings also highlight the need to target homeless IDUs women and inmate women with outreach services offering preventive interventions. More effective STI prevention and control strategies are also warranted.

Adult↗
PubMed1997

Risk factors for sexually transmitted diseases among women attending family planning clinics in Dar-es-Salaam, Tanzania.

BACKGROUND: Identification of risk factors for sexually transmitted diseases (STDs) assists in development of treatment algorithms, which are potentially important components of STD control when microbiologic facilities are limited. METHODS: A cross-sectional study was performed to assess STD and HIV risk factors of 2285 women attending three family planning clinics in Dar-es-Salaam, Tanzania during 1991-92. Women were interviewed and examined for signs of STDs. Specimens were taken for laboratory diagnosis of HIV, other sexually transmitted organisms, and Candida albicans. RESULTS: The prevalence of gonorrhoea was found to be 4.2%, prevalence of trichomoniasis was 14.3%, and positive syphilis serology was found in 2.5% of women. Unmarried women were at increased risk of trichomoniasis (age-adjusted OR = 1.48 95% CI [1.12, 1.95]), gonorrhoea (age-adjusted OR = 1.81 95% CI [1.14, 2.86]) and syphilis (age-adjusted OR 1.5 [0.84, 2.68]). An increasing number of sexual partners in the past five years was associated with an increased risk of all STDs. Current use of the oral contraceptive pill was positively associated with gonorrhoea, multivariate OR = 1.75 95% CI [1.05, 2.93]. The prevalence of candidiasis was 11.5% and was not associated with any of the demographic or behavioural risk factors examined. Clinical diagnostic algorithms for STDs in this study population had relatively low sensitivity and low positive predictive value. CONCLUSION: Being unmarried and having a higher number of sexual partners were consistently associated with each STD, while the associations for other risk factors varied between STDs, emphasising the complexity of STD distribution. Further development of diagnostic algorithms and other methods for screening women for STDs are needed to reduce the impact of STDs and HIV in developing countries.

Adolescent↗
PubMedDate not supplied

Sensation seeking, self-esteem, and unprotected sex in college students.

This descriptive correlational study examined the relationships of sexual sensation seeking, self-esteem, and self-efficacy in condom use, stages of change, and alcohol consumption to HIV risk-taking behaviors among college students. A total of 159 students completed an online survey in 2004. Instruments included the Sexual Sensation Seeking Scale, College Alcohol Problems Scale, Condom Use Scale, and Rosenberg Self-Esteem Scale. High sensation seekers had higher self-esteem, more self-efficacy in condom usage, fewer problems associated with alcohol consumption, and belonged to Greek organizations (F [1,158] = 12.54; p < .0005). Women who were high sensation seekers perceived more advantages (F [1, 116] = 1.67; p = .05) than disadvantages (F [1, 116] = 2.01; p = .01) to using condoms. Men consumed significantly more alcohol and had more social problems related to alcohol use than women (F [1, 158] = 5.04; p < .03). Students in Greek organizations had significantly more positive attitudes (X(2) [1] = 4.55; p < .03) and more respect for themselves (X(2) [1] = 11.22; p < .0008) than other students and were more likely to be tested for HIV (X(2) [1] = 3.85; p < .05). Students with low self-esteem consumed more alcohol, had more sexual partners, and had more HIV risk-taking behaviors than other students. Even though students were reported to be efficacious in condom usage, they used them inconsistently with their sexual partners and were in the earlier stages of change. Interventions are needed in the community to help sexually active individuals take responsibility for their sexual health and to increase the awareness of the need to be tested for HIV.

Adolescent↗
PubMedDate not supplied

The influence of sexual and social factors on the risk of Chlamydia trachomatis infections: a population-based serologic study.

BACKGROUND: Genital chlamydia infections often are asymptomatic, which promotes their spread in the population. In women, the possible consequences of infection are pelvic inflammatory disease and infertility. Most studies on the prevalence of Chlamydia trachomatis have been based on clinical series, and prevalences tend to vary with the clinical setting. Few seroepidemiologic studies have emerged from industrialized countries. GOAL OF THIS STUDY: To assess the prevalence of Chlamydia trachomatis using culture and serology, and its relationship with possible risk factors. STUDY DESIGN: This was a population-based study involving completion of a self-administered questionnaire, analysis of cervical samples for Chlamydia trachomatis, and serologic tests for Chlamydia trachomatis antibodies. RESULTS: The prevalence of Chlamydia trachomatis infection was 2.7%, and the seroprevalence was 24.7% among the sexually active women. Seropositivity was correlated with sexual behavior variables, and the incidence of serologic cross-reactivity with respiratory infections (strain TWAR) was low. Multivariate logistic regression analysis showed the number of sexual partners, age at first coitus, history of therapeutic abortion, and previous pelvic inflammatory disease to be independently correlated with seropositivity. CONCLUSION: Early sexual experience and multiple lifetime sexual partners are independent risk factors for Chlamydia trachomatis infection.

Adult↗
PubMed1986

Bowenoid papulosis of the male and female genitalia: risk of cervical neoplasia.

Sixteen patients with bowenoid papulosis (eleven male patients with bowenoid papulosis of the penis and five female patients with bowenoid papulosis of the vulva) were studied clinically, histologically, and virologically and followed up from 12 months to 5 years. In eleven of sixteen cases of bowenoid papulosis, molecular hybridization disclosed the presence of human papillomavirus type 16. In four cases we found new, not fully characterized human papillomavirus, and in two cases, we found both human papillomavirus 16 and new human papillomavirus (double infection). The mean age of male patients was 33 years and of female patients, 31 years. The mean duration of the disease was 2.4 and 3.6 years, respectively. The lesions cleared or did not recur in eight of eleven male patients after repeated partial excisions and in two of five female patients after conservative surgery. Cervical intraepithelial neoplasia (severe dysplasia) was present in three of five female patients, and human papillomavirus infection of the cervix was present in five of six sexual partners of male patients available for examination. Thus bowenoid papulosis presents a high risk for cervical neoplasia both for female patients and for sexual partners of male patients.

Adult↗
PubMed1993

Factors associated with multiple sex partners among junior high school students.

Twenty-one percent of a sample of inner-city junior high school students were found to be sexually active (n = 403). Only 31% of them reported a single lifetime sexual partner, 25% reported two partners, and 43% reported three or more partners. Logistic regression analysis evaluated the influence of demographic, psychosocial, and behavioral factors on the adolescents' lifetime number of sex partners. Respondents whose sexual debut occurred before age 13 years were nine times more likely to report three or more sex partners compared with those whose first sexual intercourse was at age 15 or 16 years, blacks were four times more likely than non-Hispanic whites to report three or more sex partners; and males were four times as likely as females to report this number of sexual partners. Factors not independently associated with the number of sex partners included: age, Asian or Hispanic ethnicity, human immunodeficiency virus (HIV) knowledge, self-efficacy (belief that one can protect oneself from the virus), condom use, and alcohol and drug use. We conclude that a significant proportion of school-based middle adolescents are sexually active and that most of these are at risk for contracting HIV because of behaviors such as having multiple sexual partners. Topics often stressed in school-based HIV education, such as factual knowledge about HIV, avoiding drugs and alcohol, and condom use are not associated with adolescents' choice about their number of sex partners. Intervention programs will have to identify and then target each specific HIV risk behavior and its motivations in order to reduce adolescents' risks of contracting and transmitting the disease.

Adolescent↗
PubMed1986

[Urogenital and anal papillomavirus infections].

Recently virologists and clinicians have focused attention on infections with human papillomaviruses (HPV). This is due to the ubiquity, the increasing frequency and the possible association of these viruses with the development of squamous cell carcinomas of the skin and of the mucous membranes of the respiratory, gastrointestinal, genitourinary and anorectal tracts. HPV represent a very heterogeneous group of DNA tumor viruses. By means of molecular-biological techniques, more than 40 HPV types have been recognized. In the urogenital and anal tract, papillomaviruses have been associated with venereal warts (condylomata acuminata), which have been known and recognized as a sexually transmitted disease since the Romans. Furthermore, an association has been made recently between HPV and nonpapillomatous, sometimes macular lesions: flat condylomata of the uterine cervix and of the vagina, flat condylomatous lesions and pigmented papules. The latter are localized at the mucocutaneous borders and at the skin of the lower genital tract and of the perianal and crural region. Like epidermodysplasia verruciformis, only some virus types (HPV 16, HPV 18) are regularly found in malignant, invasive squamous cell carcinomas of the genital tract, whereas others (HPV 6, HPV 11, HPV 2, HPV 10, HPV 31) are associated preferentially with benign papillomas and dysplasias. In view of the different possible oncogenic potential of the individual genotypes, early determination of the virus type probably has not only diagnostic but also prognostic value. As HPV 16 DNA is regularly present in bowenoid papulosis (flat condylomatous lesions and pigmented papules of the male genital tract), a natural reservoir has been found from which these viruses could be transmitted to the sexual partner. Knowledge of the HPV-associated clinical pictures is therefore the prerequisite for diagnosis and treatment of both the patient and his sexual partner. Clinical observation, cytology and virus typing from genital smears of both partners represent preventive methods that may contribute to the early detection of genital cancer.

Anus Neoplasms↗
PubMed2006

Childhood sexual abuse and sexual risk behavior among men and women attending a sexually transmitted disease clinic.

Childhood sexual abuse (CSA) is associated with a wide range of negative outcomes. The authors investigated the relation between CSA and sexual risk behavior in 827 patients recruited from a sexually transmitted disease (STD) clinic. Overall, CSA was reported by 53% of women and 49% of men and was associated with greater sexual risk behavior, including more sexual partners, unprotected sex, and sex trading. Alcohol use for men and drug use for women mediated the relation between CSA and the number of sexual partners in the past 3 months; intimate partner violence mediated the relation between CSA and the number of episodes of unprotected sex in the past 3 months for women. These results document the prevalence of CSA among patients seeking care for an STD and can be used to tailor sexual risk reduction programs for individuals who were sexually abused.

Adult↗
PubMed1996

Distribution of HIV-1 subtypes seen in an AIDS clinic in Sao Paulo City, Brazil.

OBJECTIVE: To determine the distribution of HIV-1 subtypes in Sao Paulo, Brazil. METHODS: Samples were obtained from 80 consecutive HIV-1-infected individuals attending the Immunodeficiency Clinic at the University of Sao Paulo in 1993. Peripheral blood mononuclear cells (PBMC) were separated by Ficoll-Hypaque gradient and a portion was used for routine CD4 counts; the remainder were frozen. PBMC were proteinase-K-digested and DNA-purified by organic extraction. Samples were amplified for the env region of HIV, and envelope sequence subtypes determined by heteroduplex mobility analysis using prototypic subtypes as references. A subset of these were also sequenced through the C2-V3 region of env. RESULTS: A total 69 of 80 samples yielded env polymerase chain reaction product enabling subtype determination; samples that did not amplify were those with low DNA yields. Among 12 injecting drug users (IDU) or sexual partners of IDU, four were typed as clade F and eight as clade B. Forty-three homosexual men or female sexual partners of bisexual men were typed as clade B. The 14 additional cases without known risk factors were typed as clade B. CONCLUSION: These data suggest that subtype F is related to injecting drug use in Brazil.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Living with genital herpes: how effective is antiviral therapy?

Twenty-five percent of American women and 20% of American men have genital herpes. Most of these individuals have never been diagnosed because of the prevalence of atypical clinical presentation and subclinical infection. This chronic, recurrent infection poses a significant public health challenge, particularly in women of childbearing age, who are at risk of transmitting the virus to their infants during pregnancy and birth, as well as to their discordant sexual partners. Antiviral therapy decreases the rate of recurrent episodes, decreases asymptomatic shedding of the virus, reduces the risk of transmission to sexual partners, and reduces the rate of operative delivery in women with a history of genital herpes. This article reviews the literature to explore evidence-based strategies for addressing the physical and psychological sequelae of herpes simplex virus infection and for accurately diagnosing and managing neonates who acquire this infection perinatally.

Antiviral Agents↗