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PubMed2004

Voluntary HIV testing, disclosure, and stigma among injection drug users in Bali, Indonesia.

Recently, large increases have been noted in injection drug use and HIV prevalence in Indonesia. Because voluntary HIV counseling and testing can play an important role in HIV prevention, it is important to understand factors related to its use. The objective of this study was to identify factors related to the use of voluntary HIV testing among drug users. In-depth interviews were conducted with a sample of 40 drug users in the Denpasar area of Bali, Indonesia. Drug users may be interested in testing if they have enough information about AIDS to know that they are at risk and that they need this information to protect themselves and others from infection. Barriers toward testing included the fear of a positive result, fear of reactions from family and community members and stigmatization. Other obstacles include a feeling of hopelessness, problems with testing, unavailability and side effects of AIDS drugs and other factors. Many persons would not disclose their status to community members and sexual partners. There were serious concerns about others being ashamed of them and the impact of HIV on relationships with spouses and sexual partners and on employment.

Adult↗
PubMed1993

HIV-related risk and antibody testing: an urban community survey.

The present study investigated patterns of human immunodeficiency virus (HIV) antibody testing in a diverse urban sample. Five hundred seventy-nine men and women (representing 88% cooperation and 67% response rates) were surveyed in Chicago's downtown at mass transit waiting areas. Participants completed measures of demographic information, sexual and HIV-risk behavior histories, information regarding HIV antibody testing status, and HIV/AIDS-related knowledge and perceptions. Results showed that only 36% of persons with histories of high-risk practices had been tested for HIV. Persons who had been tested, as compared to those not tested, were older in age and perceived themselves to be at greater risk. Results also showed a relationship between participants' knowledge of their own HIV serostatus and inquiring about their sexual partners' serostatus. As compared to persons not tested, those who had been tested were more likely to know their most recent sexual partner's HIV testing status. Results suggest that several factors found among gay men with regard to HIV testing may generalize to populations representing diverse HIV-related risk behavior patterns.

AIDS Serodiagnosis↗
PubMed1993

Risk factors for cervical cancer by histology.

A case-control study in four Latin American countries enabled assessment of risk factors for different histologic types of invasive cervical cancers, with the main analyses focusing on 667 patients with squamous cell cancers and 43 with adenocarcinomas. The epidemiology of the squamous cell tumors resembled that found in other studies, namely a high risk associated with multiple sexual partners (RR = 1.5 for > or = 2 vs 1), early ages at first intercourse (RR = 2.3 for < 16 vs > or = 20), history of a sexually transmitted disease (RR = 1.8), multiple births (RR = 2.2 for > or = 7 vs 1-3), absence of prior Pap smear screening (RR = 3.0 vs Pap within 24 months), detection of HPV DNA (RR = 3.6), and limited years of schooling (RR = 1.9 for < 4 vs > or = 7). The adenocarcinomas appeared less affected by sexual, reproductive, or socioeconomic factors. There was no relationship with age at first intercourse, history of a sexually transmitted disease or education, and only marginal associations with number of sexual partners or parity. Absence of prior Pap smear screening as well as detection of HPV DNA, however, were associated with relationships equally strong as those for the squamous cell tumors. Oral contraceptive use distinctly affected risk of the adenocarcinomas, increasing risk by approximately two-fold. Analyses of the 18 subjects with adenosquamous cancer suggested some resemblance to the squamous cell tumors, especially with respect to the role of sexual and sociodemographic variables. These findings support the need for detailed studies of etiologic differences between the different histologic types of cervical cancers, with an emphasis on careful pathologic review and precise measurement of HPV.

Adenocarcinoma↗
PubMedDate not supplied

Associations among condom use, sexual behavior, and knowledge about HIV/AIDS. A study of 13,293 public school students.

BACKGROUND: This school-based study explored associations between Mexican young people's condom use, other sexual behaviors, and HIV/AIDS knowledge. METHODS: Students (n=13,293, 11-24 years of age) from a random sample of public schools in the central Mexican state of Morelos completed a self-administered questionnaire. We performed logistic regression analysis of condom use and sexual behavior variables and a knowledge-based index on HIV/AIDS prevention and transmission. RESULTS: Average age at sexual debut was 13.6 +/- 1.9 years among young men and 14.2 +/- 2.2 years among young women; 34.5% of sample participants reported using condoms during their first sexual intercourse. More students had intermediate HIV/AIDS knowledge levels (46%, 95% confidence interval [95% CI], 45.2-46.9) than high levels (37%, 95% CI 36.2-37.8, p <0.01). Students knew more concerning HIV transmission than about prevention of HIV infection. Among young men, high levels of HIV/AIDS knowledge increased likelihood of condom use (odds ratio [OR] 1.4, 95% CI, 1.1-1.7), while among young women high levels of knowledge decreased likelihood of using condoms (OR 0.7, 95% CI, 0.5-1.0). Young men with high levels of HIV/AIDS knowledge were more likely to have had three or more sexual partners (OR 1.7, 95% CI, 1.3-2.2), but young women with high knowledge levels were more likely to have only one lifetime sexual partner (OR 0.6, 95% CI, 0.4-0.9). CONCLUSIONS: As in previous studies in smaller samples, levels of knowledge with regard to HIV/AIDS were low in Mexican youth. HIV/AIDS education programs for Mexican students should focus on conveying knowledge on HIV prevention. Because apparently knowledge is not directly correlated with condom use among young women, prevention strategies that deal with social acceptability of condoms and social skills related with condom negotiation are also needed.

Adolescent↗
PubMed1992

A comparison between a 1986 and 1989 cohort of inner-city adolescent females on knowledge, beliefs, and risk factors for AIDS.

In order to assess changes from 1986 to 1989 in knowledge, beliefs, and risk factors for AIDS, the responses of inner-city adolescent girls were compared. Although 63% of the 1989 cohort received AIDS education in school, the base knowledge of the two cohorts was not markedly different. Between 1986 and 1989, the number of sexual partners increased for adolescents of all ethnic groups, yet concerns about AIDS showed a decline. Those adolescents who had the highest number of sexual partners were also those who had the most knowledge and most concerns about AIDS. Implications for preventive education focus on ethnic diversity and gaps between adolescent knowledge and behavior.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Neutralising antibody against type 1 and type 2 herpes simplex virus in cervical mucus of women with cervical intra-epithelial neoplasia.

Patients with cervical intra-epithelial neoplasia had significantly increased neutralising antibody activity to type 2 herpes simplex virus in the cervical mucus. While patients differed from control subjects with respect to their number of sexual partners and socio-economic class, there were significant differences in neutralising antibody activity for case control comparisons within the same number of sexual partners or socio-economic groupings. The results lend support to the putative association between type 2 herpes simplex virus infection and pre-invasive and invasive carcinoma of the uterine cervix.

Adult↗
PubMed2004

Cover up or cool it? Sexual intercourse during therapy for bacterial sexually transmitted infections--a discussion of evidence for efficacy of condom use preventing transmission during an acute bacterial STI.

Effective treatment of sexually transmitted infections (STIs) such as gonorrhoea and chlamydia needs sexual behaviour modification, in addition to antibiotics, to protect the index patient and their sexual partner from re-infection during treatment. This may mean advice to avoid sex, or to use condoms for intercourse, until all current sexual partners have completed treatment. This article discusses the effectiveness of condoms as re-infection protection during therapy of gonorrhoea and chlamydial infection. Indirect evidence from studies on primary prevention indicates that, although physically, condoms are impermeable to STI pathogens, the risk of failure depends on the experience of the user and the frequency of use. Health care workers may over-estimate the protective value of condoms in this situation. Patients should be made aware of the risk of infection present, even in experienced condom users, if they choose to continue protected sexual intercourse during therapy for acute bacterial STIs.

Coitus↗
PubMed1994

Risk factors associated with prevalent HIV-1 infection among pregnant women in Rwanda. National University of Rwanda-Johns Hopkins University AIDS Research Team.

This study evaluated risk factors associated with prevalent HIV-1 infection among pregnant women in a semi-rural but densely populated area surrounding the town of Butare in Rwanda. Overall seroprevalence was 9.3% in 5690 pregnant women who sought antenatal care at one of five health centres. Factors associated with higher seroprevalence of HIV-1 included history of multiple sexual partners, history of at least one sexually transmitted disease (STD), relatively high socioeconomic status (SES), being unmarried, young age at first pregnancy, and low gravidity. Women who had used oral contraceptives, smoked more than one cigarette per day, whose partners were circumcised, and had had sex to support themselves were also at higher risk of being infected. A history of blood transfusion in the past 5 years was not associated with HIV-1 infection. History of multiple sexual partners, history of STD, high household income, partner circumcision, and past oral contraceptive use remained strongly associated with HIV-1 infection even when simultaneously controlling for other covariates. Among legally married women who lacked sexual behaviour risk factors, history of STD, high SES, young age at first pregnancy, and low gravidity were significantly associated with HIV-1 seroprevalence.

Adolescent↗
PubMed2000

Can self-reported drug use data be used to assess sex risk behavior in adolescents?

To better understand and control the spread of sexually transmitted diseases among high-risk youth, we must first acquire reliable reports of sexual risk behavior. This study evaluates one potential method for validating such reports. We examined the association between marijuana and cocaine use reporting patterns and the number of reported recent sexual partners in a sample of juvenile arrestees/detainees. Using urinalysis to validate self-reported drug use, we categorized drug use reporting patterns into four groups: overreporters, underreporters, honest users, and honest nonusers. Analyses showed, in general, that overreporters reported more sexual partners than either underreporters or accurate reporters, suggesting that overreporters of drug use may also exaggerate sex partner reports. Findings suggest a new method for validating self-reported sexual behavior and provide a challenge to theories of juvenile delinquency.

Adolescent↗
PubMed1994

Balancing sexual partnerships in an age and activity stratified model of HIV transmission in heterosexual populations.

A mathematical model of the transmission dynamics of HIV-1 in a heterosexual population stratified by age, sex, and sexual activity (defined by rates of sexual partner acquisition) is presented. The model represents an extension of previous studies with a special focus on patterns of mixing or contact between sexual activity and different age classes of the two sexes. A range of mixing patterns between these groups is specified for both sexes. Mixing is described on two scales from fully assortative to fully disassortative, with random defined either according to numbers of sexual partnerships or numbers of people. The sexual partnerships in the model are balanced by changes in the rates of sexual partner acquisition between particular groups and a range of changes, from only women changing behaviour to only men changing behaviour, are analysed. The pattern of mixing is most influential in determining the shape and magnitude of the epidemic, but the manner in which people choose partners (i.e. dependent on numbers or proportions in the population) is also important. The relative importance of variation in transmission probabilities and mean rates of partner change on the course of the HIV epidemic is also illustrated. The analysis of the sensitivity of predictions to changing parameters in the force of infection term of the model provides a theoretical basis from which the influence of control strategies and the demographic effects of HIV can be analysed.

Acquired Immunodeficiency Syndrome↗
PubMed1995

[Cervical intraepithelial neoplasia: Chlamydia trachomatis and other co-factors].

The incidence of Chlamydia trachomatis (Ct) in patients with diagnosis of Cervical Intraepithelial Neoplasia (CIN) was studied in one hundred eighty patients. The Chlamydiazyme test was performed in all of them. Endocervical samples were taken from 103 patients with CIN and 77 women who sought medical attention for different gynecological reasons (CG). Twenty three tests (12.8%) were positive; 15 of them had CIN (14.6%) and 8 were from the control group (10.4%). It was found a statistical significant difference between NIC III and early intercourse, NIC III and age, NIC and vaginal douches and, among NIC and number of pregnancies and deliveries. There was not a significant difference among Ct and early intercourse, number of sexual partners, pregnancies, deliveries, vaginal douches, oral contraceptives (OC), and vaginal discharge. No statistically significant differences were found between NIC and number of sexual partners, and OC and vaginal discharge. The low incidence of Ct in patients with CIN does not mean that Ct does not play a role in the origin and development of the cervical pathology.

Adult↗
PubMed2006

Sexual and injection risk among women who inject methamphetamine in San Francisco.

Methamphetamine (MA) use is on the rise in the United States, with many cities reporting increases of 100% or more in MA-related Emergency Department (ED) mentions. Women are keeping pace with this trend: in 2003, 40% of ED mentions and 45% of MA-related treatment admissions were female. Although there have been extensive examinations of MA use and HIV/STI risk among gay men in recent years, literature regarding female MA users is scarce. This paper examines female methamphetamine injectors in San Francisco, CA, from 2003-2005. We assessed sexual and injection related risk behaviors, comparing female MA injectors to female injectors of other drugs. We also examined whether MA use was independently associated with specific sexual and injection risk behaviors. We found that female MA injectors were significantly more likely than non-MA injectors to report unprotected anal intercourse, multiple sexual partners, receptive syringe sharing and sharing of syringes with more than one person in the past six months. In multivariate analysis, MA use among female injectors was significantly associated with anal sex, more than five sexual partners, receptive syringe sharing, and more than one syringe-sharing partner in the past six months. Deeper exploration of the relationship between MA use and sexual risk among women would benefit HIV/STI prevention efforts. In addition, existing interventions for drug-injecting women may need to be adapted to better meet the risks of female MA injectors.

Adult↗
PubMed1996

Sexual abuse history and associated multiple risk behavior in adolescent runaways.

Relationships between sexual abuse and sexual risk, substance use, emotional distress, and conduct problems were examined among 190 runaways. Those who had been abused were significantly more likely than nonabused peers to engage in unprotected sex, have more sexual partners, and use alcohol and drugs, but did not differ in emotional distress. Those abused after age 13 were more often engaged in sex work than nonabused peers. Males abused before age 13 had more sexual partners than those not abused, and runaway males were significantly more likely to have been sexually abused than has been reported in prior research.

Adolescent↗
PubMed1998

Determinants of risk of invasive cervical cancer in young women.

We analysed determinants of risk of cervical cancer in women aged less than 45 years using data from a case-control study conducted in Italy. Cases were 261 women aged < 45 years with histologically confirmed invasive cervical cancer. Controls were 257 women aged < 45 years, with acute, non-neoplastic conditions, judged to be unrelated to any of the known or suspected risk factors for cervical cancer. In comparison with women reporting one or no sexual partner, the multivariate odds ratio (OR) of cervical cancer was 2.4 (95% confidence interval, CI, 1.3-4.6), for women reporting two or more sexual partners, and, in comparison with women reporting their first intercourse at 17 years of age or before, the multivariate OR was 0.5 (95% CI 0.3-0.9) in women aged > or =23 years at first intercourse. The risk of cervical cancer was higher in parous women and increased with number of births (OR = 8.1 for three or more births). Among parous women the risk tended to increase with later age at last birth; in comparison with parous women reporting their last birth before age 25, the OR was 1.9 in those reporting their last birth at > or =35 years. No clear association emerged between oral contraceptive use, smoking, education, social class and risk of cervical cancer.

Acute Disease↗
PubMed1996

Retention in methadone maintenance is associated with reductions in different HIV risk behaviors for women and men.

Using AIDS Initial Assessment questionnaire (AIA) data from 353 injection drug users (IDUs) newly admitted to methadone maintenance (MM), three dimensions of injection risk behavior ("sharing with sexual partner," "sharing with others," and "new needle use") were identified. Among IDUs who continued to inject drugs at 1 year, men retained in treatment obtained lower scores on the "sharing with others" scale than men not retained, even when controlling for initial scale scores and injection frequency. Associations between retention in MM and changes in sexual risk were examined using two AIA measures of sexual risk behavior ("number of IDU sexual partners" and "relative frequency of protected vaginal intercourse"). Controlling for injection frequency, prior sexual risk, and age, there was no difference in sexual risk for men retained in treatment versus those not retained. Among women, those who stayed in MM for 1 year reported significantly fewer IDU partners.

Analgesics, Opioid↗
PubMed2006

A chlamydia prevalence survey of young women living in Melbourne, Victoria.

BACKGROUND: To estimate the population-based chlamydia prevalence among women aged 18 to 35 years living in Melbourne, Victoria, and to assess the feasibility of using mailed urine specimens to test women. METHODS: A simple random sample of 11,001 households in Melbourne was selected from the telephone directory. Participants completed telephone interviews and provided urine specimens through the mail for chlamydia testing. Urines were tested using polymerase chain reaction. RESULTS: 11,001 households were contacted, with 1532 households identified as including eligible women; telephone interviews were completed, with 979 women giving a response rate of 64%. Six hundred and fifty-seven women provided a urine specimen with a response rate of 43%. Among sexually active women aged 18-24 years, the chlamydia prevalence was 3.7% (95% CI: 1.2%, 8.4%) and 0.2% (95% CI: 0.0%, 1.1%) among 25-35 year olds. Chlamydia prevalence increased significantly with an increasing number of male sexual partners. CONCLUSIONS: This is the first study of its kind in Australia and shows that chlamydia prevalence increases with an increasing number of male sexual partners in the last 12 months. Mailed urine specimens are feasible for conducting population-based chlamydia-prevalence surveys but it is difficult to obtain high response rates with this methodology. Public health resources should now be directed towards investigating how to reach young women at increased risk of infection, ensuring that they are tested for chlamydia.

Adolescent↗
PubMed1996

A case control study of HIV seroconversion in gay men, 1988-1993: what are the current risk factors?

OBJECTIVE: To investigate current risk factors for HIV seroconversion among homo/bisexual men. DESIGN: Matched case control study in a large STD clinic in central London. Data on risk factors were obtained by case note review. METHODS: Fifty-six cases who had at least one negative HIV test followed by a positive test between June 1988 and July 1993, and two homo/bisexual controls (having two or more negative HIV tests) matched to each case on age, total number of HIV tests and test interval period were identified. Univariate and multivariate odds ratio were calculated for acute STD, ano-genital intercourse, condom use and HIV status of sexual partners. RESULTS: Adjusted odds ratios (95% confidence intervals) for HIV seroconversion were 4.1 (1.3-13.3) for having an acute interval STD and 4.6 (1.4-15.4) for having a known HIV infected sexual partner. Compared with men who always used condoms, odds ratios for men who sometimes or never used condoms were 7.9 (2.2-28.9) and 16.2 (3.0-86.0) respectively. Unprotected ano-genital intercourse was commonly reported by both cases and controls, and reported condom use was no greater with a known HIV infected partner than with a partner of unknown HIV status. CONCLUSION: HIV seroconversion among homo/bisexual men attending STD clinics is strongly related to having an acute STD, a known HIV infected partner and not using condoms. Although consistent use of condoms is highly protective, knowing that a partner is HIV infected does not ensure condom use between serodiscordant men. More effective, well-evaluated interventions are needed to reduce sexual risk-taking in this population.

Adolescent↗
PubMed1997

Young women's sexual risk taking behaviour: re-visiting the influences of sexual self-efficacy and sexual self-esteem.

This study investigates the influences on young women's sexual risk taking of (a) attitudes such as sexual self-efficacy and sexual self-esteem and (b) personal and sexual characteristics, such as age, the age of first sexual experience, the number of sexual partners and reported overall amount of sex. Three hundred and thirty-one young women participated in this study. With respect to regular sexual relationships, the results show that risk taking behaviour is directly and positively associated with sexual self-esteem. The effect of sexual self-efficacy on risk taking in regular relationships, however, is indirect and positive, being mediated by the overall amount of sexual activity. In contrast, with respect to casual sexual relationships, risk taking behaviour is negatively associated with self-esteem and positively associated with sexual self-efficacy. In addition, sexual self-esteem influences casual risk taking indirectly and positively, the effect being mediated by the overall amount of sexual activity. The findings in relation to sexual self-esteem and sexual self-efficacy are contrary to the expectations that these variables would be negatively associated with sexual risk taking behaviours. The implications for safe sex education are discussed.

Adolescent↗