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PubMed1988

Prevalence of risk factors for human immunodeficiency virus infection in the Australian population.

A random, stratified sample of 2601 adult Australians from all states and territories was interviewed about knowledge of the acquired immunodeficiency syndrome (AIDS). After the interview, an anonymous questionnaire on the prevalence of practices that are associated with risk of human immunodeficiency virus (HIV) infection was left with the respondents; 60.2% of these questionnaires were returned. Data from this survey suggest that the prevalences of male homosexual behaviour, prostitute contact and lesbian contact are substantially lower than were estimated previously. Men with homosexual experience were significantly more prevalent in the more populous states, but the majority of other risk factors--intravenous drug abuse, male respondents' contact with prostitutes, transfusion of blood or blood products during 1980-1985 and heterosexual contact--showed few significant associations with geographical, occupational or marital status. Intravenous drug abusers were significantly younger, and heterosexual contact was associated with age for both male and female respondents. No significant differences were found in the prevalence of homosexual contact among single, married and previously-married men, although the prevalence of homosexual contact was lower in married men. The results of the study are discussed in terms of targeting preventive campaigns and assessing the future potential for the spread of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Heterosexual gonorrhoea in central Sydney: implications for HIV control.

Gonorrhoea is a sexually transmissible disease (STD) characteristic of a core group of individuals and their contacts. From the experience of a Sydney STD clinic, as well as local and national population-based reports, trends in heterosexually acquired gonorrhoea in Australia over a decade were examined. An overall decline of 90% in case numbers between 1981 and 1989 was found, with an average yearly decline of 30%. The improved compliance with condom use by Sydney prostitutes and their clients could have been a major factor. This occurred in an environment of peer and public education about AIDS and the decriminalisation of prostitution. Improved health professional training and public access to specialist STD services against a background of demographic changes may also have contributed. However a persistent "seeding" of penicillinase-producing strains of gonorrhoea from Southeast Asia through men not using condoms was detected. These data have potential implications for the importation of heterosexually acquired human immunodeficiency virus infection into Australia.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The price of the game.

The health needs of people who engage in prostitution were debated at last year's RCN congress. Members considered the evidence of a Home Office report into the issues surrounding prostitution.

Health Services Needs and Demand↗
PubMed1994

HIV transmission and the balance of power between women and men: a global view.

This paper presents a logical analysis of the paths by which gender inequality is likely to affect the heterosexual transmission of HIV. Non-use of condoms, the combination of a sexual double standard and frequent use of female prostitutes, and a high prevalence of curable sexually transmitted diseases are considered. The 'circulation' of women as sexual and reproductive gifts, which is a near-universal feature of human societies, explains men's use of prostitutes and promiscuity, and contributes to high STD prevalence. It may also contribute to the non-use of condoms, although a separate analysis suggests this is not always the case. The empowerment of women thus might help to slow the spread of HIV/AIDS. Even more effective in countries with large commercial sex sectors would be the empowerment of female sex workers.

Condoms↗
PubMedDate not supplied

[HIV seroprevalence in patients seen at sexually-transmitted disease and family planning centers in Spain, 1995-1996. AIDS Programs of the Autonomic Communities and Network of sexually-transmitted disease, HIV and family planning centers].

BACKGROUND: The sexually-transmitted diseases (STD's) centers are good sentinels for monitoring the sexual transmitting of HIV. This study analyzes the results of voluntary HIV tests run in 1995 and 1996 within a network of STD, HIV and family planning centers in Spain. METHODS: Starting as of 1995, a questionnaire was sent out yearly to said centers for recording the number of individuals found to have HIV the previous year and the number of those who are proven to be HIV positive. A calculation of HIV incidence was based as a function of sex and the main HIV transmission categories. RESULTS: Eighty-one centers answered the survey in 1995, 78 having done so in 1996. Ninety-five percent of these centers ran the HIV test at the request of the interested parties. At the 39 centers which provided data regarding the HIV tests conducted in 1996, a total of 15,964 individuals had been tested. Positive: 4.8% (n = 760) (CI: 4.4%-5.1%). The HIV seroprevalence was higher for males (5.9%) than for females (2.6%; p, 0001). The highest HIV seroprevalence was found among injecting drug users (IDU's) (18.7%). On comparing HIV seroprevalence in 1995 with that of 1996, drops were detected in the number of homosexual/bisexual men from 7.4% to 6.1% (p = 0.049) and in women prostitutes, from 2.0% to 1.3% (p = 0.034). The Sexual partners of IDUs went from 3.4% to 4.6% (p = 0.267). CONCLUSIONS: These results provide a nationwide reference regarding HIV incidence among populations having high-risk sexual relations. The trend therein is favorable among homosexual/bisexual men and female prostitutes.

Adult↗
PubMed1999

Health care of female commercial sex workers.

This article highlights health issues related to prostitution, with special reference to the situation in Europe. Strategies aimed at improving the health care of commercial sex workers, including programs for screening for sexually transmitted infections, are discussed. Problems related to failure to follow-up, particularly of mobile (migratory, international) commercial sex workers, are considered. Other topics covered include counselling on sexual risk reduction, including medical hotline telephone services and clinical outreach work. Counselling commercial sex workers on contraception, desired termination of pregnancy and hazards of illicit drug use are also highlighted. The public-health consequences of delivering poor health care to commercial sex workers are generally severely underestimated, particularly in societies where prostitution is illegal.

Adolescent↗
PubMed2000

[Seroprevalence of HIV infection among sexually transmitted disease clinic attenders. Study Group of the Seroprevalence of Anonymous HIV Unrelated to Patients Consulting a Sexually Transmitted Disease Clinic].

BACKGROUND: To estimate the seroprevalence of HIV infection among sexually transmitted disease (STD) clinic attenders. PATIENTS AND METHODS: Unlinked anonymous serologic survey among patients from six STD clinics in 1998. RESULTS: Among 1,303 patients 3.7% were found to be infected by HIV. Seroprevalences were 48.3% in injecting drug users, 16.7% in homosexual men, 1.3% in prostitutes, 0.9% in heterosexuals from sub-Saharan Africa or Caribbean, and 3.1% in other heterosexuals. CONCLUSION: In STD clinics attenders heterosexuals from sub-Saharan Africa or Caribbean and prostitutes showed the lowest seroprevalences of HIV infection.

Adult↗
PubMed2000

[Children and adolescents selling sex].

Our knowledge about prostitution is shaped by female street prostitutes, many of whom are drug addicts. Less is known about children and adolescents from the normal population who sell sex. Total cohorts of pupils in all Oslo's schools (N 10,812) in the age groups 14-17 filled in a questionnaire at school. 1.4% of the adolescents had sold sex at least one time, more than three times as many boys as girls. Mean age for first episode was 12.6 years in boys, and 14.1 years in girls, and seventy per cent had sold sex more than three times. There were no associations to indicators of parental social class or residential area in Oslo. The adolescents who had sold sex were more lonely and more often reported symptoms of depression and anxiety than others. A multivariate analysis showed that associations to conduct problems, alcohol problems and use of drugs were most important. The majority reported no contact with public services aiming at helping adolescents with psychosocial problems. A group of children and adolescents in Oslo sell sex. Boys are involved more often than girls, their customers are assumed to be bisexual or homosexual men. These behaviours fall into a pattern of conduct and substance problems, and some of these adolescents could have high long-term risk of antisocial problems and drug abuse. More knowledge is needed, and preventive work should be intensified.

Adolescent↗
PubMed2001

The epidemiology of physical attack and rape among crack-using women.

This prospective study examines the epidemiology of physical attack and rape among a sample of 171 not-in-treatment, crack-cocaine using women. Since initiating crack use, 62% of the women reported suffering a physical attack. The annual rate of victimization by physical attack was 45%. Overall, more than half of the victims sought medical care subsequent to an attack. The prevalence of rape since crack use was initiated was 32%, and the annual rate was 11%. Among those women having been raped since they initiated crack use, 83% reported they were high on crack when the crime occurred as were an estimated 57% of the perpetrators. Logistic regression analyses showed that duration of crack use, arrest for prostitution, and some college education were predictors of having experienced a physical attack. Duration of crack use and a history of prostitution were predictors of suffering a rape. Drug abuse treatment programs must be sensitive to high levels of violence victimization experienced by crack-cocaine using women. Screening women for victimization, and treating the problems that emanate from it, may help make drug abuse treatment more effective.

Adolescent↗
PubMed2000

HIV/AIDS prevalence among male patients in Kuwait.

OBJECTIVE: To determine the prevalence of human immunodeficiency virus infection among male patients with sexually transmitted disease in Kuwait with emphasis on the type of sexually transmitted diseases and sexual partners. METHODS: A sentinel surveillance was conducted among male sexually transmitted disease patients, randomly selected among all new sexually transmitted disease patients who visited the Family Planning Clinic during June 1996 to June 1997. The patient data was recorded by the attending physician on a specially designed questionnaire. RESULTS: A total of 1984 subjects were screened, out of which not a single human immunodeficiency virus/acquired immunodeficiency syndrome case was found. Among the screened, 69% were non-Kuwaitis. Most of the subjects (76%) belonged to the age group 15-34 years, were married (53%), were illiterate (37.5%) and belonged to the low SES group (70%). The most common sexually transmitted diseases were non-specific urethritis (45%) and gonorrhea (42%). With regard to sexual practices, the majority of the respondents showed preference for female prostitutes, both inside (50%) and outside (48%) Kuwait. CONCLUSION: The absence of any human immuno-deficiency virus positive case was probably due to the mandatory screening for granting residency in Kuwait, facilitating early detection of virus carriers among non-Kuwaitis. We, as researchers, are not sure if this study is true representation of human immunodeficiency virus/acquired immunodeficiency syndrome prevalence among Kuwaiti sexually transmitted disease patients in this country who might seek treatment in private clinics. Moreover, the absence of prostitution as professional trade also tends to show the absence of indigenous circulation of the virus. Nevertheless, continuous surveillance is necessary to maintain and prevent the groups with risky behaviors from contracting the virus through sexual transmission. There is a distinct need to develop public education and awareness programs to serve as measures of prevention and protection.

Acquired Immunodeficiency Syndrome↗
PubMed2001

[HIV-positive drug users in South Limburg: number and characteristics, a capture-recapture analysis].

OBJECTIVE: To estimate the number of HIV positive drug abusers (HDs) in South Limburg, the Netherlands, and to ascertain the characteristics of this group, so that special HIV healthcare can be planned. DESIGN: Capture-recapture analysis. METHOD: Capture-recapture analysis was carried out and abuser characteristics were determined using three incomplete, partially overlapping registers of HDs from the regional AIDS hospital, the Regional Institute for Addiction and the Municipal Health Service Centres in South Limburg. RESULTS: From the 80 HDs included, the Municipal Health Service Centres observed 59 HDs, the Institute for Addiction 45 and the hospital 44. The capture-recapture analysis gave an estimate of 110 HDs (95% CI: 91-164) in South Limburg. Assuming 1100 drug users in South Limburg of which 76% had injected on one or more occasions, the HIV prevalence among injecting drug users was estimated at 13% (110/836). From the observed HDs 80% were male, with a mean age of 38 years (SD: 7) and a mean age at the onset of drug use of 18 years (SD: 5). All HDs currently injected or had previously injected. The first injected drugs were used at a mean age of 21 years (SD: 6). All HDs used heroine, 84% also used cocaine, 54% were homeless, 91% unemployed and 80% had a history of imprisonment. Further, 71% of the female HDs were prostitutes, 37% of the male ones visited prostitutes, 81% had contracted hepatitis B (of which 20% were a carrier) and all HDs were infected with hepatitis C. An estimate based on prevalence data gave 143/836 (17%) and that based on capture-recapture analysis with two registrations was 102/836 (12%). CONCLUSION: The number of HDs was estimated to be 110. The population had a marginalized existence and there was a risk of HIV spreading.

Adult↗
PubMed2001

Promoting ethical and objective practice in the medicolegal arena of disability evaluation.

As providers of medical information and testimony, clinicians have ultimate responsibility for ethical conduct as it relates to this information. The authors offer the following recommendations for enhancing ethical relationships between expert clinicians and the courts. 1. Avoid or resist attorney efforts at enticement into joining the attorney-client team. Such compromises of scientific boundaries and ethical principles exist on a continuum ranging from standard attorney-client advocacy at the beginning of the expert consultation phase (e.g., promotional information at the forefront of retaining an expert, with either provision of selective or incomplete records or less than enthusiastic efforts to produce all records) and extending to completion of evaluation, when requests for changes in reports and documentation might be made. 2. Respect role boundaries and do not mix conflicting roles. Remember that the treating doctor possesses a bond with the patient but does not as a rule obtain complete preinjury and postinjury information in the context of assessing causality and apportionment. In contrast, the expert witness must conduct a thorough and multifaceted case analysis sans the physician-patient relationship in order to facilitate objectivity and allow optimum diagnostic formulations. Finally, the trial consultant's function in this adversarial process is to assist with critically scrutinizing and attacking positions of experts for the opposing side. These roles all represent inherently different interests, and mixing them can only reduce objectivity. 3. Insist on adequate time for thorough record review, evaluation, and report generation. Also insist on sufficient time and preparation for deposition and court appearances. 4. Work at building a reputation for general objectivity, reliance on multiple data sources, reaching opinions only after reviewing complete information from both sides, and completing the evaluation. 5. Spend a good amount of time actually treating the patient population being examined or being offered testimony about. This treatment should be current and should be of a similar frequency to treating practitioner specialists. Be able to discuss relevant research and scientific methodology issues competently and without notes. 6. Arrive at opinions only after reviewing all of the evidence from both sides of the adversarial fence, employing multiple data sources, completing the evaluation, and interpreting data within the full context of comprehensive historical, behavioral observation, and contextual information. Being otherwise favorable to retaining attorney interests suggests endorsement of "opinion prostitute," "scientific perjurer," or "hired gun" status. The only way a practitioner can reduce the likelihood of facing an "opinion prostitute" on the opposing side in future cases is to insist on establishing and maintaining a reputation for scientific objectivity. 7. Balance cases from plaintiff and defense attorneys. Predilection for one side or the other suggests bias and sets up predisposition to nonobjectivity. For example, a preponderance of plaintiff work suggests an overdiagnosis or uncritical sympathy bias, whereas a ratio that favors hiring by the defense suggests an underdiagnosis or skepticism bias. Perhaps Brodsky's suggested cut-off ratio of .8 for favorability findings would represent an initial cutoff for defense versus plaintiff ratio. That is, experts should do at least 20% work for the opposite side of the current case being represented. Further, it might be a reasonable expectation that data on these ratios be collected as an important method for ensuring objective opinions. 8. Ensure against excessive favorability to the side of the retaining attorney or firm. Objectivity demands that scientific opinions not be influenced by the position of the legal advocate. Importantly, Brodsky recommends using a ratio of .8 as a cut-off for detecting excessive bias. That is, practitioners should possess prerequisite objectivity to disagree with the referring attorney at least 20% of the time. We suggest that a more useful cut-off would be .75, where experts are expected to generate findings that do not support the referring attorney's position at least 25% of the time. 9. Never arrive at opinions that are inconsistent with plaintiff records, examination data, test data, behavioral presentation, and so forth, especially when such opinions are favorable to the side of the retaining attorney firm. Instead, use the following recommendations. (ABSTRACT TRUNCATED)

Disability Evaluation↗
PubMed1988

Notification of HIV carriers: possible effect on uptake of AIDS testing.

Passing of the AIDS Prevention Bill, which demands the notification of human immunodeficiency virus (HIV) carriers, seems imminent in Japan. Its effect on people's willingness to be tested for the HIV antibody was assessed among heterosexual subjects (students, office workers) and groups at high risk of the acquired immunodeficiency syndrome (AIDS) (prostitutes, homosexual males) by means of a questionnaire. More than 70% of the 811 students and the 509 workers replied that, if notification became mandatory, they would agree to be tested but 10% of the males and 17% of the females in these two groups would prefer testing at institutes not complying with the clause; all 198 prostitutes said they would be prepared to undergo testing but 35% of them would prefer to go to non-complying clinics; 45% (410) of the 902 homosexual males replied that they would refuse testing, and 65% of those who agreed to be tested (492) would prefer to go to non-complying clinics....

AIDS Serodiagnosis↗
PubMed2001

The resurgence of sexually transmitted disease in China.

In the early years following the Chinese revolution in 1949, the Chinese mounted mass campaigns against the preventable communicable diseases including the venereal diseases. These were characterized by mass education, a national health insurance system, training and dispersion of the "barefoot doctors," elimination of prostitution, emancipation of women, and full employment. By 1996, the Chinese claimed that they had virtually eliminated venereal diseases. This was confirmed by western visitors in the 1970s. However, following the economic reforms which began in the 1980s, sexually transmitted diseases reappeared. Later, HIV infection appeared, and STDs today constitute a major public health problem in China. This resurgence parallels the privatization of the economy, the breakdown of the national health insurance system, the return of prostitution, and other factors.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Allegations of HIV infection raised in criminal trial of escort agency owner.

At the beginning of October 1999, a Toronto man who owned an escort agency went to trial in the Ontario Superior Court of Justice on numerous charges of living off the avails of prostitution and procuring for the purpose of prostitution. On the first day of trial, the prosecutor indicated he would be introducing evidence suggesting that three of the women who worked as escorts for Mark Lucacko's agency may be HIV-positive.

Commerce↗
PubMed2002

Gynecological examinations for social and legal reasons in Turkey: hospital data.

AIM: Women in Turkey are subjected to gynecologic examinations not only for legal reasons, such as sexual assault or violence against pregnant women, but also for various social reasons, such as suspicions of premarital intercourse, prostitution, loss of virginity, and pregnancy at the time of entering into a new marriage. The examinations are performed by general practitioners, forensic physicians, and gynecologists. This study presents social reasons for gynecologic examinations of women in Turkey. METHOD: We analyzed the reasons for gynecologic examination of 412 women at the 1st Obstetrics and Gynecology Department, Sisli Etfal Training and Research Hospital, between January 1, 1999 and June 30, 2001. RESULTS: Out of 27,376 women at the Department, 412 (1.5%) underwent gynecologic examination for social or legal reasons: 82 (19.9%) for entering into a new marriage, 41 (10.1%) for violence against pregnant women, 28 (6.7%) for sexual assault, 53 (12.8%) for suspicion of prostitution, and 208 (50.5%) for the determination of virginity. CONCLUSION: Gynecologic examinations for legal or social reasons in Turkey are still rather common. Medicolegal regulation of gynecological examinations should be changed to protect women's human rights.

Adolescent↗
PubMed2002

[Actual situation and social prognosis of women seeking psychiatric care at the emergency hostel of Tokyo Metropolitan Women's Counseling Center].

The emergency hostel of Tokyo Metropolitan Women's Counseling Center, established in 1957, provides protection and care for about 600 Japanese or foreign women per year. The women housed there need social support for various reasons such as prostitution, poverty, somatic or mental diseases, or domestic violence (DV). We investigated the sociodemographic characteristics, psychiatric diagnoses and social prognoses of 2667 women who consulted the psychiatric clinic in the emergency hostel between 1961 and 1997. Seventy-four women consulted the psychiatric clinic per year, on average. Most were aged between 20 and 49. During the study period, there was a gradual decline in the number referred through the prostitution prevention law. Psychiatric diagnoses at the first visit varied widely. Annual comparison showed a gradual decrease in schizophrenia and manic-depressive illness, but an increase in substance abuse, psychogenic reaction, and personality disorder. Sociodemographically, most subjects appeared to have been children from underprivileged backgrounds. The social prognoses of 930 cases judged in March 1998 were good in 25%, moderate in 23% and poor in 48%. The poor prognosis group contained significantly more women with schizophrenia and personality disorder than the other two groups. The poor prognosis group tended to include more cases of substance abuse, while the good prognosis group contained more cases of depression and mental retardation. Women in the DV group tended to have more children than those in the non-DV group, and to have a higher prevalence of psychogenic reaction and a lower prevalence of schizophrenia. The DV group also tended to include more subjects with a moderate social prognosis and fewer subjects with a poor social prognosis. Specialized treatment should be provided for women after emergency admission to the hostel and this treatment needs to be aimed at improving social adaptation of the hostel residents, especially those with schizophrenia, personality disorders and substance abuse. Victims of DV should receive more conscious attention. In particular, prevention of mental disorders should be aimed not only at the residents but also their children.

Adolescent↗
PubMed2001

[Sexually transmitted diseases (STD) and their relationship with sexual behaviour and condom use, in a cohort of teenagers referring to a STD centre. A nine-year, prospective study].

In order to assess the relationship between a diagnosis of sexually-transmitted disease (STD), sexual behaviour, condom use, and other social, demographic, and epidemiological variables in a cohort of young adults who referred to a STD centre during a 9-year period, all patients aged 13-20 years were prospectively evaluated, with special attention paid to sexual behaviour, and use of condom or other contraceptive techniques. The 284 assessed young adults represented 6.1% of all patients with a diagnosis of STD: an increasing temporal trend was noticed (from 3. % in 1991, up to 10.4% nel 1999: p<.0001). On the whole, 70.1% of subjects aged 20 years or less never used a condom during the 6 months preceding the diagnosis of STD: only 21.8% of patients reported regular condom use, and 4.9% more subjects referred occasional use, while in the remaining 3.2% of cases other contraceptive methods were employed. Among under age patients (10.6% of study population), the rate of condom use was 3.3% only, while male homosexuals always denied the use of barrier methods. Although a progressive increase in condom use was observed through the study time (from 0% encountered in 1991-1994, to 57.6% of 1999: p<.0001), this phenomenon proved linked only to the massive increase of immigrant sex workers, which occurred since 1997. When excluding from analysis any probable female prostitutes, lack of condom use tested related to the male gender (p<.05), and a low education (p<.04). Over 50% of patients reported 0-1 partners during the last 6 months, even though an increase in sexual promiscuity was observed during the last three years, compared with 1991-1996 (p<.02). Among the 297 different STD episodes (mostly nongonococcal cervicitis-vaginitis and urethritis, and HPV infection), an increasing incidence of nongonococcal STD and syphilis was found, but no correlation was observed between the spectrum of diagnosed STD, sexual behaviour, and condom use. In particular, in 69.9% of the 103 episodes nongonococcal disease occurred despite regular (65 cases), or occasional (7 episodes) condom use. Moreover, no significant relationship was disclosed between STD occurrence, condom use, and other analyzed social, demographic, epidemiological, and clinical variables. According to our survey, an increased risk of STD seems to involve young adults, and to be related to the variation of multiple demographic, epidemiological, and behavioral features. While immigration and prostitution had the major impact during the last three years, sexual promiscuity and infrequent condom use represent persistent; risk factors in this age population. Besides their diagnostic and therapeutic role, STD centres are able to carry out permanent monitoring of STD, as a starting point to plan adequate information campaigns and specific prevention strategies.

Adolescent↗