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Heterosexual behaviour and condom usage in an urban population of Delhi, India.

A survey conducted among the lower-class urban population of Delhi, India to describe the heterosexual behaviour, condom usage and awareness about STDs/AIDS revealed that 4.4% respondents had sex outside/before marriage. Female commercial sex workers, friends and neighbours were the important sexual partners. Heterosexual activity was significantly higher among males, unmarried, literates and middle/higher income groups. Almost half of those who had sex before/outside marriage never used a condom during the sexual encounter. Though only a small fraction of the population was found to be engaged in extra-/pre-marital sex, the overall impact of this may be multifold, given the nature and modes of HIV transmission. The superficial and inadequate knowledge regarding STDs/AIDS among this population, especially among those having extra-/pre-marital sex, indicates an urgent need for appropriately targeted health education and condom promotion activities in the community with an endeavour to increase awareness about STDs and HIV/AIDS and motivate people towards healthy sexual lifestyles.

Adolescent↗

Sexual health knowledge and risk behaviour in young people with first episode psychosis.

The sexual health of clients has been poorly addressed by mental health service providers and sexually transmissible infection (STI) incidence rates are increasing among young people. A self-report questionnaire was used to gather information in order to describe and to conduct a cross-sectional analysis of sexual health knowledge, risk behaviour and STI screening history among young people who have experienced a first episode of psychosis, who present to community-based early psychosis programmes in south-eastern Sydney. STI knowledge was fair and sexual risk practice knowledge was poor regarding anal and oral sex. Women reported significantly more sexual partners than men. When those young people who had had unsafe sex attended for STI screens only, 5% received a complete screen. The survey result indicates a need for sexual health screening education to be conducted for clients. Against a background of escalating rates of HIV, STIs and high risk-taking behaviours among young people, it is essential that mental health staff are provided with the skills and education to address sexual health and harm minimization issues.

Adolescent↗

Treatment of sexually transmitted chlamydial infections.

Tetracycline hydrochloride, 500 mg orally four times a day for seven days, remains the treatment of choice for C trachomatis infections in men and nonpregnant women. Either erythromycin, 500 mg orally four times daily for seven days, or an equivalent dosage of another erythromycin product is an alternative treatment for patients who cannot tolerate tetracycline and for pregnant women. These two treatment regimens can be generalized to include nongonococcal urethritis and mucopurulent cervicitis. However, other treatment regimens that are effective against C trachomatis may not be effective for treating nongonococcal urethritis or mucopurulent cervicitis not caused by C trachomatis. The optimal treatment for pregnant women with C trachomatis infections and women with acute PID has not been established. Additional treatment trials with both groups of patients are needed to determine the effectiveness of antimicrobial agents in addition to those currently used, to establish the appropriate dose of each antimicrobial agent, and to clarify the appropriate duration of treatment. All individuals who are sexual partners of patients with nongonococcal urethritis, mucopurulent cervicitis, and acute PID (within the 30 days prior to onset of their symptoms or time of positive clinical evaluation findings) should be examined for sexually transmitted disease and treated promptly with a regimen effective against uncomplicated gonorrhea and chlamydial infections. Prompt treatment of sexual partners reduces the rate of treatment failure due to reinfection, reduces the transmission of infection, and reduces the frequency of occurrence of adverse sequelae of infection.

Acute Disease↗

Identification of human immunodeficiency virus type 1 envelope genes recombinant between subtypes B and F in two epidemiologically linked individuals from Brazil.

Sequence analysis of a human immunodeficiency virus type 1 env gene PCR amplified from a Brazilian woman's peripheral blood mononuclear cell DNA (sample RJIO1) showed that it was likely to have been derived from a double recombination event between human immunodeficiency virus type 1 subtypes B and F. The major portion of the gp120 coding sequence belonged to the B lineage, but a segment of the C2 to V3 region (approximately 135 nucleotides) clearly associated with sequences of the F lineage. The subtype F-like segment had 15 noncontiguous signature nucleotides in common with Brazilian subtype F sequences that were not found, or were rare, in subtype B sequences. In contrast, this same segment had only 3 signature nucleotides shared with subtype B sequences and not present in the Brazilian subtype F sequences. Phylogenetic analysis, amino acid signature pattern analysis, and the pattern of synonymous mutations all supported the hypothesis of a recombinational origin of the RJIO1 sequence. Related recombinant genes were also detected in peripheral blood mononuclear cell DNA obtained from the woman's recent sexual partner, indicating that the recombination event probably occurred at some previous time in the chain of virus transmission. Divergent viral sequences in the V3 region were found in the male sexual partner, while a relatively homogeneous viral population was detected in the woman, consistent with her recent infection.

Acquired Immunodeficiency Syndrome↗

Comparison of clinical and epidemiological characteristics of pelvic inflammatory disease classified by endocervical cultures of Neisseria gonorrhoeae and Chlamydia trachomatis.

We compared the clinical and epidemiological characteristics of 89 women with pelvic inflammatory disease (PID) seen at a clinic for sexually transmitted diseases during 1982 and 1983. Patients were classified into four groups by having endocervical cultures positive for Neisseria gonorrhoeae only (24), Chlamydia trachomatis only (16), both organisms (14), or neither organism (35). More women with cultures positive for N gonorrhoeae were black (p less than 0.005), had a sexual partner with gonorrhoea (p less than 0.005), and had a purulent vaginal discharge (p less than 0.05). No other significant differences were found between groups regarding age, exposure to a sexual partner with non-gonococcal urethritis, history of trichomoniasis, parity, use of antibiotics, contraceptive history, duration of abdominal pain, relation of pain to the phase of the menstrual cycle, abdominal rebound tenderness, reproductive tract signs, or febrility. In women presenting to outpatient clinics, PID tends to be mild and the diagnosis unreliable. Though C trachomatis is emerging as an important aetiological agent, we found no clinical indicators that could distinguish chlamydial from gonococcal PID.

Adult↗

[ALAT and viral RNA as risk factors in 68 blood donors with anti-hepatitis C antibodies].

AIM: Determine the risk factors in blood donors with anti hepatitis C antibodies (anti-HCV ab) possible liver involvement and evaluation of their infectious potential by a search for viral RNA in blood. METHODS: Between July 1990 and October 1991, 19,632 blood donors were screened for hepatitis C. Antibodies to HCV were detected in 74 donors (2nd generation ELISA, Abbott). We evaluated the risk factors, determined ALAT levels and looked for circulating RNA virus by amplification of the non-coding region of the viral genome (RTPCR) in 68 of these 74 donors screened. A control was chosen arbitrarily from 103 donors with high ALAT levels, but with no antibodies to HCV nor detectable circulating viral DNA. RESULTS: The prevalence of anti-HCV ab in blood donors in 0.37%. No risk factor was found in 29 donors (43%). Parenteral exposure (former i.v. drug addiction and history of transfusions) was found to be the mode of transmission of hepatitis C in 23 donors (34%). History of NANB jaundice (non-post transfusion) was reported in 1 donor (1%). The remaining 15 donors (22%) were found to have minor risk factors - either isolated or in combination (exposure, tatoos, multiple sexual partners). Former i.v. drug addiction (p = 0.0000006) as well as a history of transfusions (p = 0.0071) are significantly more frequent in the group of donors with antibodies to HCV. None of the 35 sexual partners of the tested donors proved to be positive. 21 donors (30%) had high ALAT (+2 SD). Viral RNA was detected in blood of 26 donors (38%). The proportion of cases with positive viral RNA was 61% if only those donors with high ALAT levels were taken into consideration (13 positive of 21). CONCLUSIONS: Risk factors were found in 39 donors (57%) with antibodies to HCV. History of parenteral exposure was found to be significantly more frequent than in the control group (p = 0.0000054). Sexual transmission within couples was not demonstrated in the population tested. A positive PCR test is a probable indicator of a continuous viral replication and reflects a possible chronic hepatic involvement as well as a potential infectivity. This test is positive in at least 38% of donors with antibodies to HCV and in more than 60% of those who, in addition, have high ALAT levels.

Alanine Transaminase↗

Evaluation of a video based health education strategy to improve sexually transmitted disease partner notification in South Africa.

OBJECTIVES: To evaluate the feasibility and impact of a health education intervention promoting partner notification for sexually transmitted diseases (STDs). METHODS: The research setting was a busy public health clinic in a rural district in KwaZulu Natal, South Africa. A before/after quantitative study design was used to measure the effect of an audiovisual presentation of a compelling love drama, posters, and pamphlets. Measures collected from all consenting STD index patients during a 6 week pre-intervention (control) phase were compared with those collected during a 6 week intervention phase. A qualitative evaluation assessed whether the intervention accurately portrayed the intended educational messages. RESULTS: 150 index patients (55% female) were interviewed in the control phase and 185 index patients (64% female) in the intervention phase. The intervention phase showed improvements on several measures of self efficacy about notifying casual partners, such as a belief among index patients that a greater proportion of their casual partners would see the importance of seeking treatment as a result of their notification interaction. The rate of contact cards returned per index patient was 0.27 in the intervention phase, compared with 0.20 in the control phase (95% CI for the rate difference: -0.05, 0.17). The qualitative research found that the intervention was thoroughly enjoyed by patients and clinicians, but a fundamental problem with it was that patients received confused messages about the relation between HIV/AIDS and other STDs. This has potentially negative consequences for partner notification. CONCLUSION: The intervention needs further development, and then could provide a highly acceptable, cost effective model for health education in clinics in developing countries.

Adult↗

Reliability and validity of a self-efficacy instrument for protective sexual behaviors.

The authors investigated the psychometric properties of a 22-item scale that measured respondents' perceptions of their ability to refuse sexual intercourse, question potential sexual partners, and use condoms. Two hundred twenty-one male and female undergraduates completed an anonymous questionnaire that measured a wide range of constructs. The scale exhibited good internal consistency, and convergent validity was demonstrated for 5 sexual behavior items (number of sexual partners ever and in the past 3 months, condom use in past 3 months, at last intercourse, and in the future). The instrument appeared to be free of social desirability bias and was reliable and valid for assessing college students' self-efficacy for protective sexual behaviors. College healthcare professionals could administer the instrument to help students determine their levels of self-efficacy for engaging in self-protective behaviors and identify domains in which they may need to improve their skills to reduce their risks of acquiring a sexually transmitted disease or having or causing an unplanned pregnancy.

Adolescent↗

AIDS-related beliefs, attitudes and intentions among Malawian students in three secondary schools.

This preliminary investigation into factors influencing the intention of Malawian secondary school students to engage in low-risk AIDS-related behaviours was based on the Theory of Reasoned Action (Ajzen & Fishbein, 1980). A total of 191 male and female subjects (mean age 19.32) from three secondary schools in Malawi filled in a questionnaire that sought to elicit their intention to use condoms and to stick to the one same sexual partner. The study lent support to the theory that intention can be predicted from attitudes and subjective norms, F(2,186) = 31.93, p < 0.001 for condom use and F(2, 187) = 15.23, p < 0.001 for sticking to one sexual partner. The results showed that, for the subjects, the intention to comply with these two behavioural regimens was predominantly under attitudinal control though one sub-sample's intention was under normative influence. The study also provided quantitative data on the sexual behavioural patterns of the subjects and used these data to furnish explanations of the main findings. Behavioural change intervention strategies in the light of the findings are discussed.

Acquired Immunodeficiency Syndrome↗

Revenge versus forgiveness/forbearance in response to narrative-simulated victimization.

The authors engaged men and women (N = 120) who read one of two versions of a dramatic narrative in which the narrator became HIV-positive following heterosexual intercourse with an AIDS-infected partner. Assuming the role of the narrator, the participants completed two situation-instigated criterion measures as a response to becoming HIV-infected, indicated whom they blamed for their predicament, and completed two "trait" predictor measures-negative affect and response to perceived victimization in everyday life. Trait victimization response and blaming the sexual partner were strongly associated with high rather than low negative affect. Reasons for the reluctance to blame the sexual partner and seek revenge were discussed, and recommendations were made to develop less problematic simulated victimization narratives.

Adult↗

Hepatitis B e antigen, DNA polymerase activity, and infection of household contacts with hepatitis B virus.

To determine if the presence of hepatitis B e antigen (HBeAg) and elevated DNA polymerase activity in the serum of chronic HBeAg carriers indicate increased contagiousness in a household setting, the household contacts of 74 carriers were prospectively evaluated for serologic evidence of hepatitis B infection. Thirty of the HBsAg carriers had HBeAg and 44 had anti-HBe. Twenty-eight HBeAg-positive carriers regularly demonstrated elevated DNA polymerase when serially drawn serum samples were analyzed. None of the anti-HBE-positive carriers demonstrated elevation of DNA polymerase activity. Both household contacts of HBeAg-positive and anti-HBe-positive carriers demonstrated serologic evidence of hepatitis B infection (HBsAg, anti-HBs, and anti-HBc). However, infection was significantly more frequent among spouses and sexual partners of carriers who had either HBeAg (P less than 0.001) or elevated DNA polymerase activity (P less than 0.001). Thus, the data indicate that a particular subpopulation of spouses and sexual partners of hepatitis B carriers are at significantly greater risk for acquiring infection.

Adult↗

[Sexuality of women living with HIV/AIDS in São Paulo].

The social and cultural setting which increases female vulnerability to HIV does not disappear when women living with HIV/AIDS discover that they are infected. Following diagnosis, new challenges arise in their emotional lives, an issue which has received little attention in the literature. This study interviewed 1068 women living with HIV/AIDS using a questionnaire consisting of both open and closed questions, aimed at describing aspects of their sexual and reproductive lives and how they perceive counseling at Reference Centers in two cities in the State of São Paulo, where they have access to free antiretroviral therapy. Of the women with stable sexual partners, 63% used condoms in all their sexual relations, or three times the national average; 43% of the partners were HIV-negative and 14% had unknown serological status; 73% of the women had children and 15% were considering becoming pregnant. Knowledge on mother-to-child transmission was less than expected, and the interviewees complained of limited space and receptiveness for discussing sexuality, especially with regard to their childbearing wishes. Counseling on sexuality should be a continuing process and requires interdisciplinary training for the professional team working in health care services, with an emphasis on sexual and reproductive rights.

Acquired Immunodeficiency Syndrome↗

Diffusion and focus in sexual networking: identifying partners and partners' partners.

This article describes the second stage of a research project on sexual networking that aims to further understanding of the spread of sexually transmitted diseases and HIV/AIDS in Ondo State, Nigeria. A sample of 488 males aged 15-50 were interviewed in depth to ascertain (1) the numbers and characteristics of their sexual partners, (2) the numbers and characteristics of the partners of those partners, and (3) the extent to which these relationships were commercial. In addition, a census was taken of all commercial sex establishments in order to estimate the numbers of their clients. The results show that male (and female) sexual networking is extensive, that in most nonmarital relationships men do not have accurate knowledge of their partners' partners, and that detailed questioning provides a reasonably accurate picture of the number of these relationships that are commercial in nature. The situation revealed was one of sexual diffusion rather than one with a strong focus on commercial sex workers, which fits the model of a slowly increasing HIV/AIDS epidemic rather than an explosive one.

Adolescent↗

Sexually transmitted diseases reported by STD services in The Netherlands, 1984-1990.

OBJECTIVE: To present general trends in sexually transmitted disease (STD) in the Netherlands during the period 1984-1990 and to describe characteristics of the patients in order to get insight into possible factors underlying these trends. METHODS: Since 1984 patients diagnosed with STD visiting STD clinics and local public health services in the Netherlands are reported by the nursing staffs. In addition to diagnosis and gender of the patient epidemiological background information is registered. The reported annual cases of gonorrhoea, syphilis and Chlamydia trachomatis infections are presented. Further, the epidemiological features of over 25,000 patients with infections due to Chlamydia trachomatis, gonorrhoea or syphilis infections were compared. RESULTS: During the period 1984-1990 an overall decrease in the total number of gonorrhoea infections was reported; among homosexual males; however, an increase in gonorrhoea rates and an increasing number of sexual partners after 1989 was reported. Furthermore, the percentage of gonorrhoea infections caused by penicillinase-producing Neisseria gonorrhoeae was found to be on the increase in various subgroups but not in homosexual males. Syphilis rates among females declined from 1984 to 1987 after which an increase was reported reaching a peak in 1989; syphilis rates among males peaked during 1989. After 1988 Chlamydia trachomatis infections increased which, however, is largely due to the introduction of screening among all visitors of the Amsterdam STD service resulting in improved case-detection. Finally, it appeared that STDs are not randomly distributed over the population but are associated with certain patient characteristics. CONCLUSION: The data provided by STD services reveal an epidemiological pattern for STDs in the Netherlands. The increase in the reported number of gonorrhoea infections among homosexuals together with the increasing number of sexual partners among homosexual males suggest that a group of highly sexually active individuals switch or return to higher risk behaviours. Further research is needed to determine the causes of the described trends and behavioural changes in order to undertake preventive activities.

Adolescent↗

Casual sex among Australian schoolies.

This study of the casual sexual partnering of 570 male and 776 female Australian high school students on a schoolies week vacation expands on earlier research on factors that influence the sexual activity of vacationing youth. Over 60% of the men and nearly 40% of the women who engaged in sexual intercourse during schoolies week did so with a casual partner. We used logistic regression to test an expanded version of Triandis Theory of Interpersonal Behavior (TIB) in explaining casual sexual partnering. Situational experiences (similar to what others have called situational disinhibition), prior sexual experiences and intentions (similar to what others have called spillover) influenced casual sexual partnering. Different causal pathways were demonstrated for men and women.

Adolescent↗

Herpes simplex virus type 2 in prisoners, New South Wales, Australia.

Our objectives were to determine the prevalence of, and risk factors for, herpes simplex virus type 2 (HSV-2) antibodies in male and female prisoners. A cross-sectional random sample was used consisting of 789 prisoners (657 males and 132 females) from 27 correctional centres across New South Wales (NSW), stratified by sex, age and Aboriginality. Participants were questioned about demographics and behavioural risk factors and were screened for serum antibody to HSV-2. The overall prevalence of HSV-2 antibodies was higher in females (58%) than males (21%), and in Aborigines (34%) compared with non-Aborigines (24%). HSV-2 prevalence increased with the number of sexual partners. Few prisoners (1%) reported a previous diagnosis of genital herpes. Independent risk factors for the presence of HSV-2 antibodies were increasing age and Aboriginality for men, and higher reported number of lifetime sexual partners and the presence of hepatitis C antibodies for women. HSV-2 infection is common in prison inmates. There is a need to incorporate information about STDs, including HSV-2, into education programmes for inmates.

Adult↗

Is bacterial vaginosis a sexually transmitted disease?

The sexual behaviour of 400 women with and 400 women without bacterial vaginosis from a health screening programme was investigated by a questionnaire to see if women with bacterial vaginosis had similar behaviours to women considered at risk for STDs. These patients were randomly selected from computer records. Eight hundred questionnaires were distributed and 641 women answered. The age of first sexual intercourse was lower among women with bacterial vaginosis (17.8 years) than those without (18.6 years; P less than 0.001). Number of lifetime sexual partners was higher among women with bacterial vaginosis (P less than 0.001). Women with bacterial vaginosis smoked or had smoked more often. These results indicate that women with bacterial vaginosis have similar sexual behaviour to those at risk for STDs.

Adolescent↗

Mexican and Mexican American women in a battered women's shelter: barriers to condom negotiation for HIV/AIDS prevention.

Anecdotal information suggests that, for Hispanic women who are involved with abusive partners, condom use request as an HIV/AIDS sexual risk-reduction behavior may expose the women to risk of both abuse and HIV/AIDS. A qualitative study explored barriers to condom negotiation for HIV/AIDS prevention among Mexican and Mexican American women in abusive relationships. A convenience sample of 14 Mexican and Mexican American women was recruited from a battered women's shelter. A demographic form, a domestic violence assessment form, and audiotaped responses to a semistructured interview guide were used to collect data. Descriptive statistics were used to describe the sample. Audiotaped interviews were transcribed verbatim and submitted to content analysis, which revealed past and present themes of physical, psychological, and sexual abuse of Mexican and Mexican American women who requested condom use by their male sexual partners. Also identified by content analysis was the influence of men's power on women's public, private, and sexual interactions.

Acquired Immunodeficiency Syndrome↗