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PubMed2002

Decreasing intravenous cocaine use in opiate users treated with prescribed heroin.

OBJECTIVES: Providing maintenance treatment for heroin users who also use cocaine presents special problems. Poly-drug use is prevalent among clients in the Swiss Program for the Medical Prescription of Heroin (1994-1996). METHODS: A formative evaluation examines whether cocaine use was associated with a higher drop-out rate from treatment, and how cocaine use changed among those who remained in treatment. Frequency of cocaine use before and during treatment was measured by self-report every six months and by urinalysis every two months. RESULTS: There was no significant difference between the drop-out rates for cocaine users vs. non-users (n = 995). A significant reduction in cocaine use over an 18-month period from 84 to 48% was found for a sample of clients (n = 266). Overall retention in programme was high and also the prevalence of factors associated with cocaine use such as criminality, prostitution, and contact with drug scene decreased. CONCLUSIONS: The results suggest that prescribed heroin maintenance provides a treatment context that may help reduce consumption of other illicit drugs such as cocaine.

Cocaine-Related Disorders↗
PubMed1975

Sex research and social change.

The history of scientific sex research which emerged at the turn of the century with the exemplary work of Sigmund Freud and Havelock Ellis has been complexly interactive with changing general social conditions, specific trends in sexual conduct, the content of sexual ideologies, and the developing techniques of scientific inquiry. The earliest sex researchers, although serving to bring sexuality out of the Victorian cold and into the center of human development based their views of sexuality on control-repression and drive models. The Freudian tradition was especially influential in general intellectual matters and was probably the most important in the development of twentieth-century sexual ideologies. Beginning in the 1920s and culminating in the work of Kinsey in the 1940s and 1950s, a tradiition of social bookkeeping began focusing on the sexual behavior of relatively normal persons. Methodologically such studies moved away from the case history and from populations who were defined as criminal or neurotic. At the same time, general social changes were occurring that were directly affecting the rates and directions of sexual conduct in the society. The work of Alfred Kinsey charted these changes and in turn influenced public attitudes, public policy, and research interests during the 1950s and 1960s. The work of other researchers began to fill in the picture of sexual conduct in the society from a survey point of view, and some workers began studies in sexual deviance that focused anew on homosexuality and prostitution. The work of William Masters and Virginia Johnson served to open the door to studies of sexual anatomy and physiology by applying well-known techniques to the laboratory study of the sexual. While the biological tradition is still strong in the discussion of the sexual, new emphases are being placed on a cognitive-social learning persepctive that emphasizes the nonbiological factors in sexual development. Major changes have occurred in the sexual backdrop of the society in the 1960s, and while changes in sexual conduct have been less than revolutionary, they have occurred in a number of areas (contraception, abortion) that have directly influenced societal practices. Sex research and the sex researcher have played an important role in providing benchmarks for sexual practices, illuminating general understanding, and providing the content for ideiolicaal debates about the right and wrong of sexuality in the society. In few areas of research have researchers had such an important role in the debate over the measning and significance of the behavior they have studied.

Attitude↗
PubMed1984

Psychosocial characteristics of applicants evaluated for surgical gender reassignment.

Social, sexual, economic, familial, and psychological characteristics of 764 applicants for surgical gender reassignment, 479 males and 285 females, who completed the application questionnaire and were subsequently interviewed by the Gender Dysphoria Program in Palo Alto, California, are examined. All information except diagnosis was obtained from the applicants' responses to a standardized 100-item questionnaire. Diagnosis was determined by a psychiatrist after a 1 1/2-hour interview. A comparison of male applicants to female applicants indicated differences in five areas: (1) sexual history; (2) acting-out behavior or sociopathy; (3) work history; (4) strategies for physically passing in the desired gender, e.g., hormone therapy; and (5) diagnosis. Females had experienced more stable same-sex sexual relationships and fewer opposite-sex sexual relationships than the males had experienced. The females exhibited less acting-out behavior, indicated by few criminal convictions and little involvement in prostitution, compared to the male applicants. Twice as many males as females were unemployed and receiving welfare at the time of application. In addition, males used cosmetic surgery and hormone therapy more frequently to facilitate physically passing in the desired gender than did the females. The most frequent diagnosis for males was transvestitism, while for the females it was classic transsexualism.

Crime↗
PubMed1987

The sexual scripting of oral genital contacts.

There is evidence from a number of sources that contemporary cultural scenarios for sexual conduct are often very approving of oral genital sex. Two surveys of sexual conduct are analyzed to examine the changes in interpersonal sexual scripts for oral genital sex for cohorts of white and college-educated young people who entered young adulthood between 1928 and 1943 and 1963 to 1967. Males in the earlier cohort had an excess of fellatio during the premarital period from erotic contacts with prostitutes and transient partners. In contacts with potential marital partners and in marriage men and women had equivalent rates of oral sex indicating a greater sexual reciprocity in these affectional relationships. In the latter cohort male and female rates of oral sex before marriage are substantially greater than for the earlier period but are equivalent for the two genders. In both periods oral sex is most common among the coitally experienced and is initiated by males. Evidence is found for an increased amount of sexual activity unlinked to marriage, what might be labeled pre-premarital sex. Male participation in oral sex seems responsive to opportunity, lowered moral inhibition, and emotional commitment while females' participation seems more linked to features of the ongoing relationship. In a review of studies in the 1970s and 1980s a further major increase in the incidence of oral sex in the period before marriage can be found. From these data it appears that oral sex has become, over the last 50 years, part of the sexual scripts of many young people and is a common, though not necessarily a frequent, component of sexual relations in contemporary marriage.

Adolescent↗
PubMed1981

Partnership in transsexualism. Part I. Paired and nonpaired groups.

In a group of 72 transsexuals, 26 out of 55 male-to-female transsexuals had partners and 9 out of 17 female-to-male transsexuals had partners. Forty percent of the group of 35 paired transsexuals had been married, but most of these marriages had ended in divorce or separation. Six male patients were still married at the time of the enquiry. The two groups differed significantly in several respects. Those with partners (the paired group) had more fathers or heads of family in social classes I-III, while those without partners (the nonpaired group) were more often without their father in the first decade of life. Significantly more of the paired group received psychiatrists' rating of stable social adjustment. There was a tendency for the paired group to have a more successful employment history since leaving school and to change their National Insurance cards more often in order to obtain employment in their adopted gender. The groups did not differ in the amount of social drift, self-confessed criminal behavior, age at referral, history of prostitution, or incidence of rejecting parents. There were also no significant differences on the following psychological tests: Wechsler Bellevue, Progressive Matrices, Mill Hill Vocabulary Scale, Maudsley Personality Inventory, Slater Selective Vocabulary--except that the nonpaired group knew fewer male words. Any differences between the two groups are perhaps best described in terms of social adjustment rather than any background social factors, personality, or clinical differences.

Adult↗
PubMed1978

Background and sexual experience of Israeli medical students.

It is now general professional consensus that to develop a good human sexuality curriculum it is mandatory to first study the future target population, Such a study was done on a national basis at the four medical schools in Israel, concentrating on the senior students. The data on background, sexual experience, knowledge, and attitudes were analyzed and compared to findings of similar studies in other countries. This article reviews the results on background and sexual experience, also trying to analyze logical hypotheses of possible links between variables. Most Israeli senior medical students are unmarried Jewish Ashkenasi males, with a rather small proportion of females, Sephardic-originated Jews, Moslems, and Christians. Their sex education during childhood originated mostly from peers and literature, but was almost completely lacking at school. Masturbation started early, being more frequent for males. The majority of both sexes had dated, had gone steady, and had had sexual intercourse frequently with at least two partners. Only 5.4% of males had never experienced coitus. Intercourse with prostitutes was infrequent. The students' background has direct influence on their early sexual knowledge and experience. This in turn influences self-ratings on sexual matters. This is further correlated with sexual behavior.

Adolescent↗
PubMed1989

Sexual behavior of unmarried Colombian university students: a follow-up.

Since the mid-1970s, the author has conducted periodic surveys of the sexual behavior of the students of Caldas University, Manizales, Colombia. This study presents the results of the latest follow-up. It documents the accelerated convergence of male and female sexual behavior in a culture which, up to a few years ago, fully adhered to the double standard. The most striking change relates to the increase in the incidence of female premarital coitus, from 38.3% five years earlier to 64.6%, and perhaps 80% among those students who eventually marry. However, the study also shows that prostitution still plays an important role in the sexual lives of male students.

Adult↗
PubMed1997

[Assessment of AIDS risks: effects of different scale ranges and preventive knowledge].

In a sample of 552 respondents effects of different scale ranges and respondents' knowledge about AIDS for answering questions about AIDS-risks were examined. Knowledge was assessed with 12 items related to risks for HIV infections and preventive measures. AIDS hazards for different groups (prostitutes, fixers, hospital personnel, homosexuals, and haemophiliacs) had to be rated with five items, one for each group. Response variations were assessed in three parallel questionnaire versions with different ranges of risk assignments. Estimations had to be performed in comparison with the average population. Some groups were consistently rated to be at high risk, others were assigned low risks for becoming infected with the HIV-virus. The analysis of response patterns revealed that the three versions of numeric quantifiers determined the risk ratings only to some extent. The distribution patterns suggest that our subjects had an ordinal risk ordering in mind that might better be expressed in verbal terms. The knowledge about AIDS had no systematic effects on response behavior.

Acquired Immunodeficiency Syndrome↗
PubMed1978

T-lymphocytes and hepatitis B serology.

The incorporation of 14C-thymidine by peripheral blood lymphocytes stimulated by phytohemagglutinin (PHA) and the proportion and absolute number of E-rosettes were determined in 28 prostitutes and the results were correlated with hepatitis B virus (HBV) serology. Women were tested for hepatitis B surface antigen (HBsAg) and its antibody (anti-HBs) as well as for antibody to the hepatitis B core antigen (anti-HBc). It was found that women who were carriers of HBsAg had significantly lower incorporation of 14C-thymidine (median value 14451 counts per minute-cpm) compared to women positive for anti-HBc but negative for the other two markers (median value 28590 cpm) as well as to women negative for all the tested markers (median value 30600 cpm). No significant difference was found among the three groups studied with respect to either the absolute number or the percentage of E-rosettes. The results indicate that the presence of anti-HBc alone, is not related to the responsiveness of lymphocytes to PHA.

Carbon Radioisotopes↗
PubMedDate not supplied

[Deliberations and computer computations on the epidemiology of the acquired immunodeficiency syndrome in the Federal Republic of Germany].

A computer simulation of the morbidity and mortality rates of the "Acquired Immunodeficiency Syndrome" in the Federal Republic of Germany was performed. Since sexual intercourse is the main mode of transmission, the population was divided into six groups with different sexual behaviour. In several variations of the program it is demonstrated that during the next 15 years up to 41,000 AIDS patients can be expected. The importance of female prostitutes and male bisexuals as "vectors" who may transmit the infection into exclusively heterosexual groups is shown. Using this program, the effect of prophylaxis against infection as well as of changes of sexual behaviour within the population at large can also be examined.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Mobility of Scottish injecting drug users and risk of HIV infection.

Nine hundred and nineteen injecting drug users (IDUs) were interviewed in Glasgow, Scotland during 1990 and 1991, as part of a wider study of HIV risk behaviour, about their injecting and sexual behaviour outside the city in the previous two years. Forty-five percent of respondents injected outside Glasgow, 6% shared needles and syringes (n/s) and 20% had sexual intercourse. Much activity occurred outside Scotland but mainly within the UK, particularly London. Predictors of n/s sharing outside Glasgow during the previous two years included current injecting with and passing on of used n/s and sexual intercourse with casual partners. Predictors of sexual behaviour outside Glasgow included passing on used n/s, having sexual intercourse with casual partners and, for females, engaging in prostitution. Glasgow IDUs are a highly mobile group and although HIV prevalence remains low within this population, considerable potential for importation/exportation of HIV and other bloodborne and sexually transmitted infections exists. Further work is required to establish why IDUs travel to, and engage in high-risk activities in locations outside their home environment, and detailed data about activities such as frequency of condom usage and n/s cleaning practices need to obtained. While there is a widespread network of services for IDUs in the UK, information provided usually relates to local services and may not fully address the needs of this mobile population. Therefore, we recommend that IDUs be provided with details of facilities such as n/s exchange schemes and drug-treatment establishments in centres to where they most commonly travel.

Blood-Borne Pathogens↗
PubMed1985

Human cytomegalovirus infection: recent developments in diagnosis and epidemiology.

Cytomegalic inclusion disease (CID) is caused by a horizontally or vertically transmitted human herpes virus infection and may persist for life without obvious clinical symptoms. A serious course of horizontal primary and recurrent infections, however, is often observed in immunocompromised persons such as recipients of organ transplants and patients receiving fresh blood transfusions. Vertical infection may cause fetopathies. The human cytomegalovirus (HCMV) is thought to inherit an oncogenic potential as lately discussed for AIDS and M. Kaposi. Laboratory diagnosis of HCMV infection is performed by light microscopy (inclusion bodies), electron microscopy, virus isolation in cell culture, demonstration of viral DNA and antigen in clinical specimens, by histochemical methods (e.g. immunoperoxidase technique) and by DNA and peptide analysis for identification of different isolates and viral finger prints. Evaluation of cell-mediated immunity in HCMV infection is performed quantitatively (assessment of Thelper/Tsuppressor ratios) or qualitatively (specific lymphocyte stimulation by the antigen). In most cases laboratory diagnosis is achieved by serological methods, i.e. demonstration and quantitation of HCMV-specific antibodies. In this context, a number of liquid- and solid-phase immunoassays have been developed, of which immunofluorescence and ELISA are most commonly used, besides complement fixation and passive haemagglutination. These procedures on the one hand allow the use of different antigen preparations as early and late viral proteins, and on the other hand permit a specific determination of different Ig classes and subclasses. A variety of assays has been established especially for determination of virus-specific IgM antibodies, which are predominantly found in active infection. These, however, at least in part may show non-specific results caused by interference of rheumatoid factor or IgG competition. Such problems have now been dealt with and are avoided by IgG precipitation or IgM immunosorption ("mu-capture" technique). These recent methods allow an exact epidemiological identification of risk groups for CMV infection. Results from our laboratory revealed 13% HCMV-IgM positive patients among pregnant women, 16% IgM positive patients among renal transplant recipients, 4% IgM positive cases in patients after cardiosurgery and 1.7% IgM positives among prostitutes. The prevalence of HCMV infection as indicated by specific IgG antibodies was 56%, 90%, 83%, and 90%, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1987

Risk factors for HIV infection in German i.v. drug abusers. Clinical, serological and epidemiological features.

A series of 320 German i.v. drug abusers (32.2% female, 67.8% male) were tested in a cross-sectional study for antibodies against HIV. Seroprevalence increased from 0 in those who discontinued i.v. drug abuse before 1982 to 37.2% in those who stopped injecting drugs in 1985/1986 or who were still addicted. Antibodies to HIV were significantly associated with lymphadenopathy and clinical symptoms (fever, weight loss, diarrhea, fatigue, night sweat, dermal lesions) and with markers of hepatitis A and hepatitis B virus infection. Participants of the study admitted in 92.5% of cases to "needle sharing" and in 83.1% of cases to sexual contacts among drug abusers. Prostitution and drug abuse in prison were significantly correlated with seropositivity. No antibodies to HIV infection were detected in 131 subjects of a control group of household contacts.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Sources of AIDS information among low-risk and at-risk populations in five U.S. cities. AIDS Community Demonstration Projects.

Sources of HIV information were examined for 4,329 residents in five inner-city neighborhoods. Half of the respondents were female; 58% were African American, 21% Hispanic, and 21% White. Forty-nine percent of participants reported one or more practices contributing to HIV risk: injection drug use (35%), sexual contact with an injection drug user (31%), prostitution (27%), or for men, anal sex with a male partner (5% of males). Most had received HIV information in the prior three months through mass or small media sources (78%), and 47% had spoken with someone about HIV. Television was the most frequently mentioned media source (48% of all respondents), while friends and family were the most frequently cited interpersonal source (20%). Exposure to specific mass and small media sources was related to gender, ethnicity, and risk status. Women and individuals at-risk of HIV infection were most likely to have talked with someone about HIV in the past three months. African Americans, however, were less likely to have discussed HIV. Differences associated with gender, ethnicity, and risk status were also observed for interpersonal information sources. Implications for future HIV education efforts are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Failure to detect silent HIV infection by polymerase chain reaction in subjects at risk for heterosexually transmitted HIV type 1 infection.

The prevalence of silent HIV-1 infections in subjects at risk of acquiring HIV infection by heterosexual transmission was assessed using a nested polymerase chain reaction (PCR) assay. The two groups of risk subjects consisted of 92 female prostitutes and 43 heterosexual partners of infected individuals. Appropriate positive and negative control persons were included in the study. Serum samples were also tested for antibody to HIV-1 by an enzyme immunoassay (EIA) and positive results confirmed by Western blot. PCR results in the two risk groups and the positive and negative controls were in full agreement with serological results. It is concluded that silent infection with HIV-1 is infrequent in persons at risk for heterosexual transmission.

Adolescent↗
PubMed1979

[Control of sexually transmitted diseases in Senegal].

STD are an important public health problem in numerous developing countries. Although satisfactory diagnostic and therapeutic means are available, the incidence of STD is increasing. Among the causes for this are sociological factors, like the weakening of customs and the family unit, and the development of tourism, which stimulates prostitution. There is a marked ignorance of the population in respect to STD. The Senegalese Government, WHO, and the Geneva-based Sandoz Institute launched in 1976 a joint programme of service, training and sesearch. The research aims at developing a preventive approach, especially through health education. While the three centers set up have accomplished good work locally, results are still disappointing from a public health point of view. Weak spots are in particular: - inadequacy of the social and contact-tracing services; -lack of action at the periphery and of integration with primary health care; -lack of coordination with other sectors (including police), and with professionals of various disciplines who should contribute to the socio-economic investigation of the problem. Several groups have recently been created in Senegal to support the project. An evaluation will soon be carried out. Such programmes should be implemented in other countries of the region.

Female↗
PubMed1995

Surrogacy: ethical, legal, and social aspects.

In considering the interrelated ethical, legal and social aspects of surrogacy we acknowledge that society has long accepted the delegation of various parenteral functions and explore the role of a surrogate in relationship to this as well as alluding to commoner comparisons with prostitution and adultery. In particular, the "birth mother" rule, the public antipathy to "commercial" surrogacy and restrictive legislation are explored and found to be inappropriate. It is concluded that the regulation, surveillance and assessment needed to ensure the best outcome for all concerned would perhaps be easiest achieved in programmes that are formally licensed under permissive legislation and adequately funded by "commercial" means.

Bioethics↗