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PubMed1993

Cervical human papilloma virus infection of women attending social hygiene clinics in Hong Kong.

OBJECTIVE: To find the prevalence of HPV infection in women attending a sexually transmitted disease clinic in Hong Kong. METHOD: Cervical HPV infection was identified by cervical cytology and DNA filter in-situ-hybridization (Virapap) techniques in 207 women attending a social hygiene clinic. Other risk factors for cervical cancer were assessed and any association with HPV infection was sought. Statistical analysis was carried out using the chi 2-test. RESULT: The prevalence of HPV infection in the 207 Chinese women was 8.2% by cervical smear and 12.6% by DNA filter in-situ-hybridization. Risk factors for cervical cancer were not significantly associated with HPV infection in this group, 95% of whom were prostitutes. CONCLUSION: The prevalence of HPV infection in this group at high risk for cervical cancer is higher than in low-risk pregnant women, however the prevalence of HPV infection in Hong Kong is at the low end of the range of figures quoted for Caucasians. The cause of such a low prevalence is yet to be determined.

Adolescent↗
PubMed1989

Acquired immune deficiency syndrome presenting as a palatal perforation.

Head and neck manifestations are particularly frequent in the acquired immune deficiency syndrome. An unusual case of acquired immune deficiency syndrome in a female prostitute whose initial presentation included a palatal perforation is reported. This case is also noteworthy because the patient died of disseminated miliary tuberculosis, a disease only recently included in the Centers for Disease Control case definition of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1994

The spectrum of pathological changes in the lung in children with the acquired immunodeficiency syndrome: an autopsy study of 36 cases.

We present the pulmonary findings in 36 autopsies of children affected by the acquired immunodeficiency syndrome (AIDS). Twenty-three patients were male and 13 were female, ranging in age between 3 days and 13 years. Twenty children had human immunodeficiency virus (HIV)-positive parents or parents who were at high risk of exposure (intravenous drug abusers and prostitutes), five had a history of transfusion, and one had a history of renal transplantation and blood transfusion. Clinically, the patients presented with recurrent infections, failure to thrive, hepatosplenomegaly, fever, cough, and/or hemoptysis. Histologically, specific infectious processes were the most common finding (75% of cases), with Pneumocystis carinii pneumonia being the most prevalent type of infection, followed by bacterial pneumonia. Neoplastic conditions and lymphoid interstitial pneumonia were less frequent (approximately 10% of cases). In addition, in approximately 10% of the cases the pulmonary findings were non-specific (ie, pulmonary edema and atelectasis) and probably unrelated to HIV infection. Our findings suggest that specific infectious conditions constitute the most common type of pulmonary pathology in children with AIDS. However, because there is a small percentage of children with nonspecific findings, a transbronchial biopsy is important for proper evaluation before institution of therapy.

AIDS-Related Opportunistic Infections↗
PubMed1991

Drug abuse and psychiatric findings in HIV-seropositive pregnant patients.

In a sample of 55 human immunodeficiency virus (HIV)-seropositive pregnant patients, a history of drug abuse was significantly associated with increased psychopathology, particularly depression and personality disorders. Psychiatric disorders preceded the HIV diagnosis in most of the patients studied. Intravenous drug abuse was also associated with increased prostitution, incarceration, and previous suicide attempts. Psychiatric findings were influenced much less by the HIV diagnosis and much more by the presence or absence of a history of drug abuse.

Adolescent↗
PubMed1991

Hepatitis C antibody testing: problems associated with non-specific binding.

The prevalence of antibodies to hepatitis C virus (anti-HCV) was measured in a number of groups known to be at increased risk of blood-borne viral infections, using an enzyme-linked immunosorbent assay (EIA) based on a nonstructural peptide generated by recombinant DNA technology. The assay was repeatably reactive in 75.6% of men with haemophilia, 61.9% of intravenous drug users, 34.1% of homosexual men who were regular attenders at a gay sauna and 30.8% of prisoners. A lower reactivity was detected in sera collected from female prostitutes (10.4%), patients undergoing maintenance haemodialysis (5.9%), or renal transplantation (6.9%) and patients attending a sexually transmitted diseases clinic (6.2%). We also measured reactivity among inmates of a large institution for the mentally handicapped in which hepatitis B is known to be endemic, and in panels of sera which had been stored for 25-35 years. The test was positive in 41.1% of mentally handicapped patients with Down's syndrome and 7% of subjects with other forms of mental retardation. Similarly some 23% and 20% of sera collected in 1954 and 1964 from patients with a variety of illnesses were found to be reactive. As most diagnostic assays suffer from some degree of non-specificity and confirmatory tests for the anti-HCV assay were not initially available in Australia, we analysed the distribution of optical density (OD) values in the different groups, in an attempt to obtain an insight into the specificity of the results being obtained. Whereas the ODs of sera collected from patients with haemophilia and IVDU had a bimodal pattern, with two well separated sets of results on either side of the cut-off.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens, Viral↗
PubMed1991

HIV-relevant sexual behavior among a healthy inner-city heterosexual adolescent population in an endemic area of HIV.

The AIDS crisis has devastated segments of the population including the gay community and those who use intravenous drugs. HIV has spread to other groups including prostitutes and those with other sexually transmitted diseases. We have been studying adolescents in a major Northeast city where there is a major HIV/AIDS epidemic. Despite high levels of AIDS related knowledge, these adolescents reported high levels of sex risk behaviors. In addition, our data suggests that even moderate alcohol or marijuana use predicts high risk sexual behaviors. These data indicate the urgent need to develop prevention strategies for the spread of HIV among inner-city youth based upon relevant predictors of risk behaviors. The coupling of HIV in inner-city populations with a high frequency of risk behaviors in adolescents demands an immediate public health response.

Adolescent↗
PubMed1991

Gay and lesbian homeless/street youth: special issues and concerns.

Data on homeless and runaway youth were collected through a consortium of agencies, including one that provides services to a high percentage of gay- lesbian-, and bisexual-identified youth. Gay and bisexual male youth appear to be at increased risk for both homelessness and suicide. Gay male street youth may have been forced out of their homes because of their sexual orientation, and are more likely to engage in survival sex (prostitution) than their nongay male counterparts. In one sample, 53% of gay-identified street youths had attempted suicide, compared with 32% of a cohort of street youths that included both gay and nongay youths. Prejudice, discrimination, and homophobia are still rampant in society today; these factors contribute to a multiplicity of problems that face the young person who is gay.

Adolescent↗
PubMed1991

HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth.

In this article, we present data obtained with the psychosocial interview instrument, HEADSS (Home, Education, Activities, Drug use and abuse, Sexual behavior, Suicidality and depression) that was administered to High Risk Youth Clinic clients at their initial visits during a 1-year period. Of the 1,015 new patients, 63% were homeless/runaway youths and 37% were living with their families. Utilizing the HEADSS interview instrument, we compared homeless/runaway youths to nonhomeless youths in a number of areas, including risks for human immunodeficiency virus (HIV) infection. Our results showed that homeless teens tended to be younger, female, and white compared to their nonhomeless counterparts. They were more likely to have dropped out of school and were far more likely to be depressed and actively suicidal. They demonstrated all forms of drug abuse. They engaged in first sexual intercourse at an earlier age, and experienced a higher incidence of sexual abuse and prostitution. They were 6 times more likely to be at risk for HIV infection.

Adolescent↗
PubMed1991

The Los Angeles system of care for runaway/homeless youth.

Runaway and homeless young people generally do not seek help unless they are in a severe personal crisis. For the past 7 years, the Division of Adolescent Medicine, Childrens Hospital of Los Angeles, has learned a good deal about how to intervene effectively with these youths and divert them from high-risk behaviors such as prostitution and drug abuse. The program model we have developed has five major components: 1) networking and consolidation, 2) outreach, 3) short-term crisis shelter, 4) comprehensive medical and psychosocial care, and 5) long-term shelter and case management. Our approach has been collaborative; we subcontract a substantial portion of the work to other youth agencies in the community in order to build and strengthen the network of existing services. In the process, we have moved steadily closer to developing a comprehensive system of care for homeless street youth throughout Los Angeles County. Where programs previously operated in relative isolation, representatives from 40 private and public agencies now meet regularly at Childrens Hospital of Los Angeles to discuss ways to improve services. Systematized data collection has helped agencies understand how they can work together and has prompted additional funding for needed services.

Adolescent↗
PubMed1982

Patient characteristics negatively stereotyped by doctors.

A variety of studies demonstrate the existence of prejudice in the manner and content of health care delivery. Alcoholics, attempted suicides, drug addicts, prostitutes, the mentally retarded or mentally ill, the aged and women have been found to receive less adequate health care. Previous studies have identified manifestations of prejudice in health care delivery but have generally failed to determine the prevalence of negative stereotypes in a sample comprising a cross section of medical practitioners. This study reviews the negative patient stereotypes reported by 2421 Victorian (Australia) and Michigan (U.S.A.) doctors. The characteristics of patients so stereotyped are found to be remarkably consistent. The most commonly held negative stereotypes (patients who abuse alcohol, unhygienic patients, abusive patients, substance abusers and those with minor mental disorders) appear to be determined by the social values which prevail in our society. Many negative stereotypes appear to reflect a response to patients who deviate from the sick role. Other stereotypes may involve reactions to patients or to the types of problems which raise important therapeutic dilemmas.

Adult↗
PubMed1987

Medicalization and its discontents.

This paper raises the question of the ethically proper balance in health care policy between the medical-clinical-high technology model of health service and the grass-roots, community based or traditional models of care. Paradoxical imbalances between the two approaches are traced to political, economic or prestige factors. Case studies examined include the hospitalization of non-contagious leprosy patients while protecting the anonymity of AIDS-infected prostitutes, medical resistance to the adoption of a clinical role by Community Cancer Centers, and the continued preference in some quarters for elaborate (and often delayed) hospital treatment for such problems as infant diarrhea, despite the availability of much simpler solutions, as in the case of the widely successful oral rehydration therapy. A balanced approach to world health problems, we argue, rests not on inflationary lowering of health care standards to achieve nominal victories, nor on stainless steel high technology panaceas but on mobilizing resources around human needs.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Knowledge about AIDS and self-reported behaviour among Zimbabwean secondary school pupils.

Knowledge about AIDS and self-reported sexual behaviour was studied among 1532 (893 male, 633 female) Zimbabwean secondary school pupils drawn from 12 schools. Most subjects knew that AIDS is fatal and incurable. However, over 40% of subjects believed that most people with AIDS in Africa are homosexual. Over 40% of respondents did not know that many HIV seropositive individuals look healthy. Nearly 40% of participants believed that HIV can be contracted from toilet seats and 54% of subjects believed that mosquitos can transmit HIV. Pupils from homes in urban areas were better informed about AIDS than were those from homes in rural areas. Forty-six percent of males and nearly 3% of females were reportedly sexually experienced. It is suggested that female under-reporting of sexual activity occurred. Nearly 16% of males reported coital experience with a prostitute. The implications of these findings for future AIDS awareness campaigns in Zimbabwe are considered.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Social disintegration and the spread of AIDS: thresholds for propagation along 'sociogeographic' networks.

Previous work on the asymptotic spread of HIV infection along a low dimensional 'sociogeographic' network--a social network characteristically embedded within a limited geographic area--is extended to explore threshold conditions under which the infection extends widely beyond an initial set of infected individuals or communities. Results for one dimension suggest that threshold behavior is analogous to a chain reaction with criticality determined conjointly by the susceptibility of individuals within a community to a nexus of behavior conducive to rapid HIV spread and by the probability of transmission between susceptible communities. Once threshold is exceeded, a stochastic reformulation finds the asymptotic rate of transmission between communities may be markedly raised by positive correlation between susceptibility to rapid disease spread within a community and the transmissibility between communities, for example outmigration driven by social disintegration or residential instability arising from inherent structural factors associated with community susceptibility, as with male prostitution. Examination of threshold conditions for higher dimensional sociogeographic networks most likely characteristic of disease spread beyond the 'deep ghettos' now suffering the highest burden of infection suggests it is at least as, and likely more, effective to decrease the fraction of population susceptible to the high risk behavioral nexus as it is to lower the probability of disease transmission between susceptible individuals or communities.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1991

Sex, drugs and HIV: an ethnographic approach.

This is an ethnographic study of the sexual relationship that exists between a group of heroin addicted prostitutes and a Latino/Hispanic group of migrant undocumented workers from Mexico in Orange County, California. Some of the sexual practices elicited and observed by the ethnographer have implications for the transmission and prevention of the HIV. Of particular interest is a form of sexual behavior which is known to the participants as 'becoming milk brothers'. In this sexual practice several men have sexual intercourse with a single woman in rapid succession, allowing the possibility of HIV transmission to take place from male to female, from female to male, and from male to male.

California↗
PubMed1992

The anthropology of sexually transmitted disease in Liberia.

In sub-Saharan African countries where AIDS is established, HIV transmission is primarily by means of heterosexual intercourse. A major co-factor in such transmission is the presence of other, sexually transmitted diseases (STDs). Efforts to limit the heterosexual transmission of HIV in Africa must therefore address the high prevalence of other, standard STDs. The present study attempts to establish a preliminary information base for interventions to prevent the spread of HIV in Liberia where there is relatively high incidence of standard STDs but low incidence of HIV seropositivity. Employing in-depth, key-informant interviews with traditional healers, prostitutes and others, as well as focus group discussions with groups selected on the basis of several criteria, knowledge, beliefs, attitudes and behavior related to AIDS and STDs were elicited. Although evidence of exposure to scientific concepts was found, traditional, ethnomedical views predominated. Notions of sorcery, taboo violation and contamination were often expressed when describing the etiologies of locally-recognized sexually transmitted diseases. More 'naturalistic' explanations were often based on simplified notions of human anatomy and biochemistry. Three basic messages about AIDS that were broadcast in a recent radio campaign were retained, namely 'AIDS kills;' 'there is no cure for it;' and 'it is transmitted through sex.' There was also evidence of Liberians beginning to view AIDS in frameworks of interpretation compatible with traditional ethnomedical beliefs, such as sorcery. Most traditional healers reported they knew little or nothing about AIDS, including those who had a lot to say about other STDs that are well-established in Liberia. Many cases of STDs seem to be handled by traditional healers. Treatment typically consists of decoctions from the leaves and roots of various medicinal plants, administered as teas--less often as enemas or vaginal implants--to be taken over a 2-4 day period. It is recommended that efforts to lower incidence of standard STDs be given priority comparable to promotion of condom use and 'safer sex' in efforts to slow the transmission of HIV in Liberia. Strategies for combating STDs will have to take into account popular beliefs and attitudes regarding STDs as well as the role and influence of traditional healers. Strategies of this sort are recommended.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Syphilis, sex and crack cocaine: images of risk and morality.

A new epidemic of syphilis in the Portland, Oregon metropolitan region mirrors a national trend in the United States. The epidemic is centered in urban areas, is associated with heterosexual transmission, and disproportionately affects people of color, especially African-Americans. The epidemic has been linked to sexual activity among users of crack cocaine, and particularly to the practice of trading sex and crack. Here, we report an analysis of in-depth interviews of 40 respondents, of whom 31 have used crack cocaine, 12 have experience as professional sex workers (prostitutes), and 12 are confirmed recent syphilis cases or their sexual contacts. These respondents confirm that sexual activity involving multiple anonymous partners often takes place within the context of crack cocaine use. They also describe sexual activity among more casual users of the drug. But respondents present themselves as having maintained an adherence to common American values regarding cleanliness, mortality, and sexual behavior. They speak of choosing sex partners according to whether a prospective partner 'looks clean.' This image of cleanliness goes beyond simple bodily hygiene, and into the realm of judgement about moral character. A person is more likely to be judged clean if he or she is known to come from a nice family, has a pleasant demeanor, or appears concerned about self-control. Such people are seen as fundamentally decent, and therefore less likely to have syphilis, a disease associated with deterioration, tearing down, dirtiness and disordering. Thus, respondents use conceptions of cleanliness and morality in constructing definitions of high- and low-risk sexual behavior, as they negotiate a life that endangers their sense of moral control. In doing this, they invoke beliefs and values central to the dominant culture surrounding them. This points to the limits of defining crack cocaine users, and other communities of drug users, as being culturally different from the rest of us.

Black or African American↗
PubMed1993

HIV transmission through social and geographic networks in Uganda.

Long distance drivers and prostitutes at trading centres and towns have been targeted as groups that engage in risky sexual behaviours that promote HIV transmission. While towns and stops along highways have been linked to HIV transmission, the role of small urban and rural centres have been overlooked. There is need to study socio-geographical mating networks because situations not deemed to be risky may be an important aspect of HIV transmission.

Adult↗
PubMed1993

Sexual behaviors relevant to HIV transmission in a rural African population. How much can a KAP survey tell us?

KAP surveys have been proposed as a means to gather quantitative information on AIDS-related sexual behaviors, but the validity of survey results has not been tested. The validity of data gathered during a KAP survey in a rural district in Northern Uganda (N = 1486) was examined analyzing expected behavioral patterns, agreement of partner reports, and concordance of number of sexual contacts across gender. Patterns of sexual behavior and age trends are as expected. More men (50%) than women (18.5%) reported premarital sex. The likelihood of sexual intercourse before marriage increases with age at first marriage and with education. Women marry 5 years earlier than men, and the number of marriages increases with age. Peak incidence of casual sex occurs before age 25. The male/female ratio of casual sex is 4, as compared to about 3 in other African surveys. Single men are 2.5 times more likely to engage in casual sex than married males. Agreement of partner reports was examined for 392 couples selected by chance. 86% of the couples agreed on being polygamous or monogamous. On average men reported 1.3 (SD = 0.7) wives as compared to women reporting 1.5 (SD = 0.89) wives (P < 0.001). 16.8% of women declared more, and 2.8% less cowives than their husband (r = 0.65). Self-reports on frequency of sexual intercourse in the past month were examined for 256 monogamous couples. Mean frequencies differ (5.24 +/- 5.1 for men, 4.43 +/- 4.7 for women, P < 0.001). 42.8% of couples are in agreement within +/- 1 unit (r = 0.44). The total number of extra-marital and marital sex acts, as well as the total number of partners reported by each gender are similar. There is, however, a striking gender difference in reporting of casual partners in the past year. Data were found to be accurate at the aggregate level. However, accuracy of reporting at the individual level was found to be low. The gender difference in reporting of casual partners may be due to female underreporting, to not having captured prostitutes or to a different perception of the meaning of casual partnership. All KAP surveys should include a validity analysis, so as to provide a sense of the accuracy of the surveys and allow for comparison of the quality of different KAP surveys. There is an urgent need for a standardized approach to validating the findings from AIDS-related KAP surveys. Some of the indirect methods described here could be relevant for further use.

Adolescent↗