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PubMed1995

Adult immunizations--a practical approach for clinicians: Part II.

Occupational indications for hepatitis B vaccine include employment in health care services, public safety organizations (e.g., police force) and institutions for the developmentally disabled. Hepatitis B vaccine should also be given to persons having multiple sexual partners, persons abusing injectable drugs, persons receiving hemodialysis and persons recently found to have a sexually transmitted disease. Unimmunized adults should receive enhanced inactivated polio vaccine, not oral polio vaccine. Office procedures that facilitate immunizations include the provision of educational information to patients, standing orders to allow nursing personnel to administer vaccines and feedback to physicians about immunization status and rates.

Adult↗
PubMed1995

Deferral of blood donors with risk factors for HIV infection saves lives and money in Zimbabwe.

We compared the cost-effectiveness of three strategies to avert transfusion-associated HIV infection in Zimbabwe: HIV antibody testing, deferral of donors with HIV risk factors, and deferral of donors with risk factors followed by antibody testing ("Defer/Test"). The Defer/Test strategy averted the most HIV infections. Compared with antibody testing alone, the Defer/Test strategy, using history of genital ulcer or any sexually transmitted disease as a criterion for deferral, resulted in net savings. The cost per HIV-infected unit averted using history of paying for sex or having had multiple sex partners was $ 127 and $ 773, respectively. We discern four benefits of risk factor-based deferral before antibody testing. First, deferring donors at risk lessens collection of blood in the window period. Second, deferring donors likely to be HIV positive minimizes the number of units discarded. Third, ascertainment of donor risk provides an opportunity for AIDS education and prevention. Fourth, the number of false negatives is lower with a lower HIV prevalence among accepted donors. The Defer/Test strategy is cost-effective in Zimbabwe because additional recruitment costs are offset by discarding fewer HIV-positive units. We predict the Defer/Test strategy will be cost-effective in other sub-Saharan African donor populations.

Blood Donors↗
PubMedDate not supplied

Hepatitis B vaccination and screening for markers at a sexually transmitted disease clinic for men.

In Ontario, persons with multiple sexual partners became eligible for free hepatitis B vaccine in late 1991. From January 1992 to January 1993, a sexually transmitted disease (STD) clinic for men in Toronto was one site where the vaccine was delivered. The objectives of the study were to determine the seroprevalence of hepatitis B markers, the series completion rate for hepatitis B vaccine, and the seroprevalence of hepatitis B markers required before screening would be a cost-effective endeavour. The seroprevalence of anti-HBs in gay/bisexual men was 18.1% (95% CI: 15.3%-20.7%) and in heterosexual men was 5.1% (95% CI: 3.0-9.7%). HBsAg was detected in 0.9% (95% CI: 0.04%-1.8%) of gay/bisexual men and was undetected in heterosexual men. Completion of a full vaccine series was 47% for gay/bisexual men and 25% for heterosexual men (p = 0.04). A combined seroprevalence of HBsAg and anti-HBs of at least 30-64%, depending on cost figures used, was required to justify screening prior to completion of a full series.

Adolescent↗
PubMed1994

Epidemiology of urethral stricture at Tygerberg Hospital.

Over a 12-month period, 120 consecutive male patients with confirmed urethral stricture were prospectively studied with regard to the epidemiology of the disease. Specific urethritis is the main aetiological factor (45%) and internal and external trauma account for an alarming 38.3% of cases. The prevalence is highest among 40-50-year-old coloured men who have had little schooling, multiple sexual partners and who have a low annual income. The incidence can be reduced by upliftment of moral and educational standards of the local population, and by emphasising the potential dangers of catheterisation and instrumentation of medical personnel.

Adolescent↗
PubMed1994

[The age for beginning and the frequency for performing the Pap test].

The increase in sexual activity among teenagers has been well documented. One apparent result is the increasing prevalence of cervical cytological abnormalities in this age group over the last 20 years. The adolescent cervix appears to be especially vulnerable to the initiation of carcinogenesis. Consequently, the significance of early age at first coitus is thought to be related to the biologic changes that occur in the cervix during puberty. Large epidemiologic studies have implicated sexuality as the initiator of a sequence of multistage events that destabilize the healthy cervix and culminate in cervical cancer. The median interval between age at first coitus and the development of CIN1 is 9 years, with a progressive 2.5 year increase for each degree of progression from CIN 1 through 3. Unfortunately, the precise mechanism by which that biologic variable, early age at first coitus, predisposes to CIN remains enigmatic. Nevertheless, there is no doubt that the earlier the age at first coitus, the higher the risk factor. Among virgins the incidence of cervical cancer is essentially zero. Among sexually active adolescent girl no cases of invasive carcinoma have been found, but carcinoma in situ had a prevalence rate of 2.6 per 1,000 15-19 years old, whereas cervical dysplasia ranges from 0.8 to 3.5% of screened sexually active teenagers populations. Adolescents who have never been sexually active clearly do not need to be screened for cervical cancer. On the contrary teenagers with the risk factors of sexually transmitted disease or multiple sex partners should be annually screened soon after onset of sexual activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Condom use and the risk of HIV infection: who is being protected?

Descriptive baseline data at enrollment into a cohort of male factory workers who were tested for HIV serology and monitored for sero-conversion over time, were analysed for condom use. At recruitment, the 1,146 men were asked about their sexual behaviour, history of sexually transmitted diseases (STDs), condom use and circumstances under which condoms were used. HIV seroprevalence in the cohort was 18.2 pc. Self reported use of condoms was low, with only 5 pc of the men reporting using them all the time. Forty four pc reported that they had never used a condom, 11.5 pc tried a condom only once, and 30.5 pc used condoms less than half the time. HIV positive men were more likely (Odds Ratio [OR] = 2.2 95 pc CI: 1.3-3.3) to use condoms than those who tested negative. Men using a condom more than once were younger and had more education (p values < 0.0005). Univariate analysis showed that men with self reported risk factors for HIV infection were more likely to use condoms. Significantly more condom users reported paying for sex, multiple sex partners or (for married men) a girlfriend (p < 0.005). Condom users also more often had a history of genital ulcers, urethral discharge or other STDs. Few married men (24 pc) reported using a condom with their wives. Condom use was more commonly reported with commercial sex workers (44 pc) or other extramarital partners (36 pc). Some risk factors for HIV infection were also present amongst men who reported that they did not use condoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Sexual activity before marriage in sub-Saharan Africa.

Throughout sub-Saharan Africa there is notable concern about the consequences of premarital sexual intercourse, such as illegal abortions and pregnancy-related school dropouts, and the potential risk of HIV infection. Using data from the Demographic and Health Surveys, the authors investigated sexual activity among never-married women aged 15-24 in Botswana, Burundi, Ghana, Kenya, Liberia, and Zimbabwe. While there are important cross-country differentials, in most countries the majority of unmarried adolescents have been sexually active. Contrary to the common belief that teenage premarital sexual activity is a new phenomenon caused by socioeconomic development, particularly Western education, the data show that in most countries sexual activity among unmarried adolescents was also common in the past, and that increases across cohorts have occurred mostly in countries where the prevalence was already high. For most countries, there is little support for theories claiming that education is associated with loose morals and high levels of premarital sexual activity. The findings highlight the importance of family-planning services for unmarried adolescents and of family-life education in primary schools to reach children before they become sexually active.

Adolescent↗
PubMed1994

HIV in adolescents.

Although the number of adolescents with diagnosed AIDS in the United States remains less than 1000, many more have HIV infection that has not yet manifested as clinical illness. In addition, most adolescents are involved in risk behaviors that potentially expose them to the virus. Medical providers should be prepared to identify those at highest risk and be familiar with the legal and ethical issues surrounding the evaluation and testing for HIV infection in this population of teenagers. HIV prevention and the presence of infection during pregnancy are particularly challenging to the provider in light of the special developmental and social issues that are inherent to the process of adolescence.

AIDS Serodiagnosis↗
PubMed1994

Outcome of psychoeducation for HIV risk reduction.

Our objectives were to assess the effects of a psychoeducational (PE) program designed to reduce HIV risk behaviors in recovering drug abusers and to evaluate mediating variables associated with risk reduction as described by the AIDS Risk Reduction Model (ARRM). Consecutive admissions to a Department of Veterans Affairs drug dependence inpatient treatment program (n = 152) were randomly assigned to PE or a standard information (INFO) condition. PE involved a 6-hour small group intervention designed to enhance knowledge and attitudes regarding HIV prevention, improve skills in condom use and needle sterilization, and modify high-risk sex- and drug-related behaviors. The INFO condition involved presentation of audiovisual and printed HIV prevention material with similar content. Following intervention, PE subjects showed significantly enhanced self-efficacy, condom use skills, and sexual communication skills relative to the INFO group. At 3-month follow-up, the PE group showed significantly greater reductions on some measures of sexual HIV risk behaviors relative to the INFO group. Hypotheses derived from the ARRM regarding presumed relationships between positive changes in mediating variables (e.g., self-efficacy and sexual communication) and ultimate outcome variables (e.g., condom use) were supported.

Adult↗
PubMed1994

[Results of a case-control study of the current effect of various factors on risk of cervix cancer. 1. Factors in reproduction, sex behavior and infectious genital diseases].

We performed a case control study to determine factors which influence the development of cervical carcinoma. Factors like reproduction, sexual behaviour and genital infections were considered. 309 patients with cervical intraepithelial neoplasia (CIN) or invasive cervical carcinoma were interviewed as a study group. 490 patients with no cervical changes served as control group. The two groups of patients had a different age distribution with an early age summit in the study group. No differences were observed in relation to residence areas and attendance of screening for cervical carcinoma. 83.5% of the women in the study group (n = 258) and 81.0% (n = 397) of the control group attended the screening for cervical carcinoma. According to our observation, the following factors increased the risk of CIN or invasive cervical carcinoma: early menarche (< 14 years vs > 14 years), multiparity (0 vs 1-3 vs > 4), first pregnancy before the age of 20, divorced women, early sexual contact (< 14-17 years vs 18-21 years vs > 21 years), multiple sexual partners, vaginal discharge and venereal diseases (gonorrhea, syphilis). Factors like reproductive characteristics and genital infections can be interpreted as expressions of sexual behaviour. Despite the improving social status, increasing health consciousness and extensive mass-screening for cervical cancer, the above mentioned risk factors still play an important role. Risk group should be followed and examined strictly so as to reduce the rate of invasive cervical carcinoma in screened patients.

Adolescent↗
PubMed1993

Behaviour patterns which may predispose to HIV infection or further transmission and possible intervention strategy in the City of Harare. Part II.

The proportion of people with AIDS is increasing rapidly in Zimbabwe. Several strategies have been adopted to check the further spread of the disease. This paper discusses the behaviour patterns which may predispose to HIV infection and possible intervention strategies that may be taken in the City of Harare. Over a third (33.9 pc, n = 1,526) of the married respondents reported that they were living separately from their spouses. There was a high proportion (76.6 pc, n = 564) of single respondents who admitted to engaging in premarital sex. Fifteen pc of total respondents were engaging in casual sex. The proportion of single respondents (31.2 pc) engaging in casual sex was higher than among the married (11.1 pc). More single respondents (10.9 pc) had been paid for sex than the married (4.1 pc) whilst the proportion that had been paid for sex was similar for the single (21.2 pc) and the married (22.9 pc). The median age for starting sex was 17 years (range = three to 26) for the single and 18 years (range = four to 35) for the married respondents. Sixteen pc stated that they had an STD in 1989. Condom usage was low with only 9.2 pc always using a condom. Forty eight pc of the married respondents who have engaged in casual sexual relationships never use condoms. The main source of information on AIDS/HIV was the radio (74 pc). Most parents (66 pc) had not talked about AIDS to their children.

Adolescent↗
PubMedDate not supplied

Relationship between drug use and sexual behaviors and the occurrence of sexually transmitted diseases among high-risk male youth.

BACKGROUND AND OBJECTIVES: Sexually active adolescents, especially those in detention, are at high risk for acquisition of sexually transmitted diseases (STDs), including HIV infection. Yet little information is available that describes their risk behaviors associated with STDs. The overall objective was to define the relationship between risk behaviors and STD acquisition among adolescents. GOALS OF THIS STUDY: The first goal was to characterize drug use and sexual behaviors that place a population of adolescent male detainees at STD/HIV risk. The second goal was to define possible interrelationships between drug use, especially alcohol use, and risky sexual behaviors with STD acquisition. STUDY DESIGN: The study group consisted of 414 adolescent male detainees 12 to 18 years of age who participated in an interview and a clinical assessment. Two hundred sixty-nine of the 414 subjects agreed to STD laboratory tests, including serologic testing for hepatitis B and syphilis, and urethral cultures to screen for chlamydial and gonorrheal urethritis. RESULTS: Results showed that 15% had current evidence of at least one STD, and 34% had a history or current evidence of at least one STD (STD occurrence). The subjects were frequently engaging in risky sexual and drug use behaviors. Two multivariate models described three factors that significantly place the male adolescent in detention at risk for STDs: multiple sexual partners, inconsistent condom use, and the quantity of alcohol consumed per week. CONCLUSION: Youth in detention place themselves at risk for STDs including HIV because of their risky sexual behavior and drug use. Addressing alcohol use and barriers to condom use appear to be essential components of any STD prevention program targeting this largely minority youth population.

Adolescent↗
PubMed1993

Prevalence of HIV infection in pregnant women in Vellore region.

All pregnant women attending the antenatal clinic of a large hospital in Vellore, India (Christian Medical College Hospital) were screened for HIV infection between October 1987 and June 1992. A total of 36,953 blood samples were thus screened and 20 infected women were identified. Among these 18 women had acquired HIV infection from their husbands, who were also detected to be HIV infected. While these 18 women were monogamous, all the husbands had multiple sex partners. Two of the 20 women in this series were commercial sex workers. Among the 20, 17 (85%) women belonged to low socio-economic status, while three were from well-to-do families, with the husbands being businessmen or teachers. As the overall prevalence (0.054%) of HIV infection among pregnant women was relatively high and equal to or higher than many States in the USA and in areas outside London in the UK, the authors recommend that strict universal precautions be instituted in all obstetric practice in India.

Adult↗
PubMed1993

HIV screening & risk behaviour in psychoactive substance users.

Patients admitted to the Drug De-addiction and Treatment Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, were screened for HIV antibodies. Out of 116 patients, 45 (39%) were injecting drug users (IDUs), 29 (25%) were other drug users and 42 (36%) were primary users of alcohol. One IDU was HIV seropositive (2.2% of the IDUs). Analysis of HIV-related risk behaviour showed that the IDUs were at high risk, because of needle sharing as also because of having multiple sex partners. The potential for HIV infection in these persons practising high-risk behaviour calls for timely preventive measures.

Adolescent↗
PubMedDate not supplied

Sex-linked strategies of human reproductive behavior.

We present data on fertility characteristics in the Venezuelan population for each sex separately, allowing a detailed comparative analysis of the variance in fertility between males and females. We show that the fertility distribution for both sexes is discontinuous, that the average female has a larger number of offspring per individual than the average male, and that highly fertile males outnumber highly fertile females so that the total number of offspring produced by males and females is balanced. Results indicate that a few males are responsible for a relative higher fertility of the average female and that interactions between polyandric females with monogamic and polygynic males are common. Among the Yanomami, a relatively unacculturated hunter-gatherer-horticulturist tribe, similar differences in fertility distribution of both sexes are apparent. The data suggest that human populations contain statistically distinct subpopulations, with different reproductive strategies, suggesting the existence of complex interactions among human populations which are not evident from the study of individuals or groups.

Adolescent↗
PubMedDate not supplied

Pelvic inflammatory disease: diagnosis and management.

BACKGROUND: Acute pelvic inflammatory disease (PID) is a major gynecologic health problem in the United States, afflicting more than 1 million women each year and generating annual direct and indirect costs estimated at $4.2 billion. Family physicians can play an important role in the prevention, as well as diagnosis and treatment, of PID. METHODS: A MEDLINE search for articles published from 1985 to the present was made using the key words "pelvic inflammatory disease," "endometritis," "salpingitis," "tubo-ovarian abscess," "adnexitis," "pelvic abscess," "parametritis," and "oophoritis." The bibliographies of these articles and the author's personal files were also sources of information. RESULTS AND CONCLUSIONS: A number of risk factors have been linked to PID, including young age, age at first intercourse, multiple sex partners, the presence of bacterial vaginosis, vaginal douching, the use of an intrauterine contraceptive device, and a history of a sexually transmitted disease. The diagnosis of PID represents a major clinical challenge that requires a careful history and physical examination coupled with selective and knowledgeable use of the diagnostic tests and procedures currently available. Broad-spectrum antibiotics, which represent the cornerstone of therapy, must adequately cover the polymicrobial spectrum of pathogens implicated in this infection, which includes Neisseria gonorrhoeae, Chlamydia trachomatis, and specific cervicovaginal anaerobic and aerobic bacteria. The numerous sequelae associated with PID, which include infertility, ectopic pregnancy, and chronic pelvic pain syndromes, underscore the need for effective measures for preventing pelvic inflammatory disease.

Acute Disease↗