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PubMed2006

Sexual exploitation of very young Hmong girls.

PURPOSE: Recent increases in Hmong girls referred to a Midwest hospital-based child advocacy center prompted this comparison of abuse experiences for Hmong extra-familial sexual abuse cases versus peers. METHODS: Retrospective chart review of all girls, aged 10 to 14 years, with extra-familial sexual abuse 1998-2003 (n = 226). Fourteen percent of cases were Hmong (n = 32). Demographics, risk behaviors, abuse experiences, physical findings and legal outcomes were compared for Hmong (H) and Other (O) girls using chi-square. Multivariate logistic regressions explored differences in gynecologic findings and sexually transmitted disease (STD) results. RESULTS: Hmong girls were more likely to be runaways (90% H vs. 8% O), truant (97% H vs. 13% O), self-mutilating (38% H vs. 10% O), and suicidal (41% H vs. 21% O). Seventy-seven percent of Hmong reported gang rape, prostitution, or multiple assaults versus 16% Others; most had 5+ perpetrators (69% H vs. 2% O) and 5+ assaults (75% H vs. 24% O, both p < .001). Gynecologic findings were more prevalent among Hmong girls (63% H vs. 21% O). Controlling for penetration, number of partners/assaults, and acuity at examination, Hmong ethnicity predicted gynecologic findings (adjusted odds ration [AOR] = 6.57). Hmong girls were more likely to have a positive chlamydia screen (36% H vs. 4% O, p < .001), but only number of perpetrators was an independent predictor (AOR = 15.09). Most cases were prosecuted, but Hmong had higher prosecution rates (83% H vs. 57% O, p < .001). CONCLUSIONS: Hmong girl assault experiences were markedly more severe than peers. Health care providers need appropriate knowledge of Hmong culture to conduct forensic examinations. Abused Hmong girls need culturally sensitive, developmentally appropriate after-care that helps connect them back with families and school.

Adolescent↗
PubMed2006

Socio-cultural aspect of sexual practices and sexual offences - an Indian scenario.

Ignorance of the law of the land is no defence. Furthermore, it is a legal dictum that one should not be held criminally liable unless possessing a guilty mind. But during trials of some sexual offences in India it is often observed that the accused did not know that he had committed an offence because the crime in question was a part of his socio-cultural milieu. India is a vast country with great socio-cultural diversity and many different ethnic groups, each with its own distinct cultures. However, the entire Indian culture is religion based and finds its root from the ancient Holy Scriptures. The sexual culture of Indian society stems from the Kama Sutra of Vatsyayana, an epic on sex. This text is considered holy and is accepted culturally, even though many practices contained therein are offences under modern law. Child marriages and arranged marriages are an integral part of Indian society and in some tribes, even prostitution is socially sanctioned. However, all of these are also against the law. Many of the conflicts observed between the sexual practices that are accepted in Indian culture but not by the law can be explained on the basis that the Indian legal system is borrowed from that of the British.

Cultural Characteristics↗
PubMed2005

Female sex street workers and sexually transmitted infections: their knowledge and behaviour in Italy.

OBJECTIVE: This study assessed knowledge and sexual behaviour regarding sexually transmitted infections (STIs) among female sex street workers in the area of Milan, Italy. METHODS: A questionnaire was administered covering socio-demographic characteristics; knowledge about STIs; sexual behaviour. RESULTS: A total of 241 female sex street workers were interviewed. A vast majority knew AIDS and syphilis, whereas the knowledge about other STIs was unsatisfactory. Only 11.7% knew that STIs are transmitted by sexual intercourse with HIV seropositive partners, by unprotected sexual intercourse, and that kissing was not a mode of transmission. This knowledge was significantly higher in female sex street workers with a higher number of years in sex work and among those who received information from physicians and associations about STIs. The mean score of fear for contracting STIs was 7.5 and being younger, practicing prostitution for shorter period of time, and requiring more information about STIs were significantly associated with this fear. 'Ever condom use' was 100% during anal intercourse with clients; whereas only one woman reported vaginal and oral intercourse without condom. Only 15.2, 16.7, and 30% of those engaged in vaginal, oral, and anal intercourse with a non-paying sexual partner used condoms all the times. Overall, 83.5% of female sex street workers used a condom every time with clients or non-paying partners and those with fewer clients and partners routinely were more likely to use it. CONCLUSION: Interventions for preventing STIs and for improving the level of knowledge of STIs among female sex street workers are strongly needed.

Adolescent↗
PubMed2005

[Mechanisms of resistance to sexual transmission of HIV-1].

Sexual transmission is the most common pathway for HIV-1; nevertheless some individuals remain seronegative despite repeated high risk sexual exposure. These were grouped in cohorts of "highly exposed but persistently seronegative" individuals, mostly prostitutes and flailing couples. Three lines of defence were observed in these cohorts. The first one is the mucosal barrier, the determining factors of which are the type of epithelium (monolayer or multilayer), epithelial integrity, and the pre-existing microflora. The second one is linked to innate immunity directly related to the genetic and/or immune predispositions of the individual: mutations affecting the CCR5 chemokine receptor, secretion of protective soluble factors, and particular HLA alleles. The third one is acquired immunity via the mechanisms of humoral and/or specific cellular immunity. These studies suggest anti HIV-1 vaccinal strategies aiming at a local immunization combining the different types of responses observed in these individuals.

HIV Infections↗
PubMed2006

Knowledge and perceptions of parents regarding child sexual abuse in Botswana and Swaziland.

This study sought to explore the phenomenon of child sexual abuse by investigating the knowledge and perceptions of parents regarding this problem in Botswana and Swaziland. Although there are no published studies on child sexual abuse in Botswana and Swaziland, literature elsewhere has indicated that child abuse and prostitution prevail in Southern African Development Community countries and that children still continue to be rape victims within and outside the family structure [Muwanigwa, V. (1996). Child Abuse Demands More Preventive Measures. Harare: Zimbabwe. (Southern Africa News Features Southern African Research and Documentation Center)]. In Botswana in 1998, there were 300 cases of child abuse reported, of which 33 were sexual abuse cases. The same year in Swaziland, >50% of child abuse cases were sexual abuse related. In addition, the same year in Swaziland, >50% of sexual abuse case patients reporting for counseling were children younger than 21 years. Respondents of the study included 8 men (1 from Swaziland and 7 from Botswana) and 10 women (3 from Swaziland and 7 from Botswana) who were parents aged between 26 and 70 years; they were determined by way of purposive sampling. A focused interview guide with open-ended questions was used to collect data, and measures to ensure trustworthiness and ethical considerations were adhered to. Analysis of data was facilitated by categorization of themes and concepts and coding systems. The results of the study showed that the respondents acknowledged the prevalence of child sexual abuse in Botswana and Swaziland and further demonstrated their knowledge of the predisposing factors, perpetrators of the problem, and effects of sexual abuse on children. They placed major emphases on community involvement in fighting against the problem; appropriate education of children, parents, families, and community members about child sexual abuse; and improvement on the laws that protect children against sexual abuse to successfully curb the problem.

Adult↗
PubMedDate not supplied

Human immunodeficiency virus-related risk behavior among Italian psychiatric inpatients.

This study evaluated at-risk behavior for human immunodeficiency virus (HIV) infection among Italian psychiatric inpatients. One hundred patients with mental disorders consecutively admitted to an acute psychiatric unit over a 1-year period were studied using a self-report questionnaire. In these patients, 53.1% reported sex with multiple partners, 35.4% with occasional partners, 57% with prostitutes, and 6.7% with intravenous (i.v.) drug users (i.v.DUs). Forty-three percent never used condoms during sexual intercourse, 23% used drugs intravenously, and 20% shared needles. Only one third of the patients were tested for HIV, and two tested seropositive ([HIV+] prevalence, 5.8%). Most patients (62%) reported no concern about the risk of HIV infection. The rate of HIV risk behaviors was higher among psychiatric patients versus a control group of 90 healthy people. These findings indicate an alarming rate of HIV risk behaviors among Italian psychiatric inpatients and the need for closer attention to HIV assessment and education in mental health settings.

Adolescent↗
PubMed1997

Latex condom breakage and slippage in a controlled clinical trial.

Although millions of couples rely on male latex condoms to protect against unintended pregnancy and sexually transmitted infections, their use is limited in part by questions about their performance. Rates of condom breakage and slippage, two measures of performance, vary broadly across studies. This variation in part reflects study variability and limitations, including sample size, reliance on subjects' memory, user populations, and products evaluated. In an effort to define condom performance in a group of monogamous couples typical of those using condoms for contraception, we conducted a clinical trial of a single brand of lubricated condoms (Durex Ramses). A total of 4637 attempts to use the condom were evaluated. Six breaks occurred before intercourse (nonclinical breaks), and 10 condoms broke during intercourse or were only noted to have broken upon withdrawal (clinical breaks), resulting in a nonclinical breakage rate of 0.13% (95% confidence interval, 0.05-0.28%), clinical breakage rate of 0.28% (0.15-0.48%), and a total breakage rate of 0.41% (0.25-0.64%). The rate of complete slippage was 0.63% (0.42-0.90%), and total failure (clinical breaks plus complete slips) was 1.04% (0.76-1.37%). These rates are lower than those in other studies with the exception of one, a prospective investigation in a population of female prostitutes. Results indicate that condoms can, in experienced, motivated populations, provide excellent performance and suggest that their efficacy at preventing pregnancy may equal that of the most reliable forms of contraception. Because this study involved a single condom brand, these results may not be generalizable to other brands.

Adult↗
PubMed1997

Impact of roles of women on health in India.

India's population has more than doubled since 1961. Although India has been a leader in developing health and population policies, there have been major implementation problems due to poverty, gender discrimination, and illiteracy. Yet, three-quarters of the food produced annually in India is because of women. In 1991, only 39.3% of Indian women were literate. The literacy level of women can affect reproductive behavior, use of contraceptives, health and upbringing of children, proper hygienic practises, access to jobs and the overall status of women in the society. Early marriage and childbirth was a major determinant of women's health and was also responsible for the prevailing socioeconomic underdevelopment in India. The overall maternal mortality for India is 572.3 per 100,000 births, ranging from 14.9% in Bihar to 1.3% in Kerala. Anemia is an indirect factor in 64.4% of the maternal deaths. Trained birth attendants currently assist in about 60-80% of all births in women at the time of delivery. Socioeconomic factors are responsible for maternal deaths to a large extent - money in 18.3%, transport in 13.7%. When the mother dies it doubles the chances of death of her surviving sons and quadruples that of her daughters. Among the avoidable factors in maternal deaths, lack of antenatal care is the most important. Women, if educated and aware, can improve the health of their children by simple measures like good hygiene, exercise and dietary habits. Because of poverty, many of the young children, especially girls living on streets are easy prey for criminal prostitution rings, drug trafficking and consequences of HIV infection, and severe emotional and mental disturbances. Women are responsible for 70-80% of all the healthcare provided in India. Female healthcare providers can play an important role in educating society to recognize their health and nutrition needs. Women professionals and empowerment of women at all levels are required for improvement of the health and nutrition structure in India.

Family Health↗
PubMed1981

The relationship of herpesvirus to carcinoma of the prostate.

A laboratory based epidemiologic study was done to determine the possible relationship of herpesvirus type 2 to carcinoma of the prostate. A total of 305 patients (224 with benign prostatic hypertrophy and 81 with prostatic carcinoma) who underwent transurethral resection of the prostate was studied. Viral cultures were obtained from urethral swabs and urine preoperatively. Prostatic tissue removed at operation was grown as tissue explants, using a monolayer cell culture technique, and examined by specific immunofluorescence and electron microscopy for evidence of herpesvirus type 2. The sera of the patients also were tested for specific antibody to herpesvirus type 2 by the indirect hemagglutination inhibition test. Although herpesvirus was not isolated 5 per cent of the patients had evidence of herpesvirus type 2 antigen in prostatic tissues by specific immunofluorescence. Electron microscopy failed to reveal the presence of viral particles. There was an increased prevalence of herpesvirus type 2 antibody in patients with carcinoma of the prostate compared to the controls with benign prostatic hypertrophy (p less than 0.05). Although marital status was similar the patients with prostatic cancer tended to marry at an earlier age, have more children, more sexual partners and more exposure to prostitutes than their counterparts with benign prostatic hypertrophy. The demonstration of specific herpesvirus type 2 antibody in patients with prostatic cancer supports an etiologic role for herpesvirus type 2 but further studies are needed to describe more definitively the relationship since the indexes of sexual activity are remarkably high in both groups.

Antibodies, Viral↗
PubMed2000

[Human papillomavirus and human immunodeficiency virus infections as risk factors for cervix cancer in women prisoners].

BACKGROUND: The identification of high risk groups for genital human papillomavirus (HPV) infection may contribute to cervical cancer prevention. The study was designed to estimate the prevalence of HPV infection and the related risk of cervical cancer among imprisoned women. PATIENTS AND METHODS: 157 women were visited at the Medical Office of a prison in Barcelona, Spain. Women underwent a structured interview, determination of HIV serostatus and detection of HPV cervical infection by means of PCR. RESULTS: The prevalence of HPV infection was 46%. Prostitution was reported by 38.2% and intravenous drug use by 64.3%. HIV infection was detected in 56.1%. Cervical cytology revealed 19 women with ASCUS and 28 with squamous intraepithelial lesions (SIL) (all grades). HPV infection was associated with an increased risk of intravenous drug use for more than 10 years (prevalence odds ratio [POR] = 2.9) and seropositivity to HIV (POR = 4.7). The increase in risk for SIL related to HIV was explained by the presence of HPV. HIV positive women with low CD4 counts may increase the risk for SIL independently of HPV. CONCLUSION: HIV positive women are at high risk for HPV infection and as a consequence, for developing SIL. HIV positive women should be closely monitored for cervical cancer.

Adolescent↗
PubMed2003

Understanding sexual risk taking behaviour in Hong Kong university students. A health promotion perspective.

BACKGROUND: Levels of sexual experience among Chinese university students are considerably lower than in western countries. Measuring sexual risk-taking behavior of Chinese students is important in designing any effective preventive health programs. This study assessed the prevalence and factors associated with high-risk sexual behavior among students in a Hong Kong university. METHODS: A cross-sectional survey conducted among year 1 and year 3 Chinese undergraduate students in 1997, using a structured, self-administered questionnaire. RESULTS: Of the 1197 students surveyed, only 11% were sexually active (ever had sexual intercourse). Reported sexual activity was higher among year 3 (17%) than year 1 (6.6%) students and higher among males (14.4%) than females (8.3%). Consistent (always) use of condoms was reported by only 43% of the sexually active respondents. Males were more likely to think that premarital sex was acceptable than were females. About 1 in 20 students (55 of 1197) were categorized as belonging to a "greater risk behavior" group, defined by inconsistent or nonuse of condoms during sexual intercourse and having had three or more sexual partners in the past 3 months, or having has sex with prostitutes or ever having a sexually transmitted disease, or using alcohol or other stimulating drugs during sexual intercourse. Males with favorable attitudes toward premarital sex were more likely to belong to the greater risk behavior group. CONCLUSIONS: This study demonstrated the potential risk for contracting sexually transmitted diseases among a substantial proportion of university students, suggesting the need for promotion of preventive education programs.

Adolescent↗
PubMed2005

Sex-work harm reduction.

Sex work is an extremely dangerous profession. The use of harm-reduction principles can help to safeguard sex workers' lives in the same way that drug users have benefited from drug-use harm reduction. Sex workers are exposed to serious harms: drug use, disease, violence, discrimination, debt, criminalisation, and exploitation (child prostitution, trafficking for sex work, and exploitation of migrants). Successful and promising harm-reduction strategies are available: education, empowerment, prevention, care, occupational health and safety, decriminalisation of sex workers, and human-rights-based approaches. Successful interventions include peer education, training in condom-negotiating skills, safety tips for street-based sex workers, male and female condoms, the prevention-care synergy, occupational health and safety guidelines for brothels, self-help organisations, and community-based child protection networks. Straightforward and achievable steps are available to improve the day-to-day lives of sex workers while they continue to work. Conceptualising and debating sex-work harm reduction as a new paradigm can hasten this process.

Delivery of Health Care↗
PubMed1982

Importance of the male factor in cancer of the cervix.

A woman's risk of cervical cancer is generally thought to be related to her sexual behaviour. The sexual background of her male partners is also important. In some societies, a woman's risk of cancer of the cervix will depend less on her own behaviour than on that of her partner. Male sexual behaviour, particularly in relation to prostitution, may account for two hitherto unexplained features of the epidemiology of this disease--the extremely high incidence in Latin America and the decline in mortality this century. If this is so and men carry the aetiological agent, it will be important to discover whether they do so for short or long periods.

Education↗
PubMed1984

Acquired immunodeficiency syndrome in Rwanda.

To evaluate acquired immunodeficiency syndrome (AIDS) in central Africa a prospective study was done in Kigali, Rwanda, where Kaposi's sarcoma (KS) is endemic. During a 4 week period, 26 patients (17 males and 9 females) were diagnosed. 16 patients had opportunistic infections, associated with KS in only 2; 1 had multifocal KS alone; and 9 had clinical conditions consistent with prodromes of AIDS. All patients had severe T-cell defects characterised by cutaneous anergy, a striking decrease in the number of helper T cells, and a decreased OKT4:OKT8 ratio (mean 0.27). 21 of the 22 adult patients were living in urban centres and many of them were in the middle to upper income bracket. Most of the men were promiscuous heterosexuals and 43% of the females were prostitutes. No patient had a history of homosexuality, intravenous drug abuse, or transfusion in the previous 5 years. This study suggests that AIDS is present in central Africa as an entity probably unrelated to the well-known endemic African KS. An association of an urban environment, a relatively high income, and heterosexual promiscuity could be a risk factor for AIDS in Africa.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Acquired immunodeficiency syndrome after travelling in Africa: an epidemiological study in seventeen Caucasian patients.

Seventeen Caucasian patients with acquired immunodeficiency syndrome (AIDS) contracted after long stays in Africa are reported. Central Africa was concerned in all cases. Men are particularly exposed to AIDS whatever their occupation. This study suggests that the risk of contracting AIDS in Africa is high; the transmission of the virus was related to sexual contact, particularly with prostitutes, in Africa in most of the cases. It suggests also that Caucasians who travel in Africa spread the virus throughout the world by means of their heterosexual relations.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Trial of anonymous versus confidential human immunodeficiency virus testing.

Before December, 1986, all public human immunodeficiency virus (HIV) testing in Oregon was done confidentially (using names). In December, clients were offered the option of either anonymous or confidential services. As judged by questionnaire responses, the availability of anonymity increased overall demand for testing by 50%: 125% for homosexual/bisexual (gay) men, 56% for female prostitutes, 17% for intravenous drug users, and 32% for other clients. The number of gay clients who had tests increased from a mean of 42 per month during the 4 months before anonymity was available to 108 per month during the 4 months after, whereas, at public sites in Colorado or California and private sites in Oregon, the number of gay clients tested did not increase. Twice as many seropositive persons were identified during the 3 1/2 months after anonymity became available (n = 85) as in the 3 1/2 months before (n = 36). Thus, availability of anonymous HIV testing and counselling drew gay men who had not sought services under a confidential testing system.

California↗
PubMed1995

Transmission of HIV in dialysis centre.

In August, 1993, 13 dialysis patients at one dialysis centre in Colombia, South America, were found to be HIV positive, and this prompted an epidemiological investigation. We carried out a cohort study of all dialysis centre patients during January, 1992 to December, 1993 (epidemic period) to determine risk factors for HIV seroconversion. Haemodialysis and medical records were reviewed, dialysis centre staff and surviving patients were interviewed, and dialysis practices were observed. Stored sera from all dialysis centre patients were tested for HIV antibody. 12 (52%) of 23 patients tested positive for HIV antibody by enzyme immunoassay and western blot during the epidemic period. Of the 23 tested, 9 (39%) converted from HIV antibody negative to positive (seroconverters) and 10 (44%) remained HIV negative (seronegatives). The HIV seroconversion rate was higher among patients dialysed at the centre while a new patient, who was HIV seropositive, was dialysed there (90% vs 0%; p < 0.01), or when the dialysis centre reprocessed access needles, dialysers, and bloodlines (60% vs 0%). While 2 of 9 HIV seroconverters had had sex with prostitutes, none had received unscreened blood products or had other HIV risk factors. No surgical or dental procedures were associated with HIV seroconversion. Dialysers were reprocessed separately with 5% formaldehyde and were labelled for use on the same patient. Access needles were reprocessed by soaking them in a common container with a low-level disinfectant, benzalkonium chloride; 4 pairs of needles were placed in one pan creating the potential for cross-contamination or use of one patient's needles on another patient. HIV transmission at the dialysis centre was confirmed. Improperly reprocessed patient-care equipment, most probably access needles, is the likely mechanism of transmission. This outbreak was discovered by accident and similar transmission may be occurring in many other countries where low-level disinfectants are used to sterilise critical patient-care equipment.

Adult↗
PubMed2000

Child sexual abuse: historical cases in the Byzantine empire (324-1453 A.D.).

OBJECTIVE: The aim of this article is the presentation and brief analysis of some historical cases, unknown in the broader medical bibliography, of child sexual abuse in Byzantine Society (324-1453 A.D.). METHOD: The original texts of the Byzantine historians, chroniclers and ecclesiastical authors, written in the Greek language, were studied in order to locate instances of child sexual abuse. RESULTS: Although the punishment provided by the laws and the church for cases of child sexual abuse were very strict, a number of instances of rapes under cover of premature marriages, even in the imperial families, are revealed in these texts. Furthermore, cases of child prostitution, pederasty, and incest are included in the historical texts and some contemporary authors confirmed the presence of many such cases in all classes of Byzantine society. CONCLUSION: The research of original Byzantine literature disclosed many instances of child sexual abuse in all social classes even in the mediaeval Byzantine society which was characterized by strict legal and religious prohibitions.

Byzantium↗