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PubMed2005

A meta-analysis of the relationship of child sexual abuse to HIV risk behavior among women.

OBJECTIVE: This study is a meta-analysis of the literature exploring the relationship between child sexual abuse (CSA) and HIV risk behavior among women. Four outcome variables were tested: unprotected sex; sex with multiple partners; sex trading; and adult sexual revictimization. METHOD: Forty-six studies met the inclusion criteria and were included in the analysis, and separate meta-analyses were performed for each of the four dependent variables described above. RESULTS: Using the correlation coefficient r as an effect size estimate, results indicate an average effect size of .05 for the unprotected sex meta-analysis (N = 16 studies), .13 for the sex with multiple partners meta-analysis (N = 23 studies), .12 for the sex trading meta-analysis (N = 23 studies), and .17 for the adult sexual revictimization meta-analysis (N = 21 studies). We conducted a test of three potential moderator variables (source of sample, definition of CSA based on type of contact, and definition of CSA based on maximum age of victim). Results did not support the hypothesis that these three variables explain a significant amount of variability in effect sizes with one exception: Studies that define CSA more broadly to include adolescent victims (e.g., victims up to 17 years of age) had larger and more homogenous effect sizes for the sex trading meta-analysis than those that defined CSA as having occurred at younger ages. CONCLUSIONS: These findings suggest a small positive relationship between CSA and subsequent HIV risk behavior among women that varies as a function of how CSA and HIV risk behavior are operationalized.

Adult↗
PubMedDate not supplied

[Bacterial vaginosis. Epidemiology and risk factors].

Bacterial vaginosis (BV) is a change in vaginal ecosystem where lactobacilli dominate, flora is absent or greatly reduced, and replaced with a mixed, predominantly anaerobic flora, consisting of Gardnerella vaginalis, Mycoplasma hominis, Mobiluncus spp, Bacteroides spp, Prevotela spp, Peptostreptococcus spp, Fusobacterium spp and Porphyromonas spp. The concentration of bacteria increases from 100 to 1000 fold in women with BV compared to healthy women. BV has been formerly known as nonspecific vaginitis, Haemophilus vaginitis, Corynebacterium vaginitis, Gardnerella vaginitis and anaerobic vaginintis. BV is the most prevalent form of vaginal disturbances in reproductive age women. The average incidence of BV varies: 10-35% in patients visiting gynaecological wards, 10-30% in patients visiting obstetric wards and 20-60% in patients visiting services of sexually transmitted diseases. A typical clinical symptom of BV is malodorous vaginal discharge. However, more than 50% of all women with BV are asymptomatic. BV has been associated with many gynaecological and obstetric complications such as cervicitis, salpingitis, endometritis, postoperative infections, urinary tract infections, pelvic inflammatory disease, mild abnormal Pap smear results and possible link with cervical intraepithelial neoplasia, preterm delivery, premature rupture of the membranes, chorioamnionitis and postpartum endometritis. Factors that increase the risk of BV are multiple partners, exposure to semen, prior trichomoniasis, intrauterine device usage, smoking, indigent population and frequent use of scented soap. Diagnosis of BV is established by Amsel's criteria of which three of four are the following: presence of homogeneous discharge, vaginal fluid pH > 4.5, positive amine test and microscopic analysis of Gram stained smear of vaginal discharge where "clue" cells (epithelial vaginal cells covered with mass of adherent bacteria, mostly coccobacilli) should be detected. The treatment of patients with BV consist of metronidazole or clindamycin, per os or intravaginally. The treatment of asymptomatic women and male sex partners of women with BV is controversial. The aim of the study was to establish the occurrence rate of BV in our women and potential factors increasing the risk of BV. We examined 166 women at the Institute of Microbiology and Immunology, University School of Medicine, Belgrade. Diagnosis of BV was established by Amsel's criteria. Each woman filled in a special questionnaire. Pregnant women were excluded. BV was diagnosed in 25% (33/166) of women. BV was more common among women with multiple partners. The most prevalent clinical symptom of BV was malodorous vaginal discharge. Vaginal symptoms became more evident after intercourse. Taking into consideration the occurrence rate of BV and its connection with numerous gynaecological and obstetric sequelae, and taking into account that the diagnosis of BV is quick, simple and inexpensive, we suggest that the examination of BV in women becomes a usual procedure.

Adult↗
PubMed2004

Knowledge of AIDS and HIV risk-related sexual behavior among Nigerian naval personnel.

BACKGROUND: The epidemic of HIV continues to grow in Nigeria. Personnel in the military are at increased risk of HIV infection. Although HIV-risk related sexual behavior of Nigerian police officers has been studied, little is known about the sexual behavior of their counterparts in the Navy. This study describes knowledge of AIDS, and HIV-risk sexual behavior of naval personnel in Lagos Nigeria. METHODS: Four hundred and eighty personnel of the Nigerian Navy completed a 70-item questionnaire in 2002. Group discussion and in-depth interviews of four key informants were also conducted to gain insights into the context of risky sexual behaviors and suggestions for feasible HIV primary prevention interventions. RESULTS: The mean age of the respondents was 34 years. Although the overall mean AIDS knowledge score was 7.1 of 10 points, 52.1% of respondents believed that a cure for AIDS was available in Nigeria and that one can get HIV by sharing personal items with an infected person (25.3%). The majority (88.1%) had had lifetime multiple partners ranging from 1-40 with a mean of 5.1; 32.5% of male respondents had had sexual contact with a female sex worker, 19.9% did so during the six months preceding the survey. Forty-one percent of those with sexual contact with a female sex worker did not use a condom during the most recent sexual encounter with these women. Naval personnel who have been transferred abroad reported significantly more risky sexual behaviors than others. Group discussants and key informants believed that sex with multiple partners is a tradition that has persisted in the navy even in the era of AIDS because of the belief that AIDS affects only foreigners, that use of traditional medicine provides protection against HIV infection, and influence of alcohol. CONCLUSION: Many naval personnel report participating in high-risk sexual behavior which may increase their risk of acquiring and spreading HIV. Naval personnel live and interact freely with civilian population and are potential bridging group for disseminating HIV into the larger population. Interventions including sustained educational program, promotion of condoms, changes in transfer policies are recommended to address this problem.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Patterns of sexual and injecting risk behaviours in French intravenous drug users not reporting HIV and hepatitis C virus seropositivities.

AIMS: To characterize and identify determinants of risk behaviour patterns of intravenous drug users (IDUs) independently of changes due to knowledge of HIV or hepatitis C Virus (HCV) seropositivity. DESIGN: A cross-sectional survey using a structured questionnaire concerning sexual, injecting and HIV and HCV antibody testing practices. SETTING: IDUs were interviewed in the Paris region at 10 treatment or psychosocial centres. PARTICIPANTS: Six hundred and twelve consecutive sexually active IDUs over 18 years able to answer the questionnaire. MEASUREMENTS: Five hundred and ninety-five IDUs completed the questionnaire. The risk-behaviour patterns of the 328 IDUs not reporting HIV or HCV seropositivity were analysed by phi correlation. Risk factors for each risk behaviour were determined by regression logistic models yielding odds ratios (OR) and their 95% confidence intervals (95% CI). FINDINGS: Several risk behaviour patterns were suggested: (1) lending, borrowing; (2) not or inconsistently testing HIV and HCV serology and not or inconsistently using condoms; (3) having multiple partners and prostitution; and (4) not using clean equipment. Alcohol abuse was independently and specifically associated with lending (OR = 3.8; 95% CI: 2.1-7.0) and borrowing (OR = 3.3; 95% CI: 1.8-6.1); homelessness with injecting risk behaviours and with prostitution (OR = 2.7; 95% CI: 1.2-6.1); low educational level and having children with not or inconsistently using condom and serology testing; and cocaine use with not or inconsistently using condoms (OR = 0.4; 95% CI: 0.3-0.7) and serology testing and not using clean equipment (OR = 0.4; 95% CI: 0.2-0.8). Having multiple partners and prostitution had no common risk factors. CONCLUSIONS: Identifying specific risk factors could help to target drug harm reduction programmes for each risk behaviour pattern among IDUs not reporting HIV and HCV seropositivity.

Adult↗
PubMed2006

Social norms and beliefs regarding sexual risk and pregnancy involvement among adolescent males treated for dating violence perpetration.

The present study explored perceived sexual norms and behaviors related to sexual risk and pregnancy involvement among adolescent males (ages 13 to 20) participating in programs for perpetrators of dating violence. The purpose of this study was to generate hypotheses regarding the contexts and mechanisms underlying the intersection of adolescent dating violence, sexual risk and pregnancy. Six focus groups were conducted (N = 34 participants). A number of major themes emerged: 1) male norm of multiple partnering, 2) perceived gain of male social status from claims of sexual activity, 3) perception that rape is uncommon combined with belief that girls claiming to be raped are liars, 4) perception that men rationalize rapes to avoid responsibility, 5) condom non-use in the context of rape and sex involving substance use, 6) beliefs that girls lie and manipulate boys in order to become pregnant and trap them into relationships, and 7) male avoidance of responsibility and negative responses to pregnancy. The combination of peer-supported norms of male multiple partnering and adversarial sexual beliefs appear to support increased male sexual risk, lack of accountability for sexual risk, and rationalization of rape and negative responses to pregnancy. Further research focused on the context of male sexual risk and abusive relationship behaviors is needed to inform intervention with young men to promote sexual health and prevent rape, dating violence, and adolescent pregnancy.

Adolescent↗
PubMedDate not supplied

Risk factors and protective factors of pelvic inflammatory disease: a case-control study.

Risk factors and some protective factors for pelvic inflammatory disease (PID) in women were assessed in a case control study. Use of intrauterine device (OR = 3.98, p < 0.0001), sexual activity with multiple partners and younger age (ORs = 3.97, 1.9 and p = 0.0003, 0.0034, respectively), history of previous PID (OR = 4.08, p = 0.004) and history of minor gynecologic operation (OR = 3.07, p = 0.0158) were significant risk factors for PID. Pregnancy was a significant protective factor (OR = 0.25, p = .0074). Sterilisation had a significant protective effect (OR = 0.37, p = 0.0443) on multivariate analysis but not significant on univariate analysis. The results indicated that, almost half of the PID load on the population can be reduced by proper handling of four risk factors namely, use of IUD, sexual activity with multiple partners, history of previous PID and history of minor gynecologic operation (PARP = 0.2146, 0.1101, 0.0824 and 0.0794, respectively).

Adult↗
PubMed2002

Sexual activity as a risk factor for hepatitis C.

The accumulated evidence indicates that hepatitis C virus (HCV) can be transmitted by sexual contact but much less efficiently than other sexually transmitted viruses, including hepatitis B virus and human immunodeficiency virus (HIV). However, because sex is such a common behavior and the reservoir of HCV-infected individuals is sizable, sexual transmission of HCV likely contributes to the total burden of infection in the United States. Risk of HCV transmission by sexual contact differs by the type of sexual relationship. Persons in long-term monogamous partnerships are at lower risk of HCV acquisition (0% to 0.6% per year) than persons with multiple partners or those at risk for sexually transmitted diseases (0.4% to 1.8% per year). This difference may reflect differences in sexual risk behaviors or differences in rates of exposure to nonsexual sources of HCV, such as injection drug use or shared razors and toothbrushes. In seroprevalence studies in monogamous, heterosexual partners of HCV-infected, HIV-negative persons, the frequency of antibody-positive and genotype-concordant couples is 2.8% to 11% in Southeast Asia, 0% to 6.3% in Northern Europe, and 2.7% in the United States. Among individuals at risk for sexually transmitted diseases (STDs), the median seroprevalence of antibody to HCV (anti-HCV) is 4% (range, 1.6% to 25.5%). HIV coinfection appears to increase the rate of HCV transmission by sexual contact. Current recommendations about sexual practices are different for persons with chronic HCV infection who are in steady monogamous partnerships versus those with multiple partners or who are in short-term sexual relationships.

Asia, Southeastern↗
PubMed2002

Intensive genetic assessment of the mating system and reproductive success in a semi-closed population of the mottled sculpin, Cottus bairdi.

Most genetic surveys of parentage in nature sample only a small fraction of the breeding population. Here we apply microsatellite markers to deduce the genetic mating system and assess the reproductive success of females and males in an extensively collected, semi-closed stream population of the mottled sculpin fish, Cottus bairdi. In this species, males guard nest rocks where females deposit the eggs for fertilization. The potential exists for both males and females to mate with multiple partners and for males to provide parental care to genetically unrelated offspring. Four hundred and fifty-five adults and subadults, as well as 1,259 offspring from 23 nests, were genotyped at five polymorphic microsatellite loci. Multilocus maternal genotypes, deduced via genetic analyses of embryos, were reconstructed for more than 90% of the analysed nests, thus allowing both male and female reproductive success to be estimated accurately. There was no genetic evidence for cuckoldry, but one nest probably represents a takeover event. Successful males spawned with a mean of 2.8 partners, whereas each female apparently deposited her entire clutch of eggs in a single nest (mean fecundity = 66 eggs/female). On average, genetically deduced sires and dams were captured 1.6 and 9.3 metres from their respective nests, indicating little movement by breeders during the spawning season. Based on a 'genetic mark-recapture' estimate, the total number of potentially breeding adults (c. 570) was an order-of-magnitude larger than genetically based estimates of the effective number of breeders (c. 54). In addition, significantly fewer eggs per female were deposited in single than in multidam nests. Not only were perceived high-quality males spawning with multiple partners, but they were receiving more eggs from each female.

Animals↗
PubMed1995

Health risk behavioral survey from 39 juvenile correctional facilities in the United States.

PURPOSE: The study surveyed adolescents in juvenile detention facilities to determine the incidence of health risk behaviors. METHODS: A modified version of the United States Centers for Disease Control Youth Risk Behavior Surveillance System was administered to 1801 minors at 39 facilities in the United States. RESULTS: Risky behavior begins early, the initiation plateauing at age 15 or 16 years. Girls and boys reported comparable rates of drinking, binge drinking, and illicit drug use. North American Natives and those individuals who designated themselves as being other than any of the offered choices for racial designation ("Other") began drinking at earlier ages, had more binge drinking, more illegal drug use, and the most fight-related behavior. By age 12 years 62% reported onset of sexual intercourse and by age 14 years 89% were sexually active. Fighting was reported by 69% of detainees. Fight-related injuries within the past year were reported by 25% of the respondents. Nearly 47% belonged to a gang. Drug/alcohol use, fighting, and gang membership were related. Suicide was considered by 22% of the detainees, planned by 20%, tried by 16%, 8% were injured because of a suicide attempt. Younger teens (White, N.A. Natives, and "Other") had the most frequent suicide ideation. Drug/alcohol use correlated with suicidal thoughts. Onset of sexual intercourse was at an average age of 12. Multiple partners and pregnancy, was highest among blacks and "Others". Blacks had the highest sexually transmitted disease (STD) rate. Less than half of all respondents used condoms at last intercourse. STDs were related to being female, being black, and having multiple sexual partners. Pregnancy was related to multiple sexual partners and violent behavior. CONCLUSION: Male and female detainees report a high incidence and early onset of risky behaviors. N.A. Natives and those of "other" races reported the highest incidence of risk behaviors.

Adolescent↗
PubMed2004

Cellulose membrane supported peptide arrays for deciphering protein-protein interaction sites: the case of PIN, a protein with multiple natural partners.

Cellulose membrane supported peptide arrays, prepared according to the Spot method, allow the rapid identification and characterization of protein-protein interaction sites. Here, the method was used to screen reactive peptides from different proteins that bind to a single molecule, the PIN protein. PIN possesses two binding grooves, that have been shown to interact with several targets, including neuronal NO synthase, dynein intermediate chain, myosin V, the proapoptotic protein Bim, the scaffolding proteins DAP1alpha and gephyrin, and the transcription factor NRF-1. Arrays of peptides representing sequences of these targets were probed for reactivity with GST-tagged PIN, enabling the precise identification of binding motifs. Binding motifs were then minimized to seven or eight amino acid long peptides: YSKETQT for dynein IC, CDKSTQT for Bim, KDTGIQVD for nNOS, QSVGVQV for DAP1alpha and EDKNTMTD for myosin V. Alascan and substitution analysis provided proof that the Gln residue is critical for the interaction and cannot be easily replaced. Positions -1 and +1, just flanking the pivotal Gln, are also important; they consist of hydrophobic residues (Thr, Val) that could only be replaced by hydrophobic or aromatic amino acids. Position -4 is also critical for binding, with its Asp or Ser being replaceable to some extent. Alignment of sequences of proteins known to bind PIN shows that the most frequent amino acids in the motif are DKGTQT, consistent with the Spot results. We postulate that the degenerate character of binding to PIN is based on the propensity of several sequences to adopt a beta-strand conformation that allows the Gln residue to position itself in the PIN channel and on the conformational breathing of the PIN binding groove.

Amino Acid Sequence↗
PubMed2006

ADAM15 upregulation and interaction with multiple binding partners in inflammatory bowel disease.

A disintegrin and metalloproteinase (ADAM)15 is upregulated in some tissues undergoing remodeling. This glycoprotein is characterized by adhesive function through its interaction with members of the integrin family and protease properties. The goal of this work was to describe the tissue distribution of ADAM15 and its spatial relationship with its known binding partners in inflammatory bowel disease. ADAM15 expression was examined using frozen tissues from eight patients with ulcerative colitis or Crohn's disease and four normal colons by immunohistochemistry, immunoblotting and quantitative reverse transcription-polymerase chain reaction. In addition expression of alpha5beta1- and alphavbeta3-integrins, VE-cadherin, alpha-smooth muscle actin (alpha-SMA) and collagen IV was examined using immunohistochemistry and confocal microscopy. In the normal colon, ADAM15 was expressed by all epithelial cells throughout the crypt and by pericryptic myofibroblasts coexpressing alpha-SMA and collagen IV. ADAM15 was also expressed by endothelial cells and vascular myocytes in all layers of the intestinal wall as well as by nonvascular myocytes of the muscularis mucosae and muscularis propria. In inflammatory bowel diseases, ADAM15 was strongly upregulated at the mRNA level and expressed only as an active form as shown by immunoblotting analysis. Parallel to its upregulation, ADAM15 expression was found both at the plasma membrane and in the cytoplasm of epithelial cells in acute attacks of the disease. In the crypt abcesses, ADAM15-positive epithelial cells were in close contact with alpha5beta1-integrin-positive leukocytes localized between these cells and in the crypt lumen. In the regenerative areas, ADAM15-positive epithelial cells were in close contact with alpha5beta1- and alphavbeta3-positive pericryptic myofibroblasts. In endothelial cells, VE-cadherin was decreased. In contrast, ADAM15 was strongly expressed by endothelial cells and was in close contact with alpha5beta1-positive leukocytes. There is a differential expression of ADAM15 in epithelial cells during inflammatory bowel disease compared with the normal colon. In addition, the spatial relationships with its binding partners suggest a role for ADAM15 in the differentiation of regenerative colonic mucosa as well as in leukocyte transmigration across epithelial and endothelial barriers.

ADAM Proteins↗
PubMed1996

Sexual behaviour in travellers abroad attending an inner-city genitourinary medicine clinic.

OBJECTIVE: To investigate frequency of sexual encounters with new partners abroad in patients attending a genitourinary clinic (GUM). METHODS: In a case series 464 attenders at a genitourinary medicine clinic completed an anonymous self-administered questionnaire, if they had been abroad recently, enquiring about sexual behaviour abroad. RESULTS: 28.4% of subjects admitted to sex with a new partner abroad with only 41.7 per cent consistently using condoms. There were no significant differences in condom use for gender, ethnicity or type of visit and relationship. Twenty-nine per cent of those admitting to sex abroad had more than one partner. The risk of multiple partners was not associated with gender, ethnicity, type of visit (holiday or business) or type of relationship (heterosexual or homosexual). The first partner abroad for 63% of men and 62.5% of women was of a nationality other than that of United Kingdom residents. Non-Caucasians and homosexuals were significantly more likely to have first partners abroad from outside the UK than Caucasians and heterosexuals respectively. CONCLUSION: The occurrence of casual sex abroad in GUM attenders suggests that further research is needed to establish targetable risk factors for this type of behaviour amendable to change through health promotion.

Adolescent↗
PubMed2001

The Sexual Compulsivity Scale: further development and use with HIV-positive persons.

We examined the reliability and validity of the Sexual Compulsivity Scale for use in assessing HIV-positive men and women. Measures collected from 287 men and women recruited from the community, the majority of whom were African American and over the age of 30, showed that the Sexual Compulsivity Scale was reliable for men (alpha = .89) and women (alpha = .92). Correlations with measures of sexual behaviors and numbers of sex partners supported the concurrent validity of the Sexual Compulsivity Scale for men and women. Results of discriminant function analyses that included participant age, use of nonalcohol drugs, the Sexual Compulsivity Scale, and scores on measures of trait anxiety, obsessive-compulsiveness, future pessimism, cognitive depression, and borderline personality characteristics showed that sexual compulsivity clearly discriminated between persons with 1 or no sex partners and persons with multiple partners in the past 3 months, for both men and women, suggesting evidence for criterion-related validity. Associations between sexual compulsivity scores and other markers of psychopathology showed different patterns for men and women; sexual compulsivity was associated with indexes of psychopathology in men but not in women. We conclude that the Sexual Compulsivity Scale is reliable and valid in assessing men and women infected with HIV, although sexual compulsivity may present differently between genders in relation to other forms of psychopathology.

Adult↗
PubMed1996

Gender dynamics and the challenges for HIV prevention.

Information on the transmission of the human immunodeficiency virus (HIV), leading to acquired immunodeficiency syndrome (AIDS), has been widely disseminated since the early 1980s, and yet curbing new infections remains a major public health dilemma. In response to the global challenge of HIV/AIDS, most control and prevention interventions have targeted "core groups' with messages which include:- 1. Reduction of individual risk through responsible sexual behaviour or behaviour change, such as, delayed sexual debut, abstinence, monogamy and condom use. 2. Communal (as a society) adoption of a risk reduction strategy e.g. reduced rate of sexual partner change and avoiding multiple partners. 3. Improved, early and aggressive STD treatment programmes. However, data from sub-Saharan Africa and elsewhere shows how the epidemic, in the general population, appears to thrive unabatted. Large proportions of women and some men, in none of the traditional high risk core groups, are increasingly becoming infected with HIV. Most of the women appear to be at risk of infection not so much because of their own behaviour, but that of their partners of husbands. In this continuum, our response has been fragmented and non-strategic. Few programme activities have been developed that address men as a critical core group potentially propagating or sustaining the epidemic. The preoccupation with female sex workers and other core groups (e.g. truck drivers) could have overshadowed the need for programmes and interventions that make men, in general, aware of HIV risk and less likely to infect their sexual partners. Challenges posed by HIV require innovative strategies that foster behavioural and social change in the situation of men at risk and their partners.

Africa South of the Sahara↗
PubMed1994

Prevalence of HIV and associated risk behaviour in attendees at a Dublin needle exchange.

The aim of this study was to measure the prevalence of HIV infection and assess the level of equipment-sharing and unsafe sexual activity among attendees at a Dublin needle exchange. Using an anonymous unlinked approach, attendees were asked to complete a brief questionnaire and provide a sample of saliva for HIV testing. Of the 144 attendees eligible for inclusion during the study period, 106 agreed to participate and complete a questionnaire, a response rate of 74%. Of the 81 respondents who submitted a usable saliva sample, 14.8% were HIV positive. Half of the respondents claimed that they had not shared equipment during the preceding 28 days, but a third had shared with multiple partners. Half of the respondents claimed that they had multiple sexual partners during the preceding year, but only a quarter said that they always used condoms. The prevalence of HIV infection is similar to that found in routine linked testing of drug users in Ireland. The high level of unsafe injecting and sexual activity makes clear the need for more effective health promotion among drug users in Dublin.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Screening for potentially transmitting sexual risk behaviors, urethral sexually transmitted infection, and sildenafil use among males entering care for HIV infection.

The study aims were to evaluate the prevalence and predictors of sexual risk behaviors and urethral sexually transmitted disease (STD) among males entering care for HIV infection and to examine if sildenafil prescriptions are associated with potentially transmitting sexual risk behavior (PTSRB). The research design included (1) self-administered questionnaire of symptoms of sexually transmitted infection (STI), number of recent sex partners, unprotected sexual risk behaviors, use of drugs/alcohol during sex, and HIV disclosure; (2) urine gonorrhea/chlamydia polymerase chain reaction (PCR); and (3) record review for sildenafil prescriptions. A PTSRB was defined as insertive anal, vaginal, or oral sex without a condom. Between March 2001 and March 2002, 413 entrants were surveyed. The prevalence of positive urine PCR among those with and without urethral symptoms was 16.7% and 2.4%, respectively. Fifty-one percent met criteria for PTSRB during the preceding month. Those reporting PTSRB were more likely to report multiple partners. In a multiple logistic regression model, the following were significant (p < 0.05) predictors of PTSRB: drug or alcohol use during sex; white race; only male partners, and sildenafil use. Drug use during sex was associated both with more sex partners and more sexual risk behaviors. Always disclosing HIV status was associated with fewer partners. There was a high prevalence of PTSRB among HIV-infected males entering care. Men who have sex with men (MSM), white race, drug/alcohol use during sex, and sildenafil use were independent risk factors. PTSRB was associated with having multiple partners. Physicians should discuss risk behaviors before prescribing sildenafil.

Adult↗
PubMed2006

A population-based study on alcohol and high-risk sexual behaviors in Botswana.

BACKGROUND: In Botswana, an estimated 24% of adults ages 15-49 years are infected with HIV. While alcohol use is strongly associated with HIV infection in Africa, few population-based studies have characterized the association of alcohol use with specific high-risk sexual behaviors. METHODS AND FINDINGS: We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana using a stratified two-stage probability sample design. Multivariate logistic regression was used to assess correlates of heavy alcohol consumption (>14 drinks/week for women, and >21 drinks/week for men) as a dependent variable. We also assessed gender-specific associations between alcohol use as a primary independent variable (categorized as none, moderate, problem and heavy drinking) and several risky sex outcomes including: (a) having unprotected sex with a nonmonogamous partner; (b) having multiple sexual partners; and (c) paying for or selling sex in exchange for money or other resources. Criteria for heavy drinking were met by 31% of men and 17% of women. Adjusted correlates of heavy alcohol use included male gender, intergenerational relationships (age gap > or =10 y), higher education, and living with a sexual partner. Among men, heavy alcohol use was associated with higher odds of all risky sex outcomes examined, including unprotected sex (AOR = 3.48; 95% confidence interval [CI], 1.65 to 7.32), multiple partners (AOR = 3.08; 95% CI, 1.95 to 4.87), and paying for sex (AOR = 3.65; 95% CI, 2.58 to 12.37). Similarly, among women, heavy alcohol consumption was associated with higher odds of unprotected sex (AOR = 3.28; 95% CI, 1.71 to 6.28), multiple partners (AOR = 3.05; 95% CI, 1.83 to 5.07), and selling sex (AOR = 8.50; 95% CI, 3.41 to 21.18). A dose-response relationship was seen between alcohol use and risky sexual behaviors, with moderate drinkers at lower risk than both problem and heavy drinkers. CONCLUSIONS: Alcohol use is associated with multiple risks for HIV transmission among both men and women. The findings of this study underscore the need to integrate alcohol abuse and HIV prevention efforts in Botswana and elsewhere.

Adult↗
PubMed1992

Behavioral risk factors for sexually transmitted diseases in American households.

The analysis of a representative survey of households (n = 968) in a San Francisco Bay Area county provides strong evidence for the role of problem drinking as a risk factor for sexually transmitted diseases independent of drinking patterns and drug use. Among women, age, race, early age at first intercourse, history of multiple partners, drinking patterns, as well as current symptoms of problem drinking were all associated with reported STD rates. Stepwise logistic regression analysis showed, however, that female problem drinkers are nearly four and a half times more likely (adjusted O.R. = 4.65, 95% C.I. = 1.30, 16.70) than other women to have had STDs independent of all these potential risk factors. Problem drinking puts women at a greater risk for STDs than a history of multiple sex partners (adjusted O.R. = 2.75, 95% C.I. = 0.98, 7.75). This finding is also observed among men, among whom STDs were associated with a history of multiple sex partners (adjusted O.R. = 4.12, 95% C.I. = 1.90, 8.94) and the lifetime prevalence of drinking problems (adjusted O.R. = 4.95, 95% C.I. = 2.13, 11.50). Frequent bar-going, drunkenness episodes, high volume drinking, feeling disinhibited while drinking and drug use increase the risk for STDs via their effects on the rate of sex partner change. Problem drinking determines STD rates independent of these factors. The implications of these findings for future research and health policy are discussed.

Adult↗