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PubMed1999

Why screen newborns for cocaine: service patterns and social outcomes at age one year.

OBJECTIVE: To compare baseline characteristics, service provision, and child placement for infants exposed to cocaine in utero based on postnatal screening results. METHODS: We studied a retrospective cohort of 40 consecutive drug-exposed, but seemingly healthy term infants who underwent urine drug screening in the newborn nursery of a community hospital. Using clinical and service agency data, two cocaine-exposed cohorts were compared (a) screen-positive at birth (n = 22) versus (b) screen-negative at birth (n = 18). RESULTS: Both cocaine-exposed groups had similar infant birth weights, levels of paternal involvement, maternal ages, gravidity, parity, and lengths of gestation. Mothers in both groups had similar histories of prostitution, poor home environment, drug use, and prenatal drug rehabilitation. Mothers of screen-positive infants were more likely than mothers of screen-negative infants to have other children in foster care (27% vs. 6%, p = .07), to have experienced previous interventions by child protective services (CPS) (55% vs. 17%, p < .01), to have had no prenatal care (32% vs. 6%, p = .09), and fewer prenatal visits (4.7 vs. 8.6, p = .02). Compared to screen-negative infants, more screen-positive infants were referred to a high-risk infant tracking program (91% vs. 6%), referred to CPS (100% vs. 33%), placed outside the mother's home (50% vs. 22%), and had their mothers referred to drug rehabilitation (36% vs. 11%), (p < .01 for each). By 1 year of age, support services differed little between exposed cohorts. However, 6 of 22 screen-positive infants were in foster care and 3 were placed for adoption, while only 1 of the 18 screen-negative infants was in foster care and only 1 had been placed for adoption. There were no services available in this community to provide coordinated or comprehensive services or drug treatment specific to the needs of drug using mothers and drug exposed infants. CONCLUSIONS: Despite similarities between cocaine-exposed infants cared for in a normal newborn setting (with and without positive urine drug screens at birth), differences in referral services were noted. More striking than these differences was that services for families with drug-exposed infants are inadequate to even meet the needs of those families in our setting deemed to be at highest risk. Neonatal drug screening needs to be paired with effective services.

Cocaine-Related Disorders↗
PubMed1984

Epidemiology of penicillinase-producing Neisseria gonorrhoeae in Liverpool from 1977 to 1982.

After the 1976 outbreak of penicillinase-producing Neisseria gonorrhoeae (PPNG) infections had been controlled, less than 1 per cent of cases of gonorrhoea in Liverpool in 1977 and 1978 were caused by PPNG. Thereafter the steady increase in PPNG infections to 5.6 per cent of all cases in 1982 was associated with marked changes in epidemiological pattern, plasmids and auxotypes. In 1976 nearly all PPNG infections were acquired by young black males living in the inner city from women frequenting clubs; the PPNG were all of the African 3.2 megadalton (MD) plasmid type and of arginine-requiring auxotype. Between 1977 and 1982 female patients were increasingly ship girl prostitutes associating with seamen who constituted more than 50 per cent of the male patients. These men and other travellers introduced PPNG into Liverpool from the Far East and West Africa. In 1978 PPNG of the Asian type with 4.4 MD plasmid with or without 24.5 MD transfer plasmids were isolated in Liverpool where in 1979 all PPNG carried 4.4 MD and 24.5 MD plasmids. In 1982 strains of the 'new' African type with 3.2 and 24.5 MD plasmids were isolated as were PPNG of the Asian type that had been acquired in West Africa. Auxotyping of the 1982 isolates showed that none were arginine-requiring but three other types were identified: proline-requiring: proline-arginine-requiring; non-requiring. For the control of PPNG, a strategy based on constant vigilance, appropriate diagnostic procedures, rapidly effective treatment and determined contact tracing is needed.

Adolescent↗
PubMed1986

The diagnosis and treatment of chancroid.

Chancroid, a disappearing disease in the United States, was reintroduced into the country in 1980 by immigrants from the Caribbean, Mexico, and Southeast Asia. Point epidemics resulted, each of them associated with prostitution. During the 4-month period between March 1 to June 30, 1985, forty-five patients were diagnosed and treated in Massachusetts, thirty-seven from Boston alone. By means of these case records, the morphologic characteristics, laboratory diagnosis, and treatment regimens are described.

Adult↗
PubMed1999

Acute varicella zoster with postherpetic hyperhidrosis as the initial presentation of HIV infection.

A 31-year-old man presented with acute pain in his left arm and hemorrhagic vesicles that followed his left 8th cervical nerve. A diagnosis of herpes zoster was made, and the patient was treated with valacyclovir. He refused testing for antibodies to HIV because he denied being at risk. Two months later he returned with postherpetic neuralgia and postherpetic hyperhidrosis in the distribution of the vesicles, which had since resolved. Serology for HIV at this visit was positive, and the patient admitted to having sexual relations with prostitutes. Six months later the patient was being treated with triple antiretroviral therapy, and all signs and symptoms of postherpetic zoster had resolved. This case report documents the need for HIV testing in patients with unusual presentations of herpes zoster even if they initially deny being at risk.

AIDS-Related Opportunistic Infections↗
PubMed2002

[HIV infection and other sexually-transmitted infections among immigrants in Barcelona].

BACKGROUND: Immigration is a recent phenomenon in Spain. Certain subgroups of the immigrant population may be vulnerable to acquiring sexually transmitted infections (STI). MATERIAL AND METHODS: Descriptive study of the seroprevalenceof certain STI (HIV, hepatitis B and syphilis) and the general characteristicsn of persons tested for HIV infection in a specialized clinic in Barcelona during the year 2000. RESULTS: Seroprevalence of HIV was similar in immigrants and native residents(1.8% vs. 1.7% respectively). However, the seroprevalences of hepatitis B virus (anti-HBc) (19.5% vs. 8.3%) and syphilis (RPR 1 TPHA) (3.2% vs. 1.1%), as well as other STI and the practice of prostitution, were higher in immigrants. CONCLUSIONS: Several STI, including hepatitis B and syphilis, were found more frequently in immigrants than in the native population, whereas HIV seroprevalence was similar in the two groups.

Adult↗
PubMedDate not supplied

[Social marketing applied to condom promotion: a proposal for intervention in groups at risk for sexually transmitted diseases].

Sexually transmitted diseases (STDs) are an important worldwide health problem. Their association with AIDS an other insidious viral processes have brought them to the foreground of sanitary authorities and general population concern. Often, health services have to struggle with reinfections, which concentrate in pockets of risk that consume large amount of care and constitute an important link in the transmission of these diseases. General publicity have little impact among high risk groups. Thus, it becomes necessary to be more precise and divide into segments the target population we want to reach. Prevention of reinfection in these communities requires the implementation of healthy behaviours through the promotion of a tangible product (condom). Regarding these considerations, social marketing emerges as the right instrument to be used. Through individual focused interviews with prostitutes, homosexual and young promiscuous heterosexual patients from a STDs Prevention, Diagnosis and Treatment Centre, determining factors of the use condoms and related behaviour guidelines have been identified. Also, a social marketing strategy is suggested to prevent these diseases among groups at risk by means of condom promotion.

Adolescent↗
PubMedDate not supplied

[Risk behaviors related with infection by human immunodeficiency virus among adolescent students in Catalonia].

OBJECTIVE: To determine the prevalence of HIV-risk behaviours among high-school adolescents, and the association with HIV-related knowledge, attitudes and risk perception. SUBJECTS AND METHODS: In 1992-93 a questionnaire was administered to the students of a convenience sample of 30 classes, previously to an AIDS education intervention. RESULTS: 1,213 questionnaires corresponding to 12 to 21 years-old respondents were analyzed. The mean age of the sample was 16 years and 61.6% were females. The use of drugs inhibiting the capacity to avoid risk situations was frequent (alcohol: 61.7% and hashish: 11.6%). 18.5% of the respondents were sexually active, of whom 18.1% reported at least one unknown sexual partner during the former year. 3.7% and 9.8% of the sexually active males reported a sexual intercourse with a male or with a prostitute, respectively. Condoms were consistently used by 51.3% of the sexually active students. Knowledge and risk perception were not related to risk behaviours, whereas less positive attitudes towards AIDS information and the HIV-infected were associated with having had intercourse with a high risk partner, and a positive attitude towards condoms was related to consistent use. CONCLUSIONS: Nearly 20% of school teenagers are sexually active and only half of these always use condoms. This places heterosexual activity as the main potential route for HIV-transmission in this group.

Adolescent↗
PubMed1993

[Evaluation of the epidemic caused by the human immunodeficiency virus in Cambodia].

The infection by the human immunodeficiency virus is in the process of expanding to a dramatical level in South East Asia. At the moment, the few available datas on Cambodia are increasingly worrying, with a rate of seropositivity of prostitutes higher than 9% in 1992 and a clear progression of the rate of seropositivity of blood donors: 1.3% by the second quarter of 1993.

Cambodia↗
PubMed2001

Shan women and girls and the sex industry in Southeast Asia; political causes and human rights implications.

The human rights abuses which occur during civil conflicts pose special threats to the health and lives of women. These can include rape, sexual violence, increased vulnerability to trafficking into prostitution, and exposure to HIV infection. The long-standing civil conflict in the Shan States of Burma is investigated as a contributing cause to the trafficking of ethnic Shan women and girls into the Southeast Asian sex industry, and to the subsequent high rates of HIV infection found among these women. The context of chronic human rights abuses in the Shan states is explored, as well as the effects of recent forced population transfers on the part of the Burmese Military Regime. Rights abuses specific to trafficked women may further increase their vulnerability to HIV and other STD. The need for a political resolution to the crisis in Burma is discussed, as are approaches aimed at preventing trafficking, empowering women already in the sex industry, and reducing the risks of HIV and other STD among these women and girls.

Female↗
PubMed2002

HIV risk environment for Ghanaian women: challenges to prevention.

Ghana is experiencing high rates of HIV transmission and women have been identified as a group with increased vulnerability to infection. Women's vulnerability may be influenced by factors such as gender, unequal power relationships and poverty. Research was undertaken in Ghana from January to May 1999 to examine the experiences of HIV sero-positive women. Thirty-one women were interviewed to explore the broad context of disease transmission and to identify factors that mediated women's ability to protect themselves from infection. The poverty experienced by many of the women during their childhood years, coupled with a societal belief that favored the education of males, restricted the participants' educational and vocational opportunities. With limited education and few vocational skills, many of the women took boyfriends to assist them with the purchase of food, clothing and shelter, as a strategy for survival. For most women, the use of condoms with sexual partners was restricted by the high value placed on fertility, the negative association of condoms with prostitution, and the women's limited ability to influence decision-making in this area. The women's narratives provide a compelling description of the context of HIV transmission in Ghana. Strategies to expand and intensify the response to HIV prevention are presented and critiqued.

Anecdotes as Topic↗
PubMed1996

Childbearing research: a transcultural review.

This article provides an examination of the keynote and current literature concerning traditional beliefs and practices pertinent to childbearing. Toward this aim, investigations implemented in western and non-western societies spanning 35 years are discussed. Each study is summarized in a table indicating the characteristics of the population, the methodology and the results. The key issues identified for study in developing countries are: poverty, illiteracy, malnutrition, prostitution, substance abuse, family disruption, lack of child care, high rates of maternal and infant mortality and the patterns of utilization of health services. Industrialized societies are faced with different problems: isolation of the nuclear family, economic pressure for mothers to work, deficiency of child care facilities, ambiguity in the definition of parental roles, marital instability and impersonal, medicalized health care. These reported results provide the basis for culturally-sensitive suggestions to improve social welfare schemes, health prevention and treatment programs. Dominant themes and changing trends in research content and methodology have been drawn from this literature review. These trends indicate that future investigations will: (a) focus upon populations-at-risk; (b) involve large representative samples; (c) address prominant social and health problems; (d) challenge currently held assumptions; (e) and use interdisciplinary methods, ethnographic, epidemiologic and intervention approaches in concert to produce vital and culturally-informed data for research development, policy decisions and program implementation.

Anthropology, Cultural↗
PubMed1997

AIDS-related knowledge, attitudes and behaviour among South African street youth: reflections on power, sexuality and the autonomous self.

Street children in South Africa are, in the main, between the ages of 11 and 17 years. Rape, prostitution, sexual bartering and exchange, casual sex and romantic sexual relationships all occur in the experiences of young people who live and work on inner-city streets. In this study, the AIDS-related knowledge, attitudes and behaviour of 141 street youth, living in seven large cities in South Africa, were elicited in focus group discussions. At the time of the study, 79 boys (56%) were living in shelters run by nongovernmental and welfare organisations, while 62 boys (44%) were sleeping "rough". The results, both qualitative and quantitative, indicated that the AIDS knowledge of South African street children was comparable to levels reported for groups of "hard-to-reach" youth in other parts of the world. Fear of HIV infection did not appear in a list of day-to-day priorities constructed by the children, a list dominated by survival concerns with food, money and clothes. However, more than half of the boys conceded that they engaged in sex for money, goods or protection, several boys indicated that they had been raped, and most reported being sexually active with "girlfriends", who themselves frequently engaged in transactional sex. The findings are interpreted in terms of the relationships between power dynamics surrounding race and age, and how they affect self-initiated controls over sexuality and sexual protection.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Sexual regimes and sexual networking: the risk of an HIV/AIDS epidemic in Bangladesh.

Bangladesh adjoins the Asian region with the severest AIDS epidemic and has common borders with two of the most affected areas, the Indian Hill States and northern Burma. There has been disagreement about the danger to Bangladesh, one view citing the likelihood of transmission from neighbouring infected populations and the other claiming that the country's predominantly Muslim culture protects it. This paper reports on a 1995-1997 research project. Preliminary research was carried out in Dhaka in 1995-1996 which suggested that the poor squatter areas might well sustain an epidemic. The experience also showed that more accurate measures of sexual networking could be obtained from males than females. The 1997 field research reported here investigated 983 males, 52% single and 48% married in Chittagong city and two more rural areas of Chittagong Division in southeast Bangladesh. It was found that around half of all males and probably a somewhat lower proportion of females, experience premarital sexual relations, with males having a lower level of extramarital than premarital relations. The factor heightening Bangladesh's risk of an epidemic is that one-quarter of single males and a significant but lower level of married males have had relations with prostitutes. This is one explanation for quite high levels of STDs in Bangladesh. The factors restricting the chances of a major national epidemic are the small number of premarital sexual episodes per person and the low level of intravenous drug use.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Female commercial sex workers in Kramat Tunggak, Jakarta, Indonesia.

Indonesia is predicted to face a severe AIDS epidemic in the near future. More than 60% of the reported HIV-positive cases in Indonesia can be attributed to heterosexual transmission; therefore, by the nature of their work, female commercial sex workers (FCSWs) constitute one of the communities at risk. No meaningful or effective STD/HIV prevention programs for FCSWs can be planned if there is no contextual understanding of these women as persons, the nature and the risks of their job and their relations with their clients and managers. Just as it is incorrect to assume that all women enter prostitution for the same reasons, educational approaches that are modeled on shallow stereotypes will be ineffective. Interweaving qualitative and quantitative methods, this research investigates the FCSWs in an 'official' brothel complex in Jakarta, Indonesia. Results of this study give insights of four typologies of FCSWs observed in Kramat Tunggak. The personal, professional, social and other differences which influenced the women into full-time sex work and affected their willingness and ability to engage in healthy and protective behaviors, are presented. Finally, based on those findings a recommendation on how to deliver health messages to the FCSWs is offered.

Acquired Immunodeficiency Syndrome↗
PubMed2000

The sexual behavior of married Mexican immigrant men in North Carolina.

In the southern United States, North Carolina has attracted an unprecedented influx of Hispanic immigrants in the 1990s. Detailed data on the sexual behavior of these recent immigrants are lacking. This exploratory study used two methods, a survey and qualitative interviews. For both methods, participants were recruited using convenience sampling. All study participants were first-generation Mexican immigrants who had lived in North Carolina for at least six consecutive months. The survey, administered face-to-face, explored the sexual attitudes and behavior of 43 married Mexican men living in North Carolina. The qualitative interviews, conducted with men (n = 20) and women (n = 19), explored immigrants' perceptions of extramarital sex and sexually transmitted diseases (STDs). The study's results suggest that the sexual behavior of 'unaccompanied' married Mexican immigrant men, living alone in North Carolina, differs, at least in degree if not in kind, from that of 'accompanied' married men, residing in the state with their wives. Unaccompanied men who participated in the survey reported more lifetime sexual partners, more partners in the previous year, more extramarital partners and more contact with prostitutes than accompanied survey respondents. The qualitative interviews suggest that unaccompanied men's peculiar status as 'single' men in North Carolina may provide them with both motive and opportunity to have extramarital sexual relationships and that few married Mexican men and women perceive STDs as relevant to their lives. Overall, the study supports the need for male- and couple-focused STD prevention interventions for Hispanic immigrants.

Adolescent↗
PubMed1998

Violence against women: the physician's role.

Violence against women is one reflection of the unequal power relationship between men and women in societies. Reflections of this inequality include marriage at a very young age, lack of information or choice about fertility control and forced pregnancy within marriage. The different forms of violence against women are: domestic violence and rape, genital mutilation or, gender-based violence by police and security forces, gender-based violence against women during armed conflict, gender-based violence against women refugees and asylum-seekers, violence associated with prostitution and pornography, violence in the workplace, including sexual harassment. Violence against women is condemned, whether it occurs in a societal setting or a domestic setting. It is not a private or family matter. The FIGO Committee for the Study of Ethical Aspects of Human Reproduction released statements to physicians treating women on this issue. Physicians are ethically obliged to inform themselves about the manifestations of violence and recognize cases, to treat the physical and psychological results of violence, to affirm to their patients that violent acts toward them are not acceptable and to advocate for social infrastructures to provide women the choice of seeking secure refuge and ongoing counselling.

Domestic Violence↗
PubMedDate not supplied

Route of cocaine administration: patterns of use and problems among a Brazilian sample.

Route of administration has important implications for the understanding of drug addiction and related-problems. This cross-sectional study investigates patterns of consumption and cocaine-related problems among snorting and crack cocaine users in São Paulo and outlines changes in route of cocaine administration in Brazil between 1980-1997. Crack cocaine users had more social and health problems and higher involvement in crime than intranasal users. These problems, compounded by the larger doses being used and their greater involvement in prostitution, place crack cocaine users at higher risk from HIV infection and other sexually transmitted diseases as well as other physical risks.

Administration, Inhalation↗
PubMed2001

Does multisite sampling improve patient heterogeneity in drug misuse research?

The aim of this study was to investigate whether multisite sampling increased heterogeneity among a sample of cocaine users from São Paulo, Brazil. Six hundred and fourteen cocaine users were interviewed at 23 fixed sites plus an out-of-treatment sample. The sites were then regrouped into six main types: university outpatient clinics, public outpatient clinics, public inpatient units, private inpatient units, HIV services and non-treatment. Marked differences were found between users recruited at these sites, especially in relation to age, gender, employment status, criminal history, history of prostitution, previous drug misuse treatment, duration of cocaine use and lifetime use of intravenous cocaine. These results suggest that multisite sampling is a valid method for increasing patient heterogeneity, but whether it improves representativeness and thus the generalisability of drug misuse research is debatable.

Adult↗