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PubMed1989

Attitudes towards HIV infection and sexual risk behaviour. A survey among Danish men 16-55 years of age.

To describe attitudes towards HIV infection in relation to sexual risk behaviour and sociodemographic factors in a representative sample of Danish men 16-55 years of age, a self-administered anonymous questionnaire was distributed in connection with a personal health interview and returned by prepaid mail. The response rate was 55%, corresponding to 1,155 participants. In contrast to the official AIDS prevention strategy, 28% of the participants stated that HIV infected persons should be forbidden to have sexual relationships, and 44% that they should be registered by the authorities. 33% of the participants had had sexual behaviour which may be associated with increased risk of HIV infection: more than one female partner during the previous 12 months, sexual contact with prostitutes or sex with other men. Despite good basic knowledge of AIDS, only 41-59% of these men perceived themselves at risk, and only 47%-54% of men perceiving themselves at risk had adopted risk-reducing sexual behaviour. The results indicate a need for innovative health education of the general public about AIDS prevention at community and individual level. In the absence of effective treatment and without prospect of a vaccine in the near future the prevention of AIDS must focus on modifying behaviour associated with increased risk of HIV infection, in particular sexual behaviour.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Sex and the nation's health.

The Government's 'Health of the Nation', influenced by the WHO's 'Global Strategy for Health for All by the Year 2000', pledges a reduction in sexually transmitted diseases in general and AIDS in particular. The recommendations are clearly sensible but how do you persuade people to believe and comply with the 'sensible' advice? Failure to consider public health measures involving sexual behaviour without considering how different cultures respond and interpret the advice given is bound to fail. People are individuals and there is a danger in assuming that our values and beliefs are shared by people globally. For a message to succeed it needs to be simple and direct, and portrayed in its cultural context through an appropriate medium. An appreciation that the message however sensible may clash with individual needs (eg the economics of prostitution) and research into these aspects of sexual behaviour will ensure that the message remains effective. Changing the slogans and methods of conveying the message regularly will help to reinforce key points and reduce apathy.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Prevalence and risk factors of syphilis infection among drug addicts.

BACKGROUND: Recent epidemiological data show an increased trend of official estimates for syphilis infection in the general population. Many of the infected cases remain undetected leaving an underestimation of the true prevalence of syphilis in the general population, but also among subpopulations such as illicit drug users. There is limited epidemiological data published on the proportion and risk factors of syphilis infections associated with illicit drug abuse. METHODS: Illicit drug addicts (n = 1223) in inpatients units in Germany were screened (2000-01) for syphilis and interviewed regarding patterns of drug use and sexual behaviour. TPHA-test for initial screening and FTA-ABS-IgM test in TPHA-positive patients were used. RESULTS: In total, TPHA-tests were positive in 39 (3.3%) and 7 patients (0.6%) were IgM positive. The prevalence rate for syphilis in males was 1.9% and for women it was 8.5%. Female patients were 4.56 (CI 95% 2.37-8.78) times more likely to have a positive TPHA test than males. Sexual behaviours such as high number of sexual partners, sex for drugs/money, sex on the first day were associated with syphilis infection only in women. Females with frequent sex for drugs or money had 4.31 (CI 95% 2.32-8.52) times more likely a reactive TPHA test than remaining patients. Neither the sociodemographic factors nor sexual behaviour were statistically significant associated with syphilis infection among men at all. CONCLUSION: Our data suggest the need for screening for syphilis among these illicit drug users in inpatient settings, in particular among sexual active women. This conclusion is corroborated by the finding of increasing numbers of syphilis infections in the general population. The identification of syphilis cases among drug addicts would give treatment options to these individuals and would help to reduce the spread of infection in this population, but also a spread into heterosexual populations related to prostitution.

Adult↗
PubMed2005

Prevalence, types and demographic features of child labour among school children in Nigeria.

BACKGROUND: To determine the prevalence, types and demographic features of child labour among school children in Nigeria. METHODS: A cross-sectional interview study of 1675 randomly selected public primary and secondary school pupils aged 5 to less than 18 years was conducted in the Sagamu Local Government Area of Ogun State, Nigeria from October 1998 to September 1999. RESULTS: The overall prevalence of child labour was 64.5%: 68.6% among primary and 50.3% among secondary school pupils. Major economic activities included street trading (43.6%), selling in kiosks and shops (25.4%) and farming (23.6%). No child was involved in bonded labour or prostitution. Girls were more often involved in labour activities than boys (66.8% versus 62.1%, p = 0.048): this difference was most obvious with street trading (p = 0.0004). Most of the children (82.2%) involved in labour activities did so on the instruction of one or both parents in order to contribute to family income. Children of parents with low socio-economic status or of poorly educated parents were significantly involved in labour activities (p = 0.01 and p = 0.001 respectively). Child labour was also significantly associated with increasing number of children in the family size (p = 0.002). A higher prevalence rate of child labour was observed among children living with parents and relations than among those living with unrelated guardians. CONCLUSION: It is concluded that smaller family size, parental education and family economic enhancement would reduce the pressure on parents to engage their children in labour activities.

Journal Article↗
PubMed2007

Prevalence of human papillomavirus genotypes and their variants in high risk West Africa women immigrants in South Italy.

BACKGROUND: The distribution of human papillomaviruses (HPVs) varies greatly across populations and HPV surveys have been performed in different geographical regions in order to apply appropriate vaccine strategies. Little information, however, exists regarding HPV genotypes distribution in immigrant women from countries at high incidence for cervical cancer. The aim of this study was to determine the spectrum of HPVs and their variants among HIV-positive and HIV-negative women immigrants in South Italy mainly from West Africa and with a history of prostitution. RESULTS: Cervical cytological samples have been collected from 14 HIV-positive and 31 HIV-negative immigrants (38 out of 45 were born in Nigeria), attending a gynecological outpatient clinic in the Campania region. Human papillomaviruses were detected by broad spectrum consensus-primer-pairs MY09/MY11 and GP5+/GP6+-based polymerase chain reaction and characterized by nucleotide sequence analysis. Altogether, 42.2% (19/45) of samples were HPV positive with detection rates of 57.1% (8/14) in HIV-positive and 35.5% (11/31) in HIV-negative women. Among the twelve different viral genotypes identified, HPV33, 58, 70 and 81 were the prevalent genotypes with a frequency of 6.7% each, followed by HPV16, 35, 42, 54, 31, 52, 56 and 67, in descending order of prevalence. Sequence homology studies performed on the L1 amplified fragments of HPV16, 52 and 58 isolates allowed the identification of nucleotide changes distinctive of non-European variants. CONCLUSION: The overall HPV prevalence (42.2%) was high in this immigrant women group with the most common viral types other than HPV16 and 18, against which current vaccine strategies have been developed. The distribution of HPV genotypes and their variants in high-risk immigrants reflects that of their original countries. The surveillance of risk groups that may act as viral reservoirs of uncommon genotypes within different countries are necessary to determine the severity of HPV infection with the different viral types and to monitor a possible shift of prevalent strains following vaccination.

Journal Article↗
PubMed1977

Male transsexualism in Singapore: a description of 56 cases.

A psychiatric investigation on 56 cases of male transsexuals in Singapore revealed a prevalence of I in 25,000. Eighty-two per cent were prostitutes and 83 per cent had completed secondary education. All were unmarried, and 35 per cent were co-habiting with men. Fifty-eight per cent had felt they were females before the age of 5, 65 per cent cross-dressed before the age of 10, and by the age of 20, 57 per cent were completely cross-dressed of whom 73 per cent were receiving female sex hormones. Their mean IQ was 105. Thirty-two (58 per cent) underwent sexual reassignment surgery. There was no report of psychiatric complications. It was concluded that transsexualism as described by different authors may not refer to the same condition. Aetiologically, these cases did not appear to be determined by early childhood experience.

Adolescent↗
PubMed2000

Extent and contributing factors of drug expenditure of injectors in Glasgow. Multi-site city-wide cross-sectional study.

BACKGROUND: Recent concern about drug use has focused attention on the illegal income generated by users. AIMS: To investigate factors associated with drugs expenditure and to estimate the cost of illegal acquisitions used to pay for drugs. METHOD: We collected self-report data from 954 current injectors, interviewed at multiple street, needle/syringe exchange and drug treatment sites throughout Glasgow. RESULTS: Injectors' mean weekly drug spending was 324 Pounds. The mean annual illegal drugs spend was estimated to be 11,000 Pounds per injector. We provide a central estimate--194 million Pounds per annum--of the retail value of goods acquired illegally by injectors in Glasgow in order to pay for drugs. Higher drug spends were associated with having been imprisoned more often and with those reporting acquisitive crime, drug dealing and prostitution. Treatment with methadone, among individuals who injected in the previous two months, was associated with a 20% reduction in a typical spend on drugs. CONCLUSIONS: Treatment effectiveness needs to be measured both in terms of health benefit and in terms of reduction in drugs expenditure and recidivism.

Adolescent↗
PubMed2004

Sexual economics: sex as female resource for social exchange in heterosexual interactions.

A heterosexual community can be analyzed as a marketplace in which men seek to acquire sex from women by offering other resources in exchange. Societies will therefore define gender roles as if women are sellers and men buyers of sex. Societies will endow female sexuality, but not male sexuality, with value (as in virginity, fidelity, chastity). The sexual activities of different couples are loosely interrelated by a marketplace, instead of being fully separate or private, and each couple's decisions may be influenced by market conditions. Economic principles suggest that the price of sex will depend on supply and demand, competition among sellers, variations in product, collusion among sellers, and other factors. Research findings show gender asymmetries (reflecting the complementary economic roles) in prostitution, courtship, infidelity and divorce, female competition, the sexual revolution and changing norms, unequal status between partners, cultural suppression of female sexuality, abusive relationships, rape, and sexual attitudes.

Courtship↗
PubMed2000

Syphilis in Slovenia--on the threshold of the European Union.

The epidemiological situation of early syphilis (ES) in Slovenia is the subject matter of this report. After almost 25 years of decrease in Slovenia, ES is increasing again. The incidence of ES increased from 0.10 per 100,000 inhabitants in 1992 and 1993 to 1.82 in 1994 and 1.90 in 1995. In the years 1996-1998 there was a slight decrease at 1.25-1.45. The higher incidence of infections with ES is presumably the consequence of changed social conditions in the states of the former Eastern bloc and Yugoslavia, and of changing living conditions, and illegal prostitution in Slovenia. AIDS and HIV in Slovenia is still at an early stage and there is no apparent link into the same social groups as syphilis. The current epidemiological situation of sexually transmitted infections (STIs) in Slovenia and the conditions existing to the south and east of Slovenia warrant strict surveillance of STIs by the medical services.

Acute Disease↗
PubMed2000

Prevalence of HIV infection and risk behaviours among Montreal street youth.

We aim to estimate HIV prevalence and associated risk factors among street youth in Montreal, Canada. We conducted a one-year cross-sectional anonymous study in 1995. We recruited youth aged 13-25 years meeting specific criteria for itinerancy through the 20 major Montreal street youth agencies. Participation included a structured interview and provision of an oral specimen for HIV testing. Among the 909 subjects studied, 99.3% had been sexually active, 25.9% had exchanged sex for money, gifts, drugs, a place to sleep, or other things; 31.8% reported anal sex; and 36.4% reported having ever injected drugs. Overall, HIV prevalence was 1.9% (1.1% in girls and 2.2% in boys). Multivariate logistic regression showed that being over 20 years of age (adjusted odds ratio (AOR) 7.09), having injected drugs (AOR 4.48), having engaged in prostitution (AOR 3.32), and being born outside Canada (AOR 4.41) were all independently associated with HIV infection.

Adolescent↗
PubMed2003

Heterosexual activity of male prisoners in England and Wales.

A random sample of 1009 adult male prison inmates from 13 prisons covering short-, medium- and long-term establishments across England and Wales was interviewed about sexual behaviour, drug use and tattooing, inside and outside of prison. We report here on their heterosexual behaviour. Inmates had had a high number of sexual partners compared to population samples. The majority of sexual partners were casual and there were high levels of sexual involvement with injecting drug users and with prostitutes. Prisoners engaged in more risky sexual practices than did the general population and used condoms infrequently. A high number of prisoners had also injected drugs. Inmates reported a high frequency of past sexually transmitted diseases.

Adolescent↗
PubMed2003

Let it be sexual: how health care transmission of AIDS in Africa was ignored.

The consensus among influential AIDS experts that heterosexual transmission accounts for 90% of HIV infections in African adults emerged no later than 1988. We examine evidence available through 1988, including risk measures associating HIV with sexual behaviour, health care, and socioeconomic variables, HIV in children, and risks for HIV in prostitutes and STD patients. Evidence permits the interpretation that health care exposures caused more HIV than sexual transmission. In general population studies, crude risk measures associate more than half of HIV infections in adults with health care exposures. Early studies did not resolve questions about direction of causation (between injections and HIV) and confound (between injections and STD). Preconceptions about African sexuality and a desire to maintain public trust in health care may have encouraged discounting of evidence. We urge renewed, evidence-based, investigations into the proportion of African HIV from non-sexual exposures.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Association of Trichomonas vaginalis with sociodemographic factors and other STDs among female inmates in Lisbon.

A study on STDs was conducted among 211 female inmates in a prison in Lisbon, Portugal, in order to establish possible associations between Trichomonas vaginalis infection, sociodemographic factors and other STDs. T. vaginalis was found in 31.2% of the women, from whom only 65.1% presented symptoms. It was more frequently isolated in the 20-40 year age group. On univariate analysis there was an association, although not statistically significant, between the existence of T. vaginalis, multiple sexual partners, drug addiction and no condom use. A statistically significant association was found between trichomoniasis, prostitution and other STDs. These were found in 87% of all women. T. vaginalis was detected alone in 23.8% (15/63) of all women with trichomoniasis, while 76.2% (48/63) of them had multiple infections with trichomonas and other STDs. A statistically significant association was present between trichomoniasis and Mycoplasma hominis and infection with Treponema pallidum. This study showed that the prevalence of T. vaginalis is as high as that of multiple infections with other STDs. Therefore, our findings seem to confirm that trichomoniasis serves as a marker for other STDs. Screening for STDs should then be offered to Portuguese inmates, or, at least, these women should be screened for T. vaginalis, as a marker for the other STDs.

Adult↗
PubMed2006

A passage to India's HIV epidemics: sending out an SOS.

The official view is that India's epidemics are driven, directly and indirectly, by heterosexual prostitution. Review of available evidence by researchers in India undermines this weakly supported orthodoxy and suggests that correcting weaknesses in its AIDS surveillance system can lead to a more reliable picture of HIV propagation and hence to evidence-based interventions. Contenders for leading roles in HIV transmission are under-suspected and unmeasured skin-puncturing exposures.

Disease Outbreaks↗
PubMed1996

Reflections on the first decade of the HIV/AIDS pandemic: opportunities and priorities for international behavioural research and interventions.

AIDS, a sexually transmitted disease, is unlikely to respond in the near term to either common sense or scientific innovation. Other forces are at play here that embrace the psychobiology of reproduction, addictive behaviour, and the social sciences. We must explore these matters within the historical and cultural context. We must push to the limit the science of behaviour and behaviour modification. To meet this challenge, the social and behavioural sciences and the natural sciences must form a new union in which the sum is greater than the parts. The integration of population biology into research strategies will require special attention. Planning the design and employment of interventions and the evaluation of their effects will require the use of mathematical models. Efforts to change individual and social behaviour must be tailored to the cultural circumstances of the afflicted populations. None of this will be easy. But the changing sexual behaviour among homosexual men and the increasing use of condoms by prostitutes and their customers in many societies stand as testimony to the power of public efforts.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Anonymous HIV surveillance with risk-factor elicitation: at Perth (for men) and Cornton Vale (for women) prisons in Scotland.

434 male and 145 female prisoners were available to participate in cross-sectional, voluntary anonymous HIV surveillance (using saliva samples) with linked self-completion questionnaire at HMP (Her Majesty's Prison) Perth on 17 May and at HMP Cornton Vale on 18 May 1995. Three hundred and four men (70%) and 136 women (94%) completed a risk-factor questionnaire and 304 and 135 samples were received for HIV antibody testing. Two hundred and eighty-two and 132 questionnaires passed logical checks. Six saliva samples from Perth (all injectors) out of 304 and none from Cornton Vale out of 134 tested were HIV antibody positive. Four were presumptively from known HIV-infected male inmates; the other 2 were local men, under 26 years, who began injecting in 1989-91, and both reported having had a recent HIV test. Overall HIV prevalence was estimated at 2% compared to a known prevalence of 1.4% (6/434), giving a 1.5 ratio of overall: disclosed HIV prevalence at HMP Perth. HIV prevalence was estimated at 7% (6/82) for injector-participants and 14% (5/35) for local injector participants. At Cornton Vale, where both known HIV-infected inmates abstained, overall and disclosed HIV prevalence, were equal at 1.4%. At Perth Prison, 29% of prisoners had injected drugs (82/278); 85% of injector-inmates reported having injected inside (some prison and 31% (25/80) had started to inject while inside, 7 during their present sentence. Of all 21 injector-inmates who first injected after 1991, 10 had started to inject inside, including one of 69 male inmates who had never been inside before. The corresponding figures for Cornton Vale, where 46% of inmates were injectors (58/132), were that 57% of injector-inmates had injected inside (32/56) but only one woman, for whom this was not her first sentence, had started to inject inside. Twenty-eight per cent of male prisoners (78/277) and 57% of male injector-inmates (47/82) had had a personal HIV test since January 1993, as had 35% of female prisoners (43/124) and 57% of female injector-inmates (30/53). A much higher proportion of Glasgow's female prisoners (64%: 38/60) were injectors than of women prisoners from the Edinburgh, Dundee and Fife area (21%: 5/26) or from elsewhere (34%: 15/45). Rape was reported by 23% of women (30/130). Women who had been raped had a more polarized distribution of male sexual partners (none to 2 plus) in the year before sentencing than other women and were more likely to report anal sex (11/30 vs 11/100, P < 0.001). Prostitution had been engaged in by 19% of female injector-inmates (11/57) and was acknowledged by one other woman. However, only 5% of women (6/130) reported ever having been treated for an STD.

Adult↗
PubMed1997

Comparison of patients refusing with patients accepting unlinked anonymous HIV testing in an outpatient STD department in The Netherlands.

From 1 February 1993 to 1 February 1994 all new patients, known patients with new problems, and prostitutes attending the Outpatient Department of Sexually Transmitted Diseases (STD) of the University Hospital Rotterdam were asked to participate in unlinked anonymous human immunodeficiency virus (HIV) testing and to answer some questions. Data from the medical records of 300 patients refusing to participate were compared with self-reported data obtained from 2701 people accepting, to verify if the HIV seroprevalence among accepters could be representative for all STD department visitors. Men refusing were more often of foreign origin, had more often had more than one partner during the previous 6 months, more often attended the STD department for the first time, and more often had an STD diagnosed than men accepting. Women refusing were more often of foreign origin, had less often had more than one partner during the previous 6 months, and had more often used drugs intravenously than women accepting. Because most findings associated with refusing are also associated with being infected with HIV, the HIV seroprevalence among refusers is likely to be higher than among accepters. We therefore advise unlinked anonymous HIV testing of all patients visiting an STD department.

Adult↗
PubMed1997

Sexually transmitted diseases in Estonia: past and present.

The present survey covers historical events in Estonia during the era of the USSR regime and the era after independence as regards incidence of sexually transmitted diseases (STDs). The diagnostical methods used as the reporting system are presented. Reasons for the increased incidence of traditional venereal diseases such as gonorrhoea and syphilis are discussed. The importance of migration of prostitutes from Russia is also considered.

Estonia↗