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PubMed1999

Sexual and drug-use risk factors for HIV and STDs: a comparison of women with and without bisexual experiences.

OBJECTIVES: This study was done to compare risk factors for HIV/STDs in women who reported having had sex with both men and women and women who reported having had sex with men only. METHODS: Female participants in a multisite, randomized HIV/STD prevention study in the Seattle area reported both having had sex with a man in the 3 months before and having at least 1 risk factor for HIV/STDs during the year before the study. Of these women, 38% who reported ever having had sex with a woman were compared with those who reported having had sex with men only. RESULTS: Women who had had sex with both men and women were more likely than women who had had sex with men only to report drug use in the 3 months before the study, a greater lifetime number of male partners, a sex partner who had had sex with a prostitute, an earlier age at sexual debut, and forced sexual contact (P < .01 for all comparisons). Women who had had sex with both men and women had a mean of 3.2 of these 5 risk factors, vs 2.1 among women who had had sex with men only (P < .001). CONCLUSION: Women who had had sex with both men and women were more likely than women who had had sex with men only to engage in multiple risk behaviors. Health workers should be aware of bisexual experience among women, since this may be a marker for multiple risk behaviors for HIV/STDs.

Adult↗
PubMed1999

Sexual behaviour of commercial sex workers and their clients in Cambodia. Japan-Cambodia Collaborating Research Group.

OBJECTIVE: This study surveyed the sexual behaviour of commercial sex workers and their clients in an attempt to identify factors of transmission of STDs (including HIV/AIDS) and to control their epidemics in Cambodia and South-East Asia. DESIGN: Cross-sectional study. SETTING: Trained questioners asked items of the questionnaires to each objective subject in December 1996. Data were analysed to show the descriptive status by risk group of each person. PARTICIPANTS: 200 direct commercial sex workers, 220 indirect commercial sex workers, and 211 clients in Phnom Penh. RESULTS: Prostitution was widely accepted by both young males and females, and this was an easy way for young girls to obtain money. Although commercial sex workers and clients were knowledgeable about prevention methods against STDs, they seldom used condoms. Some commercial sex workers had been infected with STDs many times, and many of them incompletely treated the diseases by themselves. Social support from governmental and non-governmental organisation was poor. CONCLUSIONS: It is very important to support both commercial sex workers in practicing preventive methods against STDs and also visiting physicians when they notice symptoms of STDs. It is strongly recommended that not only governmental but also non-governmental organisations should be more active in this area.

Acquired Immunodeficiency Syndrome↗
PubMed2000

A nation in pain: why the HIV/AIDS epidemic is out of control in Zimbabwe.

There has been a dramatic increase in the number of people living with HIV and the number who have died of AIDS-related diseases in Zimbabwe since the early 1990s. This increase has caused shock waves and panic in Zimbabwe and in the entire southern African region. Understanding the factors that have given rise to and sustained patterns of sexual behavior that allow HIV to be transmitted easily and quickly among the general populace is of paramount importance if HIV/AIDS prevention campaigns are to be better formulated and to be effective in this part of sub-Saharan Africa. This article makes a contribution to those studies that seek to examine socioeconomic, cultural, political, and psychological factors determining high-risk sexual behaviors leading to heterosexual HIV infection in the African context. The author contends that the focus of HIV/AIDS prevention programs should be on a myriad of socioeconomic, cultural, political, and behavioral factors instead of just on women and prostitutes--groups that have the least negotiating power within the context of sex and reproduction in a patriarchal society such as Zimbabwe. The author also points out many important areas that have been omitted in the study of HIV transmission and AIDS in Africa.

Adolescent↗
PubMed1995

Different HIV risk profiles in samples of college students and homeless persons.

A cross-sectional survey examined demographic characteristics, self-reported sexual behaviors, and knowledge of AIDS in samples of 106 homeless persons and 260 college students. As expected, the two samples differed with respect to age, gender, race, and education. Respondents in both samples possessed moderate knowledge of HIV infection and AIDS and reported they considered their personal risk of HIV infection low. Both samples acknowledged frequent use of alcohol with sexual activity, active and passive oral sex, and lax use of condoms. A discriminant analysis indicated that a greater percentage of college students were sexually active than of the homeless sample and that the homeless group had a higher proportion of individuals who were either homosexual or bisexual, who had sexual contact with multiple partners or who had visited a prostitute, who had sexually transmitted diseases, and who had injected drugs. Although the risk profiles differed, each group reported high-risk behaviors and perceptions of low personal risk of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1997

HIV risk behaviour and HIV testing of psychiatric patients in Melbourne.

OBJECTIVES: Patients with chronic mental illnesses constitute an important risk group for HIV infection overseas. This study aimed to determine the prevalence of risk behaviours associated with HIV transmission and factors associated with HIV testing in psychiatric patients in Melbourne. METHODS: Inpatients and outpatients completed an interviewer-administered questionnaire which covered demographics, psychiatric diagnosis, risk behaviour, and HIV education and testing. RESULTS: Of 145 participants, 60% were male and 55.2% had schizophrenia. Injecting drug use (IDU) was reported by 15.9%, a figure approximately 10 times that found in other population surveys. Most patients reported sex in the last decade and over 20% had multiple sexual partners in the last year. Of males, 12.6% reported sex with another male (9.2% anal sex); 19.0% of females reported sex with a bisexual male. Nearly half of the males reported sex with a prostitute, 2.5 times that in a population sample. Only 15.9% reported ever having someone talk to them specifically about HIV and its transmission, although one-third had been tested for HIV. In multivariate analysis, male-male sex, paying for sex, and IDU were associated with HIV testing, but those whose primary language was not English were less likely to be tested. Those who had received HIV education were more likely to have used a condom last time they had sex (OR 4.52, 95%CI 1.49-14.0). CONCLUSIONS: This study provides evidence that those with serious mental illness in Victoria have higher rates of participation in risk behaviour for HIV infection than those in the general community. Attention to HIV education and prevention in this group has been inappropriately scant; strategies to encourage safer behaviour are urgently needed.

AIDS Serodiagnosis↗
PubMed1988

Condoms to prevent HIV transmission do not imply truly safe sex.

30 female prostitutes and 16 persons from the hospital staff each tested 10 latex condoms by vaginal intercourse. Six dropped out. Condom rupture occurred at least once for 7/40 persons (95% confidence interval 7-33%). Total condom rupture rate was 5%. Although encouragement to condom use is prudent in an epidemiological scale, truly safe sex with an HIV-positive partner using condoms is a dangerous illusion.

Acquired Immunodeficiency Syndrome↗
PubMed1992

A seroepidemiological survey of antibodies to HTLV-I/HTLV-II in selected population groups in Paraguay.

Between March 1987 and November 1989 a cross-sectional serological survey was conducted on 884 residents of Paraguay to obtain data on the prevalence of antibodies to human T-cell leukemia virus type I/II (HTLV-I/II). Sera from 8/884 individuals (0.9%) were positive, confirmed by Western blotting and radioimmunoprecipitation (RIPA). This study shows that HTLV-I/II is very rare (or absent) among the general (healthy) population (0/338) and ethnic Japanese (0/227) in Paraguay. However, it can be detected at a rate of 2-3% in prostitutes (4/178) and homosexuals (4/117), suggesting sexual transmission as an important route for spread of HTLV-I/II in Paraguay.

Cross-Sectional Studies↗
PubMed1992

Multiresistant Shigella species from African AIDS patients: antibacterial resistance patterns and application of the E-test for determination of minimum inhibitory concentration.

The antibacterial resistance pattern and minimum inhibitory concentrations (MIC) of 25 Shigella flexneri, 5 S. boydii, 8 S. sonnei, and 3 strains of S. dysenteriae type 2 isolated from Kenyan prostitutes with bacillary dysentery and AIDS were determined, and the applicability of the E-test for MIC determination evaluated. All strains were resistant to > or = 3 of 9 different antibacterial agents tested. All strains were resistant to tetracycline and erythromycin, 95% to trimethoprim/sulfonamide, 93% to streptomycin, 54% to ampicillin, 39% to chloramphenicol, 2% to nalidixic acid and none to gentamicin and ciprofloxacin. Six different resistance patterns were observed. The most common pattern was resistance to tetracycline, erythromycin, trimethoprim/sulfa and streptomycin (39%). The E-test was shown to be well-suited for susceptibility testing of multiresistant Shigella spp.; the reproducibility was excellent and the correlation with the microtiter dilution method and the disk diffusion method were 98% in both instances. The MIC measured with E-test and the microdilution method were within +/- 1 dilution step for 94.4% of the combinations tested.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Hepatitis C virus infection in different populations in Cameroon.

We tested serum samples collected in an urban setting (Yaounde) and in a rural area (Manyemen) for the presence of antibody to hepatitis C virus (HCV) (anti-HCV). Screening was done by second-generation ELISA and confirmation with second-generation RIBA. In Yaounde, anti-HCV was found in 12.5% of patients with febrile jaundice (95% CL 3.8-21.2), 5.5% of pregnant women (95% CL 3.3-7.3), 0% of children below 4 years of age, 31% of sickle cell patients (95% CL 20.2-41.8%), 1.6% of medical students (95% CL 0-4.7%) and 15.4% of prostitutes (95% CL 8.5-22.3). Only HBsAg-negative sera were tested for anti-HCV, except sera originating from subjects with febrile jaundice. In Manyemen, anti-HCV was detected in 6.4% of blood donors, 6.0% of pregnant women, 5.3% of HIV-positive subjects, 7.3% of RPR-positive and 3.9% of RPR-negative subjects. There was an increase in antibody prevalence with age. We conclude that HCV infection is common in Cameroon and that it is transmitted mainly by blood transfusion and probably by sexual activity.

Adolescent↗
PubMed1994

HIV-seropositive rate and HIV test activity among STD clinic attendees in Bergen, Norway.

We wanted to determine the HIV seropositive rate and to study the connection between previous HIV testing, acceptance of HIV testing and sexual behaviour among STD clinic patients in Bergen, Norway. Patients attending the STD clinic in 1986-93 requesting HIV testing were registered, and all patients visiting the clinic in April-June 1989 received a questionnaire and were asked if they wanted to be HIV tested. The overall HIV seropositive rate was 0.4% (14/3805); in homo-/bisexual men: 2.9% (8/278); IVDUs: 0.4% (1/236) and in heterosexual non-IVDUs: 0.2% (5/3291). Among the 599 individuals offered anonymous HIV testing, 42.2% were HIV tested and 69.2% did not object to HIV-testing. IVDUs/prostitutes (p < 0.001), customers of prostitutes (p < 0.001), homo-/bisexuals (p < 0.01), and patients receiving blood transfusion (p < 0.005) had all been HIV tested more frequently than 'other heterosexuals'. Respondents reporting casual sex, casual sex abroad, infection with STDs, and a greater number of partners were more frequently HIV tested and also accepted HIV testing more frequently than respondents without such behaviour, indicating that there is some rationale behind the decision to be tested.

AIDS Serodiagnosis↗
PubMed1981

Drug use and crime during a four-year posttreatment follow-up.

Follow-up interview data for 1,155 opioid addicts showed that about three-fourths of the sample reported some criminal behavior during a 4-year period after leaving drug abuse treatment. Males had a higher prevalence of "major" crimes (including crimes against persons, robbery, mugging, burglary, theft, or dealing drugs) than did females, while females reported a higher percentage engaged in the so-called "victimless" crimes (primarily based on prostitution or pimping). Criminal behavior was primarily profit-related and strongly associated with drug use, especially opioid drugs. Drug users reported more criminal behavior than nonusers, and criminality and drug use increased and decreased together among persons who showed changes in drug use during the follow-up period.

Crime↗
PubMed1992

Age at first injection and HIV risk among intravenous drug users.

The relationship of age at first injection and HIV risk was explored in a nonblinded HIV seroprevalence study of intravenous drug users (IVDUs) admitted to methadone treatment in seven United States cities between February 1987 and June 1989. Comparisons were made of IVDUs who began injecting as adolescents, young adults, and adults in terms of drug use and sexual HIV risk behaviors and HIV serostatus. Early injectors consistently reported higher levels of drug-using risk behaviors (e.g., frequency of injection, frequency of needle sharing, and use of shooting galleries), and were more likely to be HIV seropositive. Among females, early injectors were also more likely to report sexual risk behaviors (e.g., multiple sex partners, prostitution). The relationship of age at first injection with selected risk behaviors and HIV serostatus was independent of subjects' age at interview, gender, and race/ethnicity. This study suggests that adolescent injectors are an important target group for HIV prevention efforts.

Adolescent↗
PubMed1995

Needle-using practices within the sex industry. National AIDS Research Consortium.

The addicted prostitute faces a risk of AIDS from both her sexual practices and intravenous drug use. While the sexual practices of these women have been studied, much less is known about their needle-using practices. We suggest women in the sex industry are more enmeshed in the drug-using scene and occupy a more constricted set of social roles than other women. They will therefore lack the resources and have fewer opportunities to engage in safer behaviors compared to women who support themselves by other means. The analysis is based on 9,055 addicted women not in treatment. Women who trade sex for money and/or drugs are less likely to use new needles on any consistent basis or to clean old needles. They are more likely to share needles with others compared to women who support themselves by other means. Three identifiable patterns of needle-using practices emerge: indiscriminate sharing, monogamous sharing with a sexual partner, and exclusive use of new needles. To reach those engaged in promiscuous sharing, needle-swapping programs must be particularly "user friendly." Where needle-using behaviors reflect an intimate relationship, the spouse/sex partner must be engaged if change is to take place. Finally, policymakers and practitioners should capitalize on the strengths and strategies of those who report they consistently use sterile needles.

Acquired Immunodeficiency Syndrome↗
PubMed1998

A cluster analysis of not-in-treatment drug users at risk for HIV infection.

The purpose of the analysis described here was to classify not-in-treatment drug users participating in the National Institute on Drug Abuse (NIDA)-sponsored Cooperative Agreement study into several "homogeneous" HIV risk groups using cluster analysis. Data for this analysis (N=17,778) were collected at 19 study sites in the United States and Puerto Rico. Measures selected for the cluster analysis were limited to (a) current drug use and HIV risk behaviors, (b) mutually exclusive behaviors, (c) behaviors directly related to HIV risk, and (d) behaviors that were not statistically rare. Eight homogeneous HIV risk clusters were produced. Crack cocaine use was the most distinguishing feature of three clusters. Another three clusters were distinguishable by drug injection and needle use practices. Two additional clusters could not be grouped with either the crack- or the injection-dominant clusters. Prostitution was the most distinguishing risk behavior of one of these clusters, and extremely high drug injection frequencies and relative rates of risky needle use characterized the other. Composition of the clusters varied significantly by gender, race/ethnicity, educational attainment, and drug use characteristics. In addition, perceptions and behaviors initiated to reduce the chances of becoming infected with HIV varied by cluster. Subjects in the crack-predominant clusters reported low perceptions of the chances of getting AIDS. Perceptions of the chances of becoming infected with HIV among subjects in the injection-predominant clusters were strongly related to injection frequency. Seroprevalence was also related to cluster. Higher rates of HIV infection were evident among the injection-predominant clusters, and higher rates were related to frequency of injection and the rate of risky needle use. Among the crack-predominant clusters, the relationship between drug use and sexual behaviors and HIV infection was less clear.

Acquired Immunodeficiency Syndrome↗
PubMed1976

Female drug use: some observations.

This paper, based on a review of recent social science drug research, summarizes the main findings on female drug use and speculates on its future direction. The findings include the following: women are usually initiated into illicit drug use by men; rates of illicit drug use are lower among females than males (which may reflect the greater personal freedom traditionally granted to males), although the difference narrows among younger persons and among those who subscribe to more liberal values and life styles; women are more likely than men to use psychotherapeutic drugs (which may reflect strains resulting from their unequal status vis-à-vis men); and female opiate addicts, although they tend to hold conventional values, are often involved in such deviant activity as prostitution. To the extent that women gain social equality with men and subscribe to greater personal lifestyle freedom, they may be expected to show a higher rate of illicit drug use, particularly of a recreational kind. On the other hand, the rate of psychotherapeutic drug use may decrease, although if the tensions of the workplace eventually substitute for the tensions of status inequality, the resultant changes in rates and patterns of substance use are problematic.

Age Factors↗
PubMed1986

A pilot study of alcohol drinkers in Ahwaz, Iran.

The psychosocial aspects of 150 alcoholic drinkers (26 females and 124 males) were studied. They were from Ahwaz, the capital of Kuzestan Province, in southwest Iran. The alcohol drinkers were from nearly every walk of life but were not representative of the upper social class. The majority of the males were long-distance lorry drivers and the majority of the women were prostitutes. The great majority were Moslems. A few women had started to drink just to help their husbands stop drinking. The majority had an alcoholic father or mother. None was suffering from gross mental illness, but several had a family history of mental illness.

Adult↗
PubMed1989

The Lexington addicts, 1971-1972: demographic characteristics, drug use patterns, and selected infectious disease experience.

The demographics, drug habits, and medical complications of a cohort of 1,129 addicts treated at Lexington in the period 1971-1972 were studied. These patients, admitted from 41 different states, had a mean period of addiction of 5.4 years. Over one-third of the sample had engaged in pimping or prostitution, and there were no differences by gender in terms of involvement. Eight-eight percent had shared injection equipment, and surprisingly, 78% admitted to some effort at sterilizing their "works." Hepatitis was the most common associated medical condition: 87% had serologic markers of hepatitis B virus (HBV) infection, 60% had evidence of hepatitis A virus (HAV) exposure, and 47% had abnormal liver function parameters. Gynecomastia was evident in 2% of male subjects. Thirteen percent of the sample had a reactive VDRL assay, but 64% of these were biologically false positive. Subtle abnormalities of immune function were also observed; 18% of the patients had recent unexplained weight loss, 6% had lymphadenopathy, 8% had leukopenia, and 2% had lymphocytopenia. We conclude that both HBV and HAV were important infectious disease risks in these addicts, and that many evidenced deficiencies in immune function well before AIDS became a major public health concern.

Adolescent↗
PubMed1996

Sex, drugs, intervention, and research: from the individual to the social.

Epidemiological estimates of the sexual risk behavior of drug users have provided essential indicators to the current and future prevalence of HIV transmission. An overview of recent research shows the majority of drug injectors to be sexually active, low levels of reported condom use, a significant minority of female injectors to be involved in prostitution, relatively high levels of sexual mixing between drug injectors and noninjectors, and only scant indications of sexual behavior change. Epidemiological studies of risk, however, are unable to yield the data required to understand the interaction between individual risk behavior and social relationships. This is required if obstacles to safer sex compliance and sexual behavior change are to be overcome, and demands recognition of the influence and importance of social context on the production of sexual risk behavior in future research and intervention designs. In response, the paper explores the future role of qualitative research in understanding the social relations of "risk" and in contributing toward theoretical advancements in explanations of risk perception and risk behavior. The paper concludes by discussing the implications of this analysis for developing interventions which aim to target social relationships as agents of social network and community change.

Condoms↗