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Biomedical subjects

Nancy S Padian

Publications and source records attributed to Nancy S Padian.

At least 19 recordsLinked to original sources
PubMed2007

Concurrent partnerships among adolescents in a Latino community: the Mission District of San Francisco, California.

OBJECTIVES: Latino adolescents in the United States are disproportionately affected by sexually transmitted infections, yet knowledge of their sexual networks, particularly concurrent sex partners, is limited. GOAL: The goal of this study was to describe the prevalence, patterns, and correlates of sexual concurrency among adolescents in an urban neighborhood. STUDY DESIGN: The authors conducted cross-sectional analyses of 368 sexually active youth recruited from public venues within a predominantly Latino neighborhood in San Francisco, California. RESULTS: During the prior 6 months, 20% of sexually experienced youth had concurrent partnerships, but this was more likely among males (27%) as females (12%) (odds ratio = 2.6; 95% confidence interval = 1.5-4.5). Sexually transmitted infection prevalence was too low to examine its association with concurrency. Factors that increased the likelihood of concurrency among males included: immigrant generation and being below grade level; and among females: older age and use of illegal substances. CONCLUSIONS: Ample opportunities to transmit sexually transmitted infections through concurrency were present, yet very few adolescents were infected, perhaps owing to adequate condom use within a neighborhood with low sexually transmitted infection prevalence.

Adolescent↗
PubMed2006

Audio computer-assisted self-interviewing in reproductive health research: reliability assessment among women in Harare, Zimbabwe.

PURPOSE: Research on the measurement of HIV risk demonstrates that interview mode can affect reporting; however, few studies have applied these findings to assessments of hormonal contraceptive use. This paper examines how audio computer-assisted self-interviewing (ACASI) influenced reports of hormonal contraceptive use and pregnancy among Zimbabwean women. METHODS: Using a prospective, randomized, cross-over design, we compared self-reports obtained with ACASI and face-to-face (FTF) interview among 655 women enrolled in a prospective study on hormonal contraceptive use and HIV acquisition. In addition, self-report data were compared to those collected during clinical exams. RESULTS: Compared to FTF interviews, reports of hormonal contraceptive use were lower in ACASI [odds ratio (OR)=0.6; 95% confidence interval (95% CI)=0.5-0.6], and reports of pregnancy were higher (OR=1.5; 95% CI=1.1-1.9). Both modes of self-report differed from records on contraceptive method disbursement. CONCLUSION: Although ACASI yielded higher reports of several reproductive health behaviors, discrepancies between self-reports and clinical data on method disbursement highlight persistent measurement challenges.

Adult↗
PubMed2006

Sexual bridging socially and over time: a simulation model exploring the relative effects of mixing and concurrency on viral sexually transmitted infection transmission.

BACKGROUND: Sexual partnerships between people at higher and lower risk for sexually transmitted infections (STIs) (i.e., bridging) occur through dissortative mixing and concurrent partnerships, yet the relative effects of these network patterns on population STI spread are poorly understood. GOAL: Using a stochastic model, the authors investigated the impact of mixing and concurrency on the spread of a persistent viral STI. STUDY DESIGN: A total of 1,050 populations were simulated of 1,000 subjects over 400 weeks with varied concurrency levels and mixing patterns. STI prevalence and the average number of secondary transmissions per subject were analyzed with regression. RESULTS: Mixing had a greater impact on prevalence for all groups, whereas concurrency was significant for only the lowest activity group. Mixing patterns moderated the magnitude of concurrency's impact on secondary transmissions. CONCLUSIONS: Through connecting subgroups of differential risk, sexual mixing facilitates dissemination of STIs throughout a population. Concurrency expedites transmission by shortening the time between sexual contacts among infected and susceptible persons, particularly during the highly infectious period.

Computer Simulation↗
PubMed2006

Acceptability of heat treating breast milk to prevent mother-to-child transmission of human immunodeficiency virus in Zimbabwe: a qualitative study.

Although heat treatment of human milk is an official infant-feeding recommendation for human immunodeficiency virus (HIV)-positive mothers in Zimbabwe, its implementation has not been adequately addressed, because knowledge about the safety of this method is rudimentary and its acceptability is poorly understood. To address this knowledge gap, the authors conducted focus group discussions among mothers, grandmothers, midwives, and husbands in various regions of Zimbabwe. Although the practice of heat treating expressed human milk was initially met with skepticism because of potential obstacles, including time constraints and social and cultural stigma, a pattern of opinion reversal emerged in all groups. By the end of each discussion, participants believed that, given its affordability and its potential to protect infants from HIV infection, heat-treated human milk may be a feasible infant-feeding option for HIV-positive mothers in Zimbabwe. These findings merit further investigation so that appropriate behavioral strategies can be designed.

Adolescent↗
PubMed2005

Young people's sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey.

OBJECTIVES: To determine the prevalence of HIV infection, HIV risk factors, and exposure to national HIV prevention programs, and to identify factors associated with HIV infection among South African youth, aged 15-24 years. DESIGN: A cross-sectional, nationally representative, household survey. METHODS: From March to August 2003 we conducted a national survey of HIV prevalence and sexual behavior among 11 904 15-24 year olds. Multivariable models for HIV infection were restricted to sexually experienced youth. RESULTS: Young women were significantly more likely to be infected with HIV in comparison with young men (15.5 versus 4.8%). Among men, a history of genital ulcers in the past 12 months was associated with HIV infection [adjusted odds ratio (AOR), 1.91; 95% confidence interval (CI), 1.04-3.49) whereas among women a history of unusual vaginal discharge in the past 12 months was associated with HIV infection (AOR, 1.75; 95% CI, 1.26-2.44). Young women with older partners were also at increased risk of HIV infection. Among both men and women, increasing partner numbers and inconsistent condom use were significantly associated with HIV infection. Males and females who reported participation in at least one loveLife program were less likely to be infected with HIV (AOR, 0.60; 95% CI, 0.40-0.89; AOR, 0.61; 95% CI, 0.43-0.85, respectively). CONCLUSION: This survey confirms the high HIV prevalence among young people in South Africa and, in particular, young women's disproportionate risk. Programs for youth must continue to promote partner reduction, consistent condom use and prompt treatment for sexually transmitted infections while also addressing contextual factors that make it difficult for them to implement behavior change.

Adolescent↗
PubMed2005

Determinants and consequences of sexual networks as they affect the spread of sexually transmitted infections.

Because pathogens spread only within the unique context of a sexual union between people when one person is infectious, the other is susceptible to new infection, and condoms are not used to prevent transmission, the epidemiological study of sexually transmitted infections (STIs) is particularly challenging. Social network analysis entails the study of ties among people and how the structure and quality of such ties affect individuals and overall group dynamics. Although ascertaining complete sexual networks is difficult, application of this approach has provided unique insights into the spread of STIs that traditional individual-based epidemiological methods do not capture. This article provides a brief background on the design and assessments of studies of social networks, to illustrate how these methods have been applied to understanding the distribution of STIs, to inform the development of interventions for STI control.

Adolescent↗
PubMed2005

Impact of sexual networks on risk for gonorrhea and chlamydia among low-income urban African American adolescents.

OBJECTIVE: To determine whether African American adolescents, whose recent sex partners reported having another sex partner, are at increased risk for exposure to genital chlamydial infection or gonorrhea. STUDY DESIGN: A household sample of low-income urban African American adolescents 14 to 19 years of age, up to two of their close friends, and their sex partners were interviewed and tested for gonorrhea and chlamydial infection. RESULTS: Thirty-four of 145 adolescents had at least one recent sex partner infected with Neisseria gonorrhoeae and/or Chlamydia trachomatis. The adjusted model showed that adolescents, whose recent sex partners reported having another sex partner, were more likely to have a recent sex partner with gonorrhea and/or chlamydial infection. CONCLUSION: In addition to individual factors, network factors may explain why African American adolescents are at increased risk for exposure to sexually transmitted infections (STIs). Multi-level community-based interventions may need to address network factors along with personal behaviors in order to prevent STIs among low-income urban African American adolescents.

Adolescent↗
PubMed2005

Predictors of diaphragm use as a potential sexually transmitted disease/HIV prevention method in Zimbabwe.

BACKGROUND: Women who are the most vulnerable to sexually transmitted diseases/HIV are often unable to consistently use condoms. One potential alternative method currently under investigation is the diaphragm. GOALS: The goals of this study were to assess diaphragm uptake and use over time in Zimbabwe and to identify factors associated with self-reported consistent diaphragm use. STUDY: Women attending family planning clinics who were inconsistent condom users received a diaphragm intervention and were followed for 6 months. RESULTS: Of the 186 participants, 99% ever reported using the diaphragm, and, at study exit, 96% had used it in the previous 2 months. Consistent diaphragm use since the previous visit was reported by 13% to 16% of the women, and in multivariate regression analysis, it was significantly associated with never using condoms (adjusted odds ratio, 24.08; 95% confidence interval, 6.71-86.34). Other factors included discreet use, preferring diaphragms to condoms, timing of insertion, domestic violence, and contraception. CONCLUSION: Diaphragms were well accepted among women at risk for sexually transmitted diseases/HIV.

Adolescent↗
PubMed2005

A community-based study to examine the effect of a youth HIV prevention intervention on young people aged 15-24 in South Africa: results of the baseline survey.

OBJECTIVES: To determine whether South African youths living in communities that had either of two youth human immunodeficiency virus (HIV) prevention interventions [(a) loveLife Youth Centre or (b) loveLife National Adolescent Friendly Clinic Initiative] would have a lower prevalence of HIV, sexually transmitted infections (STIs), and high risk sexual behaviours than communities without either of these interventions. METHODS: In 2002 the baseline survey of a quasi-experimental, community-based study was conducted in South Africa. In total 33 communities were included in three study arms (11 communities per study arm). The final sample included 8735 youths aged 15-24 years. All participants took part in a behavioural interview and were tested for HIV, gonorrhoea (Neisseria gonorrhoeae) and Chlamydia (Chlamydia trachomatis). RESULTS: HIV prevalence was 20.0% among females and 7.5% among males (OR 3.93 95% CI 2.51-6.15). There were no significant differences between study arms for HIV, NG or CT prevalence at baseline. In multiple regression analyses, HIV was significantly associated with NG infection (OR 1.96 95% CI 1.24-3.12) but not with CT infection. Youths who reported >1 lifetime partner were also significantly more likely to be infected with HIV (OR 1.98 95% CI 1.55-2.52), as were those who reported ever having engaged in transactional sex (OR 1.86 P = 0.02) or having had genital ulcers in the past 12 months (OR 1.71 P < or = 0.001). CONCLUSIONS: HIV prevention programmes must ensure that gender inequities that place young women at greater risk for HIV infection are urgently addressed and they must continue to emphasize the importance of reducing the number of sexual partners and STI treatment.

AIDS-Related Opportunistic Infections↗
PubMed2004

Nonoxynol-9 100 mg gel: multi-site safety study from sub-Saharan Africa.

OBJECTIVES: To evaluate the safety of 100 mg nonoxynol-9 (N-9) gel, a vaginal microbicide, on the genital mucosa of women from Malawi and Zimbabwe in preparation for a phase III efficacy study. METHODS: HIV-uninfected women (180) were enrolled and randomized to either N-9 or placebo gel and instructed to insert gel into the vagina twice daily for 14 days. Follow up examinations were conducted at 7 and 14 days. RESULTS: The number of adverse events in the N-9 gel group was higher than in the placebo group (40% versus 13%; P < 0.01). Reported number of any genital symptoms was significantly higher in the N-9 group (38% N-9, 13% placebo; P = 0.01). The number of total epithelial disruptions was higher in the N-9 group (20% versus 3%; P < 0.01); however, the number of genital ulcers and abrasions in the N-9 group was low (2% and 3%, respectively) and not different from that in the placebo group (1% and 2%, respectively). CONCLUSIONS: N-9 gel 100 mg caused a significant increase in the rate of genital symptoms and epithelial disruptions compared with placebo. The clinical significance of these epithelial disruptions is unknown. Although these findings alone were not sufficient to cancel the planned phase III study, when considered together with the negative results from the COL-1492 effectiveness trial of 52.5 mg N-9 gel, the decision was made to cancel the planned phase III trial of 100 mg N-9 gel.

Administration, Intravaginal↗
PubMed2004

Early age of first sex: a risk factor for HIV infection among women in Zimbabwe.

OBJECTIVE: To explore the relationship between early age of coital debut (15 years of age or younger) and risk for HIV infection among sexually active urbanized Zimbabwean women. DESIGN: Cross-sectional analysis of screening data from a cohort study. METHODS: Sexually active women aged 18-35 years were recruited from public sector family planning clinics in and around Harare, Zimbabwe between November 1999 and September 2002. They received a brief behavioral interview and HIV testing. Of the 4675 women screened, 4393 (94%) had complete data on sexual behaviors and HIV serostatus, and were included in this analysis. RESULTS: HIV prevalence in this sample was 40.1%. The median age of coital debut was 18 years and 11.8% of women reporting having experienced coital debut at age 15 or younger. Women with early coital debut had a significantly higher risk profile, including multiple lifetime partners and not completing high school. In binary generalized linear regression models HIV risk was increased for women reporting early age of coital debut (relative hazard, 1.30; 95% confidence interval, 1.13-1.50), controlling for duration of sexual activity and current age; this effect was attenuated somewhat after controlling for other factors such as number of sexual partners. CONCLUSIONS: Our results show that early coital debut is a significant predictor of prevalent HIV infection independent of other identified factors in this population. HIV prevention strategies should include delaying the age of first coitus and should address the barriers that may prevent young women from so doing.

Adolescent↗
PubMed2004

Sexual power and HIV risk, South Africa.

Gender power inequities are believed to play a key role in the HIV epidemic through their effects on women's power in sexual relationships. We hypothesized that lack of sexual power, measured with a four-point relationship control scale and by a woman's experience of forced sex with her most recent partner, would decrease the likelihood of consistent condom use and increase the risk for HIV infection among sexually experienced, 15- to 24-year-old women in South Africa. While limited sexual power was not directly associated with HIV, it was associated with inconsistent condom use: women with low relationship control were 2.10 times more likely to use condoms inconsistently (95% confidence interval [CI] 1.17-3.78), and women experiencing forced sex were 5.77 times more likely to use condoms inconsistently (95% CI 1.86-17.91). Inconsistent condom use was, in turn, significantly associated with HIV infection (adjusted odds ratio 1.58, 95% CI 1.10-2.27).

Adolescent↗
PubMed2003

Determinants of contraceptive method among young women at risk for unintended pregnancy and sexually transmitted infections.

The objective of this study was to examine the relationship between contraceptive method choice, sexual risk and various demographic and social factors. Data were collected on 378, 15- to 24-year-old women, recruited from health clinics and through community outreach in Northern California. Logistic regression analysis was used to estimate the association of predictors with contraceptive method used at last sex. Asian and Latina women were less likely to use any method. Women who were raised with a religion, or thought they were infertile, were also less likely to use any method. Women with multiple partners were generally less likely to use any method, but were more likely to use barrier methods when they did use one. Few women (7%) were dual method users. Women appear to act in a rational fashion within their own social context and may use no methods at all or use methods that are less effective for pregnancy prevention but offer more protection from sexually transmitted infections.

Adolescent↗
PubMed2003

Sexual partners and use of emergency contraception.

OBJECTIVE: This study investigates the role of male sexual partners and relationships in determining whether women seek emergency contraception (EC) when needed. STUDY DESIGN: Data on EC use from a clinic-based sample of sexually active women, aged 15 to 30 years, in the San Francisco Bay area (n=497) were analyzed with multivariate logistic regression analysis. RESULTS: Results show that factors measuring power dynamics, such as male dominant decision making (odds ratio [OR]=4.1, P=.035) and pressure for sex (OR=2.7, P=.006), as well as a strong desire to avoid pregnancy on the part of the male partner (OR=4.2, P <or=.001), have a significant association with the use of EC. However, relationship factors known to be associated with use of other contraceptive methods, such as communication, satisfaction, and commitment, show no association with EC use. CONCLUSION: Factors predicting EC use, including male partner and relationship factors, may not always be evident to a clinician, so it is important to include EC as part of routine counseling.

Adolescent↗
PubMed2003

Barrier contraceptive method acceptability and choice are not reliable indicators of use.

BACKGROUND: The need for safe and effective female-controlled methods that protect against sexually transmitted pathogens is widely recognized. Product effectiveness is inextricably bound to use, and, therefore, the needs and preferences of potential consumers must be considered. The degree to which measures of acceptability correlate with actual barrier method use remains unexamined. GOAL: The goal was to evaluate associations between measures of acceptability and use of existing over-the-counter barrier methods. STUDY DESIGN: In the San Francisco Bay Area, 510 females aged 15 to 30 years were recruited from reproductive health clinics for this longitudinal study. RESULTS: Neither hypothetical acceptability nor product choice predicted use. Fewer than 50% of participants who chose a female-controlled method used it. Similarly, method satisfaction was not associated with use (14.3-51.4% of satisfied users used the method again). However, dissatisfaction was predictive of low levels of subsequent use (0-15.3% used the method again). Male condoms were used despite dissatisfaction. CONCLUSION: The lack of association among assessments of acceptability, choice, satisfaction, and use suggests a need to reframe how product acceptability is evaluated in prevention research so it is more predictive of method use.

Adolescent↗