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PubMedDate not supplied

The relationship of substance use to sexual activity among young adults in the United States.

Data on substance use and sexual activity from a nationally representative, probability-based sample of young adults aged 18-30 in 1990 indicate that 86% of respondents had had sex in the previous 12 months, with three-fourths reporting no more than one sexual partner. Seventy-five percent of respondents had consumed alcohol in the past 12 months, 40% had smoked cigarettes and 20% had used marijuana. After adjustment for demographic factors, both sexual activity and a history of multiple partners were positively associated with some measures of substance use. Respondents who drank more frequently, those who were heavy drinkers, those who smoked cigarettes and those who used marijuana in the past year were more likely than others to be sexually active. Those who consumed five or more drinks at a sitting and those who used marijuana were more likely than others to have had more than one sexual partner. Heavy drinkers were also less likely to use condoms; however, the results showed no association between having sex under the influence of alcohol and engaging in unsafe sexual practices.

Adolescent↗

PubMed1993

Anthropology and AIDS: the cultural context of sexual risk behavior among urban Baganda women in Kampala, Uganda.

One hundred and thirty Baganda women (65 HIV antibody positive and 65 HIV antibody negative), recruited from the Makerere University-Case Western Reserve University Collaborative Pediatric follow-up clinic in Kampala, Uganda were interviewed about cultural rules and norms for sexual behavior and HIV-specific risk behaviors. Interviews were analyzed for themes related to sexual risk, cultural rules regarding sex, and individual sexual practices. Statistical relationships were tested using chi 2 and t-test statistics. The mean age of the women was 21 years (range 15-30). Despite sexual norms prohibiting sex for women outside marriage, subjects reported that there are certain circumstances when a woman may take other partners, including economic need, desire for greater sexual satisfaction, or revenge on a husband with other partners. Cases were more likely to state that women may have outside partners for economic reasons (P < 0.05) and that women have outside partners for sexual satisfaction (P < 0.01). Women interviewed for this study are complying with Ugandan AIDS control messages to 'zerograze' and 'stick to one partner'. Fear of AIDS remains high, however, because women fear that their partners have not responded to risk reduction messages. Of those women stating fear of AIDS, 57% of cases and 62% of controls based their fear on their perceptions of their partners' activities. Therefore, women feel that they remain at risk of infection despite their own behavior change. We find that, while the potential for risk reduction is high for these women, cultural norms permitting males to have multiple partners limit a woman's ability to control her risk reduction. Important conclusions are: (1) a focus on women's behavior alone is not sufficient as both partners must respond to risk reduction messages; (2) knowledge about AIDS is not sufficient to achieve change in sexual behavior because sexual behavior is linked to economics, gender relations, and other complex socio-cultural factors; and (3) a study of Baganda male sexual values and behavior is urgently needed.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Increased condom use without other major changes in sexual behavior among the general population in Switzerland.

OBJECTIVES: This study is part of a continuous evaluation of the Swiss AIDS prevention strategy from 1987 through 1994. METHODS: Annual telephone surveys of samples representative of the general population aged 17 through 45 years have been conducted since 1987 to monitor behavioral change. RESULTS: No major changes in level of sexual activity (lifetime number of partners, frequency of sexual encounters in the past week) or potential exposure to risk of HIV transmission (acquisition of a new steady partner during the year or of casual partners in the last 6 months) were observed. Systematic condom use with a new steady partner increased between 1988 and 1994, from 40% to 64% among 17- to 30-year-olds and from 57% to 72% among those aged 31 to 45. Systematic condom use with casual partners increased from 8% to 56% between 1987 and 1994 among 17- to 30-year-olds and from 22% to 42% between 1989 and 1994 among those aged 31 to 45. Condom use was higher among those with multiple partners. CONCLUSIONS: A general-population approach to AIDS prevention was able to achieve large-scale improvements in condom-based protection against HIV infection without inducing other major changes in sexual behavior.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Cognitive and behavioral adaptations to HIV/AIDS among gay and bisexual adolescents.

PURPOSE: To examine short-term changes in HIV knowledge, beliefs, and behaviors among gay and bisexual adolescents, 139 gay and bisexual male adolescents (13-21 years of age) completed interviews and self-administered surveys of HIV-related knowledge, attitudes, and behaviors during an initial assessment (Time 1) and 3-6 months after intervention (Time 2). METHODS: The intervention included individualized HIV/AIDS risk assessment and risk reduction counseling, peer education, and referrals to needed services. Cross-sectional (group) and individual cognitive and behavioral changes were examined; adolescents who reported unprotected anal intercourse and/or injecting drug use after interventions were compared to those who did not. RESULTS: Compared to Time 1, 60% fewer subjects at Time 2 reported unprotected anal intercourse with recent partners. Subjects also reported less frequent anal intercourse and more consistent use of condoms during follow-up. Substance abuse severity scores and use of amphetamines and amyl nitrite declined. One-quarter of subjects reported ongoing high-risk behaviors associated with multiple partners, frequent anal intercourse, completion of education, and relative numbers of gay friends. CONCLUSIONS: Compliance with HIV risk reduction improved over time. Constructive change most often involved the practices of anal intercourse and, to a lesser extent, oral sex. Ongoing risk-taking behavior may reflect serious psychosocial problems.

Adaptation, Psychological↗

PubMed1991

The epidemiology of group B streptococcal colonization in pregnancy. Vaginal Infections and Prematurity Study Group.

Risk factors for cervicovaginal group B streptococcal colonization at 23-26 weeks' gestation were studied in 7742 women participating in the Vaginal Infections and Prematurity study. The prevalence of group B Streptococcus was 18.6%, and was greatest in (predominantly Caribbean) Hispanics from New York City, followed by blacks, whites, and other (predominantly Mexican) Hispanics. Group B Streptococcus was more common among older women and women of lower parity, and less common among women living with their partner compared with those living alone. Current smoking was associated with a decreased risk of colonization, and group B Streptococcus was less common among women with more education. Increased risk was seen only with extreme increases in sexual activity including both frequent intercourse and multiple partners during the previous year. The risk of colonization was greater when there was concurrent colonization with Candida sp, but group B Streptococcus was not associated with carriage of Chlamydia trachomatis, Ureaplasma urealyticum, Trichomonas vaginalis, and Mycoplasma hominis. External genital erythema and scaling, purulent vaginal discharge, and pH greater than 5 were associated with increased colonization. Although these associations can raise the clinical index of suspicion for group B streptococcal colonization in a given patient, the study data did not enable us to select a small group of women with a very high probability of colonization. We conclude that selective screening is not useful in detecting group B streptococcal colonization in pregnancy.

Adolescent↗

PubMed1996

Cumulative sexual intercourse patterns among middle adolescents: problem behavior precursors and concurrent health risk behaviors.

PURPOSE: The purpose of this study is to document associations among problem behaviors in childhood and early adolescence and several health risk behaviors in middle adolescence, including a cumulative index of sexual intercourse risk. METHOD: A nontreatment sample of 1167 10th and 11th grade students was recruited from three homogeneous suburban high schools in western New York. Intercourse activity and number of sexual partners were assessed four times at 6-month intervals over a 2-year period via self-report questionnaires administered in classroom settings. RESULTS: Sexual intercourse activity, once initiated, was found to be relatively persistent, rather than sporadic, for most adolescents. Repeated intercourse experience with multiple partners over the assessed time periods was associated with higher levels of externalizing childhood behavior problems, earlier onset of antisocial behaviors and substance use, and higher concurrent substance use. An avoidant, withdrawn behavioral style in childhood was associated with lower rates of sexual involvement in adolescence. CONCLUSIONS: Temporal linkages among childhood precursors and adolescent sexual behaviors were identified as critical to understanding adolescent risk behaviors. These cross-time relationships may identify potential targets for future intervention/prevention efforts among high risk subsamples of children and adolescents.

Adolescent↗

PubMed2001

CO(2) laser vaporization as primary therapy for human papillomavirus lesions. A prospective observational study.

BACKGROUND: Human papillomavirus manifestations occur with increased frequency and severity amongst sexually active people. Several therapeutic approaches have been suggested to treat this viral disease. The aim of this prospective observational study was to assess the effectiveness of CO(2) laser vaporization for human papillomavirus warts. MATERIALS AND METHODS: Eighty healthy sexually active women with cytologically, colposcopically and histologically diagnosed human papillomavirus urogenital and perianal warts were enrolled and then treated by CO(2) laser (16-18 W). Male partners were also investigated, and interferon-beta was eventually administered. All patients were then followed up for twelve months consecutively. RESULTS: At twelve-month follow-up, warts clearance was observed in 70 (87.5%) women. Recurrence was reported in ten (12.5%) women with multiple partners and affected by flat or endophytic condiloma of the cervix. Moreover, there were no complaints of pain, scar tissue deformity or other side effects. CONCLUSIONS: CO(2) laser vaporization is an effective, as well as safe and simple therapeutic approach for treatment of human papillomavirus warts. Its use should be encouraged for condyloma acuminata not associated with malignancy, as well as during pregnancy.

Adult↗

PubMedDate not supplied

[Key aspects of sexual behavior and safer sex practice among men in the city of São Paulo].

Heterosexual relations currently constitute the predominant route of HIV transmission to women in Brazil. Few studies have approached male sexual behavior taking women into account. This study included 597 men ages 21 to 50 in São Paulo city and explored several aspects pertaining to safer sex, such as sexual partners, knowledge of sexually transmitted diseases (STDs)/AIDS, risk perception, and protective practices aimed at AIDS prevention. The results showed that, similar to other countries, the proportion of men who have sex with men is low (5%), that younger men adopt more protective behavior than older men regarding multiple partners and condom use, that knowledge of AIDS is widespread (but that there is still a lack of knowledge concerning STDs in general), and that although risk perception increases protective behavior, presumption of the partner's behavior influences this perception, placing men and women in a vulnerable situation.

Acquired Immunodeficiency Syndrome↗

PubMed1999

Psychological abuse: implications for adjustment and commitment to leave violent partners.

The contribution of psychological abuse, beyond that of physical abuse, to battered women's psychological adjustment and their intentions to terminate their abusive relationships was examined. Sixty-eight battered women residing in shelters for battered women provided information on their: (1) physical and psychological abuse; (2) psychological symptomatology; (3) strategies for coping with and perceptions of control over partner violence; and (4) intentions to return to their abusive partners. Multiple regression analyses indicated that frequency and severity of physical abuse was not a significant predictor of posttraumatic stress disorder (PTSD) symptomatology nor of women's intentions to terminate their abusive relationships. However, psychological abuse was a significant predictor of both PTSD symptomatology and intentions to permanently leave abusive partners even after controlling for the effects of physical abuse. PTSD symptomatology moderated the relationship between psychological abuse and intentions to terminate the abusive relationships: resolve to leave the abusive partner as a function of level of psychological abuse was significant only among women characterized by low levels of PTSD symptomatology. Greater use of emotion-focused coping strategies, absolutely and relative to problem-focused coping, had direct effects on PTSD symptomatology. However, neither coping nor perceptions of control moderated the effects of psychological abuse on psychological adjustment. The results of the investigation suggested that psychological abuse and ensuing PTSD symptomatology are important variables to assess among physically battered women.

Adaptation, Psychological↗

PubMed1983

Acquired immunodeficiency syndrome, opportunistic infections, and malignancies in male homosexuals. A hypothesis of etiologic factors in pathogenesis.

The acquired immunodeficiency syndrome (AIDS) occurs in a subgroup of male homosexuals having sexual contact with a large number of partners. Uncommonly, AIDS has also been diagnosed in Haitians, hemophiliacs, and intravenous drug users and their infants. Manifestations include autoimmune disturbances, opportunistic infections, Kaposi's sarcoma, chronic lymphadenomegaly, non-Hodgkin's lymphoma, or squamous cell carcinoma. The hypothesis receiving most consideration is that a yet-to-be-identified virus causes AIDS. An alternative view is that repeated sexual involvement with multiple partners, in a subgroup of male homosexuals, exposes the men to the immunosuppressive impact of cytomegalovirus (CMV) and allogeneic semen. Antibody to asialo-Gm1 and other antigens on sperm react with and impair lymphoid cells. We propose a biphasic process. First, a reversible acquisition phase of impaired T-cell immunoregulation permits reactivation of Epstein-Barr virus (EBV), and autoantibodies are produced by the activated B cells. If sexual activity continues at a high level, accumulating immune defects, including destruction of thymic epithelium, lead to a second, self-sustaining phase wherein cytotoxic lymphocytes fail to eliminate herpesvirus-infected cells. Evidence is mounting that Kaposi's sarcoma is caused by CMV and that EBV is responsible for the B-cell lymphomas in these patients. Multiple factors, rather than a novel virus, probably induce AIDS in male homosexuals. If this hypothesis is correct, then rational bases for prevention and intervention can be designed.

Acquired Immunodeficiency Syndrome↗

PubMed2002

Men who have sex with men and also inject drugs-profiles of risk related to the synergy of sex and drug injection behaviors.

OBJECTIVES: Men who have sex with men and also inject drugs (MSM-IDU) are among the groups at highest risk for acquiring and transmitting HIV in Colorado and the US. We conducted formative research and a survey among MSM-IDU in Denver to better understand sexual and drug HIV risk behaviors and how they interact. METHODS: Formative data were collected with 30 persons who work, live or otherwise interact with MSM-IDU using a semi-structured interview instrument. Survey data on sexual and drug risk behaviors were collected with 100 MSM-IDU; eligible participants have had sex with men and injected drugs within the past six months. RESULTS: Results from formative research were used to generate the survey instrument. The survey results demonstrate high-risk sexual behaviors with multiple partners of both genders; 82% of the sample had primary and non-primary male partners, 20% had non-primary female partners, and 15% exchanged money or drugs for sex. Condom use was inconsistent and infrequent for all types of sex (vaginal, anal and oral) and with all types of partners. Drug risk behaviors highlight that the injection drugs of choice for this sample (90% shoot cocaine and 59% shoot methamphetamine) stimulate sexual desire and cocaine injection increases opportunities for injection risk behavior. Forty-five percent of the sample were HIV-infected. Significant differences between HIV infected and non-infected men were not observed with regard to many sexual and drug risk behaviors. CONCLUSIONS: These data show that MSM-IDU are engaging in multiple risk behaviors that may have a synergistic effect on HIV transmission, and that their injection drug of choice contributes to their risk. That there do not appear to be consistent differences in preventive behaviors between men with or without HIV infection suggests a greatly increased risk for HIV transmission in this group of men and their partners. Because MSM-IDU do not identify strongly with either MSM because they may not gay identify or IDU because they do not use heroin, targeted HIV prevention strategies for this group are urgently needed.

Adult↗

PubMed1995

Patterns of sexual behavior and risk taking among young New York City gay men.

One-hundred and seventy-four young New York City gay men (aged 18-24) were studied over a two-year period. We describe patterns of HIV risk taking behavior and factors that predict risk taking. Among men who engaged in receptive anal intercourse we discerned different patterns of behaviors. We defined risk takers as men who engaged in receptive anal intercourse. About two-thirds of the men fall into this category in each year, and about half of those (one third of the total) engaged in unprotected anal intercourse. Most of these men seem to make implicit decisions in managing their risk for HIV. Men who engaged in receptive anal intercourse were more likely to be in a coupled relationship and to know their partners' HIV status. Alcohol and/or drug use during sex, earlier sexual experiences, and greater integration into the gay community were also related to receptive anal intercourse. By contrast, a significant minority of the men, about 6% of the sample, engaged in very high risk behavior in each year of the study-defined as unprotected receptive anal intercourse with multiple partners. It appears that very high risk takers are qualitatively different from other risk takers: They reported more mental health problems, including more drug use, and higher levels of internalized homophobia and AIDS-related traumatic stress response. Implications for AIDS education and prevention are discussed.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Sexual behavior and condom practices among Los Angeles women.

BACKGROUND: The sociodemographic correlates of the number of recent sexual partners and condom use are investigated in a population-based sample of 1,178 unmarried women living in Los Angeles County. RESULTS: Asian Americans, foreign born, and older women are less likely to be sexually active and that more educated and previously married women are more likely. Among the sexually active (n = 909), Hispanic women and older women are less likely to have multiple partners, and younger and previously married women more are more likely. African-American women and younger women are more likely to use condoms; older and previously married women are less likely. CONCLUSIONS: Results from this study indicate that women-centered primary and secondary prevention efforts may benefit from targeting women not previously considered, such as women of post-reproductive age and divorced women.

Adult↗

PubMedDate not supplied

Sex, alcohol and sexually transmitted diseases: a national survey.

The analysis of a representative national survey of households provides strong evidence that alcohol overshadows illicit drug use as a risk factor for sexually transmitted diseases (STDs). Men and women who report a history of STDs are significantly more likely to have a history of problem drinking, independent of high-risk sexual activities and demographic characteristics. However, a high rate of change in sexual partners over the past five years also increases the chance of STD infection. Sexual orientation is a major STD risk factor among men but not among women. Although both black men and black women are at greater risk of STDs than are those in other racial or ethnic groups, results indicate that black women's greater likelihood of having sex with men who have multiple partners, rather than their own rates of partner change, makes the crucial difference between their risk and that of white women.

Adult↗

PubMed1990

Hepatitis B: transmission by sexual contact and needle sharing.

In the Western world most cases of hepatitis B virus (HBV) infection are acquired through sexual intercourse and through needle sharing by intravenous drug users (IVDU). The major risk factors for HBV infection in homosexual men include the number of sex partners and receptive anal intercourse. In heterosexuals, this risk also rises with an increasing number of sex partners. IVDU consistently show the highest HBV infection rates in Europe and North America, presently accounting for 25 to 50% of all hepatitis B cases. Infection with the human immunodeficiency virus affects the course of HBV infection as well as the immunological response to hepatitis B vaccines. Thus, in the industrialized world, interventions against HBV infection should primarily be targeted to homosexual men, heterosexuals with multiple partners, and IVDU.

HIV Infections↗

PubMed2001

Incidence and prevalence of chlamydia, herpes, and viral hepatitis in a homeless adolescent population.

BACKGROUND: High rates of unprotected intercourse and illegal drug use have been reported among homeless adolescents. As a transient population with the potential to act as disease vectors from one location to another, incidence and prevalence of sexually transmitted infections in this population are of particular concern. GOAL: To assess a homeless adolescent population for incidence and prevalence of Chlamydia trachomatis, herpes simplex virus type 2, hepatitis B virus, hepatitis C virus, HIV, and psychosocial correlates of the acquisition of sexually transmitted infections. STUDY DESIGN: Longitudinal with assessments at baseline, 3 months, and 6 months (n = 536; 319 males and 217 females). RESULTS: Baseline prevalence of C trachomatis was 4.17% for males and 6.30% for females. Prevalence of herpes simplex virus type 2 was 5.73% for males and 12.50% for females. Hepatitis B virus and hepatitis C virus prevalences were 3.60% and 5.0%, respectively. HIV seroprevalence was 0.3%. The incidence of sexually transmitted infections was significantly higher among females than among males (16.7% versus 9.8%) and was associated with inconsistent condom use and, for females, number of partners and sex with older partners. Incident hepatitis B virus and hepatitis C virus infection rates were 3.44% and 6.61%, respectively; both were associated with injection drug use. CONCLUSIONS: Among females, the incidence of herpes simplex virus type 2 (> 25%) and C trachomatis (12%) was relatively high. Inconsistent condom use was the primary factor associated with a significantly greater risk of incident sexually transmitted infections. This was especially true for females with multiple partners. Homeless adolescents also are at high risk for hepatitis B virus and hepatitis C virus infection, primarily associated with self-reported injection drug use.

Adolescent↗

PubMed1998

Multiple-risk behaviour in adolescents and young adults.

OBJECTIVES: This article examines the prevalence of four risk behaviours among teenagers and young adults: smoking, binge drinking, sex with multiple partners, and sex without a condom. DATA SOURCE: The data are from a Health Canada-sponsored supplement to the 1994/95 National Population Health Survey. The analysis is based on 905 respondents aged 15 to 19 and 1,055 respondents aged 20 to 24. ANALYTICAL TECHNIQUES: Prevalence estimates of the four risk behaviours were calculated for males and females in each age group. An index of multiple-risk behaviour was derived by summing the four risk behaviours. Hierarchical multiple regression was used to examine how sets of variables are related to multiple-risk behaviour. MAIN RESULTS: Multiple-risk behaviour was higher among young people who had never married, who were not students, and who did not live with a parent. Feeling distressed was positively linked with multiple-risk behaviour, while regular attendance at religious services was negatively linked with such conduct.

Adolescent↗

PubMed1995

Factors predicting continued high-risk behavior among gay men in small cities: psychological, behavioral, and demographic characteristics related to unsafe sex.

Nearly 6,000 men entering gay bars in 16 small American cities were anonymously surveyed to assess their sexual behavior and to determine predictors of risky sexual practices. Excluding individuals in long-term exclusive relationships, 27% of the men reported engaging in unprotected anal intercourse in the past 2 months. Factors strongly predictive of risk included having a large number of different male partners, estimating oneself to be at greater risk, having weak intentions to use condoms at next intercourse, believing that safer sex is not an expected norm within one's peer reference group, being of younger age, and having less education. These findings indicate that HIV prevention efforts are urgently needed for gay men in smaller cities, with efforts particularly focused on young and less educated men sexually active with multiple partners. Prevention should focus on strengthening intentions to change behavior and on changing social norms to foster safer sex.

Acquired Immunodeficiency Syndrome↗