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Epidemiologic factors correlated with multiple sexual partners among women receiving prenatal care.

A cross-sectional survey methodology was used to respond to the need of a local health department to identify correlates of high-risk behaviors related to human immunodeficiency virus (HIV) transmission among pregnant women attending prenatal care clinics. This study of 488 maternity patients was conducted at two public health clients in Tampa, Florida, in 1991. The prevalence of high-risk behaviors was assessed using a self-administered questionnaire. Out of 428 respondents, 25% reported having had intercourse with two or more male partners in the past year. Following multiple logistic regression analysis, four variables remained consistently and significantly associated (P < 0.05) with having two or more sexual partners: (1) annual household income of less than $10,000/y (prevalence odds ratio (POR) = 4.5; 95% confidence limits (CL): 1.5, 13.1); (2) history of prostitution (POR = 8.1; 95% CL: 1.5, 42.1); (3) history of rape or forcible intercourse (POR = 2.2; 95% CL: 1.0, 4.6); and (4) an expressed desire for confidentiality among women seeking further information about acquired immunodeficiency syndrome (AIDS) prevention (POR = 2.1; 95% CL: 1.1, 4.0). Assessment of these factors may lead to better direction of HIV education programs, as well as identification and counseling of specific individuals at high risk for engaging in behaviors that can lead to HIV infection. Short, self-administered questionnaires provide confidential, rapid, and inexpensive means of generating baseline data for further interventions.

Acquired Immunodeficiency Syndrome↗

Methods of HIV disclosure by men who have sex with men to casual sexual partners.

The purpose of this paper is to report results of a qualitative investigation into the methods that HIV-positive men who have sex with men (MSM) use to disclose their serostatus to casual sexual partners. In-depth, qualitative interviews were conducted with 57 HIV-positive adult MSM from a large midwestern city. Using an inductive approach to data analysis, our participants revealed a typology of disclosure consisting of strategies that can be placed into five primary categorizations of disclosure. These include: point-blank disclosure, indirect disclosure, stage setting, buffering, and seeking similars. This information can be especially beneficial to those working with men to develop better disclosure skills.

Adult↗

Absence of HIV-1 infection in antibody-negative sexual partners of HIV-1 infected hemophiliacs.

In order to confirm the presence and determine the frequency of human immunodeficiency virus, type 1 (HIV-1) infection prior to antibody production, 23 healthy women with histories of repeated unprotected sexual exposure to HIV-1 infected hemophiliacs were tested for evidence of HIV-1 infection. Female subjects were tested for HIV-1 antibody (enzyme immunoassay [EIA] and Western blot), HIV-1 serum antigen, HIV-1 DNA gag sequences by the polymerase chain reaction, and HIV-1 virus isolation from peripheral mononuclear cells. Twenty-two of 23 (96%) women were negative by all HIV-1 assays. One woman was positive by all the HIV-1 assays including an EIA screening test for HIV-1 antibody. These preliminary results suggest that the frequency of HIV-1 infection in antibody-negative sexual partners of HIV-1 infected individuals is probably very low.

Acquired Immunodeficiency Syndrome↗

Fulminant hepatitis B in successive female sexual partners of two anti-HBe-positive males.

In two separate families, consecutive, unrelated female sexual partners of a symptom-free, male, HBsAg-positive carrier died of fulminant hepatitis B. Although one man was HBeAg positive on the first occasion, both men were considered of low infectivity, being anti-HBe positive, negative for serum DNA polymerase activity, and negative for serum hepatitis B virus (HBV) DNA when their second partners presented with fulminant hepatitis B. By means of molecular hybridisation techniques, both men were found to have HBV DNA (3.2 kb) in seminal fluid, sputum, saliva, peripheral blood leucocytes, and liver.

Acute Disease↗

Review of evidence from risk factor analyses associating HIV infection in African adults with medical injections and multiple sexual partners.

Studies of risk factors for human immunodeficiency virus (HIV) infections in sub-Saharan Africa present a wealth of evidence relevant to ongoing debates about the contributions of unsterile health care and sexual transmission to Africa's HIV epidemics. From studies which meet search criteria (n = 39) we calculate population attributable fractions (PAFs) for incident and prevalent HIV infections associated with exposure to medical injections and with having more than one sexual partner. Median and mean crude PAFs for injections for both incident and prevalent HIV exceed those for multiple partners. Evidence suggests that adjustments for reverse causation (people with HIV-related symptoms seeking injections) and confounding do not explain away the large PAFs for injections. Misreporting of sexual behaviour has an unknown impact on PAFs for multiple partners. However, most PAFs for incident HIV infections are from communities with low-growth epidemics; hence data about the most important risk factors fuelling high-growth epidemics are sparse. Empirical resolution of ongoing debates may be possible with the aid of future research-especially in high-growth epidemic settings-that investigates risks for HIV transmission through a full range of sexual and parenteral exposures with attention to reverse causation, confound, and quality of sexual behaviour data.

Africa↗

Should sexual partners of women with bacterial vaginosis receive treatment?

Bacterial vaginosis is the most prevalent infectious cause of vaginitis. It is associated with significant morbidity, particularly in pregnant women and following gynaecological operations. Cure is difficult. There is some controversy over whether treating sexual partners of affected women can improve cure rates. This paper provides a critical appraisal of the evidence for simultaneously treating the male partner of women affected by bacterial vaginosis. Unfortunately, no evidence was found supporting the treatment of partners of women affected by bacterial vaginosis.

Adolescent↗

Transmission of syphilis between sexual partners in Gabon.

The prevalence and transmission of syphilis was studied in a semirural community in south eastern Gabon. The overall prevalence was 8% (99/1251) and there was no difference in age adjusted prevalence between men and women. The transmission of syphilis between sexual partners occurred in 18.1% (8/44).

Adolescent↗

Designing interventions to prevent HIV-1 infection by promoting use of condoms and spermicides among intravenous drug abusers and their sexual partners.

This paper summarizes the results of a 2-day workshop to identify the most effective educational strategies to promote use of condoms and spermicides for preventing heterosexual transmission of HIV-1 virus from intravenous drug abusers (IVDA) to their steady, nonintravenous drug abusing (NIVDA) sexual partners. Representatives from health departments, drug abuse treatment centers, academic institutions, service organizations, and the community discussed issues relating to population characteristics, educational strategies and recruitment techniques. A consensus document that identifies the most effective recruitment and intervention strategies was developed. Recruitment issues include locations, recruitment targets, anticipated difficulties, and ethical considerations. The majority of workshop participants agreed that an intervention should target the couple (both IVDA and NIVDA). Intervention concerns encompass obtaining trust, maintaining participation, and identifying guidelines to maximize program impact.

Acquired Immunodeficiency Syndrome↗

Bacterial vaginosis: a double-blind randomized trial of the effect of treatment of the sexual partner.

In a double-blind randomized controlled trial we assessed the effect of metronidazole treatment of the male partner on the recurrence rate of bacterial vaginosis. Women who fulfilled the diagnostic criteria for bacterial vaginosis were treated with metronidazole given in single doses of 2 g on days 1 and 3. The sexual partners were randomized to receive either the same dosage of metronidazole or a placebo. A total of 107 pairs completed the study. One week after the start of treatment 89% of the women considered themselves improved or cured and 93% no longer had the diagnostic criteria for bacterial vaginosis. At assessment 5 weeks after the treatment, 75% reported that they were cured or improved and the diagnostic criteria were not present in 73%. Treatment of the male partner did not affect subjective symptoms, clinical signs and isolation rates of Gardnerella vaginalis at 1 and 5 weeks after treatment.

Adolescent↗

Human papillomavirus DNA detection in male sexual partners of women with genital human papillomavirus infection.

OBJECTIVES: To determine the prevalence of human papillomavirus (HPV) DNA in the male partners of HPV-infected women, assess the concordance of the viral group in the infected pair, define the most affected sites in the male genitalia, and compare diagnostic methods in men. METHODS: Fifty male, stable sexual partners of women positive for HPV DNA by the Hybrid Capture 2 (hc2) test had material brushed from six different anogenital areas for hc2 testing. One week later, patients underwent classic peniscopy, and the lesions were biopsied for histologic analysis and hc2 testing. RESULTS: The brushings were HPV DNA positive in 35 (70%) of the 50 men: 32% in the high-risk HPV group, 14% in the low-risk HPV group, and 24% in both groups. HPV detection per anatomic site was 24% in the glans, 44% in the prepuce internal surface, 30% in the distal urethra, 24% in the prepuce external surface, 12% in the scrotum, and 8% in the anus. Acetowhite lesions were seen in 44 (88%) of the 50 patients. Overall, HPV DNA was detected in 27 (26%) of the 104 biopsy specimens, but histologic examination showed evidence of HPV infection in only 14 (13.5%) of 104 biopsy specimens. In 3 (6%) of 50 patients, hc2 was positive only in the histologic examination. Overall, the prevalence of detectable high-risk HPV DNA among male partners was 60% (30 of 50). CONCLUSIONS: Of the 50 male partners studied, 76% were HPV DNA positive. Histologic examination was an inaccurate method to diagnose HPV DNA infection in men; however, brushings detected HPV in 92.1% of the infected men.

Acetic Acid↗

Urological evaluation of sexual partners of women with human papillomavirus (HPV) infection.

Cancer of the uterine cervix has been related to HPV infection, based on clinical and laboratory data. The high recurrence rate in couples undergoing treatment for HPV infection points to a probable viral reservoir, either in subclinical lesions or in male internal genital organs. We have evaluated 31 men, all sexual partners of women with HPV infection. Eleven patients (35.5%) had related lesions: 4 (12.9%) with condyloma acuminatum; 5 (16.1%) with lesions revealed by magnified examination after reaction with 5% acetic acid and 2 (6.5%) with condyloma and subclinical lesions. A short-term follow-up confirmed a successful treatment with podophyllin.

Adult↗

Investigating the presence of HIV sequences and the distribution of virological markers in hemophiliacs and their sexual partners.

In this study, we report the investigation of a hemophiliac cohort, in which the last HIV-1 seroconversion occurred in 1985. We wanted to evaluate whether 5 years later the results of serological screening and polymerase chain reaction (PCR) technology would match. We examined 61 German patients with congenital deficiencies of factors VII, VIII-c, and IX, and 16 sexual partners (15 partners of anti-HIV-1-negative hemophiliacs). Patients' and partners' anti-HIV-1 status was determined by ELISA and Western blot. Further, we applied the PCR to investigate the possible presence of HIV sequences in anti-HIV-1-negative individuals. Four sets of primers were used in four separated reactions to avoid false-negative results due to genetic variation, as well as false-positive results due to DNA carryover. The data by PCR were not different from the data attained by conventional serological methods. The prevalence of serological markers for HBV and HCV was determined.

HIV↗

Could the sexual partner be a risk factor in breast cancer?

Based on a possible viral etiology and a certain type of sexual behaviour (oro-telia), the Author examines and then argues about the possibility that the sexual partner could be a risk factor in breast cancer. Therefore he hopes that specialists (mammologist, sexologist, psychologist, psychotherapist, sociologist, etc.) will be motivated to verify this hypothesis.

Breast Neoplasms↗

Multiple sexual partners and mother-to-child transmission of HIV-1.

OBJECTIVE: To investigate risk factors for mother-to-child transmission of HIV-1, particularly sexual behavior before and during pregnancy. DESIGN AND METHODS: This study is part of a prospective cohort study in Butare, Rwanda, of 318 HIV-1-seropositive and 309 HIV-1-seronegative women enrolled during pregnancy and followed for a mean duration of 21 months (range, 8-34 months). Clinical follow-up of the mother-infant pairs was performed at 6-week intervals during the first year of life and at 4-month intervals thereafter. Detailed sexual history interviews were conducted during pregnancy and at the first postnatal visit. RESULTS: Of 184 singleton infants born to HIV-1-infected mothers who survived the neonatal period, 32 (17%) children were classified as HIV-1-infected, 130 (71%) as not infected, and 22 (12%) died with indeterminate HIV-1 infection status. The vertical transmission rate was estimated to be between 20 and 29%. Unprotected sexual intercourse with increased number of partners during the past 5 years was strongly associated with mother-to-child transmission (P < 0.001), even after adjustment for maternal CD4/CD8 ratio, parity, history of sexually transmitted diseases, and evidence of genital infection during pregnancy. In a multivariate analysis, excluding children with indeterminate HIV-1 status, odds ratios for vertical transmission were 2.6 [95% confidence interval (CI), 1.0-6.9] for maternal CD4/CD8 ratio < 0.5 and 3.6 (95% CI, 1.1-11.8) for more than three sexual partners versus a single partner. Women with more than one sexual partner during the first trimester of pregnancy were at particularly high risk of transmitting the virus. CONCLUSION: Unprotected sexual intercourse with multiple partners before and during pregnancy in a population with high HIV-1 seroprevalence may well increase the likelihood of HIV-1 transmission from an infected mother to her child.

CD4-CD8 Ratio↗

Sexual partners of injecting drug users: the risk of HIV infection.

The sexual mediation of HIV infection by injecting drug users to the heterosexual population has become a major issue in AIDS prevention. Infection that is acquired through sharing contaminated injecting equipment can be passed on to non-injecting drug using partners and to non-drug using partners through sexual intercourse. A study of risk behaviour among injecting drug users in the North West of England focused, inter alia, upon aspects of their sexual activity and attitudes that have relevance for HIV transmission. It was found that in those respondents with regular partners, the level of sexual activity was related to the partner's use of drugs. The use of condoms was low in the sample as a whole, including those who reported having casual sexual contacts and sharing others' injecting equipment. These data confirm the need for concern and the advisability of targetting safer-sex education on drug users.

Adult↗

Awareness of sexual partners' HIV status as an influence upon high-risk sexual behaviour among gay men.

OBJECTIVE: To evaluate the extent to which 'high-risk' sexual behaviour is influenced by awareness of partners' HIV status among gay men. DESIGN: Structured interviews and collection of saliva samples for anonymous linked testing for HIV-1 antibodies. SETTING: Genitourinary medicine clinics and the gay community. SUBJECTS: Men (n = 677) who reported sexual contact with another man in the last 5 years. RESULTS: The majority of respondents (63%) had had an HIV-antibody test. Analysis of data showed that in 15% of the respondents' 1380 partnerships, HIV status was known by both parties. However, the majority of partnerships involved only safe sex. Only 26% of the partnerships in which unprotected penetrative anal sex had occurred involved mutual knowledge of HIV status and was most likely to occur with regular rather than non-regular/causal partners. Logistic regression revealed that this latter association could not be explained in terms of mutual HIV status knowledge. CONCLUSIONS: Despite widespread HIV testing, the majority of gay men engaging in high-risk sex are unaware of their partner's HIV status.

Adolescent↗