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PubMed1998

Augmented HIV vaccine trial design for estimating reduction in infectiousness and protective efficacy.

It is important to design HIV vaccine trials to estimate the efficacy of a vaccine in reducing infectiousness in addition to the protective efficacy. Currently planned phase III HIV vaccine field trials in which at-risk individuals are randomized and followed over time do not permit estimation or testing of the vaccine's effect on reducing infectiousness of vaccinees who become infected. We suggest an augmentation of these field trials that recruits steady sexual partners of the primary participants into the trial as far as they are willing to participate. This study design would allow estimation of the efficacy of the vaccine on reducing infectiousness as well as the protective efficacy. We compare the classical design that does not include partners to two different types of augmented design. In the first type of augmentation, called the non-randomized partner design, the steady sexual partners are not randomized to vaccine or placebo. In the second type of augmentation, called the randomized partner design, the steady sexual partners are also randomized to vaccine or placebo. We present a probability model based on infection status at the end of the trial that provides maximum likelihood estimates of the protective efficacy of the vaccine, VES, and the efficacy of the vaccine on reducing infectiousness, VEI. Wald statistics are used for one degree of freedom tests on VES and VEI. With the augmented design, a likelihood ratio test is used to test whether the vaccine has any effect at all. The randomized partner design has more power and provides narrower confidence intervals than does the non-randomized partner design.

AIDS Vaccines↗

PubMed1995

Self-disclosure of HIV-1 antibody test results: the San Francisco General Hospital Cohort.

We followed 93 subjects from the San Francisco General Hospital Cohort for one year after notifying them of their HIV-1 antibody test results in order to examine self-disclosure, reactions, and concerns regarding disclosure. By one year post-notification, 92% of gay friends, 82% of primary sexual partners, 56% of new sexual partners, 46% of co-workers, 71% of physicians, 37% of dentists, 57% of psychotherapists, and 37% of family members had been told. Subjects were twice as likely to tell primary sexual partners, and more likely to self-disclose to all categories of persons (except physicians and dentists) than anticipated prior to notification. Least favorable reactions to seropositivity were from male family members and primary sexual partners, while seronegative subjects experienced unfavorable reactions only from some family members. Subjects were most concerned about health insurance (71%) and stigmatization (61%), but the latter declined (to 36%) at 12 months. Although encouraging, these findings suggest that self-disclosure should be discussed in both pre- and post-test counseling sessions.

AIDS Serodiagnosis↗

PubMed1996

Maintaining safer sex behaviours in HIV-infected adolescents with haemophilia. The Hemophilia Behavioral Evaluative Intervention Project Committee.

Adolescents with haemophilia comprise 44% of the reported AIDS cases in teenagers. Unprotected sexual intercourse among this group increases the risk of HIV transmission. Understanding the influences which others may have on the sexual behaviour of adolescents with HIV and haemophilia may lead to the development of effective risk reduction strategies. An evaluative instrument, administered to 307 HIV-infected adolescents with haemophilia, assessed their behavioural stage of change (Prochaska & DiClemente), attitudes, beliefs and behaviours about safer sex practices. The influence of parents, peers and sexual partners on sexual behaviour was compared between (1) those who were sexually experienced and (2) and those who were sexually inexperienced. Barriers and facilitators to practising safer sex were identified. Although parents influenced the sexual behaviour of both groups, this influence was significantly greater in the sexually inactive group. Fewer than 20% reported that their peers impacted their decisions about sexual behaviour. Eighty-six per cent of the sexually active indicated that partners significantly impacted their sexual decisions, while 60% of the sexually inactive indicated that future partners would affect their decisions about sex. Most participants agreed that disclosure of HIV status before intercourse was desirable, but only 31% of the sexually active said they told every partner. Fear of rejection or a negative reaction from the partner, and lack of communication skills were the greatest barriers to disclosure of HIV status and practising safer sex. This study indicates that behavioural interventions for both groups should focus on developing communication skills and self-efficacy. Interventions should include the key influences for each group--parents for the sexually inactive and partners for the sexually active.

Adolescent↗

PubMed1990

Carcinoma of the cervix uteri and risk factors.

A prospective study included 210 patients and 100 healthy individuals in whom risk factors for the onset of malignant disorders of the cervix uteri were investigated. The following parameters were analyzed: age, profession, religious affiliation, former pregnancies, chronic irritative process on the cervix uteri, socio-economic status, heredity, contraceptive usage, smoking, sexual life and presence of the human papilloma viruses in the injured and healthy cervix. The results of the research emphasized the relevant risk factors for the genesis of the disease. They are presented in an original sheme. The central place in the pathogenesis of the disease is taken by the existing metaplasia on the portio vaginalis uteri and its contact with definite types of human papilloma viruses. The risk factors that contribute to the genesis of metaplasia and cervical infection by human papilloma viruses proved to be of great importance for the appearance of disorder. The adolescent period, the chronic irritative process on the portio vaginalis and the long-term use of hormonal contraceptives influence the genesis of metaplasia. Early sexual life, the changing of sexual partners, the sexual life of male partners, poor sexual hygiene, and the use of nonbarrier contraceptive devices favour the development of human papilloma viral infections of the cervix uteri.

Adult↗

PubMed2004

Sexual patterning and condom use among a group of HIV vulnerable men in Thika, Kenya.

BACKGROUND/AIM: A composite sample of 37 peer educators and 215 members of self help groups of male informal sector workers in Thika, Kenya, targeting HIV/AIDS prevention, were interviewed about their sexual behaviour, using a customised template, as part of a broader survey on gender attitudes and peer pressure. METHOD: Details on each sexual partner reported by each man over a 12 month recall period included type of partner, months during which sexual relations took place, and condom use. RESULTS: The men reported 471 sexual partners over the recall period, with a range of 0-16 partners, and an average of just under two partners. 8% of men had had no sexual partner, half were monogamous, and 3% had multiple partners with whom they used condoms exclusively, leaving 39% at varying degrees of risk. Condom use increased significantly with reduced intimacy of partner. 16% of men reported having at least one liaison with a female sex worker and two thirds of such liaisons were exclusively protected by condom use. Younger, single men had significantly more partners, but were more likely to use condoms. Duration of membership in self help groups was strongly associated with exclusive use of condoms with casual or FSW partners. Recorded attitudes corresponded somewhat with practice, but the data showed large gaps between the two, and low levels of gender sensitivity. CONCLUSION: There is some evidence that group membership has resulted in increased condom use and partner reduction, but there are doubts as to the extent to which the "ABC" strategy can be successful in stemming the HIV/AIDS epidemic. It may be necessary for interventions to target contextual issues, particularly gender relations, if the approach is to be more successful.

Adult↗

PubMedDate not supplied

Patient-led partner referral in a district hospital based STD clinic.

CONTEXT: Sexual communication and appropriate treatment of sexual partners is critical to the success of STD and HIV/AIDS prevention and control. AIMS: To understand factors influencing intention of STD patients to inform their regular sexual partners and identify predictors influencing actual return of the partners. SETTINGS AND DESIGN: A non-randomised survey of patients attending STD clinic in a district hospital between May and November 2000. METHODS AND MATERIAL: 182 patients were administered structured questionnaires to understand their intention to notify their regular sexual partners and encouraged to refer their regular sexual partners to the clinic for management. Factors related to intent to notify partners and actual partner referral were analysed. STATISTICAL ANALYSIS USED: Chi square test and forward stepwise logistic regression. RESULTS: Of the 182 STD patients 77.47% expressed their positive intention to notify their regular sexual partners. However, overall partner return rate was 40.65%. Patients from a better economic class (p=0.014), those who had sex since having the disease (p=0.001), those who felt it was easy to tell their partners (p=0.047) and perceived the necessity of investigating their partners (p<0.001) were more likely to have an intention to notify their partners. Independent predictors of actual return of sexual partners were patients' perception of partners' susceptibility (p=0.044), positive intention to notify partners (p=0.001), partners already informed before clinic visit (p=0.030) and presence of genital ulcerative diseases (p=0.033). CONCLUSIONS: STD clinic counselling and education should focus on risk reduction, partner susceptibility, role of STDs in HIV transmission and improving spousal communication.

Adolescent↗

PubMed1996

Partner-specific sexual practices among heterosexual men and women with multiple partners: results from the French national survey, ACSF. Analyse des Comportements Sexuel en France.

Heterosexual men and women with several partners are at risk of acquiring and transmitting sexually transmitted diseases and HIV. Risk depends on parameters such as the sexual practices themselves which may vary according to the type of partner (regular vs. casual). It is therefore important to describe the sexual practices and identify the correlations between the type of partner and these practices among heterosexuals with multiple partners. A subsample of all subjects having had at least two sexual partners during the previous year (n = 1644) was obtained from the ACSF survey (n = 20,055), the French national telephone survey on sexual behavior conducted between September 1991 and February 1992. Questions concerned in particular sexual practices of the last encounter as well as type of partner. Petting and vaginal penetration were almost systematic, mutual manual stimulation and orogenital sex were common, while self-masturbation and anal sex were infrequent. On average, a condom was seldom used. However, it was used more often when the partner was occasional. Nonpenetrative and oral practices were also more frequent with occasional partners. Women tended to report lower frequencies of practices and of condom use than men. A subset of heterosexuals with multiple partners engaged in safe sex. Practices tend to be partner-specific, with safer sex practices more likely to occur with occasional partners, although the magnitude of the difference is moderate.

Adult↗

PubMed1994

Risk factors for HIV-1 infection in adults in a rural Ugandan community: a case-control study.

OBJECTIVE: To study in depth sexual history and sexual behaviour variables as risk factors for HIV-1 infection in a rural Ugandan population. METHODS: Following a socioeconomic and serological survey of a rural population in Masaka District, south-west Uganda, 233 randomly selected HIV-1-positive cases and 233 negative controls matched on age and village of residence, were invited in October 1990 to participate in a case-control study. A total of 132 cases and 161 controls attended for in-depth investigation including an interview about sexual behaviour. RESULTS: The factor most strongly associated with increased risk of infection was a greater number of lifetime sexual partners, with odds ratios (OR) of 2.1 and 4.9 for those reporting 4-10 and 11 or more partners, respectively, compared with those reporting less than four partners. Having only one sexual partner did not provide complete protection, a total of seven (one male, six female) subjects reporting only one sexual partner were HIV-1-positive. Other significant factors were a history of genital ulcers [OR, 2.9; 95% confidence intervals (CI), 1.0-9.1) and not being a Muslim (OR, 5.4; 95% CI, 1.8-16.5) suggesting a possible protective effect of circumcision. There was a suggestion that those who married within the last 7 years (OR, 2.4; 95% CI, 0.9-6.1) and men exposed to menstrual blood (OR, 5.7; 95% CI, 0.7-49.8) were at an increased risk of HIV-1 infection. CONCLUSIONS: These results confirm the predominant role of sexual behaviour in the HIV-1 epidemic. Of particular concern is the observation of HIV-1 infection among those reporting only one partner. Where HIV-1 infection is widely distributed in the general population, risk reduction strategies should, in addition to the promotion of partner reduction, place strong emphasis on safe-sex techniques.

Adolescent↗

PubMed1992

Psychosocial predictors of "safer sex" behaviors in young adults.

This study tested a model of safer sex behavior using variables from social learning theory, the health belief model, the theory of reasoned action, and theories of cognitive coping style. Two types of safer sex behavior were measured: frequency of condom use and the discussion of AIDS and past partners with a sexual partner. The participants--275 undergraduate students--completed an anonymous written questionnaire. The variables (behavioral intention, perceived susceptibility, barriers, self-efficacy, monitoring, blunting, and social support) predicted 35% of the variance in condom use and 13% of the variance in discussion (adjusted R2s). Intention was the strongest predictor of both types of safer sex behavior. Perceived susceptibility and perceived barriers were associated with intention to use a condom; perceived barriers was inversely related to condom use. Self-efficacy was associated with the intention to discuss and reported discussion of AIDS and past partners with a sexual partner; social support was related to the intention to discuss. An information-avoiding coping style was negatively associated with condom use. Implications for future research and intervention efforts in the area of AIDS prevention are discussed.

Adaptation, Psychological↗

PubMed1987

Feminine gender identity and physical aggressiveness in heterosexual and homosexual pedophiles.

This study explored the differences among six groups of adult males in retrospective self-reports of childhood gender identity and physical aggressiveness. The three groups of homosexual men preferred prepubescent, pubescent, or physically mature sexual partners. The three groups of heterosexual men preferred prepubescent partners, normal sexual interaction with physically mature partners (controls), or anomalous interaction with physically mature partners. Childhood gender identity was measured with the Feminine Gender Identity Scale (FGIS), and boyhood aggressiveness was measured with the Physical Aggressiveness Scale (PAS). Duncan tests at the .05 level showed that the FGIS differentiated the homosexuals who preferred mature partners from the five other groups; whereas the PAS differentiated all homosexual groups from all heterosexual groups. These results suggest that male homosexuals in general tend to be unaggressive in boyhood, whereas only those who prefer mature sexual partners show significant levels of feminine identification.

Aggression↗

PubMed1984

Chlamydia trachomatis infection in sexually active adolescents: prevalence and risk factors.

The prevalence of Chlamydia trachomatis genital infection was studied in a sexually active urban Baltimore adolescent population. Possible risk factors such as age, past history of sexually transmitted disease, number of sexual partners, contact with sexually transmitted disease, oral contraceptive use, and concomitant gonococcal infection were also evaluated. The prevalence of chlamydial infection in the 280 adolescents studied was 26%: 35% in male adolescents, 27% in pregnant female adolescents, and 23% in nonpregnant female adolescents. Chlamydia was almost three times as prevalent as gonorrhea in the same population. Age, past history of sexually transmitted disease, oral contraceptive use, and concomitant gonorrhea were not significantly associated with chlamydial infection. However, multiple current sexual partners, contact with sexually transmitted disease, genitourinary symptoms, and cervical ectopy were significantly associated with chlamydial infection. Testing for chlamydial infection in sexually active urban teenagers is recommended for those with genitourinary symptoms, those with cervical ectopy, or those who are contacts of persons with sexually transmitted disease. Considering the reservoir of infection in the asymptomatic female adolescents, screening for chlamydial infections in family planning clinics warrants consideration.

Adolescent↗

PubMedDate not supplied

Data from the National AIDS Behavioral Surveys. I. Sexual risk for human immunodeficiency virus infection among women in high-risk cities.

Data from 3,482 women aged 18-49 living in 23 urban areas of the United States who participated in the 1990-1991 National AIDS Behavioral Surveys show that in the preceding year, approximately 15% engaged in sexual behavior that might expose them to the human immunodeficiency virus (HIV). Risk behaviors include having multiple sexual partners, having a risky main sexual partner or having both multiple partners and a risky main partner. An additional 17% of women with no other risk factor report that they do not know their main partner's HIV risk status. Predictors of risk factors vary by ethnicity, and having multiple partners and having a risky main partner appear to have distinct sets of predictors. Single women are more likely than others to have multiple partners, and among white women, those with more than 12 years of education are more likely to have multiple partners. Among blacks and Hispanics, younger women are more likely than older women to have multiple partners. Among Hispanic women, married respondents and those with more than 12 years of education are more likely than others to have a risky main sexual partner; the latter pattern is reversed among white women, however, with those having less than 12 years of education being more likely to have a risky main sexual partner. In general, women with a risky main partner are the least likely to use condoms consistently.

Adolescent↗

PubMed2005

[Investigation of acquired immunodeficiency syndrome correlated with high risk sexual behavior and knowledge of male homosexuality in Hangzhou Province, China].

OBJECTIVE: To find out the acquired immunodeficiency syndrome (AIDS) correlated high risk sexual behavior and knowledge in male homosexuals in Hangzhou Province. METHODS: Using an self-designed anonymous questionnaire, 927 male homosexual were investigated anonymously in May 2003 to January 2004. RESULTS: Among the male homosexuals surveyed, the average age of this population was (29.8 +/- 9.9) years, the average number of sexual partners per person in past one year was 7.34 +/- 5.61. Among them, 199 (21.46%) had one sexual partner, 165 (17.79%) had 2 - 5 sexual partners, and 563 (60.73%) had more than 5 sexual partners, and 179 (19.30%) also had opposite-sex sexual partner the average number of opposite-sex sexual partner of this group was 1.16 +/- 0.21. According to sexual behavior, 40.66% of them used anal sexual behavior, 62.99% used oral sex, 74.11% used masturbation and 3.66% used oral-anal touch. Among 179 male homosexuals having opposite sexual partners, the percentage of using vagina sex, anal sex, oral sex and masturbation was respectively 59.77%, 36.87%, 40.22% and 26.25%. Although their understanding level about AIDS was high, the risk rate of sexual behavior among them was also very high. Only 11.11% of male homosexuals used condom when they had anal sex with same sex, most of them rarely used or never used protection measures. When having sex with female, almost none of them used protection. CONCLUSION: The risk rate of sexual behaviors in male homosexuals is very high that some appropriating and effective measures for prevention should be taken.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Considering HIV risk and intimate partner violence among older women of color: a descriptive analysis.

This study describes the types of intimate partner violence (IPV) and sexual HIV-risk factors reported by a sample of 139 African American and Latina women ages 50 and older receiving care in outpatient clinics of an urban medical center. Additionally, we obtained estimates of the associations between experiencing IPV in a primary heterosexual relationship and the following HIV-risk behaviors among our sample of older minority women: (a) having multiple sexual partners, (b) STD history, (c) partner-related risk (i.e., having a partner who has multiple sexual partners, is HIV-infected, injecting drugs, and/or has an STD), and (d) self-perception of risk for HIV infection. Results indicate that many of these women are engaged in sexual risk behaviors, and such behaviors are associated with increased likelihood of IPV for this cohort. Implications for health care professionals are discussed.

Academic Medical Centers↗

PubMed2004

Lifetime depression history and sexual function in women at midlife.

We examined the association between lifetime depression history and sexual function in a community-based sample of midlife women. Specifically, 914 women aged 42-52 who were participants in the Study of Women's Health Across the Nation completed a self-report assessment of their sexual behaviors, sexual desire, sexual arousal, and sexual satisfaction over the past 6 months. On the basis of the Structured Clinical Interview for the DSM-IV , participants were categorized into 1 of 3 lifetime major depressive disorder (MDD) history groups: no MDD history, single episode MDD, and recurrent MDD. In line with previous reports, women with a history of recurrent MDD reported experiencing less frequent sexual arousal, less physical pleasure, and less emotional satisfaction within their current sexual relationships. Although the groups did not differ in their reported frequency of sexual desire or partnered sexual behaviors, lifetime depression history was associated with increased rates of self-stimulation (masturbation). Associations between lifetime depression history and lower levels of physical pleasure within partnered sexual relationships and higher rates of masturbation remained significant following control for current depressive symptoms, study site, marital status, psychotropic medication use, and lifetime history of anxiety or substance abuse/dependence disorder. Future research is needed to characterize the temporal and etiologic relationships among lifetime depressive disorder, current mood state, and sexual function in women across the lifespan.

Adult↗

PubMed2001

Sexual behaviors, sexual orientation and gender identity in adult intersexuals: a pilot study.

PURPOSE: Sexual preference and adjustment of intersexuals have rarely been investigated. Interview techniques were used to explore these issues. MATERIALS AND METHODS: Ten adult intersexuals (average age 34.2 years) were randomly selected from Intersex Society of North America members. Of the 10 subjects 8 had initially been gender assigned as female and 2 as male. A structured telephone interview was used to assess sexual orientation, sexual activity and satisfaction with gender assignment. RESULTS: Sexual debut occurred at age 18.1 years (range 15 to 22). At debut, 4 females and 2 males engaged in heterosexual intercourse, and 4 females engaged in gynephilic (female) sexual contact. Despite female gender assignment of 8 and initial heterosexual activity by 4 subjects, the final choice of a sexual partner was female in all 8. Both males had initial heterosexual contact but only 1 continued to prefer female partners. Current number of sexual partners averaged 0.9 (range 0 to 2) and total number of sexual partners ranged from 1 to 300. Currently, 9 subjects are in a committed sexual relationship and 8 are able to achieve orgasm. Of the subjects 8 preferred being identified as intersexual, 1 male as male and 1 female as female. Two intersexuals with initial female gender assignment were undergoing male reassignment. CONCLUSIONS: Most intersexuals preferred being identified as intersexual and had female partners. Most reported being satisfied with overall physical appearance but satisfaction with genitalia was highly variable. Based on these results, further study of a larger population is warranted.

Adult↗

PubMed1982

Reiter's syndrome in the population. An Interview Study.

To obtain data on the incidence of Reiter's syndrome (RS) as well as on possible simultaneously appearing signs and symptoms of RS in sexual couples we have made interview reports of randomly selected 530 persons: 219 males and 311 females, aged 15 to 54. None had RS. Six males (2.7%) and seven females (2.3%) had a history of probable RS (PRS). Almost all (5/6) female sexual partners of the men with PRS and more than half (4/7) male sexual partners of the women with PRS had a history of urogenital involvement. Twenty-seven men and 54 women said they did not have any sexual partners at that time. Forty (21.5%) of the female sexual partners of the remaining 186 men and likewise 11 male sexual partners (4,4%) of the 250 women had a history of urogenital involvements. Thus the relative risk of urogenital involvement is increased 3.9-fold in females and 13-fold in males who are sexual partners of persons with a history of PRS. Likewise in couples where one of the consorts has a history of PRS the simultaneous occurrence of urogenital involvement in both partners as well as the simultaneous occurrence of joint involvement in one and urogenital involvement in the other consort were registered significantly more frequently than in couples where neither of the consorts has a history of PRS. Sexual partners of persons with PRS even show a tendency to have joint and back pains more frequently than sexual partners of persons lacking a history of PRS. These results emphasize the role of infections in the genito-urinary tracts of sexual couples as a possible channel and reservoir of microbes which may cause, or contribute to, the initiation of and/or repeated attacks of RS. Sexually acquired and maintained rheumatic diseases may be one of the major problems in rheumatology.

Adult↗

PubMed1996

HIV-related concerns and behaviors among Hispanic women.

Hispanic women whose sexual partners have other sexual partners may be at risk for HIV. A structured interview was administered to 106 Dominican and Puerto Rican women who reported that they knew or suspected that their partner had other partners. A subsample participated in qualitative interviews. The study assessed concern about HIV and predictors of condom use. The majority of women reported that they worried about getting HIV and almost half had been HIV-tested. Most of the women discussed HIV/AIDS concerns with their partners, and one-third reported some condom use. Predictors of condom use were: born in the Dominican Republic/Puerto Rico, having talked with their partner about being tested, and belief that he used condoms with others. Although the women were concerned about HIV, condom use was infrequent. Results suggested methods to address this discrepancy: introducing condoms early in the relationship, developing women-controlled methods, and directly influencing men's behavior.

Adult↗