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PubMed2004

Early marriage and HIV risks in sub-Saharan Africa.

This article examines the effects of girls' early marriage on their risk of acquiring HIV/AIDS. By comparing several underlying HIV risk factors, it explores the counterintuitive finding that married adolescent girls in urban centers in Kenya and Zambia have higher rates of HIV infection than do sexually active unmarried girls. In both countries, we find that early marriage increases coital frequency, decreases condom use, and virtually eliminates girls' ability to abstain from sex. Moreover, husbands of married girls are about three times more likely to be HIV-positive than are boyfriends of single girls. Although married girls are less likely than single girls to have multiple partners, this protective behavior may be outweighed by their greater exposure via unprotected sex with partners who have higher rates of infection. These results challenge commonly held assumptions about sex within marriage.

Adolescent↗

PubMed2001

A YRBS survey of youth risk behaviors at alternative high schools and mainstream high schools in Hong Kong.

In Hong Kong, prevocational schools serve as an alternative to mainstream schools to provide education with more emphasis on practical and technical subjects. In this paper, health-risk behaviors of prevocational school (PVS) students were identified, and comparisons of health-risk behaviors with or without adjusting the demographic factors from prevocational schools and mainstream schools were made. The PVS students were at higher risk for most categories of health-risk behaviors such as unintentional and intentional injuries, smoking, alcohol drinking, glue sniffing, inadequate physical activity, insufficient consumption of fresh fruits and vegetables, and early sexual activity with multiple partners. Female students of PVS reported higher prevalence of emotional problems and substance abuse. Findings suggest that the school environment is an influential factor on the lifestyle behavior of students. Comprehensive health education and intervention programs are needed for youth in Hong Kong prevocational schools.

Adolescent↗

PubMed2006

Dating violence victimization: associated drinking and sexual risk behaviors of Asian, Native Hawaiian, and Caucasian high school students in Hawaii.

Ethnic minority groups such as Asian/Pacific Islanders (APIs) and native populations in Hawaii are seldom studied in the area of intimate relationships. Using the 1999 Hawaii Youth Risk Behavior Survey, this study examined gender and ethnic differences in experiencing physical dating violence and whether drinking (early initiation, binge drinking), unsafe sexual behaviors (early initiation, multiple partners, use of alcohol and drugs with sex, history of sexual abuse), and suicidality constitute risk for victimization among APIs, Native Hawaiian (NH), and Caucasian high school students in multiethnic state of Hawaii. The final analysis included 559 boys and 683 girls. The overall rate of experiencing physical violence was 7.8% with both genders reporting similar rates (boys 7.6%, girls 8.0%). Although not significantly different, NH students reported a higher rate (11.6%) than Caucasians (7.3%) and APIs (6.5%). Significant bivariate associations were found between victimization and many of the risk factors. Regression analyses indicated that students 16 years or older were nearly 3 times more at risk for experiencing dating violence. The risk was 8-fold if youth were sexually active by age 13 compared to those who abstained. The risk is 3-fold for those who reported prior sexual abuse. Early initiation of drinking (<12 years) and suicidality doubled the risk of being a victim. Clearly, the study highlights the risk of experiencing dating violence when a teen engages in sex very early or uses alcohol. Schools must routinely educate youth about various forms of dating violence, the effects of engaging in early sex, and drinking. Screening adolescents for associated risk factors such as drinking and depression is crucial to identify victimization. Dating violence is an antecedent for adult partner violence. Thus, by reducing youth dating violence, we may consequently reduce the incidence of adult partner violence.

Adolescent↗

PubMed2000

The optimal number of fathers. Evolution, demography, and history in the shaping of female mate preferences.

Around the world polygynous marriage (one man, several women) is vastly more common than polyandrous marriage (one woman, several men), and women tend to be more cautious about entering into sexual relationships than men are. Such patterns are often assumed to reflect essential differences between the sexes. However, the same dichotomy between "ardent" males and "coy" females is not found in other primates. Furthermore, under a range of circumstances females enhance their reproductive success by mating with multiple partners and use polyandrous mating (soliciting copulations from several or more males) to circumvent male-imposed costs on their free choice of mates. The existence of one-male mating systems does not prove that females "naturally" gravitate to them. Typically monandrous (copulating with just one partner) mating systems are maintained by one male excluding rivals or by other circumstances that distort female options. As with many other animals, primate females (including women) can benefit reproductively from polyandrous matings. Understanding this takes us beyond narrow research programs intent on demonstrating "universal" differences between the sexes, and allows us to study females as flexible and opportunistic individuals who confront recurring reproductive dilemmas and tradeoffs within a world of shifting options.

Biological Evolution↗

PubMed2006

Assembly of distinct pilus structures on the surface of Corynebacterium diphtheriae.

Different surface organelles contribute to specific interactions of a pathogen with host tissues or infectious partners. Multiple pilus gene clusters potentially encoding different surface structures have been identified in several gram-positive bacterial genomes sequenced to date, including actinomycetales, clostridia, corynebacteria, and streptococci. Corynebacterium diphtheriae has been shown to assemble a pilus structure, with sortase SrtA essential for the assembly of a major subunit SpaA and two minor proteins, SpaB and SpaC. We report here the characterization of a second pilus consisting of SpaD, SpaE, and SpaF, of which SpaD and SpaE form the pilus shaft and SpaF may be located at the pilus tip. The structure of the SpaDEF pilus contains no SpaABC pilins as detected by immunoelectron microscopy. Neither deletion of spaA nor sortase srtA abolishes SpaDEF pilus formation. The assembly of the SpaDEF pilus requires specific sortases located within the SpaDEF pilus gene cluster. Although either sortase SrtB or SrtC is sufficient to polymerize SpaDF, the incorporation of SpaE into the SpaD pili requires sortase SrtB. In addition, an alanine in place of the lysine of the SpaD pilin motif abrogates pilus polymerization. Thus, SpaD, SpaE, and SpaF constitute a different pilus structure that is independently assembled and morphologically distinct from the SpaABC pili and possibly other pili of C. diphtheriae.

ATP-Binding Cassette Transporters↗

PubMed2004

Ski negatively regulates erythroid differentiation through its interaction with GATA1.

The Ski oncoprotein dramatically affects cell growth, differentiation, and/or survival. Recently, Ski was shown to act in distinct signaling pathways including those involving nuclear receptors, transforming growth factor beta, and tumor suppressors. These divergent roles of Ski are probably dependent on Ski's capacity to bind multiple partners with disparate functions. In particular, Ski alters the growth and differentiation program of erythroid progenitor cells, leading to malignant leukemia. However, the mechanism underlying this important effect has remained elusive. Here we show that Ski interacts with GATA1, a transcription factor essential in erythropoiesis. Using a Ski mutant deficient in GATA1 binding, we show that this Ski-GATA1 interaction is critical for Ski's ability to repress GATA1-mediated transcription and block erythroid differentiation. Furthermore, the repression of GATA1-mediated transcription involves Ski's ability to block DNA binding of GATA1. This finding is in marked contrast to those in previous reports on the mechanism of repression by Ski, which have described a model involving the recruitment of corepressors into DNA-bound transcription complexes. We propose that Ski cooperates in the process of transformation in erythroid cells by interfering with GATA1 function, thereby contributing to erythroleukemia.

Animals↗

PubMed2003

Risk of prevalent HIV infection associated with incarceration among injecting drug users in Bangkok, Thailand: case-control study.

OBJECTIVES: To identify risks for HIV infection related to incarceration among injecting drug users in Bangkok, Thailand. DESIGN: Case-control study of sexual and parenteral exposures occurring before, during, and after the most recent incarceration. SETTING: Metropolitan Bangkok. PARTICIPANTS: Non-prison based injecting drug users formerly incarcerated for at least six months in the previous five years, with documented HIV serostatus since their most recent release; 175 HIV positive cases and 172 HIV negative controls from methadone clinics. MAIN OUTCOME MEASURE: Injection of heroin and methamphetamine, sharing of needles, sexual behaviour, and tattooing before, during, and after incarceration. RESULTS: In the month before incarceration cases were more likely than controls to have injected methamphetamine and to have borrowed needles. More cases than controls reported using drugs (60% v 45%; P=0.005) and sharing needles (50% v 31%; P<0.01) in the holding cell before incarceration. Independent risk factors for prevalent HIV infection included injection of methamphetamine before detention (adjusted odds ratio 3.3, 95% confidence interval 1.01 to 10.7), sharing needles in the holding cell (1.9, 1.2 to 3.0), being tattooed while in prison (2.1, 1.3 to 3.4), and borrowing needles after release (2.5, 1.3 to 4.4). CONCLUSIONS: Injecting drug users in Bangkok are at significantly increased risk of HIV infection through sharing needles with multiple partners while in holding cells before incarceration. The time spent in holding cells is an important opportunity to provide risk reduction counselling and intervention to reduce the incidence of HIV.

Adult↗

PubMed2006

Risk and protective factors for meningococcal disease in adolescents: matched cohort study.

OBJECTIVE: To examine biological and social risk factors for meningococcal disease in adolescents. DESIGN: Prospective, population based, matched cohort study with controls matched for age and sex in 1:1 matching. Controls were sought from the general practitioner. SETTING: Six contiguous regions of England, which represent some 65% of the country's population. PARTICIPANTS: 15-19 year olds with meningococcal disease recruited at hospital admission in six regions (representing 65% of the population of England) from January 1999 to June 2000, and their matched controls. METHODS: Blood samples and pernasal and throat swabs were taken from case patients at admission to hospital and from cases and matched controls at interview. Data on potential risk factors were gathered by confidential interview. Data were analysed by using univariate and multivariate conditional logistic regression. RESULTS: 144 case control pairs were recruited (74 male (51%); median age 17.6). 114 cases (79%) were confirmed microbiologically. Significant independent risk factors for meningococcal disease were history of preceding illness (matched odds ratio 2.9, 95% confidence interval 1.4 to 5.9), intimate kissing with multiple partners (3.7, 1.7 to 8.1), being a university student (3.4, 1.2 to 10) and preterm birth (3.7, 1.0 to 13.5). Religious observance (0.09, 0.02 to 0.6) and meningococcal vaccination (0.12, 0.04 to 0.4) were associated with protection. CONCLUSIONS: Activities and events increasing risk for meningococcal disease in adolescence are different from in childhood. Students are at higher risk. Altering personal behaviours could moderate the risk. However, the development of further effective meningococcal vaccines remains a key public health priority.

Adolescent↗

PubMed2004

Seroprevalence of and risk factors for HIV-1 infection among South American men who have sex with men.

OBJECTIVES: Sex among men constitutes an important route of transmission for HIV type 1 (HIV-1) in Latin America. Seeking better understanding of risk behaviours in this region, we determined the seroprevalence, potential risk factors, and geographic distribution of HIV-1 among groups of men who have sex with men (MSM). METHODS: Seroepidemiological, cross sectional studies of 13,847 MSM were conducted in seven countries of South America during the years 1999-2002. Volunteers were recruited in city venues and streets where anonymous questionnaires and blood samples were obtained. HIV-1 infection was determined by enzyme linked immunosorbent assay (ELISA) screening and western blot (WB) confirmatory tests. RESULTS: HIV-1 seroprevalence varied widely (overall 12.3%, range 11.0%-20.6%). The highest HIV-1 seroprevalence was noted in Bolivia (20.6%) and the lowest in Peru (11.0%). Predictors of HIV-1 infection varied among countries; however, a history of previous sexually transmitted disease (STD) was associated with a consistent increased risk (ORs=1.9-2.9, AORs=1.8-2.7). Multiple weekly sexual contacts was found to represent a secondary risk factor in Ecuador, Peru, and Argentina (ORs=1.6-2.9, AORs=1.6-3.1), whereas use of drugs such as cocaine was found to increase risk in Bolivia, Uruguay, and Paraguay (ORs=2.5-6.5, AORs=2.6-6.1). CONCLUSION: The results of this study illustrate an elevated HIV-1 seroprevalence among MSM participants from Andean countries. A previous STD history and multiple partners predicted HIV-1 infection in the seven countries of South America. In Southern Cone countries, HIV-1 infection was also associated with use of illegal drugs such as cocaine.

Adolescent↗

PubMed2006

Evidence for population level declines in adult HIV prevalence in Kenya.

The HIV/AIDS epidemic in Kenya has been tracked through annual sentinel surveillance in antenatal clinics since 1990. The system started with 13 sites and now has over 35. Behaviours have been measured through national Demographic and Health Surveys in 1993, 1998, and 2003. The surveillance data indicate that prevalence has declined substantially starting in 1998 in five of the original 13 sites and starting in 2000 in another four sites. No decline is evident in the other five original sites although the 2004 estimate is the lowest recorded. Nationally, adult prevalence has declined from 10% in the late 1990s to under 7% today. Surveys indicate that both age at first sex and use of condoms are rising and that the percentage of adults with multiple partners is falling. It is clear that HIV prevalence is now declining in Kenya in a pattern similar to that seen in Uganda but seven or eight years later. Although the coverage of preventive interventions has expanded rapidly since 2000 this expansion was too late to account for the beginnings of the decline in prevalence. More work is needed to understand fully the causes of this decline, but it is encouraging to see Kenya join the small list of countries experiencing significant declines in HIV prevalence.

Adolescent↗

PubMed1987

Influence of special surveillance programmes and AIDS on declining incidence of syphilis in Amsterdam.

In 1976-8 the incidence of syphilis in Amsterdam doubled from 41 to 88 per 100,000. Contact tracers identified two major risk groups, homosexual men with multiple partners and prostitutes using drugs, and special surveillance programmes for these groups have been organised on a regular basis since 1979. As a result of these two programmes the incidence of syphilis started to decline appreciably in 1981-3. From 1984 onwards a further decline occurred in men as a result of a change of lifestyle by homosexual men, probably because of the appearance of AIDS. In 1985 the incidence of syphilis in Amsterdam had dropped to 30 per 100,000, the lowest level since notification started.

Acquired Immunodeficiency Syndrome↗

PubMed1991

Chlamydia trachomatis in sexually active teenage girls. Factors related to genital chlamydial infection: a prospective study.

The incidence of new infections with C trachomatis was found to be 19%. Predisposing factors for a subsequent chlamydial infection were multiple partners, smoking and previous infection with C trachomatis. Girls with a spread cervical ectopy were not more likely to contract a chlamydial infection in one year than girls without an ectopy. Oral contraceptive use was not found to predispose for a chlamydial infection.

Adolescent↗

PubMed2000

Report of sexually transmitted diseases by HIV infected men during follow up: time to target the HIV infected?

OBJECTIVES: To compare the rate of self reported sexually transmitted diseases (STDs) among HIV infected men with men who remained HIV negative during follow up of a Harare male factory cohort. METHODS: Male factory workers were offered enrolment and behavioural data were collected at entry then every 6 months, along with HIV testing. Self report of STDs was used to calculate incidence per 100 person years. Cox proportional hazards models examined independent risk factors for STDs, with hazard ratios (HRs). RESULTS: At entry 20% of men were HIV infected and 11% reported STDs in the previous year. A total of 2777 (82%) of 3383 men enrolled were followed at least once. Compared with men who remained HIV negative, seroconverters had the highest incidence of STDs (16.8 per 100 person years; IRR = 3.3, 95% CI = 2.5-4.3); men enrolled HIV positive also reported higher STD incidence (14.5 per 100 person years, IRR = 2.8; 95% CI 2.3-5.5). Among HIV positive men, the only independent risk factor for report of urethral discharge was history of multiple partners (HR = 10, 95% CI 1.4-73.2). CONCLUSION: HIV positive men reported threefold higher incidence of STDs than HIV negative men, many related to high risk sexual behaviour.

Adult↗

PubMedDate not supplied

Sexual selection, seminal coagulation and copulatory plug formation in primates.

This study examines the question of whether multipartner matings by female primates, with resulting sperm competition among males, may have favored the evolution of biochemical mechanisms to enhance seminal coagulationand copulatory plug formation. Comparative ratings of seminal coagulation (using a four-point scale where 1 = no coagulation and 4 = copulatory plug formation) were obtained for 40 species representing 26 primate genera. Coagulation ratings were highest (mean = 3.64) in those genera where females commonly mate with multiple partners, and lowest (mean = 2.09) in genera where females are primarily monogamous or belong to polygynous (one male) units(p < 0.0001). This result remained significant (p < 0.001) after the use of comparative analysis of independent contrasts (CAIC) to control for possible phylogenetic biases in the data set. Results indicate that sexual selection has played an important role in the evolution of seminal coagulation, and copulatory plug function, in primates.

Adaptation, Biological↗

PubMed2003

[Sexual abuse in adolescence: patient assessment, necessity and meaning of the physical examination].

The objective of this paper is to report on the characteristics of sexual abuse in adolescence, on the medical evaluation and interpretation of findings and on the necessity of a multidisciplinary intervention. Sexual abuse is a common problem affecting children and adolescents, males and females of any age or socio-economic class. 10-22% of adolescents are victims of sexual abuse. They engage more frequently in risk-taking behaviours, such as early sexual activity, unprotected sexual contact with multiple partners (risk of sexually transmitted diseases, of an unwanted pregnancy), substance abuse, delinquency, school failure or suicide. Professionals who deal with adolescents should be aware of the devastating medical and psychosocial sequelae of sexual abuse and should be able to recognize it, incorporating questions regarding victimization into the psycho-social or sexual history. A medical examination, including an external anogenital inspection and in selected cases a pelvic examination, should always be performed. It is important to acknowledge that normal anogenital findings do not exclude sexual abuse and that a multidisciplinary medical-psychosocial evaluation is mandatory.

Adolescent↗

PubMed2005

Major mental disorders, substance use disorders, comorbidity, and HIV-AIDS risk behaviors in juvenile detainees.

OBJECTIVES: This study determined the prevalence of 20 HIV-AIDS risk behaviors of four groups of juvenile detainees: those with major mental disorders alone, those with substance use disorders alone, those with comorbid mental and substance use disorders, and those without any major mental or substance use disorder. METHODS: Interviewers administered the AIDS Risk Behavior Assessment to 800 randomly selected juvenile detainees aged ten to 18 years who were initially arrested between 1997 and 1998. Diagnoses were determined with the Diagnostic Interview Schedule for Children, Version 2.3. RESULTS: The sample included 340 females and 460 males. As with the other groups of detainees, youths with major mental disorders had a high prevalence of most HIV-AIDS risk behaviors, much higher than the rates found among youths in the general population. Comorbid substance use disorders substantially increased risk; 96 percent of youths in this group had been sexually active, 62 percent had had multiple partners within the past three months, and 59 percent had had unprotected vaginal sex in the past month. Among youths with a substance use disorder, either alone or with a comorbid major mental disorder, more than 63 percent had engaged in five or more sexual risk behaviors. CONCLUSIONS: Delinquents with substance use disorders, either with or without comorbid major mental disorders, are at particular risk of HIV-AIDS. The juvenile justice and public health systems must provide HIV-AIDS interventions as well as mental health and substance abuse treatment. Greater coordination between community services and correctional facilities can reduce the prevalence of HIV-AIDS risk behaviors of juvenile delinquents and stem the spread of HIV infection among young people.

Acquired Immunodeficiency Syndrome↗

PubMed2000

Modeling intervention efficacy for high-risk women. The WINGS Project.

This study evaluates the effectiveness of two strategies--communication and condom skills training--for increasing condom-protected sex in a sample of 510 high-risk women ages 17 to 61. Baseline and 3- and 6-month postintervention interview data were gathered in three cities participating in a randomized trial of a six-session, group skill-building intervention. This analysis was conducted for the entire sample and for six subgroups categorized by age, single or multiple partners, and history of childhood sexual abuse. The dependent variable was the odds ratio of protected sex acts at each follow-up. Structural equation modeling was used to estimate effects for two intervention pathways. The pathway through condom skills increased the odds of protected sex for the intervention group (chi 2 difference = 35, df = 2, p < .05) as well as for all subgroups. The pathways through communication were significant for the intervention group (chi 2 difference = 23, df = 3, p < .05) but fully effective only for participants under 30 and participants who reported childhood sexual abuse. The effectiveness of both pathways diminished at 6 months. WINGS demonstrates that condom skills training can increase protected sex for a heterogeneous group of women. Further research needs to examine how such skill training translates into use of condoms by male partners. To increase the duration of intervention effects, booster sessions may need to be incorporated.

Adolescent↗

PubMed1989

Family background and physical health of adolescents admitted to an inpatient psychiatric unit, II: Physical health.

The charts of 100 adolescents admitted to a special unit of a provincial psychiatric hospital were reviewed. These patients primarily had a conduct disorder (71.6% of boys and 77.5% of girls) or an affective disorder (6.6% of boys, 15.0% of girls). There was a higher incidence of congenital disorders in the population than expected, suggesting that such disorders may predispose to psychological troubles later in life. Convulsions also occurred more often in this population. Most patients (78.3% of boys and 85.0% of girls) had one or more medical diagnoses. Several potentially serious findings (anemia, pregnancy, hepatomegaly, thyroiditis) were first noted on the admission physical examination. Patients with conduct disorder had certain health problems that are likely to be the result of the psychiatric disorder, such as liver function changes in drug and alcohol abusers and abnormal Pap smears in sexually active girls with multiple partners. If these medical conditions are not followed and treated, they have the potential for causing serious problems at a later date. These findings point out the continued need for the expertise of psychiatrists and other physicians in children's mental health facilities.

Adolescent↗