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PubMed1993

AIDS-related knowledge, perceptions, and behaviors among impoverished minority women.

OBJECTIVES: The aims of this study were to (1) describe AIDS-related knowledge, perceptions, and risky behaviors of impoverished African-American and high- and low-acculturated Latina women; (2) delineate relationships involving high-risk behaviors; and (3) determine whether risky behaviors differ by race and levels of acculturation. METHODS: Survey instruments were administered to 1173 impoverished women of color residing in homeless shelters and drug recovery programs. RESULTS: Differences based on ethnicity and level of acculturation were found in AIDS-related knowledge, perceived risk of acquiring AIDS, and risky behaviors. Low-acculturated Latinas reported low perceived risk and were least likely to engage in illegal drug use and sexual activity with multiple partners. Intravenous drug use was most prevalent among high-acculturated Latinas, whereas nonintravenous drug use and high-risk sexual activity was most prevalent among African-American women. CONCLUSIONS: The data indicate the need for culturally sensitive AIDS prevention programs for women that deal with general issues of drug use and unprotected sex, and that include separate sessions for women of different ethnic backgrounds and acculturation levels to address specialized areas of concern.

Acculturation↗

PubMed1991

Antibiotic prophylaxis in hysterectomy and induced abortion. A review of the evidence.

By the early 1980s, perioperative prophylaxis in vaginal hysterectomy had been shown consistently to be of such value in reducing postoperative infection that some authors maintained that further placebo-controlled studies were no longer ethical. The benefit of prophylaxis in abdominal hysterectomy was less uniformly demonstrated, in studies which were prospective, placebo-controlled, double-blind and randomised. Prophylaxis may significantly reduce the incidence of febrile morbidity and/or wound/pelvic infection, the duration of hospital stay, or the total usage of antibiotics. It is therefore generally agreed that each centre should itself scientifically evaluate the efficacy of prophylaxis before a decision on its routine use in abdominal hysterectomy is made. In comparative studies, agents which were active against both anaerobic and aerobic organisms were more efficacious than those active against anaerobes only. Antibiotics with similar spectra of activity showed similar efficacy in both types of hysterectomy. Multiple- and single-dose regimens of the same antibiotics also showed equal efficacy. The new cephalosporins with a longer half-life were attractive theoretically as agents in single-dose regimens; ceftriaxone, however, has been shown to have an adverse effect on the normal gut flora. With the increased numbers of induced abortions carried out in the UK and other parts of the world in recent years, the need to reduce postabortal infection is generally appreciated. The results of early studies using tetracyclines as the prophylactic agents were difficult to evaluate because of the incomplete follow-up and different definitions of pelvic infections. No benefit was demonstrated in 2 studies using a single preoperative dose of tinidazole, whereas oral metronidazole in 3 doses and penicillin/pivampicillin for 4 days were shown to be efficacious in reducing postabortal infection. In a recent study with doxycycline, significant benefit was shown in patients with negative preoperative screening for gonococcal and chlamydial infection. These genital infections, together with a history of previous pelvic inflammatory disease (PID)/gonorrhoea, nulliparity with multiple partners, young age of the patient and gestational age have been described as significant risk factors. Some researchers hold the view that selective prophylaxis based on these risk factors should be practised instead of mass prophylaxis. All agree that an antibiotic regimen that is both efficacious and well tolerated has yet to be found.

Abortion, Induced↗

PubMed1995

Different HIV risk profiles in samples of college students and homeless persons.

A cross-sectional survey examined demographic characteristics, self-reported sexual behaviors, and knowledge of AIDS in samples of 106 homeless persons and 260 college students. As expected, the two samples differed with respect to age, gender, race, and education. Respondents in both samples possessed moderate knowledge of HIV infection and AIDS and reported they considered their personal risk of HIV infection low. Both samples acknowledged frequent use of alcohol with sexual activity, active and passive oral sex, and lax use of condoms. A discriminant analysis indicated that a greater percentage of college students were sexually active than of the homeless sample and that the homeless group had a higher proportion of individuals who were either homosexual or bisexual, who had sexual contact with multiple partners or who had visited a prostitute, who had sexually transmitted diseases, and who had injected drugs. Although the risk profiles differed, each group reported high-risk behaviors and perceptions of low personal risk of HIV infection.

Acquired Immunodeficiency Syndrome↗

PubMed2002

High risk behaviors in a sample of Mexican-American college students.

This study explored different types of high risk behaviors of Mexican-American college students attending a small university in south Texas. High risk behaviors for contracting HIV/AIDS examined in this study included unprotected sex, drug use, and alcohol abuse. In 1995 in the United States, HIV/AIDS is the leading cause of death in people between the ages of 25 and 44. Because use of alcohol and certain recreational drugs lowers inhibitions, their use could increase the possibility of having unprotected and unplanned sex with multiple partners. Thus, it was expected that Mexican-American college students who use drugs and alcohol would be more likely to engage in unprotected sex. Data were from 105 men and 211 women between the ages of 18 and 30 years. Drug use and alcohol abuse were significantly associated with high risk sexual behavior. Individuals in monogamous relationships were more likely to not use condoms than those involved in casual relationships. Self-reported religiosity was not correlated with high risk behaviors, although there were implications that stronger religious affiliation did alter sexual beliefs and practices. Lastly, parental communication was not significantly associated with high risk behaviors, but family unity did seem related to some risky sexual practices.

Acquired Immunodeficiency Syndrome↗

PubMed1999

PCNA binding proteins.

PCNA (proliferating cell nuclear antigen), originally characterized as a DNA polymerase accessory protein, functions as a DNA sliding clamp for DNA polymerase delta and is an essential component for eukaryotic chromosomal DNA replication. Recent studies have revealed a striking feature of PCNA in its ability to interact with multiple partners, involved, for example, in Okazaki fragment joining, DNA repair, DNA methylation and chromatin assembly. Since these reactions take place mainly on replicating DNA, PCNA has applications as a marker for DNA synthesis. It is of interest that proteins involved in cell cycle regulation may also exhibit PCNA binding activity. For example, the CDK inhibitor, p21 (Cip1/Waf1) interacts with PCNA blocking its activity necessary for DNA replication and also affecting interactions with other PCNA binding proteins. The available data indicate that DNA sliding clamps have generated additional functions with evolution of eukaryotes from simple prokaryotes. In mammalian cells, they play key roles in controlling DNA synthesis reactions and the reorganization of replicated DNA at replication forks. Several cell cycle regulation proteins target these processes by affecting PCNA actions

Animals↗

PubMed1992

High-risk sexual behaviors of intravenous drug users in- and out-of-treatment: implications for the spread of HIV infection.

This paper examines the sexual behaviors of 255 intravenous drug users (IVDUs) to assess the potential for the sexual transmission of HIV and to examine differences in sexual behaviors between in- and out-of-treatment IVDUs. In-treatment subjects (N = 152) were a random sample of clients at a large, publicly funded methadone maintenance program. Out-of-treatment subjects (N = 103) were recruited through a chain referral technique, using the in-treatment subjects. Forty-five percent of the study subjects reported multiple partners and 32% reported exchanging sex for money or drugs in the preceding 6 months. Fifty-three percent reported no use of condoms. After controlling for demographic differences between the in- and out-of-treatment groups, out-of-treatment IVDUs reported significantly more partners than in-treatment IVDUs (4.6 vs 2.3, significant t < 0.01), and more often had exchanged sex for money or drugs (44 vs 26%, relative odds 1.8, p < .05). In- and out-of-treatment subjects did not differ with respect to condom use. We conclude that IVDUs both in- and out-of-treatment continue to be at risk of contracting and spreading HIV infection through sexual behaviors, and that being in drug treatment is associated with a lower incidence of high risk sexual behaviors.

Acquired Immunodeficiency Syndrome↗

PubMed1995

Short report: prevalence of hepatitis C viral antibody among Brazilian children, adolescents, and street youths.

The prevalence of hepatitis C antibodies (anti-HCV) was investigated in 1,378 central Brazilian children, students, and street youths (homeless adolescents without family links or adolescents working in poorly paid activities). Sera were tested with a second generation enzyme-linked immunosorbent assay, and positive samples were retested by a confirmatory assay (line immunoassay). All children attending day care centers were anti-HCV negative. Only one (0.2%) adolescent was positive in the student group. However, higher positivity was found in street youths; four (1.0%) living at home and three (3.0%) living in the streets and anti-HCV antibodies. Among these, the prevalence of anti-HCV increased significantly with age from 0% in the 9-12-year-old group to 6.9% in the 17-20-year-old group. Risk factors including blood transfusion, tattooing, intravenous drug use, and sexual intercourse with multiple partners were significantly associated with the presence of anti-HCV in street youths. These results indicate that apparently healthy children and adolescents attending day care centers or primary schools in central Brazil have a low exposure to HCV infection, but street youths in the same area are at risk for infection with this virus.

Adolescent↗

PubMedDate not supplied

Does efficacy mediate stage of change and condom use in injected-drug users?

OBJECTIVE: To examine condom efficacy and the stages of change in explaining condom usage among a sample of 278 injected-drug users (IDUs). METHODS: Data were collected as part of a statewide behavioral surveillance study. RESULTS: Participants reported multiple risk behaviors, including having unprotected sex with multiple partners and exchanging sex. Approximately half the sample was in the precontemplation or contemplation stage for condom use, whereas 21% were in maintenance. Mediational analyses indicated that condom efficacy partially mediated the association between stage of change and self-reported condom use. CONCLUSIONS: The findings are discussed within the context of targeting HIV prevention interventions.

Catchment Area, Health↗

PubMed1982

Autoimmune thrombocytopenic purpura in homosexual men.

Since November 1980 we have diagnosed 11 cases of severe autoimmune thrombocytopenic purpura in homosexual men; their mean platelet count (+/- SE) was 16 000 +/- 3000/mm3. All patients have been sexually active with multiple partners and exposed to numerous viruses and drugs. During this period, we also have diagnosed 20 cases of classic autoimmune thrombocytopenic purpura in heterosexual persons, with a normal women to men ratio of 3:1. Eight of nine homosexual patients had elevated platelet IgG compared with normal values in eight of 10 homosexual control subjects having normal hemograms (p less than 0.01). All responded moderately or completely to steroids. The three patients who had splenectomy had excellent responses. Four of five patients had a decreased helper/suppressor T cell ratio compared to healthy controls (p less than 0.001). Circulating immune complexes and total gamma globulin levels were elevated and lymphocytes relatively decreased in homosexual patients compared with homosexual controls (p less than 0.05). Thus, some sexually-active homosexual men seem to have an increased incidence of an immune regulation disorder directed against platelets.

Adult↗

PubMed1996

The challenge of genuine power sharing in participatory research: the gap between theory and practice.

Participatory research is often suggested as a strategy to overcome power imbalances between researchers and research "subjects" because it values equally the knowledge of each individual who participates in the project. However, there is little documentation of the dilemmas that may arise when a complex community service organization attempts to engage in participatory research. In our experience of a participatory research project with multiple partners, power imbalances arose from organizationally based perspectives that were unaccounted for in the participatory research literature, demonstrating that power is a complex and elusive factor in establishing equal relations.

Clinical Trials as Topic↗

PubMed1999

Pap smears: screening, interpretation, treatment.

Cervical cancer remains an important public health problem in the United States. Cervical dysplasia and rarely carcinoma in situ can occur during adolescence, especially in adolescents who become sexually active with multiple partners or who have been exposed to HPV, especially types 16 and 18. Papanicolaou smear is recommended for any adolescent who has ever been sexually active or exposed to human papillomavirus or is 18 years of age. This article discusses the new classification systems for cytological diagnoses, as well as some of the new types of Pap smear preparations, including the ThinPrep system and computer-assisted automated Pap test screening, which may increase the sensitivity of this screening test and reduce the false-negative rate of Pap smears.

Adolescent↗

PubMed1999

STD-related knowledge, beliefs and attitudes of Xhosa-speaking patients attending STD primary health-care clinics in South Africa.

The primary aim of this study was to describe patients at sexually transmitted disease (STD) clinics in Cape Town, South Africa, in terms of gender, education and age differences relative to their STD knowledge and beliefs, their condom use, as well as their attitudes towards condom use and their condom-use behaviour. The information was collected with a view to developing a health education intervention. Structured interviews were conducted with 2978 randomly sampled Xhosa-speaking STD clinic attenders about their knowledge, beliefs and practices regarding STDs and related behaviours. More males (75%) than females (25%) presented for STD treatment. The majority of patients (92%) were younger than 35 years. Female patients were found to be more aware than male patients of the sexual nature of STD transmission, valued personal autonomy in sexual behaviour and expressed a greater need to use condoms. Males perceived STD symptoms to be more serious, had more misconceptions about the cause of STDs and also more negative beliefs and attitudes towards condom use. Only 34.9% of the patients reported using condoms in the last 6 months while only 24.5% reported regular use. Those who reported condom use were more knowledgeable about the sexual transmission of STDs and the effects of STDs on the neonate. They also had fewer misconceptions about the causes of STDs and perceived STD symptoms to be more serious, attached greater value to personal autonomy in sexual behaviour and condom use and had more positive outcome expectancies of refusing sex than those who never used condoms. The data suggest that targeted interventions directed at males will have to address their inadequate knowledge regarding STDs in terms of transmission, causes, consequences, prevention and cure. Their negative beliefs and attitudes towards condoms will need special attention, especially in view of their multiple partner behaviour. Interventions directed at females will need to improve their knowledge regarding STD consequences, causes, recognition of symptoms as well as improve their knowledge of aspects of prevention and cure. All interventions must facilitate personal autonomy in decision making about sexual behaviour and condom use for both men and women, through skills development programmes that promote self-efficacy in the individual and instil a culture of mutual respect of such in the community.

Adult↗

PubMed1999

Drug use, sexual behaviour and HIV risk of the homeless in Port-of-Spain, Trinidad.

Data were collected from 88 homeless persons in Port-of-Spain, Trinidad to assess HIV risk. 68% of the sample were engaging in unprotected sex with multiple partners, 25% were exchanging sex for money, and 29.5% were regularly smoking crack cocaine. Many had two or more of these behaviours that put them at high risk of HIV infection. Females were significantly more likely to be sex traders, to engage in bisexual behaviour and to have a history of psychiatric illness. The relationship between psychiatric illness and HIV risk behaviours among homeless female persons is explored. Educational interventions are suggested to reduce the public health risks in this population.

Adolescent↗

PubMedDate not supplied

Sexual practices of older adults in a high HIV prevalence environment.

Based on recent epidemiologic evidence, AIDS in older persons (ages 55-79) in Maryland appears to be increasingly contracted heterosexually, particularly in women. Little is known about sexual practices or beliefs about HIV in older persons living in high HIV prevalence urban populations. The purpose of this study was to assess sexual practices, particularly high risk behavior, modifications of behavior including condom use, and perceptions of risk. A behavioral survey, containing 41 potential responses, was developed through modification of The National AIDS Behavioral Survey, focusing on heterosexual activity. The survey was administered to a convenience sample of 55 to 79 year olds attending the Union Memorial Hospital medical clinic. Sexual activity is common within the older population, especially among men. Multiple partners is not unusual in older men. Condoms are commonly used. Older individuals typically are aware of HIV heterosexual transmission risk and a proportion have modified sexual behavior because of perceived risks.

Age Factors↗

PubMed2000

The C-class chemokine, lymphotactin, impairs the induction of Th1-type lymphokines in human CD4(+) T cells.

Chemokines are involved in the regulation of leukocyte migration and for some of them, T-cell costimulation. To date, the only direct property of lymphotactin (Lptn), the unique member of the C class of chemokines, consists of T-cell chemoattraction. This report describes a novel function for Lptn in human T-lymphocyte biology, by demonstrating the direct ability of Lptn to both inhibit and costimulate CD4(+) and CD8(+) T-cell activation, respectively. Lptn but not RANTES inhibited CD4(+) T-cell proliferation, through a decreased production of Th1 (interleukin [IL]-2, interferon [IFN]-gamma) but not Th2 (IL-4, IL-13) lymphokines, and decreased IL-2R alpha expression. Transfections in Jurkat cells showed a Lptn-mediated transcriptional down-regulation of gene-promoter activities specific for Th1-type lymphokines, as well as of nuclear factor of activated T cells (NF-AT) but not AP-1 or NF-KB enhancer activities. This suppressive action of Lptn could be compensated by overexpression of NF-ATc but not NF-ATp. CD4(+) T-cell proliferation was completely restored by exogenous IL-2 or reversed by pertussis toxin, wortmannin, and genistein, suggesting the involvement of multiple partners in Lptn signaling. In contrast to CD4(+) cells, Lptn exerted a potent costimulatory activity on CD8(+) T-cell proliferation and IL-2 secretion. These data provide important insights into the role of Lptn in differential regulation of normal human T-cell activation and its possible implication in immune response disorders. (Blood. 2000;96:420-428)

Androstadienes↗

PubMed1999

HIV-risk practices among homeless and low-income housed mothers.

BACKGROUND: Knowledge of human immunodeficiency virus (HIV) and its risk behaviors have not been systematically studied in homeless mothers. The identification of the factors associated with HIV-risk practices will guide interventions for low-income housed and homeless women. METHODS: We interviewed 220 homeless and 216 low-income housed mothers living in Worcester, Massachusetts, to gather information on demographic, psychosocial , and HIV-risk practice characteristics. We used standardized instruments and questions drawn from national surveys. The primary study outcome was high HIV-risk behavior. RESULTS: Although homeless mothers were more likely than low-income housed mothers to report first sexual contact at an early age, multiple partners during the last 6 months, and a history of intravenous drug use, homelessness was not associated with high HIV-risk practices. Both homeless and low-income housed mothers demonstrated misconceptions about HIV transmission through casual contact. Among high-risk women, approximately 75% perceived themselves as having low or no risk for contracting HIV. A history of childhood victimization, adult partner violence, or both placed women at a significantly increased likelihood of high HIV-risk practices. African American race, knowledge about HIV, and self-perception of risk were also significantly associated with high-risk practices. CONCLUSIONS: Homeless mothers are a subgroup of poor women at high risk for HIV and should be targeted for preventive interventions. In addition, there are potentially modifiable factors associated with HIV-risk practices in both low-income housed and homeless mothers that should be directly addressed.

Adult↗

PubMed1997

Epidemiology and clinical characteristics of HIV-infected patients in Kuala Lumpur.

Between 1987 to 1995, a total of 334 patients infected with HIV were treated at the Hospital Kuala Lumpur. There were 159 Malays, 108 Chinese, 64 Indians, and 3 from other ethnic groups. Three hundred and twenty-one (96.1%) of these individuals were males and 262 (65.9%) were between the ages of 26-45 years. Intravenous drug users made up 77% (256) of the attributable risk behaviour from the group although many of them also had added risk behaviours like heterosexual activity with multiple partners (50 patients), tattoos (7 patients), homosexual practice (4 patients) and previous transfusions (3 patients). The others acquired their infection through heterosexual promiscuity (59 patients), homo/bisexual activity (7 patients), previous transfusion (5 patients) and tattoos (1 patient). Sixty-six patients (all males) had since progressed to full blown AIDS and 10 have died. The two commonest AIDS-defining events were tuberculosis infection and Pneumocystic carinii pneumonia occurring in 37 (56%) and 15 (22.7%) of patients respectively. Forty-one patients with AIDS presented for the first time with their AIDS-defining infections. The mean CD4 count of the patients when they progressed to AIDS was 130/mm3. The mean time for progression from "known" seropositivity to AIDS was 2.42 years. These results suggest that Malaysians infected with HIV are not coming forward for treatment until they are in the advanced stage of the disease.

AIDS-Related Opportunistic Infections↗

PubMed2001

[Recent progress in epidemiologic research of uterine cancer].

Although the mortality and incidence of cervical cancer have been decreasing, those of uterine-body, or endometrial, cancer have been increasing. The proportion of endometrial cancer was reported to have become 33.6% of primary uterine cancers in 1995. Infection with certain types of human papilloma virus (HPV) is considered to be etiologically important for the occurrence of cervical cancer. Because HPV is sexually transmitted, some risk factors for cervical cancer are associated with certain kinds of sexual behavior such as a young age at first intercourse, multiple partners, and infrequent use of barrier-type contraceptives such as condoms. Frequent conceptions and deliveries and histories of sexually transmitted diseases like infection with herpes simplex virus type 2 or chlamydia also have been suggested to be associated with the risk of cervical cancer. Smoking habits and infrequent intake of vegetables and fruits may be related to the increased risk of cervical cancer by supporting persistent infection of HPV through impaired immunological function. Although host factors such as a variant of a tumor suppressor gene like p53 have been assessed in terms of the risk of cervical cancer, these are not yet clearly elucidated. Estrogen stimulation of the endometrium unopposed by progesterone stimulation, namely, unopposed estrogen stimulation, is thought to be involved in the etiology of endometrial cancer. Frequent intake of animal fat, obesity or being overweight, infertility, and histories of diabetes mellitus, hypertension, and polycystic ovary syndrome have been reported to be risk factors for endometrial cancer, and they are thought to increase unopposed estrogen stimulation. Estrogen replacement therapy for postmenopausal symptoms, tamoxifen therapy for breast cancer, and taking sequential-type oral contraceptives have been shown to be exogenous risk factors for endometrial cancer in that they increase unopposed estrogen stimulation to endometrium.

Adult↗