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PubMed2004

Self-disclosure of HIV serostatus in recently diagnosed patients with HIV in South Africa.

Failure of people living with HIV/AIDS to disclose their HIV serostatus can place their sexual partners at risk. The current study examined HIV serostatus disclosure and its relationship to risky sexual behaviours in 69 sexually active, heterosexual, married (62%) or cohabiting (38%) patients recently diagnosed as HIV positive. Results show that 78% had not disclosed their HIV serostatus to their sexual partners and 46% had no knowledge of their sexual partner's serostatus. Compared to those who disclosed their serostatus, those who did not disclose were more likely to be male (chi2 = 7.02, p = 0.00), to have not used a condom during their last sexual encounter (chi2 = 29.64, p = 0.000), to have used alcohol heavily before sex (chi2 = 6.79, p = 0.00), to have multiple sexual partners (t = 3.01, p = 0.05), and to have engaged more frequently in sexual intercourse in the six months preceding the study (t = 8.21, p = 0.00). Logistic regression analysis show that being in a married relationship (OR = 0.86, 95% CI = 0.65, 1.15), being male (OR = 1.48, 95% CI = 0.24, 1.99), having more than two multiple partners (OR = 2.03, 95% CI = 1.11, 3.68) and non-use of condom at last sex (OR = 1.53, 95% CI = 0.83, 1.88) were significantly associated with non-disclosure of HIV serostatus. Preventive strategies among HIV-positive patients should place emphasis on the management of self-disclosure and its importance in safe sexual behaviour.

AIDS Serodiagnosis↗

PubMed1994

A socioeconomic, clinical and serological study in an African city of prostitutes and women still married to their first husband.

The aim of this paper was to compare women involved in prostitution with a group of women still married to their first husband and reporting having had only one sexual partner, in order to ascertain what factors if any contributed to women going into prostitution or staying still married to their first husband, their only sexual partner, and thereafter to compare clinical and serological aspects of the gynaecological conditions of the women in these two groups. The role of prostitutes in transmission of sexually transmitted diseases (STD) is widely recognised. Socioeconomic factors determining whether a woman will drift into prostitution or have a stable first marriage are largely unknown as are prevalence rates of STD, pelvic inflammatory disease (PID) and cervical cancer in these women. A socioeconomic, clinical and serologic study is reported for 2111 Ethiopian women attending teaching hospitals and maternal and child health clinics in Addis Ababa, analysing basic demographic data of three groups of women: (i) 278 engaged in prostitution, (ii) 730 still married to their one and only sexual partner, and (iii) 1103 single, widowed, divorced or married to their second or subsequent partner. Thereafter groups (i) and (ii) were compared and contrasted with regard to further socioeconomic, clinical and serological associations. The most significant socioeconomic associations for women in prostitution were low income (95% had < 50 Ethiopian birr [< U.S. $25] per month), ethnic group, and the timing of first coitus in relation to the menarche (81% were first married by age 15), in that order. Women still married to their first sexual partner had higher income, higher age at first marriage and longer duration of marriage. Sero-prevalence rates of STD in prostitutes were high: gonorrhoea 88%, genital chlamydiae 78%, syphilis (TPHA) 62%, HSV2 and HBV 46%, and chancroid 19%: 67% had PID and 2.9% cervical cancer. In comparison, rates for women married to their first and only sexual partner were: gonorrhoea 40%, genital chlamydiae 54%, syphilis (TPHA) 19%, HSV2 33%, HBV 35%, chancroid 13%, PID 47% and cervical cancer 1%. While the very high prevalence of STD in women involved in prostitution is not so unexpected, the high rate of STD in women still married to their first and only sexual partner is indicative of male promiscuity. Control of prostitution and diseases spread by it, together with education of both men and women is a national priority.

Adolescent↗

PubMed1992

Prevalence of AIDS-related risk factors and condom use in the United States.

A national probability survey of human immunodeficiency virus (HIV)-related risk factors among the general heterosexual population, the National AIDS (acquired immunodeficiency syndrome) Behavioral Surveys, has obtained data from 10,630 respondents. Data are presented on the prevalence of HIV-related risks in the general heterosexual population, on the distribution of the three largest risk groups across social strata, and on the prevalence and distribution of condom use among heterosexuals reporting a risk factor. Between 15 and 31 percent of heterosexuals nationally and 20 and 41 percent in cities with a high prevalence of AIDS reported an HIV risk factor. Condom use was relatively low. Only 17 percent of those with multiple sexual partners, 12.6 percent of those with risky sexual partners, and 10.8 percent of untested transfusion recipients used condoms all the time. Overall, the results suggest that current HIV prevention programs have, to a very limited extent, reached those heterosexuals with multiple sexual partners but have failed to reach many other groups of the heterosexual population at risk for HIV. New public health strategies may be needed for these specific risk groups.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Casual sex, extramarital sex, condom use and alcohol intake among heterosexual patients attending an STD clinic in Norway.

A study excluding homosexuals was performed to study casual sex, extramarital sex, the use of a condom with a casual sexual partner and the combination of alcohol intake and casual sex among patients attending a clinic for sexually transmitted diseases (STDs). Heterosexual patients (467) received a questionnaire, and 458 were included. Men reported more (94%) casual sexual partners than did women (76%). According to a multiple logistic regression analysis a condom was used significantly less frequently in "old" respondents, those having a permanent sexual partner, those having low education, those infected with STDs (earlier STDs), those who had had more than 4 sexual partners over the last year, and those combining alcohol intake and casual sex. Intravenous drug users/prostitutes used a condom more often than did men with paid sex and "other heterosexuals". To have an effect on STD patients, innovative forms of health education may be necessary, and greater emphasis should be placed on more informal means of information, including interactive health education and communication strategies to promote positive attitudes regarding condom use.

Adolescent↗

PubMed1992

Correlates of HIV risk behaviors in black and white San Francisco heterosexuals: the population-based AIDS in multiethnic neighborhoods (AMEN) study.

This study, the first random household probability sample of unmarried adults in an HIV epicenter, examined the prevalence and correlates of HIV risk behaviors among sexually active unmarried heterosexual white and black adults (n = 848) in San Francisco, California. Racial or gender differences were found in the HIV risk factors among the men and women in our sample. More whites (17% men, 15% women) than blacks (12% men, 5% women) reported they had ever used injection drugs. White women were more likely to report that they had a sexual partner who used injection drugs (17%) than white men (11%), black women (5%), or black men (4%). Also, men were more likely than women to have had two or more sexual partners in the past year without using condoms: 43% of white men compared to 34% of white women and 40% of black men compared to 24% of black women. Among all ethnic and gender groups, more than half of those at sexual risk for HIV infection reported never using condoms. Of those at risk, more black women (75%) than white women (53%) reported they never used condoms with their sexual partners within the past year. However, only slightly more black men (62%) than white men (60%) at sexual risk for HIV reported they never used condoms with their sexual partners during the past year. High levels of HIV risk behaviors were associated with low income, not having a primary sexual partner, less enjoyment of condoms, and greater barriers to using condoms. The results support the need for major intervention programs and social marketing campaigns to promote the use of condoms by enhancing enjoyment of and reducing barriers to condom use, especially among sexual partners of black women.

Adult↗

PubMed2005

Assessment of sexual behavior, sexual attitudes, and sexual risk in Sweden (1989-2003).

To assess changes in sexual behavior, sexual attitudes, and sexual risk related to HIV, we conducted mailed questionnaire surveys in random samples of the Swedish general population in 1989, 1994, 1997, 2000, and 2003 (total N = 13,762). Each sample consisted of 4,000-6,000 subjects aged 16-44 years, stratified by age: 16-17, 18-19, 20-24, 25-34, and 35-44 years. The overall participation rate was 63.8% (for men, 55.9%; for women, 71.9%). The prevalence of three or more sexual partners and casual sexual contacts without the use of a condom was comparatively high for men, for persons aged 16-24 years, single persons with and without a regular partner, and persons living in towns and urban areas. The prevalence of multiple sexual partners and casual sexual contacts increased significantly over time. There was a significant decrease in the proportion of participants who agreed with the statement "Sexual intercourse should only take place in a stable relationship." Personal risk assessments related to HIV did not change significantly over time. The study shows that risky sexual behavior related to HIV/AIDS increased in the Swedish population between 1989 and 2003, and that attitudes concerning casual sexual relations became more permissive.

Adolescent↗

PubMedDate not supplied

Lesbians' sexual history with men: implications for taking a sexual history.

BACKGROUND: Health care providers may not solicit a comprehensive sexual history from lesbian patients because of provider assumptions that lesbians have not been sexually active with men. We performed this study to assess whether women who identify themselves as lesbians have a history of sexual activities with men that have implications for receipt of preventive health screening. OBJECTIVE: To convey the importance for health care providers to know their patients' sexual history when making appropriate recommendations for preventive health care. METHODS: A survey was printed in a national news magazine aimed at homosexual men, lesbians, and bisexual men and women. The sample included 6935 self-identified lesbians from all 50 US states. The outcomes we measured were respondents' number of lifetime male sexual partners and partners during the past year, their lifetime history of specific sexual activities (e.g., vaginal intercourse, anal intercourse), their lifetime condom use, and their lifetime history of sexually transmitted diseases. RESULTS: Of respondents, 77.3% had 1 or more lifetime male sexual partners, 70.5% had a lifetime history of vaginal intercourse, 17.2% had a lifetime history of anal intercourse, and 17.2% had a lifetime history of a sexually transmitted disease. Exactly 5.7% reported having had a male sexual partner during the past year. CONCLUSION: These findings reinforce the need for providers to know their patients' sexual history regardless of their reported sexual orientation, especially with regard to recommendations for Papanicolaou smears and screening for sexually transmitted diseases.

Adult↗

PubMed2005

Chlamydia trachomatis infections in Greece: first prevalence study using nucleic acid amplification tests.

The present retrospective study was initiated to determine the prevalence of Chlamydia trachomatis and to assess the risk factors for infection in adult women and men presenting to general practitioners, gynecologists, dermatologists, and family-planning centers in Greece. The study was carried out in four different Greek hospital centers using highly sensitive nucleic acid amplification techniques. Altogether, 16,834 women and 1,035 men were enrolled from October 1998 to April 2004. Two types of specimens were collected from each patient: cervical swabs from women, urethral swabs from men, and first-catch urine from women and men. All specimens were examined with the Cobas Amplicor C. trachomatis polymerase chain reaction assay (Roche Molecular Systems, Branchburg, NJ, USA) or the LC x C. trachomatis ligase chain reaction assay (Abbott Laboratories, Abbott Park, IL, USA). Demographic and behavioral data were collected by clinicians using a standardized questionnaire. A total of 704 (3.9%) patients were infected with C. trachomatis. The prevalence among female patients was 3.5% and that among male patients 11.2%. Among infected patients, 88% were under 30 years of age, 71% reported more than one sexual partner, and 91% reported a new sexual partner within the last year. In conclusion, the prevalence of C. trachomatis infection in Greece is low. Young age and new and multiple sexual partners within the last year were factors consistently associated with an increased risk of chlamydial infection.

Adolescent↗

PubMedDate not supplied

Cultural politics and masculinities: Multiple-partners in historical perspective in KwaZulu-Natal.

Drawing from ethnographic, archival and secondary research, this article examines multiple-sexual partners in historical perspective in KwaZulu-Natal, a South Africa province where one in three people are thought to be HIV positive. Research on masculinities, multiple-partners, and AIDS has been predominantly directed towards the present day. This paper stresses the importance of unraveling the antecedents of contemporary masculinities particularly the gendered cultural politics through which they have been produced. Arguing against dominant conceptions of African masculinity as being innate or static, it charts the rise and fall of the isoka, the Zulu man with multiple-sexual partners, over the last century. Showing how the isoka developed through changing conditions occasioned by capitalism, migrant labour and Christianity, it contends that an important turning point took place from the 1970s when high unemployment threatened previous expressions of manliness, notably marriage, setting up an independent household and becoming umnumzana (a household head). The high value placed on men seeking multiple-partners increasingly filled the void left by men's inability to become men through previous means. Turning to the contemporary period, the article argues that, shaken by the huge AIDS deaths, men are betraying increasing doubts about the isoka masculinity.

Attitude to Health↗

PubMed1992

The low rate of HIV infection in Japanese homosexual and bisexual men: an analysis of HIV seroprevalence and behavioural risk factors.

OBJECTIVE: To assess the seroprevalence of HIV-1 infection in homosexual and bisexual men in Nagoya City, Japan. DESIGN: A prospective study ongoing since April 1986. METHODS: Nine hundred and thirty-eight serum samples were collected from 531 participants in August 1990 in an anonymous, confidential testing programme. A self-administered questionnaire was completed and all participants anonymized by a code number. Interviews were conducted and HIV-antibody test results given by telephone, except for the positive test results, which were given in person and counselling offered. RESULTS: Two out of the 531 participants (0.38%) were found to be seropositive for HIV-1, although the seroprevalences of sexually transmitted diseases, including hepatitis B, syphilis, chlamydia infection and amoebiasis, were remarkably high. A small number of participants had had sexual contact with individuals from countries where HIV infection rates are high. No patient had had a recent episode of intravenous drug use. Numbers of male sexual partners were decreasing and unsafe sexual practices, such as anal intercourse without condom use, were also decreasing. CONCLUSIONS: The apparent low-risk behaviour of the men studied here (low levels of sexual contact with foreigners, absence of intravenous drug use, decreasing numbers of sexual partners and unsafe sexual practices) may explain the low prevalence of HIV infection.

Adolescent↗

PubMed2002

Sex difference in partner notification: results from three population based surveys in France.

OBJECTIVES: To estimate the proportion of individuals in the general population who did not notify their sexual partners at the time of an STD diagnosis, according to the sex of the patient and the type of partner. METHODS: We analysed behaviour at the time of diagnosis of a self reported STD, using data from three large French national population based surveys of adults (ACSF, Barométre Santé) and adolescents (ACSJ). Univariate and multivariate analyses took into account the complex sampling design. RESULTS: In the ACSF, 14% (95% CI: 4% to 24%) of men reported that they had not informed their main sexual partner compared with only 2% (95% CI: 0% to 5%) of women (p = 0.03). This sex difference was independent of the nature of the STD, the patient's age, level of education, and number of partners. Similarly, in the ACSJ, 51% (95% CI: 21% to 81%) of boys reported that they had not talked about this STD with their current sexual partner compared with only 9% (95% CI: 0% to 26%) of girls (p = 0.04). Notification by a sexual partner had led to discovery of the STD more frequently in male subjects than in female subjects, both in adults (32% of men compared with 4% of women (p=0.04)), and adolescents (36% of boys compared with 12% of girls). Most subjects, irrespective of sex, had not informed partners other than their main or current partner: 73% (95% CI: 62% to 84%) of adults and 86% (95% CI: 77% to 95%) of adolescents. CONCLUSIONS: Procedures must be developed urgently to improve the notification of sexual partners, particularly female partners and adolescents, who are unlikely to be tested early without such notification.

Adult↗

PubMed1989

Characteristics of reproductive life and risk of breast cancer in a case-control study of young nulliparous women.

Between 1982 and 1985, a case-control study of nulliparous women, aged 25-45, was conducted to analyse the relationships between the risk of breast cancer and causes of nulliparity, including contraceptive methods. Fifty-one cases of breast cancer diagnosed less than 3 months before interview were matched with 95 controls on age at diagnosis, year of interview, and medical center. The causes of nulliparity related to female sterility or subfertility (mechanical or hormonal disorders) were not found to be associated with a significantly higher risk of breast cancer. The causes related to fertilization failure, i.e. no sexual partner, rare sexual intercourse (less than once per month), or partner with abnormal semen, were found to lead to an increased risk. Detailed analysis of contraceptive methods showed that the risk of breast cancer increased (p = 0.02) with a longer duration of use of barrier methods (withdrawal or condom). Conversely, the risk significantly decreased (p = 0.004) with a longer duration of use of non-barrier methods (oral contraceptives, IUD, cap, local spermicides, vaginal douche, safe period, or no method), i.e. methods allowing a direct exposure to human semen.

Adult↗

PubMed1997

Determinants for contraceptive use in young, single, Danish women from the general population.

Determinants for contraceptive use were studied in 5031, non-pregnant women aged 20-29 years from the general population in Denmark. Most women (72%) had never been pregnant, 34% had a history of a sexually transmitted disease, and 22% had ever had a legal abortion. Current contraception was most frequently condoms (60%) or oral contraceptives (33%). Among the women who used OCs or IUD, 32% reported additional condom use (double contraception). Important predictors of using one contraceptive method were lifetime number of sexual partners, parity, and age at first sexual intercourse for condoms and age for oral contraceptives. Also, women with a previous legal abortion were more likely to use condoms currently and women with a history of STDs were less likely to use condoms, but more likely to use OCs. Lifetime number of sexual partners was the only predictor of double contraception. Our data suggest a potential for reducing the number of unintended pregnancies and STDs in single women by increasing the information about the double principle in contraception.

Abortion, Induced↗

PubMed1991

Reduction of high-risk sexual behavior among heterosexuals undergoing HIV antibody testing: a randomized clinical trial.

BACKGROUND: We evaluated the effect of HIV antibody testing on sexual behavior and communication with sexual partners about AIDS risk among heterosexual adults at a clinic for sexually transmitted diseases. METHODS: We randomized 186 subjects to receive either AIDS education alone (the control group) or AIDS education, an HIV antibody test, and the test results (the intervention group). These subjects were then followed up 8 weeks later. RESULTS: At follow-up, mean number of sexual partners decreased, but not differently between groups. However, compared with controls, HIV antibody test intervention subjects, all of whom tested negative, questioned their most recent sexual partner more about HIV antibody status (P less than 0.01), worried more about getting AIDS (P less than 0.03), and tended to use a condom more often with their last sexual partner (P = 0.05): 40% of intervention subjects vs 20% of controls used condoms, avoided genital intercourse, or knew their last partner had a negative HIV antibody test (P less than 0.005). CONCLUSION: HIV antibody testing combined with AIDS education increases concern about HIV and, at least in the short term, may promote safer sexual behaviors. Additional strategies will be necessary if behaviors risky for HIV transmission are to be further reduced.

AIDS Serodiagnosis↗

PubMed2006

An assessment of high risk sexual behaviour and HIV transmission among migrant oil workers in the Niger Delta area of Nigeria.

BACKGROUND: A cross--sectional behavioural survey undertaken amongst migrant oil-workers of an oil exploration outfit operating in the Niger-Delta of Nigeria with the aim of assessing the interplay of migrancy, high-risk sexual behaviour and HIV transmission. METHOD: A total of 300 randomly selected migrant oil workers were assessed using structured questionnaires to evaluate key high - risk sexual behavioral parameters such as multiplicity of sexual partners, bisexuality (closet homosexuality), high grade sexual behaviour and lesbianism. Sampling period was two months with a control cohort of 200. RESULT: The prevalence of high risk sexual behaviour (HRSB) amongst the migrant oil workers was found to be 7.7% while low-risk sexual behaviour (LRSB) was 92.3%. There was no record of HRSB in the control group. We did not also encounter any lesbian sexual orientation in this study. The distribution of HRSB amongst the migrant oil workers showed that the commonest variety was bisexuality (closet homosexuality) with 10(43.5%) followed by high-risk sexual behaviour 7(30.4%), while the least common was multiplicity of sexual partners with 6 (26.1%). Furthermore, majority of these individuals 19 (82.6%) were above the age of 35 years. The index of condom-use and acceptance was high. Here 14 (60.9%) found condom-use convenient while 13 (56.5%) regularly used the condom. CONCLUSION: This study confirms the existence of HRSB among migrant oil workers in the Niger delta. It is therefore advisable to focus interventionist and prevention programmes on this group which appear to be pivotal in the transmission and spread of HIV/AIDS in this environment.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Co-risk factors for HPV infection in Northeastern Thai women with cervical carcinoma.

HPV infection is the main cause of cervical cancer; however, factors that promote and maintain HPV infection are still unclear. This study was designed to search for factors responsible for the HPV infection in Northeastern Thai women. A total of 190 volunteers with a normal histopathologic appearance of cervix as controls (n=100) and with squamous cell cervical carcinoma (SCCA) (n=90) were the subjects. Variables of risk factors including sexual behaviors, history of reproduction, history of sexually transmitted diseases and smoking were conducted with self-report and direct interview. Number of sexual partners and smoking history increased the likelihood of high-risk HPV infection. Multiple sexual partners showed significantly higher 3.94-fold risk for HPV infection (95% CI = 1.82-8.82, p-value<0.001). Smoking history of partner increased the risk for HPV infection 3.03-fold (95%CI=1.42-6.58, p-value< 0.002). After OR were adjusted, significant difference was still observed in the number of sexual partners (p-value <0.0001) and smoking history of the partner (p-value<0.005). To decrease the incidence of cervical cancer, we should prevent HPV dissemination and be on the alert for having multiple sexual partners and a partner's smoking habit, which must be included in our public health planning.

Adolescent↗

PubMed2004

Prevalence and patterns of gender-based violence and revictimization among women attending antenatal clinics in Soweto, South Africa.

Gender-based violence is a key health risk for women globally and in South Africa. The authors analyzed data from 1,395 interviews with women attending antenatal clinics in Soweto, South Africa, between November 2001 and April 2002 to estimate the prevalence of physical/sexual partner violence (55.5%), adult sexual assault by nonpartners (7.9%), child sexual assault (8.0%), and forced first intercourse (7.3%). Age at first experience of each type of violence was modeled by the Kaplan-Meier method, and Cox hazard models with time-varying covariates were used to explore whether child sexual assault and forced first intercourse were associated with risk of violent revictimization in adulthood. Child sexual assault was associated with increased risk of physical and/or sexual partner violence (risk ratio = 2.43, 95% confidence interval: 1.93, 3.06) and with adult sexual assault by a nonpartner (risk ratio = 2.33, 95% confidence interval: 1.40, 3.89). Forced first intercourse was associated with increased risk of physical and/or sexual partner violence (risk ratio = 2.64, 95% confidence interval: 2.07, 3.38) and nonsignificantly with adult sexual assault by a nonpartner (risk ratio = 2.14, 95% confidence interval: 0.92, 4.98). This study confirms the need for increased attention by the public health community to primary and secondary prevention of gender-based violence, with a specific need to reduce risk among South African adolescents.

Adolescent↗

PubMed1992

Interactions between persons at risk for AIDS and the general population in Denmark.

A nationwide study of sexual behavior was undertaken among 4,680 randomly selected Danes aged 18-59 years. The median number of sexual partners (lifetime) was highest for men aged 30-34 years (eight partners) and for women aged 25-29 years (seven partners). After adjustment for age and sex, having had greater than or equal to 5 sexual partners in the past year was strongly associated with living in larger cities, intravenous drug use, and having sex with a prostitute, a bisexual man, an intravenous drug user, or a resident of sub-Saharan Africa. The frequency of ever having had anal intercourse was highest among women aged 20-34 years (range, 27%-36%) and was independently associated only with increasing number of sexual partners (lifetime). Overall, 2.7% of men reported any homosexual experience, among whom most (88%) had also had heterosexual intercourse. Prostitute contact (ever) was reported by 13% of all men and was associated with a high educational level, a history of travel, a greater number of sexual partners, and intravenous drug use. Overall, sexual contact with someone considered at high risk of human immunodeficiency virus (HIV) infection (a homosexual/bisexual man, intravenous drug user, prostitute, or sub-Saharan African resident) was reported by 15.9% of men and 4.8% of women. Among active blood donors (past year), 12.5% of men and 4.0% of women had engaged in potentially risky behavior. HIV testing was deliberately sought more often by respondents exposed to someone at increased risk of HIV infection (10.6%) than by those unexposed (6.5%, p less than 0.01). Exposure to persons at risk of HIV infection is considerable in Denmark. The majority of persons who have had potential exposure to HIV have not yet been tested for HIV.

AIDS Serodiagnosis↗