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PubMed1994

[HIV-positive drug addicts treated at the Copenhagen City Drug Dependency Clinic 1986-1992].

The Copenhagen City Drug Dependency Clinic at the former Rudolph Bergh's Hospital was established in 1986 as part of the measures taken by the municipality of Copenhagen to control the spread of HIV/AIDS among the intravenous drug addicts in the City of Copenhagen. The aim was to attract those HIV-positive drug addicts who were in no formal treatment for their drug addiction at other treatment centres and to retain them in treatment for a longer period acknowledging the fact that no causal cure exists for either the drug addiction or for AIDS. The goal of the treatment was to reduce HIV-risk behaviour i.e. sharing needles and syringes and unprotected sex with multiple partners and to reduce the adverse medical and social consequences of continued drug abuse. The treatment was supported by methadone treatment. During the five year period of 1986-92 a total of 196 HIV-positive drug addicts were referred to the clinic. A little more than half of those referred for the first through the third time and five out of six referred for the fourth time were admitted to treatment at the clinic. Half of the 126 first-time treated patients were retained in treatment for up to one year, while the rest were retained in treatment from one to five years. The mean time spent in treatment at the clinic was shorter for the relatively few patients who were admitted for the second time than for those admitted for the first time. At the end of the study 39 patients (20%) had died, most of them for non-AIDS related reasons.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Condom breakage and slippage among men in the United States.

Data on condom breakage and slippage from a nationally representative survey show that the average condom breakage rate experienced by 20-39-year-old men who have used a condom in the preceding six months was 2.7%, and that 1.9% of all condoms used during that time broke. Comparable condom slippage rates are 2.7% and 2.0%, respectively. Condom breakage and slippage appear to be 4-5 times higher among black men than among men of other races. Levels of breakage and slippage are also elevated among low-income men and those who used condoms relatively infrequently in the six months before the survey. The data also indicate that men who engage in high-risk sexual behavior, such as having multiple partners and engaging in anal intercourse, are more likely to experience condom breakage and slippage.

Adult↗

PubMed1994

Aids-related knowledge and practices in migrant populations: the case of Montrealers of Haitian origin.

The objectives of the study were to determine knowledge levels regarding AIDS and its modes of transmission, and to describe sexual behaviour of Montrealers of Haitian origin. A serial cross-sectional study was conducted in three phases between 1987 and 1990. A questionnaire was administered in a face-to-face interview with the exception of the section concerning sexual practices which was self-administered for those respondents who were literate in French. The study was conducted among 775 men and women residing in the metropolitan Montreal region. These individuals were aged 15 to 39, were born in Haiti or had at least one parent born in Haiti. Knowledge levels were high except for misconceptions about HIV transmission through casual contact and mosquito bites. There was a significant association between high risk sexual behaviour and marital status with the odds of having had multiple partners significantly raised for previously married individuals (OR = 5.96, 95% CI = 3.09; 11.50). High risk behaviour was also associated with being under 25 years of age (OR = 2.83, 95% CI = 1.40; 5.74), knowing someone with HIV/AIDS (OR = 1.88, 95% CI = 1.05; 3.37), being male (OR = 6.81, 95% CI = 3.99; 11.60) and earlier year of interview. Montrealers of Haitian origin, with their specific AIDS-related socio-cultural characteristics, constitute a community which is intermediate between their country of origin, Haiti, and their host country, Canada.

Acquired Immunodeficiency Syndrome↗

PubMed1993

HIV antibody testing among those at risk for infection. The National AIDS Behavioral Surveys.

OBJECTIVE: To determine the prevalence of testing for human immunodeficiency virus (HIV) antibody among adults with various risk factors for infection, particularly those residing in large metropolitan areas where the bulk of cases of acquired immunodeficiency syndrome (AIDS) have occurred. DESIGN: A nationwide, population-based telephone survey eliciting testing, sexual, and injection drug use histories. PARTICIPANTS: A total of 2673 randomly chosen US residents and 8263 randomly chosen residents of 23 metropolitan areas containing 64% of reported cases of AIDS. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Testing for HIV antibody. MAIN RESULTS: Overall, rates of individuals ever tested were only slightly higher in the urban areas (23%) than in the nation as a whole (21%). Testing frequencies were low among all risk groups (less than 40%), except men engaging in same-sex sexual activity (60%) and male and female injection drug users (46% and 73%, respectively). The low rate of testing (35%) among the largest risk group, heterosexual men and women engaging in unprotected sexual intercourse with multiple partners, was particularly worrisome. CONCLUSIONS: To encourage antibody testing among the many at risk for infection who have not yet been tested, promotional campaigns should explain the universal susceptibility to infection among those at risk, and the availability of prophylactic medical therapies and social support services to persons who are HIV-seropositive. As there were comparable levels of risk-taking behavior among subjects in both samples, these campaigns must be designed to reach all segments of the population.

AIDS Serodiagnosis↗

PubMed1993

AIDS epidemic among Florida women.

Impact of the human immunodeficiency virus among women in Florida is increasingly recognized in the second decade of the AIDS epidemic. Illicit drug use, sexual activity with multiple partners, lack of access to health care, and socioeconomic disadvantages are greatly contributing to the increase of female AIDS cases. Current salient features of the epidemic are summarized as well as prevention strategies to reduce transmission of the virus.

AIDS-Related Opportunistic Infections↗

PubMed1995

Chlamydia trachomatis in pelvic inflammatory disease.

The prevalence of genital Chlamydia trachomatis infection and some epidemiologic factors associated with it were studied in 273 pelvic inflammatory disease (PID) patients attending Gynaecologic clinic, Government Medical College, Nagpur. For detection of chlamydial antigen Pharmacia Diagnostics Chlamydia EIA test was used. This study revealed an overall positivity rate of 33% for C. trachomatis infection in PID patients. Of the hypothesised risk factors low socioeconomic status, history of sexual contacts with multiple partners and use of intrauterine devices (IUD) were significantly associated with C. trachomatis infections. However, use of oral contraceptives, barrier contraceptives and increasing age were found to be protective factors for C. trachomatis infection. Thus considering the significant contribution of C. trachomatis in etiology of PID and its independent association with some epidemiologic risk factors, extensive epidemiologic measures are recommended for prevention of these infections.

Adult↗

PubMedDate not supplied

Dissemination research in primary care: impacting the real world of the practitioner.

Dissemination research in primary care should focus on getting information our and changing practice. Family physicians have a strong orientation toward prevention and are a trusted source of advice for patients but often lack an infrastructure to assist in prevention. Physicians provide such preventive care as: health enhancement, risk avoidance, risk reduction, early identification, and complication reduction. Within this framework important research questions are raised within five areas: the system of care, office organization, the professional, the patient, and education. Increasing the capacity for research should focus on the need for multi-disciplinary teams; longitudinal community-based cohort studies; inter-provincial studies; funded multiple-partner research programs; practitioners organized with a regional focus; and support for fellowships and investigators. The success of dissemination depends on its respect for the context and priorities of both practitioners and the public.

Family Practice↗

PubMed1996

Predictors of African American adolescents' condom use and HIV risk behavior.

This study evaluated predictors of risky and safer behavior in a sample of low-income African American adolescents, assessed their perceptions of the risk associated with their sexual behavior, and examined differences between adolescents who used condoms consistently, inconsistently, or engaged only in unprotected intercourse. African American adolescents (N = 312) completed measures related to AIDS knowledge, frequency of condom use, attitudes toward condoms, and sexual behavior over the preceding 2 months. Multiple regression analyses for the sexually active youths (N = 114) revealed that lower self-efficacy, higher perceived risk, and male gender were associated with high-risk behavior. Positive attitudes toward condoms and younger age had the strongest association with condom use. Consistent condom users were more knowledgeable and held more positive attitudes toward condoms, and nonusers were older. Regardless of their behavior, the adolescents generally did not perceive themselves to be a risk for HIV infection. The findings suggest that precautionary practices (condom use) and high-risk behavior (unprotected sex with multiple partners) may have different correlates. In addition, the data indicate that theoretical models developed with homosexual male populations may also be generalizable to African American adolescents' sexual behavior.

Adolescent↗

PubMed1997

Evaluation of the HIV risk reduction intervention for women entering inpatient substance abuse treatment.

OBJECTIVES: Interventions to lower HIV risk behavior among drug users have concentrated on reduction of high risk injection practices. Less attention has been directed to non-injecting drug users and drug-involved women. Female non-injecting drug users (e.g., women who abuse alcohol or crack cocaine) are also at substantial risk for sexual transmission of HIV due to multiple partners, partners who self-inject and share needles, exchange of sex for drugs, coerced sex, high rates of sexually transmitted diseases, and low rates of condom use. This study compared the effectiveness of an educational intervention (EC) against the behavior skills training intervention (BST) in reducing sexual risk behavior among women (N = 117) court-ordered into inpatient drug treatment. METHODS: Participants were assessed at baseline, post intervention, and 2 months after discharge from the drug treatment facility. RESULTS: Women in both conditions reported high rates of sexual risk behavior prior to the intervention. Women in both conditions had more positive attitudes toward HIV prevention and reported greater partner agreement with condom use at the post intervention assessment. However, these changes were not maintained at follow-up for women in the EC condition, whereas women in BST continued to show improvement post discharge. Women in the BST condition showed marked, while women in EC showed little improvement in communication skills and no improvement in condom application skill. At follow-up, women in both conditions had reduced drug use and drug-related high risk sex activities. BST women had increased their condom use while women in EC evidenced a decrease. Condom use increased from 35.7% to 49.5% of vaginal intercourse occasions for BST women and decreased from 28.8% to 15.8% for women in EC. CONCLUSIONS: Results suggest a brief skills training intervention embedded in drug treatment programs can reduce sexual risk for HIV-infection after discharge.

Adult↗

PubMedDate not supplied

HIV risk behaviors among inner-city African American women. The Community Housing AIDS Prevention Study Group.

This study examined the prevalence and predictors of HIV risk behaviors among a sample of 875 low-income, African American women residents of inner-city housing developments. The women completed an anonymous questionnaire that revealed that one third of them were at high risk for HIV either because they had multiple partners or because of the high-risk behaviors of their regular partner. HIV risk was highest among women who accurately perceived themselves to be at increased HIV risk, reported weak behavioral intentions to reduce risk, and held stronger beliefs about psychosocial barriers to condom use. Women at high risk were also younger, reported higher rates of substance use, and indicated that their housing development lacked social cohesiveness. These findings suggest that HIV prevention efforts for this population should focus on strengthening women's risk reduction behavioral intentions and self-efficacy through skill development, overcoming psychosocial barriers to condom use, managing the risk related to substance use, and incorporating approaches that take into account the social, psychological, and relationship barriers to change among economically impoverished African American women.

Adolescent↗

PubMedDate not supplied

Acute and chronic viral hepatitis.

Hepatitis A, B, C, D, E, and G are important causes of viral hepatitis. It is estimated that there are at least 32,000 new cases of hepatitis A, 300,000 new cases of hepatitis B, and 150,000 new cases of hepatitis C each year in the United States alone. Risk factors for hepatitis infection include sexual activity with multiple partners, intravenous drug use or sharing cocaine straws, tattooing or body piercing, exposure to blood and body fluids through health-care work, and having a blood transfusion or transplant. Diagnostic markers are important to determine the type of hepatitis and to differentiate acute from chronic infection. Up to 5% of adult patients infected with hepatitis B virus and up to 80% of those infected with hepatitis C virus become chronic carriers. Whereas acute hepatitis C virus infection is usually mild, chronic hepatitis C infection develops insidiously after an average of 10 years and may lead to cirrhosis and possibly hepatocellular carcinoma. Currently, interferon-alpha is the only FDA-approved agent to treat chronic hepatitis B and C and relapses are common with hepatitis C infection. There are many clinical trials using other antivirals and combination therapies to treat these chronic infections. Prevention through patient education of high-risk behaviors and immunization remain the best defense against acute and chronic viral hepatitis.

Acute Disease↗

PubMed1997

Abnormal cervical lesions in young adults.

The objective of this study is to determine the prevalence of cervical lesions in a population of young adults. This study took into account 897,900 pap smears kindly provided by the cytopathology division at the University of Mississippi Medical Center. These cases were subdivided into three different groups based on age. Group one represents the age population of 0-17, group two represents the age population of 18-34, and group three represents the age population of 35 and higher. Seven different parameters were evaluated in this study. These include negative: unsatisfactory, atypia, CIN I, CIN II, CIN III, and invasive carcinoma. Data obtained from this study suggests that cervical lesions among young teenagers were found to be significant and our observations recommend that this population be screened and evaluated on a regular basis. The results of this study conclude that cervical lesions are significant among young adults. This age group would benefit from education and routine screening. In addition early sexual activity, multiple partners, and infectious diseases were noted in cases with cervical cancer. This could be due to the high occurrences of SIL in young adults. Screening of this age group is highly recommended for those young adults at "high risk."

Adolescent↗

PubMed1998

Survivors of sexual abuse: clinical, lifestyle and reproductive consequences.

BACKGROUND: In recent years, an increase in the prevalence of sexual abuse of women has been reported in Canada and elsewhere. However, there are few empirical data on the extent of the problem in Canadian aboriginal populations. The authors investigated the presence of a reported history of sexual abuse and other health determinants in a sample of women attending a community health centre with a substantial aboriginal population. This allowed determination of whether reported sexual abuse and its associated demographic and health-related effects were different for aboriginal and non-aboriginal women. METHODS: A sample of 1696 women was selected from women attending a community health centre in a predominantly low-income inner-city area of Winnipeg for a cross-sectional survey designed to study the association between sexual behavior and cervical infections. The survey was conducted between November 1992 and March 1995 and involved a clinical examination, laboratory tests and an interviewer-administered questionnaire. A substudy was conducted among 1003 women who were asked 2 questions about sexual abuse. RESULTS: The overall response rate for the main study was 87%. Of the 1003 women who were asked the questions about sexual abuse, 843 (84.0%) responded. Among the respondents, 368 (43.6%) were aboriginal. Overall, 308 (36.5%) of the respondents reported having been sexually abused, 74.0% of the incidents having occurred during childhood. The prevalence was higher among aboriginal women than among non-aboriginal women (44.8% v. 30.1%, p < 0.001). Women who had been sexually abused were younger when they first had sexual intercourse, they had multiple partners, and they had a history of sexually transmitted diseases. In addition, non-aboriginal women who had been sexually abused were more likely than those who had not been abused to have been separated or divorced, unemployed and multiparous and to have used an intrauterine device rather than oral contraceptives. Aboriginal women who had been sexually abused were more likely than those who had not been abused to have been separated or divorced, unemployed and multiparous and to have used an intrauterine device rather than oral contraceptives. Aboriginal women who had been sexually abused were more likely than those who had not been abused to have had abnormal Papanicolaou smears. The proportion of smokers was higher among the abused women than among the non-abused women in both ethnic groups. INTERPRETATION: A history of sexual abuse was associated with other clinical, lifestyle and reproductive factors. This suggests that sexual abuse may be associated with subsequent health behaviors, beyond specific physical and psychosocial disorders. Aboriginal and non-aboriginal women who have suffered sexual abuse showed substantial differences in their subsequent health and health-related behaviours.

Adult↗

PubMed2007

Prevalence and correlates of risky sexual behaviors among injection drug users in Tashkent, Uzbekistan.

The objective of this paper is to describe prevalence and correlates of sexual risk behaviors among injection drug users (IDUs) in Tashkent, Uzbekistan. Participants in this cross-sectional study completed a questionnaire detailing sociodemographic, medical and drug and sexual risk behaviors and HIV antibody testing. Of 701 IDUs surveyed, only 20.5% reported consistent condom use, which was more likely for women. Prior sexually-transmitted infection (STI) diagnosis was reported by 36.2% of participants and was associated with early (</=18 years) drug initiation, group drug use, being older, higher educational level, marriage, needle sharing, multiple sex partners in the preceding month and daily injection use. Having multiple partners in the preceding month was common (29.71%) and related to employment, consistent condom use with regular partners and STI self-treatment in multivariate logistic regression. Participants with a history of sharing needles were less likely to have had multiple partners in the previous month. Risky sexual behaviors are common and interrelated with risky injection habits among IDUs in Tashkent, Uzbekistan, representing a continued threat of infection with HIV and other blood-borne agents.

Adolescent↗

PubMed2002

Sexual coercion among adolescent women seeking abortion in China.

PURPOSE: To probe the backgrounds and reasons of sexual coercion (SC) among the adolescent abortion-seekers in China. METHODS: In this case-control study, we considered the abortion-seeking women (1,137) who reported that they had ever experienced SC as "case group" and we considered the abortion-seeking women (1,246) who reported that they had never experienced SC as "control group." We compared the differences in demographic characteristics, some relevant factors (e.g., abusing alcohol, multiple sex partners, etc.). We used OR as a criterion to measure the relative risk (that is, the strength of association between these factors and SC). RESULTS: The factors that were more likely to be associated with SC included: poor education (OR, 1.51), beaten by her partner (OR, 3.70), multiple sex partners (OR, 2.93), sex after abusing alcohol (OR, 6.45), selling sex for money (OR, 17.07), having sex for material benefits (OR, 11.68), sex owing to watching pornographic videotape (OR, 3.88), younger age (<18 years) at first intercourse (OR, 1.92), and larger age difference (>5 years) between male and female partners (OR, 1.34). CONCLUSIONS: The rate of SC among Chinese adolescent women seeking abortion is rather high, and SC is associated with many factors.

Abortion, Induced↗

PubMed2005

Seroepidemiology of Trichomonas vaginalis in rural women in Zimbabwe and patterns of association with HIV infection.

Serological assays using dried blood spots from 5221 women in rural areas of eastern Zimbabwe were used to assess the epidemiology of Trichomonas vaginalis infection, and its association with HIV. Antibodies to T. vaginalis and to HIV were detected by enzyme immunoassays. Behavioural and demographic data were collected by confidential questionnaires. In total, 516 (9.9%) women were seropositive for T. vaginalis and seroprevalence increased with age among younger women. Divorced, widowed and single women were more likely to be seropositive. After controlling for age, seropositivity was significantly associated with being sexually active, having multiple sex partners, having a partner who had multiple sex partners, and having a new sex partner in the past year. Seropositivity was associated with a recent history of genital discharge. Overall, 208 (40.3%) T. vaginalis-positive samples were also positive for HIV, compared with 1106 (23.5%) T. vaginalis-negative samples (age and sex adjusted OR 2.11, 95% CI 1.74-2.55, P < 0.001). There was increased risk for being HIV-positive amongst T. vaginalis-seropositive women regardless of residence, employment or education. In a logistic regression controlling for common risk factors, the association remained significant. T. vaginalis-seropositive young women with a history of genital discharge were much more likely to be HIV-positive than women who were T. vaginalis-seronegative and had no history of discharge (OR 6.08, 95 % CI 2.95-12.53). Although a causal relationship cannot be assumed, detection and treatment of trichomoniasis may be important in strategies to reduce HIV transmission through sexually transmitted infection control.

Adolescent↗

PubMedDate not supplied

High-risk sexual behavior in the general population. Results from a national survey, 1988-1990.

The responses of 2,896 adults who completed the General Social Survey (1988-1990), a nationally representative household probability sample of the United States adult population, were analyzed. Three outcome variables were examined: engaging in sexual intercourse with two or more partners, with five or more partners, or with a stranger in the past year. Age, marital status, gender, pattern of alcohol consumption, and race have the strongest and most consistent relationship with having multiple sexual partners or sex with a stranger. Marriage reduces the odds of having 5 or more sexual partners by a factor of 90% (odds ratio, OR, = 0.10). For each single year increase in age, the odds of having multiple partners or sex with a stranger also decrease (OR = 0.95). Alcohol consumption, on the other hand, increases the odds of sexual risk behavior by a factor of 2 to 3 in the three models. Men are more likely to have 5 or more sexual partners (OR = 7.17) and sex with a stranger (OR = 5.62) than women; and blacks are more likely to have multiple partners (OR = 2.82) than members of other racial or ethnic groups. In the United States last year, an estimated 3 to 6 million adults had sex with 5 or more partners and an estimated 5 to 8 million had sex with a stranger.

Adolescent↗

PubMed2006

Translocator proteins in the two-partner secretion family have multiple domains.

The two-partner secretion pathway in Gram-negative bacteria consists of a TpsA exoprotein and a cognate TpsB outer membrane translocator protein. Previous work has demonstrated that the TpsB protein forms a beta-barrel structure with pore forming activity and facilitates translocation of the TpsA protein across the outer membrane. In this study, we characterized the functional domains of the Haemophilus influenzae HMW1B protein, a TpsB protein that interacts with the H. influenzae HMW1 adhesin. Using c-Myc epitope tag insertions and cysteine substitution mutagenesis, we discovered that HMW1B contains an N-terminal surface-localized domain, an internal periplasmic domain, and a C-terminal membrane anchor. Functional and biochemical analysis of the c-Myc epitope tag insertions and a series of HMW1B deletion constructs demonstrated that the periplasmic domain is required for secretion of HMW1 and that the C-terminal membrane anchor (HMW1B-(234-545)) is capable of oligomerization and pore formation. Similar to our observations with HMW1B, examination of a Bordetella pertussis TpsB protein called FhaC revealed that the C terminus of FhaC (FhaC-(232-585)) is capable of pore formation. We speculate that all TpsB proteins have a modular structure, with a periplasmic domain that interacts with the cognate TpsA protein and with pore forming activity contained within the C terminus.

Adhesins, Bacterial↗