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PubMed2002

Risk behaviours associated with urethritis and genital ulcer disease in prison inmates, Sindh, Pakistan.

We evaluated the epidemiological differences with respect to demographics, drug use and sexual behaviours associated with lifetime risk of urethritis, genital ulcer disease (GUD) and urethritis and GUD together among 3395 male prisoners in Sindh. Factors associated with urethritis and GUD alone were sex with multiple females, sex with men, and ethnicity. Additional factors associated with urethritis alone were sex with prostitutes, sex with partners having multiple partners and sex with partners believed to be injecting drugs. Behaviours associated with lifetime risk for urethritis and GUD together were sex with multiple females, sex with prostitutes, sex with men, sex with partners believed to be injecting drugs and ethnicity. These relationships were consistently stronger compared to urethritis or GUD alone.

Adult↗

PubMed2006

Self-esteem, emotional distress and sexual behavior among adolescent females: inter-relationships and temporal effects.

PURPOSE: The current analyses attempt to clarify the relationship between psychological factors and sexual behavior. We test a model examining relationships between sexual history (e.g., age at initiation, partner history) and self-esteem and emotional distress (e.g., depression, anxiety, stress, hostility) and their impact on future sexual risk behavior (e.g., unprotected sex, multiple sexual partners). METHODS: The current analyses included 155 sexually active adolescent females, aged 14-19 years, who participated in the first two waves of a longitudinal study of human immunodeficiency virus (HIV)/sexually transmitted disease (STD) and pregnancy risk. The Rosenberg Self-esteem scale, the Perceived Stress Scale, and three subscales of the Brief Symptom Inventory (depression, anxiety, hostility) and a variety of self-report measures of sexual history and sexual behavior were administered. Structural equation modeling using LISREL 8.51 was used to assess the proposed model. RESULTS: Our model exhibited adequate fit and demonstrated that sexual history reported retrospectively at baseline was related to self-esteem and emotional distress also measured at baseline. These variables predicted sexual risk behavior measured 6 months later. Adolescents who had lower self-esteem at baseline reported initiating sex earlier and having had risky partners. Alternatively, adolescents with more emotional distress at baseline were less likely to have had a previous STD, had more partners per year of sexual activity and a history of risky partners. Self-esteem influenced subsequent unprotected sex and emotional distress influenced subsequent multiple partners. CONCLUSIONS: This model suggests that self-esteem and emotional distress have contrasting relationships with sexual behavior and demonstrates the importance of the temporal nature of these variables. Implications for intervention are discussed.

Adolescent↗

PubMed2005

Characteristics and sexually transmitted diseases of male rural migrants in a metropolitan area of Eastern China.

GOAL: The goal of this study was to identify the correlates and determine the prevalence of sexually transmitted diseases (STDs) among male rural migrants in Shanghai, China. STUDY: The authors conducted a community-based cross-sectional study with an anonymous questionnaire interview and collection of blood and first-void urine samples for STD screening. RESULTS: One thousand eighty-six (85.3%) of 1273 male rural migrants approached were interviewed. Among the 986 sexually active migrants, the prevalence of chlamydia, gonorrhea, and syphilis was 3.5%, 0.5%, and 1.0%, respectively. None were infected with HIV. The prevalence of STDs was 3.2% for construction workers, 5.6% for market vendors, and 5.6% for factory workers. Risk factors for STDs were longer duration in Shanghai, frequent hometown visits, having multiple sex partners, and the desire to have multiple sex partners. CONCLUSIONS: The prevalence of STDs among male rural migrants is relatively low. Maintaining the current low prevalence can reduce the risk of an HIV epidemic among Shanghai migrants, but prevention messages need to be tailored to the low level of literacy in many migrants.

Adolescent↗

PubMed1997

Determinants of high-risk sexual behaviour and condom use among adults in the Arusha region, Tanzania.

Determinants of multiple sexual partners and condom use among adults were assessed through a population-based survey in one urban, one semi-urban and one rural community in the Arusha region, northern Tanzania. The study samples were obtained by randomly selecting clusters of 10 households from the 3 communities. Informed verbal consent was sought from each respondent for participation in the study. High-risk sexual behaviours and condom use were assessed using a structured questionnaire. It was observed that significantly more men than women reported having multiple sexual partners (49% vs 25.2%; OR = 1.69; 95% CI = 1.51-1.90) and urban men were significantly more likely to report having multiple sexual partners than men in rural areas. In both men and women, early sexual debut was associated with having multiple sexual partners while travel, alcohol use, and sex under the influence of alcohol were significantly associated with multiple sexual partners in men only. AIDS-related discussion was significantly associated with having fewer sexual partners in both men and women. Of the 1551 respondents, 320 (20.6%) reported having ever used a condom and of the 320 respondents who had ever used a condom, 34 (10.6%) reported having used it at the last sexual intercourse. Significantly more men than women reported having ever used a condom (34.1% vs 14.1%; OR = 1.77; 95% CI = 1.56-2.01). In both men and women, early sexual debut and being young, unmarried, travelling out of the Arusha region and having multiple sexual partners were associated with increased condom use. For both men and women, frequent discussion of AIDS with family members or friends was associated with increased condom use. These data suggest that interventions targeting adolescents and young adults may be effective for control of HIV transmission in Tanzania. In particular, creation of opportunities for people to come together and discuss AIDS might be an important strategy.

Adolescent↗

PubMed2001

Determinants of high-risk sexual behavior among immigrant groups in Amsterdam: implications for interventions.

OBJECTIVES: To determine predictors for sexual risk behavior among immigrant men in Amsterdam. METHODS: From May 1997 to July 1998, 650 men from Surinam, the Antilles, and Ghana were recruited by convenience sampling. Multivariate logistic regression was used to find independent predictors for 1) multiple sex partners (>sexual 1 partner in the past year), 2) unprotected sex with casual partners in The Netherlands, 3) sexual activity in country of origin, and 4) unprotected sex in country of origin. RESULTS: 1) Multiple sex partners were reported by 50% of respondents. Independent predictors were a recent infection with a sexually transmitted disease (STD), youth, low educational level, Afro-Surinamese origin, lack of a long-term relationship and history of commercial sex contact. 2) Unprotected sex occurred in 24% of casual partnerships. Independent predictors were a recent STD infection, low educational level, use of hard drugs, age between 20 and 29, few sexual partners, unprotected sex in country of origin, and a partner from the respondent's ethnic group. 3) During the past 5 years, 24% were sexually active in country of origin. Independent predictors were Ghanaian origin, age over 20, a relatively high income, and multiple partners. 4) Unprotected sex occurred in 39% of the partnerships in country of origin. Independent predictors were low educational level, history of STDs, lack of health insurance, Ghanaian origin, frequent visits to home country, few sexual partners, and unprotected sex with casual partners in The Netherlands. CONCLUSION: Among immigrant men in Holland, important target groups for AIDS prevention programs have been identified. Men who visit their country of origin should be made aware of the risk of sexual contact with local women. Furthermore, it should be taken into account that immigrant men use condoms less frequently with women of their own ethnic group than with Dutch women.

Adolescent↗

PubMed1991

Sexual behaviors of intravenous drug users in treatment.

Sexual behaviors of a group of 313 intravenous drug users (IVDUs) (225 men, 88 women) were assessed by a structured interview at the start of an AIDS prevention project. Although the majority were celibate or monogamous during the prior year (men 52.5%, women 64.3%), many IVDUs had multiple sexual partners in that time, including 19.6% of men and 7.2% of women reporting five or more. Married male and female IVDUs were more likely to have multiple sexual partners than married people in general population samples. Only 38.5% of male and 35.4% of female IVDUs ever used condoms during the previous 5 years. Percentage of sexual encounters in which condoms were used correlated significantly with the number of partners for women (r = 0.37, p less than 0.01), but not for men (r = 0.03, ns). Use of intravenous drugs in the prior year, sharing of needles, use of stimulants, exchange of sex for money or drugs, and combining sexual events with drug use were all associated with greater numbers of sexual partners. A subset of male IVDUs engages in the dual-risk behaviors of needle sharing and unprotected intercourse with multiple partners. This group could act as a highly efficient vector for human immunodeficiency virus transmission and should become a focus of intensive preventive intervention.

Acquired Immunodeficiency Syndrome↗

PubMed2000

Improving surveillance of intimate partner violence by use of multiple data sources.

BACKGROUND: Intimate partner violence (IPV) is a significant public health problem in the United States. Estimates of incidence and prevalence vary widely, depending on the data source used. Combining information from different sources can enhance our understanding of IPV. METHODS: In this paper, we used 1998 data from the Rhode Island (RI) Department of Health Violence Against Women Public Health Surveillance System to describe the prevalence of IPV reported to police, the demographic characteristics and help-seeking efforts of women reporting IPV, and characteristics of IPV incidents. We used data from the 1998 RI Department of Health Behavioral Risk Factor Surveillance System survey to examine associations between health care use and health outcomes of victims and nonvictims of IPV, and to explore the correlates of IPV. We also discuss the use of both narrow and broad definitions of IPV. RESULTS: Our findings show that the definition of IPV and the source used to identify IPV victims can produce a markedly different picture of IPV victims, and that combining information from different data sources can enhance our understanding of IPV. An important finding for health care providers is that IPV victims do not appear to be significantly different from nonvictims in their access to and utilization of routine health care, and that more than 60% of victims at highest risk for injury reported seeing a health care provider because of IPV. CONCLUSIONS: Our findings underscore the importance of health care providers addressing IPV and its consequences among their patients.

Adolescent↗

PubMed1994

Survey of knowledge, behaviour and attitudes relating to HIV infection and AIDS among Kenyan secondary school students.

To evaluate the knowledge, attitudes and sexual behaviour with respect to HIV and AIDS among Kenyan secondary school students, a questionnaire was issued to 3,018 students of mean age 16.3 years in 11 Kenyan schools. Questions of knowledge were answered correctly by an average of 77.1% of students. Areas where students' knowledge was less complete included the inability of mosquitoes to transmit the virus, the protective effect of condoms, the lack of protection from medications, the fatal and incurable nature of AIDS, and the fact that those infected with HIV may appear healthy. No prior sexual experience was reported by 71.3% of females and 25.2% of males. Multiple sexual partners were reported by 41.2% of males and 7.3% of females. Sixty per cent of students denied ever using condoms during sex and only 6.8% of those with multiple partners used them all the time. A prior sexually-transmitted disease was reported by 5.6% of students. Although a high level of knowledge regarding HIV and AIDS is evident among Kenyan students there is a sizable number who admit to extensive sexual experience, but who are not using condoms, thereby putting themselves at risk.

Acquired Immunodeficiency Syndrome↗

PubMed2000

The influence of gender on sex: a study of men's and women's self-reported high-risk sex behavior.

An investigation is presented of the relationship between gender and five self-reported high-risk sex behaviors: ever having had casual sex, the lifetime number of vaginal sex partners, the lifetime number of anal sex partners, having had multiple vaginal sex partners over the short term, and having had multiple anal sex partners over the short term. The analysis was guided by a conceptual model that emphasized the constraints and opportunities for high-risk sex behavior that arise from an individual's structural position and cultural context. Gender differences in high-risk sex behaviors were predicted to be due to differences in men's and women's family roles, work roles, religious behaviors, and past sex experience. In addition, the effects of certain sociocultural factors on the high-risk sex behaviors were expected to be dependent on an individual's gender. The hypotheses were evaluated using national data from the United States on self-reported sex behaviors for men ages 20 to 39 years old and women ages 20 to 37 years old. Data analyses were conducted using ordinary least-squares regression and logistic regression. Findings provided mixed support for the predictions. Gender was not significantly related to short-term, self-reported high-risk sex behaviors once social and cultural factors were included in the statistical models. But it continued to predict lifetime behaviors. Several variables, including race, age, age at first sex, and marital status, had gender-specific effects on the self-reported high-risk sex behaviors. The study demonstrates how the effects of structural and cultural factors on sex behavior differ for men and women.

Adolescent↗

PubMed1994

Predictors of high-risk behavior in unmarried American women: adolescent environment as risk factor.

BACKGROUND: Heterosexual intercourse with two or more partners in a short time period represents a high-risk behavior for acquisition and transmission of sexually transmitted pathogens (STDs). Identification of factors that may predict high-risk sexual behavior can help to focus primary prevention strategies on women at risk for future acquisition of infection. METHODS: We analyzed survey data obtained in 1988 from a nationally representative sample of 8,450 American women of reproductive age in order to identify such factors. RESULTS: Of all sexually experienced unmarried women, 6.6% reported having had two or more sexual partners in the preceding three months. Earlier age at first sexual intercourse was associated with multiple recent partners, and with lower reports of abstinence. Birth region in the West, lack of attendance at religious services as an adolescent, and having a mother who had her first child before she was 25 years of age were factors associated with multiple recent partners. Among unmarried white women having a mother who worked full time and not living with both parents during adolescence were associated with multiple recent partners; among unmarried black women, the inverse was true (p for racial difference < .05). Multivariate analysis showed western birth region and earlier age at first sexual intercourse to be significant predictors of having multiple recent sex partners. CONCLUSIONS: Early environment and race influence later sexual behavior. These factors should be considered in targeting and planning education for STD prevention.

Adolescent↗

PubMedDate not supplied

Parent and peer communication effects on AIDS-related behavior among U.S. high school students.

Data from a 1989 national probability sample of 8,098 high school students in the United States indicate that young people's discussions about the human immunodeficiency virus (HIV) with parents and with peers are highly correlated and have opposite effects on behavior. Students who discussed HIV with their parents were less likely than those who did not to have had multiple sex partners, to have had unprotected sexual intercourse and to have ever injected drugs; on the other hand, students who discussed HIV with their peers were more likely than those who did not to have had multiple partners and to have had unprotected sexual intercourse. Subgroup analyses show that young women were influenced more by HIV discussions with parents, while young men were influenced more by discussions with peers; some communication effects differed by race and ethnicity. Students who received HIV instruction in school were more likely to have talked about HIV with both parents and peers.

Adolescent↗

PubMed1998

Immunoglobulin A, G, and M responses to L1 and L2 capsids of human papillomavirus types 6, 11, 16, 18, and 33 L1 after newly acquired infection.

OBJECTIVES: We performed a study to establish the pattern of serological reactivity for immunoglobulins (Ig), to capsids of human papilloma virus (HPV) after new HPV infection in two groups of subjects. METHODS: The pattern of serological reactivity after acquisition of infection with HPV was investigated by measuring IgA, IgM, and IgG antibodies to capsids containing L1 and L2 proteins of HPV types 6, 11, 16, 18, and 33 in longitudinal studies of groups with different patterns of sexual activity. Individuals who tested negative for HPV DNA by the polymerase chain reaction at enrolment, but who became HPV DNA positive during follow up, were examined for antibodies to HPV capsids by enzyme linked immunosorbent assay. One group consisted of 15 young girls (with eight controls who remained HPV DNA negative) who were becoming sexually active and the other comprised 12 male (with five controls) and 35 female (with seven controls) heterosexual attenders of a sexually transmitted disease clinic who had had multiple sexual partners. RESULTS: The sexually inexperienced girls showed IgA and IgG responses, but seldom an IgM response to infection with HPV types 6/11, 16, and 18. No consistent pattern of serological reactivity was apparent for the heterosexuals with multiple partners. The lack of association between current HPV DNA positivity and detectable antibodies in these individuals was possibly related to the duration of infection or to prior exposure to HPV. For the latter group serological reactivity to HPV capsids was significantly greater in women than in men (p = 0.001, p = 0.003, and p = 0.024, for IgG to HPV 6, 11, and 16, respectively). CONCLUSION: The sex difference in antibody response detected in previous studies with assays based on peptide antigens was thus corroborated in the present study with capsid based serological assays. This sex difference might reflect a difference in sexual activity and prior exposure to HPV between men and women in this particular group.

Adult↗

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↗

PubMed2005

The role of depressive symptoms in predicting sex with multiple and high-risk partners.

Existing research examining the role of psychopathology on HIV risk behaviors has relied heavily upon cross-sectional data, making it difficult to assess causal relationships. This paper uses longitudinal data to examine the relationship between depressive symptoms and sexual risk behaviors in a community sample of 332 inner-city drug users. Results from repeated measures analysis using generalized estimating equations suggest that high depressive symptoms may be causally related to having sex with multiple partners (odds ratio = 1.55, CI: 1.12, 2.14) and having sex with injection drug users (odds ratio = 1.57, CI: 1.11, 2.22) and crack users (odds ratio = 1.37, CI: 1.02, 1.86). Findings support greater attention to depressive symptoms in HIV prevention interventions for illicit drug users to reduce sexual risk behaviors.

Adult↗

PubMed1999

Predictors of increased condom use following HIV intervention with heterosexually active drug users.

Research with injection drug users (IDUs), at risk for acquiring and transmitting HIV, has focused primarily on their risky drug practices, with far less attention paid to their risky sex behaviors. The purpose of this study was to determine what variables were associated with an increase in condom use following an HIV intervention with 3357 IDUs in nine cities. Participants reported using condoms during 15% of their sexual encounters prior to the HIV intervention, and during 22% of their sexual encounters six months later. A logistic regression analysis indicated that individuals who increased their condom use were likely to be HIV seropositive (odds ratio OR = 2.49), to have received AIDS information prior to the intervention (OR = 1.28), to have multiple sex partners (OR = 2.14), to be single with multiple sex partners (OR = 1.34), or to have exchanged drugs or money for sex (OR = 1.33). Discussion focuses on the generally low incidence of condom use and the need for increased intervention, particularly among drug users in monogamous relationships and sex workers.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Chlamydial and gonococcal cervicitis in HIV-seropositive and HIV-seronegative pregnant women in Bangkok: prevalence, risk factors, and relation to perinatal HIV transmission.

OBJECTIVES: To determine the prevalence and risk factors associated with cervicitis caused by Chlamydia trachomatis and Neisseria gonorrhoeae in human immunodeficiency virus (HIV) type 1-seropositive and HIV-seronegative pregnant women in Bangkok, and the relation to perinatal HIV transmission. METHODS: As part of a multicenter perinatal HIV transmission study in an antenatal population with 2% HIV seroprevalence, endocervical swabs obtained at mid-pregnancy from a consecutive sample of 222 HIV-seropositive and 219 HIV-seronegative pregnant women at two large hospitals in Bangkok were tested for the presence of C. trachomatis and N. gonorrhoeae by DNA hybridization probe (Gen-Probe). Clinical risk factors and DNA probe results were analyzed in relation to the women's and newborns' HIV infection status. RESULTS: The prevalence of C. trachomatis was 16.2% in HIV-seropositive pregnant women and 9.1% in HIV-seronegative pregnant women (P = 0.03). The prevalence of N. gonorrhoeae was 2.7% in HIV-seropositive pregnant women and 1.4% in HIV-seronegative pregnant women (P = 0.5). The overall population prevalence estimate was 9.2% for C. trachomatis and 1.4% for N. gonorrhoeae. Women with gonococcal infection were more likely to be positive for C. trachomatis (RR(MH) = 5.2, P < 0.01). Young age (<21 years) and primigravid status were associated with C. trachomatis infection among HIV-seropositive women; history of multiple sex partners (>1) were associated with C. trachomatis infection among HIV-seronegative women. For HIV-seropositive women, primigravida status also was associated with C. trachomatis infection. The perinatal HIV transmission rates were similar for those with and without C. trachomatis (24.1% and 23.2%, P = 0.9) and among those with and without N. gonorrhoeae (20% and 23.5%, P = 1.0). CONCLUSIONS: Among pregnant women in Bangkok, C. trachomatis infection was considerably more common than N. gonorrhoeae infection and was associated with HIV infection, young age and first pregnancy (HIV-seropositive women), and multiple partners (HIV-seronegative women). Our data do not suggest an association between perinatal HIV transmission and maternal C. trachomatis or N. gonorrhoeae infection identified and treated during pregnancy. The high prevalence of C. trachomatis found using a test not readily available in Thailand emphasizes the need for improved, inexpensive ways to screen for and diagnose these sexually transmitted infections in developing countries.

Adult↗

PubMed2005

Workplace and HIV-related sexual behaviours and perceptions among female migrant workers.

Data from 1,543 female migrants working in eight occupational clusters in Beijing and Nanjing, China were analysed to examine the association of workplace with HIV-related behaviours and perceptions. For sexually experienced women (n = 666, 43.2%), those working in entertainment establishments or personal service (e.g., nightclubs, dancing halls, barbershops, beauty salons, massage parlours, etc.) engaged in risky sexual practices twice as frequently as those working in non-entertainment establishments (e.g. restaurants, stalls, domestic service, factories, etc.). About 10% of women in the entertainment establishments reported having sold sex, 30% having multiple sexual partners and 40% having sex with men with multiple sexual partners. The rate of consistent condom use was less than 15%. They also tended to have a higher level of perceptions of both peer risk involvement and positive expectancy of risk behaviours, and lower perceptions of severity of STDs and HIV. For women who were not sexually experienced, those working in 'stalls' or 'domestic service' tended to perceive higher peer risk involvement, less severity of HIV infection, and less effectiveness of protective behaviour. The occupational pattern of sexual risk behaviours and perceptions observed in the current study indicates employment conditions are associated with HIV risk. Intervention strategies should be tailored to address occupational-related factors.

Adolescent↗

PubMed2004

[Survey of behaviors and knowledge about HIV/AIDS among intravenous drug users at a city in Sichuan Province].

OBJECTIVE: To understand high risk behaviors related to HIV/AIDS and the intravenous drug users' knowledge about HIV/AIDS. METHODS: Forty-eight intravenous drug users (IDUs) were interviewed by using questionnaires. RESULTS: The survey showed that 75% of the subjects were male, 83.3% of their educational levels were below junior middle school, and most of them lived in cities(83.0%), having no occupation or having special occupation. The age at the beginning of drug use was 11 years old, the ages in cities were earlier than those in the countryside (F = 3.898, P = 0.029). For the reasons of using drug, 58.1% of IDUs did so through curiosity; 57.1% of IDUs had ever shared the syringes and needles with others, 62.5% of them shared with fixed people. 79.5% of the IDUs had casual sex partners, and 68.75% had multiple sex partners, but only less than 40% of them used condoms when having sex with casual partner. CONCLUSION: There are many high risk factors related to the IDUs' drug addiction and sex behaviors which can facilitate the transmission of HIV.

Acquired Immunodeficiency Syndrome↗