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PubMed1990

Risk factors for cervical human papillomavirus and herpes simplex virus infections in Greenland and Denmark: a population-based study.

Risk factors for genital human papillomavirus (HPV) types 6/11 and 16/18 and any HPV type as well as for herpes simplex virus type 2 (HSV-2) infections were investigated in a population-based study of 1,600 randomly selected women (20-39 years) from Godthåb (native, Nuuk), Greenland, and Nykøbing Falster, Denmark. A total of 586 Greenlandic women and 661 Danish women were included, respectively. They all had a personal interview and a gynecologic examination with cervical smear and swab for HPV analysis (filter in situ hybridization). Moreover, a blood sample was obtained for analysis for HSV-2 antibodies by enzyme-linked immunosorbent assay. In view of the general concept of HPV as a sexually transmitted virus, it is unexpected that women with "multiple" partners revealed a significantly lower risk for all types of HPV than did women with "few" partners, the odds ratio (OR) being 40-60% decreased in women with greater than or equal to 30 partners compared with women who had 0-4 sexual partners. In contrast, the risk for HSV-2 infection was significantly increased among women with early age at first sexual intercourse (OR = 2.9 for age less than or equal to 13 vs. 14-16 years) and multiple partners (OR = 2.6 for greater than or equal to 20 vs. 0-4 partners) (hereafter referred to as "high sexual activity" as well as with an increasing number of sexually active years with an unprotected cervix (i.e., without the use of barrier contraceptives) (OR = 2.0 for greater than or equal to 15 vs. 0-9 years). The results of this study thus demonstrate a surprising risk pattern for HPV types 6/11 and 16/18, but a pattern for HSV-2 in line with that to be expected for a sexually transmitted virus. This could indicate the existence of factors, especially in women with high sexual activity, which interfere with the expression of HPV or with the ability to detect it and/or that HPV may be transmitted by means other than sexual contact.

Adult↗

PubMed1995

Health risk behavioral survey from 39 juvenile correctional facilities in the United States.

PURPOSE: The study surveyed adolescents in juvenile detention facilities to determine the incidence of health risk behaviors. METHODS: A modified version of the United States Centers for Disease Control Youth Risk Behavior Surveillance System was administered to 1801 minors at 39 facilities in the United States. RESULTS: Risky behavior begins early, the initiation plateauing at age 15 or 16 years. Girls and boys reported comparable rates of drinking, binge drinking, and illicit drug use. North American Natives and those individuals who designated themselves as being other than any of the offered choices for racial designation ("Other") began drinking at earlier ages, had more binge drinking, more illegal drug use, and the most fight-related behavior. By age 12 years 62% reported onset of sexual intercourse and by age 14 years 89% were sexually active. Fighting was reported by 69% of detainees. Fight-related injuries within the past year were reported by 25% of the respondents. Nearly 47% belonged to a gang. Drug/alcohol use, fighting, and gang membership were related. Suicide was considered by 22% of the detainees, planned by 20%, tried by 16%, 8% were injured because of a suicide attempt. Younger teens (White, N.A. Natives, and "Other") had the most frequent suicide ideation. Drug/alcohol use correlated with suicidal thoughts. Onset of sexual intercourse was at an average age of 12. Multiple partners and pregnancy, was highest among blacks and "Others". Blacks had the highest sexually transmitted disease (STD) rate. Less than half of all respondents used condoms at last intercourse. STDs were related to being female, being black, and having multiple sexual partners. Pregnancy was related to multiple sexual partners and violent behavior. CONCLUSION: Male and female detainees report a high incidence and early onset of risky behaviors. N.A. Natives and those of "other" races reported the highest incidence of risk behaviors.

Adolescent↗

PubMed1996

Sexual behaviour in travellers abroad attending an inner-city genitourinary medicine clinic.

OBJECTIVE: To investigate frequency of sexual encounters with new partners abroad in patients attending a genitourinary clinic (GUM). METHODS: In a case series 464 attenders at a genitourinary medicine clinic completed an anonymous self-administered questionnaire, if they had been abroad recently, enquiring about sexual behaviour abroad. RESULTS: 28.4% of subjects admitted to sex with a new partner abroad with only 41.7 per cent consistently using condoms. There were no significant differences in condom use for gender, ethnicity or type of visit and relationship. Twenty-nine per cent of those admitting to sex abroad had more than one partner. The risk of multiple partners was not associated with gender, ethnicity, type of visit (holiday or business) or type of relationship (heterosexual or homosexual). The first partner abroad for 63% of men and 62.5% of women was of a nationality other than that of United Kingdom residents. Non-Caucasians and homosexuals were significantly more likely to have first partners abroad from outside the UK than Caucasians and heterosexuals respectively. CONCLUSION: The occurrence of casual sex abroad in GUM attenders suggests that further research is needed to establish targetable risk factors for this type of behaviour amendable to change through health promotion.

Adolescent↗

PubMed1996

Gender dynamics and the challenges for HIV prevention.

Information on the transmission of the human immunodeficiency virus (HIV), leading to acquired immunodeficiency syndrome (AIDS), has been widely disseminated since the early 1980s, and yet curbing new infections remains a major public health dilemma. In response to the global challenge of HIV/AIDS, most control and prevention interventions have targeted "core groups' with messages which include:- 1. Reduction of individual risk through responsible sexual behaviour or behaviour change, such as, delayed sexual debut, abstinence, monogamy and condom use. 2. Communal (as a society) adoption of a risk reduction strategy e.g. reduced rate of sexual partner change and avoiding multiple partners. 3. Improved, early and aggressive STD treatment programmes. However, data from sub-Saharan Africa and elsewhere shows how the epidemic, in the general population, appears to thrive unabatted. Large proportions of women and some men, in none of the traditional high risk core groups, are increasingly becoming infected with HIV. Most of the women appear to be at risk of infection not so much because of their own behaviour, but that of their partners of husbands. In this continuum, our response has been fragmented and non-strategic. Few programme activities have been developed that address men as a critical core group potentially propagating or sustaining the epidemic. The preoccupation with female sex workers and other core groups (e.g. truck drivers) could have overshadowed the need for programmes and interventions that make men, in general, aware of HIV risk and less likely to infect their sexual partners. Challenges posed by HIV require innovative strategies that foster behavioural and social change in the situation of men at risk and their partners.

Africa South of the Sahara↗

PubMed1994

Prevalence of HIV and associated risk behaviour in attendees at a Dublin needle exchange.

The aim of this study was to measure the prevalence of HIV infection and assess the level of equipment-sharing and unsafe sexual activity among attendees at a Dublin needle exchange. Using an anonymous unlinked approach, attendees were asked to complete a brief questionnaire and provide a sample of saliva for HIV testing. Of the 144 attendees eligible for inclusion during the study period, 106 agreed to participate and complete a questionnaire, a response rate of 74%. Of the 81 respondents who submitted a usable saliva sample, 14.8% were HIV positive. Half of the respondents claimed that they had not shared equipment during the preceding 28 days, but a third had shared with multiple partners. Half of the respondents claimed that they had multiple sexual partners during the preceding year, but only a quarter said that they always used condoms. The prevalence of HIV infection is similar to that found in routine linked testing of drug users in Ireland. The high level of unsafe injecting and sexual activity makes clear the need for more effective health promotion among drug users in Dublin.

Acquired Immunodeficiency Syndrome↗

PubMed1992

Behavioral risk factors for sexually transmitted diseases in American households.

The analysis of a representative survey of households (n = 968) in a San Francisco Bay Area county provides strong evidence for the role of problem drinking as a risk factor for sexually transmitted diseases independent of drinking patterns and drug use. Among women, age, race, early age at first intercourse, history of multiple partners, drinking patterns, as well as current symptoms of problem drinking were all associated with reported STD rates. Stepwise logistic regression analysis showed, however, that female problem drinkers are nearly four and a half times more likely (adjusted O.R. = 4.65, 95% C.I. = 1.30, 16.70) than other women to have had STDs independent of all these potential risk factors. Problem drinking puts women at a greater risk for STDs than a history of multiple sex partners (adjusted O.R. = 2.75, 95% C.I. = 0.98, 7.75). This finding is also observed among men, among whom STDs were associated with a history of multiple sex partners (adjusted O.R. = 4.12, 95% C.I. = 1.90, 8.94) and the lifetime prevalence of drinking problems (adjusted O.R. = 4.95, 95% C.I. = 2.13, 11.50). Frequent bar-going, drunkenness episodes, high volume drinking, feeling disinhibited while drinking and drug use increase the risk for STDs via their effects on the rate of sex partner change. Problem drinking determines STD rates independent of these factors. The implications of these findings for future research and health policy are discussed.

Adult↗

PubMed1994

Attitudes to sex and sexual behaviour in rural Matabeleland, Zimbabwe.

Though HIV prevention campaigns in Zimbabwe have increased public awareness of HIV, they have not meaningfully changed sexual behaviour. Possibly these campaigns are based on wrong assumptions about sexual behaviour. By means of 111 structured interviews with hospital patients, secondary school students and teachers, and 11 focus group discussions with traditional healers, midwives, village community workers, secondary school students and teachers, and commercial sex workers in a rural district of Matabeleland in Zimbabwe, this low-budget study explores attitudes towards sex and sexual behaviour in order to define more appropriate health education messages. Results indicate that traditional sex education no longer takes place and that communication between sexual partners is limited. The almost ubiquitous expectation of women to get rewards for sex outside marriage motivates mostly single women out of economic necessity to meet the male demand for sexual partners, which is created by large scale migrant labour and men's professed 'biological' need for multiple partners. Types of sexual behaviour other than penetrative vaginal sex are uncommon and considered deviant. Safe sex messages from the West therefore are inappropriate in the Zimbabwean context. Recommendations are given to restore traditional communication about sexual matters across generations and to urge sexual partners to discuss sex. Women who, for economic reasons, engage in casual sex should at least learn to negotiate the use of condoms. Men seriously need to reconsider their attitudes to sex and sexual practices in view of the high HIV sero-prevalence. Faithfulness, rather than multiple sexual contacts, should become a reason to boast.

Adolescent↗

PubMed1994

Sexual partner change and condom use among urban factory workers in northwest Tanzania.

OBJECTIVE: To describe sexual partner change and condom use at the intake of a cohort study of urban factory workers in Tanzania. METHODS: From October 1991 to March 1992, 926 male and 170 female factory workers were interviewed using a structured, pre-coded questionnaire. Questionnaire reliability was assessed by pre-testing and comparison with results of unstructured interviews and carrying out repeat questionnaires on a sub-sample. RESULTS: Almost half of both men and women had had sexual intercourse by their 17th birthday. The period of premarital sex had an interquartile range of 2 to 10 years in men and 0 to 2.5 years in women. Having had sexual intercourse in the past month with more than one partner was reported by 22% of the men and 5% of the women. Factors associated with multiple partners in men were being born in or near Mwanza Region, having low education and low income, and being married. Condoms had been used in the past month by 3% only, mainly with casual partners. Condom use in men was associated with being young, living in town, being born in Kagera Region, high education and high income, being circumcised, and having causal or steady (non- martial) partners. CONCLUSION: Information, education and communication (IEC) on sexual relationships and condom use should start at an early age, and include education at primary schools. Much sexual partner change appears to occur through steady (non-marital) partnerships, indicating the need for IEC to be expanded beyond groups such as commercial sex workers and their clients.

Adolescent↗

PubMed1990

Risk behaviours for HIV infection among drug users in prison.

OBJECTIVE: To study a group of injecting drug users to establish the degree of illicit drug use in prisons, the prevalence of risk behaviours for HIV infection, and the uptake of treatment for drug dependency with drugs within the prison system. DESIGN: Anonymous, self administered, questionnaire. SETTING: Two drug agencies in central London; one operating a scheme for exchanging needles, and the other offering drug advice and information. SUBJECTS: 50 (42 Men, eight women) self selected injecting drug users (mean age 31.2 (range 21-42)), all of whom had been held in custody at some time since 1982. MAIN OUTCOME MEASURES: Details about periods served in custody since 1982; the number of respondents who took drugs (orally or by injection), either illicitly or prescribed, while in prison and the types of substances taken; the respondents' sexual activity in prison and between periods in custody. RESULTS: The average time spent in custody before the study was 20.6 months (range 1-72). Most prosecutions were directly or indirectly related to drug taking. 47 Of the 50 respondents reported taking at least one illicit drug while in custody; 33 by injection, 26 of whom had shared injecting equipment. 30 Had been treated for drug dependency by the prescribing of drugs while in prison. While in custody, one woman and four men (with a mean of seven (range 2-16) male partners) had had sex. Between periods spent in custody, men reported having a mean of eight (range 0-90) female partners and women a mean of one (range 0-3) male partner. Three men had had sex with other men, with a mean of six (range 2-11) partners. Since their last period in custody, men had had a mean of two (range 0-18) female partners and women had had a mean of two (range 1-3) male partners. Five men had also had male partners. CONCLUSIONS: A high prevalence of injecting and sexual risk behaviours among injecting drug users within and between periods in custody has been shown. Most of these offenders continued to take drugs while in custody, and just over half not only injected drugs but shared equipment. Some of the male prisoners compounded their risk of HIV infection by engaging in sexual activity with multiple partners. Prisoners who then have multiple sexual partners after release place their partners in the community at particular risk of HIV infection. Although many of the drug users were prescribed drugs for their dependency, limited access to appropriate treatment, counselling, and health education may compound the situation.

Adult↗

PubMed1998

Prevalence and risk factors of HIV-1 and HIV-2 infection in urban and rural areas in Tamil Nadu, India.

We aim to study the factors associated with the prevalence of HIV-1 and HIV-2 infection in the urban and rural areas of Tamil Nadu, India. The population of Tamil Nadu is approximately 60 million. Between April 94 and March 95, 992 samples from 5 representative urban centres and 1071 samples from 5 representative rural centres were collected and studied. A questionnaire was administered privately and it preceded collection of each sample. Samples were screened using ELISA and antibodies to HIV-1 and HIV-2 were confirmed using Western blot. The study was anonymous and unlinked. The prevalence of HIV infection in urban and rural areas was 7.2% (95% CI=6.1 to 8.31%); HIV-1 antibodies were found in 7.4% (95% CI=5.8 to 9.2%) of urban and 7.0% (95% CI=5.6 to 8.7%) of rural population; HIV-2 antibodies were found in 0.8% of urban and 0.3% of rural population. Heterosexual transmission, more so among those with multiple partner sex, was the main mode; higher prevalence of HIV infection among divorced/single individuals both in urban (21.1%) and rural (26.1%) was found. HIV infection among housewives stood at 4.1% (urban) and 3.8% (rural). The strength of association between STDs and HIV was observed to be greater in rural subjects (OR=8.89; 95% CI=5.11 to 15.57) than in urban subjects (OR=1.9; 95% CI=1.14 to 3.18). The prevalence of condom use was found to be less than 2% in the study subjects. HIV-2 is not as widely prevalent in Tamil Nadu as HIV-1. In our study the most common risk factors for HIV infection that emerged were (a) having multiple sexual partners, and (b) history of STDs or Venereal Disease Research Laboratory (VDRL) reactivity. Mobility of individuals between urban and rural areas has furthered the dissemination of HIV infection. Low condom usage among study subjects questions the effectiveness of the existing AIDS awareness and education programme. The study indicates the importance of placing equal emphasis on HIV prevention in rural India. HIV infection among housewives in urban and rural areas is indicative of gender inequalities and the importance of empowering women to prevent infection from spouse.

Adult↗

PubMed1994

What is the significance of black-white differences in risky sexual behavior?

A sample of African-American and white young adults were classified as having multiple sex partners or one sexual partner. Subjects with multiple sexual partners were more likely to use drugs and practice risky sexual behaviors such as having anal intercourse, having sexual experiences with a prostitute, and having a history of gonorrhea (P < .001) and genital warts (P < .01). Additional analyses were conducted to determine African-American versus white differences in risky sexual behaviors. Results indicated that whites in the multiple partners and single partner groups were more likely to engage in anal and oral sex, while African Americans were more likely to have sex with prostitutes. Attitudes about the use of condoms differed significantly by multiple partner status (P < .004) and gender (P < .007), but not ethnicity. However, angry reactions about the use of condoms occurred more with African Americans (P < .003) and males (P < .05) than with whites or females. While whites reported a greater use of drugs and a significantly higher level of knowledge about HIV/AIDS, African Americans reported a significantly greater perception of risk for being exposed to human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (P < .01) and significantly more gonorrhea (P < .10), syphilis (P < .05), and HIV/AIDS (P < .05). No whites in our sample were treated for syphilis nor had they tested positive for HIV/AIDS. On the other hand, 4.5% of the total sample of African Americans reported testing positive for HIV/AIDS. Finally, the results from discriminant analysis indicate that a large number of variables significantly discriminate between subjects who engage in risky sexual behaviors and those who do not. Although there is some similarity in the variables for African Americans and whites, there was tremendous variability between the ethnic groups in the factors that predict risky behaviors. These findings are discussed with reference to the need to develop HIV/AIDS prevention programs for African Americans that are based on data derived from African-American populations rather than from black versus white comparison studies.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Hepatitis B infection among Chinese STD patients in Kuala Lumpur, Malaysia.

This study documents the prevalence of Hepatitis B serological markers among STD patients who have had multiple sexual partners in Kuala Lumpur, Malaysia, and compares the rates with those of a sample of the population with single or no sexual partners. A total of 336 Chinese STD patients (multiple partners group) and 234 Chinese control subjects (non-multiple partner group) were screened. Those with a history of blood transfusion or parenteral drug abuse had been excluded from the study, and all study subjects were heterosexuals. The overall carrier rate was 9.2% for the multiple partner group (MP group) and 6.8% for the non-multiple partner group (NMP group). Infection rates were 64.3% for the MP-group and 38.9% for the NMP group. After adjustments for age and sex, there was no significant difference in carrier rates between the two groups, but infection rates were significantly different with the MP group, being 3.2 times more likely to acquire infection than the NMP group. The study concludes that in heterosexuals, those with multiple sexual partners have increased chances of acquiring HBV infection.

Adolescent↗

PubMed1992

Transforming growth factor beta differentially regulates expression of integrin subunits in guinea pig airway epithelial cells.

The integrin family is composed of a large number of heterodimers, each one mediating distinct interactions with extracellular matrix and/or cell surface ligands. The expression of integrins appears to be tightly regulated in vivo, but the mechanisms by which cells control the formation and surface expression of specific pairs of subunits have not been well characterized. Two integrin subunits, the alpha subunit alpha v, and the beta subunit beta 1, could pose special problems in regulation because of their capacity to associate with multiple partners. In the present study, we have examined the effects of the cytokine transforming growth factor beta 1 (TGF-beta 1) on the expression of alpha v- and beta 1-containing integrins in primary cultures of guinea pig airway epithelial cells, e.g. cells that we have previously found to express multiple potential partners for both alpha v and beta 1. TGF-beta 1 increased the surface expression of both alpha v- and beta 1-containing heterodimers after periods of stimulation from 24 to 72 h. These increases in surface expression were associated with significant increases in the concentrations of mRNA encoding each of the partners of alpha v and beta 1, but with only minimal increases in mRNA encoding alpha v and beta 1 themselves. Airway epithelial cells metabolically labeled with [35S]methionine during stimulation with TGF-beta 1 demonstrated only a minimal increase in the synthesis of new alpha v protein at a time when synthesis of alpha v's beta subunit partners and surface expression of alpha v-containing heterodimers were dramatically increased. These data suggest that, at least in some cells, promiscuous integrin subunits (both alpha and beta) may normally be synthesized in excess. Thus, the surface expression of specific integrin heterodimers can be regulated primarily through regulation of the synthesis of the specific partners of these subunits.

Animals↗

PubMedDate not supplied

Adult sexual behavior in 1989: number of partners, frequency of intercourse and risk of AIDS.

Questions on sexual behavior that were added to the National Opinion Research Center's 1988 and 1989 General Social Surveys reveal that 97 percent of adult Americans have had intercourse since age 18. Respondents report having an average of about 1.2 sexual partners during the year preceding the survey and nearly 7.2 partners since age 18; men claimed to have had considerably more partners than did women. About one-fifth of adult Americans had no partners during the previous year. Moreover, over a year's time, only 1.5 percent of married people reported having had a sexual partner other than their spouse. On average, adults report engaging in intercourse 57 times per year. About two percent of sexually active adults reported being exclusively homosexual or bisexual during the year preceding the survey, and 5-6 percent have been exclusively homosexual or bisexual since age 18. Seven percent of adults are at relatively high current risk of contracting AIDS--three percent because they have had multiple partners, three percent because they have had unfamiliar partners and one percent because of their sexual orientation. However, 33 percent have engaged in relatively risky behavior at some time since age 18.

Acquired Immunodeficiency Syndrome↗

PubMed1990

Television and adolescent sexuality.

Existing studies of the sexual content of television programming and advertising and the effects of this content on adolescent viewers are reviewed. Content studies show that the frequency of sexual references have increased in the past decade and are increasingly explicit. Studies of the effects of this content, while scarce, suggest that adolescents who rely heavily on television for information about sexuality will have high standards of female beauty and will believe that premarital and extramarital intercourse with multiple partners is acceptable. They are unlikely to learn about the need for contraceptives as a form of protection against pregnancy or disease. Suggestions for future research and trends in television programming policies are explored.

Adolescent↗

PubMedDate not supplied

Crack cocaine use and sexual activity in Miami, Florida.

Data are analyzed from the Multicenter Study of Crack Cocaine and HIV Infection in Miami, Florida, examining interrelationships among use of crack cocaine, use of other drugs, sexual activity, and exchange of sex for money and drugs. This study was designed to recruit two groups of approximately equal size: persons who reported current use of crack cocaine three or more times per week, and those who had never used crack. Participants (N = 641) were recruited in Miami. Participants' median age for first use of crack cocaine was higher than for use of alcohol, marijuana or powdered cocaine. It was also higher than participants' ages at first sexual activity, and somewhat higher than the median age for reporting initiation of trading sex for money or drugs. The median age of first crack use was lower among younger participants, suggesting that crack use in older participants followed quickly upon availability of the drug. Crack users reported reduced desire for sex and diminished ability to have sex after smoking crack. However, crack use was associated with increased sexual activity, trading sex for money or drugs, and sex with multiple partners. Participants who traded sex for money or drugs (traders) reported higher rates of condom use than nontraders; however, neither traders nor nontraders reported rates of condom use sufficient to substantially reduce the transmission of sexually transmitted diseases and HIV infection.

Adolescent↗

PubMed1991

Predictors of vulnerability to AIDS risk behavior relapse.

Sixty-eight gay men who earlier attended AIDS prevention sessions were longitudinally followed for 16 months and categorized as successful or unsuccessful in change maintenance. Psychological and behavioral data obtained prior to entry in the prevention program were used as variables to predict long-term change. Resumption of high-risk sexual practices was associated with younger age, earlier history of frequent unprotected receptive anal intercourse with multiple partners, greater number of past sex partners, reinforcement value levels of high-risk practices and condom use, intoxication preceding sex, lower scores on a depression measure, greater belief that HIV infection is largely determined by external factors such as chance or luck, and homosexuality "outness." Discriminant analysis revealed that 86% of Ss could be classified as relapsers or change-maintainers on the basis of these variables. Prevention implications are discussed.

Acquired Immunodeficiency Syndrome↗

PubMed1995

AIDS prevention with adolescents.

Prevention of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) among adolescents is increasingly recognized as an important public health priority. Sexual risk acts associated with HIV/AIDS transmission (unprotected sexual intercourse with multiple partners of unknown serostatus) are typically initiated by late adolescence, with many youths engaging in sexual relations earlier. Despite being well informed about HIV/AIDS and having positive attitudes toward HIV/AIDS prevention, adolescents have not changed their behavior in response to the pandemic. AIDS-prevention programs must be tailored to consider stereotypic sex roles, gay youths' sexual orientation, and substance abuse. Intensive prevention programs focusing on helping youths perceive HIV as a problem, motivate them to act safely, and implement safe acts by acquiring coping skills, access to condoms and health care, and identifying individual barriers to implementing safe acts have successfully reduced adolescents' risk acts. However, avenues for broad-scale dissemination of such programs or alternative models to change youths' behaviors must be identified.

Acquired Immunodeficiency Syndrome↗