Social epidemiology in Africa: slowing the heterosexual transmission of AIDS.
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ISSUES ADDRESSED: This study was conducted to describe the sexual risk behaviours of youth within the Pacific Island nations of Vanuatu, Tonga and the Federated States of Micronesia. METHODS: General health behaviour surveys were conducted with youth aged 15-19 years and not attending school in the three countries. A sample of 390 Ni-Vanuatu youth from the Shefa Province, 934 youth from three island provinces of Tonga and 92 youth from Pohnpei, the main island of the four island states of the Federated States of Micronesia, were interviewed in gender-specific groups. Questions were asked about sexual behaviours that may contribute to unintended pregnancy or sexually transmitted infections (STIs). RESULTS: Moderate to high percentages of youth were sexually active (had a least one sexual partner) in the Pacific island nations of Vanuatu (49.7%), Tonga (35.5%) and the Federated States of Micronesia (76.1%). Young men were more likely to engage in sexually risky behaviour than young women. They were more likely to be sexually active, have had multiple sexual partners and have had sex when drunk or high. Of those sexually active, more young men than women in Vanuatu (36.1% compared with 30.6%) and Micronesia (54.2% compared with 50%) never used protection against STIs. However, of the sexually active Tongan youth, the proportion of females (61.1%) who reported never using protection against STIs was nearly double the proportion reported by Tongan males (32.2%). CONCLUSION: A high percentage of young people not attending school in the Pacific island nations of Vanuatu, Tonga and the Federated States of Micronesia are at risk of unintended pregnancy and STIs, including HIV, because of patterns of sexual risk behaviour.
OBJECTIVE: To ascertain factors associated with having a test for human immunodeficiency virus (HIV) antibody. DESIGN: All attenders at a sexually transmitted diseases (STD) clinic who were at risk of HIV infection and had not been tested previously were included in the study and classified as requesting a test or being offered a test. SETTING: The study was conducted at a central city STD clinic. PARTICIPANTS: Of all patients in 1990, 1835 men and 849 women were excluded because of previous HIV tests and 259 men and 120 women were not tested because of their low risk, leaving a target population of 2249 men and 1153 women. MAIN OUTCOMES: Among men tested the results in 1.2% (9/771) of those requesting a test and in 0.6% (7/1177) of those not requesting a test were positive. There were no positive results among the women tested. RESULTS: Among men, accepting testing was related to intravenous drug use (odds ratio [OR] = 3.49), not having a steady partner (OR = 1.40), and having an STD (OR = 0.57) or a history of STD (OR = 0.67). Among women, accepting testing was related to not having a steady partner (OR = 1.73), being an STD contact (OR = 0.43), having vaginal discharge and/or dysuria (OR = 0.51), and having a history of STD (OR = 0.61), and was unrelated to having an STD. In both men and women accepting testing was unrelated to having multiple sex partners. CONCLUSIONS: The findings are consistent with a failure to associate the risk of HIV infection with risks associated with other STDs. This has implications for health education programs as well as approaches to testing by doctors. Those requesting a test accounted for only 56% (9/16) of infections detected.
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OBJECTIVE: To identify the epidemiologic characteristics of women who have mild dyskaryosis on cervical smear but cervical intraepithelial neoplasia (CIN) grade II or III at biopsy. METHODS: We analyzed information from 291 women (median age 33 years, range 17-69) observed for the first time with a single smear test showing mild dyskaryosis. All subjects underwent colposcopy, and histologic confirmation was obtained by biopsy. We compared the characteristics of women who had CIN I or no evidence of CIN with those of women with CIN II or III at biopsy. RESULTS: Twenty-eight women (10%) had CIN I at biopsy, 46 (15%) CIN II, and 23 (8%) CIN III. The frequency of CIN II or III tended to decrease with increasing education; compared with women reporting 11 or fewer years of education, the multivariate odds ratios (OR) of CIN II or III lesions was 0.5 (95% confidence interval [CI] 0.3-0.9) in those reporting 11 years of education or more. Compared with nulliparas, the OR of CIN II or III was 1.8 (95% CI 1.1-3.5) for parous women. Furthermore, compared with never-smokers, the OR of CIN II or III was 2.3 (95% CI 1.0-5.4) for current smokers. Ex-smokers were at increased risk, too; the estimated multivariate OR was 3.8 (95% CI 1.9-7.6). Compared with women reporting one sexual partner, the multivariate ORs of CIN II or III were 1.4 and 2.3 for women reporting two to three or four or more sexual partners, respectively (chi 2(1) trend = 6.65, P < .05). CONCLUSION: Our results show that smoking is a risk indicator of CIN II or III in women with a single smear showing mild dyskaryosis. Parous women, those of low social standing, and those reporting multiple sexual partners also are at increased risk of CIN II or III.
OBJECTIVE: Little is known about variations in patterns of sexual behaviour in different countries, cultures, and subpopulations that determine the spread of HIV-1. Quantitative studies are required to improve understanding. METHODS: To assess reported patterns of sexual behaviour, we administered a standardized questionnaire to 416 men and 498 women aged 15-49 years from a rural population in northwest Tanzania. RESULTS: Reported levels of sexual activity were highest in men and among younger age groups. The number of sexual partners and number of sex acts per unit of time were strongly correlated: men reported 10 times as many lifetime partners than women. Frequency of sexual partner exchange plateaued earlier in women (by age 25 years) than in men (by age 35 years). For the great majority, age of first intercourse was 15 years or younger; older subjects were older at first intercourse and had fewer lifetime partners than younger subjects. CONCLUSIONS: This age-related pattern suggests that more recent birth cohorts have behaviour patterns that increase the risk of sexually transmitted infectious agents such as HIV. Preventive education programmes should be targeted at young adults, who adopt higher risk profiles of frequent partner exchange linked with first intercourse at an early age.
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A study on STDs was conducted among 211 female inmates in a prison in Lisbon, Portugal, in order to establish possible associations between Trichomonas vaginalis infection, sociodemographic factors and other STDs. T. vaginalis was found in 31.2% of the women, from whom only 65.1% presented symptoms. It was more frequently isolated in the 20-40 year age group. On univariate analysis there was an association, although not statistically significant, between the existence of T. vaginalis, multiple sexual partners, drug addiction and no condom use. A statistically significant association was found between trichomoniasis, prostitution and other STDs. These were found in 87% of all women. T. vaginalis was detected alone in 23.8% (15/63) of all women with trichomoniasis, while 76.2% (48/63) of them had multiple infections with trichomonas and other STDs. A statistically significant association was present between trichomoniasis and Mycoplasma hominis and infection with Treponema pallidum. This study showed that the prevalence of T. vaginalis is as high as that of multiple infections with other STDs. Therefore, our findings seem to confirm that trichomoniasis serves as a marker for other STDs. Screening for STDs should then be offered to Portuguese inmates, or, at least, these women should be screened for T. vaginalis, as a marker for the other STDs.
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The sexual life style, drug habit and socio-demographic status of 253 male hospitalized drug addicts were investigated. This study was conducted during the period June 1997 to July 1998, and each case was selected by the random sampling method. The research instrument was an interviewer-administered questionnaire, the sexual habits, number and quality of sex partners, use of condoms, sexually transmitted diseases, etc., were considered as indicators of the sexual life style of the drug addicts. Eighty-eight percent (n=233) of the addicts were heterosexual. Bisexuality was found only in 7% (n=18) of the addicts. Eighty-seven percent (n=240) of the addicts have multiple sex partners of either commercial or residential category. Most of the drug addicts (72%,n=181) did not use condoms. Fifty-seven percent (n=145) of the addicts were observed to have sexual diseases. As indicators of a drug habit, starting drug, choice of drug, period of addiction, sharing of needles, etc., were included. Cannabis was the starting substance for 59% (n=149) of the addicts. Heroin was the drug of choice for 60% (n=157) addicts. A single drug was taken only by 8% (n=20) of the addicts and the remaining 92% (n=233) took multiple drugs. The drug addicts (n=97) who used mostly injection (87%,n=84) shared needles. Education, occupation, income, age, marital status, influencing factors for addiction were considered as socio-demographic characteristics. Young adults (79%,n=199), secondary educated (46%,n=116), low-mid income (60%,n=150), businessmen (46%,n=150) and married (60%,n=151) people were found highly involved in addiction. Self-curiosity and a friend's incitement were revealed as the most important influencing factors for taking drugs.
The purpose of this study was to assess the prevalence of high risk health behaviours among adult Jamaicans aged 15-49 years in 2000, and to compare the results with the 1993 survey. A nationally representative sample of 2013 persons aged 15-74 years was surveyed in 2000 using cluster sampling in the Jamaica Healthy Lifestyle Survey (Wilks et al, unpublished). Interviewer administered questionnaires and anthropometrical measurements were done. Data for a sub-sample of adults aged 15-49 years were analyzed The sub-sample included 1401 persons (473 men and 928 women). Significantly more men (18.6%) than women (4.3%) reported never having had a blood pressure check (p = 0.0001). Approximately one-third of the women reported that they had never had a Pap smear (36.0%) or a breast examination (31.2%). Current cigarette smoking was reported in 28.6% of men and 7.7% of women (OR 3.73 CI 2.71, 5.15), while 49.0% of men and 15.0% of women ever smoked marijuana (OR 3.28 CI 2.56, 4.20). Significantly more men (28.0%) than women (11.7%) reported ever having a sexually transmitted disease (OR 2.93 CI 2.16, 3.97); having more than one sexual partner in the past year (49.1% vs 11.4%, OR 4.31 CI 3.22, 5.76) and usually using a condom during sexual intercourse (55.3% vs 40.5%, OR 1.3 CI 1.11, 1.68). Between 1993 and 2000, significant trends include: more persons reported having a blood pressure check, a reduction in multiple sexual partners, increased condom use at last sex (women), reduced crack/cocaine use (males) and increased marijuana smoking. Although there were some significant positive lifestyle trends between 1993 and 2000, high risk behaviours remain common among Jamaican adults. Comprehensive health promotion programmes are needed to address these risk behaviours.
OBJECTIVES: To assess the risk factors of ectopic pregnancy in Thai women. SETTING: Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University. DESIGN: Case controlled study. MATERIAL AND METHOD: From 1999 to 2000, 208 cases of ectopic pregnancy and 781 controls (postpartum women) were included in the study. The women were interviewed by trained research interviewers using a standardized questionnaire. Detailed information regarding age at first intercourse, number of sexual partners, history of changing partners within 6 months, previous obstetric history, history of spontaneous and criminal abortion, history of pelvic inflammatory disease, smoking, history of endometriosis and history of previous ectopic pregnancy was collected. RESULTS: By multivariate analysis, 5 variables remained as strong and independent risk factors for ectopic pregnancy: the number of sexual partners > or = 2 (OR = 3.02, 95% CI (1.75-5.23), vaginal delivery > or = 1 (OR = 0.005, 95% CI (0.002-0.0015), history of pelvic inflamatory disease (OR = 3.17, 95% CI (1.40-7.19), smoking (OR = 2.49, 95% CI (1.36-4.55), infertility (OR = 2.74, 95% CI (1.35-5.54)). CONCLUSION: Problems of multiple sexual partners, pelvic inflammatory disease, smoking and infertility were the main risk factors of ectopic pregnancy in Thai women.
PURPOSE: Incarcerated adolescents are at increased risk for infection by sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). Moreover, condom use by this population is extremely low. Although interpersonal variables such as sexual communication have been found to be associated with condom use in other populations, few researchers have investigated this relationship among adolescents requiring detention in juvenile facilities. The present study investigated the relationship between communication about sexual history and incarcerated adolescents' condom use. METHODS: We used multivariate logistic regression techniques to analyze interview data from a predominantly Latino sample of 2,132 sexually active adolescents detained in Los Angeles County Juvenile Hall. RESULTS: Despite high numbers of lifetime sexual partners, a substantial majority of respondents (67%) reported that they never used condoms during sexual intercourse. Respondents who communicated with their sex partner(s) about each others' sexual history were significantly more likely to use condoms during sexual intercourse. Adolescents who reported that they knew someone with AIDS were also more likely to use condoms. CONCLUSIONS: Interventions designed to increase condom use among sexually active incarcerated adolescents should include a component addressing sexual communication practices. More research is needed on the ways in which adolescents learn to communicate about sex.
A number of studies have established high human immunodeficiency virus (HIV) seroprevalence among severely mentally ill men and women living in large urban areas. Much less research has characterized the patterns of risk behavior that contribute to elevated vulnerability to HIV/AIDS among the mentally ill, as well as psychological, situational, and gender-related influences on risk in this population. One-hundred thirty-four severely mentally ill men and women who reported sexual activity outside of an exclusive relationship or with high-risk partners completed an extensive measure battery concerning HIV risk. Knowledge about HIV was low and sexual risk behavior levels were high in the sample. On average, condoms were used in only 32% of intercourse occasions in the past three months, and nearly one-half of participants reported multiple sexual partners in the same period. Patterns common in the sample were sex associated with substance use; coerced sex, bartering sex for money, food, clothes, or a place to stay; and sex with injection drug user partners. Factors predictive of greater risk were being female, presently being in a relationship, perceiving oneself to be at risk, high levels of alcohol use, and weak risk reduction behavioral intentions. Mental health programs serving severely mentally ill men and women are reaching a population at elevated risk for contracting HIV infection, and can serve as a venue for targeted HIV prevention interventions.
"Study of the initial stages of HIV transmission along a 'sociogeographic network'--a large, complex, spatially focused social network with possibly fractal geometry--is extended to include interaction between a low-dimensional ghettoized 'core group' within which the disease spreads very rapidly and a higher dimensional, more loosely structured 'general population' in which spread is relatively slow. A mathematical modeling exercise suggests that contextually modulated interaction between them can be highly nonlinear and may greatly increase the initial rate of disease transmission within the general population. This work contributes to a growing body of literature which suggests that programs to control HIV infection within the majority heterosexual population of the United States will fail spectacularly without particular focus on the coupled physical and social stabilization and rehabilitation of the urban ghettoes of marginalized populations which are the present, and rapidly expanding, disease epicenters. Evidence suggests their continued disintegration can both increase disease rates within the epicenters and increase the coupling between core groups and general populations by creating large numbers of spatially or economically displaced refugees."