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Sexual behaviors in an urban bathhouse 15 years into the HIV epidemic.

OBJECTIVE: To characterize the population and sexual behaviors of men currently attending gay bathhouses. METHODS: Men entering a bathhouse in Portland, Oregon, were asked to complete a one-page questionnaire. Data collection ended when 1000 surveys were obtained. Questionnaires assessed demographics, self-reported HIV status, drug and alcohol use, and sexual behavior in the preceding 30 days. RESULTS: The estimated response rate was 80%-90%. Of 1000 respondents, 829 (83%) reported having anal or oral sex at a bathhouse in the previous 30 days, 715 (86%) engaged in oral sex, 420 (51%) in anal sex, and 89 (11%) in high-risk (unprotected anal) sex. In multivariate analysis, characteristics associated with men reporting high-risk sex compared with men reporting other sexual activities at the bathhouse were HIV infection (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.02-4.0); >or= 5 sexual partners in previous 30 days (OR, 3.2; 95% CI, 2.0-5.3); having anonymous sex at other sites (OR, 2.1; 95% CI, 1.2-3.8). CONCLUSIONS: Although most bathhouse patrons engaged in lower risk activities, those reporting unprotected anal sex were more likely to report HIV infection and to have multiple sexual partners. Well into the HIV epidemic, bathhouses remain venues for ongoing spread of HIV and opportunities for intervention.

Adult↗

Risk factors for Chlamydia trachomatis infection of the cervix: a prospective study of 2000 patients at a family planning clinic.

Two thousand and thirty-four patients attending a family planning clinic were tested for the presence of Chlamydia trachomatis infection of the cervix. The incidence of infection was 17.5%. Pregnant patients had a higher incidence of infection (23%), than nonpregnant patients (16.8%; p less than 0.05), and in the former this was not related to age. In nonpregnant women age was found to be an important determinant of infection rate, 22% in the 20 and under age group, and 9% in those over 25 years (p less than 0.01). There was a higher rate of infection in those with abnormal cervical smears, and in those with a coincident sexually transmitted infection; this was not statistically significant. Risk factors for acquiring this infection were identified as patients with more than five life time partners, those 20 years old or less, and pregnant patients, regardless of age or number of partners.

Adult↗

Towards developing a diagnostic algorithm for Chlamydia trachomatis and Neisseria gonorrhoeae cervicitis in pregnancy.

C trachomatis and N gonorrhoeae are major causes of maternal and neonatal morbidity and mortality in developing countries. To identify characteristics predictive of cervical infection, we examined pregnant women attending an antenatal clinic in Nairobi, Kenya. C trachomatis was isolated from 14/178 (8%), and N gonorrhoeae from 17 (10%); cervical infection with either pathogen was present in 28 (16%). Two characteristics were independently predictive of cervical infection by logistic regression analysis; the presence of either endocervical mucopus or induced endocervical bleeding, relative risk 4.2 (95% confidence interval (CI) 2.2 to 8.0) and having more than one sexual partner during pregnancy, relative risk 3.3 (95% CI 1.4 to 7.6). A screening programme for cervical infection which tested women with one or both risk markers would have a sensitivity of 68% (95% CI 51 to 85%) and a positive predictive value of 0.35 (95% CI 0.22 to 0.47). In countries where resources are limited, diagnostic algorithms incorporating clinical signs and behavioural characteristics may be useful in identifying pregnant women at high risk of cervical infection.

Adult↗

The experience of sexual coercion among young people in Kenya.

CONTEXT: Studies of sexual behavior among young people in the developing world have generally neglected the circumstances in which sex takes place, most often assuming that when young people have sex, it is wanted and consensual. The few published studies on non-consensual sex have often used highly selective samples, ignoring the experience of males and of married young people. METHODS: A 2001 population-based survey of young people in Nyeri, Kenya, included a special module on sexual coercion. Descriptive data and multivariate analysis are used to explore the prevalence and patterns of sexual coercion among married and unmarried males and females aged 10-24. RESULTS: Among the sexually experienced respondents, 21% of females and 11% of males had experienced sex under coercive conditions. Most of the perpetrators were intimate partners, including boyfriends, girl friends and husbands. In a multivariate logistic regression, females who had ever been married and those who did not live with a parent or spouse had a significantly elevated risk of sexual coercion (odds ratios, 2.6 and 3.1, respectively); sexual coercion was associated with having had multiple sexual partners and with having had a reproductive tract infection (2.2 and 2.5). Males who had been coerced into sex were significantly more likely than those who had not to have had a first partner who was older by at least five years (82.9). CONCLUSION: Reproductive health programs for young people need to address non-consensual sex, including the special needs of males and of married females.

Adolescent↗

Relation of sexual risks and prevention practices with individuals' stigmatising beliefs towards HIV infected individuals: an exploratory study.

OBJECTIVE: To investigate how an individual's stigmatising beliefs towards people living with HIV are related to his or her own sexual risk and protective behaviours. METHODS: A cross sectional survey was conducted to assess HIV related stigmatising beliefs, risk sexual behaviours, and preventive practices among sexually experienced rural to urban migrants aged 18-30 years in 2002 in Beijing and Nanjing, two large Chinese cities. RESULTS: Among 2153 migrants, 7.2% reported having had more than one sexual partner in the previous month, 9.9% had commercial sex partners, and 12.5% had an episode of a sexually transmitted disease (STD). Only 18% reported frequently or always using condoms, with 20% sometimes or occasionally using them. 57% of the Chinese migrants were willing to take a voluntary HIV test, and 65% had HIV related stigmatising beliefs towards people living with HIV. Multiple logistic regression analysis depicts that individual's stigmatising beliefs towards people with HIV were positively associated with having had an episode of an STD, having multiple sex partners, or having had commercial sex partners, and were negatively associated with condom use and the willingness to accept an HIV test. CONCLUSION: The finding that one's own stigmatising belief is a potential barrier to HIV related preventive practices highlights the difficulties and challenges in implementing behavioural interventions.

Adolescent↗

Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners.

BACKGROUND: It is uncertain whether male circumcision reduces the risks of penile human papillomavirus (HPV) infection in the man and of cervical cancer in his female partner. METHODS: We pooled data on 1913 couples enrolled in one of seven case-control studies of cervical carcinoma in situ and cervical cancer in five countries. Circumcision status was self-reported, and the accuracy of the data was confirmed by physical examination at three study sites. The presence or absence of penile HPV DNA was assessed by a polymerase-chain-reaction assay in 1520 men and yielded a valid result in the case of 1139 men (74.9 percent). RESULTS: Penile HPV was detected in 166 of the 847 uncircumcised men (19.6 percent) and in 16 of the 292 circumcised men (5.5 percent). After adjustment for age at first intercourse, lifetime number of sexual partners, and other potential confounders, circumcised men were less likely than uncircumcised men to have HPV infection (odds ratio, 0.37; 95 percent confidence interval, 0.16 to 0.85). Monogamous women whose male partners had six or more sexual partners and were circumcised had a lower risk of cervical cancer than women whose partners were uncircumcised (adjusted odds ratio, 0.42; 95 percent confidence interval, 0.23 to 0.79). Results were similar in the subgroup of men in whom circumcision was confirmed by medical examination. CONCLUSIONS: Male circumcision is associated with a reduced risk of penile HPV infection and, in the case of men with a history of multiple sexual partners, a reduced risk of cervical cancer in their current female partners.

Adult↗