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Evidence-based recommendations for prevention of human immunodeficiency virus and sexually transmitted infections in the Angolan Armed Forces: challenges and opportunities at the end of 30 years of war.

OBJECTIVE: The goal was the development of culturally sensitive, evidence-based recommendations for human immunodeficiency virus (HIV) prevention for Angolan soldiers. METHODS: Eight focus groups (N = 68) were conducted with Angolan soldiers in 2002. Qualitative data were analyzed for soldiers' HIV/sexually transmitted infections (STIs)-related knowledge and behaviors. RESULTS: More than 37% of participants reported having more than one sexual partner at the time of the study. Many soldiers had little knowledge regarding HIV/STI transmission and symptoms, and most did not use condoms. Soldiers identified the following factors that need to be addressed in HIV/STI prevention campaigns among military personnel: lack of HIV awareness and knowledge, limited condom availability and use, heavy alcohol use before sex, and the tendency to have multiple sexual partners. CONCLUSIONS: Recommendations for prevention in the Angolan military are presented. A multifaceted HIV prevention program for the Angolan military that addresses informational, interpersonal, and system-level barriers must be implemented now.

Adolescent↗

Kinsey revisited, Part I: Comparisons of the sexual socialization and sexual behavior of white women over 33 years.

This research compared data from two studies of women's sexual behavior--one conducted in the 1940s, the other in the 1980s. The first sample included 3952 white women, ages 18 to 36, drawn from the larger sample of women who participated in the original Kinsey study. The second comprised 122 white women, in the same age range, who had taken part in a recent study of sexual socialization and experiences among women in Los Angeles County, CA. Log-linear analyses were used to control for differences between the samples on age, education, and marital status. Comparisons were conducted in the areas of childhood family characteristics; sexual socialization and education; sexual behavior in childhood, adolescence, and adulthood; contraceptive practices; and child sexual abuse. Results tended to reflect changes that have taken place in society and in patterns of sexual behavior. Differences in sexual socialization pointed to the increased role of the media and the schools and to more relaxed attitudes about nudity in the home. Shifts in sexual behavior were particularly dramatic. As compared to women in the Kinsey sample, the newer subjects began intercourse earlier, were less likely to have a fiance or husband as their first partner, reported a higher number of sexual partners, and participated in a broader range of sexual behaviors. Contraceptive practices differed considerably, especially among never-married women. Women in the new study were also more likely to report instances of child sexual abuse. Methodological and social factors contributing to the findings are discussed.

Adolescent↗

Risk-taking sexual behaviour and self-reported depression in middle adolescence--a school-based survey.

BACKGROUND: Early sexual activity has been widely studied in the context of pregnancies, substance use and antisocial behaviour, but the aspects of psychosexual health have received less attention. AIM: To study the associations of early sexual activity and self-reported depression. SETTING: A school survey in Finland in 1999 and 2000 in the eighth and ninth grades. METHODS: Adolescents with experience of sexual intercourse were studied (11,793 girls and 10,443 boys, mean age 15.5 years). Scores of 8 or more in the Beck Depression Inventory were regarded as indicative of self-reported depression. Associations with sexual behaviour variables were analysed using logistic regression models. RESULTS: In both genders, self-reported depression increased in proportion to the number of sexual partners and with the non-use of contraception. A higher number of coital experiences correlated with depression only among boys. Adjusting for age and age at menarche/oigarche did not affect the associations detected. In stepwise logistic regression, an increasing number of partners increased the risk for self-reported depression [for boys with at least five partners odds ratio (OR) 2.5, 95% confidence intervals (CI) 2.2-3.0, and for girls OR 2.7, 95% CI 2.3-3.2]. Boys and girls who did not use contraception showed roughly twice as high a risk as contraceptive users. However, girls with five or more coital experiences had a significantly lower risk for depression compared to girls with only one sexual intercourse. CONCLUSIONS: Multiple sexual partners and non-use of contraception may reflect a depressive disorder in both genders. While adolescent health service providers should be aware of the risk for depression among sexually active adolescents, the sexual health of depressed adolescents also warrants special attention.

Adolescent↗

Factors related to condom use with casual partners among urban African-American and Hispanic males.

Constructs from the Health Belief Model and the Theory of Reasoned Action were tested for their relationship to condom use with casual partners in a probability sample of urban African-American and Hispanic males aged 15-24. The results indicate the importance of 1) promoting a sense of male responsibility regarding condom use; 2) promoting the belief that condoms should be used with all partners; 3) developing skills for condom use and partner communication; and 4) increasing perceived susceptibility to HIV infection in design of intervention programs.

Adolescent↗

Migfilin and its binding partners: from cell biology to human diseases.

Links between the plasma membrane and the actin cytoskeleton are essential for maintaining tissue integrity and for controlling cell morphology and behavior. Studies over the past several decades have identified dozens of components of such junctions. One of the most recently identified is migfilin, a widely expressed protein consisting of an N-terminal filamin-binding domain, a central proline-rich domain and three C-terminal LIM domains. Migfilin is recruited to cell-matrix contacts in response to adhesion and colocalizes with beta-catenin at cell-cell junctions in epithelial and endothelial cells. Migfilin also travels from the cytoplasm into the nucleus, a process that is regulated by RNA splicing and calcium signaling. Through interactions with multiple binding partners, including Mig-2, filamin and VASP, migfilin links the cell adhesion structures to the actin cytoskeleton. It regulates actin remodeling, cell morphology and motility. In nuclei, migfilin interacts with the cardiac transcriptional factor CSX/NKX2-5 and promotes cardiomyocyte differentiation. It probably functions as a key regulator both at cell adhesion sites and nuclei, coordinating multiple cellular processes, and is implicated in the pathogenesis of several human diseases.

Carrier Proteins↗

Risk factors for HIV-1 infection in adults in a rural Ugandan community: a case-control study.

OBJECTIVE: To study in depth sexual history and sexual behaviour variables as risk factors for HIV-1 infection in a rural Ugandan population. METHODS: Following a socioeconomic and serological survey of a rural population in Masaka District, south-west Uganda, 233 randomly selected HIV-1-positive cases and 233 negative controls matched on age and village of residence, were invited in October 1990 to participate in a case-control study. A total of 132 cases and 161 controls attended for in-depth investigation including an interview about sexual behaviour. RESULTS: The factor most strongly associated with increased risk of infection was a greater number of lifetime sexual partners, with odds ratios (OR) of 2.1 and 4.9 for those reporting 4-10 and 11 or more partners, respectively, compared with those reporting less than four partners. Having only one sexual partner did not provide complete protection, a total of seven (one male, six female) subjects reporting only one sexual partner were HIV-1-positive. Other significant factors were a history of genital ulcers [OR, 2.9; 95% confidence intervals (CI), 1.0-9.1) and not being a Muslim (OR, 5.4; 95% CI, 1.8-16.5) suggesting a possible protective effect of circumcision. There was a suggestion that those who married within the last 7 years (OR, 2.4; 95% CI, 0.9-6.1) and men exposed to menstrual blood (OR, 5.7; 95% CI, 0.7-49.8) were at an increased risk of HIV-1 infection. CONCLUSIONS: These results confirm the predominant role of sexual behaviour in the HIV-1 epidemic. Of particular concern is the observation of HIV-1 infection among those reporting only one partner. Where HIV-1 infection is widely distributed in the general population, risk reduction strategies should, in addition to the promotion of partner reduction, place strong emphasis on safe-sex techniques.

Adolescent↗

Risk factors for hepatitis B virus infection among women attending a clinic for sexually transmitted diseases.

Risk factors for and serologic evidence of hepatitis B virus (HBV) infection were analyzed among 557 women. Study subjects were attending a clinic for sexually transmitted diseases and enrolled in a clinical trial of nonoxynol-9 prevention of gonococcal and chlamydial infections. Seventy-eight (14%) showed serologic evidence of past HBV infection. Only age at time of serum collection was significantly associated with HBV marker prevalence (P = 0.04). None of the four measures of sexual activity taken (number of sex partners per month, frequency of sexual intercourse, number of documented episodes of sexually transmitted diseases, and lifetime number of sexual partners) were significantly related to the presence of HBV markers. For each measure, however, differences observed between HBV positive and negative subjects were consistent with what would be expected if these factors did contribute to HBV infection risk. These results support the role of heterosexual transmission of HBV infection in women and are consistent with recommendations for hepatitis B immunization of heterosexually active persons with multiple sexual partners.

Adult↗

Estimating sexual behaviour parameters in the light of AIDS: a review of recent UK studies of young people.

This paper reviews UK surveys of the sexual behaviour of young people since the advent of AIDS. The studies, which are restricted to those whose samples were intended to be representative of the general population, reveal broadly similar estimates of key sexual behaviours (numbers with sexual experience, numbers of partners, frequency of intercourse, condom use and anal penetration). In spite of these similarities and the usefulness of such information for estimating the potential rate of transmission of HIV a number of methodological issues continue to afflict this kind of research. The paper calls for standardized question formats and a centralized body to monitor changes in these parameters of sexual behaviour.

Acquired Immunodeficiency Syndrome↗

A study of sexual behavior among rural residents of China.

OBJECTIVE: Although the recent spread of HIV/AIDS and other sexually transmitted diseases (STDs) in China has been associated with sexual activities, little information has been available about sexual behavior in rural areas with high HIV prevalence. Studies identifying high-risk sexual behaviors are needed to formulate effective prevention programs. METHODS: A cross-sectional study design was used to measure sexual activities using a two-stage cluster sampling method. A two-part anonymous questionnaire was used. Sensitive questions related to sexual behavior were administered using a tape recorder, earphones, and an answer sheet which did not include the text. RESULTS: In total, 1057 subjects were interviewed. Among 886 sexually active individuals, 7.8% had >1 sexual partner, 22.8% had premarital sex, 2.4% had anal intercourse, 4.1% had oral intercourse, and 2.3% had both anal and oral intercourse. Less than 2% reported past or current sexually transmitted diseases. Overall, 10.4% used condoms; only 11.2% for every sexual act. History of premarital and extramarital sex was higher in younger people. CONCLUSIONS: Sexual norms in rural China are changing rapidly and high-risk sexual behavior among young rural residents is increasing. Strategies to prevent HIV/AIDS should include education to promote delayed onset of sexual activity, safer sexual behavior, and condom use.

Adolescent↗

Sexual relationships, risk behaviour, and condom use in the spread of sexually transmitted infections to heterosexual men.

OBJECTIVE: To examine the effect of patient defined non-regular sexual relationships and other risk behaviours on the incidence of sexually transmitted infections in heterosexual men and the role of condom use in the prevention of their spread. DESIGN: A prospective cross sectional study of sexual behaviour reported by a standardised self administered questionnaire in new patients who presented for screening and diagnosis. SETTING: A genitourinary medicine clinic in west London. SUBJECTS: 957 consecutive newly attending heterosexual men who completed a sexual behaviour questionnaire in 1993/94. MAIN OUTCOME MEASURES: Variables relating to sociodemographic status, sexual behaviour, condom use, sexually transmitted infections and testing for HIV infection, stratified by the reporting of non-regular partners. RESULTS: We found that the 65% of men who reported non-regular sexual partners were more likely to be white collar class (d = 7.5%, 95% CI = 1.3, 13.7) and to have had sexual intercourse with non-United Kingdom born women (d = 7.8%, 95% CI = 3.5, 12.2). They also reported coitarche before 16 years of age (d = 13.4%, 95% CI = 8.0, 18.8) and many more sexual partners both in the last year (d = 13.1%, 95% CI = 10.2, 16.0) and in their lifetime (d = 27.9%, 95% CI = 21.6, 34.2). They were significantly more likely to practise anal intercourse (d = 8.7%, 95% CI = 3.3, 14.1), to smoke (d = 16.3%, 95% CI = 9.8, 22.6), to drink alcohol (d = 4.9%, 95% CI = 1.2, 8.6), and to have chlamydial infection (d = 5.7%, 95% CI = 2.2, 9.2), of which 30% was subclinical. Increasing condom use with regular partners correlated with decreasing incidence of urethral infection (gonorrhoeal and/or chlamydial infection) (p < 0.03) and candidal balanitis (p < 0.03) and a greater likelihood of no infection being detected (p = 0.0002). Use of condoms with non-regular partners was much more frequent than with regular partners (d = 21.4%, 95% CI = 16.7, 26.1). However, we found evidence of oral transmission of urethral gonorrhoea and chlamydial infection among men who reported always using condoms. HIV infection was found in only two men (0.2%), both of whom reported intercourse with non-United Kingdom born women. CONCLUSIONS: Heterosexual men who reported non-regular sexual relationships compensated for their increased risk lifestyle by using condoms more frequently and showed only an increased incidence of chlamydial infection. More consistent condom use with regular partners was significantly associated with the absence of sexually transmitted infection. These findings suggest that transmission between regular partners has been underestimated.

Adolescent↗

Age differences in morphological patterns of axonal sprouting and multiple innervation of neuromuscular junctions during muscle reinnervation following nerve crush injury.

During the first 4-20 weeks after sciatic nerve crushing injury regrowing axons return to the neuromuscular junction and its reformation is in progress. During this time period age differences in patterns of axonal reinnervation from Wistar rats, with special reference to multiple axonal innervation and sprouting, was morphologically investigated using a neuronal marker (protein gene product 9.5). In young (4 months old) and aged (24 months old) animals, terminal outgrowth at the junction consisted of offshoots extending out from the junctional zone (extraterminal sprouts), and an extraterminal sprout extending to an adjacent endplate (endplate-to-endplate connections). Endplate-to-endplate connections and a nodal sprout served as partners of multiple axonal innervation. Large and complex junctions were formed by multiple innervation and elaboration of terminal branching. The most obvious changes in aged animals were as follows. (1) There were consistently more frequent numbers of extraterminal sprouting, endplate-to-endplate connections, and multiple innervation. The rates of process extension in extraterminal sprouting, however, displayed a significant drop at 4 and 8 weeks post-crush. (2) Late in reinnervation (12, 20 weeks), persistent aberrant changes in axonal reinnervation were more frequently observed, such as clumping of poorly organized nerve bundles, aggregates of multiple extensions, and poorly developed endplate-to-endplate connections, along with disorderly development of nerve terminals. Thus, age affects the reinnervating and sprouting capabilities of axons giving rise to persistent compensatory (though impaired) growth, extension, and branching in the formation of motor pathways during muscle reinnervation and endplate regeneration. The spatiotemporal relationship of these axonal changes to that of the postsynaptic receptor region is discussed.

Animals↗

Condom use due to the risk of AIDS. Trends in the general population of Sweden.

This study examines the use of condoms due to the risk of AIDS in the general population of Sweden during 1986-1989. The study is based on annual mail surveys (1986-1989) of random population samples aged 16-44 years - 4000 individuals in each sample. The response rate was 71%. The study indicates that the use of condoms increased significantly during the first years of the study period, particularly among 18-24-year-olds. Roughly the same tendency was observed regarding the perception of personal risk related to HIV infection. In 1988 a positive connection was established between condom use and personal risk perception. Between 1988 and 1989 (as the public interest in the AIDS issue declined) no further increase in condom use was observed but rather a tendency of reversal towards previous levels. Having several sexual partners was not significantly associated with a more frequent use of condoms, nor was the occurrence of casual sexual contacts. In most of the casual sexual contacts reported condoms were not used.

Acquired Immunodeficiency Syndrome↗

Contraception and STDs.

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Acquired Immunodeficiency Syndrome↗

Levels of sexual activity among adolescent males in the United States.

Although three-fifths of adolescent males aged 15-19 say they have had sexual intercourse, analyses of data from the 1988 National Survey of Adolescent Males indicate that their level of sexual activity is relatively moderate. The data show that among sexually experienced young men the mean number of partners in the last 12 months is 1.9, and the mean frequency of intercourse in the last four weeks is 2.7 times. Black males have had more partners than white or Hispanic males; however, after the number of years since first intercourse are controlled for, these differences disappear. On average, sexually experienced youth spent six out of the last 12 months with no sexual partner, and only 21 percent of sexually active males had more than one partner in any month in the last year. Comparisons with 1979 data suggest that proportionately more adolescents were sexually experienced in 1988, but fewer non-black males had first intercourse before their 15th birthday. The number of partners since first intercourse and in the past four weeks appears to have decreased, as has the frequency of intercourse in the last four weeks.

Adolescent↗