Relationship of sexual mixing across age and ethnic groups to herpes simplex virus-2 among unmarried heterosexual adults with multiple sexual partners.

Sexual mixing is important to understanding how sexually transmitted diseases (STDs) spread in the general population, and, identifying people who mix across social groups aids HIV-STD prevention. The authors examined (a) the extent to which people have sexual partners from other sexual networks (disassortative mixing) in a probability sample of unmarried heterosexual adults reporting multiple sexual partners (N?=?545) and (b) the relationship between mixing and Herpes Simplex Virus-2 (HSV-2). After demographic variables and number of lifetime sexual partners were controlled for, heavy mixers were significantly more likely to be HSV-2 positive. Degree of mixing down produced the most powerful relationship to HSV-2. Age, education, ethnicity, and a history of incarceration or IV drug use were found to distinguish between light and heavy mixers, although differences between ethnic and age mixing were observed. The results have implications for understanding HIV-STD transmission and for directing interventions toward population segments at high risk for transmitting HIV-STDs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of vaginal microbicides for the prevention of heterosexual transmission of HIV

The conformation and flexibility of sonicated 'native' and 're-natured' xanthan have been investigated by size exclusion chromatography (SEC) with coupled multi-angle light scattering and viscosity detectors. 'Native' xanthan (NX) refers to xanthan dissolved in moderate ionic strength aqueous solution, which has not been exposed either to high temperature or very low ionic strength, and 're-natured' xanthan (RX) here refers to xanthan which has been heated above the conformational melting temperature and then recooled. The mass distributions of the NX and RX are virtually identical, implying that the RX does not involve aggregates of, or disassociated fragments of, NX. The flexibilities and conformations between NX and RX, however, are strikingly different; RX is far stiffer than NX, the persistence lengths being roughly 1000 A and 300 A, respectively, and the mass per unit length M/L of the RX is roughly double that of NX. With estimated M/L of 200 Da/A and 98 Da/A, respectively, the results strengthen the notion that RX is double stranded, whereas as NX appears single stranded. The nature and mechanism of formation of the double-stranded form is still unclear, and a few speculative scenarios are suggested. Finally, preliminary results on the kinetics of xanthan self-association in HCI are presented which illustrate the complexity of such processes in xanthan.     

Moral agency and the sexual transmission of HIV.

Sexual transmission of HIV occurs because an infected person has unprotected sex with a previously uninfected person. The majority of HIV infections are transmitted by individuals who are unaware of their infection, and most persons who are diagnosed with HIV significantly reduce or eliminate risk behaviors once they learn they have HIV. However, a minority of known-infected individuals engage in transmission risk behavior, sometimes without disclosure to their partners. Such behavior may involve a breakdown or temporary suspension of moral mechanisms, such as personal responsibility beliefs and anticipatory self-evaluative reactions to one’s behavior. The present article reviews the literature on sexual transmission risk behavior within A. Bandura’s (1999) theoretical framework of moral agency. The article first reviews evidence for the operation of moral agency in transmission risk behavior and HIV status disclosure. Next, suggestive evidence is presented for the operation of mechanisms of moral disengagement described by Bandura. Finally, the article reviews a small number of interventions that have been shown to be effective in reducing transmission risk behavior, through the lens of moral agency, and make recommendations for future intervention research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship quality of partners in heterosexual married, heterosexual cohabiting, and gay and lesbian relationships.

Studied the relationship quality of 44 married, 35 heterosexual cohabiting, 50 male homosexual, and 56 female homosexual monogamous couples. Each couple lived together and did not have children in the home. Relationship quality was dimensionalized as love for partner (LP), liking of partner, and relationship satisfaction (RS). Cohabiting partners had the lowest LP and RS scores on a questionnaire assessing relationship quality. Differences were found among partner types on barriers to leaving the relationship, alternatives to the relationship, a belief that mind reading is expected in the relationship, masculinity, femininity, androgyny, dyadic attachment, shared decision making, and perceived social support from family. The 4 groups did not differ in psychological adjustment. For each type of couple, LP was related to many barriers to leaving the relationship and high dyadic attachment; liking of partner was related to few alternatives to the relationship, high dyadic attachment, and high shared decision making; and RS was related to many attractions, few alternatives, few beliefs regarding the destructiveness of disagreement, high dyadic attachment, and high shared decision making. Results are discussed in the context of existing models of relationship quality. (57 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Regional distribution and incidence of human papillomavirus infections among heterosexual men and women with multiple sexual partners: a prospective study

OBJECTIVE: To assess prevalence, incidence and potential risk factors of human papillomavirus (HPV) infection among heterosexual men and women with multiple partners and to identify niches of HPV-infection. DESIGN: A prospective study of heterosexual men and women with multiple partners attending an STD clinic as participants in a study on HIV from May 1988 until January 1991. Routine STD examination and physical examination using colposcopy were performed, interviews with standardised questionnaires were administered. Specimens for HPV DNA detection by polymerase chain reaction were collected from multiple sites of the genital, anorectal and oral regions. In women cervical cytology was performed. SETTING: The STD Clinic of the Municipal Health Service of Amsterdam. PARTICIPANTS: 162 women and 85 men entered the study, 110 women and 48 men were followed up. RESULTS: At entry of the study 37 (23%) women and 24 (28%) men were found positive for HPV DNA at any site. Only in one woman was oral presence of HPV DNA found during follow-up. Abnormal cervical cytology was observed in four women. In multivariate analysis, diagnosis of condylomata [odds ratio (OR) 5.61, 95% confidence interval (CI) 1.86 to 16.90)], reporting genital dermatological abnormalities (OR 3.72, 95% CI 1.38 to 9.99) and age (OR per year 0.93, 95% CI 0.88 to 0.99) predicted independently the presence of HPV DNA in women at entry of the study. In women 59 of the 99 (60%) HPV infections were observed in the genital region and 40% in the anorectal region: in men these figures were 65% and 35%, respectively. The incidence of HPV infection was 47.1 and 50.5 per 100 person-years for women and men respectively. At least 20/99 (20%) infections in women were intermediate or long persistent and only 3/48 (6%) HPV infections in men (P = 0.03). No risk factor for persistency could be determined, either in women or in men. CONCLUSIONS: HPV infection was found to be a multicentric genital and/or anorectal event both in women and men. The oral presence of HPV DNA was detected only once in one of the participants. In women persistent HPV infection was more common than in men. Independent predictors for presence of HPV DNA in women were diagnosis of condylomata acuminata, reporting genital dermatologic abnormalities and age. Incidence of HPV infection in women turned out to be 47.1 infections per 100 person-years and for men 50.5 per 100 person-years.     

HIV knowledge, beliefs and sexual behavior of male heterosexual drug users and non-drug users attending an HIV testing clinic in Israel

The aim of the study was to compare HIV-related knowledge, beliefs in self-control and sexual behavior of non-drug using and drug using heterosexual men. All individuals attending an HIV testing site during a two-month period were asked to complete a questionnaire anonymously. Data for 49 drug users (DU), most of them non-injectors, were compared to that of 94 non-drug using (non-DU) men with similar education levels (high school or less). Sexual behavior items refer to previous six months. FINDINGS: HIV-related knowledge was reported correctly by the majority of men in both groups, but the DU showed significantly more misconceptions (p < 0.01). Consistent but statistically insignificant lower levels of self-control were reported by the DU. Type of sexual relations and the number of regular sexual partners were not different between the groups: 55% of the DU and 67% of the non-DU were not monogamous. DU had either none or many casual partners (three or more), significantly different from the non-DU. The proportion of DU who never used condoms (65%) was higher as compared to non-DU men (43%, p < 0.05). However, when controlling for type of partnership, this difference was sustained only among monogamous men (82% of DU vs. 42% of non-DU never used condoms, p < 0.05). Condom use was significantly associated with age, HIV knowledge and sexual partnership in the DU. The greater deficiencies in HIV-related knowledge, and the prevalence of risk behaviors among DU require intensive individual and group counselling, specifically adapted for the needs and the culture of drug users in Israel and incorporated with social-influence-orientated change processes.     

High-dose intravenous immunoglobulins in the treatment of adolescent and adult HIV-infected hemophiliacs

In children infected with human immunodeficiency virus (HIV) placebo-controlled trials with intravenous immunoglobulins have resulted in a significant reduction in morbidity; however, the results of small trials in adolescents and adults have been inconsistent. In this study 17 HIV-infected hemophiliacs aged 9-30 years were treated with monthly intravenous immunoglobulins for an average of 32 months. At the end of the study, 8 years after the HIV infection, three patients (18%) had progressed to the acquired immunodeficiency syndrome (AIDS), and the average decrease in CD4 cells was 81 cells/microliter per year. The natural history of HIV infection in hemophiliacs in this age group shows a manifestation rate of AIDS between 11% and 26% 6-8 years after seroconversion and an average yearly decrease in CD4 lymphocytes of 68-110 cells/microliters. In conclusion, we observed no difference either in the manifestation rate of AIDS or in prognostic markers in this small cohort of HIV-infected hemophiliacs treated for more than 30% of their latency period with intravenous immunoglobulins compared to the well-documented natural history of HIV-infected hemophiliacs. However, none of the patients developed severe bacterial infections during the study period.     

History of sexual abuse among HIV-infected women

OBJECTIVE: To study the changes in patterns and resistances of bacteria from patients with bacteremia in 11 years. METHODS: Diffusion tests were used to measure the antibiotic sensitivity of bacteria isolated from the patients with bacteremia. RESULTS: The proportion of staphylococcus epidermidis in bacteremia increased significantly. The proportion of methicillin-resistant Staphylococcus aureus (MRSA) in bacteremia caused by staphyiococcus increased markedly. Resistance of MRSA and methlcillin-sensitive staphylococcus aureus (MSSA) to penicillin, and gentamycin increased significantly. Compared 1986-1990, with 1991-1996, the resistance of S. epidermidis to penicillin, erythromycin and methicillin increased markedly, so did resistance of pseudomonas aeruginosa to carbenicillin, and piperacillin, resistance of E. coli to gentamycin and cefoperazone, resistance of klebsiella to ampicillin and carbenicillin. The resistance of enterobacteriaceae which induced beta-lactamase to the first to the third generation of cephalosporins was relatively high. CONCLUSION: The resistance of bacteria to the commonly used antibiotics was produced in various degrees.     

Alcohol use, expectancies, and sexual sensation seeking as correlates of HIV risk behavior in heterosexual young adults.

Most theoretical models of HIV risk behavior have not considered the role of personality factors, and few studies have examined mechanisms accounting for dispositional influences on sexual risk taking. This study elaborated on a conceptual model emphasizing sexual sensation seeking, alcohol expectancies, and drinking before sex as key predictors of HIV risk (S. C. Kalichman, L. Tannenbaum, & D. Nachimson, 1998). Multiple groups structural equation modeling was used to determine whether gender moderated relationships among these variables in a sample of 611 heterosexual, young adult drinkers (49% women, 76% Caucasian, mean age = 25 years). The model provided an excellent fit to the data, and gender differences were not substantiated. Sexual sensation seeking predicted HIV risk directly as well as indirectly via sex-related alcohol expectancies and drinking in sexual contexts. Findings suggest that expectancies and drinking before sex represent proximal mechanisms through which dispositional factors influence sexual risk outcomes. Moreover, these relationships appear to be similar in men and women. Interventions could benefit from targeting alcohol expectancies and drinking before sex in individuals with a dispositional tendency toward sexual risk taking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Human papillomavirus infection and its relationship to recent and distant sexual partners

OBJECTIVE: To determine the relation between the detection of genital human papillomavirus (HPV) DNA and the number of new sexual partners in the last year, 1-5 years, and 5-10 years. METHODS: In a cross-sectional study, 298 women collected tampon specimens and completed self-answer questionnaires on the known risk factors for HPV infection, including the number of sexual partners during the last 1, 5, and 10 years. The tampons were analyzed for the presence of HPV DNA by polymerase chain reaction using L1 consensus primers. RESULTS: Ninety-two (30.9%) tampons were positive for HPV DNA. In univariate analysis, the presence of HPV DNA was associated with a younger age, single marital status, a previously abnormal or currently abnormal Papanicolaou smear, and one or more new sexual partners in the last year, 1-5 years, and 5-10 years. The presence of HPV DNA was not associated with education level, past pregnancy, current or past oral contraceptive use, or the age at first intercourse. In multivariate analysis, only the number of sexual partners during the last year and 1-5 years, and a previously abnormal Papanicolaou smear were associated with HPV. CONCLUSION: The presence of HPV DNA is best predicted by the number of new sexual partners in the last 5 years. Transiently detectable HPV DNA is one possible explanation for this observation.     

Testing a social-cognitive model of HIV transmission risk behaviors in HIV-infected MSM with and without depression.

Objective: Social-cognitive models have been used to explain health risk behaviors in numerous populations, including people with HIV. However, these models generally do not account for the influence of clinically significant psychological problems such as major depression. Design: This study examined whether a social-cognitive model would explain recent sexual transmission risk behavior among sexually active HIV-infected men who have sex with men (MSM) who meet or do not meet screening criteria for major depression. Main Outcome Measures: Participants (n = 403) completed self-report assessments of negative expectancy, social models, and self-efficacy (SE) related to condom use, as well as recent STRB and a screening measure for major depression. Multiple group modeling was used to examine whether condom use SE explained associations of negative expectancy and social models for condom use with recent STRB among participants who screened positive (n = 47) or negative (n = 356) for major depression. Results: The multiple group model fit the data well (χ2(36) = 30.55, p = .73; CFI = 1.00; RMSEA     

Neural correlates of sexual arousal in homosexual and heterosexual men.

Men exhibit much higher levels of genital and subjective arousal to sexual stimuli containing their preferred sex than they do to stimuli containing only the nonpreferred sex. This study used event-related functional magnetic resonance imaging to investigate how this category-specific pattern would be reflected in the brains of homosexual (n = 11) and heterosexual (n = 11) men. Comparisons of activation to preferred sexual stimuli, nonpreferred sexual stimuli, and sports stimuli revealed large networks correlated with sexual arousal, spanning multiple cortical and subcortical areas. Both homosexual and heterosexual men exhibited category-specific arousal in brain activity. Within the amygdala, greater preference-related activity was observed in homosexual men, but it is unclear whether this is a cause or a consequence of their sexuality. In a subsequent analysis of regions hypothesized to support arousal, both participant groups demonstrated widespread increases in evoked activity for preferred stimuli. Aggregate data from these regions produced significant differences between stimulus types in 16 out of 22 participants. Significant activational differences matched reported sexual orientation in 15 of these 16 participants, representing an advance in psychophysiological measures of arousal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost-effectiveness of post-exposure prophylaxis following sexual exposure to HIV

OBJECTIVES: To assess the cost-effectiveness, relative to other health-related interventions in the U.S., of post-exposure prophylaxis (PEP) following potential HIV exposure through sexual contact with a partner who may or may not be infected, and to compare the relative cost-effectiveness of dual- and triple-combination PEP. METHODS: Standard techniques of cost-utility analysis were used to assess the cost-effectiveness of PEP with a four-week regimen of zidovudine and lamivudine, or zidovudine, lamivudine, and indinavir. Due to a lack of empirical data on the effectiveness of PEP with combination drug regimens, the analysis assumed that combination PEP was no more effective than PEP with zidovudine alone. The main outcome variable is the cost per quality-adjusted life year (QALY) saved by the program. RESULTS: Providing PEP to a cohort of 10,000 patients who report receptive anal intercourse with a partner of unknown HIV status (who is assumed to be infected with probability equal to 0.18) would prevent about 20 infections, at an average net cost of about US$ 70,000 per infection averted. The cost-utility ratio, US$ 6316 per QALY saved, indicates that PEP is highly cost-effective in this instance. Moreover, triple-combination PEP would need to be about 9% more effective than dual-combination PEP for the addition of indinavir to the regimen to be considered cost-effective. Prophylaxis following receptive vaginal exposure is cost-effective only when it is nearly certain that the partner is infected; PEP for insertive anal and vaginal intercourse does not appear to be cost-effective. CONCLUSIONS: From a purely economic standpoint, PEP should be restricted to partners of infected persons (e.g., serodiscordant couples), to patients reporting unprotected receptive anal intercourse (including condom breakage), and possibly to cases where there is a substantial likelihood that the partner is infected. Providing PEP to all who request it does not appear to be an economically efficient use of limited HIV prevention and treatment resources.     

Immunosuppression may lead to progression of hepatitis C virus-associated liver disease in hemophiliacs coinfected with HIV

OBJECTIVE: The aim of this study was to examine the interaction between HIV and hepatitis C virus (HCV) in hemophiliacs coinfected with the viruses and to investigate the possible relationship between immunosuppression and liver failure. METHODS: To identify risk factors for impending liver failure in hemophiliacs coinfected with HIV and HCV, we analyzed clinical and laboratory parameters, including CD4 count, aminotransferases (ALT, AST), cholinesterase, alkaline phosphatase, bilirubin, and gamma-glutamyltransferase, during 3 yr of follow-up (1990-1993) in four groups of patients: hemophiliacs with progressive immunodeficiency who were coinfected with HCV and HIV (group A, n = 49); hemophiliacs with stable immune function who were seropositive for HIV and HCV (group B, n = 95); hemophiliacs who were infected with HCV but not HIV (group C, n = 72); and homosexuals with progressive immunodeficiency who were infected with HIV but not HCV (group D, n = 24). RESULTS: Univariate analysis of data for group A showed a significant rise in gamma-glutamyltransferase and alkaline phosphatase (p < 0.01) that was not seen in groups B, C, and D. In a multivariate Cox regression analysis, age (odds ratio, 1.054 per yr; 95% confidence interval, 1.014-1.096 per yr), decline in CD4 count (odds ratio, 1.063 per cell/microl; 95% confidence interval, 1.037-1.091 per cell/microl), and alkaline phosphatase level (odds ratio, 1.012 per U/L; 95% confidence interval, 1.002-1.021 per U/L) emerged as independent determinants of death. CONCLUSIONS: Our data suggest that progressive immune dysfunction in hemophiliacs coinfected with HIV and HCV may influence progression of liver failure. In these patients cholestasis is an additional prognostic marker for survival that may reflect both exhausted immunity and impaired liver function.