Testing for HIV and other sexually transmitted diseases: Implications for risk behavior in women.

A sample of 808 nonpregnant women residing in an area of high prevalence of sexually transmitted diseases (STDs) was studied with respect to sexual risk behaviors in the 4-month period before and after testing for a series of STDs. All women were tested for both Chlamydia trachomatis and Trichomonas vaginalis and were given the option of also taking a test for the HIV antibody. Neither the experience of receiving a negative HIV test result nor that of receiving a positive versus a negative diagnosis for STDs resulted in significant mean changes in self-reports of STD or HIV susceptibility, condom use consistency, or number of sexual partners during the 4 months following testing. However, perceived susceptibility was found to predict when women would decrease the consistency with which they used condoms as a function of HIV testing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Women who have sex with other women: HIV seroprevalence in New York State counseling and testing programs

This report provides HIV seroprevalence data for women who are sexually active with women (WSW) choosing to access services in four of New York State's counseling and testing programs from January 1993 to June 1994. During that period, these programs tested 27,370 women. When questioned about sexual activity since 1978, 3.7% of these women reported sexual activity exclusively with women, 5.3% reported sexual activity with both women and men and 90.1% reported sexual activity exclusively with men. HIV seroprevalence in women sexually active exclusively with women in this sample was calculated at 3.0%, at 4.8% in women sexually active with both women and men and at 2.9% in women sexually active exclusively with men. According to the self-reported data in this study, injecting drug use is, by far, the predominant risk factor for seropositive WSW. Significant HIV-related public health/preventative implications for WSW and their service providers are suggested by this data, including the need for prevention education targeted to WSW who are IDUs, the need to provide culturally sensitive education to WSW detailing safer sexual behaviors both with women and with men as well as the need for evaluation of all risk factors when providing risk reduction education to WSW.     

Planned condom use among women undergoing tubal sterilization

BACKGROUND AND OBJECTIVES: Women who are undergoing tubal sterilization are at risk for various sexually transmitted diseases (STDs) if they do not use a barrier method of contraception. There is a paucity of data concerning dual use of condoms among sterilized women. GOAL: Planned use of condoms for protection against STDs was examined among 2,782 women undergoing surgical sterilization from 1991 to 1996. STUDY DESIGN: Cross-sectional survey. RESULTS: Planned condom use increased significantly over the 6-year study period. Of women who were using condoms before sterilization (n = 646), nearly half indicated no plans to do so after becoming sterilized. Thus, 11% of the total sample experienced an increased risk for exposure to human immunodeficiency virus or other STDs. Condom abandonment was significantly higher among Hispanic and married women. Multiple regression analysis was used to examine the association between condom use and various characteristics. Factors associated with future condom use were younger age, black ethnicity, being unmarried, previous STD, not having a steady partner, higher number of previous sexual partners, having used condoms for disease prevention in the past, and lack of partner involvement in the decision to undergo sterilization. CONCLUSIONS: Use of condoms among sterilized women appears to be on the rise, women at higher risk for disease are more likely than others to be using condoms, and only a small group of women experience an increased risk for exposure to disease as a result of selecting this permanent method of contraception.     

Dual-method use among an ethnically diverse group of women at risk of HIV infection

CONTEXT: Few U.S. women protect themselves against both pregnancy and sexually transmitted diseases (STDs) by using an efficient contraceptive method and a condom. Understanding the factors that influence dual-method use could help improve interventions aimed at encouraging protective behaviors. METHODS: Interviews were conducted with 552 low-income women at risk of HIV who attended public health or economic assistance facilities in Miami in 1994 and 1995. Multinomial logit analyses were used to determine the influence of women's background characteristics, perceived vulnerability to pregnancy and AIDS, and relationship characteristics on the odds of dual-method use. RESULTS: Overall, 20% of the women used dual methods. Women who were not married, who worried about both pregnancy and AIDS, who had ever had an STD, who were confident they could refuse a sexual encounter in the absence of a condom and who made family planning decisions jointly with their partner were the most likely to use dual methods rather than a single method (odds ratios, 2.0-3.5); those who considered the condom only somewhat effective in preventing AIDS or who shared economic decision-making with their partner were the least likely to use dual methods rather than a single method (0.5-0.6). The results were generally similar in analyses examining the odds of dual-method use involving an efficient contraceptive, except that black and Hispanic women were significantly more likely than whites to use condoms in conjunction with efficient contraceptives (3.3-7.1). CONCLUSIONS: Both women's individual characteristics and the context of their sexual relationships influence whether they simultaneously protect themselves from pregnancy and HIV. The involvement of male partners in family planning decision-making and women's control over economic decision-making ensure greater protection against HIV infection.     

Spread of HIV infection in married monogamous women in India

CONTEXT: A high prevalence of human immunodeficiency virus (HIV) infection in female sex workers (FSWs) and men who attend sexually transmitted disease (STD) clinics poses a risk for spread of infection to other populations. OBJECTIVE: To examine spread of HIV to a low-risk population by comparing prevalence of, and risk factors for, HIV and STDs in FSWs and non-FSWs. METHODS: Women attending STD clinics in Pune, India, were assessed for STDs and HIV from May 13, 1993, to July 11, 1996. Demographic and behavioral information was collected, and clinical and laboratory assessment was performed. MAIN OUTCOME MEASURE: Prevalence and risk determinants of HIV infection. RESULTS: Of 916 women enrolled, 525 were FSWs and 391 were non-FSWs. Prevalence of HIV in FSWs and non-FSWs was 49.9% and 13.6%, respectively (P<.001). In multivariate analysis, inconsistent condom use and genital ulcer disease or genital warts were associated with prevalent HIV in FSWs. History of sexual contact with a partner with an STD was associated with HIV in non-FSWs. CONCLUSIONS: Infection with HIV is increasing in non-FSWs, previously thought to be at low risk in India. Since history of sexual contact with their only sex partner was the only risk factor significantly associated with HIV infection, it is likely that these women are being infected by their spouses. This underscores the need for strengthening partner-notification strategies and counseling facilities in India.     

Effective communication of risks to young adults: Using message framing and visual aids to increase condom use and STD screening.

Sexually Transmitted Diseases (STDs)—including HIV/AIDS—are among the most common infectious diseases in young adults. How can we effectively promote prevention and detection of STDs in this high risk population? In a two-phase longitudinal experiment we examined the effects of a brief risk awareness intervention (i.e., a sexual health information brochure) in a large sample of sexually active young adults (n = 744). We assessed the influence of gain- and loss-framed messages, and visual aids, on affective reactions, risk perceptions, attitudes, behavioral intentions, and reported behaviors relating to the prevention and detection of STDs. Results indicate that gain-framed messages induced greater adherence for prevention behaviors (e.g., condom use), whereas loss-framed messages were more effective in promoting illness-detecting behaviors (e.g., making an appointment with a doctor to discuss about STD screening). The influence of the framed messages on prevention and detection of STDs was mediated by changes in participants' attitudes toward the health behaviors along with changes in their behavioral intentions. Moreover, when visual aids were added to the health information, both the gain- and loss-framed messages became equally and highly effective in promoting health behaviors. These results converge with other data indicating that well-constructed visual aids are often among the most highly effective, transparent, fast, memorable, and ethically desirable means of risk communication. Theoretical, economic, and public policy implications of these results are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Correction of the hypoplastic nasal ala using an auricular composite graft

OBJECTIVES: The study investigated if women with experience of casual travel sex, with a previously unknown man abroad, on different types of journeys (charter, vagabond, business and education trips), differ with regard to sexual risk behavior and history of sexually transmitted diseases (STDs). STUDY DESIGN: The study population consisted of 996 women. Of these, 27.7% admitted that they had had casual sex during journeys. The remaining women were used as a comparison group. History of STDs and sexual risk behaviors were investigated. RESULTS: The frequency of women who had more than ten lifetime sexual partners were greatly increased in all groups, as compared to the controls. A history of gonorrhea was most frequent among the charter travellers. A history of genital chlamydial infection was most common among the vagabond travellers. The lowest frequencies of a history of STDs was observed in women engaging in casual sex on 'business' journeys and they had significantly less often a history of STDs as compared to the charter travellers. A high frequency of STDs were seen in women who had experience of casual sex on different types of journeys. CONCLUSION: Women on business trips, although they had a similar sexual risk behaviour as the other groups of travellers, had less often a history of STDs.     

Late results of surgery for abdominal aortic aneurysm

Little is known concerning sexually experienced and inexperienced adolescent girls' perceptions of the prevalence of condom use and sexually transmitted diseases (STDs). Girls (n = 174; 41% sexually experienced) rated the prevalence of condom use among friends and STDs among male and female friends and adolescents in general. Girls perceive the prevalence of STDs similarly across both gender and level of familiarity. For the most part, however, the girls perceived the prevalence among boys and girls more similarly than among friends and adolescents in general. No significant differences were found between sexually experienced and inexperienced girls in perceptions of condom use prevalence, but girls with a history of STD perceived condoms as used less frequently. Girls with an STD history perceived STDs as the most prevalent, followed by sexually inexperienced girls and then sexually experienced girls without a history of an STD. After an adolescent girl initiates sexual intercourse, STD experience could be a key variable in affecting her perceptions. Prevention programs can incorporate an understanding of patients' perceptions of condom use and STDs.     

The effects of an abusive primary partner on the condom use and sexual negotiation practices of African-American women

OBJECTIVES: This study examined the consequences of having a physically abusive primary partner on the condom use and sexual negotiation practices of young African-American women. METHODS: Interviews were conducted with 165 sexually active African-American women aged 18 through 29 in San Francisco, Calif. RESULTS: Women in abusive relationships were less likely than others to use condoms and were more likely to experience verbal abuse, emotional abuse, or threats of physical abuse when they discussed condoms. They were more fearful of asking their partners to use condoms, worried more about acquiring the human immunodeficiency virus (HIV), and felt more isolated than did women not in abusive relationships. CONCLUSIONS: HIV prevention programs for women should address domestic violence prevention strategies.     

Risk factors for HIV infection in a rural cohort in Zimbabwe: a pilot study

OBJECTIVE: To identify demographic, sexual behavioural and cultural risk factors for human immunodeficiency virus (HIV) infection in a rural community in Zimbabwe. DESIGN: Prospective study. SETTING: Rural area in Zimbabwe. SUBJECTS: 207 subjects (81 males, 126 females) mean age 31.6 years (SD 15.3), range 12 to 76 years living in the area. MAIN OUTCOME MEASURES: HIV seropositivity and seroconversion, exposure or no exposure to risk factor. RESULTS: Prevalence of HIV was 7.7% and was associated with being divorced or widowed [Odds ratio (OR) 4.26, 95% confidence interval (CI) 1.17 to 14.97] and past history of sexually transmitted diseases (STDs) [(OR 3.54, 95% CI 1.31 to 9.89)]. Seroconversion rate was 3.6% per year and was associated with history of STD [Relative Risk (RR) 13.22, 95% CI 1.15 to 156.1)] during the follow up period. Individuals over 20 years of age, those reporting one or more sexual partners, those reporting irregular use of condoms and those scarified were at greater risk than their counterparts. Individuals who reported being circumcised were at slightly lesser risk than those who did not report circumcision. CONCLUSION: STDs were major determinants of HIV transmission in the study area. In addition being divorced or widowed was a risk factor for HIV infection. Scarification, tattooing and circumcision require further investigations.     

Sexual behavior among U.S. high school students, 1990-1995

CONTEXT: High rates of unintended pregnancy and sexually transmitted diseases (STDs), including HIV infection, among adolescents are major public health concerns that have created interest in trends in teenage sexual activity. METHODS: Nationally representative data from Youth Risk Behavior Surveys conducted in 1990, 1991, 1993 and 1995 are used to examine levels of sexual experience, age at first intercourse, current sexual activity and condom use at last intercourse among students in grades 9-12. RESULTS: The proportion of students who reported being sexually experienced remained at 53-54% from 1990 through 1995, while the percentage of sexually active students who used condoms at last intercourse rose from 46% to 54% between 1991 and 1995. Black students were more likely than white students to report being sexually experienced, being currently sexually active and having had four or more lifetime sexual partners; black students also reported a significantly younger age at first intercourse. Gender differences in sexual behavior were found more frequently among black students than among white or Hispanic students. CONCLUSIONS: Although levels of sexual experience for high school students in the United States have not risen during the 1990s, a very high percentage of students continue to be at risk for unintended pregnancy and STDs, including HIV infection.     

STD/HIV prevention in Turkey: planning a sequence of interventions

This study was initiated to assess which mix of early STD/HIV prevention interventions would potentially be effective, cost-effective and sustainable in Turkey; and to program an intervention sequence to maximize synergy among the interventions. During rapid assessment we: 1) reviewed past issues of 3 leading newspapers; 2) collected information on TV coverage; 3) interviewed key informants including taxicab drivers, hotel employees, grocery store owners, academicians in public health and law, investigators of STD/HIV and reproductive tract infections, and officials in the ministry of health; 4) reviewed available evidence on STD/HIV morbidity, sexual behavior patterns, migration patterns and same/opposite gender sex trade. We found: 1) discrepancies between decision makers' perceptions and social realities with respect to the epidemiology of sexual behavior and STDs, and the state of public health programs; 2) discrepancies between sexual practices and public expression regarding sexual practices; 3) economic, demographic, and political pressures in Turkey and in surrounding countries for the expansion of prostitution; 4) a sexual double standard and gender specific migration patterns which sustain a high demand for commercial sex; 5) patterns of health care seeking behaviors and provision of STD clinical services which indicate other STDs may play a very important role in spread of HIV infection; 6) an important mass media role in opinion formation; 7) consensual denial of risk for the majority based on beliefs embedded in machismo, nationalism and religion, and a resulting marginalization and externalization of STD/HIV risk; 8) high prevalence of syphilis among both Turkish and immigrant female prostitutes in Istanbul (early latent 8 and 13%; late latent 0 and 4%; previous history 9 and 22%) 9) and high rates of syphilis among male prostitutes (early latent 11%, late latent 21% and previous history 58%). We concluded that interventions should initially include, in the following order; 1) awareness raising for decision makers and opinion leaders including members of parliament and mass media; 2) awareness raising for members of the general population; 3) needs assessment and intervention development for sex workers; 4) training in HIV and other STDs for medical personnel; and 5) quality assurance and control for laboratory procedures for STDs/HIV.     

HIV/AIDS risk factors among adolescent students in Puerto Rico, 1994

PURPOSE: Identify several HIV risk behaviors among adolescent students. METHODS: The sample (n = 3,648) was selected using a two-staged stratified cluster sampling design, and weighted to represent all junior high and high school students. RESULTS: About 28.8% of the students reported ever having sexual activity. Less than half of the sexually active (44.5%) used condoms during their last sexual activity; 27.6% used them always. Only 54.7% knew correctly > 75% of the HIV knowledge questions. A HIV risk scale was constructed using five risk factors. About 15.9% of the students did not have any risk factor, 36.2% had one, 47.9% had two or more. Males and high school students had significantly more risk factors. Half of the students will abstain from having sex next year because they don't want to get HIV/AIDS. CONCLUSIONS: It is important to implement effective HIV prevention programs for adolescents in order to change their attitudes and behaviors.     

Knowledge, attitude and behavior among patients with Chlamydia. Perspectives for prevention

Patients with chlamydial infections (Ct) attending the outpatient Venereal Disease Clinic of Copenhagen from July 1-November 30 1995 were asked to fill in a questionnaire focusing upon knowledge, attitude and behaviour related to sexually transmitted diseases (STDs) in order to strengthen the future prevention of Ct. The questionnaire was answered by 37 men and 35 women with a median age of 27 and 21 years and a median number of three and two sexual partners within the last six months, respectively. Half of the patients had previously had an STD, and 92% had been tested for HIV, of whom one homosexual man was known HIV-positive. Notification about exposure from a partner was the reason for attending for 24%. All but one were in favour of partner notification, but only 6% wanted provider referral. During last intercourse condoms had neither been used with a steady partner by 75% especially by the young and women, who thought themselves safe, nor with a casual partner by 52% especially among the young and men, mainly because of thoughtlessness or perception of low risk. Before the actual STD diagnosis only 49% were able to name one symptom and 35% one complication related to Ct. A majority (79%) stated, that fear of catching another Ct would lead to better protection, and 70% found that more information would have a preventive effect. Future Ct prevention programs in Denmark should include intensified chlamydial screening and partner notification together with centrally produced mass media information supplemented by individual counselling.     

Pregnant women as a reservoir of undetected sexually transmitted diseases in rural South Africa: implications for disease control

OBJECTIVES: This study was undertaken to determine the prevalence of sexually transmitted diseases (STDs) in pregnant women in rural South Africa and to determine the value of using abnormal urogenital symptoms to identify infected women. METHODS: This was a cross-sectional study of 327 patients attending prenatal clinics. RESULTS: Of the 271 women with complete data, 141 (52%) had at least 1 STD and 49 (18%) had more than 1. Abnormal symptoms were common (n = 225; 83%), but associations were weak, and the positive predictive value of different symptoms for infection ranged from 2% to 54%. CONCLUSIONS: Most STDs in rural South African women remain undetected and untreated. As the scope for laboratory diagnosis in resource-poor settings is limited, presumptive treatment of pregnant women and their partners may be a cost-effective option to reduce transmission of STDs and HIV infection.     

Risk behavior for HIV transmission among gay men surveyed in Seattle bars

Men attending four Seattle gay bars were asked to complete a self-administered questionnaire including measures of sexual behavior, perceptions of peer norms in the area of sexual safety, personal human immunodeficiency virus (HIV) risk estimate, and knowledge and use of a variety of acquired immunodeficiency syndrome (AIDS) prevention services. Twenty-nine percent of the sample reported engaging in unprotected anal intercourse at least once during the 2 months before the survey. Differences in peer norm perceptions, age, HIV risk estimate, and intent to be sexually safe in the future were found between those engaging in unprotected anal intercourse and those not reporting unprotected anal intercourse. No significant differences were found in level of education, use of AIDS prevention services, and whether or not a person had been tested for HIV. Implications for prevention programs are discussed.     

Practice what we preach? HIV knowledge, beliefs, and behaviors of adolescents and adolescent peer educators

The purpose of this article is to (a) describe the knowledge, beliefs, and sexual behaviors of urban adolescents and adolescent peer educators, and (b) identify elements needed to design effective HIV/AIDS prevention programs for out-of-school youth. Thirty-three predominantly African American adolescents (female = 14; male = 19) between the ages of 14 and 24 in a large urban city including adolescent (n = 18) and adolescent peer educators (n = 15) participated. Paper-and-pencil questionnaire and focus-group interviewing methods were used. Adolescents and adolescent peer educators had a moderately high level of HIV knowledge, confidence in their ability to use condoms, and beliefs that condom use would not decrease sexual pleasure or imply infidelity. Both groups reported low perceptions of susceptibility of HIV infection. Engagement in sexual risk behavior was low, but was significantly higher among males. Although adolescent male peer educators engaged in a higher frequency of risk behaviors over time, they had a lower frequency of sexual risk behaviors in the past 2 months compared with male adolescents. Study findings showed that HIV prevention interventions need to include information about specific risk behaviors, such as using condoms for oral sex, and cleaning drug paraphernalia. Community-based and church programs, visible HIV prevention messages, specifically those aimed at increasing perceptions of HIV risk, and the development of condom-use skills were identified by adolescents and adolescent peer educators as relevant approaches to reduce HIV infection among this population.     

Managed obstetrical care

BACKGROUND: Infertility is common in Africa, but virtually no data exist on HIV prevalence among infertile women. Mainly anthropological studies in Africa have shown that infertile women have higher risks of marital instability and possibly also have more sexual partners than fertile women. METHOD: This study was conducted in a hospital in northwest Tanzania during 1994 and 1995. Women presenting themselves with infertility problems to the outpatient clinic were interviewed, examined and blood was drawn. Women who came to deliver in the hospital, excluding primiparae, were taken as a control group. The analysis was limited to women > or = 24 years. In total 154 infertile and 259 fertile women were included in the study. RESULTS: HIV prevalence was markedly higher among infertile women than among fertile women: 18.2% and 6.6% respectively (adjusted odds ratio [OR] for age, residence and occupation 2.7; 95%-confidence interval [CI]: 1.4-5.3). Data on past sexual behaviour showed that infertile women had more marital breakdowns, more lifetime sexual partners and a higher level of exposure to sexually transmitted diseases (STD). CONCLUSION: Women with fertility problems appear to have higher HIV prevalence, which justifies more attention for such women in the context of AIDS programmes. In addition, caution is needed when using sentinel surveillance data from antenatal clinics to monitor HIV prevalence.